While the current coronavirus pandemic is affecting all of us, it isn’t affecting all of us equally. Some communities—especially communities of color—are feeling the brunt of the virus more than others, in terms of higher rates of infection as well as economic fallout, among many other ways.
In this third special COVID-19 episode of The Brain Architects podcast, host Sally Pfitzer is joined by Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies, Harvard Faculty of Arts and Sciences. Dr. Williams discusses ways in which the coronavirus pandemic is particularly affecting people of color in the U.S., and what that can mean for early childhood development. He also pinpoints the importance of creating “communities of opportunity” that will allow all families to thrive—both during and after this pandemic.
Upcoming episodes of this special podcast series will focus on domestic violence, and the mental health implications of a global pandemic. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. This episode is the third in our series, and our guest today is Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health – Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies -Harvard Faculty Arts & Sciences. Thanks for being with us today, Dr. Williams.
Dr. Williams: Thank you, it’s good for me to be here with you.
Sally: Just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. So, the data that’s coming out now that we’ve been seeing continue to reinforce the research that you have been doing for many years around racial disparities, and we’re seeing that this virus is disproportionately effecting people of color. What are you seeing now in terms of the data?
Dr. Williams: We are seeing in multiple states more than half of all deaths from the Coronavirus are African American, and in virtually every state the percent of deaths of African Americans who die from the Coronavirus exceeds—it’s larger than the percent of African Americans in the population in that state. So, there is a disproportionate negative impact on African Americans in New York City, and we see a similar pattern for Hispanics. I think the important point I would like to make at the onset is that first, this is not a surprise. Two, this reflects a longstanding pattern, not just for Coronavirus but for virtually all of the leading causes of death. And that this pattern does not reflect failures on the part of the individuals, the families, and the communities that experience such disproportionate losses.
Sally: I think a lot of times when we’re hearing about this data coming out, there is a missing component where people are hearing this is disproportionately affecting communities of color, but there is not a lot of talking happening right now around the ‘Why?’. Could you share a little bit more about what the underlying causes of this disproportionate impact actually are?
Dr. Williams: Sure. Before we talk about underlying causes, I think it’s also important to emphasize that when we see one group in our society disproportionately affected, it affects all of us. It is about all of us. We are all connected. Higher rates of death for one population effects the entire profile and the entire risk for all of the population. In terms of what are the causes of these patterns? We’ve known for a long time many of the culprits. Number one I would mention is lower income, lower education, lower occupational status. In virtually every country of the world, persons of lower levels of education and income have higher rates of disease and death than those who are better off than they are. And when we say race and ethnicity in the United States, we are talking about groups that really vary dramatically in economic resources. I’ll give you two numbers that makes this very concrete. If you look at the latest income data for the United States, published in 2019 by the U.S Census Bureau1, we find that for every dollar of household income White households receive, African American households receive .59 cents. That .59 cents to the dollar figure is identical to the racial gap in income in 1978. Most of my students think we have made a lot more progress than that. As bad as the income gap is, it dramatically understates racial differences in access to economic resources. Because income captures a flow of resources into the household, it tells us nothing about the economic reserves that households have to cushion short falls of income. We get that from data on wealth. The latest report from the Federal Reserve Board indicates that for every dollar of wealth White households have, African American households have .10 cents, and Latino households have .12 cents.2
So, we are looking at groups that are disproportionately, economically disadvantaged; number one. And in multiple ways that raises the health problems and challenges that they will face. COVID-19 really illustrates this phenomenon very powerfully. What we know is that minorities have early onset of disease, early onset of chronic conditions, hypertension, diabetes, heart disease, all occur at younger ages. Part of this is driven by the lower economic status and higher levels of stress. Also, persons of color disproportionately in jobs where they have to go to work in order to get paid. We are working in jobs that don’t provide benefits, often don’t provide healthcare benefits, which lowers access to medical care. In New York City, for example, the hardest hit area of the pandemic, 60% of the essential workers in New York City are persons of color.3 Research also documents that in disadvantage communities, even if you get access to primary medical care, many of those primary care providers do not have admitting privileges at the best academically based or private health care systems where the best specialists are, so that those populations are also limited in the access to quality care. More generally, there is at least one study since the COVID-19 epidemic has begun that looked at a data from multiple states and that reported for testing for COVID-19 that African Americans, with the same symptoms as whites, showing up requesting a test were less likely to get the test.4 We also have evidence of the persistence of discrimination in terms of access to tests in addition to the fact that most of the testing sites are in suburban communities and there are fewer testing sites in central city communities that have a larger unrepresentative minority population.
COVID-19 is a perfect storm in terms of having a disproportionate negative impact on disadvantaged populations in the United States.
Sally: A lot of what you’re describing reminds me of that saying, “a person’s zip code has more to do with their health outcomes than their genetic code does.” What does that mean and how does that relate to this current situation?
Dr. Williams: I think it’s important to recognize that challenges these communities face are long standing and it didn’t happen by chance – they are not random events. They actually reflect the successful implementations of social policies. We had social policies implemented in the United States, but residential racial segregation being one of the most profound of them in terms of its far reached negative effects that still persist today that restricted a way a person lives based on race or ethnicity. That has had a dramatic effect in reducing access to opportunities – opportunities in early childcare and good early childcare environments. Access to good early education, access to employment opportunities. Opportunity in terms of the quality of neighborhood and housing environments and whether it’s easy or difficult to get exercise safely in your neighborhood. Whether it’s easy or difficult to have access to good primary care in your neighborhood. Across a broad range of factors that drive opportunity and success and society, we have large segments of our population restricted by these historic inequities.
Just to illustrate how powerful some of these effects are; a national study led by Harvard economists showed that if we could eliminate residential segregation in the United States overnight, we would completely eliminate or erase black and white differences in income, in education, and in unemployment, and reduce the black white differences in single motherhood by two-thirds.5 All of those differences driven by opportunities linked in place. What we need to think is how can we create communities of opportunity? Communities with high-quality early childhood programs, where every child is given a fighting chance to be successful—not only prepared for school, but also prepared for good health – a good foundation for health for the rest of their life. What can we do to reduce childhood poverty? What can we do to enhance employment opportunities for parents? One of the ways we can improve outcomes for children is by enhancing opportunities for their parents. How can we improve housing and neighborhood conditions?
The good news is there are examples of programs in the United States that are doing these things right now, and many of the studies show that these programs not only work but they will save society money. There is a range of opportunities of things we could do now to make a difference. When we take care of all of us and all of us have the opportunity, we not only build a more educated, a more productive workforce, we not only enhance the economic productivity of our society and the global economic competitiveness of our nation, but we also do something more that is profound, and that is we take care of all of us. We are all in this together, and what hurts one of us hurts all of us. It is in our best interest to work together to create a society that provides opportunity for everyone.
Sally: You mentioned stress as a factor contributing to the racial disparities and outcomes. Would you mind talking a bit more about how stress can affect communities and long-term health?
Dr. Williams: Sure. I want to talk a little bit more about the fact that minorities; African Americans, Latinos, Native Americans, have higher rates of underlying chronic conditions. The question is why? Is it their fault? Is it all linked to the bad choices that they are making? What the research points to is that you are looking at populations that are experiencing higher levels of stress. In some of my own work, I have found that the most of common stressors—stressors like loss of a loved one, unemployment, financial difficulties, violence in a neighborhood—all of these occur at higher levels among African Americans and among U.S. born Latinos.6 Not only do they have higher levels of the individual stressors, but they have greater clustering of stressors, so if you have one you are more likely to have multiple. What research is pointing out is that living out of the conditions of high levels of chronic stress leads to a physiological dysregulation across multiple biological systems. There is a body of research suggesting that at the same chronological age, racial ethnic minorities may be biologically older than Whites in the United States.7 It reflects the high levels of exposure to psychosocial as well as physical chemical stressors.
Let me give a practical example of the physical chemical stressors. There is one recent study done by researchers at Harvard University documenting that persons who live in areas with higher levels of air pollution, which are disproportionate minority, those persons if they get COVID-19, it is more severe and they’re more likely to die.8 The air pollution, this chemical stressor, has a negative effect in terms of adversely impacting health. In addition to higher levels of the chronic stressors, one of my areas of research has also been looking at stress of racial discrimination. I have developed measures to capture discrimination. One of them that is very widely used around the world is called The Everyday Discrimination Scale.9 It captures minor indignities – being treated with less curtesy and respect than others, receiving poorer service than others at restaurants or stores. The research documents that these little indignities accumulate and adversely impact physical health, mental health, the quality of sleep. It predicts early onset of multiple chronic diseases and even adversely impacts how individuals access and utilize medical care. If you’ve been treated badly in multiple domains of society, then you become less trusted in even the healthcare context. What emerges is a picture of the cumulation of negative experiences of chronic stress that have long term negative impacts on health.
The challenge, though, is that most Americans are unaware that racial ethnic disparities even exist. Raising awareness levels is really important, because if we don’t even know a problem exists, we are not mobilized to address it. Maybe COVID-19 provides us an opportunity to become more informed and hopefully to become more committed to working together to create a better future for all.
Sally: So, we’ve talked a lot about racial disparities in physical health related to COVID-19, but could you talk a little bit more about other ways in which people of color may be disproportionately impacted by this pandemic?
Dr. Williams: COVID-19 is an unprecedented challenge that we are all facing together as a society. This unprecedented challenge is a physical health problem, but it is going to produce a large scale of economic devastation, which we have touched on to some degree. It also will have large scale, negative emotional consequences. One of the things that we really need to think of is how do we provide support for all communities, but especially those who are already suffering disproportionately from the economic effects—those who are suffering disproportionately from the loss of loved ones. When we say that African Americans and Latinos are experiencing higher rates of death, that’s people losing mothers and fathers, grandparents, brothers and sisters. This is a community that will also be experiencing higher levels of grief and loss in addition to all of the negative effects of the pandemic. So, we really need to think of how can we enhance the access to emotional resources that helps people cope, and how all of us as individuals, even as we socially distance, we do not emotionally distance. That we do reach out to others and be supportive and be helpful, so that people can still have that sense of caring from others and that sense of emotional support from others.
Sally: I’m imagining that many listeners might be wondering what they can do, and how we might be able to help change this for the future?
Dr. Williams: Sure. I think when it comes to stress and environment, there are things that individuals who are suffering now can do that can protect them from some of the negative effects of stress. So for example, even the research on stress in general, but also research on discrimination in particular, points out that individuals who are embedded in close-knit, emotionally supportive relationships, the quality of social ties can reduce at least some of the negative effects of stress on health. There are some research suggesting that higher levels of religious involvement can also protect individuals from some of the negative effects of stress on health. There are things that can be done at the individual level. At the same time, what can we do to create environment where stress levels are lower? How can we create high quality neighborhoods so we will reduce the levels of neighborhood stress? How can we promote greater civility and respect of others as a value, so that we reduce the occurrence of discrimination in the first place? How do we make workplaces more friendly and more stress free than they currently are today? So, I think we do need to think of the high-level policy solutions that create environments that are low in stress, even as we empower individuals to more effectively cope with and deal with the stresses they face.
Sally: I really appreciate you taking the time, I know it’s incredibly busy and I know there are a lot of people asking for your time, so thank you so much for the opportunity to interview you.
Dr. Williams: You’re very welcome.
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.
1U.S. Census Bureau 2019 Income Data
5Cutler, David M., and Edward L. Glaeser. 1997. “Are Ghettos Good or Bad?” The Quarterly Journal of Economics 112(3): 827–72.