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Why African Americans Are Hardest Hit by COVID-19
By V. Nikki Jones, DSW, LCSW, LMFT

The current impact of the COVID-19 crisis in the African American community is principally explained by three factors: the cultural memory of African Americans, specifically distrust of the medical profession; social determinants of health (SDOH); and African Americans as essential workers.

During the first few weeks of April, I watched politicians, health care providers, and scientists, including many African Americans, tout the immunity myth as a major contributing factor for African Americans’ increased COVID-19 infections. In addition to these public speeches, I viewed several video clips shared on social media by African Americans claiming that melanin shielded black people from coronavirus.

I do not doubt that the immunity myth has contributed to some indifference or weakening of social distancing guidelines among African Americans. However, there are other myths about youth and religion serving as protective factors from coronavirus. I have heard similar reporting about and watched social media clips of youths maintaining their normal activities, such as going to the beach during spring break, and adults of varying ages congregating in churches. Undeniably, these myths have also contributed to infections rates, in particular the spread of the disease by asymptomatic persons.

Cultural Memory
More important than myths is cultural memory. African Americans have a cultural memory of medical experimentation and mistreatment by the medical profession that has led to mistrust (Washington, 2006). This cultural memory, which is preceded by racism in medicine and scientific research, plausibly contributes to myths about diseases and underutilization of medical services when and where they are available.

As Davis et al. explains, “myths are stories that transform the unknown to the known without the presence of facts” (1995, p. 791). The authors argue that the absence of health care education in the African American community has influenced myth making, which has also contributed to racial disparities. However, the authors recognize that myths became a way for African Americans to cope with history and continued discrimination by health care systems (Davis et al., 1995).

Health myths and misunderstandings are just one of many secondary issues contributing to racial disparities in morbidity and mortality among African Americans. The primary issue faced by African Americans relative to their health continues to be racism. We do not want to discuss or face how racism shows up in everyday life. For example, who decides who gets COVID-19 testing? How does the racial gap in testing for coronavirus impact African Americans’ perception about immunity?

Ray (2020) describes how underfunded and underserved neighborhoods, higher exposure, contact with police and health care providers, colorblind COVID-19 policy, and unequal access to COVID-19 testing and treatment all contribute to African Americans’ disproportionality. And, we cannot selectively ignore history, including the severity of slavery; medical experimentation; segregation in health care; underfunded health professional education for black, indigenous, and people of color (BIPOC); and racial discrimination in health care services (Byrd & Clayton, 2000).

It is unfair and prejudicial to speak about African Americans’ myths and fantastical ideas about coronavirus (Ross, 2020) without circulating the complete context for this behavior.

SDOH
A second factor are SDOH, which are linked to cultural memory and historical trauma. The SDOH framework provides understanding on how external or environmental factors impact individuals and communities.

The World Health Organization (2020) defines SDOH as “conditions in which people are born, grow, live, work, and age.” These determinants are largely responsible for health disparities because “circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.”

For African Americans, Quinn (2018) asserts that historical trauma is an intersectional between social determinants of mental and physical health that must be recognized by health care systems in order to reduce health disparity and improve comprehensive care. The author recognizes that even several generations after the initial triggering event, “populations (African Americans) previously subjected to historical traumas such as slavery exhibit a higher prevalence of disease” (Quinn, 2018).

Perhaps the health behaviors of African Americans do contribute to the infection rates of COVID-19. Researchers have long established that cultural beliefs and health practices influence health, well-being, and utilization of health services (Noonan et al., 2016; Russell & Jewell, 1992). But behaviors account for roughly 30% of health factors; the other 70% of health factors include clinical care, social and economic factors, and physical environments (Magnan, 2017). These are external factors less directly controlled by African Americans and more so by governmental policies and practices.

Healthy People 2020 outlines five key SDOH: economic stability, education, social and community context, health and health care, and neighborhood and built environment (Office of Disease Prevention and Health Promotion, 2020).

Essential Workers
The third and final factor is African Americans as essential workers. African Americans have a long history as “essential workers,” formerly known as slaves, laborers, domestics, sharecroppers, or Pullman porters. This history traces back to American chattel slavery where African Americans were forcibly and legally bound to work without compensation, personal time off, childcare, insurance benefits, or retirement plans. It is this history that informs reparation claims for black descendants of slaves.

“America Set Up Black Communities to Be Harder Hit by COVID-19” is the title of Calma’s (2020) article on the underlying racial and social injustices impacting the infection rates among African Americans. Throughout the COVID-19 pandemic, many African Americans have not had the luxury to telecommute for work because BIPOC comprise a majority of essential workers who cannot do their job remotely (Cerullo, 2020).

Yet, America did not just set up black communities to be harder hit by COVID-19. The structural or socioeconomic systems of the United States were designed to continually exploit the poor, black, and brown labor force to meet its needs (Keita, 1979; Luna, 2016; Svart, 2019; Tabb, 1971). From the past to present day, these are the workers who are meeting American sales, food preparation, delivery, transportation, medical, maintenance, and cleaning needs. It is problematic that BIPOC are still overrepresented in these industries as a result of historical and current racial inequities in education, employment, etc.

The current health crisis elucidates the need for policies, practices, and advocacy efforts to equitably diversify the American workforce to enable BIPOC greater employment options and better wages, childcare, health care, professional development, and retirement options. We cannot minimize or avoid the conclusion that African Americans are harder hit by COVID-19 due to a sustainable historical context, namely racial discrimination and capitalism, that has restricted their social mobility to largely frontline work.

Reparations
The current exposure of African Americans to COVID-19 and the associated problems of poor access to health, effects of poverty, and racial discrimination reveal the pressing need for reparations to address the ongoing racial disparities in the United States.

Reparations, an increasingly important area of interest, are both symbolic gestures (eg, apologies and acknowledgements of wrongdoings) and material remedies (eg, therapies, policies, interventions, and monetary compensation) (Roht-Arriaza, 2004). Providing reparations for BIPOC can begin to address the legacies of slavery and present-day socioeconomic equalities (Evans & Wilkins, 2019). BIPOC need strong advocacy for health policies and legislation that can remove racism in medicine, eliminate racial health disparities, improve health and wellness, increase culturally aware education and evidence-based interventions, and increase the number of BIPOC health care providers (Hood, 2001).

Social workers are integral to helping realize reparations for BIPOC. As a profession, social work has a mission of and commitment to social justice (Morgaine, 2014), as well as an obligation to help close the health gap, reduce extreme economic inequality, and achieve equal opportunity and justice (Grand Challenges for Social Work, 2020). Social workers can present recommendations for reparations in order to improve the social, health, and behavioral health needs of BIPOC through the Council on Social Work Education (2020) and NASW (2020).

Final Thoughts
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides emergency assistance for Americans impacted by the 2020 coronavirus pandemic, passed with bipartisan support and was signed into law by President Donald Trump on March 27. (Coronavirus Aid, Relief, and Economic Security Act or the CARES Act, 2020; U.S. Department of the Treasury, 2020). This legislation was a failed opportunity to equitably compensate African Americans who were disproportionately impacted by COVID-19. The CARES Act purported to provide equal “fast and direct economic assistance” to all Americans; however, all Americans were not equally impacted by COVID-19.

In the United States, African Americans and black businesses were disproportionately impacted by the coronavirus pandemic because they comprise a large number of essential workers. Health care providers, retail stores, and restaurants that were already struggling are now forced to close due to social distancing policies (Adams, 2020; Perry & Harshbarger, 2020; Perry et al., 2020; Williams, 2020). Consequently, economic assistance should have targeted those most vulnerable.

Continued allegiance to the contexts and traditions of equality in the United States, such as equal accommodations and aid for all, is both inappropriate and deceptive. We need equity.

Social justice is about equitable accommodations and distributions of aid and resources, which often requires that some of us need and thus receive more than others. We must prioritize assessment and interventions to those individuals and communities who need it most; these actions involve distributing resources and monetary compensation to those who are most impacted and will benefit most (Magnan, 2017).

As the country begins to normalize and move beyond the COVID-19 pandemic, I am hopeful that social workers will act fast and direct in their advocacy efforts related to reparations for BIPOC. The CARES Act does not address the particular susceptibility and disproportionality faced by African Americans. In the future, social workers can fill the gaps and advocate for social, economic, and environmental equity, and justice policy—a starting place is reparations.

— V. Nikki Jones, DSW, LCSW, LMFT, is a scholar, teacher, and practitioner who currently serves as an assistant professor and BSW program coordinator at Middle Tennessee State University. She teaches undergraduate and graduate courses. Her main research and publication interests are social determinants of sleep disparity among nonmajority groups, minority stress and gendered racism, and issues impacting the LGBTQ community. She provides direct services to couples and families in private practice and behavioral health settings.

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