Health departments are releasing the demographic data that has been collected regarding COVID-19 cases.
While the numbers are preliminary, it appears that African Americans are suffering a disproportionate amount of deaths compared to other racial groups.
Recent data revealed that African Americans made up 68% of the deaths in Chicago while only being 30% of that city’s population.
In like manner, Louisiana has seen 70% of its COVID-19 deaths from the African American community, which makes up 32% of the population.
Illinois and Michigan are seeing similar statistics with African Americans making up around 40% of deaths while being less than 15% of the population.
In Milwaukee, African Americans make up about 27% of the population but almost half of the coronavirus deaths.
This disproportionate number of African American deaths forces us to ask why. There may be three main reasons for the disparity.
First, it may be related to community health issues.
We know COVID-19 has more severely impacted people with comorbidities like obesity, kidney disease, hypertension and diabetes.
These comorbidities are seen at disproportionate rates among African American communities nationwide.
Health systems and public health departments have acknowledged the rise of the problem since the 1980s and 1990s. Health groups have targeted these diseases in the African American community in recent decades.
Yet, as far as COVID-19 is concerned, these efforts might not be enough and might be a case of too little too late. The damage of neglect by public health officials has already been done.
Second, large urban areas have been hit the hardest.
Cities like New York, Chicago and New Orleans have a high percentage of African Americans who are blue-collar workers and in the service industry.
Hourly workers usually do not receive a lot of personal time off from their employer and do not have the ability to work from home.
While residents of more affluent neighborhoods have the ability to choose what to do, workers in poor neighborhoods have to go to work and risk being exposed to the virus.
Both health care professionals and essential hourly workers are the heroes of this crisis.
They are on the streets keeping essential services running. The problem is they are typically doing this without the personal protective equipment (PPE) that health care workers enjoy. Thus, workers are put at a high risk of infection.
The third reason is seldom talked about in the hallowed halls of medicine: There is often a mistrust of the health care system among African Americans.
In 2007, the American Journal of Public Health published an article based on research that ranked the level of trust in providers of different racial groups.
It revealed that on average the African American community has a low level of trust in physicians and the health care system.
The reasons for this are historical. African Americans have been mistreated by the health system through experimentation from the antebellum period right up through the Tuskegee syphilis study.
This is coupled with a lack of focus upon the health needs of the community and the lack of minorities in leadership among the major health care systems.
Mistrust should cause concern among public health officials. Without a level of trust, citizens will be less likely to seek health care early.
The disparity in mortality rates should encourage health professionals to focus more upon the needs of the African American community.
In the short term, public health officials and health care systems need to focus resources toward these communities, like offering COVID-19 drive-through testing.
Resources also need to be routed to employers in order to ensure their workers are able to take off when sick while also assisting employers to improve working condition through PPE for employees.
The larger issue is not about today, but about the future. We need a targeted approach to provide health care to minority and vulnerable communities.
This has been taking place among many private health systems, but these efforts need to be exponentially expanded.
Trust cannot be built overnight or during a pandemic. It has to be built over decades.
This can begin by acknowledging the mortality disparity and immediately targeting resources for these communities.
After the pandemic is over, health systems and public health departments need to continue to build bridges of trust through concerted efforts that include an acknowledgment of historical failings.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
