COVID-19 and Black America: Lessons Learned from Past Health Inequities
By Theresa Summers, Manger of Applied Epidemiology, and Madeline Kuney, Policy Associate
Freddie Lee Tyson was a sharecropper from Tuskegee, Alabama who in 1932 was approached by a member of the US Public Health Service and offered treatment for what they described as “bad blood.” What he did not know at the time, nor did the 600 other Black men who were infected with syphilis and similarly approached, was that the “treatments” being offered were nothing more than placebos and that he was unknowingly being enrolled in a study called “Tuskegee Study of Untreated Syphilis in the Negro Male.” The study would continue for another 40 years and went to great lengths to deny the men treatment for their syphilis infection, even as penicillin became available in 1945.
In the summer of 1972, the Associated Press broke the story about the study and marked the first time the American public, as well as the participants and their families, learned of the real intentions of the study. Lillie Head, Tyson’s daughter, described the feeling within the Tuskegee community upon finally learning the truth: “There was distrust, there was a feeling of shame, a feeling of being betrayed by people you thought were there to help you.”
What we commonly know now as “The Tuskegee Syphilis Study” is perhaps the most well-known example of unethical treatment of Black Americans by the US medical community, but by no means the only. In the 19th century Dr. J Marion Sims, widely known as “the father of modern gynecology,” developed a treatment technique for vesicovaginal fistula (VVF) following four years of repeated experiments, done without anesthesia, on 14 slave women. And this use of slaves in experimentation was not unusual during that era, as medical historian Stephen C. Kenny, who has written extensively on the subject, argues that “exploitative experiments on slaves were culturally embedded and enabled.”
The question then becomes, what do these examples from history teach us about the health inequities that Black Americans continue to experience today? Turns out, a little more history would help. During the era of Jim Crow, the segregated health system in the United States, wherein hospitals, clinics, and doctor’s offices were segregated by race, coincided with segregation in education, housing, and employment. Such disparities in these conditions in which people are born, grow, live, work and age – otherwise known as the social determinants of health – have continued to intersect with structural racism, leading to disparities in healthcare access and outcomes among Black Americans in the United States. A 2020 survey of 777 Black Americans by the Kaiser Family Foundation and ESPN’s The Undefeated found that “seven out of 10 Black adults believe that race-based discrimination in health care happens somewhat often, and one in five say they have personally experienced it in the past year.”
While these examples of discrimination against Black Americans throughout the history of the US healthcare system are striking, the COVID-19 pandemic has revealed that the impact of that discrimination continues today. During the first few months of the pandemic, researchers began to note significant racial disparities among individuals who became severely ill and those who died as a result of COVID-19. By April 2020 it was reported that 33% of hospitalized COVID-19 patients were Black, though Black Americans make up 13% of the US population. This was compared to white Americans, who constituted 45% of nationwide hospitalizations despite making up 76% of the US population. A similar disparity arose in the number of individuals who died of COVID-19. Also in April, Johns Hopkins University and the American Community Survey found that predominantly Black counties were experiencing death rates more than six times greater than predominantly white counties across the nation. While these statistics are discouraging and disgraceful, many in the Black community are not all that surprised by them. As Albany City Commissioner Demetrius Young put it, “Historically, when America catches a cold, Black America catches pneumonia.”
The reasons for these disparities are complex and inextricably linked to one another. One thing that is certain about COVID-19 is that it takes a particularly hard toll on those with underlying health conditions. Prior to the pandemic, higher rates of diabetes, heart disease and lung disease were documented within the Black American community. Many, including Dr. Anthony Fauci, have partially attributed the community’s disproportionately higher COVID-19 death rate to those pre-existing disparities, crediting the pandemic for “shining a bright light on how unacceptable” those disparities are. But those pre-existing health disparities are the result of inequities among other social determinants of health such as housing, educational, income and wealth gaps, occupations, healthcare access and utilization, and discrimination. These inequities make it more likely for Black Americans to contract COVID-19 and less likely to have access to the health resources they need to treat it.
To address and avoid adding on to these existing disparities, we must ensure that COVID-19 vaccines are delivered equitably to individuals irrespective of race. For the Black community, this will require a special effort to dispel the distrust towards the medical community and counteract the underlying social determinants of health. Though vaccine rollout has only recently begun, some counties and states are already seeing racial disparities in vaccination rates. In Michigan, white residents have thus far been vaccinated at twice the rate of Black residents and Connecticut has reported that, as of February 3, nearly 2% of residents of the age of 75 who had received the vaccine are Black while 59.7% are white. There is still time and opportunity to change these trends. Connecticut’s Department of Public Health Commissioner said they are “redoubling efforts to ensure that vaccine is reaching the communities and populations who have been disproportionately impacted by COVID-19…[by] re-allocating additional vaccine to communities with large minority populations, encouraging our vaccine providers to conduct outreach and implement other measures to ensure that individuals from underserved communities have equitable access to vaccinations.” Other efforts to reach the Black community include novel ideas like setting up pop-up vaccine clinics throughout Cincinnati to counterbalance racial disparities. Meanwhile, several leaders from within the Black community, such as Rev. Miniard Culpepper, senior pastor of Pleasant Hill Missionary Baptist Church in Boston, are sharing their vaccination experiences in order to serve as role models and dispel vaccine hesitancy among others.
While history and current data might suggest that COVID-19 vaccination will prove to be yet another example of health disparity faced by the Black community, that does not have to be the case. Targeted, informed efforts to reach Black Americans where they are - both physically, in terms of vaccine access, and mentally, in terms of vaccine hesitancy and distrust - can help reverse these trends. We must call on community, local and state leaders to include leaders from the Black community when developing vaccine delivery strategies to ensure that COVID-19 vaccine delivery is not only fast, but also equitable.