As of May 19, 2020, in the 40 states that report such information, African Americans were dying from COVID-19 at 2.4 times the rate of whites. This disparity is alarming and surprising to some Americans—as it should be. However, it is consistent with other matters of disease and death among African Americans.
African Americans have higher death rates than whites for 12 of the 15 leading causes of death in the United States, and in some instances, the racial disparity is almost as high as that of COVID-19. Blacks die from diabetes at 2.1 times that of whites. The rate of infant mortality has been steadily decreasing over the years; however, the gap is larger now than it was in 1960. The Black rate is currently 2.3 times the white rate.
A typical approach to addressing health disparities is to consider individual health behaviors. Health behaviors, including a nutritious diet, physical activity, and avoiding tobacco use and excessive drinking, can prevent or reduce chronic diseases. Racial differences in these behaviors contribute to racial disparities in major chronic diseases. But socioeconomic status is a more critical factor, as, among other issues, it can limit a person’s ability to engage in healthy behaviors.
Interventions addressing health behaviors alone are unlikely to eliminate health disparities. Thus, we must focus upstream—before we get to the individual—and address the more significant causes of COVID-19 and other health disparities.
The culprit is quickly revealed to be socioeconomic status when we focus upstream at the causes of health disparities. The most fundamental cause of health disparities is socioeconomic disparities. On average, the lower a person’s SES, the lower their health status.
• Socioeconomic status is defined traditionally by education, income, and occupation. We should also add wealth, which is simply one’s assets minus debts or liabilities. Each component provides different resources and displays different relationships with various health outcomes.
Socioeconomic status (SES), whether assessed by income, education, or occupation, is linked to a wide range of health problems, including low birth weight, cardiovascular disease, hypertension, arthritis, diabetes, and cancer.
In addition to being linked to health behavior, SES affects health through two other sets of determinants: environmental exposure and health care, with environmental exposure including both social and physical environments.
While people from all walks of life experience stress, lower-SES persons live and work in more stressful environments. Several factors contribute to higher stress at lower SES levels, including economic strain, insecure employment, little control at work, and stressful life events.
Eliminating health disparities will require attention to all SES components and the pathways by which they influence health.
Research shows that SES differences between Blacks and whites account for much of the racial disparities in health. Lower SES persons have worse health than others, and African Americans are disproportionately in the lower socioeconomic position, and this is caused substantially by racial discrimination.
One of the primary measures of SES is income, a significant factor in the relationship between SES and health. Black families earn only 61 cents for every dollar white families earn. Consequently, blacks tend to be disproportionately at the bottom of the SES ladder.
At our 8th annual community meeting of the Montgomery Country Dialogue on Race, we showed how African Americans end up consistently worse off than whites. We provided data on the extent of racial discrimination in employment locally, in the State of Virginia, and nationally. And we ran a simulation game to demonstrate how wealth is accumulated—or not accumulated by blacks.
If we focus upstream, we can readily see that a significant step in reducing health disparities is to minimize the SES gap. This can be done only by reducing or eliminating the amount of racial discrimination in employment.
