For many people of color, health concerns are never just about a particular disease, but they also include other socioeconomic factors that could affect their physical well-being, said Rodriguez-Diaz, an associate professor at the Milken Institute School of Public Health at George Washington University.
The Pew survey, published last week, found that a majority of Americans of all races and ethnicities see the coronavirus as at least a minor threat to their health. But among African Americans, 46 percent see it as a major threat to their health, as do 39 percent of Hispanics. Among white adults, 21 percent see the coronavirus as a major threat to their health. Older people and those who did not attend college also were more likely to see the coronavirus as a major threat to their health.
Rodriguez-Diaz said his work focuses on people of color and “populations that are socially vulnerable,” including LGBTQ individuals, poor people, the incarcerated, drug users and those experiencing homelessness. Their social and economic conditions make a difference to their perceptions about their health.
African Americans and Latinos have higher uninsured rates than white Americans do, and also are disproportionately represented among the low-wage workers who have faced layoffs, with businesses scaling back or closing as a result of the pandemic. In a new Washington Post-ABC News poll on the public’s concerns about the financial fallout of the coronavirus, about 4 in 10 African Americans and Hispanics say an immediate family member has lost a job, compared with about 3 in 10 white people.
Individuals with chronic illnesses such as high blood pressure, diabetes, heart disease and asthma are at greater risk of becoming severely ill from the coronavirus, and people of color are disproportionately affected by such conditions.
Congress appears poised to pass a $2 trillion relief package, including extended unemployment benefits for workers, but it’s not clear how it will affect some of the groups that Rodriguez-Diaz is concerned about.
“In terms of how worried these groups are, it might be affected by other identities and experiences,” Rodriguez-Diaz said in an interview this week. “Those identities or experiences intersect, so it’s not like you’re black or Latino and that’s the only thing that will affect your health outcome.”
It also doesn’t help that public officials have made conflicting and confusing statements about how people should prepare for and protect themselves against the coronavirus, and that President Trump has seemed more concerned about the disease’s toll on the national economy. This week he has repeatedly said he wanted to see businesses reopen and people going back to work, even as public health experts say it’s too soon to curb social distancing.
About US talked with Rodriguez-Diaz about why people of color might have more fears about the pandemic. This interview has been lightly edited for length and clarity.
You want to make the point that this disproportionate concern is not so much about race or ethnicity as it is about social conditions that many people of color experience in the United States?
If we look at traditional health trends, let’s take asthma or cardiovascular disease, we know that people of color — African Americans and Latinos — are disproportionately affected among those who have been diagnosed with those conditions. That’s only looking at race. If you look at socioeconomic status, we also know that people who have lower socioeconomic status have an increased risk for certain negative outcomes.
It’s different if you’re black and have a high socioeconomic status, access to health care, the ability to work from home and savings. That experience is different from somebody who is black and poor, living paycheck to paycheck, has no savings because it’s difficult to survive with a minimum-wage job, worried about not having health care, and if you get exposed to the virus, you wonder, where will I go and how can I afford health care? It’s a combination of factors, not just perceived risk of infection, but the experiences these racial groups have in the United States.
You call those social determinants of health outcomes. What does that mean?
That means our health outcomes are determined by social factors, and not only by biological factors. Some examples of social factors are employment, health-care systems, education and food security. Food security means not only having food, but having the right food. A very good example is, even if we look at our neighborhoods here in the [Washington metropolitan area], we know there are pockets where we have more African Americans or more Latinos, and if you look at the supermarkets and restaurants available for those communities, the quality of the food is different.
It’s the same with health care. Even in places such as D.C., where technically anybody can have health care, my experience with the Latino population is that they might know they have access to care, but are hesitant because they don’t want to go through a process that they see as too invasive. Because of the policies of this administration, they don’t want to disclose as much information and put their immigration status and ability to stay here at risk. And for Latinos, language can also be a barrier; you can’t assume all Latinos are bilingual. We could also talk about other populations such as Ethiopians and other groups that live here.
Why do you say that the public health conversation about the coronavirus is problematic for vulnerable communities?
Public health is political. It’s hard to make the right public health policies without the political will, and I think overall that’s what we’re seeing in the United States right now. The public discourse going on is — what is important? Lives or the economy, and whose lives matter. We are not doing well [with messaging] for the general public, so we can predict that we are doing very poorly for the populations that need special approaches. For example, I was just reading that one problem we’re going to see will be among people who are incarcerated. I haven’t heard anybody from public health authorities talk about prisoners. Typically we don’t talk about prisoners. It’s not a population most people even think about. Certain conditions in prison increase the risk for infection because you have so many people confined in a space, and once it’s in the system, the likelihood of it spreading is very high. It’s like being on a cruise ship.
How do statements and actions by political leaders that seem to prioritize the national economy affect people from different socioeconomic groups?
It affects how people have to make decisions about their well-being. If you have the privilege to work from home, even when your industry opens, you can stay home. If you do not have that option, you have to decide, I need income to pay rent or mortgage, so do I put myself at risk? It’s not what I want to do, but what are my options — lose my job, lose my home, and then be out on the street? It’s precisely an example of social determinants of health: People know their risk, but it’s not only biology and knowledge of disease and what to do to prevent it, but all of the social factors, including employment and income, that affect their ability to keep doing what is healthy.
What should we be doing to make sure that everyone, especially those from vulnerable groups, gets the information they need and are included in decisions about how we navigate the pandemic?
The first thing is to stay home and practice physical distancing. That’s something we have to do. Second, let’s take the opportunity because we’re home. Many of us have the technology and access to the Internet. Let’s advocate for good practices and policies that we believe in. We should be calling our representatives, from the county level to the national level. We can write letters to local or state newspapers. Third, we can help others. We can help our neighbors by getting them groceries or taking their trash out or engaging with them socially using technology.
The last example is for people who are very active on social media — call out information that is incorrect. Point it out and try to get it taken down because that increases the risk for other people who might not be able to discern that that is not good information.