Speaking of Psychology: Why is COVID-19

Bonus Episode — Why is COVID-19 Disproportionately Affecting Black and Latino Americans

While we do not have a complete national picture, data from a few states and cities are showing that COVID-19 is disproportionately infecting African Americans and Latinos. Why is this so? And what can we do to alleviate these skewed proportions and flatten the curve. Listen to what APA’s Dr. Brian Smedley has to say about the underlying reasons for these disparities and what we need to do to mitigate them.

About the expert: Brian Smedley, PhD

Brian D. Smedley, PhD, is chief of psychology in the Public Interest, where he leads APA’s efforts to apply the science and practice of psychology to the fundamental problems of human welfare and social justice. A national thought leader in the field of health equity, Smedley got his start in Washington, DC, as an APA Congressional Science Fellow, and subsequently served at APA as director of public interest policy. Most recently, he was co-founder and executive director of the National Collaborative for Health Equity, a project that connects research, policy analysis and communications with on-the-ground activism to advance health equity. He was also co-director of the Robert Wood Johnson Foundation Culture of Health Leadership National Program Center.

Transcript

Kim Mills: Although we don’t have a complete national picture, data from a few states and cities are showing that the COVID-19 virus is disproportionately infecting and killing African-Americans. In Illinois, for example, African-Americans comprise 43% of people who have died from the disease and 28% have positive tests, even though they’re only 15% of the state’s population. Similarly, in Detroit, Milwaukee, North Carolina, Connecticut, South Carolina, African-Americans are disproportionately at risk. Why is this so? What can we do to alleviate these skewed proportions as we work together to flatten the curve and beat back this pandemic?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association. I’m your host, Kim Mills. Most media reports of these inequities suggest that African-Americans are at higher risk than other populations because of a higher incidence of underlying chronic medical conditions such as diabetes and hypertension and because African-Americans are less likely to have health insurance or a regular healthcare provider.

Well, these factors may be true. This analysis overlooks the root causes of the African-American health gap, historic and contemporary racism and discrimination. Here, to talk about these issues and what psychology can do about them, is Dr. Brian Smedley, APA’s chief of psychology in the Public Interest. In this post, Dr. Smedley leads APA’s efforts to apply the science and practice of psychology to the fundamental problems of human welfare and social justice. Welcome to Speaking of Psychology, Dr. Smedley.

Brian Smedley: Thanks for having me, Kim.

Kim: My first question to you as we began to see the disparate impact of COVID-19 on African-Americans in places like Chicago, New Orleans, and the other locations I mentioned a moment ago. Were you surprised?

Brian: Unfortunately, I’m not. Epidemics and pandemics historically have hit our most vulnerable and marginalized populations hardest. We know this from past epidemics. In the US context, of course, African-Americans have faced generations of systemic discrimination and racism, as you pointed out. The fact that African-Americans have higher rates of chronic health conditions to begin with is, in itself, a reflection of that social and economic inequality.

Pandemics such as COVID-19 are going to spread most rapidly among those populations that are most vulnerable and have been in fact marginalized historically. Unfortunately, we could have predicted that this would happen. As the epidemic continues to spread, we can predict that other populations that have faced historic discrimination and marginalization will also experience higher rates of spread of the virus.

Kim: Are we seeing some of that already? I’ve read that some of the rates among the Latino community are also out of proportion.

Brian: Yes and there are a number of factors that contribute, of course, to the spread of the virus in these populations. You look at living conditions, where people may not be able to practice physical distancing, you look at the kinds of work that people of color are disproportionately in, sectors where they might be considered essential workers or don’t have the economic luxury of being able to stay home, rather than going out and working. Housing conditions, conditions in neighborhoods, all of these factors may contribute to the spread of the virus.

It’s important to note that in many cases these are environmental conditions that the residents of those neighborhoods have very little control over such as the presence of environmental pollutants. There’s some new research, for example, suggesting that in neighborhoods with a higher concentration of air pollution, that the COVID-19 virus is spreading more rapidly. You can see how that might be the case, given the fact that respiratory illnesses are more often linked with air pollution and other sources of environmental degradation.

Kim: What about immigration status? How is that playing into the infection rates in those communities?

Brian: Yes. This is a complex issue that again complicates our ability to flatten the curve, to contain the spread of the virus. There are many new arrivals to our country, some are legal immigrants, some are folk who are here without documentation. Of course, among those without documentation, there’s a fear of ICE intervention and detainment/deportation.

You can see how individuals who are here without documentation might be fearful of coming forward if they’re symptomatic or they might be fearful of getting relatives tested who might be symptomatic. Even among folk who are here legally, among legal immigrants, the fact that the administration has taken steps to curtail their use of or access to public benefits such as safety-net programs for fear that that might be detrimental when applying for permanent legal residency.

That kind of fear can also suppress the ability or willingness of folk even among legal immigrants to access testing or other public health services or public benefits that might be otherwise helpful to them.

Kim: Do you think that the historic mistrust of organized medicine among some black people, especially older black people, is playing a role in this?

Brian: Well, the mistrust issue is a complex one. Certainly, there is mistrust among some segments, but I think a broader issue is the fact that people of color, African-Americans in particular, are very aware of the research showing that they often receive a lower quality of care than white patients, even when they’re presenting with the same illnesses, the same kinds of health insurance, and sometimes even in the same health systems.

The fact that there are disparities in healthcare and the quality of care for these populations may be playing a larger role than the issue of mistrust itself. I think all of these factors of course are things that our healthcare systems need to actively address. So, when we allow this kind of fear to persist, what it does is it increases risk for all of us if some of our communities are left vulnerable.

Kim: Is there some impact from basically the reticence of some people to even get tested? I think we know from the HIV epidemic that there are a lot of people who said, “I don’t even want to know. I won’t get tested because what can I do about it?” Is that playing into it as well?

Brian: That possibly may be the case. Certainly, we know that in the early days of the HIV epidemic, because it was often a death sentence, that certainly people felt a loss of control, even if they knew their status. Nonetheless, it’s important of course to know one’s status, whether we’re talking about COVID-19 or HIV. The other challenge of course though with the issue of stigma in testing, is that some populations who may be at heightened risk may not even be offered testing. The issue of bias and stigma goes both ways.

On the one hand, there may be, stigmatized populations may fear getting tested, but on the other hand, those health professionals who are charged with determining where these tests are being applied because remember there aren’t enough tests at present to address the needs of the population or at least those who might be symptomatic. They are making decisions about who gets testing. Again, we know from a large body of research that unfortunately patients of color are less likely to get evidence-based or recommended interventions, possibly including testing based on their identity status and stereotypes and biases, even unconscious biases that health professionals may hold.

Kim: Some of the messages that are being spread in minority communities and elsewhere and it’s creeping into the media for certain, include that the coronavirus was created in a lab in the United States and it was sent to China, that this was all a plot. There’s also President and others who are hyping untested medications. What’s the psychological impact of hearing this kind of information and how can people sort out the scientific facts from misapprehensions or even in some cases, outright falsehoods?

Brian: Right. Yes, you’re touching on an issue that’s critically important in the pandemic response. It’s vitally important that everyone has accurate scientific information about what they can do to reduce their risk, what they should do if they’re symptomatic, and what they should do to help their families and their communities. Certainly, we know that misinformation is more likely to spread when people are fearful, when people are anxious, and when people are uncertain. That is certainly the psychological state of much of the population during this pandemic.

That’s why it’s so vitally important that our elected officials and our public health leaders communicate clearly and in culturally excellent ways to reach all of our populations. Providing the best scientific information so that people can trust what they’re hearing. They can take action to reduce their risk. But when we have the opposite, when we have clear instances of misinformation, when people are not getting the facts, it only contributes more to the fear and anxiety.

Those kinds of psychological states can make it harder to help reduce risk for many of our populations and ultimately, flatten the curve. Clearly, the psychological dimensions of the pandemic are absolutely vital to address just as we do things like physical distancing.

Kim: What are some of the possible solutions to these health inequities? What is APA and Psychology asking our governments and the public to do?

Brian: Absolutely. There are a number of steps that have to be taken. We know that it’s essential that public health agencies conduct surveillance. Collecting data to understand which populations are at risk, where is the virus going, where do we need to focus resources to help communities to manage their risk. We’ve called on much more robust standardized data collection. The federal government has a significant role to play in terms of providing resources and technical assistance to state and local health agencies who are often on the frontlines of testing.

Then ultimately, we need to coordinate all of the state and local and federal data collection into one comprehensive database. We only know that African-Americans are at high-risk because of the data collection surveillance work that some states and localities are engaged in. We need all states and localities to have the resources, capacity, and a technical know-how to be able to do this. Unfortunately, over the past several decades, the public health infrastructure has been decimated by funding cuts at all levels, federal, state, and local, leaving us poorly prepared to deal with the pandemic such as that which we’re dealing with now.

What we need is a much more robust effort led by federal support and resources to help collect data. Data collection is a first step. A second thing that we have to do is to ensure that people have access to the services they need. Healthcare obviously is a critically important service, but mental and behavioral healthcare are critically important as well, particularly for vulnerable populations that may be at higher risk and face a host of other sources of stress and other kinds of psychosocial stressors.

Addressing the health and mental health needs of communities is critically important as well, and we can do that by doing things like expanding health and safety net programs. States that have expanded Medicaid for example are much better prepared and equipped to handle the crush of coronavirus cases that they’re experiencing. Beyond that, we have to ultimately address the upstream factors, the root causes of health inequities that we see across racial and ethnic groups, across groups with different levels of income and education, across groups who are arriving here from different locations from around the globe.

Addressing those inequities requires understanding the social, economic, and environmental determinants of health. I mentioned earlier that there are some neighborhoods that are experiencing higher rates of air pollution and that there may be– There’s some indication that those communities may experience a higher incidence of infection with coronavirus.

Well, those also happen to be neighborhoods that are disproportionately people of color, disproportionately low-income. Addressing ultimately the factors that expose some neighborhoods to greater risk, things like neighborhood poverty concentration. Addressing sources of environmental degradation. Improving sources of nutrition for these neighborhoods.

Many of them are so-called food deserts, lacking access to healthy food retail, which could help to build the necessary physical capacity to fight off infection. Addressing other neighborhood amenities like parks and recreational facilities. It’s interesting to see the disparity in terms of who is able to get out and exercise during this period of physical distancing and staying at home.

Some neighborhoods enjoy access to parks, recreational facilities, other kinds of amenities that allow them to stay physically active, while many neighborhoods, particularly those that are characterized by high levels of poverty and disinvestment may lack access to those kinds of resources, which again help build community capacity to avoid risk for infection.

Kim: A lot of these situations that you’ve just described are very entrenched in our society. They have existed for decades and people have been complaining about food deserts and disparate pollution levels and so forth. What’s different now? Do we really have the will power to change it? Are you feeling more hopeful that somehow out of this pandemic will come the change that we need?

Brian: I think pandemics and epidemics definitely expose inequities that we all need to be concerned about. Pandemics ultimately know no boundaries. We are all at risk no matter what your race or ethnicity, your income, your education level. Clearly, if some communities face higher risk, then we’re going to be much more challenged to be able to contain the pandemic and flatten the curve.

I think people are starting to see that persistent social and economic inequality, persistent discrimination, persistent racism, and other kinds of destructive social hierarchies ultimately impede our ability to manage epidemics and pandemics and to promote good public health and mental health. Sadly, as tragic as this pandemic has been, part of what it is signaling to the country is that our fates are deeply intertwined, and we ignore the needs of our most vulnerable communities at our own peril.

Kim: How much has xenophobia played a role in what’s happening in some of these minority communities? And what are you doing to counteract that?

Brian: Unfortunately, again, because of fear, because of uncertainty, because people don’t have facts, it tends to engender stereotypes, it tends to create space for xenophobic attitudes and racist attitudes to creep into the public consciousness. It’s particularly troubling when leaders and elected officials use irresponsible language that [unintelligible 00:17:22] xenophobic feelings.

The APA has called for our leaders to use responsible language, to call the virus what it is, COVID-19. There’s no need to link it to a specific region of the country, because all that does is it increases risk for people of Asian descent to be attacked, to be bullied with racist and xenophobic attacks both in public spaces and in virtual spaces. The problem with that, again, is that it divides our communities. It makes it easier to blame an innocent victim rather than blaming the real culprit here, which is the virus itself.

What we know from psychological research is that communities that have come together, that have found ways to solve their challenges, communities that have high levels of what we call collective efficacy are those communities that are going to rebound the quickest from the pandemic. It strongly suggests that even though we’re physically distancing, it’s social cohesion, social coming together that’s going to help us solve this problem.

Kim: I happen to know that the APA recently sent a letter to the White House asking the federal government to take the lead on requiring states and localities to report race, ethnicity, and other demographic characteristics of people who are infected with the coronavirus, as well as those who die from it. What’s been the response?

Brian: We’ve been very pleased with the response. People understand at all levels, federal, state, and local, that collecting this data is essential to understanding who has been affected and where the virus is going. We’re very pleased. The White House Domestic Policy Council is seeking a meeting. We have elected officials on both sides of the aisle, who are looking for solutions.

Certainly, when it comes to things like data collection, we need to be very concerned about personal privacy and our federal laws protecting the privacy, the private health records of individuals, but in this instance, when we’re facing a pandemic, we need coordinated federal, state, and local action to understand who’s being tested, who’s being hospitalized, what kinds of treatments are they getting.

Again, as I mentioned earlier, we have research showing that on average, patients of color are less likely to get the kinds of medical interventions and services that are the gold standard for medicine. Unless we’re collecting this data, we are not likely to see where there might be disparities that might be dangerous for all of us. The APA is calling for a much better coordinated federal response.

We’re looking to see if the private sector can get engaged, helping to apply tools like artificial intelligence, again, to model and understand where this virus is going and spreading going forward. We’re certain that there’s a short-term response that’s necessary in terms of getting this data collected quickly and disseminated and a longer-term response in terms of understanding how we coordinate the vast array of federal data sources that can give us a more complete picture on how to stop the virus.

Kim: Dr. Smedley, thank you so much for joining Speaking of Psychology today. I think this has been an interesting conversation. I appreciate the work that you’re doing to try to flatten the curve and end this pandemic.

Brian: Thank you so much, Kim.

Kim: For our listeners, if you have any comments or ideas that you want to share about our podcast, you can send an email to speakingofpsychology@apa.org. That’s speakingofpsychology, all one word, @apa.org. You can find previous episodes of Speaking of Psychology on Apple, Stitcher, Spotify, or wherever you get your podcasts. You can also go to our website and download all the episodes at www.speakingofpsychology.org. Thanks for listening. For the American Psychological Association, I’m Kim Mills.