The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic

Abraham, Péter; Williams, Ellen; Bishay, Anthony E.; Farah, Isabella; Tamayo-Murillo, Dorathy; Newton, Isabel G.

doi:10.1016/j.acra.2021.03.025

Cited by 39 publications

(25 citation statements)

References 42 publications

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“…Many African American and Latinx participants cited structural and interpersonal racism, and anti-immigrant discrimination as factors reducing their trust in government and public health disseminated information and their willingness to be vaccinated [ 10 , 36 , 37 ]. Comments such as “You kept everything from us; now you suddenly want us first in line” highlight the potential for well-intentioned vaccine outreach efforts to communities of color to heighten vaccine skepticism if not designed and implemented with strong community input to earn trust.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 vaccination readiness among multiple racial and ethnic groups in the San Francisco Bay Area: A qualitative analysis

et al. 2022

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Background COVID-19 vaccination rates are lower among historically marginalized populations, including Black/African American and Latinx populations, threatening to contribute to already high COVID-19 morbidity and mortality disparities for these groups. We conducted a community-based participatory research study using qualitative methods to explore knowledge and beliefs about COVID-19 vaccination among Black/African American, Latinx, and Chinese American residents of the San Francisco Bay Area and assess their views on vaccination outreach and delivery strategies. Methods and findings Data were collected from January 14, 2021, to February 24, 2021, with adult residents (N = 109 [Female: N = 76; 70%]) in San Francisco. Focus groups (N = 10) and in-depth interviews (N = 25) were conducted among Black/African Americans (N = 35), Latinx (N = 40), and Chinese Americans (n = 34) in English, Spanish, Cantonese, or Mandarin. Themes were identified using grounded field theory, and included misinformation, mistrust of government and health institutions, and linguistic and other barriers to vaccine access. All three racial/ethnic groups had experiences with vaccine misinformation and information overload. Many African American and Latinx participants cited structural and interpersonal racism, and anti-immigrant discrimination, as factors reducing their trust in government and public health disseminated information and their willingness to be vaccinated. Participants expressed trust in community-based organizations, including faith-based organizations and community-run clinics. Participants often experienced barriers to vaccine access, such as transportation to drive-in sites, with Latinx and Chinese American groups also frequently citing language barriers. Conclusions Vaccine outreach strategies must acknowledge how longstanding systemic, institutional, and structural racism contributes to mistrust in government and health institutions and engage with and support trusted messengers from the community to eliminate cultural, linguistic, and other barriers to vaccine access.

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Section: Discussionmentioning

confidence: 99%

COVID-19 vaccination readiness among multiple racial and ethnic groups in the San Francisco Bay Area: A qualitative analysis

et al. 2022

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“…[18][19][20] The lasting impacts of chattel slavery, Jim Crow era policies, the genocide of Indigenous peoples, the occupation of Mexican territories, and other state-sanctioned violence have led to contemporary fundamental causes of health such as residential segregation, occupational segregation, policing, incarceration, health care access, and medical racism. 17,21 Prior literature has demonstrated that each of these systems is responsible for increasing racial/ethnic inequities in health and mortality in the years before the pandemic. [22][23][24][25][26][27][28] During the pandemic, multiple mechanisms have been identified through which structural racism has further increased racial/ethnic inequities in mortality, including differential infection rates, weathering, and experiences in health care.…”

Section: Introductionmentioning

confidence: 99%

“…18–20 The lasting impacts of chattel slavery, Jim Crow era policies, the genocide of Indigenous peoples, the occupation of Mexican territories, and other state-sanctioned violence have led to contemporary fundamental causes of health such as residential segregation, occupational segregation, policing, incarceration, health care access, and medical racism. 17,21 Prior literature has demonstrated that each of these systems is responsible for increasing racial/ethnic inequities in health and mortality in the years before the pandemic. 22–28…”

Section: Introductionmentioning

confidence: 99%

Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022

Lundberg

Cho

Raquib

et al. 2022

Preprint

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Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased—but were not eliminated—for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic’s second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.

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“…15 These disparities highlight impacts of systematic underinvestment in public health, unequal access to healthcare services, and multifaceted distrust in vaccines, created in part by structural racism and medical mistreatment of underserved groups. [15][16][17][18] Behavioral and social drivers of vaccination may play a role in the geographic and sociodemographic heterogeneity of COVID-19 vaccination coverage and intent. 19,20 Connections between behavioral, social, and practical factors and their impact on COVID-19 vaccination were evaluated using the Behavioral and Social Drivers of Vaccination (BeSD) Framework.…”

Section: Introductionmentioning

confidence: 99%

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Masters

Zhou²,

Meng³

et al. 2022

American Journal of Preventive Medicine

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The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic

Cited by 39 publications

References 42 publications

COVID-19 vaccination readiness among multiple racial and ethnic groups in the San Francisco Bay Area: A qualitative analysis

COVID-19 vaccination readiness among multiple racial and ethnic groups in the San Francisco Bay Area: A qualitative analysis

Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

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