COVID-19 has plainly revealed issues in American society that many hadn’t seen or chose to ignore. One impact that has been experienced across the country is that people of color are disproportionately affected in the rates of COVID-related sickness and death.
Nationwide and on a local level, communities of color account are represented in the numbers of cases and deaths far beyond their representation in the population, as seen in the reported data below (figures are from early May).
- Black individuals make up approximately 15% of Illinois’ population, but represent 43% of those who have died and 28% of positive tests in Illinois.
- In Washington state, Latinx individuals are 13% of the population but represent 31% of COVID cases.
- In Iowa, 6% of the population is Latinx but represents 20% of COVID cases.
The CSUN Health Equity and Research Education (HERE) Center was created in 2019 to research and address these types of issues, with the goal of improving health equity in the Los Angeles region.
The HERE Center hired four faculty members, and CSUN has about 30 total faculty members around the campus who conduct research and work on health disparities issues. In the HERE Center, located in Lilac Hall, more than 50 undergraduates and graduate students, volunteers and staff collaborate on research projects. As CSUN classes and labs operate remotely for the most part, this work goes on, online.
The researchers’ aim is to better understand the problems surrounding health disparities and then work with impacted communities — serving as a trusted source of information and support.
CSUN psychology professor and HERE Center Director Carrie Saetermoe this month answered a number of questions, to provide insight on racial disparities during the COVID-19 pandemic.
Q: How is COVID-19 impacting patients differently?
A: We know less about racial and ethnic groups than we should because we weren’t initially collecting nor reporting data (a persistent problem that contributes to health disparities). Early patterns suggest tremendous disparities for African American and Latinx people who are at greater risk of having COVID-19 and at greater risk of dying from it, nationally, than whites.
Latinx in areas of the country with less established Latinx communities have fewer resources and support systems, and struggle the most to protect themselves with less access to information, specific resources, family connections, etcetera. Initially, dense cities were most affected, but now we’re seeing spreading to regions less densely populated, where people of color have even greater disadvantages.
In Los Angeles County, race data is available for about 99% of deaths, but the race information for those who are diagnosed with COVID-19 is much less complete. While the percentages in Los Angeles County aren’t as dramatic, some communities have been impacted disproportionately.
Hawaiian/Pacific Islanders, African American, and residents of Asian descent in L.A. County are especially at risk. At great risk are residents of L.A. County who are of Hawaiian and Pacific Island descent, who represent 0.2% of our population but 1.2% of COVID cases (while only a disparity of 1 percentage point, it represents a rate of infection five times their population rate).
Recent information tells us that Latinx and African Americans are at much greater risk of death at ages 41-65.
Also, infection rates per 100,000 people are nearly double in the lowest-income neighborhoods, when contrasted with the highest-income neighborhoods.
People in lower-income communities are less likely to be tested than those in higher-income neighborhoods, even though they are at greater risk of contagion. This is despite the fact that they are more likely to request testing than whites and those of pan-ethnic Asian descent. [According to the data], whites were more likely to be admitted to hospitals without needing ICU admission than any other ethnic group.
Q: What is the relationship between systemic racism and public health? How does one affect the other?
A: What we do know is this: Regardless of social class, education or income, people of color, Black, Latinx, Asian descent and Native descent are all more likely to experience health inequities. These inequities are entrenched in historically embedded laws and policies that allow unconscious biases to go unchecked.
Health is related to environments, housing density, availability of healthy food and exercise, healthcare workers who are culturally responsive and trained to recognize their own unconscious biases, and so much more. While policies like the Affordable Care Act and [programs such as] MediCal are necessary, they are not sufficient to truly challenge the underlying conditions that lead to health inequity.
Today, Black women in Los Angeles are three to four times [more] likely to die in childbirth than women of any other racial or ethnic group. Their infants are two to three times more likely to die before the age of 1 than infants from any other racial or ethnic group in L.A. Black women in Los Angeles with a doctorate are more likely to die in childbirth than white women who didn’t complete high school.
Studies find that nearly half of medical students believe that their African American patients have thicker skin than their white patients, and many, many anecdotal reports of women in childbirth indicate that they are not believed when they report symptoms to their physicians, leading to exacerbating conditions that contribute to high death rates.
These statistics, along with thousands of others, tell us that while public health has improved the overall health of our society, it has also intensified pre-existing inequities.
Q: What are some of the factors that lead to health disparities in Los Angeles communities?
A: During this pandemic, Black and Latinx individuals are disproportionately required to continue to travel to work, often high-risk work environments that do not meet social distancing requirements. They are more likely to use public transportation, work at a public-service job like [in a] grocery store or in food delivery. They are less likely to be insured and more likely to have health conditions, yet racial bias keeps them from seeking healthcare.
In one study, white individuals were more likely to work at home, were more often furloughed or were more often unemployed than those in Latinx communities — so therefore, [the white individuals were] more able to shelter in place.
Some Native Hawaiian/Pacific Islanders in L.A. live in crowded conditions in boarding houses, multi-family and multi-generational households, and they are less likely than whites to seek healthcare. They rely on faith-based organizations and community groups, but they are not currently receiving timely information — in part because they often do not have materials available in their language. There is culturally incongruent messaging, lack of trust and other issues that interfere with seeking healthcare.
Q: Why is it crucial to shed light on racial disparity in the healthcare industry, especially during a pandemic?
A: Black individuals are at higher risk for complications from COVID-19, in part because of enduring health disparities in diabetes, hypertension and other conditions that make them vulnerable to the harder symptoms of the virus. Patients who are denied care often do not show up in hospital records — therefore, they are uncounted victims of discrimination. Shortages of tests and materials mean that more people are turned away — this exacerbates bias that is already built into the system.
More than anything, we need a singular, scientific voice with clear information and recommendations that are consistent with the behaviors of trusted leaders. We need materials in a format that people have access to — we cannot presume that everyone has equal access to WiFi, cell phones, computers, etcetera. All materials need to be available in multiple languages. All materials should be targeted toward each community’s cultural beliefs and practices. We need on-the-ground information from trusted sources such as faith-based organizations, community nonprofits and local businesses.
Q: What kind of research does the HERE Center do into this issue?
A: We are working to serve as a source of information and support for the community. Accurate information is power; at the HERE Center we see dissemination as central to the beginnings of social change.
We hope to build awareness of social problems, deconstruct the reasons why we are not well-informed, why health disparities persist so that we can reconstruct a different, humanizing framework.
Many communities do not trust public information because it does not serve them well. At the HERE Center, we plan to work with local promotors who are active and engaged in the community as a bridge to our academic work. Lack of trust in public health information means that trusted information needs to come from someone who is familiar, similar and who shares — not judges — their reality.
We hope to work in local groups throughout the San Fernando Valley through Community Cafés where we can identify community health contexts, topics, and problems, even at a very micro-level, and support one another in researching, finding solutions, finding resources, and building community around a healthier, more equitable framework.
In the near future, we are working toward securing HERE Center interns in health communications and a film editor to work with us to identify accessible and multi-language messages through social media and film. When it is safe, we will work with local communities in person, when we can be more effective, especially with sensitive matters, in communicating and addressing community concerns.
Q: Is the HERE Center doing any new research in response to COVID-19?
A: To provide summer research programs for BUILD PODER students, the HERE Center is preparing three new research experiences for CSUN students, including BUILD PODER students, which will help to better understand and document the student experience in this historic time. We will look to understand students’ personal experiences, how people’s connections with one another have changed, and how we as an institution responded to the COVID-19 crisis for students.
In addition, we are in early conversations with CSUN’s public health program around continuing this work into the fall and spring semesters in order to analyze and publish this work. We hope to work with undergraduate and graduate students in public health on projects around COVID-19 that are as yet to be specified.
We believe that CSUN is a powerful force for change, and that we have incredible talent to contribute to local awareness and response to the pandemic, which has already exacerbated pre-existing health disparities. We at the HERE Center hope to serve as a welcoming space for students, faculty members, and community members and organizations to bring awareness and greater health equity to the San Fernando Valley.
Q: What possible solutions are you aware of, or has the HERE Center identified?
A: One of the primary solutions we see is to diversify the biomedical workforce. We are affiliated with the National Institutes of Health program BUILD PODER (Building Infrastructure Leading to Diversity, Promoting Opportunities for Diversity in Education and Research). BUILD PODER was designed to invite students who are currently underrepresented in the biomedical research workforce to participate in enrichment activities, hands-on research, and a variety of professional experiences that prepare them for graduate school and a career.