Even Before COVID-19, Black Americans Were Dying More

The pandemic is the latest iteration of longstanding racial health disparities.

Black Americans are dying from the novel coronavirus at a shockingly disproportionate rate. In majority-black counties, the Washington Post found, infection rates are triple that of majority-white counties. Deaths among Black Americans, meanwhile, are six times higher than that of whites.

Yet long before the pandemic, Black Americans have been dying at far higher rates than other Americans. They are victims of a longstanding epidemic of structural racism and unequal access to care. Unfortunately, the disparate impact of COVID-19 is only the latest chapter in an ongoing national tragedy, one that the virus has only brought into sharper relief.

Black Americans suffer from higher rates of diabetes, hypertension, and other underlying conditions that put them at higher risk of complications from the coronavirus. What’s more, they also disproportionately work in jobs that put them on the front lines of the pandemic; roughly 30 percent of bus drivers, for instance, are black, according to the Brookings Institution, as are 20 percent of food service workers, cashiers, and other now “essential” personnel.

But Black Americans also die at higher rates compared to similarly situated whites, including those with the same levels of income and education. A 2010 Department of Health analysis of New York City found that even in the city’s wealthiest neighborhoods, Black residents lived shorter lives than their white counterparts.

Overall, according to the Centers for Disease Control, the pre-pandemic death rate among Black Americans from all causes was 40 percent higher than the death rate for whites. Heart disease, for example, kills 204 Black Americans per 100,000 people, compared to 162 whites. Black Americans are also seven to nine times more likely than whites to die from HIV and at the same time suffer higher death rates for cancer, strokes, diabetes, and kidney disease.

Tragically, the same disparities exist among children. The infant mortality rate for black infants is more than double that of whites. In fact, the U.S., black infants have a higher mortality rate than Libya, Argentina, and Thailand. Even more shocking is the rate of maternal mortality. According to an analysis by the Center for American Progress, Black American mothers die at three to four times the rate of white mothers.

Unsurprisingly, all of this has contributed to white Americans enjoying significantly higher life expectancies than their black counterparts.

What’s causing this imbalance? For starters, higher poverty rates and a lack of access to care among Black Americans are principal drivers. Among other things, poverty often means unhealthier living conditions, inadequate nutrition, fewer opportunities to exercise, and the inability to afford health insurance.

Before the Affordable  Care Act (ACA), the uninsured rate among Black Americans was as high as 24.4 percent, according to the Commonwealth Fund, compared to 14.4 percent among whites. While the ACA’s implementation has significantly narrowed this gap, the Commonwealth Fund also reports that black uninsured rates have been creeping upward since 2016.

There are other causes of concern. Black Americans are less likely to have a primary care provider than whites and less likely to have visited a doctor in the past year because of cost, according to the Centers for Disease Control and Prevention.  That can have life-or-death consequences. Black women are more likely to be diagnosed with advanced-stage breast cancer, which could possibly have been detected earlier with a primary care doctor and health insurance.

Higher black mortality rates up and down the socioeconomic spectrum points to deeper problems in the quality of care available to Black Americans. These are inequities that will need to be addressed aggressively in a post-COVID world.

In their responses to the coronavirus outbreak, states like Michigan and Maryland are taking the right steps to require the reporting of infections and deaths by race and zip code. This tracking will help ensure that all Americans have better access to testing and treatment of COVID-19—and point out the disparities that are resulting in one group of Americans dying at a far greater pace than others.

That’s why the effort to tackle these disparities should not end when the pandemic recedes. Rather, the tragedy of COVID-19 should restart a national conversation to prevent the stark inequalities the current crisis has brought.

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Anne Kim

Anne Kim is a contributing editor to the Washington Monthly and the author of Abandoned: America’s Lost Youth and the Crisis of Disconnection.