Since the start of the pandemic in the U.S. in March 2020, Black Americans have borne the brunt of the virus. The Centers for Disease Control and Prevention reports that Black Americans are twice as likely to die from COVID-19 compared to their White counterparts. In the nation’s capital, while Black Americans make up 45% of the population, they account for 76% of the COVID-19 deaths, according to D.C. government data.
The centuries of mistreatment that have infused distrust in Black communities impact health, said Gail Christopher, executive director of the National Collaborative for Health Equity.
“The essence of the disproportionate impact of COVID-19 had to do with preexisting conditions and excess exposure because of the economic inequity,” Christopher said.
What is unclear, longtime activists and advocates say, is whether the systemic racism that was magnified by the pandemic—overrepresentation in poverty, underrepresentation in wealth, lack of access to housing and transportation—will remain.
By August, 71% of Black D.C. residents had not been fully vaccinated, according to D.C. government data.
The gated unit in D.C.’s 5th Ward was once Yolanda Corbett’s hope for stability, but now it’s a source of anxiety.
The neighborhood doesn’t compare to the Southeast D.C. community where she grew up. But the red-painted brick townhome is at least a roof over her family’s head—an improvement from their previous rental, where the ceiling caved in on them.
But as the pandemic started, she was about to be evicted. The nationwide moratorium temporarily spared her family.
Her current reality of applying for food stamps and relying on community members to provide food for her and her children is far from the future she would’ve chosen while majoring in psychology at Talladega College in Alabama.
“At the end of the day, my wallet doesn’t match up with my intellect,” she said. “That part is the part that always weighs me down… It’s not for lack of drive or ideas, it’s for lack of access. And that part, for a person who likes to control their own destiny, is the most frustrating part.”
Corbett’s experience exemplifies a preexisting housing crisis in D.C. and the rest of the nation. Zillah Wesley, a co-chair of the Poor People’s Campaign, estimates that affording a two-bedroom apartment in the city, without utilities, requires an income of more than $33 an hour.
But with a minimum wage of $15.20 an hour, many Black D.C. residents can’t afford housing, as rent rates increase faster than working-class incomes, according to the D.C. Fiscal Policy Institute. In D.C. more than one in every five Black people live below the poverty line.
“We’re always told, ‘Just pull yourself up by your bootstraps, you’ll make it work,’” Wesley said. “But a lot of people don’t even have boots.”
The nation’s capital is a microcosm of the inequity playing out in communities across the country. Christopher, of the health equity collaborative, argues that social determinants—such as access to employment, transportation, food and safe neighborhoods—are largely responsible for a community’s health.
Rather than focus on health care, which emphasizes treatment, Christopher argues that the government should invest in systems that prevent poor health, like housing. “We have a policy for housing that is driven by a profiteering real estate industry,” Christopher said. “That is one issue that I think we must address, because housing and health go hand in hand.”
The slow-paced, porch-culture community of Lowndes County, Alabama, spans more than 700 square miles. It has 10,000 residents, one physician and no hospital. It also experienced one of the highest COVID-19 infection rates in the state, according to data from the U.S. Department of Health and Human Services.
George Thomas, the county’s only doctor, laments the systematic lack of access in a county that is 75% Black and where one in every three Black residents lives below the poverty line.
“It’s not just endemic in Lowndes County, it’s all the counties, because all of them are facing pretty much the same issues,” Thomas said. “And basically it’s poverty. With poverty, you don’t have access to certain things that you need to survive or thrive.”
Thomas and several other public health and community officials in Lowndes, Montgomery and Macon Counties cited Alabama’s failure to expand its Medicaid program as a major reason for COVID-19’s disproportionate impact on its poorer residents.
The restrictions mean an estimated 324,000 of Alabama’s residents who would otherwise be covered are uninsured and therefore unable to access primary and preventive care services, according to a study by the Urban Institute.
And rural hospitals face a closure crisis. Over the past decade, an average of 12 rural hospitals have closed each year, often due to unexpanded Medicaid leading to large portions of local patients being unable to afford hospital services, according to the Chartis Center for Rural Health.
“You need primary care, you need preventive care, when you’re dealing with chronic disease,” Christopher said. “And remember, it was the chronic diseases, the obesity, the diabetes, the heart disease, the kidney disease, the asthma, cancer, which are all, again, disproportionately experienced by African Americans.”
Ozelle Hubert, who lives in Clarke County, worked for decades as a pharmacist in Lowndes and before that in Cook County, Illinois. He said he sees the same health care access issues in Lowndes as he saw in Chicago.
“When you’re in urban areas where you have poverty, where you have projects, health care disparity, it’s no different, in my opinion, than it is in the rural areas,” Hubert said. “It means a lack of access or lack of quality care.”
Hubert commutes two hours to Lowndes to consult with county officials on economic development and health care. Now president and chief executive officer of the newly established Lowndes County Chamber of Commerce, he wants a hospital in a county that has never had one.
“So when we do have a pandemic like this [in the future] … guess what? We can take care of our residents,” Hubert said.
This story was excerpted from a larger story and republished with permission from News21, a Carnegie-Knight national investigative project.