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Who Bears the Weight of Covid-19?

The current CDC methodology erases a key mechanism through which structural racism operates: social and spatial segregation.

Guest Authors Keletso Makofane, Jourdyn A. Lawrence, Onisha S. Etkins, Brigette A. Davis, Tori Cowger
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Read Time: 4 minutes

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“If we do not know how to meaningfully talk about racism, our actions will move in misleading directions.” ― Angela Y. Davis, Freedom Is a Constant Struggle

Earlier this year, Mr. Avik Roy, president of the Foundation for Research on Equal Opportunity, testified before the US House Energy and Commerce Subcommittee on Health in a session on Covid-19 racial inequalities. Citing data from the Centers for Disease Control and Prevention (CDC), he argued that “whites and Blacks are both overrepresented in their share of Covid-19 deaths.” In the same session, pediatrician and expert in racial health disparities, Dr. Rhea Boyd, highlighted the disproportionate impacts of Covid-19 among Black, Asian, Latinx, Indigenous, and Native Hawaiian and other Pacific Islander populations, not including white individuals. She, too, drew on CDC health disparities data to support her argument.

Their disagreement is consequential: the decisions of the Subcommittee influence legislation on public and private insurance, public health, and quarantine. So, how did two experts citing the same data come to such diametrically opposed conclusions?

The way CDC presents data on racial and ethnic disparities in Covid-19 mortality is misleading. To track disparities, the CDC publishes the racial and ethnic breakdown of individuals who died of Covid-19 to be compared with the racial and ethnic distribution of the US population. However, CDC shows two distinct reference populations, one being the population from the US census, and the other a weighted population that CDC constructs by weighting counties with high Covid-19 mortality more heavily than other counties.

To truly assess health disparities, it is crucial to compare the racial distribution of deaths against the racial distribution in the true US population as recorded in the census.

According to the CDC, the weighted population is shown to account for the fact that “certain race and ethnicity groups may be found in higher proportions in areas where there have been more Covid-19 cases and deaths.” By re-weighting the population, the CDC allows users of the data to compare the racial breakdown of Covid-19 deaths to the racial make-up of the counties that have been hardest hit. ButBlack people are more likely to live in these areas than white people. As a result when one compares the racial make-up of Covid-19 deaths to the racial make-up of the weighted population it seems as if Covid-19 has had a disproportionate impact among white people and less so among Black people.

But this analytic approach ignores that the risk of acquiring Covid-19 varies based on living and working conditions — including household crowding and concentration of low-wage essential workers and occupational risk. History shows that where people live in the US is a reflection of structural racism. For marginalized groups, especially Black people, discriminatory practices and policies have been explicitly used to restrict integration and social mobility. These practices include exclusionary zoning, ordinances, restrictive covenants, and housing discrimination. They also include the kind of white supremacist terrorism that continues its chokehold over the lives and livelihoods of Black Americans.

To truly assess health disparities, it is crucial to compare the racial distribution of deaths against the racial distribution in the true US population as recorded in the census. The current CDC methodology erases a key mechanism through which structural racism operates: social and spatial segregation. This leaves an incomplete picture of inequities of Covid-19 mortality.

In their testimony to a House committee, Mr. Roy and Dr. Boyd both found support for their views in published CDC data. Yet Roy’s analysis, by using the weighted population as a reference, considerably understated the disparate impact of Covid-19 among Black, Asian, and Latinx, Indigenous, and Native Hawaiian and other Pacific Islander populations. This approach belies two facts about the social epidemiology of the Covid-19 pandemic: health inequities arise because of racism, not race. And racism shapes the places and conditions in which people live and die.

Photo via Getty Images

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Keletso Makofane

Guest Author

Keletso is a social network epidemiologist interested in how socioeconomic status interacts with social network structure to produce health disparities. His research interests include the social epidemiology of HIV, causal inference methods that account for interference and spillover, and the use of data for activism. He is a doctoral candidate in the department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and a doctoral affiliate with the François-Xavier Bagnoud Center for Health and Human Rights at Harvard.

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Jourdyn A. Lawrence

Guest Author

Jourdyn is a social epidemiologist whose research focuses on addressing racism as a cause of racial health inequities. Her research interests also include methods in social epidemiology, measurement of race and racism, and the differential health impacts of social policy. Jourdyn is a doctoral candidate in the department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and a doctoral affiliate with the François-Xavier Bagnoud Center for Health and Human Rights at Harvard.

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Onisha S. Etkins

Guest Author

Onisha is a social epidemiologist whose research focuses on the impacts of racism on mental health in Black immigrant communities. She also combines her experience as a dancer with her research to explore how healing processes already existing within marginalized communities can be used to foster joy, pleasure, and positive mental health. Currently, she is a doctoral candidate in the department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and a doctoral affiliate with the François-Xavier Bagnoud Center for Health and Human Rights at Harvard.

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Brigette A. Davis

Guest Author

Brigette is a social epidemiologist interested in the impact of structural racism and health, with a particular interest in the intersections between the police, the state, and racism as a traumatic event. Brigette’s work also focuses on the measurement of racism in epidemiologic research. Brigette is a PhD candidate in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, and a doctoral affiliate with the François-Xavier Bagnoud Center for Health and Human Rights at Harvard. She is also an RWJF Health Policy Research Scholar.

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Tori Cowger

Guest Author

Tori is a social epidemiologist whose research focuses on understanding and eliminating health inequities. Specifically, she is interested in social and structural determinants of infectious diseases and substance use related harms, health impacts of the criminal legal system and incarceration, geospatial methods, and social networks. Currently, she is a doctoral candidate in the department of Epidemiology at the Harvard T.H. Chan School of Public Health and a doctoral affiliate with the François-Xavier Bagnoud Center for Health and Human Rights at Harvard.

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