As the numbers are coming in, statistics show that communities of color, particularly Latinx and Black communities are both contracting COVID at higher rates and dying from it at higher rates. What is causing this inequity? What solutions can we enact, both now and in the future, to change this? Sarah Edwards (MPP ’20) spoke with Rashawn Ray, David M. Rubenstein fellow at the Brookings Institution and an associate professor of sociology at the University of Maryland.

To learn more about this issue, we recommend reading these two articles Rashawn wrote for Brookings:

• “Why are Blacks dying at higher rates from COVID-19?”
• “How to reduce the racial gap in COVID-19 deaths”

Transcript

Sarah: [00:00:00] It's week seven of shelter in place due to the COVID-19 pandemic. At Talk Policy To Me, we're trying to be responsive to the issues that are developing around the crisis. One thing that I've been thinking the most about has been the issue of racial inequities in COVID-19 cases. To understand the problem and some possible actions that we can take, I spoke with Rashawn Ray, a David M. Rubenstein fellow at the Brookings Institution and an associate professor of sociology at the University of Maryland.

Sarah: [00:00:29] I'm Sarah Edwards, and this is Talk Policy To Me today on the podcast, talking racial inequity and COVID-19. Let's turn to my conversation with Rashawn and dive straight in.

Sarah: [00:00:48] Just kind of to frame it up a little bit, not everywhere is reporting right now–the disaggregated rates–but from the places that are reporting coronavirus cases and deaths disaggregated by race, it's really bad, right? Black and Latino people in particular are having these higher rates of both contracting COVID and higher death rates. It really is illuminating these preexisting inequities in the system. And you've written both about somewhat around why this is happening and some about some potential solutions. So I want to talk a little bit about both that both sides of that today. First out, is there a specific factor that has a bigger impact that's causing this disparity in COVID-19, or is it just a larger picture of racial inequity built and reinforced by historic policy choices?

Rashawn: [00:01:47] Yeah, I think when it comes to the racial gap in COVID-19, I think the latter. I mean, I think that structural conditions undergird preexisting health conditions, and in moments like this, structural conditions actually enhance people's exposure to COVID-19. And when we look at COVID-19, it's an equal opportunity virus. I mean, anyone can catch it at any given time. We've seen that from politicians to celebrities. I mean, even high profile academics such as the president of Harvard. However, what ends up happening is that structural conditions collide oftentimes on the bodies of black people. And one thing that I've been saying and this is a long, long standing saying, particularly within the black community that I added on to, which is that when America catches a cold, black people get the flu. Well, in 2020, when America catches COVID-19, black people die. And the reason why black people are more likely to die has to do with, as you mentioned, not only the historical ramifications of, say, redlining and policies that have segregated us, but the fact that those policies have impacts in contemporary times. So you can take maps of Washington, D.C., Philadelphia, New York, Baltimore from 100 years ago, and you can literally lay them on top of maps from today. And of course, there have been a lot of social scientists who have done this and shown that the correlation between those two maps is significantly high. So it's not like that we have some kind of way gotten away from from redlining. And I think in many regards, we see the impact of that today when it comes to structural conditions. We're specifically talking about things like lack of access to health care. What that means is predominantly black neighborhoods compared to predominately white neighborhoods are less likely to have hospitals, less likely to have hospital beds, less likely to have urgent care places, less likely to have pharmacies. The pharmacies that do exist oftentimes are stopped. So in this case, even if we get to the point where a person has gotten tested and they've gotten treated and of course, we know that that there is a racial barrier there as well. But even if we get to that point, they come back and try to fill a prescription in their neighborhood. It might take two or three or four days for their pharmacy to fulfill that prescription. Those are days that people don't have. We also know that predominately black neighborhoods are less likely to have healthy food options. What this means is fewer grocery stores, fewer places that have fresh fruits and vegetables and healthy foods, more likely to have fast food places. One big thing I've been saying is people have been trying to blame black people's behavior or their blood, which is, you know, Ludacris in a lot of ways. But when it relates to decision making, if you have a family of four like I do and you have $10 in your pocket, are you going to go to the Whole Foods that doesn't exist in your neighborhood or are you going to go to the McDonald's on the corner? Most people are going to choose the McDonald's because the food is unhealthy and you can get things from the dollar menu and essentially feed your entire family. Those are oftentimes decisions that are being taken away from black Americans in ways that doesn't necessarily have to for white Americans. Then we further lay this up with the fact that blacks are more likely to live in densely populated neighborhoods. What this means is from the I was talking to someone about this earlier who lives in New York from the time that she tries to leave her building to the time she might get to her vehicle, which might be parked two or three blocks down the road because she couldn't park right in front of her place. She is passed by probably 30 or 40 people who are trying to do the exact same thing, which is simply get to their car, to go to the store, go to work if they're if they're an essential worker. So social distancing is also a privilege is something that people who live in densely populated areas, which are more likely to be blacks and Latinos, simply can't engage in social distancing in the way that they're many others of us can. Final point deals with work, which is that black Americans are more likely to be working these new essential jobs working across. Three stores working as transit drivers, working at restaurants, working in health care, working in custodial care. So blacks represent about 20 to 25% of people who work in this new essential workforce. You put all these together and these factors literally collide on black bodies To expose them more to COVID-19 leads to them being less likely to get treated for COVID-19 and then of course, being more likely to die from COVID-19.

Sarah: [00:06:24] Definitely. It's really, really terrible. Something else that I think you touched on a little bit and I've been like really sad to see is like there's a terrible version of this conversation that mentions the disparities but is placing blame right or, you know, at its most, quote unquote, neutral is like ignoring the picture of the inequalities that are driving these disparities. What do you feel like is at stake when the the racial gap in COVID-19 is presented in that way?

Rashawn: [00:06:56] Yeah. To your point, I mean, that's a great point. I mean, I think people have to realize how detrimental these narratives are. You ask specifically what's at stake. I think resources and lives are at stake. And to be specific about it, if we look in New York City or most places around the around the United States, but of course, New York City being ground zero, most of the testing and triage places have not been in predominately black or Latino neighborhoods. However, we know black, black and Latino neighborhoods have been hardest hit. Then a lot of politicians, mayors, governors put in place stay at home orders and then restricted the use of public transit. So what they did was they went to a reduced schedule. What that does for a person who's working on a central job in a densely populated area who doesn't have a vehicle now means that they are on a train that runs every hour instead of running every 15 minutes. And now they are standing right beside someone, like when I'm going to Washington, D.C., to go work at Brookings on a normal day where I mean, literally, if someone I mean, you can smell people's breath like they are so close to you, that is still happening to people even during this pandemic. And so that's an example where social distancing simply can't happen. So I think it's about resource allocation. It's about the fact that if you blame people instead of blaming systems in places or in this case governments, what that means then is that these people shouldn't get the same timeliness, they shouldn't get the same response time, they shouldn't get the same set of resources. Like why should we give? Why should we put a testing center there when they're not adhering to the rules and regulations that are put in place? I find that fascinating because even though people are criticizing, people say in Florida for being out, the narrative is still different, like the nuances of the narrative between blaming people who are on the beach in Florida compared to people who are in a housing project in Philly or Baltimore or New York are drastically different. And when we look at the differences, yeah, it has to do with oftentimes their social class background, but it also has to do with their racial background. And so even though COVID-19 is an equal opportunity disease, our health care system in our society is not an equal opportunity society. And up to this point, we've employed a colorblind approach to dealing with COVID-19, when instead we should be employing and we should have already been employed, but we should be employing a health equity approach to deal with the racial gaps. Governor Cuomo, for example, in New York, Gavin Newsom, for example, in California, I think they've done that. Governor Larry Hogan in Maryland, I think has done that. The governor, Ohio, I think has done that. And I think what's important there is the four people who I just named two are Republican, two are Democrat. This isn't about partizanship. This is about putting people over profits and actually prioritizing people's health regardless of their race, regardless of their level of oppression and marginalization, and also regardless of the decisions they make. For example, the people who are protesting all around the country about reopening up, reopening up their states and also the United States, I think they should still get the same care that anyone else does, even though they are actually making horrible decisions for their health and also for the other people they around.

Sarah: [00:10:11] Definitely. That's a that's a really important way to think about it. Moving to thinking about what is being done well and moving to, I think, some of the potential ways that we can reduce this gap. You had a piece outlining a few kind of ranging from expanding testing in black communities to key economic supports to essential workers to universal health care. I'm curious if you think that there is a piece that would be most important to do first or maybe is most feasible to do first?

Rashawn: [00:10:42] Mm hmm. Yeah, that's a really good question. Do first. So the way that I've really been thinking about it are short and long term solutions. I think in the short term, there are four things they can be done simultaneously and should be. And in part of the reason why I'm going to frame it this way is because our society is so inequitable that if you only address one part of a you, you actually potentially put more strain on another part. Like as an example, the social distancing thing with the trains like that makes sense for one one side of people who might live in Manhattan or live, you know, in DuPont Circle by Brookings or live out in the suburbs around DC to reduce the transit schedule. But it doesn't work for other people. I kind of think about inequality like a pipe. If you have a pipe that is busted and you and it's an old pipe and you just wrap it up in some and some tape and some contractor tape, well, this is going to hold that area, but it simultaneously puts more pressure on the other side of the pipe and it's going to probably lead to it, it exploding on the other side. And so you might actually end up doing something worse. So I think the things that can be done in the short term, we need to collect demographic data on who's being tested. And I say who is being tested because as you know, this isn't just about the numerator, meaning how many people have contracted COVID-19. It's also about the denominator. How many people are we actually testing? Who's immune? Why are they immune? Who's built up in antibodies? Who was positive and now isn't? I mean, so we have to essentially triage it at this point. Part of what that means is we need to collect information on race and place. You know, race in place are highly correlated. When I was the Robert Wood Johnson Foundation Health Policy Scholar at Berkeley, when the Affordable Care Act was being rolled out, I specifically did research on physical activity and obesity and really learn just how linked race and place actually are to one another. We also need to continue to get information on age and gender. I think these are intersectional factors going on. Like when I look at at least the information we have now, unclear what that will look like in a month from now, for example. But currently I see in a lot of ways that COVID 19 is is is being is having the most detrimental impact on middle age to older black men. That's not surprising. It shouldn't be surprising if we take an intersectional perspective on this. We knew from the beginning that older people were more likely to be hit. We also knew that men were more likely to be hit. Men are less likely to utilize health care, less likely to do things that they should do to take care of themselves. And then we know, as I just described, about how race operates, we put those together. We see it colliding oftentimes on middle age to older black men. And I think we've seen that whether or not we're looking in Michigan or Illinois or whatnot. Second thing is we need testing in triaging predominantly black neighborhoods. And that's because there's a gap there. And we really need to utilize black churches. The work that I've done with Dr. Abigail Sewell, who's at Emory University, we found that when people who attend black Protestant churches, which is most black, most predominately black churches in the United States, that they are more likely to utilize health care, more likely to trust health care. That's because there's a new social network that's been formed that all of a sudden leads to people getting referrals and trusting that the referral that they've gotten to go seek care is going to actually be fruitful for them. And I put it I put these very simply because people like I don't understand. People don't go to the doctor. Well, first off, you don't understand that health insurance is a premium in the United States. So a lot of these essential workers are going to work because they have to write, they get paid by the hour and they don't have good health insurance or or they might not necessarily have health insurance at all. So if they don't go to work, they don't get paid. They're going to work exposing themselves and their families and all the other people who they come in contact with every single day to COVID-19. Part of what that means then is I use this analogy. If you go to a restaurant and, you know, say I say, I've told you, I've told you this restaurant is good, you go to the restaurant in a service is horrible, the food is terrible. And you're like, Oh, geez, look at that. This was going to be good. All right, I'm gonna try one more time. So you go again in. The service is bad again and the food is terrible again. What are you going to do? You're not going to go back anymore. That's what happens to black people with health care. They oftentimes, during the patient physician relationship, black people are spoken to instead of being spoken with. And so that is one of the key differences. Like oftentimes white people are so accustomed to people having a conversation with them, whether it be health care providers, police officers, teachers that they don't understand. When black people say that they've had a different experience because they're like, my experience was so good. Yeah, but unfortunately, people don't treat us the same based on the way based on our skin color. So we need testing and triage in black communities. And black churches can help deal with medical mistrust, help deal with space issues, help deal with safety issues, just a lot of things that really become similar to what president. Obama has put in place, which were promise zones so black churches can become health equity zones. I mean, they're already giving out bag lunches and laptops and bringing in homeless people and all this kind of stuff. Last two things deal with these new essential workers need hazard pay and any paid leave. Those things can be done with executive orders from governors and also from the federal government to make sure that these new essential workers get hazard pay like they are putting their lives on the line. The Department of Labor and the Department of Commerce say that hazard pay is when you are exposed to something that might kill you. Well, obviously, COVID-19, that's the case. There was a young woman, 27 years old, works and worked at a giant grocery store in Lanham, Maryland, who was bagging people's groceries so that we had the luxury to go home and make brownies with our kids and stuff while we're quarantined in and doing home schooling, watching movies. And she died at 27. Like, that should not be happening in a country that is supposedly the wealthiest in the world. But it's only wealthy for certain people. For other people, unfortunately, their everyday conditions are very similar to what people perceive third world countries to actually be. That was a report that came out of Hopkins that ranked 195 countries on their preparedness for a pandemic. The United States was number one, only got 84%, as you know. Look, you know, we teach classes. I'm a university professor. I mean, 84%. That's nothing to write home about. It's just a B. But the reason why I got a B is because it was number one in finance, but only got 66% in health care access, health care, quality and responsiveness. They actually the United States actually ranked lower than some countries in Africa that were responding to Ebola like Congo in Liberia. So we put all of these factors together. And it's not necessarily just, I think, one solution. It is a series of policies that have to deal with the broken pipeline that creates inequality in our country.

Sarah: [00:17:31] I hate this version of a silver lining in this conversation, but I have to hope that there's like a lessons learned situation, right? Where what is being illuminated right now that has been, to be clear, has been completely obvious, like the level of inequity in our country and the way that opportunities are not the same based on race. But I have to hope that this now is so pressingly clear that will actually make the changes that we've needed to make for so long. If if you had the power, you know, what do you think should change in a post-COVID world?

Rashawn: [00:18:03] I think in a post-COVID world, and I'm only cautiously optimistic about this, but I do think that universal health care is the thing that needs to be implemented. I mean, I'm really worried right now as southern states are preparing to re to reopen and, you know, as soon as this week. And that's troubling. I'm a native Tennessee and I grew up in in Atlanta, Georgia, so I'm very concerned about the Deep South and I'm really concerned about rural areas, predominately black and predominantly white, rural areas that I think are going to be hit hard. Most rural counties don't have one hospital bed in those counties. People are driving several, several miles to get to any sort of urgent care facility to get treated. So I'm really worried there. And a lot of those areas, to be frank about it, turn down health care money because they didn't want to align with President Obama's Affordable Care Act. And that's unfortunate because that's an example of putting politics over people, putting profits over people instead of actually doing what's best for the people that are being served. So I would like to hope that universal health care is going to be one of the first things that's put in place in is second. I really think we need to raise the minimum wage and have a guaranteed income. I just mentioned Tennessee, in the state of Tennessee, the minimum wage is $7.25, that's less than 1200 dollars if a person working 40 hours a week, that's less than 1200 dollars in one month. The average rent in Nashville is 1400 dollars. People can't live on that. One of my Brookings colleagues, Molly Kinder, has been doing interviews with frontline workers, these new essential workers. And one of the things that she said, or they one of the respondents said was, you know, I see my coworkers ringing up people's groceries and in having to give food stamps so that they can purchase food for their own families. I mean, that that's shameful. I mean, it is honestly almost criminal that in about 40 years, the minimum wage has not kept up with inflation. So I would say those are two main things that need to happen.

Sarah: [00:20:00] Thank you. Just final question. Is there anything you feel like that's really important to this conversation that we haven't touched on?

Rashawn: [00:20:07] Hmm. I mean, I think we've covered a lot. I mean, I'll just quickly say that on a personal level, I think what people have to do is to use their knowledge and skill set to debunk stereotypical narratives and misinformation. And my grandfather, who served 21 years in the military, served in two wars, Purple Heart, Bronze Star, from the time that I came out the womb, he would always tell me that my silence was my acceptance. And I think oftentimes a lot of us are in situations where we hear something that is incorrect and we're silent about it, either because of power dynamics or because it's a family member that we don't feel like getting into with, but I always remember that my silence is my acceptance. It doesn't always mean that we get into it with the person, but we can simply say, you know, I'm not sure if that's true. I don't necessarily agree with that. And I think that's particularly important right now if we want to move forward. One question you asked me before is what is a post-COVID world look like? And I mean, I think it drastically changes. I like to be cautiously optimistic. But one thing I hope is that a lot of people just don't go back to normal with the types of conversations that they are having. And part of what I mean by that is, is I think people can become what I call racial equity advocates that extends beyond allyship. Allyship means, you know, you can wear a pin, you can wear. When I was little white ribbons, you can be in solidarity, am in solidarity with these people. But oftentimes that means that you're reactionary and it gives you off into allyship. You can be silent. Oftentimes you see somebody getting mistreated and you don't say anything. Meaning being an advocate is speaking up for that person, especially when they're not present. Because one thing I know is that often times and Shirley Chisholm said it, is that when people are sitting at a table and you're not there or your group isn't there, the people who you're trying to represent are out there. Oftentimes you're on the menu and someone's eating you for lunch. So you have to bring up a folding chair. Well, sometimes that folding chair can't come up, so there needs to be somebody at their table who is speaking up and speaking out for the groups that are being misrepresented at that particular table to make sure that we hold people accountable for their mistreatment of other people.

Sarah: [00:22:18] Definitely, definitely that feels incredibly important now and all the time. Well, that's all I have. And I can let you get back to your very busy world right now, but thank you so much for taking the time. I really appreciated the chance to talk to you about this.

Rashawn: [00:22:36] Thank you for having me. I look forward to additional conversations.

Sarah: [00:22:48] Thanks for tuning in. We'll be releasing more conversations like this around COVID-19, as well as our previously scheduled episode as a part of the series exploring policies to strengthen our democracy. Subscribe to make sure you don't miss any of our upcoming episodes. Talk Policy To Me is brought to you by the Berkeley Institute for Young Americans and the Goldman School of Public Policy. Our executive producers are Bora Lee Reed and Sarah Swanbeck. Our audio engineer is Michael Quiroz. Music heard on today's episode is by Pat Mesiti-Miller and Blue Dot Sessions. I'm Sarah Edwards. Until next time, stay safe and stay home.