Soon after COVID-19 infection rates began to skyrocket in New York City and other densely populated urban areas, progressives and Democrats demanded data on the racial disparities of testing, treatments, and deaths. The data showed that blacks and Latinos were much more likely to die from the virus than whites and Asians. As expected, progressives moved to explain these disparities in terms of structural, systemic injustice in America’s health care system: Such injustice follows the country’s material and economic inequality. The truth, however, is more complicated, and if we misunderstand the core issues, we will opt for solutions that could do more harm than good.
The accumulated impact is staggering. According to NPR, in New York City:
[C]oronavirus is twice as deadly for these minorities as for their white counterparts. In both Chicago and Louisiana, black patients account for 70 percent of coronavirus deaths, even though they make up roughly a third of the population. At Massachusetts General Hospital, where we practice, an estimated 35% to 40% of patients admitted to the hospital with the coronavirus are Latino — that’s a 400% increase over the percentage of patients admitted before the outbreak who were Latino.
The Los Angeles Times reported that, among patients 18 to 49 years old, “black residents are dying nearly two and a half times as often as their share of the population.” Overall, blacks and Hispanics are dying disproportionately as compared to whites and Asians. According to the Chicago Tribune, “about 68% of the city’s deaths have involved African Americans, who make up only about 30% of Chicago’s total population, according to data from the Cook County medical examiner’s office and the Chicago Department of Public Health.”
What is the cause? Why these disparities? Again, the progressive answer is “structural racism.” At Vox, Fabiola Cineas describes COVID-19 deaths as a racial injustice issue this way:
Still, the emergence of just a smidgen of the Covid-19 data on race already tells a grim story that shouldn’t shock anyone who knows a little about the systemic oppression of black people in America. Hundreds of years of slavery, racism, and discrimination have compounded to deliver poor health and economic outcomes for black people heart disease, diabetes, and poverty, for starters — that are only being magnified under the unforgiving lens of the coronavirus pandemic. And negligible efforts to redress black communities are being agitated like a bee’s nest prodded with a stick.
Although there is no scientific evidence to back this claim, “systemic oppression” provides a simple explanation for poor health outcomes, like heart disease and diabetes, in the eyes of many who seem uninterested in the possibility of multiple correlations. For example, we now know that the most significant factors in the disproportionate deaths of blacks and Hispanics during the pandemic are age and certain preexisting health conditions like hypertension, diabetes, obesity, and respiratory challenges like as asthma. One study of New York City-area COVID-19 cases found that 88% of those patients had more than one preexisting condition, while 6.3% had only one, and 6.1% had none at all.
The question that matters, then, is why do so many blacks and Latinos have the types of preexisting conditions that make them vulnerable to the worst effects of a coronavirus that has taken the lives of thousands of people across the United States? The question is complex, but the answers fall somewhere between the expansion of government and cultural norms.
In New York City, it is hard to make the case that poverty-based systemic injustice is the cause of health disparities in COVID-19 infections. New York state already spends billions of dollars providing health care to underprivileged citizens, especially blacks and Latinos. In City Journal, Seth Barron observes:
The uninsured rate among black New Yorkers is only slightly higher than the white rate; Latino New Yorkers, including many illegal aliens, have much higher uninsured rates but a slightly lower death rate. Meantime, Asians in New York City, with higher poverty rates than any other group, show the lowest incidence of COVID-19 deaths, by a significant margin.
The actual data point to something other than systemic racism in the health care system or lack of access. What seems to be emerging is that those who are the most at risk of infection and death are those receiving the most government assistance for health care, income assistance, and public housing, especially for senior citizens.
It is beyond the scope of this article to lay out the full history of all the policies that have undermined black and Latino striving in the American experience, but a more sinister culprit than racism for COVID-19 health disparities is the expansion of government power. The government continues to restrict the lives of minorities and their ability to exercise their volition and participate in political and economic liberty. One of the important questions we need to as is this: What kinds of policies undermine the capacity of people to make good choices for food, housing, or other factors that put their health at risk?
In addition to the coercion of government power, many preexisting conditions are behavioral and cultural. Historically speaking, it is the expansion of government power and the social assistance state that continue to keep low-income minorities out of the marketplace. It is the social assistance state that traps low-income minorities in public housing, shackles them to public assistance programs, and usurps marriage and family norms by having government institutions replace parents. Public schools provide up to three meals a day in many cities, and judges discipline children instead of parents. Moreover, government officials refuse to allow parents to choose better schools for their children. They create housing scarcity through red-lining and zoning laws, and they keep low-income people comfortable living at or below the poverty level rather than providing the means, structures, incentives, and opportunities to experience social and economic mobility by divorcing themselves from the chains of government oversight. For example, it is the federal government that subsidizes the very industries that produce the cheap, processed foods correlated with hypertension and diabetes. It is urban planners in the local government who decided to build pollution-generating public transportation hubs adjacent to dense populations of residential housing, creating the conditions that contribute to generations of asthmatics.
To make matters worse, there the cultural factors that many of us are unwilling to discuss. For example, the dietary preferences of people correlated with the onset of Type II diabetes include highly processed carbohydrates, whole grains, sugary drinks, red meat, and processed meats. These foods put people at high risk of multiple, long-term illnesses, including the ones most susceptible to COVID-19 mortalities. The personal choice to smoke cigarettes often leads to respiratory challenges that the coronavirus exploits.
Critics will retort that residents of low-income neighborhoods live in “food deserts” and do not have better food options. The theory holds that if people have better food options, they would naturally chose them, even though there are no data to back up that claim. Perhaps we should ask, why are there food deserts? Why is unhealthy food so cheap? Why do healthy restaurants not locate in certain neighborhoods? What cost barriers keep grocery stores with healthy food from operating in low-income neighborhoods? Could it have anything to do with the fact that neighborhoods with high levels of violence and crime are the ones where businesses are the least likely to operate? Could it be that high taxes, government rules and regulations all raise the costs of doing business in ways that eliminate margins for reinvestment, which drives low-skilled jobs away?
Finally, there are so many more questions we could ask that one could easily conclude that placing the blame for COVID-19 racial disparities on “systemic injustice” is intellectually lazy, sophomoric, and myopic. These assumptions blind us to better data and better explanations. Better explanations lead to better solutions.
If the public healthcare system treats people poorly, we need to ask what incentives are at work. Racism does not cause diabetes, obesity, hypertension, or asthma but it easy to put people in positions where their best choices are sabotaged by government bureaucrats. When people are free to make better choices—and they are properly formed to make virtuous choices for themselves, their family, and their communities—we will see health disparities dissipate, and we will be able to focus on effective strategies that lead to sustainable human flourishing regardless of race and class.
(Photo credit: U.S. Air Force photo by Senior Airman Dylan Murakami. Public domain.)