Covid-19: Challenges for BME

Communities

David R. Williams, PhD, MPHFlorence & Laura Norman Professor of Public Health

Chair, Department of Social and Behavioral Sciences

Professor of African & African American Studies and of

Sociology

Harvard University

Deaths of Covid-19, U.S.

APM Research Lab, http://www.apmresearchlab.org/covid/deaths-by-race

26.2

61.6

28.2 26.3

0

10

20

30

40

50

60

70

White Black Hispanic Asian

Deaths Through June 10, 2020

Dea

ths

per

/10

0,0

00

Covid-19 Deaths by Race

• If all racial/ethnic groups had died at the

same rate as white Americans:

- 14,400 Black Americans

- 1,200 Hispanic Americans, and

- 200 Indigenous Americans

would still be alive

APM Research Lab, http://www.apmresearchlab.org/covid/deaths-by-race Pixabay.com

Data for Covid-19 are consistent

with other Health Data

Infant Mortality in the U.S., 2015

Health United States, NCHS, 2017

4.9

11.3

8.6

54.1

0

2

4

6

8

10

12

White Black American

Indian

Hispanic Asian/Pl

White Black American Indian Hispanic Asian/Pl

Infant Mortality by Ethnicity, England, 2014

2.2

3.6

6.8

5.8

7.1

3.7 3.9

0

1

2

3

4

5

6

7

8

All

Cau

se I

nfa

nt

Morta

lity

Deaths per 1,000 live births. Public Health England, 2018

Pregnancy-Related Deaths, U.S., 2011-15Deaths Per 100,000 Live Births, by Race/Ethnicity

17

13

43

33

1411

0

10

20

30

40

50

All White Black American Indian Asian/Pacific

Islander

Hispanic

Pre

gn

an

cy-R

elate

d D

eath

s

Race

E.E. Peterson et al., MMWR, May 7, 2019

0

10

20

30

40

50

White Asian Black

40

Ethnicity and Risk of Dying in Pregnancy2014 -2016, UK and Ireland

Marian Knight et al, MBRRACE-UK, 2019

Deaths per 100,000 people

8

15

There are large Inequities in

Socioeconomic Status by Ethnicity

Median Household Income and Race, 2018

Racial Differences in Income are Substantial:

U.S. Census Bureau, Semega et al., 2019; * For 2017; US Census Bureau, ACS, 2017

1 dollar 1.23 dollar 73 cents 59 cents

Whites Asians Hispanics Blacks

59 cents

Am Indians*

Median Household Income, 2009/10-2012/13

For every £ of weekly income that White majority earns

Other Whites earn 79p

Indians earn 86p

Pakistanis earn 57p

Bangladeshis earn 52p

Fisher & Nandi, Joseph Rowntree Foundation, 2015

Medium Household Income, 2009/10-2012/13

For every £ of weekly income that the White majority earns

Chinese earn 76p

Black Caribbeans earn 77p

Black Africans earn 60p

Fisher & Nandi, Joseph Rowntree Foundation, 2015

Wealth versus Income• Home ownership

• Other real estate

• Checking, savings, money

market accounts, CDs

• Vehicles

• Businesses

• IRA/Keogh, stocks, bonds,

mutual funds, treasury bills

• Subtracting mortgages and

debt pixabay

Median Wealth and Race, 2016

For every dollar of wealth that Whites have,

Blacks have 10 cents

Latinos have 12 cents

Other Races have 38 cents

Dettling et al., FEDS Notes, Federal Reserve Board (SCF), 2017

Median Household Wealth, 2014-2016

£282£266

£127

£30

£89

£300

50

100

150

200

250

300

Wea

lth p

er h

ouse

hold

ONS Wealth and Assets Survey Omar Khan, Runnymede, 2020

Wealth by Ethnic Group, 2014-2016

Ethnic Differences in Wealth are Substantial:

ONS Wealth and Assets Survey Omar Khan, Runnymede, 2020

1 pound 95 pence 50 pence 10 pence

White

British Indian PakistaniBlack

African

20 pence

Black

Caribbean Bangladeshi

10 pence

What Low Economic Status Means

We are in the same storm, but in different boats

Pixels

Low Income and Covid-19

•Not everyone can work from home

•For low-wage, non-salaried workers with unpredictable

and unstable hours, working from home is a luxury

• In poor neighborhoods, with overcrowded housing, social

distancing is not a viable option.

•Low income & minority workers overrepresented among

essential workers – our drivers, building maintenance

staff and grocery store employees.

Race Still Matters for Health after

Social class/Socieconomic

Status is taken into Account

Covid-19 Deaths, Relative to Whites

4.2

3.6

2.4

1.9 1.8

1.3

4.3

3.4

2.7

1.91.6

1.4

0

1

2

3

4

5

M - Age Adjusted M - Fully Adj F - Age Adjusted F - Fully Adj

Male Female Male Female Male Female

Black Bangladeshi/Pakistani Indian

Odds

Rat

ios

Office of National Statistics, May 7, 2020

Fully Adjusted: age, urbanicity, IMD, HH, education, HH tenure, health

Residing in Disadvantaged

Communities

Opportunities Linked to Place (an

individual or group’s community

of residence) is a powerful driver

of economic status, resources,

quality of life and exposure to

stress in society

Neighborhood Opportunity Index

1. Institutions: number & quality of

schools, early childhood centers

2. Influences shaping norms and

expectations: (high school graduation

rate, adults with high skill jobs)

3. Economic Resources: income, home

ownership, employment, public assistance

4. Environmental Quality: air, water,

soil pollution, hazardous waste sites

5. Resources for health: green space,

healthy food outlets, walkability

Acevedo-Garcia, 2020, Diversitydatakids.org Shutterstock.com

Percentage of Children at Neighborhood

Opportunity Level

18 17

6567

15

19

58

18

2322

16

62

53

18

29

0

10

20

30

40

50

60

70

80

Very Low/Low Moderate High/Very High

Percen

t a

t o

pp

ortu

nit

y l

ev

el

NH White Black Hispanic API AmI/AN

D. Acevedo-Garcia 2020, Diversitydatakids.org

100 largest Metropolitan areas

Residential Segregation and SES

A study of the effects of segregation on young African American adultsfound that the eliminationof segregation would eraseblack-white differences in:

▪ Earnings

▪ High School Graduation Rate

▪ Unemployment

And reduce racial differences in single

motherhood by two-thirdsCutler & Glaeser, 1997

Residential Segregation in

Western Europe

Douglas Massey, Oxford Handbook of Social Science, 2016

• Levels of segregation in Europe

are rising compared to the steady

or falling levels in\

]\ North America

• Patterns of Segregation in Europe:

1. Religion: Segregation greater for Muslims than

for other religious groups

2. Skin Color: After religion, segregation is greater

for darker skinned nationalities

0

10

20

30

40

50

60

70

Caribbean Blacks Indians Pakistanis Bangladeshis

61

Segregation in Britain

35

56

43

Douglas Massey, Oxford Handbook of Social Science, 2016

Percentage of Ethnic Group Living in Most

Deprived 10% of Neighbourhoods England 2015

8%

9%

9%

10%

10%

12%

18%

19%

20%

28%

31%

0% 5% 10% 15% 20% 25% 30% 35%

Indian

White British

White Irish

Chinese

White other

Gypsy/Traveller

Black Caribbean

Arab

Black African

Bangladeshi

Pakistani

GOV.UK, Ethnicity Facts & Figures, Index of Multiple Deprivation and 2011 Census

Lower economic status, living in more

disadvantaged neighborhoods and

exposure to racism leads to higher

levels of:

1. Economic Stressors

2. Psychosocial Stressors

3. Racial Discrimination

4. Physical & Chemical Stressors

The Stress of Discrimination and

its effects on Health

Every Day DiscriminationIn your day-to-day life how often do these happen to you?

• You are treated with less courtesy than other people.

• You are treated with less respect than other people.

• You receive poorer service than other people at restaurants or stores.

• People act as if they think you are not smart.

• People act as if they are afraid of you.

• People act as if they think you are dishonest.

• People act as if they’re better than you are.

• You are called names or insulted.

• You are threatened or harassed.

What do you think was the main reason for these experiences?

Williams, Yu, Jackson, Anderson, J Health Psychology, 1997

Everyday Discrimination & Adult Health

Incident-MetabolicSyndrome

-CVD outcomes-Breast cancer -Type 2 diabetes

Nicotine dependenceBinge eatingSmoking & drug useAt-risk drinking

CAC (coronary artery calcification)

IMT (intima media thickness)

Visceral fat

HRV

Atrial fibrillation

Adult onset asthma Nocturnal amb. BPCognitive functionIncreases in SBP, DBP

Sleep duration

Sleep quality

Inflammation (CRP, IL-6, e-selectin)

CortisolTelomere lengthAllostatic load

Waist circumference

Obesity

Weight gain

Breast cancer screening

Cervical cancer screening

Lower adherence

Delays in seeking

treatment

DSM Disorders

Emotional Distress

Well-being

Changes in personality

Williams, Lawrence, Davis & Vu, Health Services Research, 2019

The Consequences

“Accelerated Aging”

“Premature Aging”

Biological “Weathering”

Earlier Onset of Chronic Disease

Earlier Onset of High Blood Pressure

41%

22%

10%

61.00%

33%

12%

0% 10% 20% 30% 40% 50% 60% 70%

Age 50-64

Age 35-49

Age 18-34

African American White

Behavioral Risk Factor Surveillance System, 2015

Earlier Onset of Diabetes

14%

6%

1.4%

23%

10%

1.5%

0% 5% 10% 15% 20% 25%

Age 50-64

Age 35-49

Age 18-34

African American White

Behavioral Risk Factor Surveillance System, 2015

Individual Discrimination and

Health Care

Racial Bias in

Medical Care

Reducing Racial Inequities in

Health

What Can We Do?

Interventions to Reduce Inequities in Health

Create Communities of Opportunity to minimize,

neutralize and dismantle the systems of racism that

create inequities in health

Communities of Opportunity

• Ensure access to high quality care

• Invest in early Childhood

• Reduce Childhood Poverty

• Enhance Income and Employment

Opportunities for Youth and Adults

• Improve Neighborhood and Housing

Conditions

• Provide Care that Addresses the Social context

• Raise Awareness levels of Racial Inequities and

Build Political Will to Address them______________________________________________________________________

David R Williams & Lisa Cooper, Int J Environmental Res & Public Health, 2019

“It may well be that we

will have to repent in this

generation. Not merely

for the vitriolic words and

the violent actions of the

bad people, but for the

appalling silence and

indifference of the good

people...”

Martin Luther King

-