“I Can’t Breathe:” The chokehold of racism on America’s public health response to covid-19 

Racism is a public health crisis. The heartbreaking events of the past few weeks, along with the covid-19 pandemic, have laid bare that stark reality, not only to public health officials who have long grappled with persistent health disparities, but to Black Americans who are forced to confront it every day. 

That fact is once again palpable in the brutal killing of George Floyd, an outrage that has rightfully sparked one of the most intense national demonstrations in a generation. But the deadly consequences of racism are not limited to the epidemic of police violence that disproportionately claims black lives. The fact is, the legacy of slavery and segregation persist across the many social determinants of health—and Black Americans are suffering and prematurely dying as a result. 

Look no further than the response to two pandemics, one hundred years apart. 

Just over a century ago, at the height of Jim Crow, the 1918 Influenza was ravaging the United States. Cramped living and working conditions meant that Black Americans were more vulnerable to the disease, and those who came down with it were largely left to fend for themselves. They were stigmatized for getting sick—even blamed for inciting the outbreaks. When they did get medical help, they were relegated to substandard hospitals, and the limited healthcare and social systems that were available to them quickly became overwhelmed.

We’re seeing many of the same injustices of 1918 play out in the covid-19 pandemic. The novel coronavirus may not discriminate, but our society always has. And this coronavirus has once again revealed the consequences of structural racism, which today have a tremendous impact on who falls ill, what type of care they’ll have access to, and whether they will suffer from underlying health conditions that make the disease deadly. 

Black Americans are dying of this coronavirus at a rate 2.4 times that of white Americans—and predominantly black US counties are seeing three times the rate of infection compared with predominantly white counties. Sadly, this is not a failure of the system, but a result of its design. 

Throughout history, entrenched white supremacy has intentionally robbed Black Americans of benefitting from the very advancements they’ve fought and died for. The continuum of injustice still manifests in a multitude of ways—from police brutality, to underfunded schools and social programs, to financial redlining, mass incarceration, voter suppression, and healthcare disparities. 

A growing body of research shows how these injustices hurt the health and prematurely end the lives of black Americans—both in ways that are caught on video for the world to witness and ways that are far less visible. Yes, Black Americans are more likely to be killed by police. They are also more likely to suffer from a range of underlying health conditions stemming from unequal access to healthcare, education, employment, and more. This is to say nothing of the emotional and physical “wear and tear” that comes from the daily stress of experiencing racism itself.  

It is time for us to acknowledge this full spectrum of health outcomes perpetuated by racism—from hypertension and diabetes to heart disease and maternal mortality.  

Right now, our nation is uniquely primed for that discussion.George Floyd’s  tragic death has sparked a movement that has the potential to change it for the better. We’re seeing that power in cities across the country, as lawmakers consider a range of substantive policing reforms. But overhauling law enforcement policy is merely a start. 

Today, more than ever, we have the data to illuminate the countless ways in which racism drives health inequities, both through disparities in healthcare access and the countless other social determinants of health. It’s imperative that we in the public health community draw attention to this wider set of forces at play—and seek intersectional policy solutions that finally begin to address them. 

Michelle A. Williams is an epidemiologist and Dean of the Faculty, Harvard T.H. Chan School of Public Health. She is the Angelopoulos Professor in Public Health and International Development at the Harvard Chan School and Harvard Kennedy School.

Jeffery Sanchez is former Chair of the House Ways and Means Committee, Massachusetts Legislature. He is Lecturer, Harvard T.H. Chan School of Public Health.

Competing interests: None declared.