According to Centers for Disease Control and Prevention (CDC) reports as of March 15, 2021, race and ethnicity is known for about 53% of individuals who have received at least one Covid-19 vaccine dose. Interestingly however, the demographic breakdown reveals that of the 53%, over two-thirds of vaccine recipients were white (66%), while other racial groups each made up under or around only 10% (1). This data raises concerns about “emerging” racial disparities with regard to vaccination equity. But since the first detected case of the novel coronavirus on United States soil, the pandemic in many metrics—from morbidity to mortality—has revealed that the apparent question surrounding racial equity in medicine is not emerging at all but rather a lasting symptom of the larger illness that is a deep history of racialized medicine.
According to History of Science and Medicine scholar Rana A. Hogarth, so long as we refrain from naming racism as both an explicit and implicit catalyst for the observed disparities, our attention remains fixated on specificity of circumstance rather than on larger structural problems that exist in all spheres of life, medicine included (2). Therefore, we then often fail to recognize and properly address how people of color must navigate a society with structural racism.
“Our refusal to explicitly name racism as a possible factor in explaining poor health outcomes for racial minorities, we run the risk of framing health disparities in such a way that draws our attention to the bodies of those suffering under the disparities rather than drawing our attention to why the disparities exist in the first place,” Hogarth says.
American medicine was built on the backs of enslaved people (3). Birthed out of the marriage between antebellum slavery and beginnings of American medical practice, racialized medicine is a historical and present-day contributor to the inequity faced by people of color in the health sector. Historically, Black bodies and their health were bound to the chattel principle as whites calculated Black illness by means of expense and inconvenience to slaveholders participating in the market. White medicine, thus, was left in a battle between neglect and intrusive treatment of the enslaved which would later solidify as systemically racist practices of medicine from the Reconstruction to the modern era. From antebellum to now, American medicine has carried with it the prejudiced beliefs of physiological and fundamental differences between races — for example, pain tolerance — as well as social, economic, and political stakes that have deep ties to the institution of slavery and existing racist attitudes.
Despite our knowledge of the historic mistreatment of Black people in medicine, history continues to repeat itself relative to racial disparities in healthcare. For example, Black health in and around times of epidemics and pandemics serves as a critical lens through which one can better understand how racialized medicine’s response to social determinants have plagued marginalized communities, especially in the United States.
In the late-19th century, the smallpox epidemic took the lives of thousands of newly-freed people. However, “despite the medical and public knowledge that smallpox could be easily transmitted through contact with an infected person, medical and governmental officials interpreted the growing number of cases of smallpox as consequences of the ‘dirty habits’ and immoral behavior of former slaves,” Historian Jim Downs says. As a result, leaders of the Medical Division of the Freedmen's Bureau did not allocate sufficient funds or resources to build proper quarantine facilities or launch vaccination campaigns for the newly-freed (4).
In the early-20th century, the 1918 Influenza epidemic “mobilized African Americans, but shortages of resources, health-care facilities, and practitioners hampered their efforts,” physician and medical humanities scholar Vanessa N. Gamble says. In the wake of the flu, however, government officials failed to implement any public health or medical initiatives to improve the generally poor health of Black Americans (5).
Today, Covid-19 is following the historic racial disparity trendline. According to the APM research lab, about 180 Black people out of every 100,000 have died from the coronavirus, the second-highest mortality rate of all racial groups, behind Indigenous people (256 of every 100.000) (6). People of color are afflicted by limited access to health care, as hospitals and healthcare facilities in predominantly minority neighborhoods are more likely to close down than hospitals in predominantly white ones (7). Furthermore, Black communities are 30% more likely to suffer from comorbidities—due to the social determinants of health (which include race and socioeconomic status— and therefore ventilator rationing plans left fewer Blacks to receive proper treatment as they performed worse on the “objective” sequential organ failure assessment (SOFA) scale (8).
In order to adequately tackle racial inequity in the medical sphere, an explicit naming of racism—structural, institutional, and any other forms—as a catalyst for the perpetuation of racialized medicine and the disparities that result from it must occur. This recognition is the first step in attempting to adequately rework a system that has capitalized on, and subsequently excluded, marginalized communities. To effectively and objectively assess how to maximize equity in fields such as healthcare, a deep understanding and reckoning with the histories that complicate how and for whom systems have been built is imperative. Without it, we run the risk of watching global community members of color confront death and disease at 2-3 times the rate of their white counterparts, battling justified distrust while also struggling to gain access to treatments and preventative resources.
Our contemporary presumption about health often relies on antiquated ideologies of race. Therefore, we must shift our attention from the superficial to the structural issues at hand as the most marginalized are sick and tired of, well, being sick and tired.
- V. N. Gamble, “'There Wasn’t a lot of comfort in those days:' African Americans, public health, and the 1918 influenza epidemic” Public Health Rep. 2010; 125 Suppl 3:114-22.
- Rana Hogarth, “The Myth of Innate Racial differences between white and Black people’s bodies: Lessons from the 1797 yellow fever epidemic in Philadelphia, Pennsylvania,” American Journal of Public Health (AJPH) 109: v. 10; 1339- 1341.
- Jim Downs, Sick From Freedom: African-American Illness and Suffering During the Civil War and Reconstruction (2015)
- Ko M, Needleman J, Derose KP, Laugesen MJ, Ponce NA. Residential segregation and the survival of U.S. urban public hospitals. Med Care Res Rev. 2014 Jun;71(3):243-60. doi: 10.1177/1077558713515079. Epub 2013 Dec 19. PMID: 24362646.