Ensure access to PrEP.

The first HIV/AIDS case was officially reported by the CDC a little more than forty years ago (NBC News). Since then, there have been incredible advancements in HIV treatment options. Today, antiretroviral therapies can suppress the HIV virus enough to help HIV-positive people live with undetectable amounts of the virus.

Good morning and happy Wednesday! Preventative treatments for HIV can save countless lives, but disparities exist for who can easily gain access to these medications. Today, Tiffany explains the historical discrimination in HIV/AIDS treatment and how we can advocate for equitable access to PrEP.

Thank you for your support! This daily, free, independent newsletter is made possible by your support. If you can, consider making a donation to support our team. You can start a monthly subscription on Patreon or our website, or give one-time using our website, PayPal, or Venmo (@nicoleacardoza).

Have a great day!

Nicole

TAKE ACTION

Support the Transinclusive Group (Instagram), a Black trans-led group offering HIV services in South Florida.
Educate yourself about AIDS history and Black efforts to address historical inequities. AIDS 1969: HIV, History, and Race.
Spread the word about resources such as Ready, Set, PrEP which help individuals interested in PrEP access to the medication at a low or no cost.

GET EDUCATED

By Tiffany Onyejiaka (she/her)

HIV prevention options have greatly expanded as well. Pre-Exposure Prophylaxis (PrEP) medication can reduce a person’s risk of contracting HIV through sex by 99% and their risk of contracting it through intravenous drug use by 74% (CDC).

But communities with the highest rates of HIV actually use PrEP the least. Men who have sex with men (MSM) – including gay and bisexual men as well as those who don’t identify as either – are at higher risk of contracting HIV. Though Black and Latinx MSM are five to ten times more likely to contract HIV than white MSM, white MSM both know about and use PrEP at higher rates than men of color (CDC). One reason for this discrepancy is the barriers people of color face in accessing care.

PrEP medication access is hardest for patients to access in the South, where 56% of Black Americans live (Pew Research). 38% of Affordable Care Act Marketplace health plans in southern states require prior authorization before individuals receive PrEP, a rate significantly higher than anywhere else in the country (JAMA). Requiring prior authorization means treatment will only be covered by the insurance company if the company approves it before the treatment is prescribed (TikTok). This increases the burden on doctor’s offices and causes delays in treatment. “Prior authorizations have been cited by clinicians as being one of the biggest barriers for PrEP uptake,” according to Dr. Kathleen McManus, who researched the subject (UVA). 90% of physicians stated prior authorizations delayed patient’s access to care and 75% stated they can lead patients to abandon treatments. (AMA).

Each year, 50% of new HIV cases occur in the South (CDC). Out of those new HIV cases in Southern states, Black women comprise 67% of cases in women, Black men are 70% of cases in men, and out of men who have sex with men, 50% of new cases are Black men (CDC). Insurance company policies create unnecessary hurdles for accessing crucial HIV prevention measures in a high-risk region where Black people are at disproportionate risk. This constitutes a deadly form of structural racism.

The government and medical establishment’s approach to HIV/AIDS has always been rooted in discrimination. Ronald Reagan’s administration refused to prioritize AIDS research and treatment in the 1980s since it was viewed as a “gay plague” (NBC News). It took years of activism and pressure from groups like ACT UP for the passage of the Ryan White Cares Act in 1990 to mandate serious federal funding and attention to HIV care and treatment (Hornet, History). Despite the historical framing of HIV as a virus that primarily affected gay white men, Black and Brown people have always been overrepresented in the HIV-positive population. They also long been central to AIDS activism and resistance (Drain).

In the words of Raniyah Copeland of the Black AIDS Institute, “HIV is a disease that affects the most marginalized: Black and brown people, LGBTQ people, people living in poverty, people who don’t have housing, people experiencing substance addiction, and so many others who aren’t able to thrive simply because of who they are, who they love, or where they live” (Black Aids Institute) The prior authorizations that delay access to HIV prevention medication are the product of a healthcare corporations and government policies that place little emphasis on HIV and other health conditions that disproportionately affect Black and Brown people and members of other oppressed and marginalized communities.

Southern state governments have the power to create laws that require their state healthcare plans on the exchange to include coverage of PrEP medications without requiring prior authorization. They must act. In the meantime, organizations like South Florida’s Transinclusive Group are acting to ensure HIV prevention isn’t pushed to the side for Black and Brown folks (Instagram). We must fix a system where discriminatory barriers block entire communities from life-changing treatments.

Key Takeaways

PrEP dramatically reduces the risk of HIV-negative people contracting HIV.
Black people in the South are at high risk of contracting HIV, but many ACA insurance plans in southern states require an additional step, prior authorization, before getting PrEP.
The government has long neglected HIV research and HIV-positive people because of systemic discrimination against queer people, people of color, poor people, and drug users.

1/19/2021 | Advocate for universal healthcare.

8/14/2020 | Support Black mental health.

PLEDGE YOUR SUPPORT

Thank you for all your financial contributions! If you haven't already, consider making a monthly donation to this work. These funds will help me operationalize this work for greatest impact.

Subscribe on Patreon | Give one-time on PayPal | Venmo @nicoleacardoza

Nicole Cardoza 2/11/21 Nicole Cardoza 2/11/21

Support an equitable vaccine rollout.

Happy Thursday, and welcome back. We started covering COVID-19 in the newsletter each week back in June. Many of our articles have the same theme: this pandemic is disproportionately affecting communities of color, and there are inadequate resources to support their wellbeing. Unfortunately, the same narrative is unfolding with access to the vaccine. Take action today to support those in your community.

Thank you all for your contributions! This newsletter is made possible by our subscribers. Consider giving $7/month on Patreon. Or you can give one-time on our website or PayPal. You can also support us by joining our curated digital community.

Nicole

Ps – The latest news released during the impeachment trials are harrowing. Be sure to review and amplify the Black Lives Matter movement's list of demands in response to those events. Details here.

TAKE ACTION

Urge your elected officials to improve your state’s COVID-19 race and ethnicity data reporting by using the resources on The COVID Tracking Project.
Search for petitions and other action items to ensure an equitable rollout of the vaccine in your state. Here are example actions to take in North Carolina and Georgia.
Contact your local mutual aid network to see how you can support those eligible for vaccinations in your community. You may be able to offer transportation or schedule appointments on behalf of others.
Individuals across the country are designing their own websites, Google docs, and social media accounts to make vaccine testing information more accessible (MIT Technology). Find the latest for your community and share/support where needed.

GET EDUCATED

By Nicole Cardoza (she/her)

Over the past few weeks, valiant efforts to increase vaccination rates have been lauded by the press. Tuesday, White House officials announced a program to ship doses of the vaccine directly to a network of federally funded clinics in underserved areas (NYTimes). Pfizer expects to cut COVID-19 vaccine production time by close to 50%, promising more accessibility (USA Today).

But so far, the federal government has gathered race and ethnicity data for just 52% of all vaccine recipients. Among those, just 11% were given to recipients identified as Latino/Latina, and 5% were given to those identified as Black Americans (Politico). Although public health experts believe delivering vaccines directly to underserved communities is helpful, they note that the absence of comprehensive data makes it impossible to know whether vaccine distribution is truly equitable (NYTimes).

The lack of data on COVID-19 contraction and treatment’s racial disparities has been a persistent issue since the pandemic began in the U.S. last March. A study from the John Hopkins' Coronavirus Research Center published last June noted that racial and ethnic information was available for only about 35% of the total deaths in the U.S. during that time. Various advocacy organizations, including the Black Lives Matter movement, demanded accountability. While data have improved over time, they continue to have significant gaps and limitations, particularly on a state-by-state level (KFF). These discrepancies have made it difficult to understand its effects across communities and respond appropriately.

And now that we’re rigorously attempting to distribute the vaccine, the same challenges apply. In the NYTimes, Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, notes that the lack of data is alarming.

“

The race and ethnicity data is important because we know who’s bearing the brunt of the pandemic, so there is a fairness and an empathy issue. But there is also a disease control issue. If those are the groups most likely to get affected and die, those are the groups we need to make sure we are reaching with the vaccine.

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, NYTimes

Even with limited data, the differences are apparent. NPR studied the locations of vaccination sites in major cities across the Southern U.S. and found that most are based in whiter neighborhoods (NPR). This data mirrors the organization’s previous reporting last May, which analyzed COVID-19 testing facilities (NPR). This continued disparity has immediate and urgent implications. Residents express their frustration with finding transportation to facilities for an available vaccine. But it also indicates a broader issue. Most vaccine distribution and tests are hosted in existing health care facilities, and those, too, are inequitably distributed. It’s a reminder that COVID-19 doesn’t just cause these disparities but exacerbates them.

And the South isn’t a unique case. Similar studies in other major cities show that vaccine accessibility prioritizes whiter neighborhoods (NPR). As Grist notes while analyzing Chicago data, these disparities often mean that more polluted communities are left behind (Grist). Communities with higher rates of pollution tend to have compounding health issues that can worsen the impact of COVID-19.

But it will take more than presidential intervention and speedier production timelines to get those most vulnerable vaccinated. A significant barrier to ensuring vaccines are utilized is trust. The Black community – and other communities of color - have a deep distrust of the medical system, an issue we’ve written about frequently in previous newsletters. Organizations have rallied quickly to create cross-cultural awareness campaigns, but it’s likely insufficient for solving generational trauma alone (Ad Council).

As individuals, we have little control over the systemic and political forces in play that makes vaccine distribution inequitable. But we can do our part to ease access for those in our communities. As the rollout continues, consider how you can also advocate for changes that transform our healthcare system, making it more responsive in times of future emergencies.

KEY TAKEAWAYS

The vaccine rollout seems to favor white communities, with few people of color receiving the vaccine so far
Data on the vaccine rollout is limited due to constraints and disparities in state-by-state reporting
The lack of racial/ethnic data in the response to COVID-19 is a persistent issue that's affecting access to testing and treatment
Part of the issues in lack of accessibility stem from broader systemic disparities evident in healthcare

PLEDGE YOUR SUPPORT

Nicole Cardoza 1/19/21 Nicole Cardoza 1/19/21

Advocate for universal healthcare.

During the COVID-19 pandemic, as many as 7.7 million workers had lost their jobs (Commonwealth Fund). Health insurance had left with, leaving millions of people uninsured during a global pandemic (Business Insider). Not only has the pandemic exposed the inequitable healthcare system, but has underscored the need for universal healthcare, or medicare, for all.

Happy Tuesday and welcome back to the Anti-Racism Daily. Today we're diving into the importance of universal healthcare, one of several political changes we'll be advocating for this month during the political shift.

As the inauguration nears, please be sure to take care of yourself and your community. Revisit our election safety plan and learn more about the priorities of community organizers where you live.

This newsletter is made possible by our subscribers. Consider subscribing for $7/month on Patreon. Or you can give one-time on our website, PayPal or Venmo (@nicoleacardoza). You can also support by joining our curated digital community.

Nicole

TAKE ACTION

Advocate for healthcare reform on social media.
Participate in elections at all levels by educating yourself about and voting for candidates that want health care for all.
Support and consider donating to organizations that are advocating for universal healthcare policies and reform such as Healthcare-NOW and Community Catalyst.

GET EDUCATED

By Kayla Hui (she/her)

Universal healthcare is a system that provides all people - regardless of financial need - access to health care services and resources such as preventative care, treatment, rehabilitation, and palliative care (World Health Organization). Over the past few decades, the United States has witnessed skyrocketing healthcare costs, which has prevented people from seeking or delaying care.

In 2018, the U.S. spent $3.6 trillion on healthcare, the highest of any other nation. These costs are expected to rise to $6.2 trillion by 2028 (Peter G. Peterson Foundation). Healthcare costs remain high because the U.S. relies on a free market where hospitals have the authority to set their prices. Because a free market relies on capitalism, when healthcare is in high demand, prices can surge. So access to medical care, especially during a pandemic, is strenuous, especially for those who can’t afford to see a doctor. “When a society is seriously concerned about its people having equitable access to care and about polling health risks efficiently, the free market is not a good choice,” Jui Fen, Rachel Lu, and William C. Hsiao state in an online article. (Health Affairs). The high healthcare costs – especially during a pandemic where a scarcity of resources exists – are what makes the U.S. healthcare system inequitable and systemically racist.

In 2019, BIPOC communities had the highest uninsured rates, leaving them vulnerable to existing health conditions prior to the pandemic (Kaiser Family Foundation). People who are uninsured are three times more likely than insured adults to say they have not had a doctor’s visit to discuss their health (Kaiser Family Foundation). They are also less likely to receive recommended screenings such as blood pressure, cholesterol, pap smears, mammograms, and colon cancer screenings (Kaiser Family Foundation). When a disease or health condition is left untreated, the health consequences can be dire especially for those with chronic illnesses.

When looking at the COVID-19 pandemic, Black, Indigenous, Latinx, and other people of color have been disproportionately impacted (The COVID Tracking Project and Boston University’s Center for Antiracist Research). Nationwide, Black people are dying at 1.7 times the rate of white people with Native and Hispanic and Latino people trailing not too far behind.

One of the main reasons why millions of people lost health insurance is because of a flaw in the system: employer-based insurance (EBI). EBI is a system where health insurance is tied to employment instead of being provided by the government. In the U.S., health is not a guaranteed right. Rather, it is a commodity, an “add on for an extra dollar” if you will expense, and only those most privileged to afford its exorbitant costs will reap the benefits and have healthier outcomes - preventative screenings to catch diseases early on, access to the medical care they need when they are sick, can afford to see a doctor any time of year, etc.

Historically, the use of preventative health services has been low, especially among BIPOC, the uninsured, and low-income communities (Center for Disease Control and Prevention). It’s not that people don’t want to get these screenings, it's that they can’t afford to. Nearly one in four people in the U.S. are skipping medical care because of the cost (CNBC). If the U.S. adopted preventative measures such as cancer screenings, approximately 100,000 lives could be saved each year (Center for Disease Control and Prevention).

So how did EBI come to be? In 1943, the Internal Revenue Service (IRS) ruled that employer-based health care should be tax-free (National Public Radio). However, by the 1950s, after a decade of growth, the Eisenhower administration reserved tax-free status for employers only. Since then, employer contributions to health insurance would be tax-free. By the mid-1960s, people started to equate a good job with health care benefits. Thus, EBI was born.

This decision created a burdensome challenge when the pandemic forced a national shutdown, especially for those working jobs that require in-person contact. While grocery and essential workers were allowed to remain open through plexiglass installation and COVID-19 safety guidelines, other workers were not as lucky, including my parents (NPR). The banquet halls where my mother and grandmother worked, shut down indefinitely. Pre-pandemic, my mother and popo (grandmother in Chinese) would carry plates of catered food to hundreds of guests during proms, weddings, and business conferences. As those functions got canceled, so did my family’s health insurance.

“Dear Diane, the table below shows the last day you and/or your dependent(s) have healthcare coverage,” I read to my parents. While the letter was highly-anticipated, the gravity of our situation didn’t sink in until I processed what the lack of health insurance would mean for me and my family. Because my two sisters and I were dependents under our mother’s insurance, we too, had lost coverage, leaving five members in my immediate family without health insurance. I was most worried about my popo, who lives with chronic respiratory illness and asthma. The stress and uncertainty of our health insurance coverage doesn’t just affect my family but millions of BIPOC and low-income households.

In 2018, 66% of U.S. adults had stated that the cost of health insurance was a stressor for themselves and loved ones (American Psychological Association). If the U.S. adopted universal healthcare coverage, 137 million people would not have to face medical hardship, struggle to pay their medical bills, or incur medical debt (Medpage Today). In addition, the country would save 13% in national healthcare expenditures which totals $450 billion annually. (U.S. News). Patients would have the freedom to choose their doctors and hospitals without bearing the cost of high premiums, copayments, and deductibles.

Adopting universal health care would require a redesign of the U.S.health care payment infrastructure. It would require a mix of private insurance (for those who can afford it) and quality public services while weighing cost, access, quality, and equity (ProPublica). In the beginning of 2020, 43.4% of U.S. adults were inadequately insured (The Commonwealth Fund). While some argue that universal healthcare would look like medicare for all, we know that the current system we have does not work and the cost of human life is at stake without health insurance coverage.

The fight to expand healthcare for all has been a debate that predated COVID-19. In order to achieve “good” health, people must have access to the resources that will keep them healthy. Universal healthcare shouldn’t be a controversial issue because healthcare is a human right and it is the basis for which people can live and lead healthy and happier lives.

KEY TAKEAWAYS

Employer-based insurance is a flawed component of the United States healthcare system, only benefiting those who are able to access “good” jobs.
By implementing universal healthcare in the U.S., everyone, regardless of financial status, would be offered essential healthcare services.
BIPOC and low-income communities bear the burden of disease and health disparities in the United States. They are more likely than white people to be uninsured.

PLEDGE YOUR SUPPORT

Nicole Cardoza 9/17/20 Nicole Cardoza 9/17/20

Abolish ICE.

This is the third time I've referenced forced sterilizations in our newsletters over the past two weeks. And this time it's with a new and harrowing story. It's heartbreaking to see how our history keeps repeating itself, and the lasting implications of generations of violence against communities of color. This story is still developing, but our persistent action will ensure this conversation doesn't fade away. The violence that's been happening at these camps are an act of genocide.

If you're enjoying these newsletters, consider making a contribution to support our work. You can give one-time on our website, PayPal or Venmo (@nicoleacardoza), or subscribe for $5/mo on our Patreon.

– Nicole

TAKE ACTION

Sign United We Dream’s petition to release immigrants and asylum‐seekers at detention centers.
Support the GoFundMe of Dawn Wooten, a Black single mother of five who risked her job and safety as a whistleblower.
Call your senators and urge them to defund ICE, which operates under DHS.
Follow and support the voices that have been telling us about the atrocities happening at detention centers: Project South, Georgia Detention Watch, Georgia Latino Alliance for Human Rights, and South Georgia Immigrant Support Network

GET EDUCATED

By Nicole Cardoza (she/her)

This week, a whistleblower filed a complaint with the Department of Homeland Security’s Office of the Inspector General about “medical neglect” practiced at an ICE facility in Georgia. Dawn Wooten, a nurse at the Irwin County Detention Center (ICDC), reported that the facility was underreporting COVID-19 cases and not correctly testing or protecting staff and detainees (The Intercept). She also reported that the immigrants are being subjected to a high rate of hysterectomies without “proper informed consent” (The Intercept).

“I became a whistleblower; now I’m a target. But I’ll take a target any day to do what’s right and just, than sit and be a part of what’s inhumane.”
Dawn Wooten

Before we continue, I think it needs to be made clear that the allegations of medical neglect during a global pandemic alone should be enough for us to call for change. The forced separations of families are enough to call for change. In fact, the fact that these detention centers even exist is more than enough for me. We need to abolish ICE for the system itself, not just because we're hearing more allegations about forced sterilizations.

The latter allegation in particular has spurred lawmakers and advocacy groups into action. Organizers of the complaint, along with Wooten, include Project South, Georgia Detention Watch, Georgia Latino Alliance for Human Rights, and South Georgia Immigrant Support Network, and consists of the voices of detained immigrants that have “reported human rights abuses including lack of medical and mental health care, due process violations, unsanitary living conditions” since 2017 (Project South). They've been rallying to close this facility – and others – for years, and detainees have specifically complained about the rough treatment from the same gynecologist that's accused (AJC).

168 members of Congress sent a letter urging DHS Inspector General Joseph Cuffari to investigate the allegations (Congresswoman Jayapal website). They're demanding to know the status of the investigation by September 25th (NPR).

These allegations are horrifying. And, these allegations are nothing new. As we discussed in two newsletters over the past two weeks, our country has a history of medical violence, particularly against women and women of color. These procedures are sexist, xenophobic, racist, and ableist, and often homophobic. And they’re an act of violence against marginalized people, many of whom rely on the same institutions for their protection.

To understand this, we have to start with eugenics, the practice of improving the human species by “breeding out” disease, disabilities, and other characteristics from the human population (History). The concept gained traction in the U.S. in the early 1900s with the creation of the Race Betterment Foundation, led by John Harvey Kellogg – yes, that Kellogg (History). Through their “registry” of “pedigree” status and a series of national conferences, they promoted the idea that to improve the country, we needed to preserve the racial status of those that inhabit it (History). This meant that people that did not fit this category – including immigrants, Black people, Indigenous people, poor white people, and people with disabilities – needed to be maintained.

Via CNN: Eugenics had won such mainstream acceptance that Americans competed in "fitter families" contests at state fairs during the 1920s.

From this, 31 states sanctioned sterilizations. Many were presented to individuals as “protective” measures to prevent their “undesirable” traits from passing to others. But many more were nonconsensual, performed when patients believed they were receiving other forms of care (The Conversation). And although the programs initially targeted men, they quickly evolved to focus on women and women of color – particularly as the country began to desegregate.

From 1950 to 1966, Black women were 3x more likely to be sterilized than white women, and more than 12x the rate of white men (The Conversation). Hospitals in the South let medical students practice unnecessary hysterectomies on Black women, a practice so common it was given the euphemism “Mississippi appendectomies” (The Cut).

The U.S. Indian Health Service (IHS) applied forced sterilized over 3,000 Indigenous women in the U.S. in 1973 and 1976. A study from two years earlier found that at least one in four Indigenous women had been sterilized without consent (Minn Post).

In California alone, over 20,000 people were sterilized, and were disproportionately Latinx, primarily individuals from Mexico (Smithsonian). During that time, anti-Mexican sentiment was spurred by theories that Mexican immigrants and Mexican-Americans were at a “lower racial level” than white people (Internet Archives).

Via The Conversation: A pamphlet extolling the benefit of selective sterilization published by the Human Betterment League of North Carolina, 1950. North Carolina State Documents Collection/State Library of North Carolina

By 1976, over 60,000 people were recorded sterilized in 32 states during the 20th century (Huffington Post).

Although the Supreme Court moved to end these practices in 1974, these practices are still happening. Between 1997 and 2010, unwanted sterilizations were performed on approximately 1,400 women in California prisons, which primarily targeted women of color (Fox News). A judge in Tennessee offered those incarcerated thirty days off jail time if they volunteered for vasectomies or contraceptive implants, saying that he hoped repeat offenders would “make something of themselves” (Washington Post). Ten states still require transgender people to obtain proof of surgery, a court order, or an amended birth certificate to update their driver’s licenses – and 17 states require sex reassignment surgery to update birth certificate gender markers (The Daily Beast). And there are still terrifying stories of forcible sterilizations happening on people with disabilities deemed constitutional by the courts (Rewire News).

There’s been jokes and memes floating around that we’re “officially” living in the dystopian Handmaid’s Tale. But we’re not. We’re living in the reality of the United States. And when we distance ourselves from this painful reality, we allow it to persist. As investigators race to verify these allegations, we cannot continue to allow any injustices to continue in these spaces. We must keep listening and supporting to the voices that have been shouting this to us for years – that these institutions must be dismantled. The costs are far too great.

Key Takeaways

A whistleblower filed a complaint against ICE for “medical neglect" at the detention camp she worked at, including mass hysterectomies without detainees' content
Forced sterilization was a state-sanctioned practice, often funded by the federal government, that disproportionately impacted women and women of color during the 19th century
Forced sterilizations procedures are sexist, xenophobic, racist, and ableist, and often homophobic
Unwanted sterilizations are still happening today

PLEDGE YOUR SUPPORT

Nicole Cardoza 9/16/20 Nicole Cardoza 9/16/20

Fight for paid sick leave.

It's Wednesday!

And we're unpacking the importance of paid sick leave as we head into fall in the midst of a pandemic. Ebony shares more about the importance of paid sick leave, particularly for marginalized communities. Luckily, recent legislation has passed for Philadelphia and California, showing that local advocacy efforts are generating results. Join in by examination paid sick leave legislation in your city and state, and consider how you can encourage the same policies at your workplace.

If you're enjoying these newsletters, consider making a contribution to support our work. You can give one-time on our website, PayPal or Venmo (@nicoleacardoza), or subscribe for $5/mo on our Patreon.

– Nicole

TAKE ACTION

Support the Healthy Families Act by signing this petition, which urges Congress to pass a national sick leave policy.
If you live in a state or city that has enacted a paid sick leave law, know your rights by researching how you are protected as an employee. Use this resource to get started.
Reach out to your local politicians and ask them to create a paid sick leave law for your city/state.

GET EDUCATED

By Ebony Bellamy (she/her)

As COVID-19 cases continue to rise and flu season quickly creeps upon us, the Center for Disease Control and Prevention has emphasized that reducing the spread of germs and respiratory illnesses is extremely important this fall and winter (CDC). And the best way to reduce the spread of both is for individuals to stay home when they’re feeling sick. However, this isn’t a luxury many workers have since there is no national sick leave policy in place.

The workers who are most affected by this are people of color and immigrants. For immigrants, only 50% have paid sick days compared to 60% of their native-born counterparts (The Center for Law and Policy). At the same time, more than 7.3 million Black workers can’t earn a single paid sick day (National Partnership for Women and Families). That’s roughly 40% of Black employees, and of those workers, 41% are Black men, and 36% are Black women (National Partnership for Women and Families).

And these numbers are even higher within the Latinx community. Despite them having the “highest labor force participation rate of any racial or ethnic group in the US and the fastest-growing segment of the workforce,” almost 15 million Latinx workers are unable to earn a single paid sick day (National Partnership for Women and Families). This includes 55% of Latinx men and 51% of Latinx women (National Partnership for Women and Families).

With Black and Latinx people primarily being paid less than their white and Asian counterparts, they can’t afford to take a day off. The median weekly earnings, in 2020, for full-time Black workers are $806 and $786 for Latinx workers while full-time white workers earn about $1,018 (Bureau of Labor Statistics).

Compared to 83% of full-time workers who receive paid sick days, only 43% of part-time workers have paid sick leave (The Center for Law and Policy). With over 4 million people working fewer hours than they’d like and having to work multiple part-time jobs to support themselves and their families, they’re less likely to have guaranteed paid sick leave (The Center for Law and Policy).

Unfortunately, workers with low-wage jobs are more likely to deal with financial burdens. For example, more than 30% of black households have no savings or assets to utilize if a family member unexpectedly loses their job (National Partnership for Women and Families). And as of 2015, more than one in five black families were living in poverty (National Partnership for Women and Families). The same is true for Latinx families. Approximately 27% of Latinx households have no savings or assets to utilize during an unexpected loss of income. As of 2018, more than one in six Latinx families was living in poverty (National Partnership for Women and Families).

For low-income families, missing a few days of work can equate to losing a month’s worth of groceries, missing a rent payment, or not being able to pay a majority of their bills. But, maintaining perfect attendance at work means being able to feed their family, not being homeless, and not going into debt.

A lack of sick leave is extremely devastating to those who also serve as caregivers. Not only are they risking their health, but they’re risking the health of family members since they don’t have time to attend or prioritize medical appointments and emergencies (Essence). One in five Black people act as a caregiver to an adult family member or someone close to them, and 52% of these caregivers work full time (National Partnership for Women and Families). While more than one-quarter of Latinx individuals live in multigenerational households, so about 20% of them are caregivers for loved ones (National Partnership for Women and Families).

People of color need paid sick leave so that they can take care of themselves and their families. Yet, only 13 states and Washington D.C. have enacted laws that require employers to offer paid sick leaves. Depending on the state, you can receive one hour of sick leave for every 30, 35, or 40 hours of work. Some states require more, and those hours equate to three to seven paid sick days (National Conference of State Legislature). Unfortunately, each state has specific guidelines that determine who qualifies for paid sick leave, so do your research because not all employees are covered.

Even though some states have a paid sick leave policy in place, people of color are often reluctant to take advantage of it. A Pew Research study found that 69% of employees took less sick leaves because they couldn’t afford to lose money, while 47% were afraid they would risk losing their job if they asked for a sick day (Essence).

And some people don’t even know paid sick leave is an option for them. About one in five people don’t know if their employers offer any form of paid leave for situations such as routine doctor appointments, minor illnesses, and vacations (Essence). To fix this, employers need to let their employees know paid time off is available to them. They should have their policies posted in highly visible places around the office and ensure it’s written so that employees can understand them, which means posting the sick day policies in various languages (Essence).

To ensure all employees can take advantage of paid sick leave, we need to support the Healthy Families Act. This legislation ensures all American employees can earn up to seven days of paid sick time per year. Employees earn this by gaining an hour of sick leave for every 30 hours they work, and these sick days can be carried over to the next calendar year if they’re not used (The Center for Law and Policy). Sick days can be used for a multitude of reasons such as caring for their own physical or mental illness, caring for an injury or medical condition, obtaining a medical diagnosis, receiving preventive care, and caring for a family member, child, spouse, or loved one (The Center for Law and Policy). Read the National Partnership for Women and Families Fact Sheet to learn more about the Healthy Families Act.

There are over 32 million workers, who can’t earn paid sick leave, and we need to change that. No one should feel forced to choose between their health, their families’ health, and their financial security when they’re feeling sick.

Key Takeaways

Approximately 7.3 million Black workers and 15 million Latinx workers can’t earn a single day of paid sick leave (National Partnership for Women and Families).
People of color make less than their white counterparts, which hinders their ability to take a day off.
83% of full-time workers receive paid sick days, while only 43% of part-time workers have paid sick leave (The Center for Law and Policy).
Only 13 states and Washington D.C. have laws that require employers to offer paid sick leave (National Conference of State Legislature).
69% of employees took less sick leaves because they couldn’t afford to lose money, while 47% were afraid they would risk losing their job if they asked for a sick day (Essence).
The Healthy Families Act is a legislation that aims to create a national paid sick leave policy.

RELATED ISSUES

9/9/2020 | Make the census count.

8/9/2020 | Understand the unemployment gap | COVID-19

7/23/2020 | Know our racist presidential history.

7/21/2020 | Honor the legacy of Rep. John Lewis.

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Nicole Cardoza 9/13/20 Nicole Cardoza 9/13/20

Understand representation in vaccine trials.

Happy Sunday!

Today marks our weekly review of the racial disparities of COVID-19. It's important to remember that this virus doesn't discriminate. But our systems do. And we're trying to respond swiftly to its catastrophic impact while reckoning with our deep history of oppression and harm. Today's topic – the fight for representation in vaccine trials – is a good example of this. As you read, consider how much our mistakes from the past affect our ability to respond equitably in the present – and its implications for the future.

Thank you all for your contributions. To support our work, you can give one-time on our website, PayPal or Venmo (@nicoleacardoza), or subscribe for $5/mo on our Patreon.

Nicole

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Support the Black Doctors COVID19 Consortium, which is building trust in their community by offering free COVID-19 testing in Philadelphia, New Jersey and New York
Respect the racial and historical context that may make people wary of a vaccine
Consider: how may your racial identity influence your perception of vaccine trials? What privilege(s) may have helped you build trust in the healthcare system?

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The U.S. is moving at an unprecedented pace to create a vaccine to respond to COVID-19. The Trump administration has dubbed these efforts “Operation Warp Speed,” with the hopes to deliver “initial doses of a safe and effective vaccine” by January 2021 — shortening the development time from years to months (NPR). More recently, Trump has hinted that a vaccine may be ready by the election (what a coincidence), which is highly unlikely. And part of that is because of a lack of representation in testing groups.

350,000 people have registered online for a coronavirus clinical trial, but only 10% are Black or Latino, according to Dr. Jim Kublin, executive director of operations for the Covid-19 Prevention Network (CNN). An additional 8% represent Indigenous communities. This isn’t nearly enough, considering over half the COVID-19 in the U.S. have been in the Black and Latino communities (CNN). And beyond that, 1.3% of reported cases are from Indigenous groups, despite only representing .7% of the population (CDC).

In fact, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, expressed his desire to see non-white communities enrolled in coronavirus vaccine trials at levels at least double their percentages in the population, which would mean 66.4% of participants need to identify as "Black or African American, Latin, American Indian, and Alaskan Native” (CNN). Scientists, doctors, and advocates are urging both pharmaceutical companies and the government to increase their efforts to enroll a diverse group of volunteers.

As we discussed in last week’s newsletter, communities of color have a deep distrust of the U.S. health care system, and for good reason.

📰 Read more about the history of medical violence against communities of color >

Also, the U.S. (and other parts of the world) have a long history of using people of color as trial subjects for vaccines. Thomas Jefferson tested what would become a successful smallpox vaccine on enslaved people before extending it to his family (Smithsonian). A British doctor serving as a plantation physician in rural Jamaica subjected enslaved people to trial tests without consent (Futurist).

As a result, people of color are historically underrepresented in clinical trials of new drugs, even when the treatment is aimed at an ailment that disproportionately affects them (ProPublica). Data from the FDA shows that Black people are the least likely to participate in drug trials – and that participation by people of color decreased between 2018 and 2019 (Outsourcing-Pharma).

“The absence of significant participation by Black patients creates not only a hole in the data, but can contribute to less effective treatments with little data on the impact on that specific population.”
Dr. Valerie Montgomery Rice, president and dean of the Morehouse School of Medicine, via Governing

One outreach effort includes reaching out to historically Black colleges and universities, encouraging students to participate in the trials, and engage medical staff and students in the process. Advocates believe this can grow trust in the community and encourage more Black people to join (NYTimes). Here’s an example of a letter from Xavier University. But this initiative, paired with efforts to increase testing across campuses, is garnering mixed feedback (Twitter).

📰 Read why it’s essential to have more representation of people of color in research >

Also, the COVID-19 Prevention Network, a group created by the National Institute of Allergy and Infectious Diseases, created an advertising campaign urging Black and Latino people to get involved. The ads center the voices of essential workers, grandparents, food industry workers, and other groups within communities of color that have been disproportionately impacted by COVID-19 (NBC News).

📰 Read more about the impact of COVID-19 on essential workers, the elderly, and workers in the food industry.

And leaders from the communities are doing their part to build trust. A group of faith-based leaders has joined together to enhance trust and engagement with people of color (Newswise). And the Navajo Nation has announced its participation in a Pfizer-BioNTech COVID-19 vaccine trial on a patient-volunteer basis (Indian Country Today).

“I would encourage people, but I know everybody won’t. It’s like ingrained in the mindset of Black people when you consider the syphilis injections. Black folks don’t want to be guinea pigs and we have been. Even in light of that, if the data is transparent, if the information makes sense, if the research is credible, then I think we can overcome that particular fear.”
Rev. Kenneth L. Samuel, senior pastor of Victory for the World Church in Stone Mountain, via Governing

Regardless of the accelerated timeline for finding a vaccine, there’s “no shortcut” to authentically engaging communities of color for trials, emphasizes Dr. Dominic Mack of Morehouse School of Medicine in Atlanta (NPR). It will take a long time to repair a history of discrimination and harm, but that work has to start now.

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Nicole Cardoza 8/14/20 Nicole Cardoza 8/14/20

Support Black mental health.

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It's Friday! And we're rounding out the week with our first of many stories on the racial disparities of mental health diagnoses and treatment. It comes at no surprise, but I was still shocked to read the psychological impact of the protests is profound, noted in this recap of the current state of Portland. As our nation rallies for change, it is also grieving and trying to heal. Adequate mental health resources are critical for us to move forward, and I appreciate Ebony's insights below.

If you prefer reading our resources weekly, you can edit your profile settings here. You'll only receive our emails on Saturdays, where I answer questions and insights from the community regarding the content from the past seven days. Have a question? Respond to this email and we'll get back to you.

As always, consider making a contribution to help this work grow. You can give on our website, Paypal, Venmo (@nicoleacardoza) or subscribe $5/mo on Patreon. A huge thank you for those that have already supported!

Nicole

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1. Donate to BEAM, a non-profit organization committed to the mental health of Black communities.

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By Ebony Bellamy

Lately, the news has been flooded with stories about Black celebrities and their mental health. From Kanye West’s strange, erratic behavior (New York Post) to Tamar Braxton’s possible suicide attempt (Essence), their actions have accelerated conversations surrounding Black mental health and the disparities Black people face to receive adequate treatment.

Compared to white people, Black and African American people have a higher risk of developing mental health disorders because of the historical, economic, social, and political influences they’ve been systemically exposed to for decades (Columbia University). This race-based exclusion makes their community more likely to experience poverty, homelessness, incarceration, and substance abuse (Mental Health America). And these factors are known to be damaging to a person’s psychological and physical health.

Approximately 46 million individuals identify as Black or African American in the U.S., and of those people, over 16 percent reported having a mental illness within the past year (Mental Health America). That’s over 7 million people.

Unfortunately, these numbers have drastically increased since the video of George Floyd’s death was released. Within a week, the Census Bureau reported that “anxiety and depression among African Americans shot to higher rates than experienced by any other racial or ethnic group, with 41 percent screening positive for at least one of those symptoms” (Washington Post). The number of Black people showing clinical signs for anxiety or depression jumped from 36 percent to 41 percent, which means approximately 1.4 million more people started struggling with their mental health (Washington Post).

Yet, in 2018, it was reported that 58.2% of Black and African Americans between the ages of 18 and 25 and 50.1% of adults between the ages of 26 and 49, who have a severe mental illness did not receive treatment (SAMHSA).

There is a “lack of trust in the medical system due to historical abuses of Black people in the guise of health care, less access to adequate insurance, financial burden, and history with discrimination in the mental health system” (Columbia University). These factors have caused Black people to feel reluctant about seeking psychiatric help when dealing with a mental illness.

In the United States, during the 1800s and 1900s, scientific racism was used as a way to justify slavery and the mistreatment of enslaved people (Counseling Today). During this time, prominent physicians and psychologists were known to discover “new” mental illnesses that only affected enslaved people. Prime examples of this were “ ‘drapetomania’ which was a treatable mental illness that caused Black enslaved people to flee captivity and ‘dysaethesia aethiopica’ an alleged mental illness that was the proposed cause of laziness, ‘rascality’ and ‘disrespect for the master’s property’” (Counseling Today). And to treat these “illnesses,” whipping and other forms of physical abuse were recommended.

The mislabeling of mental illnesses with Black people continued well after slavery was abolished. In the 1960s “schizophrenia was described as a “protest psychosis” in which Black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to or aligning with activist groups such as Black Power, the Black Panthers or the Nation of Islam” (Counseling Today). And today, Black and African American adults are more likely than white people with similar symptoms to be diagnosed with schizophrenia (Mental Health America). Black men, in particular, are overdiagnosed with schizophrenia. They are four times more likely than white men to be diagnosed with it. And are underdiagnosed with posttraumatic stress disorder and mood disorders (Counseling Today).

This overdiagnoses of schizophrenia caused people to believe the Black psyche should be perceived as unwell, immoral, and inherently criminal (Counseling Today). Society even used this belief to justify police brutality during the civil rights movement, the creation of Jim Crow laws, and mass incarceration in prisons and psychiatric hospitals (Counseling Today). Unfortunately, this old belief has negatively impacted the way people view Black mental health today.

Black and African American adults with mental health illnesses, specifically those that involve psychosis, are more likely to be placed in jail or prison than people of other races (Mental Health America). In 2016, it was reported that the imprisonment rate for Black and African American men was six times greater than that of white men. The imprisonment rate for Black and African American women was nearly double that of white women (Bureau of Justice). Due to this tremendous incarceration rate, “there are more than three times as many people with serious mental illnesses in jails and prisons than in hospitals” (Counseling Today).

Rather than receiving treatment for mental illness, Black and African American adults are punished and incarcerated for their mental health struggles. This wouldn’t need to happen if access to affordable health insurance was made available sooner. Before the Affordable Care Act (ACA) was introduced in March 2010, “nearly one in three Hispanic Americans and one in five Black Americans were uninsured, compared to about one in eight white Americans” (Brookings Institution). Although the ACA has helped communities of color gain health insurance, there are still 30 million people in America without insurance, and half of those are people of color (Brookings Institution).

“There's a strong relationship between socioeconomic status and health such that people at the lower end, people in poverty tend to have poorer health and tend to have fewer resources ... for dealing with the stressors of life.”
Diane R. Brown, Professor at the Rutgers School of Public Health and author, for HuffPost

Despite more Black and African American adults having access to affordable health insurance, they’re still hesitant to seek help due to a lack of representation in the mental health field. Approximately 60 percent of psychologists are white, while less than two percent of American Psychological Association members are Black or African American (American Psychological Association).

This lack of diversity among providers makes individuals doubt that therapists or psychologists will be culturally competent to treat their mental health struggles (Mental Health America). Researchers recognize that a therapist’s lack of cultural responsiveness, cultural mistrust, and potential negative views from a therapist can significantly impact the level of care and service the Black community receives for their mental health (Columbia University).

To combat this, providers have been practicing cultural responsiveness. Being culturally responsive is when a provider recognizes and understands the role culture plays in their and their patient’s life and use that understanding to adapt a treatment plan that meets their patient’s needs within their cultural framework (Columbia University).

Although mental health facilities have spent the last four decades increasing cultural awareness and cultural competency training (Counseling Today), there’s still a lot of work that needs to be done to ensure Black and African American adults receive access to mental health services and receive adequate care. We can start by understanding how someone’s race and ancestral history impacts their mental health.

KEY TAKEAWAYS

Black people have a higher risk of developing mental health disorders due to the historical, economic, social, and political influences they’ve been systemically exposed to.
Over 7 million Black and African American adults deal with a severe mental illness.
Black and African Americans are less likely to seek psychiatric help because of a lack of trust, limited access to affordable insurance, and a history of discrimination.
Black and African American adults with mental health illnesses, specifically those that involve psychosis, are more likely to be placed in jail or prison than people of other races.
Only two percent of psychologists are Black or African American.

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8/3/2020 | Stay awake.

7/19/2020 | Rally for representation in science and research: COVID-19 and CDC.

7/12/2020 | Learn how air pollution exacerbates COVID-19.

6/28/2020 | Understand disparities in healthcare treatment.

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Nicole Cardoza 7/30/20 Nicole Cardoza 7/30/20

Support Black maternal health.

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Happy Thursday!

I have to say, the challenges I know Black women face through the pregnancy process has discouraged me from having kids of my own. I'm incredibly grateful that this work is happening in Congress. Today's newsletter only scratches the surface of the racism people of color experience related to maternal health, and as I wrote this email it morphed into three more! But I do know that if we improve Black maternal health, we'll make maternal health more accessible for everyone.

We will keep reporting on racism until it doesn't exist anymore. And we'd love your support to make that happen. Consider giving one-time on our website, (or Venmo @nicoleacardoza), or pledge $5/month on our Patreon to keep this work growing. Many thanks to all that have supported so far!

Nicole

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Contact your senator and urge them to support the Black Maternal Health Momnibus using the letter found here.

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By Nicole Cardoza

Amid the racial reckoning of 2020, leaders and allies in the reproductive justice movement are calling for action. Congresswomen Alma Adams and Lauren Underwood launched the Black Maternal Health Caucus in April 2019, which has blossomed into a comprehensive initiative for Black maternal health rights. This includes the Black Maternal Health Momnibus, a compilation of nine bills that aim to address the disparities in access and treatment for Black people. This work calls for “reproductive justice,” a term created by a group of Black women (the Women of African Descent for Reproductive Justice) gathered in 1994 to create change based on not just reproductive rights, but social justice.

Learn more about the Black Maternal Health Caucus with Rep. Lauren Underwood in this podcast with the American Hospital Association >

And this level of action is long overdue. In the United States, women are more likely to die from complications of pregnancy and birth than in any other high-resource country. Black and Indigenous women are 2x to 3x more likely than white women to die (Every Mom Counts). And although Black women make up about 13% of the female population, they account for nearly 40% of maternal deaths (NYTimes). The campaign behind Black maternal health, organized by Every Mom Counts, puts it simply: “racism, not race, is killing Black, Brown, and Indigenous people in our maternity care system” (Every Mom Counts).

This insight is not new. The gross disparity of mortality rates between white and Black communities has existed since the U.S. started collecting data in 1850 (NYTimes). Prominent sociologist W.E.B. Du Bois wrote about this in his book “The Philadelphia Negro” in 1899 and mourned the death of his baby son in “The Soul of Black Folk” a couple of years later (NYTimes). But the collision of COVID-19 and the protests exacerbated decades of searing inequalities, highlighting the limited access and poor care that Black people receive from hospitals (NYTimes).

There have also been more documented stories of Black women experiencing discrimination – and worse – through their maternal health journey. Kira Johnson went to the hospital for a routine C-section. She suffered from internal bleeding for ten hours before the medical staff at Cedars Sinai took action, and ultimately lost her life (4Kira4Moms). Serena Williams publicly shared her horrifying experience giving birth in Vogue Magazine, and Olympian Allyson Felix testified in Congress about a traumatic birthing experience of her own (Washington Post).

It’s clear, as we covered in one of our earliest newsletters, that our society has a long way to go to respect Black women. We saw that with the coverage of the death of Breonna Taylor and other cis and trans women murdered during the protests (Anti-Racism Daily), and watching that unfold with the violence against Megan Thee Stallion, a prominent Black female artist (Jezebel).

As a result, Black, Ingenious, and other cisgender, transgender and gender non-binary people of color are left unheard in the conversation on reproductive justice. A recent article in the NYTimes garnered controversy when young activists expressed how their focus on reproductive rights is different than the feminist movement of the 1970s, which centered the needs of more affluent white women. Instead, they feel more compelled to address immediate, ‘life or death” situations that endanger the rights to access and opportunity for those services (NYTimes).

“A lot of the language I heard was about protecting Roe v. Wade. It felt grounded in the ’70s feminist movement. And it felt like, I can’t focus on abortion access if my people are dying. The narrative around abortion access wasn’t made for people from the hood”.

Brea Baker, an activist and organizer in Atlanta, for the NYTimes

But here’s the thing: data suggests that the majority of maternal deaths are preventable. Expanding Medicaid coverage before delivery and post-partum can prevent two-thirds of maternal mortality (NYTimes). Data from the CDC shows that this coverage is critical, particularly after childbirth. Lower-income mothers are eligible for Medicaid, which supports 40% of all pregnancies in the U.S. Still, coverage expires shortly after their child is born – although the coverage varies widely by state. Women of color are more likely than white women to be covered by Medicaid, so this disparity contributes to the high mortality rates for Black women (KFF). Studies prove that consistent support throughout the pregnancy decrease mortality rates and increase the health of mother and child (NYTimes).

Increasing health insurance coverage is part of the movement (and is one of the nine bills included in the Momnibus). But so is addressing the broader, systemic aspects of racism that affect Black maternal health long before someone decides to have a child. Everything from the environment to the stress of racial microaggressions, housing insecurity, unequal pay, access to transportation and healthy food, and many other factors influence one’s opportunity to have a healthy pregnancy and birth.

So as we do this work, we must remember that reproductive justice extends beyond the hospital. Reproductive justice is means solving environmental racism (New Security Beat) and dismantling the harmful practices at immigration detention, including the forced separation of families and barring access to necessary medical support (American Progress). It means abolishing the over-policing of Black, Indigenous, and people of color (Every Mother Counts). And most importantly, it means listening to Black women and centering their needs, especially when transforming maternal care.

KEY TAKEAWAYS

Congresswomen are passing a series of bills to support Black mental health, supported by dozens of leaders, allies, and activists in the reproductive justice movement
Black women are disproportionately more likely to experience poor maternal health
Although lack of coverage plays a major role, the systemic impact of racism – from treatment at hospitals, to police brutality, unsafe environments and more – affects Black maternal health
We need to listen to Black women and center their needs, in this movement and all others

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Nicole Cardoza 6/28/20 Nicole Cardoza 6/28/20

Understand disparities in healthcare treatment.

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It's Sunday, so we're continuing our weekly series that analyzes the racial disparities exposed by COVID-19. I hoped this series would feel like old news after a while because I was hopeful COVID-19 rates would decline.

But, as we watch some states reach their all-time highs, it's clear that this global pandemic is here to stay. Which also means that unless more action is taken, the disparities in testing and treatment will persist. Today we isolate these differences and how they've been pervasive in our healthcare system for decades.

Consider investing to keep these daily emails going. You can give one-time on PayPal or Venmo (@nicoleacardoza), or subscribe monthly on Patreon – just like a newspaper subscription.

Nicole

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See if your city or state has an equity task force to support those most vulnerable in your community. If not, contact your local officials to ask why.
Sign the petition from the Black Lives Matter movement demanding the collection and release of more racial demographic data related to COVID-19: https://blacklivesmatter.com/demand-racial-data-on-coronavirus/

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Racial disparities in treatment started well before COVID-19.

Note: This is our third installation of the series analyzing how systemic and interpersonal racism impacts the disproportionate impact of COVID-19 on communities of color. As we focus on disparities in treatment today, it's important to remember that this is not the sole, singular issue causing disparities of COVID-19. And although we're looking at in isolation for the sake of this newsletter, solving it alone won't solve everything. I say this not to be pessimistic, but to emphasize how pervasive and interconnected racism is in all aspects of our society. It's recommended you read our previous emails in the series:

Racism as a public health crisis
Protect essential workers

Understanding the full scope of the impact of COVID-19 was greatly limited in disproportionate access to testing. And although state and city–level data on COVID-19 and racial / ethnic backgrounds varies widely, initial reports are clear. In NYC, two-thirds of the 30 ZIP codes with the highest rates of testing were either whiter or wealthier — and frequently both — than the city average population (via NYPost). NPR found that testing sites are disproportionately found in white neighborhoods in 4 of the 6 biggest cities in Texas (via NPR). Initial rollouts of the partnership between the Trump administration and major drugstores (Walgreens, CVS, Target and Walmart) was also inequitable: out of the 63 sites, only 8 were in Black neighborhoods (via Vox). Inequitable testing doesn't just prevent individuals from quarantining and caring for themselves more difficult. It prevents local governments and healthcare providers from adequately preparing for a spike in cases, leaving the system weakened based on this lack of information.

Beyond testing, many cases of disparities in treatment are causing people to die, evident in stories like this Deborah Gatewood (via Blavity) and Jason Hargrove (via Time) in Detroit, two Black frontline workers that were both turned away from the hospital multiple times before dying of COIVD-19 at home. These stories are especially unsettling to read because in Michigan, 40% of the people that have died from COVID-19 are Black, although only consisting of 14% of the population (via Michigan state COVID-19 data). But these stories aren't unique to Detroit, like the stories of Reginald Relf (via NYTimes), Gary Fowler (who was never officially tested for COVID-19) (USA Today), and Rana Zoe Mungin (via UMass).

But treatment disparities, too, have a deep history. One study of 400 hospitals in the U.S. showed that black patients with heart disease received older, cheaper, and more conservative treatments than their white counterparts. Black people were also less likely to receive coronary bypass operations, and discharged earlier from the hospital than white patients—at a stage when discharge is inappropriate (via American Bar).

“Race doesn’t put you at higher risk. Racism puts you at higher risk.”

Camara Phyllis Jones, epidemiologist and family physician in Scientific American

If you spend time on social media, you may have seen the viral TikTok video by Oregon-based OBGYN Dr. Jennifer Lincoln where she talks about the differences in care (watch video and learn more on Buzzfeed). In it, she states that "a 2016 study showed that 50% of medical students and residents who were studied thought that Black people couldn't feel pain the same way because they had thicker skin or their nerves didn't work the same way," which surprised many, but is absolutely true (read the full study here). The study makes the claim that these perceptions are likely to influence how doctors support pain management for Black people, which was also noted in the study (via American Bar).

Note: The video goes on to discuss how these false perceptions are rooted in the days of slavery. We'll discuss this in depth in another newsletter, but this NYTimes article is a powerful explanation of how physical racial difference between Black people and white people were used to justify enslavement.

These points illuminate that disparities in healthcare aren't just caused by structural factors, but individual ones as well. The study stresses that the implicit biases of physicians and health care providers are a contributing factor to these differences in treatment. And when physicians were given the Implicit Association Test (IAT)—a test that purports to measure test takers’ implicit biases by asking them to link images of black and white faces with pleasant and unpleasant words under intense time constraints—"they tend to associate white faces and pleasant words (and vice versa) more easily than black faces and pleasant words (and vice versa)" (American Bar).

You can take the test for yourself for free on the Harvard website, but know that it's not designed to be an individual assessment (via Vox). I recommend taking the test more to understand what implicit bias is, and how the aggregated data can inform research.

The CDC updated their recommendations for supporting racial and ethnic minorities to include implicit biases, citing that healthcare providers should "provide training to help providers identify their implicit biases, making sure providers understand how these biases can affect the way they communicate with patients and how patients react" (quote from CDC website, insight from NYTimes).

As Congress works to pass a bill creating a federal task force to address COVID-19's disproportionate impact (via Kamala Harris' website), cities across the country have started to implement their own health equity task forces (see work from Boston, NYC, Houston and Michigan). But is it too little too late? Even if testing locations can grow to keep up with demand, and be placed in accessible locations for everyone, implicit biases may not be able to be solved in just a training or workshop. However, as the devastating impact of COVID-19 persists, we can only hope this critical attention will help to combat the scope of its impact on marginalized communities.

There are countless other examples of disparities in healthcare treatment in specific contexts – like maternal health and traumatic brain injuries, for starters – that we will unpack in future newsletters.

KEY TAKEAWAYS

Existing disparities in our healthcare system exacerbate how we test and treat COVID-19 for specific populations
These disparities are structural and individual, showing that our relationship to racism at all levels influences how we can take care of those most marginalized
Efforts are underway, but it's unclear if it's enough to combat the rampant spread of the disease

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“Race doesn’t put you at higher risk. Racism puts you at higher risk.”Camara Phyllis Jones, epidemiologist and family physician in Scientific American

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“Race doesn’t put you at higher risk. Racism puts you at higher risk.”

Camara Phyllis Jones, epidemiologist and family physician in Scientific American