By Hope O’Dell and Gregory Manni
For some background to this article and a brief explanation of systemic racism, read Part 1
Dr. Khan Nedd, a specialist in internal medicine and a founding member of the Grand Rapids African American Health Institute (GRAAHI), wasn’t surprised that people of color and those in the ethnic minority were being hurt more by COVID-19.
“COVID kind of opens up, or to some degree, puts a spotlight on something that those of us in the business have already known,” Nedd said. “Which is, there are significant healthcare disparities in the United States, and it’s defined by race and ethnicity, and sometimes your zip code.”
Nedd, who’s worked in Michigan’s medical field for over twenty years, and at GRAAHI for almost as long, said injustices due to health, environment, and race cross his path on a daily basis.
“It’s a scientific fact,” Nedd said, of healthcare disparity. “Whether you are politically on one side or the other, I think when you look at the data, you know it exists.”
According to the CDC, people of color and Hispanic people account for 59.3% of COVID-19 cases and 49.1% of deaths, while they make up only 39.9% of the American population.
The healthcare industry has historically victimized people of color, from the infamous Tuskegee Study, where Black men were unknowingly used to study untreated syphilis, to the forced sterilization of Indigenous women. It’s led to a widespread sense of distrust among people of color. In 1951, for example, doctors at Johns Hopkins stole the cells of a Black cancer patient named Henrietta Lacks—and without payment or consent, her unique cells were used in study after study, eventually becoming an indispensable part of modern medicine.
These individual cases make the medical community look bad enough in retrospect, but the most egregious injustice was the communitywide healthcare segregation all Black Americans faced. Black mistrust of healthcare is justified. Looking back, people of color have been treated more like lab rats than patients.
While overt injustices like segregation and sterilization are less prevalent in the medical world today, many remain beneath the surface in the form of systemic racism. COVID-19 has exacerbated these systemic inequities to a breaking point, causing some government officials to take notice and act. In August, Gov. Gretchen Whitmer declared racism as a public health crisis in Michigan. In her declaration, Whitmer cited the fact that COVID-19 is more than 4-times as likely to kill a Black Michigander compared to a white one.
People of color continue to endure lower-quality healthcare—a factor which may be contributing to increased COVID-19 infection and death rates. Environmental injustice, income disparity and barriers to quality housing can intertwine with healthcare inequity, too. Together, they make it harder for people of color to thrive, especially in a world burdened by COVID-19.
However, giving these communities the support to participate in setting the rules behind healthcare and housing may help them to take control of their own wellbeing—and overturn the effects of systemic racism.
Healthcare Disparity and the Pandemic
One in seven Black children have asthma, compared to one in twelve white children, nationwide. Black Americans are 1.3 times more likely to experience obesity as well. Alongside related issues like hypertension and diabetes, these underlying conditions make it much more difficult to fight off the coronavirus: those with asthma are 1.5 times more likely to be hospitalized from COVID-19, and those with obesity are at least 3 times more likely. In summary, it means a lower chance of survival for Black Americans.
According to a 2005 study by the Institute of Medicine, now called the National Academy of Medicine, the lower overall health of Black Americans had nothing to do with income, insurance status, or age, but rather, it was because they were receiving lower-quality healthcare compared to white people. It wasn’t a lack of access, but a lack of proper care.
The study found that physicians could hold unconscious, or implicit, biases about people of color, which would make them less likely to prescribe the most effective treatments. The individual physicians and their biases accumulated to create an inequitable healthcare system, with far-reaching effects. Namely, communities of color were more likely to experience lower levels of health overall.
While healthcare can be influenced by the implicit bias of care providers, there are also discrepancies in the way medical solutions filter down to the public—like when a vaccine for COVID-19 becomes available, for example.
“The oxygen in disparities is this very baked-in concept,” Nedd said. “When you have good things that can affect all of the world’s population, the method in how it’s distributed is still in a caste kind of a format.”
Nedd is concerned that the ingrained disparity in our healthcare system may cause a potential COVID-19 vaccine to be distributed unfairly.
“It often goes first to people who can afford it,” Nedd said. “People who are at the front of the line, so to speak.”
Those at the front of the line would most likely be white people, due to what Nedd calls the “disparity gap,” a barrier that prevents healthcare research and solutions from reaching the most vulnerable people. This often means people of color, who are more likely to be lower-income compared to whites, and may not have the resources to pay for their healthcare.
For people of color, limited access to a COVID-19 vaccine would only compound the current injustice of increased infection and death. But Nedd said that the answer goes beyond the here and now—that it’s important to fix the problems at the foundation of this crisis.
“To only respond to COVID is just the tip of the iceberg,” he said.
He pointed to some of the root causes of health conditions like asthma, diabetes and obesity: environmental injustice and food insecurity.
Communities of color breathe in nearly 40% more polluted air than white communities. Additionally, 68% of Black Americans live within 30 miles of a coal-fired power plant—facilities that can emit mercury, arsenic, lead, and other toxins into the surrounding environment. As Nedd suggested, air pollution is linked to childhood asthma.
In terms of access to healthy food, non-Hispanic Black and Hispanic households in the U.S. were at least twice as likely to experience food insecurity than white households. For people of color and ethnic minority groups, food insecurity is linked to disproportionate rates of diabetes and obesity.
These health conditions can generally be tracked by demographic and neighborhood, Nedd said. Put another way, conditions like asthma, diabetes and obesity occur in a systemic pattern across the entire country. It turns out that demographic data and zip code are a powerful tool for estimating a lot of things about a person’s life, such as the level of investment or disinvestment in their community, the barriers or life opportunities they might have, the impact of climate change, or even the cost of their energy bill.
Energy Injustice and COVID-19
Tony Reames, assistant professor of environment and sustainability at the University of Michigan, has been studying the role of racial, spatial, and socioeconomic disparity in communities and neighborhoods for years. Some of the inequalities at the center of his research are being amplified by the COVID-19 pandemic.
“One thing that this current moment is highlighting is the racial inequities, particularly those tied to place and housing,” Reames said. “Although housing discrimination is illegal—and segregation is illegal now, the vestiges of those things are very strong and pervasive.”
Reames’ research is particularly focused on “energy injustice.” Energy injustice, he said, is the understanding that social inequities around race, ethnicity and income level can prevent certain populations from making their homes more energy-efficient, which results in an increased cost of living, and ultimately, a reduced quality of life.
In Michigan, Reames said, energy injustice can be seen in low-income communities where households make too much money to be considered for government-funded home-improvement programs, but not enough money to do the work themselves. One in eight households in Michigan fall into this income gap, he said.
The inability to replace insulation, update lightbulbs or get a furnace repair means these homes are leaking energy, which leads to larger utility bills. For those who struggle to make ends meet, high energy costs can bring about something Reames calls the “heat or eat” phenomenon: where households are forced to choose between a comfortable living environment, and other essential costs, like buying food. Faced with the “heat or eat” problem, households often opt to cut down on energy bills, which can mean a house that’s colder in the winter and hotter in the summer.
Uncomfortable homes can carry along a host of health risks, Reames said, such as respiratory illness from breathing in cold, low-quality air, or an increased risk of heatstroke during summer heatwaves, which continue to worsen with the arrival of climate change.
The coronavirus pandemic and ensuing stay-at-home order added another layer atop these hazards for some households, as people were pushed into close proximity for extended periods of time.
With families stuck at home, stable utilities have become more important: this summer’s regular ninety-degree heat meant an increased need for air conditioning—and internet access became a greater necessity, both for at-home workers, and children attending school from a distance. As fall turns to winter, the need for heat will raise utility bills further.
Utility companies in Michigan promised not to shut off any utilities during the pandemic, which Reames said was the proper response. However, several major utilities ended that moratorium in mid-June, including DTE and Consumers Energy. Even with government assistance, it’s probable that, of the 17,937 households with past-due bills, some number will fall through the cracks.
A Moment for Change
At a time of such uncertainty, Reames said now is a good opportunity for tangible change—especially as climate change gets worse. Whatever the outcome of the 2020 general election, he sees a possible window for change in 2021, fostered by a mixture of persistent progress on the state and local level, and the potential for national policy shifts, like green stimulus plans and the Green New Deal.
“We have an opportunity to really put forth a green stimulus package that creates jobs and focuses on equity,” Reames said. He also said that policy changes should “treat housing as a part of the energy infrastructure.”
That’s because housing in an important piece of the puzzle when trying to bolster a community’s resilience toward climate change, he said. Because systemic oppression and environmental injustice have made people of color more vulnerable overall, their communities are more likely to be negatively impacted by climate change.
“Our buildings consume a lot of energy, but they’re also places where you live and thrive,” Reames said. “So how do we think about those things, while also being resilient to climate change?”
It’s important to ensure that vulnerable populations have the resources to adapt their own houses to meet the hazards of climate change, Reames said. As climate change causes heat waves that are more frequent and more intense, for example, air conditioning may become a more significant necessity. This is a multifaceted issue, he said, both in improving access to technologies like air conditioning, and in tackling the kind of energy that powers them. A green stimulus plan should ensure that resources are both renewable, and accessible to everyone.
“I think we have the opportunity for an equitable policy that is more holistic, that sets us on a path to both adapt to, and address, climate change at the same time,” Reames said.
As change comes, and renewable energy becomes more common, Reames said that a pull away from fossil fuels should address the double injustice at the center of dirty energy production: energy’s unaffordability, and its toxic effect on people of color.
“We have to recognize that the unaffordability of energy is directly related to racist policies that determine where people live,” Reames said. “Where the energy is being generated, particularly the dirty places, are those same communities that can’t afford the energy—that they’re suffering the environmental impacts of that production.”
While the pandemic has brought a sense of urgency to finding solutions to energy injustice, Reames has been working toward tangible change for a long time. He said for him, positive change toward “energy justice” means a public informed and in control of their energy options.
“Energy justice, to me, looks like the equitable distribution of technology, programs, policies and participation,” Reames said.
That means showing people how to understand their utility rates, Reames said, but also encouraging them to participate in the process. He said not many people know they can attend Public Service Commission meetings, make comments, ask questions and even voice their disapproval of high utility rates.
“That’s how we build an equitable energy future—an energy future that addresses climate change mitigation and adaptation, and an energy future that addresses the needs and wants of the people,” Reames said.
For Nedd’s part, he said new solutions to healthcare disparity need to be formulated very carefully, so as not to perpetuate the problems they set out to fix. He said policy shifts, like the expanse of government-run healthcare, should be a part of the solution.
“Populations facing disparity, if given the opportunity, will step up to, and not shirk their responsibility in participation,” Nedd said.
Nedd’s vision of change echoes that of Reames: educating vulnerable people on how to navigate the systems that build everyday life—whether that be the healthcare industry, or energy utilities—so that they have the power to actualize their own wellbeing.
“But we never get there,” he said.
This is the end of Part 2. Keep reading to learn more about the disproportionate impact of COVID-19 from community leaders in Grand Rapids, and find out how it’s influencing discussions around racial and environmental justice in West Michigan. Part 3 coming soon.
Thanks to Crystal Scott-Tunstall, an editor for this piece, and Carlos Calderon, for help in tracking down sources.