“Racial disparities have…become central in the national conversation about COVID-19…The experience of past epidemics—and recent natural disasters— suggests that the most socially marginalized populations will suffer disproportionately.”

–  (Chowkwanyun and Reed, 2020)

INTRODUCTION

A familiar theme in public health is the uneven distribution of outcomes across segments of the population occupying different tiers of the socio-cultural hierarchy. Despite the tremendous progress North America has made in promoting equity between classes and groups over the past half-century, the fact remains that not all walks of life experience the same degree of privilege when it comes to individual and community well-being.

Race is no exception, and a recent article by Chowkwanyun and Reed (2020) revealed that Black Americans have been disproportionately impacted by COVID-19 in comparison with the US population as a whole. Other research points to similar conclusions, with African, Latino, and other non-White groups perishing due to the pandemic at rates far above those of White populations.

In light of these racial disparities in COVID-19 outcomes, some members of the public health community have advocated for the collection of race-based data in order to expose and target key inequities. This approach is not without its critics, however, and there continues to be fierce debate regarding the merits and demerits of such a strategy.

In this episode, the PHI team explores the intricacies of race-based health, discussing both the potential benefits of race data collection while emphasizing the need for caution in approaching what remains a highly sensitive subject in many segments of our society.

Table of Contents

1. The pros and cons of race data collection
2. Race data collection in the context of COVID-19 and some cautions
3. Adopting the socio-ecological model

The pros and cons of race data collection

Proponents of race data collection argue that it enables the identification of minority groups as a basis for rectifying inequities in well-being and the creation of a culturally competent model of healthcare. They assert that such an approach may bring much-needed attention to individuals and groups that remain underserved in the current healthcare context due to a plethora of racial and cultural barriers.

For example, clinicians and other healthcare professionals might utilize race data in order to pinpoint race-related or race-specific risk factors that contribute to a particular disease (such as COVID-19) and target them as part of specialized treatment plans uniquely adapted to the needs of racial minorities. This would contribute to a shift of healthcare paradigms away from “equal treatment for all” toward a more equity-based philosophy.

On the other hand, there are detractors of the practice who assert that it may paradoxically exacerbate racialization by amplifying racial consciousness among healthcare users. Indeed, there is justifiable concern in certain quarters that race data may be used against patients, contributing to further discrimination and marginalization of non-White groups (Nestel, 2012).

Critics also note that jurisdictions face significant challenges in systematically collecting race data in an ethical manner, including hesitancy in requesting racial information from patients, concerns with the way data is used, questions regarding privacy and confidentiality, and the often-steep costs involved in undertaking data collection.

Race data collection in the context of COVID-19 and some cautions

Clinicians and public health professionals should be aware of the need to interpret research findings on racial disparities in COVID-19 outcomes with caution. In the absence of other measures, it may be tempting to ascribe solely biological explanations for observed differences in health between races.

While it is plausible that genetics may play a role, the overrepresentation of certain racial minorities among those with subpar health should not be analyzed to the exclusion of other important determinants such as socio-economic status (SES).

The repercussions of wrongly ascribing biological explanations for racial disparities in COVID-19 and other health phenomena must not be overlooked. In many cases, this has resulted in minorities, such as Blacks and Latinos, receiving inferior care compared with White patients despite suffering from similar physical ailments. Historically, the African-American population was described as being “resistant to improvement” because their supposedly “inferior” bio-behavioral disposition was thought to have rendered them particularly susceptible to disease.

Some have suggested that data on COVID-19 should be disaggregated in order to highlight finer nuances in the distribution of cases and deaths between higher- and lower-SES neighborhoods, and by extension, racial-majority and racial-minority populations. While this idea has been welcomed in some quarters, there is a need to consider the potential for such an initiative to perpetuate the “stigma of place” often associated with economically deprived areas, which can oftentimes hinder healthcare efforts.

Adopting the socio-ecological model

One prominent school of thought asserts that influence in public health is exerted at multiple levels of societal power, beginning with individuals and encompassing interpersonal networks, communities, organizations, and finally, governments. This is known as the socio-ecological model and it can serve as a helpful framework for societies navigating the challenges of racial disparities in health.

A key tenet of the socio-ecological paradigm is the vital importance of communication between all sectors of society. Increased transparency can alleviate many of the concerns associated with the collection of race data and allow various stakeholders to assume a position of confidence in research participation. In addition, racial minority communities can benefit significantly from clinicians and other healthcare professionals who are rigorously trained in cultural competency and message tailoring.

Enhanced collaboration between different levels of the societal “ecosystem” can also benefit efforts to reduce racial disparities. Understanding the unique vulnerabilities of minority populations to COVID-19, for example, can inform policies in which vaccination centres are strategically placed. In addition, communities can engage in partnerships with business and academia to facilitate the provision of equipment and expertise to areas most in need.

Finally, it is imperative that advocacy that seeks to enshrine the need for racial equity in public policy is included as a central pillar of public health efforts in the context of COVID-19 and other major health crises. Potential policy measures should attend to the need to establish standard race data collection measures as well as the need to ensure that vulnerable racial groups are not unjustly discriminated against.

Written by: Shenbei Fan BMSc, MPH (c)