Abstract
So any time you have a major disaster that somehow hits a community, or a city, the communities that is most vulnerable are the same communities that are most marginalized when it comes to health impacts and economic impacts.
COVID-19 is a pandemic that has highlighted and really shone the spotlight on issues of vulnerability, marginalization, and health disparities, showing how the physical environment and health are intertwined. So, in a sense, COVID-19 is like a heat-seeking missile that is targeting the most vulnerable populations, and the bull's-eye is actually the environmental justice communities, the communities that are the poorest, that are the most polluted, that are the sickest when it comes to comorbidity, and the result of this heat-seeking missile called COVID-19 is a death bomb, and you can see that in the elevated hospitalization and the elevated deaths among African Americans particularly, but people of color in general.
We know that not only air quality, but also housing quality, indoor air pollution, and poor ventilation can be factors in the spread of disease, creating conditions for more concentrated exposure. It can also be the indoor air pollutants that tax the lungs and make the lungs more vulnerable to the spread. If someone has COVID-19, which also attacks the lungs, this then becomes a double attack on the lungs.
The last point I will make is around the various illnesses that tend to be more prevalent in communities of color, including historic redlining (the systematic denial of services, loans, access to certain neighborhoods, insurance, etc., to certain groups based on race or ethnicity), modern-day redlining, and current food insecurity that happens in our communities that leads to exacerbation of these underlying chronic health conditions, because we are not eating the types of foods that will build up our immune systems, or we are eating the types of foods that would actually exacerbate those, whether they are high in sodium or high in preservatives, high in sugars, and so forth, which make those conditions more difficult to control, because they are constantly being plucked by these diets that we have no choice but to consume, because we do not have the access to fresh and healthy fruits and vegetables and so forth in our communities. Those are just a few examples.
We talk about mapping food deserts, mapping toxic waste facilities, landfills, power plants, chemical plants, refineries, and highways. We know that the built environment has an impact on health.
When it comes to social determinants of health, in many cases, racism and racialized places have created this saturation of the bad stuff in certain areas. At the same time, these are the same neighborhoods and communities that have a high concentration of households and families that are uninsured and that do not have transportation to get to health appointments at hospitals and clinics. We also talk about economic structure and how racial discrimination impacts what kind of jobs people have and what benefits people have when it comes to those jobs. In some cases, if an individual does have a job, but it is a low-wage job that does not come with health insurance, then having a hospital right next door will not make a difference when it comes to those individuals seeking out health care.
And so, when we talk about those things such as access to health care, we have to talk about other factors affecting daily living, such as having health insurance, having jobs that will pay individuals a living wage, and some kinds of benefits such as paid sick leave, and so on. Those kinds of things will be drivers of impact in terms of whether or not you have a healthy life, and that shows up in health outcomes.
It is important to also know that whereas many of us have jobs that we can do at home while sheltering in place, the kinds of jobs that we are realizing as essential workers have the kinds of jobs where if you do not go to work, you do not get paid; if you miss too many days, you will get fired. If you look at the percentage of people of color who are in those essential jobs and who have to go to work versus those who are able to work remotely, those numbers are very different in terms of demographics.
As a matter of fact, I saw statistics that actually reported that ∼61% of surveyed Hispanics and 44% of African Americans 3 said that someone in their household was laid off or had wages cut in April 2020, compared with 38% of whites. It also showed that the workers who are in those jobs such as delivery, store clerks, and people (not doctors) working in hospitals in positions that placed them at greater risk do not always have the necessary kinds of protective gear and they are getting sick.
There is talk about workers in the meatpacking industry. This industry disproportionately employs Black and Latino workers. Roughly 44 percent of meatpackers are Latino and 25 percent are African American. 4 These jobs can't be performed from home. Black and Hispanic workers are much less likely to be able to telework. Just 16.2 percent of Hispanic workers, 19.7 percent of Black workers compared with 29.9 percent of white workers are able to work from home. 5
I think about the statistics around African American women with breast cancer. It is one thing to have higher incidence of breast cancer, but another thing that black women are more likely to die from breast cancer earlier. I think about amputations and how when African Americans report to a health care facility seeking treatment for diabetes, for instance, and how they are more likely to experience amputation than white Americans who seem to experience more extensive efforts to salvage limbs. In most cases, African Americans are the most likely to have the most extreme impacts for engaging with the health care system.
Most recently, there was a special on CNN 6 about material mortality in African American women, highlighting issues around how people of color in the hospital in care are often unable to get quality care. There was one heartbreaking story where the husband was there, the mother had given birth, and he said, “Something is wrong,” and he was really crying for help. And in the end, the hospital staff did not pay enough attention. They were dismissive. And when they finally started to pay attention and started to treat her, it was too late, and she passed away. And we have too many stories like that.
In the context of COVID-19, you are hearing those same stories again—people going in and saying, “I need treatment. I need testing. I think there is something wrong,” and they are being sent home, going back, being sent home, going back, being sent home, and then, in the end, people are passing away because they were not afforded the same responsive level of care and treatment as other people. Too often, layered on top of race, is a differential response to women, rendering black women in a situation of double jeopardy.
When you start looking at these disparities when it comes to asthma and when it comes to hospitalization and when it comes to the deaths, you know, African Americans are three to four times more likely to have asthma. If you look at the death rates among black children, it is 10 times greater than it is for white children. If you look at the whole idea of where pollution is located, and the access to the health care and start mapping out ZIP codes and overlay life expectancy, it is like night and day; I am talking before COVID-19. Then, you can start mapping out where the dialysis centers are concentrated, and see where people live who are at a greater risk in terms of getting diabetes. When you start mapping out where the hotspots are when it comes to these disparities, well, COVID-19 is basically zeroing in on those hotspots when it comes to issues around diabetes and hypertension and asthma and kidney disease.
We can start naming all those things that are concentrated in one area, and then the discussion will naturally lead to what kinds of resources do many of these populations have at their disposal to get quality care, and to continue to get to the hospital or to the clinic or to wherever they need to get to when they do not own a car and have to depend on public transportation.
Ninety-five percent of Americans own cars, but if you disaggregate that and look at African Americans, specifically, you will see that those numbers shift. Nationally, 4.6% of white individuals, 13.7% of Hispanic individuals, and 19.0% of black individuals do not own a car. The overall carless population is much higher in our cities: New York (54.4%), Washington, DC (37.3%), Boston (33.8%), Philadelphia (29.5%), Chicago (27.5%), and New Orleans (20.2%). On the whole, the comparison is stark, with roughly ∼4% of whites do not own a car, but ∼20% of black folks do not own a car in cities. 7
It varies from city to city. You know, a place like New Orleans that had Katrina, the city was flooded and people were on rooftops and at the conversation center and the Superdome. Many people who do not live in New Orleans were saying things like, “Why do they not just get in their cars and drive out?”
Well, you know, 35% of black individuals in New Orleans do not own a car. And if the buses are flooded, then if a disaster hits, you are stuck. And that is the kind of thing that existed before COVID-19.
So having access to those things such as good health care, the ability to drive to good grocery stores, the ability to keep our schedules and appointments on time and not have to depend on somebody else, or the bus that may not be as reliable, those are things that exacerbate health disparities. COVID-19 basically is really making these disparities front-page news.
It just struck me in terms of the level of exposure that people were having there, the notion of their labor being seen as essential, but care and attention to their lives and preservation of their lives were not seen as an essential.
We have seen that across the continuum as it relates to marginalized communities and the lack of real care. For example, it is not seen as essential to provide the proper level of protection for people who are incarcerated, too many as a result of racial profiling and systemic inequities, and who are at high risk from living in close quarters. We have seen the many cases that have arisen as a result and too many deaths as well. As the National Association for the Advancement of Colored People (NAACP), we have relationships with multiple prison branches and we are hearing these types of stories firsthand.
The economic impacts are also being disproportionately felt by African Americans. Whether it is not being able to access unemployment because many of us are in the gig economy, or the fact that we are in jobs where we cannot work from home and are also experiencing massive layoffs because of social distancing requirements.
The paycheck protection policies are also causing some concern due to differential access. Studies show that companies and organizations owned by black individuals are disproportionately represented in the applications that are being rejected by the paycheck protection program, which means that we, again, are disproportionately in harm's way, even in the response to the pandemic, on top of the impacts of the disease contagion itself.
And this is what we saw with Hurricane Katrina, as well, where the natural disaster was the first thing, and the second disaster was the lack of real care and protection and upholding the human civil rights of people who were further marginalized.
If you look at the money that was sent out the door for COVID-19 in terms of stimulus or rescue or relief funds, you can see who got the money first: the big banks and the big companies. And if you look at even a program designed for small businesses, for example, the first people in line who got the first wave of small business money, followed that same pattern: money following money, money following power, and money following whites.
And so the same thing occurs when you talk about jobs and rescuing wages for workers. Those workers who are on the bottom of the bottom in many cases do not even qualify. In order for you to get money, it is almost like you have to have certain kinds of positions to access the system.
We see this pattern in all disasters. When you talk about recovery dollars flowing to areas where there are billion-dollar hurricanes or severe weather events, communities that are the most affluent get the money first. As a matter of fact, there was a study that was done that showed that in places in the United States where there were $10 billion severe weather events, white communities on average came out better off by ∼$126,000, whereas communities of color who were marginalized before these big events lost on average ∼$30,000. 9
And so it means that if affluent white communities are going to be better off after these disasters and people-of-color communities are going to be worse off, that shift needs to be made so that we have money following need as opposed to that dominant paradigm. We do not have that today.
This is the problem that needs to somehow build in an equity lens and a justice lens as we talk about a just recovery and a just return to normalcy, as opposed to pushing people out the door and making them go to these jobs and not giving them the sufficient amount of protection they need to be safe.
In many cases, our families are extended families. It is not uncommon to see three generations living under one roof, with grandkids, the parents, and then the grandparents. That is the inequity that exists in the way that policy gets pushed down and ultimately impacts economic health as well as physical health.
Usually one of the first things we see after these disasters is the establishment of the disaster recovery centers as the traditional way that people have been able to get assistance. Given the prohibitions on congregating in the COVID-19 reality, how are we going to pivot? After all, with June 1 being just the beginning of hurricane season and with wildfire season following closely on its heels, we know that these disasters are going to continue to come.
When I went to that disaster recovery center in Nashville, it was in this community where one out of every four houses was reduced to rubble. That was an African American community. Whether it is the fact that too often the quality of our housing stock makes our homes more likely to be rubble in the context of these disasters, or the fact that many members of our communities do not have the financial cushion to go to stay at a hotel, we have a differential level of vulnerability and impact that make us more likely to rely on the services provided by the disaster recovery centers. As such, if we do not make the pivot to a new way of providing recovery services, African American communities will suffer first and worst.
Second, in the context of climate change, as we said before, access to nutritious foods would help to support healthy immune systems to defend against the assault of viruses such as COVID-19. These immunity-boosting foods tend to be the very foods that are absent from too many of our communities, and we know that climate change contributes to the shift in agricultural yields. So one of the things that we are doing at the NAACP is we started the Seeds of Resistance and Resilience Project to advocate for better food policy, so we can actually start to have food sovereignty where we are growing our own food and not waiting for somebody to put a grocery store or farmer's market in our communities and, instead, provide for ourselves. We have seen the long lines at the food banks already, which speaks of the need. The combination of the economic hits that our communities have taken and the lack of foods in our communities from the outset is causing great harm to our communities.
So, increasing our food sovereignty links to our efforts to increase sovereignty in all realms of the commons. We must claim power and ownership. We need to switch from a dynamic in which someone can sit in a distant office, flip a switch, and turn off our access to electricity, or water, in effect, our access to life. Because these resources are essential to life, we have to shift our society from one where the profit-driven economy means that certain people are paying the price of poverty with their very lives.
When we go back to civil rights, again, because of financial strife, whether it is cutting off our water or cutting off our electricity or us not having access to foods, all of these are tied to climate issues, and all of these are direct civil rights that are being hampered in the context of the intersection of climate change and COVID-19.
So, as we go into this disaster season, we are having active conversations with FEMA and the Red Cross about making sure their response and services are rooted in civil and human rights.
Also, as we have seen the lifeline that the Internet has been as we all stay at home and we have seen the differential access due to the digital divide. One of our key advocacy points for the stimulus packages is universal access to broadband so that we have access to be able to get information.
I drafted a document titled “Ten Equity Implications of COVID-19,” 10 on March 10, 2020, before any of these patterns started to really emerge and become clear, because we know these patterns of inequity are going to leave the same communities even more marginalized and even more vulnerable, and the same is true in the context of climate change. As the Environmental and Climate Justice Director, it was even easier to write about all the issues across programmatic areas, because it all ties to environmental and climate justice. In that document, we said, “All right, not only are we going to see this pattern emerge, but instead of just dealing with these as we do in this kind of emergency-management, short-term, serve-the-people-who-are-vulnerable way, we need to think systemically about how to eliminate the systemic underpinnings of these vulnerabilities so we do not see the same pattern emerging time and time again, disaster after disaster after disaster.”
Climate change impacts have been hurting a lot of people since before COVID-19, and now we are going to be fighting two wars at the same time with hurricane season kicking off June 1 and fighting COVID-19 at the same time. It is hard for sick people to fight a war and survive. It is hard to survive when you are healthy, and that is the injustice. The sickest people who are on the frontline and who are in the bull's-eye of COVID-19 are going to be disproportionately affected if a major storm hits while we are expected to shelter in place in a major arena, for instance. In an environment like that, how can you maintain social distancing? If your home is destroyed and you have to go to a shelter, how can you keep distance? That is what we are facing right now. That is where the injustice is with us, and so we have to prepare, and we have to force our officials to be able to fight two wars at the same time, keeping justice, equity, and fairness at the core.
How do you get national attention to address the well-documented pre-existing health disparities? COVID-19 made many of these issues, such as social determinants of health and structural racism, on the front-page news for America, in human terms, for the first time, and I think we have to seize this moment.
Right now, we are going through a complete reimagination of where we are going in the future, and it is being written, and it is being written without us if we are not careful.
We have got to keep our eye on where the ball is going to be. What that means is we have to be aware of who is participating in COVID-19 clinical trials. Who is going to receive the vaccine? Who is going to receive valid and reliable COVID-19 testing? Who is going to make sure that communities of color also have access to whatever therapeutics are going to come along? Today, we are not seeing any of that data broken out by race in terms of access to testing.
I think we have to somehow keep beating the drum. There is no strategic national response to the alarming impact of COVID-19 on racial and ethnic minority populations. Have you noticed? Nobody has stepped up to fill that void, not the White House, not the historic civil rights organizations, not even the CDC and its sister offices of minority health at the NIH, FDA, and CMS, for instance. I think it is clear we are all on our own and we are going to have to solve the problem and implement evidence-based solutions community by community, neighborhood by neighborhood.
On May 1, 2020, the Department of Health and Human Services' Office on Minority Health issued a funding announcement seeking proposals to establish the national infrastructure for addressing COVID-19 and minority populations. This 3-year $40 million grant was announced on a Friday after business hours and set a 7 business day deadline for final proposals. It makes you wonder how fair the review process will be. Given the impact of COVID-19 on racial and ethnic minority communities, one can only hope this initial 3-year grant is just a beginning. It will be important that the national narrative remain “…we are all in this together…” and that COVID-19 not become characterized as a disease of the poor and underserved, marginalized populations that are deemed expendable. There will be on one grant awarded.
Role models matter. So, what does it communicate when Vice President Pence visits the Mayo Clinic in Rochester, MN, that has a mandatory mask policy inside the hospital, yet, the vice president (VP) was surrounded by over a dozen people all wearing masks with the exception of the VP himself, the person in charge of the White House COVID-19 Task Force. When asked the obvious question, his answer was, “I get tested routinely, and I know I am not infected.” Oh, therefore all the other people, those with masks, are the infected people? We get these mixed messages from our leaders and it trickles down to our own communities and translates into the message that COVID-19 must not be so bad after all.
I do not know about all parts of the nation, but here in Prince George's County, Maryland, which is part of metropolitan Washington, DC, we have a public health program focused on training barbers and stylists in health promotion and disease prevention activities. The barbers and stylists gather local intelligence and one of them sent me a photo of flyers being circulated in the community. These fliers say things like, “COVID-19 is a hoax. Do not be tested. Do not take the vaccine.” What concerns me is that currently there are no countermeasures to fliers like these out in our communities because our health departments are just overwhelmed with the surge, so I think that we have to harness the power of technology and start sending up loud and clear flares and counteract disinformation. If we fail to do this, I anticipate far too many people of color will refuse to be tested and reluctant to take the COVID-19 vaccine once developed.
Add to this the images in Georgia where the first businesses called to open were barbershops, massage parlors, tattoo parlors, and nail salons. The workers in these businesses cannot do their jobs 6 feet away. How do you think this is being interpreted in black and brown communities? According to these barbers, it is being interpreted as, “You are fodder. You go out first. We will see what happens. Then we will open up the five-star restaurants and the country clubs.” That means it is reinforcing the narrative that some lives are less valuable than others.
Another concern is how early definitions of who was at greatest risk for death from COVID-19 included people aged 60 years and older. Well, I am somebody over the age of 60 years, I am going to tell you, I have never thought of myself as vulnerable because of my age until now. I was very disturbed when some elected officials were quoted as suggesting some “elders” should be willing to sacrifice their lives so that the economy could reopen. Commerce over some lives. This way of thinking is very very dangerous. 12
Far too few leaders are talking about the ethics and the moral values that are being expressed, that we cannot return to life as what we think of as normal anytime soon. The vulnerabilities in the environment are just as important as the vulnerabilities of underlying chronic diseases, and any solution has to address both and more.
There is not going to be one person, such as a President Obama, or Dr. King, or Fredrick Douglass who is going to show up and be our savior. We are going to have to figure out how to do this in a different way, using an approach that draws upon but transcends the civil rights traditions of the past.
But we have been saying this for the past 40 years. And the fact that this is immoral, what this administration is talking about doing, it is unjust, unfair, and it should be illegal, and it should be challenged at every step.
It means fast-tracking air, water, waste, and other environmental permits, and not enforcing environmental regulations is nothing more than a fast track to the hospital or the cemetery for black people and other people of color. We must resist that. That is unacceptable.
This adds another layer to the economic impacts that we are suffering. It is just egregious to have this kind of rollback happen in the face of knowing that our communities were already suffering and dying. The NAACP recently launched a social media campaign using the hashtag #wearedonedying. It really calls out these assaults on our communities and calls out this pandemic as another thing that is exacerbating the existing assaults with the disproportionate placement of toxic facilities being just one of many.
We just did a successful Facebook Live event with the legislators 15 from the state of Maryland. It is often said, we are preaching to the choir. However, most great choirs I know practice, practice, practice. We can sing in different harmonies, but we definitely need to be singing from the same page. Many of our students' internships have been totally disrupted, and as a result we have a cadre of students who absolutely need help. We could get some actual staff support right now even in the absence of brand-new resources.
And, as I said before, in the long term, we as African American communities need to also be looking at sovereignty and looking at how we make sure that we are pushing forward on land ownership and housing ownership for our communities, making sure that we are pushing forward on growing our own food and having food sovereignty so that no one can have control over whether or what we eat every day.
We should be making sure that we have more municipally owned water systems where there is community control over our water system so that no one shuts us off from the essential resource of water. As we know, water is life.
We should be making sure that we have energy sovereignty so that we have control over our own electricity. How do we make sure that we are harnessing clean energy and also advancing energy efficiency so that we, again, are not at the mercy of someone who operates solely with a focus on profit from shutting off our energy systems? So we need to increase our sovereignty and ownership and control as African American communities in the long term.
How might we ensure that any pre-COVID19 progress we were making toward elimination of health disparities to achieve health equity is not lost in our post-pandemic future? Look what has been done in the midst of this pandemic, such as extending sick leave. There are a number of things that we have done that may have been impossible had it not been for the pandemic. How do we make sure these things do not go away? How do we make sure that now we recognize that something as simple as a cell phone is seen as being as essential as air and clean water? The Surgeon General, Dr. Adams, made national news when he attempted to connect with people from the “common walk of life” by speaking in black vernacular. He talked about “Big Mama” and “Pap-Pap,” and shared his personal experience as someone with pre-existing conditions that made him vulnerable to COVID-19 exacerbations. Dr. Adams was roundly criticized for speaking in such a way from the White House podium to a worldwide audience. I understand the concern. Yet, he made a point that we need to expand upon. How do we stress that the Internet is just as much an essential lifesaving service as other components of the environmental justice framework?
Unfortunately, far too many of the health disparity campaigns focus on specific chronic diseases and organ systems, this fragmentation is minimized by the pandemic and creates an opportunity to come together and address the whole person in the context of their daily lives.
So how do we come out of our fragmented silos and use the door that has been opened by COVID-19 to address the deferred maintenance of our public health infrastructure and many other factors that have been exposed by the virus?
My big concern after seeing footage of the violent arrest of a man in New York by the New York Police Department because he did not have a mask, and watching people be pulled off buses and watching people be shot, that there is a tipping point here that we want to pay attention to. Who is monitoring that?
The pollution of disinformation is just as damaging as the pollution in the air. Who is monitoring that? Can we be a repository of trusted information for people around the country as we collectively work to battle against all the disinformation, such as the fliers I mentioned earlier? This could be that kind of a turning point in the history of our world right now.
Environment is where we live, work, play, worship, learn, as well as the physical and natural world. So that means housing and transportation. It means energy. It means employment. It means health. It means all of that. Intersectionality is the word of the day. These things interlace all of our institutions, whether we are talking about unions, black colleges and universities, small businesses, faith-based institutions, or any other type of institution.
Our five-state HBCU-CBO Equity Consortium was making a lot of progress in delineating the connection between poverty, pollution, unequal environmental protection, and elevated health disparities in the five Gulf Coast communities. Although our consortium partners are in mandatory lockdown, they are still working remotely at home on environmental justice and health equity issues that impact many of the working class, low-wage residents, and “essential workers” who cannot telework. The individual HBCUs-CBOs have continued their monthly calls and virtual convening team through Zoom during the lockdown. Also, the full consortium (35 participants) met through Zoom for 3 hours on Saturday in April 2020 for a Water and COVID-19 Workshop.
We are deploying the collective resources of our community–university partnerships to build a strong multistate Gulf Coast Network whose goal is to educate, motivate, and liberate people's minds that they can and must take the lead in fighting for environmental, climate, economic, and racial justice and health equity—especially for those who have been marginalized, left out, and left behind. Waiting for someone from the outside to “save” low-income people of communities has never worked. Our Consortium is building a “bottom-up” data and science-driven movement—with the community–university partnerships at the core. We can muster the resources to fight back against the types of misinformation that was sent out early during the pandemic, such as indications that black people cannot get COVID-19. That is the kind of ignorance we have to fight every day. So, this is not a white man's war. This is a war against structural racism that is basically confining us to areas that are polluted in terms of the physical pollution, but also polluted in terms of misinformation.
We have to bring to bear these little movements that are out there and change the narrative to reflect that there is only one movement: a movement for justice, fairness, and equity. We need to focus on getting the right people in the right positions to make those decisions.
Voting does matter. And the fact that we have to make sure we have good folks who are moving into leadership positions and who are fearless, like we were in the 1960s. It is the 2020s, so we have to be fearless. We have young folks out there who are fearless. And being a 70-something myself, I feel that we have to step aside and be good elders. When the younger generations need us, we come and stand with them, not in front of them, but with them.
We have to see this not as a sprint, but a marathon. There is a lot to do, but I think we can get this done. We cannot say, “Oh, we cannot do this. Oh, that has been tried.” No, no. We have to say, “There is always a way to do it if we have a will.”