Covid-19 and Health System Segregation in the Us: Racial Health Disparities and Systemic Racism

ISBN-13: 9783030887650 / Angielski / Miękka / 2021 / 138 str.

Prem Misir

Opis

This book highlights and suggests remedies for the racial and ethnic health disparities confronting people of color amid COVID-19 in the United States. Racial and ethnic health disparities stem from social conditions, not from racial features, that are deeply grounded in systemic racism, operating through the White racial frame. Race and ethnicity are significant factors in any review of health inequity and health inequality. Hence, any realistic end to racial health disparities lies beyond the scope of the health system and health care. The book explores structuration theory, which examines the duality between agency and structure as a possibly potent pathway toward dismantling systemic racism, the White racial frame, and racialized social systems.In particular, the author examines COVID-19 with a focus on the segregated health system of the US. The US health system operates on the doctrine of ‘separate but equal’, whereby the dominant group has access to quality health care and people of color have access to a lesser quality or zero health care. ‘Separation’ implies and enforces inferiority in health care. Through the evidence presented, the author demonstrates that racial and ethnic health disparities are even worse than COVID-19. As in the past, this contagion, like other viruses, will dissipate at some point, but the disparities will persist if the US legislative and economic engines do nothing. The author also raises consciousness to demand a national commission of inquiry on the disproportionate devastation wreaked on people of color in the US amid COVID-19. COVID-19 may be the signature event and an opportunity to trigger action to end racial and ethnic health disparities. Topics covered within the chapters include:

Introduction: Segregation of Health Care

Systemic Racism and the White Racial Frame

Dismantling Systemic Racism and Structuration Theory

COVID-19 and Health System Segregation in the US is a timely resource that should engage the academic community, economic and legislative policy makers, health system leaders, clinicians, and public policy administrators in departments of health. It also is a text that can be utilized in graduate programs in Medical Education, Global Public Health, Public Policy, Epidemiology, Race and Ethnic Relations, and Social Work.

Spis treści

Foreword

Chapter 1: Introduction: Challenges Facing People of Color in the Healthcare System

COVID-19 continues to wreak havoc in the United States for many Americans, but especially bringing disproportionate untold damage to people of color. This situation is not surprising because the U.S. health system operates on the doctrine of ‘separate but equal’, whereby the dominant group has access to quality health care and the people of color have access to a lesser quality or zero health care. The health system is segregated, whereby there is, by law, the de jure health system for all, but it is the de facto health system in effect that creates a segregated health system, one for the dominant group and one for the people of color. And ‘separation’ implies and enforces inferiority in health care.

Chapter 2: Systemic Racism in Public Health in the United States -- A Systematic Review of the Literature

This Chapter carries the findings of the systematic review of the literature on systemic racism in public health in the United States. Systemic racism, conceptually, is White-generated discrimination and other forms of oppression against people of color, that generally spreads throughout the society. The racism is systemic, as it represents racist ideas and practices that become embedded in institutions and networks, and which shape race relations in a White-dominated racial hierarchy. Public health is one of many institutions that racism has subverted. And so, racism drives the social determinants of health (housing, education, employment, etc.), and becomes a barrier to health equity. For instance, profound racial bias in health care has also fast-tracked inequitable health outcomes for people of color; the Institute of Medicine (now the National Academy of Medicine) in 2002 in its study of over 100 clinical studies found that racial minorities are less probable than whites to obtain required services, including clinically essential procedures. Health disparities, discrimination, and residential segregation are by-products of racism, which are usually discussed without showing their links to racism. And so, subverting the impact of racism enables the inequities to persist. The disproportionate impact of COVID-19 on people of color is directly related to systemic racism.

Chapter 3: Epidemiology of COVID-19

This chapter presents the findings of several systematic reviews and meta-analyses on COVID-19 from scholarly journals over the period December 2019 through TBD 2020.

- Origin and disease progression

- Restrictive measures

- Risk factors for infectious and severe outcomes

- Therapeutics as interventions

Chapter 4: Disproportionate Burden on Cases, Hospitalizations, and Mortality Among People of Color

This Chapter presents the data and information on the disproportionate devastation of COVID-19 on people of color in the United States. COVID-19 numbers for laboratory-confirmed cases, hospitalizations, and deaths are still growing, and so the data is still preliminary. For instance, for 131 mainly black counties in the United States, the infection rate is 137.5/100 000 and the death rate is 6.3/100 000. This contagion rate is more than 3-fold higher than that in primarily white counties. Moreover, this death rate for largely black counties is 6-fold higher than in principally white counties. People of color are contracting COVID-19 infection more regularly and dying disproportionately. CDC statistics on COVID-19 cases as of April 19, 2020, suggested that about 34% of African Americans were confirmed cases, equally distributed by about a third in each of these age groups: 18-44, 45-64, and 65-74 years; and almost a third were aged under 18 years. About 23% of Hispanics/Latinos were confirmed cases, where 40% of them were under age 18, and almost a third in the 18-44 age group. The distribution of COVID-19 deaths as of April 21, 2020, were, viz. African Americans 19.9%, and Hispanic/Latino 16.7%. Clearly, COVID-19 is unleashing an alarming rate of damage on African Americans and Hispanics/Latinos, who constitute about 13.4% and 18.3% of the total population, respectively.

Chapter 5: Case Narratives for Better Understanding

This chapter focuses on case narratives of people’s experiences during lockdowns, quarantines, etc., and also healthcare providers’ observations during the pandemic.

Chapter 6: Link Between Socioeconomic Status (SES) and COVID-19 Among People of Color

Among people of color, living conditions input underlying health conditions, and so, it becomes problematic to comply with guidelines to prevent contracting COVID-19, or even to acquire treatment in the case of illness. People of color generally live in densely populated areas, largely arising from institutional racism manifested as residential housing segregation. Inhabitants of densely populated areas have a hard time engaging in prevention measures as physical distancing, etc. Indeed, racial residential segregation is a central cause of health disparities. A good number of people of color live in neighborhoods that do not have medical facilities nearby. Multi-generational households, a characteristic feature of the family system of people of color, will encounter serious problems caring for ill family members, where the household physical space is grossly inadequate. Many people of color are essential workers on the frontlines of COVID-19. And poor economic circumstances demand that they go to work. About 25% of employed Hispanic and/or African American workers have employment in service industry jobs compared to 16% of whites. Hispanics constitute about 53% of agricultural workers, and African Americans constitute about 30% of licensed practical and licensed vocational nurses. Many of them in these jobs not having paid sick leave are more likely to be at work and to have exposure to COVID-19-infected workers. In general, in comparison to Whites, people of color have no health insurance, carry the burden of significant underlying medical conditions, and experience stigma and systemic racism and inequalities. Harvard-educated W.E.B. Du Bois was among the first to document that health disparities of African Americans compared to Whites in the United States emanated from social conditions and not racial traits and tendencies; and should there be better sanitary conditions, better education, and improved economic opportunities, their mortality may decline and become normal. Du Bois also noted that ‘Whiteness’ had become a new religion in society, molded by the color line and racial hierarchies created by the dominant Whites. 

Chapter 7: Discussion and Conclusion

O autorze

Prem Misir, PhD is Former Vice-Chancellor, The University of Fiji; Former Pro Vice-Chancellor, Solomon Islands Campus and Professor and Head, School of Public Health, The University of the South Pacific. Professor Misir also was Dean, Centre for iTaukei Studies, The University of Fiji; Dean, Foundation Studies, The University of Fiji; and Dean, University–Wide Program, The University of Fiji.

Professor Misir is the holder of PhD (University of Hull, England); MPH (University of Manchester, England); MPhil (University of Surrey, England); B.S.Sc. (Honours) (Queen’s University of Belfast, United Kingdom); Fellow of the Royal Society for Public Health (FRSPH, England); and Certificate, Harvard University – Improving Global Health: Focusing on Quality and Safety.

Professor Misir was Visiting Professor at the University of the West Indies; Visiting Professor, Anton de Kom University of Suriname; and Honorary Professor at the University of Central Lancashire in England. He was the former Pro-Chancellor of the University of Guyana.

In addition to journal articles, he is the author of 11 books, the most recent being: HIV/AIDS and Adolescents: South Pacific and Caribbean, Singapore, Palgrave Macmillan, 2019; The Subaltern Indian Woman: Domination and Social Degradation, Singapore, Palgrave Macmillan, 2018; and HIV & AIDS: Knowledge and Stigma in Guyana, University of the West Indies Press, 2013.