PRESIDENT TRUMP “DISCOVERED” this spring that African Americans are disproportionately impacted by COVID-19. “Why is it three or four times more so for the black community as opposed to other people?” he asked during a live coronavirus task force briefing in April. Black social media erupted.
One friend wrote, “The white man said it, but we have been screaming this for years.” Another person posted, “Blackness is not a risk factor. Anti-blackness is the comorbidity.”
I began to seriously consider the impact of race on health while becoming a registered nurse. Combating health disparities in the black community eventually brought me to midwifery. As a health care provider, the language of “comorbidity” (two or more chronic health conditions) and “modifiable health risk” (a risk factor for illness that can be lowered by taking an action) has become part of my vocabulary.
Following Trump’s question at the press briefing, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, responded, “When you look at the predisposing conditions that lead to a bad outcome with coronavirus ... they are just those very comorbidities that are unfortunately disproportionately prevalent in the African American population.” A few days later, U.S. Surgeon General Dr. Jerome Adams noted that minorities are not more predisposed to infection “biologically or genetically,” but rather they are “socially predisposed” to it.
In other words: It’s not race that’s killing black people, it’s racism.
Let me present a case study on hypertension and guidelines for treatment from one of my medical classes. Gerald is a 66-year-old black man with a history of asthma, obesity, and Type 2 diabetes. He smokes a pack of cigarettes a day, denies alcohol use, and rides his bike three times a week. The teacher says, “Tell me, what are his risk factors?” Students shout: “Smoker.” “His age.” “He’s black.” The instructor nods, we move on.
More than once my peers and I have reminded our instructors that presenting race as a risk factor is erroneous, cultivates bias, and can be harmful to patients. Racism, in U.S. society, is a modifiable health risk. Race is not a risk factor.
In April, New York City officials noted that black and Latino residents were dying of the coronavirus at twice the rate of white people. In cities such as Milwaukee and Chicago, more than 70 percent of virus-related fatalities were among African Americans—a staggering statistic given that the percentage is more than double their share of the population.
Anti-blackness has become a distinct social disorder linked to the reality of living as a black person in a highly racialized country. It’s a comorbidity because of how it affects one’s ability to get optimum health care. Anti-blackness mentality and behavior slip into clinical care settings in a variety of ways: When primary care providers don’t trust what black patients say about their levels of pain; when primary care providers label patients who are people of color as “noncompliant” for not having followed medical recommendations; and when health care providers forget that black bodies have historically been experimented on, such as in the Tuskegee syphilis study that ended in 1972.
Black social media’s critique of inequality in health care comes from a credible source: Black experience in America. Those affected by racism do not need experts to inform them that racism is a problem or the problem.
Cornel West talks about the dangers of maintaining an “allegiance to the status quo.” The current status quo is a modern health care system that includes institutions that are racist and built on principles of white supremacy. Racial/ethnic equity can be achieved when equity is set as a priority, eliminating institutional racism is our focus, and communities that are most affected are equipped with the resources needed to lead this process.
Before my classes moved online due to the COVID-19 lockdown and my on-site clinicals were canceled, one of my professors shared what it means to be a primary care provider. To be a nurse, she said, is to be grounded in the notion that the care we provide must be excellent. Its aim is to create and cultivate the societies that we want to live in—both now and in the future. We cannot allow disparities in health to persist under the weathered guise that it’s all too complex or enigmatic.
Kierra Jackson, RN, is a master’s student in advanced practice nursing at Yale University.
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