The COVID-19 pandemic of 2020 has brought to our attention, once again, that the designation of various groups of humanity by race in America has had real life health consequences.
In some posts in Real Answers, we have made reference to how the virus is causing harm and death in some places, and some communities, more than others. Readers may recall reference to areas being places of higher risk, typically because of people staying over long periods of time in close contact with large numbers of people, and examples included large factories (esp. meat packing plants), nursing homes, and prisons.
But there is also a higher risk group of people who are at higher risk without being in more sustained contact with others. This risk is not a risk of place, but a risk created by choices made by the nation over many years. We are of course talking about the fact that if you are seen as a person of color in the United States, your chance of dying from this pandemic is dramatically higher. Why is that? Does it have something to do with biology with history, or both?
We embark on this posting in response to a particular request from a parent in the practice, so I would like to thank this family for asking to me to write about the intersection of race, health, and America.
The Notion of Racism- the Example of Infant Mortality Teaches us What This Word Means
Perhaps the most important fact about racism in America is that it is not about feelings. When we speak about racism, we will be looking at realities of life, not feelings one group has for another. Of course, in any society, there seems to be always one group that hates another, but that is bigotry, not racism. If people hated each other with no consequence we would say there was hatred or bigotry in that group, but not racism.
From my own perspective, the clearest example of a reality of life that is racism has to do with the statistic called infant mortality. Infant mortality asks a troubling question: how many infants in any group of people, will not live to reach their first birthday, after being born alive? Infant mortality can be measured in any group of people: a town, a hospital, a state, a nation, a group of nations, this or that group of people. The tragic fact of infant mortality in America is that across the nation, in every state, in every city and village, if a baby is born to a parent of color, that baby will have double to triple the chance of dying before reaching their first birthday than a baby born to a white family. This tragedy has proven true and enduring even if you compare black and white outcomes in wealthy families, in 1902, or 2020. Over time, the chance of a baby dying in their first year of life has dropped dramatically, but the black-white difference remains about the same.
The fact that being a member of a community of color condemns your baby to have double the chance of dying is of course outrageous. And for many, many years, big efforts have been tried to end this tragedy. In our own community of Cleveland, over the last 50 years, a number of major initiatives have been undertaken for the express purpose of ending this reality. Over 50 years, many attempts, all failed. What was learned, however, was that fault had nothing to do with the babies of their families, or their families’ health or behaviors.
Each of these programs addressed issues such as compliance with pre-natal care, substance abuse, and other health care issues, but to no avail. One item discovered time and again, here and across the US- when tested, white and black pregnant mothers used alcohol and drugs at the same rate, no difference, and thus also not the explanation.
Another observation comes from the US Army, the only place in the United States where the color of your newborn has little impact on the chance of living healthy to one year of age.
This is the fact across ranks, across various regions of the US, and even world. This shows there is no biological reason for the infant mortality problem outside of military life, since being in the military resolves these differences without changing anyone’s biology.
The US military is a community of over 1 million people, which over time sees very little difference in infant mortality by color.
This means the US can be a community of over 320 million people, in which their could be very little difference in infant mortality by color.
And so we come to the heart of the notion of racism, it is the imposition of needless death and suffering through mechanisms defined by color. Release these mechanisms, as done in the military, and the suffering ends.
The Roots of Racism- The Concept of Choices Made and Maintained
Many people plausibly think racism is the fruit of ignorance- of prejudice kept alive through the insistence on not learning a better truth. And there is some truth in that.
But as so well proven in the landmark, scholarly history of racism since 1492, Stamped from the Beginning (by Ibram X. Kendi), the source of racism actually comes from theory rather than ignorance. Time and again, across Europe and America, racism arose when people in power found that whipping up racial theories could benefit their business interests.
In a compelling step-by-step series of proofs, the book demonstrates that at every key juncture, it was very specific people who were far from ignorant, but deviously well-informed, who chose to guide their communities towards formal approaches to locking certain groups into a lesser status.
Once these mechanisms were chosen by those in a position to impose them, then the next question was how best to maintain them. And here, in each instance, a divide-and-conquer strategy was initiated that split populations into favored and unfavored, tightly binding the loyalty of the favored towards each other, and against the unfavored.
In another extremely powerful book, White Fragility (by Robin DiAngelo), one further step is presented that helps keep the mechanisms of racism in place, unchallenged. And that is the stance of the favored to take umbrage when the subject comes up. This brings us back to the essential difference between bigotry/hatred, and racism. When discussions of racism come up, when efforts are made to end it, often the favored group feels that someone is accusing them of being hateful. Such a reaction effectively ends any conversation that could find paths to end the impacts of racism, and so nothing changes, the very definition of maintaining a system.
American Racism and COVID-19
This discussion has illustrated a real example of what racism, in its purest form, is all about. One group singles out another to suffer certain fates and sustains that suffering across long periods of time. Our example was infant mortality, but there are many, many examples. They include the fact that in America solely by being a person of color your:
- Life will be much shorter as demonstrated by the difference in life expectancy
- Education will be far inferior as demonstrated by the difference in school budgets, quality, and educational opportunities
- Income will be far less
- Total assets of your family (wealth) will be far less
- Far more likely to be imprisoned.
- Far more likely to suffer amputation from diabetes, as demonstrated by an important report showing that risks of amputation from diabetes track precisely with the incidence of slavery in a county in the US over its history. https://features.propublica.org/diabetes-amputations/black-american-amputation-epidemic/
For me the most striking aspects of this list is how disparate each of the impacts are, they really are different, to a degree that any objective observer would have to notice that our nation really has chosen, and very effectively, to consign one group, as defined by color, to a different life.
This is the reality, carefully created and maintained over a 400 year period. The amputation data demonstrate the consignment by the nation of one group to greater suffering tracks directly from the days of slavery to 2020.
Given this is our reality, the severely increased risk of dying from COVID-19 if you are a person of color in the United States is right in line with so many other ways in which the white majority has succeeded in forcing a shorter, more difficult life on those of color. All these, and many more, paths to harm inflicted take their toll.
It is this, and not biology, that explains why hypertension and obesity are more common in the African-American community. And now comes virus that is far more likely to kill you if you have hypertension and/or obesity.
And it is this, and not biology, that explains why working in menial jobs where work conditions crowded, because if you don’t take that job, you may not be able to eat, is far more common in the African-American community. And now comes this virus that is far more likely to infect you if you work in crowded working conditions.
For many Americans, the phenomenon of “re-opening” without implementing strategies, often spoken of in Real Answers, to actually stop the spread of this virus for real, is consigning those in menial jobs to much higher risk of coming down with the disease, so that those who can afford to stay socially distanced can enjoy the services they provide.
It Can Change, I Have Seen It
This note will end with sharing an experience I had in Atlanta that is being planned to be repeated in two neighborhoods right here in Cleveland- Glenville and Woodhill areas. The program, called Purpose Built Communities, uses already existing dollars to renovate whole neighborhoods, and I mean really upgrade them. The neighborhood I saw in Atlanta looks so nice, a place any of us would love to live, with excellent health care facilities in the neighborhood, and extraordinary schools. This neighborhood once had 13% (!) employment, a 30% graduation rate, and just in this neighborhood, a $65 million drug trade and 16x the national average of arrests and incarceration.
Now, this neighborhood has enjoyed a near elimination of violent crime, down 98%. Graduation from high school is at 100% with over 80% placed in college! The high school is one of the most amazing schools I have ever seen. Physically stunning, students clearly engaged in exciting learning, some already developing patents, doing great writing. And the employment rate rose to nearly 100% prior to the pandemic.
And speaking of the COVID-19 Pandemic of 2020, preliminary data show that the rate of COVID-19 infection in this predominantly African-American neighborhood is far lower than in surrounding African-American neighborhoods in Atlanta.
This neighborhood demonstrates beyond any doubt that the structures that we call racism are reversible, and their harms can end, once we choose to end them. Check out Purpose Built Communities, https://purposebuiltcommunities.org/our-network/cleveland-cle-purpose-built-communities/ It is a very real opportunity to end racism, in two neighborhoods.
- I want to thank the parent in our practice who asked me to share my thoughts on this subject. It turns out the timing for thinking about racism in America could not be more urgent.
- Racism, although using hatred for sure, is not primarily about hatred. It is a system carefully fashioned to allow one group to consign another group to a lesser life. Bigotry is a feeling, it is hatred. Racism is more about shorter lives, stunted opportunities, less income, far worse health, babies who do not make it to one year of age, all as a result of systems crafted to advantage one group over another.
- Racism cannot end until the group that is advantaged puts and end to taking this advantage. And that will never happen as long as the advantaged group nurtures the temptation to say it isn’t so. But the facts are glaring, the babies who want to live, the lives of real people cry out that it is so. One group in the United States continues to force another to suffer, for no very good reason.
- And it can change. I have seen it change. Stop the harm and cruelty, and good lives sprout and well. Even the course of the COVID-19 Pandemic of 2020 can benefit from choices our nation can make, neighborhood by neighborhood.
Our nation is in such pain, maybe now, we will be willing to not flinch from this problem. We have proven quite adept at not flinching to continue the harm, I know that all of us can benefit if we now push to end the harm we are causing.
To your health,
Dr. Arthur Lavin