A version of this post first ran in Ms. Magazine on October 28, 2020. It has been adapted slightly for Bill of Health.
By Aziza Ahmed
In recent months, public health guidance from the U.S. Centers for Disease Control and Prevention (CDC) has become a site of political reckoning.
The agency has taken an enormous amount of heat from a range of institutions, including the executive and the public, during the COVID-19 pandemic. The former has sought to intervene in public health guidance to ensure that the CDC presents the President and administration’s response to COVID-19 in a positive light. The latter consists of opposed factions that demand more rigorous guidance, or, its opposite, less stringent advice.
Importantly, these tensions have revealed how communities experience the pandemic differently. CDC guidance has produced divergent consequences, largely depending on demographics. These differences have been particularly pronounced along racial lines.
Some people were able to work from home and shelter from the virus. But for others, particularly the poor, the epidemic produced financial ruin as business closures caused unemployment numbers to skyrocket, creating a cascade effect resulting in housing insecurity through evictions. This has had grave impacts on women of color, primarily Black and Latinx, many of whom work in the service industry, and are now experiencing financial instability.
Even where women of color remained employed, it was often their employment in essential services that placed them at risk of contracting SARS-COV-2. Many of these jobs are in traditional health care settings, from nursing assistants to medical assistants, in which approximately 45-50% of the labor force is made up by women of color. In these settings, exposure to the coronavirus placed healthcare workers in danger.
Increased engagement with the gig economy and in sectors like agricultural work also placed workers at risk as they fulfilled the needs of those who were lucky enough to stay at home. For Latinx workers, meatpacking plants became hotspots early in the pandemic placing thousands of workers at risk. 87% of the people infected with SARS-COV-2 in meatpacking plants were racial minorities.
Households themselves tragically proved to be risky environments when conditions are crowded and multiple generations reside together. A recent study in the Journal of the American Medical Association utilized data from the universal testing of pregnant women in New York City to find that the elements of the built environment — including household membership, household crowding (greater than one person per room), and low socioeconomic status — were associated with a higher prevalence of SARS-COV-2.
The combination of housing conditions and work in an essential role has now also been directly connected to the vulnerability of children contracting coronavirus. Black and Latinx children are dying at higher rates in the pandemic, which can be explained, as the CDC notes in a Mortality and Morbidity Weekly Report, by the fact that essential workers at higher risk for exposure and have a higher risk of intra-household transmission.
But what about healthcare? African-American and Hispanic-Americans are less likely to be insured than other race groups.
In 2013, around 40% of Hispanics and 25% of Black Americans were uninsured, compared with 15% of white Americans.
Over the last several years, Latino and Black children top the charts respectively for losing health insurance. Latino children, in particular, have been impacted by the Trump administration’s public charge rule, which will take into consideration an immigrant’s use of public benefits for over 12 months when determining admissibility for the individual. This could mean that individuals are less likely to seek out health services when needed, not only for a potential coronavirus infection, but also for the underlying conditions that exacerbate COVID. And, when people do seek out services, they must contend with health discrimination in the clinical setting, which contributes to an ongoing sense of distrust in the medical system.
Only when CDC guidance on COVID-19 fully takes the social determinants of health into account will it begin to make a dent in our ability to control the pandemic. Right now, so many people cannot do what is necessary to protect their own health and the health of others.
Incorporating the social determinants of health into CDC guidance may require ongoing pressure on the agency. This departs from the commonplace idea that we should treat the agency as apolitical and protect its neutrality, and instead acknowledges that the CDC may be at the heart of future advocacy to change the distribution of health protections.
Aziza Ahmed is a professor of law at Northeastern University School of Law. Her scholarship examines the legal, regulatory and political environments regarding health in US domestic law, US foreign policy and international law.