Health Injustice and COVID-19
Through racist, exclusionary, and oppressive systems, differences in health and safety throughout the United States and the world are inherently unjust. These injustices are amplified through urban issues, especially through segregation. Marginalized communities often live in segregated areas and have access to fewer resources and opportunities as a result. COVID-19 has made this even more obvious, with these communities having notably fewer testing centers in their neighborhoods, amongst other things. Similarly, marginalized and low-income communities are often forced to live in less ‘desirable’ locations that may be subject to more health risks.
To explore health differences as injustice, we first must define what health inequity is. According to the World Health Organization, “Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age,” (WHO). Essentially, poor and marginalized communities often are subjected to conditions that worsen their health. These may manifest themselves in a variety of ways: higher infant mortality rates, lower life expectancies, and higher rates of cancer, to name a few. In the United States, the Black infant mortality rate is over twice as high as the white infant mortality rate: 11.4 deaths per 1000 live births versus 4.9 (Infant Mortality). The gap in life expectancy between the richest 1% and the poorest 1% in the U.S. is 14.6 years for men and 10.1 years for women (Chetty et al.). This is no coincidence; being born into poorer and/or marginalized communities almost guarantees a less healthy life.
Statistics can only tell us so much. We may learn about the outcome of health injustices, how they transpire in terms of numbers, and the quantitative proof of inequality. They do not, however, explain the why. How is it possible that marginalized communities have such a significant disparity in health? What is the cause, the root of these health injustices? Observing a few case studies may help with this understanding.
One example that exists throughout the world wherever there are landfills is that of waste pickers. As seen in the film Wasteland, hundreds of people who are unable to get jobs or need to help their family financially resort to spending their days in the landfills, finding recyclables and useful objects that can be sold. Although some take pride in this work, many are ashamed of it but still prefer it over prostitution or selling drugs. It is a last resort for many, and is a task solely done by poor and marginalized communities. The work, beyond being dirty, is extremely dangerous. In an article studying a landfill in Phnom Penh, a worker recounts the many fatal accidents he has seen happen, the first of which he was when he was ten and a “dump truck careened into a neighbor from a nearby village,” (McPherson). While these injuries are immediate, there are also long-term effects. Researchers have found “dangerous levels of cancer-causing dioxins in the soil and heavy metals in the metabolisms of children working there…People reported afflictions common to dump life worldwide: diarrhea, headaches, chest and stomach pain, typhoid and irritation…” (McPherson).
Low-income jobs often have more hazards associated with them than higher-income jobs, and sometimes these risks affect the families too. In The Last Mountain, many people living in the Appalachian area work as coal miners. Not unlike waste pickers, the hazards of this job can be both immediate and long-term. Explosions in the mines are known to trap and kill workers. In the long-term, respiratory illness and lung cancer are common afflictions. The communities living around the mines are often made up of the families of miners and are low-income. The health effects of mining extend to them as well. A woman tells explains how a huge number of people living in her neighborhood have had brain tumors and have died from them. Schools in the area are concerned about the air quality that the children breath in. These families cannot pack their bags and go: their jobs and thus livelihood is centered around the mines. They are unable to leave but staying is killing them. This is a health injustice.
Health injustices are common in segregated communities, which often receive less funding and have fewer opportunities than their wealthier, whiter neighbors. One of the most well-known examples of the strong relationship between segregation and health injustice is that of Flint, Michigan. The story of Flint made headlines throughout the United States. Flint is a majority Black community that has one of the highest poverty rates in the U.S. In 2014, when officials decided to switch to a new water source, residents quickly noticed that “there was something wrong with the water, which smelled terrible, tasted like metal, and seemed to give them skin rashes…only to be told, again and again [by elected officials], that the water was fine,” (Smith et al.). For eighteen months, the protests of the residents of Flint were largely ignored. Imagine this happening in Palo Alto: the very second something was off with the water, the local government would have already fixed it. The contaminated water doubled and even sometimes tripled the levels of lead in the blood of the city’s children, and the Michigan Civil Rights Commission concluded that the “poor governmental response to the Flint crisis was a “result of systemic racism”,” (Denchak). Residents are still scared to drink the water in fear that their government is still deceiving them.
According to the Furman Center,
“On average, disproportionally minority, and low income, neighborhoods provide lower quality educational and employment opportunities, expose residents to a disproportionate burden of unhealthy environmental risks, and discourage healthy behaviors by forcing residents to navigate degraded built environments and targeted advertising campaigns that encourage consumption of health damaging foods, alcohol, and other products. In combination with other risks, segregation contributes to striking health disparities over even extremely short distances. In Chicago, a few stops on the L can mean up to a sixteen-year gap in life expectancy, while just six subway stops separates neighborhoods with a 10-year difference in life expectancy in New York City.” (Aracaya and Schnake-Mahl)
The United States have never truly made reparations for slavery, the foundation on which we have built this country, and Black communities throughout the country continue to suffer because of it today, especially with regards to their health. This is inherently unjust: nobody chooses where they are born or what body they are born into, and a huge portion of the U.S. population (as well as populations throughout the world) are forced to suffer for choices that were not theirs.
With the spread of COVID-19 in recent months, low-income and marginalized communities have been much more deeply affected than others. The virus has affected us all, but it has not affected us all equally. One example of this is the locations of testing centers. According to an article by NPR, whiter neighborhoods in Texan cities sometimes have as much as two times more testing sites than their more diverse counterparts (McMinn et al.). Testing disparities have been reported in other cities in the U.S. as well, such as New York and Chicago. Meanwhile, data has suggested a “disproportionate burden of [COVID-related] illness and death among racial and ethnic minority groups,” (CDC). There are a variety of causes for this health difference. Minority groups often face worse economic and social conditions than whites, which may isolate them from the resources they need in order to be properly prepared for such a pandemic. Worse living conditions, especially in segregated communities, may contribute to a higher proportion of people with underlying health issues that worsen COVID-19’s symptoms and mortality rate. Members of marginalized communities may also be more likely to live in densely populated areas, thus further contributing to the virus’s spread. Low-income communities may be unable to access and/or pay for hospital visits to treat their illness. They also may be working in essential minimum wage jobs, such as grocery store cashiers, and thus have a higher exposure risk (CDC).
White America continues to ignore the plight of low income, marginalized communities in the country, especially Black Americans. Members of these communities have fewer opportunities to attend college, obtain a high-paying job, and achieve financial stability. They are thus subjected to conditions that constantly put their health at risk, especially when compared to the conditions of the majority of white Americans. This difference is unjust, and it is imperative that America and its privileged citizens work to begin to repair this injustice in any and all ways possible. The recent protests are only the first step in this journey; there is much work left to be done.
Arcaya, Mariana C., and Alina Schnake-Mahl. Health in the Segregated City. furmancenter.org, https://furmancenter.org/research/iri/essay/health-in-the-segregated-city. Accessed 6 June 2020.
CDC. “Coronavirus Disease 2019 (COVID-19).” Centers for Disease Control and Prevention, 11 Feb. 2020. www.cdc.gov, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html.
Chetty, Raj, et al. “The Association Between Income and Life Expectancy in the United States, 2001–2014.” JAMA, vol. 315, no. 16, Apr. 2016, pp. 1750–66. PubMed Central, doi:10.1001/jama.2016.4226.
Denchak, 2018 Melissa. “Flint Water Crisis: Everything You Need to Know.” NRDC. www.nrdc.org, https://www.nrdc.org/stories/flint-water-crisis-everything-you-need-know. Accessed 6 June 2020.
Haney, Bill. The Last Mountain. 2011.
Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC. 27 Mar. 2019. www.cdc.gov, https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm.
McMinn, Sean, et al. “In Large Texas Cities, Access To Coronavirus Testing May Depend On Where You Live.” NPR.Org. www.npr.org, https://www.npr.org/sections/health-shots/2020/05/27/862215848/across-texas-black-and-hispanic-neighborhoods-have-fewer-coronavirus-testing-sit. Accessed 7 June 2020.
McPherson, Poppy. “‘Hell on Earth’: The Great Urban Scandal of Family Life Lived on a Rubbish Dump.” The Guardian, 11 Oct. 2016. www.theguardian.com, https://www.theguardian.com/cities/2016/oct/11/hell-earth-great-urban-scandal-life-rubbish-dump.
Smith, Mitch, et al. “Flint’s Water Crisis Started 5 Years Ago. It’s Not Over.” The New York Times, 25 Apr. 2019. NYTimes.com, https://www.nytimes.com/2019/04/25/us/flint-water-crisis.html.
Walker, Lucy. Wasteland. 2010.
“WHO | 10 Facts on Health Inequities and Their Causes.” WHO, World Health Organization. www.who.int, http://www.who.int/features/factfiles/health_inequities/en/. Accessed 6 June 2020.