It seems like an eternity since you heard that Sars Cov2 (Covid-19) was coming to America. At first, it was considered the great equalizer because no one was immune. But that proved not to be true. As the virus’ spread across the United States, it exposed pronounced racial fault lines. African Americans are more likely to die from the disease than white Americans. How much more? A lot.
Based on data from the many states (26) reporting racial data, African-Americans account for 42% of the deaths from Covid-19, as published by the Associated Press on April 9th. The data also suggests that the disparity is found highest in the South. In Louisiana and Mississippi, African-Americans account for a horrifying 65% of known Covid-19 deaths. Many local communities have found similar patterns in their data.
What’s the story here? Why is there such disparity?
Like the parable of a group of blind men who have come across their first elephant and conceptualize it only by touch, each feels a single different part of the elephant’s body and draws a different conclusion – but each has only a small part of the total picture. So it is with the disparity of health amongst the African American population compared to the general population.
A great deal of these stunning problems comes from our American societal issues. For instance, jobs most often filled by African Americans, are considered part of the critical workforce by the U.S. Department of Homeland Security. Quarantining is never an option for them. This means that they are required to sacrifice their health and continue to work for the benefit of us all. This includes caregivers, nurses, cashiers, stock clerks, hospital and nursing home staffing, sanitation workers, farmworkers, and public transit employees.
How are they traveling to these vital jobs? Nearly 34% of African Americans use public transit regularly (compared with only 14% of whites, according to a 2016 report from the Pew Research Center. The necessary continued use of public transportation during the pandemic brought African Americans into greater constant contact with infected people.
Access to Care
African Americans also face hidden biases to care. For instance, in October 2019 in Science, researchers reported that the algorithm used to determine which patients should receive access to specific health care programs “inadvertently” prioritized white patients over African-American patients. African Americans are also more likely to be uninsured than whites. Those African Americans who are insured also spend a higher percentage of their income on premiums and out-of-pocket costs, about 20% compared to whites, who spend only about 11% and receive better over-all health coverage.
“There also is bias among healthcare workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals,” reports Marc Morial, president, and CEO of the National Urban League.
According to Robert Sampson, Sociologist at Harvard University, “All the ingredients are in place for there to be a sharp racial and class inequality to this [pandemic].” He cites that African-Americans’ risk of higher exposure to Covid-19, has deep historical roots. This includes legal segregation in schools and housing, discrimination in the labor market, and redlining, denying home loans to those living in predominantly African American neighborhoods. These are the strong forces that have contributed to a persistent racial wealth gap, with African Americans continuing to struggle for economic parity with whites and having the opportunity to move into neighborhoods with the kind of socioeconomic opportunities that allow white families to avoid exposure Covid-19 better.
A disproportionately high percentage of African Americans live in geographical locations that increase their risk of exposure. Only 44% of African Americans own their own home compared with almost 74% for whites. This vastly increases exposure risk for a family living in a crowded inner-city apartment and a more densely packed community, according to epidemiologist Martina Anto-Ocrah of the University of Rochester Medical Center in New York.
Robert Sampson and fellow Harvard sociologist Robert Manduca showed that poor African-American neighborhoods have higher levels of lead, and air pollution than even poor white communities. African-Americans’ disproportionate exposure to air pollution has been linked directly to chronic health problems, including asthma, obesity, and cardiovascular disease.
There are additional health concerns related to African American neighborhoods. According to Joseph Valenti, a physician in Denton, Texas, who promotes awareness of the social determinants of health through his work with the Physicians Foundation, “If they also live in a food desert, they have to put themselves in greater risk if they want access to healthy food. They may need to take a bus, with people that have Covid-19 but aren’t showing symptoms, to get access to nutritious food.”
We all can agree that maintaining a healthy weight, exercising regularly, eating a balanced diet, and reducing harmful behaviors could help prevent or slow the progression of multiple chronic diseases like Covid-19. The roots of chronic illness are not isolated to any one thing. They stem from the way people live and the choices that may or may not be available to them. African Americans with chronic illnesses that put them at higher risk of Covid-19 often lack access to affordable and healthy foods or live in neighborhoods where it’s not safe to play or exercise outside.
4 in 5 African American women are obese or overweight; that ratio for men is 3 in 5. Mass media (including billboards placed in neighborhoods) ushers this along through incessant subliminal bombardment. Research shows that more food advertisements appeared during programs targeting African Americans than general market programs. The ads were more likely to be for fast food, meat, candy, soda, dessert, or alcohol and less likely to be for fruits and vegetables, cereals, grains, or pasta. Of all of the food advertisements, 14.9% made a weight-related nutritional claim. More claims related to fat content appeared during African American programming, whereas more light and lean claims appeared in general market advertisements.
The primary engine behind the growing obesity epidemic in the African American population begins with overwhelming levels of Chronic Depression and PTSD. Chronic illnesses, like diabetes and hypertension, are also commonly associated with depression. Research has shown that those with depression were 2.4 times more likely to suffer from multiple chronic conditions than those without depressive symptoms. The prevalence of depression in African Americans is reported to be twice that of whites. And depression in African Americans persists for longer durations ~ 56.5% for African Americans and 38% for whites. Thus, major depression is considered as a chronic disorder for African Americans. William Lawson, M.D., Ph.D., chair of the Psychiatry Department at Howard University, emphasized this point. “About half of African Americans with depression never get diagnosed or treated.” Furthermore, “Many are treated improperly even if they are diagnosed with depression.”
But research has revealed another level of complication. Anywhere from 10 to 25% of their participants who were identified with depression were also positive for posttraumatic stress disorder (PTSD). Epidemiological studies reveal that PTSD rates in the general United States population range from 1% to 9% and lifetime PTSD. However, among African Americans to be around 8.7 to 12% rate.
Depressive symptoms, PTSD, and the development and progression of physical multimorbidity correlated not only to urban, low-income, or “Inner City” populations but to the broader African American population as a whole due to constant pressures of discrimination.
Research has shown that people who report higher levels of stress are more likely to catch a virus when exposed than people who are not stressed.
Renã Robinson, who researches chronic disease at Vanderbilt University, points out that when a person experiences racial discrimination, it contributes to chronic stress. She refers directly to several studies that link discrimination and stress to higher inflammation levels among African American adults. “And chronic stress can make one more vulnerable to infection because it can lower your body’s ability to fight off an infection,” she says.
According to the American Heart Association, over 40% of African-Americans have high blood pressure, among the highest rates in the world. Similarly, African-Americans tend to have higher rates of diabetes. Among those at the highest risk of getting severely ill with Covid-19 are patients with high blood pressure, diabetes, and heart disease. By comparison, only about a third of whites have high blood pressure.
Pro-Active Measures in the African American Community
Beyond all of these daunting hurdles to be overcome, there are yet some positive measures to be taken at the individual level.
Daily Exercise: Non-Negotiable. With your doctor’s approval, perhaps starting only at first with a 20-minute walk (rain or shine) – preferably outdoors. One of your immediate benefits is that this naturally drives your insulin and cortisol levels down. For this same reason, you may consider an exercise technique called simply High-Intensity Interval Training. You do this just three days weekly for 12 – 20 minutes. It entails repeating a 30sec interval burn with a 90sec medium pace sequence.
Also, consider training with light free weights (2 – 3 pounds) two or three times in brief 15min sessions weekly. Your benefits will include an increase in your metabolism to support your immune system and cardiovascular health, maintaining a balanced ratio of lean muscle to optimize your weight loss goals, and a decrease in your injury risk. This type of strength can be useful for people with an injury or arthritis, according to a January 2018 paper by the Mayo Clinic.
Daily 20 Minutes of Meditation: Yes, really – Both meditation and deep breathing activate your parasympathetic nervous system bringing you into a state of calm with increased focus and concentration. There’s quite a bit of research in this area, with studies showing that this will lower your cortisol levels (thereby reducing conditions such as compromised immune system function, increased glucose levels, increase arterial plaque, high blood pressure, weight gain, digestive disorders, muscle weakness, slow healing, irritability, headache, thinning skin, irritability, acne, poor concentration, and fatigue). Meanwhile, it raises activity in your brain centers known to control pain.
Eliminate Added Sugar and Refined Carbs:
For decades salt was decried as the villain behind high blood pressure but, a growing body of research shows an even higher risk factor is the link between added sugar and high blood pressure. The Framingham Heart Study concluded that women who drank even one soda per day had higher levels than those who drank less than one soda per day.
But it’s not only sugar. You need to curb all simple, refined carbs (the kind found in foods made with white flour, bread, pastries, cookies, cakes, French fries, potato chips, colas, soda, Vitaminwater, fruit juices, ice cream, etc.) convert rapidly to sugar in your bloodstream and may cause cardiovascular issues and also reduce your immune system function by causing constant low levels of chronic inflammation.
Daily ~ Eat Fruits & Vegetables:
There is a direct connection between nutrition and immunity. A form of malnutrition that is common in African Americans is known as “micronutrient malnutrition.” This describes a person deficient in some essential vitamins and trace minerals obtained from or supplemented by diet. This includes deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E, which are known to alter immune responses.
Drinking 32 ounces of filtered water daily is another essential key to immune system function. Drink alcohol only in moderation.
If you’re unsure that your diet provides you with all your micronutrient needs, consider taking a daily multivitamin and mineral supplement. This may bring other health benefits beyond any possibly beneficial effects on your immune system.
Get Adequate Sleep: 8 hours minimum nightly.
While the challenges are many, there is an urgent responsibility to bolster the one thing that we retain some control over ~ one thing that can be positively influenced and strengthened daily ~ the health of our immune system through conscious and constant self-care.