Is Race a Pre-Existing Condition?

By UREC Communications Committee

“When white folks catch a cold, black folks get pneumonia”: an old saying to describe the often unequitable effect of an economic downturn on the Black community. Does it actually bear some truth in the field of public health as well? It appears so. The effects of the novel Coronavirus have been devastating across all spectrums of race, income, gender, and age, but as the weeks wear on, data begins to tell an age-old story of inequality: African Americans are falling ill and dying at much higher rates than any other group in our country, which begs the question: why?

A closer examination of the history of epidemiology in our country tells us this isn’t the first time Black Americans are sicker and more prone to die from infectious disease during epidemics. Before our country was even a nation, inhumanity brought disease to our shores. In the 16th century, European colonization and the African slave trade imported smallpox into the Carribean and Central and South America. In the 17th century, European colonization imported the disease into North America, decimating indigenous communities.

The National Park Service reports that during the Civil War, “the costliest aspect of discrimination in the Union army was its medical care. Throughout the Civil War medical care was for the most part dreadful, but for Black soldiers it was especially horrible and at times reprehensible. Men in the USCT served a disproportionate amount of duty in the most unhealthy environments, suffered from a shortage of qualified physicians and staff, endured the abuse of racist surgeons, and lost countless lives to separate and woefully unequal hospital facilities. All this resulted in a mortality rate from illness of two and one-half times per one thousand men greater than for white soldiers.” Refugees from the South after Emancipation were crowded into makeshift tents in unsanitary conditions where smallpox tore through the community of the formerly enslaved.

A few decades later, during the 1918 Spanish flu epidemic, Black Americans were relegated by housing policy into crowded, dirty living conditions that spread disease, then often left to fend for themselves and treated with substandard care in segregated hospitals. In the modern era, AIDS has disproportionately impacted communities of color, and Black Americans are more likely to suffer from high blood pressure, cancer, diabetes, complications of pregnancy, addiction, and homelessness. 

In his article, The Brother Killer, New York Times columnist Charles Blow posits that “the devastating effects of this virus may be as much about pre-existing social conditions as pre-existing medical ones.” And where can we look to discover what we might call “policy zero” – the source of all the ills that create a perfect environment for devastation within communities of color during this current pandemic? An understanding of our nation’s housing policy reveals the ways in which deadly discrimination has been written into law.

A 2016 study by the Urban Institute and Brookings Institution found that the household wealth of a typical white family ($171,000) was ten times that of a typical African American family ($17,150). A major reason for this is the huge gap in homeownership between the two groups. About 74% of white families own their homes, whereas only 44% of black families do.

This disparity became part of federal policy during the Great Depression. As the Depression wore on, the construction industry ground to a halt. One of President Franklin Roosevelt’s top priorities was jump-starting housing construction. In 1934, he set up the Federal Housing Administration (FHA), which guaranteed bank mortgages—so long as the homes and borrowers met FHA’s appraisal standards. This rejuvenated the housing construction industry and led to a vast increase in the rate of home ownership among white families, particularly after World War II. However, black families did not enjoy increased access to home ownership. 

In the late 1930s, FHA sent agents into about 250 cities around the country. They consulted with local realtors and bankers about the desirability and riskiness of neighborhoods. Together, they drew up maps that graded cities into four categories of risk: areas colored in green were the “best,” blue areas were “still desirable,” yellow areas were “definitely declining,” and red areas were “hazardous.” 

Although the practice of redlining has been illegal since the 1970s, it was accepted practice for two generations. Redlining made it much harder for families of color to buy homes in decent neighborhoods and to build family wealth through home ownership. And discriminatory lending still takes place. In 2019, giant mortgage lender Wells-Fargo settled a suit with the City of Philadelphia for $10 million. The city found that the bank steered “African-American and Latino borrowers towards high-cost or high-risk loans even where those borrowers’ credit permitted them to obtain more advantageous loans.”

Because generations of Black Americans have missed the opportunity to build wealth, they are less likely to have health insurance and receive substandard medical care. Unequal access to quality schools means they are more likely to have service-industry jobs where working from home is not an option. They are more likely to live in areas farther from work and services and so require public transportation where social distancing is not an option, and more likely to experience food insecurity, which directly results in high rates of the underlying medical conditions that make Covid-19 more deadly (cancer, diabetes, high blood pressure).

Where do we go from here? We can sustain the entrenched bias that is embedded in our housing and public health policy, or we can take this opportunity to look deeply into how we are addressing systemic racism, poverty, and access to medical care in our country. We can demand current data to better understand disparities in public health. We can encourage our young people to pursue careers in the fields of medicine and public health and focus them on areas where need is greatest. We can support community health centers. We can work to create a powerful national movement to push for transformative solutions to housing policy. What we can’t do is maintain the status quo, because we’re not well unless we’re ALL well.