Unsanitized: Structural Racism and the Coronavirus Crisis

The pandemic has held up a mirror to our unequal society. This is The COVID-19 Daily Report for Juneteenth, 2020.

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First Response

On a day marking the emancipation of slavery, I’m reminded that the coronavirus crisis has held up a mirror to America’s existing inadequacies. And some of the biggest come in the area of race. The protest movement of the past month expresses rage at structural racism, first and foremost expressed through murder by the police. But the context of the crisis has made that racism undeniable, and reinforced that recognition by even white Americans. Numerous studies just in the last week document how people of color faced the crisis at a structural disadvantage.

One set of numbers has been pretty prominent: mortality. According to data from the APM Research Lab, Black Americans have died of COVID-19 at a rate of 61.6 per 100,000, compared to 26.2 per 100,000 for whites. Some studies put the death rate for Black people at 3.57 times that of white people (and nearly two times as much for Latinos).

There are a litany of reasons for this. Black Americans are overrepresented in the “essential” occupations, and more likely to have to come in to work rather than working from home. They live in worse environments and are more likely to have pre-existing health conditions.

But it goes much further than this. NPR reported last month that coronavirus testing sites in Dallas are over three times more likely to be found in white areas than in communities of color. More directly, the hospitals frequented by Black and Latino people are physically worse and subsequently offer less beneficial care.

Read all of our Unsanitized reports

A first-of-its-kind peer-reviewed study from researchers at Harvard and Princeton released yesterday found that funding for patient care at hospitals that primarily serve white people was between 50 and 60 percent higher ($8,325) than at hospitals serving the highest proportion of Black ($5,197) and Latino ($5,763) patients. And there was nearly twice as much funding for modernization and new equipment at white-serving hospitals. Out of 27 specialized services, 19 were less available at Black- and Latino-serving hospitals, things like cardiac surgery and catherization, computer-assisted orthopedic surgery, and weight-loss surgery. There was even more room to walk in hospitals that serve more white patients.

The study built on prior findings of worse nurse-to-patient ratios, more safety hazards, and higher readmission rates in hospitals serving communities of color. Hospitals serving white patients are simply more profitable, and that’s connected to their capital spending, and ultimately their results. “We need to reverse the structural racism that’s literally built into our hospitals,” said Kathryn Himmelstein, one of the co-authors of the study.

Race is a factor in a number of medical decisions as well, as a New England Journal of Medicine study highlighted this week. The calculations and even the equipment used to determine diagnoses are racially biased, tending to move certain treatment away from Black people. Shera Avi-Yonah, now one of our interns, actually wrote about this for the Prospect last year in the context of kidney testing.

Black business owners have been shortchanged in the crisis along with Black bodies. A Center for Responsible Lending report from May found that the Paycheck Protection Program’s structure, which valued relationships with existing banks and prioritized larger loans, disproportionately damaged Black-owned businesses. This just reinforces existing disparities in access to capital. Fewer black business owners applied for and received PPP forgivable loans. A whopping 41 percent of Black-owned businesses have shuttered, according to a survey out of Stanford’s Institute for Economic Policy Research. Those businesses are more concentrated in retail and restaurants, which explains the disproportionate pain.

For workers of color, the struggle is compounded. Black and Latino workers were both more likely to work in exposed environments and more likely to lose their job. An Institute for Policy Studies survey of 800 Black immigrant domestic workers in three regions found that 70 percent have either lost jobs or seen hours and pay cut. Around 65 percent feared eviction or utility shut-off, and 51 percent had no health insurance. One-quarter either had COVID-19 symptoms or lived with someone who had them.

Of course all of this culminates in the racial wealth gap, which limits options in the pandemic for treatment and emergency survival funding. A separate Institute for Policy Studies report out today notes that the average Black family has $3,557 of wealth (that doesn’t count durable goods), and Black and Latino families are twice as likely to have no wealth as white families. The crisis has exacerbated this as the investor class has been rescued. Between March 18 and June 11, the combined wealth of billionaires in the U.S. increased by $637 billion, equivalent to over 13 percent of all Black wealth. Just 12 U.S. billionaires hold as much wealth as all Black home equity.

After 2008 nearly all the gains in the recovery went to the top, worsening the racial wealth gap. The IPS report has a bunch of policy recommendations to prevent that outcome, most of them familiar (basic income, Medicare for All, job guarantee, baby bonds). But I want to highlight one in particular which Mehrsa Baradaran noted in her feature for the Prospect on the racial wealth gap this week: the racial equity audit. The idea is to have the Congressional Budget Office score pandemic response legislation for its effect on the racial wealth gap, rather than just the budgetary cost. By seeing stimulus measures in this light, we can better understand the inherent bias in certain policies and work to correct them. It’s an innovative and important idea.

Structural racism is a historical reality that shines most brightly in moments of crisis. This is a legacy in America that can be changed, and in this moment of anti-racist demands we have to work toward that goal.

More Juneteenth Reading

At the Prospect main site, we have Randall Kennedy, who wrote a feature for us six years ago after Ferguson on why he considered himself a racial optimist. Today he writes about the George Floyd moment, its promise and peril, and why his faith has been both shaken and reinforced in the past month. It’s a great essay.

Also today, we have Marcia Brown on the fight between prison reformers and prison abolitionists, and Harold Meyerson on how Gone With the Wind wasn’t the only product of white supremacy out of Hollywood; so were Westerns.

Meanwhile, you can check out all of our coronavirus coverage at prospect.org/coronavirus. And email me with tips and perspectives.

Days Without a Bailout Oversight Chair

84. The rest of the oversight panel managed to release its second report yesterday, where all members from across the political spectrum agreed that the Federal Reserve bailout has distributionally benefited large corporations over smaller ones, or state and local governments. The Commission asked the Fed and Treasury whether it would attempt to force businesses that get direct loans from their credit facilities to retain workers, and while there’s a clause about “commercially reasonable efforts” to maintain payroll, the Fed and Treasury replied that they would “monitor the program’s impact on the economic recovery broadly rather than on a borrower-by-borrower basis.” In other words, there will be no monitoring and employers can do whatever they want with the money.

This would be a good thing for a bailout oversight chair to prod. If we had one.

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