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How Health Disparities Are Shaping the Impact of COVID-19

Karen Kruse Thomas

After COVID-19 cases began to mount, the heightened risk for communities of color was the first concern for Lisa A. Cooper, MD, MPH ’93, Bloomberg Distinguished Professor and director of the Johns Hopkins Center for Health Equity at the Bloomberg School.

There’s a saying that when America catches a cold, African Americans catch pneumonia. Although racial and ethnic identity is not available for all COVID-19 deaths, even across the existing data, black Americans are 2.4 times more likely to die from the virus than the general population.

In this Q&A, Cooper discusses the importance of local leadership in fighting COVID-19 and the ways that providers are helping the communities hardest hit by the pandemic.

What’s at the top of your mind right now?

When it became clear that this was becoming a pandemic, I felt it would hit our country pretty hard because we don’t invest in the social infrastructure and services that provide protections for the most vulnerable, who can’t leave town or stock up on supplies when a crisis occurs. When that actually happened, so many people were shocked by it, but those of us who work with vulnerable populations know these disparities are there every day and have existed for a very long time.

African Americans and people with lower incomes are disproportionately represented in COVID-19 cases and deaths. Especially with public health officials calling for more extensive contact tracing, are you concerned that higher-risk populations might be stigmatized?

Yes, there is always the concern that when we highlight that certain groups are disproportionately impacted by a condition that is known to be deadly and easily spread, those groups will experience stigma. This is even more concerning for ethnic minorities and poor persons, because they are often the target of negative stereotypes. So, testing positive could negatively affect a person’s chances of housing and employment stability, especially for those on the fringes. But we have to get the message out to the public that higher rates of infection or death are not a reflection of an inherent characteristic of a person. The elevated rates result, in large part, from living circumstances and the unequal political and social structure of opportunities for certain groups of people. These disparities are shaped by the fact that our policies and institutions create inequities in access to many resources that could help people make healthier choices, including seeking health care. We must look at the problem holistically and focus on collective responsibility.

Why is leadership from within the community so important for ensuring that the response reaches disadvantaged populations?

Community leadership is important across the board during a pandemic, when cooperation among government and private sector groups is essential. We have seen communities where social distancing is not being practiced getting hit hardest. The results have been better where there is greater trust in leadership, and where leaders began earlier with fact-based, consistent messaging to the public but gave no false reassurances. This strategy is particularly important in ethnic minority communities where discrimination is common and people are predisposed to fear and distrust authority.

With the COVID-19 pandemic, the recommendations guided by science may conflict with people’s cultural beliefs and values. Unfortunately, in some faith communities here in the U.S., certain leaders have decided not to listen to experts and have continued holding in-person worship services, which have brought harm by spreading the coronavirus. This is similar to what happened with the Ebola virus outbreak in West Africa a few years ago, when scientists told people they couldn’t touch the dead bodies of their loved ones, which really went against cultural practice. Being from Liberia, I understand the strong value placed on being together as a community and embracing, especially in hard times. Changing those practices during the Ebola epidemic required religious leaders to come to an understanding of science and set the example.

In disadvantaged communities, leaders are not necessarily people with titles or elected officials; they are the people who have served others in ways that enable them to deliver well-received messages. I’ve been struck with how well leaders in Baltimore and across Maryland have worked together, from the governor down to city agencies and private organizations, academia and philanthropies. We have tried to include different voices in identifying people’s needs and concerns, and in delivering messages about what to do to stay safe and where to get help.

How are health care providers who serve low-income populations reacting to the pandemic?

These dedicated providers have really stepped up to work with people and be flexible with them. To protect patients from having to come out to the clinic for routine visits, providers are available by phone and use whatever communication methods are most comfortable for patients. The providers are also helping patients find resources to enable them to pick up their medication, find food and housing, and apply for unemployment or other assistance.

In more resourced communities, providers who are not used to dealing with these issues are having to learn on the fly, since so many of their patients are out of work and suddenly in bad situations as the economy is slowing down. The pandemic has shown the importance of a more holistic, integrated approach to health that takes into account not only medical issues, but social ones as well.

Could this pandemic open the door to new solutions to reduce health disparities?

I think the COVID-19 pandemic has revealed how interconnected and vulnerable we all are, and how much our well-being is dependent as much on what those around us do as it is on what we do ourselves. When others don’t have the opportunity to be healthy by engaging in social distancing, it puts all of us at risk. This is much more apparent with an infection like this than it might be for another type of condition. Even if you telework and wear a mask to avoid spreading your germs to others, you may still be affected by essential workers who had to go out to do necessary tasks but didn’t have protection. They may have used public transportation which exposed them to the virus, or they may have been working while sick because they had no paid sick leave and were afraid of losing their job. And If these essential workers get sick, we may not be able to get needed food or supplies.

The pandemic could bring a shift in thinking toward valuing all people regardless of background, economics, or what’s on the surface. We know now more than ever that every member of our society is important. It may force us to come up with new ways, including technology, to connect everyone with the things they need, from food, education, and work, to worship, social connection, and entertainment. COVID-19 has also pushed us to ensure that more people have their basic needs met, [because] it has now become a matter of life or death.

Karen Kruse Thomas, PhD, is the Bloomberg School historian.