Systemic racism, chronic health inequities, andCOVID‐19: A syndemic in the making?

Abstract

For a brief moment, in the early days of COVID-19, some reports heralded the new coronavirus, SARS-CoV-2, as a "great equalizer." It is unlikely that any anthropologist, human biologist, historian, or public health scientist found this idea tempting. Pandemics always follow the fault lines of society-exposing and often magnifying power inequities that shape population health even in normal times (Wade, 2020). Soon, that stark reality became clear to all. By early April, evidence began to emerge in the United Statesfirst in Milwaukee, then in Detroit, eventually everywhere data were disaggregated by race-that mortality from COVID-19 was disproportionately affecting Black people and communities (Johnson & Buford, 2020). During the entire course of the pandemic so far, data compiled by the non-profit APM Research Lab (2020) has shown that the crude death rate for Black Americans is more than double that for all other racialized groups. When adjusted for age, the risk of death from COVID-19 is as much as nine times higher for African Americans than it is for whites (Bassett, Chen, & Krieger, 2020). This inequity-as appalling as it is-may still underestimate the problem, as data remain woefully incomplete. Despite calls for comprehensive, nationwide data on COVID-19 cases and deaths by race and socioeconomic status, the U.S. federal government has no such system in place, and journalists and scholars have stepped in to collate disaggregated data by race from a patchwork of state health departments. The need for better data remains. But data alone are not enough. We also need an explicit conceptual framework to know what the numbers mean, shape the questions researchers ask, and direct attention to appropriate public health and policy responses. In the absence of such a framework, the legacy of racial-genetic determinism in American medicine makes it likely that excess Black death will be interpreted as intrinsic Black vulnerability-a pattern that has already begun to emerge (Gravlee, 2020). Here I propose that the theory of syndemics may be a useful framework for making sense of the unfolding pandemic and directing future research on COVID-19.

The prognostic value of comorbidity for the severity of COVID-19: A systematic review and meta-analysis study

“…In addition, COVID-19 prevents access to health care for the most vulnerable individuals due to health inequalities [ 157 ]. Although structural racism has been shown to affect the distribution of health determinants and risk factors in society, but due to the lack of understanding on the exact influence of these variables on social health, appropriate action is not given by the health system [ 158 , 159 ]. Focus on addressing both unsupplied social needs (i.e.…”

Knowledge, Attitude and Practices (KAP) towards COVID-19 pandemic in America: A preliminary systematic review

“…The most marginalized communities, with low levels of education and minimal incomes, are generally most impacted by pandemics because they simultaneously face other dangerous threats to their psychophysical health [60]. It is not at all surprising that wider gaps on KAP levels were generally found among elderly, less educated and rural residents including Latin immigrant in the USA [30,31,61].…”

Coronavirus Disease 2019 (COVID-19) Transmission in the United States Before Versus After Relaxation of Statewide Social Distancing Measures

“…The United States is home to the largest epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) globally, having surpassed 7 million reported cases and 200 000 deaths by late September [ 1 ]. The burden of the coronavirus disease 2019 (COVID-19) epidemic in the United States has been disproportionately and inequitably borne by Black, Latin, and American Indian populations [ 2 ]. After experiencing large, localized epidemics in March and April, all 50 US states and the District of Columbia implemented social distancing measures, with inadequate social protection [ 3 ], in an attempt to interrupt transmission and reduce morbidity and mortality from COVID-19.…”