Racism contributes to COVID-19 susceptibility
Understanding why communities of color experience higher rates of COVID-19 can be a little like pulling at a thread that unravels the sweater. The more you pull, the more you realize everything is connected. Long-standing economic, social, political and environmental inequities are very much connected to why some communities are hit so hard by COVID-19, and these inequities create susceptibility to the effects of the virus. The truth is: It’s not race that is the risk factor, but racism.
Members of racial minority communities are dying from COVID-19 at higher rates than in white communities, laying bare the longstanding health divide that’s split along racial lines. Black Americans account for a higher share of confirmed cases, complications and deaths compared to their share of the total population. In New York City, more Hispanics have died from the disease than any other ethnic group. In Arizona, Native Americans account for 7 percent of cases and 21 percent of deaths, and are only 4 percent of the state’s population. But it’s not biological or cultural differences that contribute to the disparity of deadly outcomes from COVID-19 – it is racism.
It’s well documented that where we live determines our health. Your zip code is the greatest predictor of how long you’re likely to live. This is because place-based health disparities are born out of a system that has persisted since the time of slavery. Black people in the U.S. are more likely than white people to live in food deserts, with limited access to fresh fruit and vegetables. Children of racial minority communities are more likely to grow up with toxic stress levels from adverse economic and social conditions, be limited by educational gaps, have income inequality, experience more violence, have less access to green spaces and be exposed to more environmental contaminants than white children. The centuries of racial discrimination in our country contributes directly to the underlying health conditions disproportionately affecting members of racial minority communities. These are the same underlying health conditions that make people more at risk for dying from COVID-19.
It starts in the womb, and even before
At the earliest stages of development, a fetus begins to receive signals from the mother about the environment it is developing within. These signals translate into changes in the cells of the developing baby called epigenetic changes.
However, while the mother provides the environment for the developing baby, the community provides the environment for the mother. The community in which a mother experiences pregnancy directly affects the health and well being of her developing baby. Does she have access to adequate and nutritious food? Is she being exposed to environmental contamination? Is she experiencing poverty, abuse or racism? Is she getting high quality health care? What we know is that in America, the racial health divide means Black women are three times more likely to experience life threatening complications during delivery than white women, even when accounting for other risk factors. Black infants are 50 percent more likely to be born preterm, are twice as likely to be born at a low-birth weight and more than twice as likely to die in the first year of life. Research in the field of Developmental Origins of Health and Disease shows how these conditions are connected to racism, discrimination and the cycle of disadvantage many racial minority communities experience on a daily basis.
For example, a developing fetus will respond to having limited nutrition by making developmental trade-offs in the womb in order to protect the most critical developing organs: the heart and brain. These trade-offs are known as “first hits.” This means some organs, such as the kidneys and pancreas, will take a “hit” and won’t develop as robustly. When this happens, it sets the baby up for future health problems that these organs are affected by: high blood pressure (kidneys), diabetes (pancreas) and asthma (lungs).
Likewise, a fetus will respond to environments that are unsafe, stressful or threatening. This includes situations marked by racism, lack of opportunity, poverty, personal insecurity or domestic violence. This kind of stress is known as “toxic” stress, and causes cortisol – the stress hormone – to circulate at high levels within the mother, which then pass to the developing fetus. High levels of cortisol cause our immune systems to be suppressed. A host of non-essential functions get suspended until the immediate threat can be addressed. Once the threat is gone, our systems can go back to normal. However, if the threat never goes away and cortisol levels remain chronically high, it creates problems for the fetus.
Sustained high levels of cortisol can harm a developing baby. It can cause the developing brain to be permanently wired to remain on high alert and potentially cause enduring cognitive issues for the baby. High levels of cortisol can also inhibit fetal growth, putting the baby at higher risk for being born too early or at a low birth weight, two conditions that put them at higher risk for developing underlying health conditions later in life - the same conditions that cause COVID-19 to be more deadly. Stress and cortisol also play roles in obesity, which is a marker for a number of other problems including excess inflammation and heart disease.
The environment the baby is born into will determine whether or not the biological changes made in the womb lead to disease risk. If the baby is born into an environment where there is continued stress, lack of access to nutritious foods, and other disadvantages, these become what are known as “second hits.” Second hits are the lived conditions that activate biological vulnerabilities, or make them worse. Second hits further increase the chance that the baby develops underlying health conditions as an adult. Those most likely to experience first hits are also at the highest risk of exposure to second hits. And the second hits of the current generation can become the first hits of the next, causing an intergenerational transfer of risk. This cycle perpetuates and reinforces the health disparities we see today.
Insights from Developmental Origins of Health and Disease research show how structural racism contributes to the disparities of COVID-19 outcomes we’re seeing in racial minority communities. To date, the pandemic has sickened millions and killed over 130 thousand people in our country. It’s also shining a spotlight on the way our health is inextricably linked to that of our neighbors, family members, care providers, co-workers, teachers, essential workers, first responders and others. Public health solutions are required to change or enact policies that will put resources where they’re needed so we can move toward a healthier and more equitable nation, and make prevention at the earliest stages of life a priority.