Black, indigenous, and people of color (BIPOC)
They are traditionally marginalized across all social systems, but it’s more apparent today than ever due to the devastating effects of COVID-19 on BIPOC communities. In 2020, BIPOC account for 27.3% of the U.S. population (Census.gov, 2020), yet BIPOC account for 58.1% percent of all COVID-19 cases to-date (CDC.gov, 2020). Researchers and social scientists point to structural disparities as the main cause of the disproportionate COVID-19 infection rate among BIPOC (Cantos & Rebolledo, 2020; Valenzuela et al., 2020). The data shows that a consequential proportion of the BIPOC communities are essential or service-related workers with limited or no access to health care, lower socioeconomic and education status, overcrowded housing with limited ability to social distance, and limited or no access to personal protective equipment. These realities have created conditions where COVID-19 affects every aspect of the BIPOC social constructs.
Barriers to Health Care
The black community has been the victim of significant abuse and neglect from the medical profession throughout history. A significant number of blacks believe that medical misconduct is a significant threat to the black population (Pew Research Center, 2020). This belief stems back to pseudo-health care under the Freedman’s Bureau (1619 Project), the lack of access to free medical treatment based on the argument that it would cause freed people to be overly dependent on government assistance, segregated hospitals under Plessy v. Ferguson (1896), and egregious medical research and medical practices, such as the Tuskegee Experiment, leading to generational mistrust of doctors and other medical practitioners. Barriers to health care is yet one more component of inequities created by systemic racism.
Within the black population, black men have a lower life expectancy than black women and whites (Bond & Herman, 2016). Additionally, the majority of blacks are underinsured or have no access to medical insurance. The Affordable Care Act made minimal impact on providing medical coverage for the black population and the Medicaid expansion efforts in some states are minimal to non-existent (Taylor, 2019). With the emergence of COVID-19, the black population has been profoundly negatively impacted and are experiencing proportionately higher rates of infection and death compared to whites (CDC.gov, 2020). In some urban areas, such as Washington, D.C., blacks account for less than half the population but consistently upwards of 80% of the COVID-19 deaths (New York Times, 2020). The generational healthcare inequities within the black population are evident with minimal effort by federal, state, and local leadership to enact purposeful policies or programs to address the inequities and negative impact of COVID-19.
In 2019, over 60 million Hispanics were living in the United States with an estimated one-sixth of the population identified as unauthorized immigrants (Pew Research Center, 2020). The relevance of the unauthorized status is a critical correlation for federal, state, and local leadership and healthcare providers to understand when addressing access to healthcare during the COVID-19 pandemic. There is traditionally a significant level of mistrust from black and brown populations towards healthcare providers in the U.S. (Armstrong et al., 2007). However, this mistrust is compounded within the Hispanic population with fears of being identified as an unauthorized immigrant as part of COVID-19 screening (Cabral & Cuevas, 2020). Within the Hispanic community, access to healthcare is limited but is also exacerbated within the unauthorized immigrant community due to fears of deportation and incarceration for seeking assistance within most social systems.
While there is currently limited to no evidence of unauthorized Hispanic immigrants being subjected to deportation or incarceration as a result of requesting COVID-19 testing, the perception is often a reality. In Michigan, farmers and advocacy groups are battling over mandatory testing of migrant workers, forcing the legal battle into federal court, and further eroding the individual rights of workers (Rahal, 2020). Psychological safety is nearly non-existent, driving potentially COVID-19-positive unauthorized workers to operate status quo within their communities and employment settings. Even within the Hispanic population authorized to work in the U.S., mistrust coupled with language, financial, and transportation barriers prevents significant populations from accessing necessary COVID-19 testing.
Leadership in some public school districts have offered to use school buses to transport students from black and brown populations, as well as their families, for weekly COVID-19 testing only to be repeatedly turned down by local health departments. The health departments have countered with alternative public events, offering no transportation and publicizing events only through social media. Herein lies one of many examples of leaderships’ limited understanding of the complexities of addressing inequities. How does a population with limited transportation and access to technology and the internet become aware or access public testing events? (Brown, Lopez, & Lopez, 2016)
Native Hawaiian and Pacific Islander populations experience many of the same barriers to health care, health insurance, and health outcomes as Native Americans and Native Alaskans. Native Americans and Native Alaskans have traditionally experienced significant barriers to equitable access to health care, and have subsequently experienced lower life expectancy and overall health wellness compared to whites (CDC.gov, 2020). Conversely, the Native Hawaiian and Pacific Islander populations shares a similar life expectancy as whites (HHS.gov, 2020), yet experience a disproportionately higher level of negative health conditions than whites (Morisako et al., 2017). All U.S. indigenous populations experience lower access levels to affordable healthcare insurance. As with many issues facing black and brown populations, research on health disparities and strategies for implementing equitable access to healthcare within the U.S. indigenous populations is limited (CDC.gov, 2020; LaFontaine, 2018; Narcisse et al., 2018).
U.S. indigenous populations have experienced disproportionately higher infection and death rates than whites (Hatcher et al., 2020; Kaholokula et al., 2020). One exception to the higher infection rates is being seen within smaller Native Hawaiian communities who implemented strict isolation and social distancing practices early on in the pandemic. Given the limited research on U.S. indigenous populations and barriers to health care, the reason(s) for the higher infection and death rate compared to whites is speculative but reasonably attributed to perceived or real barriers to equitable health care. For example, elderly Native Americans are more likely to be uninsured, live below the poverty line, and have traditionally experienced limited access to healthcare (Tai et al., 2020). The logic would follow that elderly Native Americans would be less likely to seek COVID-19 testing and treatment due to financial barriers, leaving an already vulnerable population at higher risk for a significantly negative and traumatic outcome from COVID-19.
Racism and Public Health
The link between systemic racism and public health may have been easy to overlook within the BIPOC community. However, with the emergence of COVID-19, the disparities are undeniable and devastating to already vulnerable communities. Systemic racism is a public health crisis. COVID-19 has made the disparities more public, yet little has been done at federal, state, or local levels to make purposeful and systematic progress towards dismantling the inequities in health education, preventative care, and long-term health care. Many BIPOC communities are subjected to perfunctory social support in the form of weekly free public testing sites advertised on social media, which in theory appear to be an outward sign of community outreach. The reality is that many people within the BIPOC communities have limited access to the internet to even be aware of the testing or limited transportation options to get to the testing sites. In another example, political leaders and pharmaceutical companies are offering to give BIPOC populations priority access to vaccine treatment when available, while being seemingly unaware that the BIPOC populations have significant mistrust of healthcare professionals and have no desire to be test-subjects for a new vaccine protocol (Cornfield, 2020).
As with most issues related to inequities with the BIPOC populations, there is a dire need for a purposeful and long-term call-to-action by all levels of leadership in the public and private sectors to address healthcare disparities. The barriers to health care access within the BIPOC populations is a national health crisis that will require both public and private support from all economic, social, and political constructs. With the emergence of COVID-19, already vulnerable BIPOC populations have been significantly adversely affected by higher infection and death rates compared to whites. Community outreach and support have been perfunctory at best. If there is any hope for meaningful and lasting change, leaders must learn to be comfortable in an uncomfortable space, learn how to not be defensive for the indefensible and embrace a vision of change that manifests itself in a system of equity and equality for all people. For those committed to equity and justice for BIPOC populations, allyship must evolve beyond traditional supporting roles to one of being an accomplice–the call-to-action in a purposeful way by making systemic change.