Lessons Not Learned About Race and COVID-19

DGHI affiliate Keisha Bentley-Edwards explains why Black, Latino and indigenous communities were put at greater risk during the pandemic — and why it could happen again.

Medical team during COVID-19

By Michael Penn

Published March 6, 2024, last updated on March 11, 2024 under Research News

When Keisha Bentley-Edwards, Ph.D., set out to analyze why racial minorities fared worse during the COVID-19 pandemic, she was keenly aware of a historical pattern. When Black people get sick, society tends to look for reasons why it’s their own fault. 

Notions of “Black peculiarity” – the belief that Black people are biologically more or less prone to diseases – have long been offered to explain away inequities in health or rationalize putting Black people at greater risk, notes Bentley-Edwards, an associate professor of medicine who studies the impact of race and racism on health. 

“Instead of pointing to the prevalence of a disease, they’ll say it is your Blackness that is the cause,” she says. “We have to think about how these are social disparities and not due to Black peculiarity.” 

Such myths are an all-too-convenient distraction from the larger social forces that drove higher rates of COVID-19 hospitalizations and deaths among Black, Latino and indigenous communities, Bentley-Edwards and colleagues assert in an article published Feb. 26 in The British Medical Journal. The researchers point instead to “multiple reinforcing inequitable systems” that put racial minorities at greater risk of infection and afforded them less access to care when they became ill. 

The paper is one of five new analyses published by the British Medical Journal that break down the systemic shortcomings in the U.S. pandemic response. Collectively the series, which was co-edited by Duke Global Health Institute professor Gavin Yamey, shows that many of the issues that led the U.S. to suffer disproportionate deaths have not been fixed, leaving the country prone to more loss in a future pandemic.  

That is certainly true for most of the drivers of racial disparities in COVID outcomes, which according to the article include economic inequality, racially segregated education and housing, and the lack of protection for “essential workers,” who are disproportionately members of racial minority groups. For example, mortality among Black retail workers increased by up to 36 percent during 2020 due to COVID-19, the researchers note. 

The article’s title, “Race, Racism and COVID-19 in the U.S.: Lessons Not Learned,” reflects the missed opportunity to address the impact systemic racism continues to have on public health, says Bentley-Edwards, the associate director for research at Duke’s Samuel DuBois Cook Center on Social Equity and an affiliate with the Duke Global Health Institute.

“We were thinking about all of these opportunities to improve,” she says, noting the positive effect of stimulus payments, eviction bans and labor protections put in place during the pandemic. But when the immediate crisis abated, “we went back to the way things were before.”

The research also flags a tendency in the public narrative to emphasize individual, rather than societal, factors as driving differences in COVID risk. Higher infection rates in a community were more often attributed to poor hygiene or personal choices than inadequate access to protective equipment, the article notes. Similarly, lower vaccine uptake rates among racial minority groups were frequently blamed on a lack of knowledge or awareness, rather than ineffective outreach or access. 

“We’re not taking away an individual level of agency. We are also talking about the context in which people live, work and play,” says Bentley-Edwards, who was the study’s lead author. “You can only behave as much as your environment allows you to and provides opportunity. And so we have to create changes in systems.”

Co-authors on the analysis include Whitney Robinson, an associate professor of obstetrics and gynecology at the Duke School of Medicine; Duke third-year medical student Olanrewaju Adisa and Kennedy Ruff of the Samuel DuBois Cook Center on Social Equity at Duke; and Elizabeth McClure, a postdoctoral researcher at the Gillings School of Public Health at the University of North Carolina-Chapel Hill. 

Bentley-Edwards and the other lead authors of the BMJ series will discuss their findings during a DGHI Think Global event, U.S. Pandemic Response: What Will It Take to Do Better?, on April 2.