A call for more complete race and ethnicity health data for COVID-19 response
Reported race and ethnicity health data is incomplete, with only 40 out of 50 states including this information, which is a barrier to equitable pandemic response and recovery
I grew up in Ghana in an environment where people were suffering and dying from preventable diseases. There were also glaring inequalities in health that followed a social gradient, where people from poor household bore a disproportionate burden of disease with worse health outcomes. My experiences inspired my life’s work as a physician and researcher focused on addressing disparities, eliminating discrimination, bias and barriers to achieving health equity.
Nothing however prepared me for the devastating effects of COVID-19 pandemic on people all over the world. Nothing prepared me for the challenges that have emerged to our civil liberties, as well as the social, economic, mental and physical health in communities of color. My friends and I have lost family members to the pandemic, and I have a young cousin currently battling the disease. I’ve been on an emotional roller coaster since losing my husband to cancer six months ago. I am sure there are many people from communities of color who have similar experiences of loss and grief.
But public health data that should be recording health outcomes is often incomplete and does not represent the full impact in communities of color. Currently, only 40 out of 50 US states report race and ethnicity data. Despite its incompleteness, current data from the US Centers for Disease Control (CDC) indicates that COVID-19 is disproportionately impacting racial and ethnic minority groups.1
Aggregated data from 40 states reporting race and ethnic data, and the District of Columbia, (as of May 26) shows that 1 in 1,850 African Americans, 1 in 4,000 Latinos and 1 in 4,200 Asian Americans have died from COVID-19. By comparison, 1 in 4,400 white Americans have died. In New Mexico, the indigenous mortality rate is eight times as high as the white mortality rate. The latest overall COVID-19 death rate for African Americans is 2.4 times as high as the rates for whites and 2.2 times as high as the rate for Asians and Latinos.2 While this data is from the United States, these disparities have revealed themselves in communities around the world.
Our experience with COVID-19 illustrates how underlying systemic factors such as structural and institutional racism predisposes socially disadvantaged populations, especially Black communities, to COVID-19 hospitalization, severe disease and death.
In my opinion, the rapid emergence of COVID-19 cases within the short four months since we documented a handful of first cases of mortality in Washington State, indicates deeper, more structural and systemic inequities. Underlying reasons for the widening disparities in COVID-19 rates fall into four main areas:
- Social Determinants of Health – Economic and living conditions can contribute to potential risk for COVID-19. For example, living in densely populated areas may make it difficult to practice social distancing.
- Workforce – Continuing to work may increase risk of infection because it increases contact with others. People in some racial and ethnic groups are overrepresented in some essential jobs; for example, nearly a quarter of employed Hispanic, Black or African American workers are employed in service industry jobs, compared to 16% of non-Hispanic whites.3
- Underlying Conditions – Existing health conditions can exacerbate the effects of COVID-19. Racial and minority groups are often more likely to suffer from chronic health conditions, such as hypertension, heart disease and diabetes.4
- Access to testing and timely care – Some racial and ethnic minority groups are less likely to have health insurance than whites, which may impact access to care.5
We need more consistent data collection and transparency on the impact of COVID-19 on communities of color. We need to address bias and discrimination and rectify the structural inequalities. The time for action is now.
- Bartel et al. Racial and ethnic disparities in access to and use of paid family and medical leave: evidence from four nationally representative datasets, Monthly Labor Review, U.S. Bureau of Labor Statistics, January 2019