The Economist - USA (2020-11-21)

TheEconomistNovember 21st 2020 53

1

“I

stopped countinghow many people

I knew from my community,” says Ma-

rina Del Rios, a doctor in an emergency

ward in Chicago, of the flood of desperately

ill covid-19 patients. Infection rates among

Latinos in Chicago are double those of the

city’s African-Americans and triple those

of whites. Of the city’s 15 worst-affected zip

codes, 11 are predominantly Latino.

In the few countries that collect and

publish such data, it is clear that covid-19

has hit ethnic minorities harder than

whites. That is in part because the disease

disproportionately affects those in jobs,

such as security guards and supermarket

staff, where ethnic minorities are over-rep-

resented. But it is also because of racial dis-

parities in health. Doctors have long ar-

gued about the extent to which those

disparities are the result of broader in-

equalities compared with other factors,

such as racism or biology. Covid-19 has

thrown those questions into stark relief.

Health outcomes differ for racial and

ethnic groups. In Brazil people of colour

can expect to live three years fewer than

white people. In America, where the black-

white health gap is at its narrowest ever,

black men still live for four-and-a-half few-

er years than their white counterparts. Co-

vid-19 has magnified such differences.

It has hit ethnic minorities particularly

hard. In Britain all non-white groups (ex-

cept Chinese women) have been more like-

ly to contract and to die from covid-19 than

whites. Trends are similar in America. Dis-

parities are worst among the working-age

population. In America a 40-year-old His-

panic person is 12 times as likely to die as a

40-year-old white person, according to the

Institute for Health Metrics and Evaluation

at the University of Washington. Black

Americans are nine times as likely to do so.

America and Britain are unusual in col-

lecting and publishing detailed data about

health and race or ethnicity. Some coun-

tries, such as France, outlaw it. Nonethe-

less a similar picture is emerging else-

where. In São Paulo, Brazil’s richest state,

black people under the age of 20 are twice

as likely to die from covid-19 than their

white counterparts. Sweden tallied deaths

early in its epidemic and found that those

born abroad were several times more likely

to die than those born in Sweden.

Professor Sir Michael Marmot, an epi-

demiologist, writes about how people’s

health is determined by social factors. The

debate about covid-19 reminds him of 19th-

century America, when northern doctors

attributed higher rates of tuberculosis

among black patients to poverty; southern

doctors thought it was genes. “When social

conditions improved, tb plummeted in

both groups,” he says, “and we learnt that it

was overwhelmingly social.”

How rich or well educated people are or

what jobs they do is a strong predictor of

health. It is the primary driver of racial

health inequities. People who suffer more

deprivation, which minorities often do,

have poorer health and shorter lives.

“There’s long been an excessive focus in

America on health care as the determinant

of health,” says Lisa Angeline Cooper, who

researches racial health disparities at

Johns Hopkins University.

West Garfield Park is one of the poorest,

fastest-depopulating neighbourhoods of

Race and health

Far from equal

CHICAGO AND SÃO PAULO

Covid-19 has shone a light on profound racial disparities in health

and the complexity of their causes

International