
Who'll Stop the Rain?
The outsized toll COVID-19 has taken on people of color reflects the insidious effects of structural inequity
The statistics are alarming. Between March and June of 2020, Latinx and non-Hispanic Black people were hospitalized for COVID-19 at a rate of up to four and a half times that of non-Hispanic white people. Indigenous people were hospitalized at five and a half times that of white people. And as of late July, the Navajo Nation, which has a population of only about 175,000, had seen more coronavirus cases per capita than any U.S. state, while Black people, who make up only 13 percent of the U.S. population, accounted for one-quarter of COVID-19 deaths—2.3 percent more than white people, who represent around 60 percent of the population.
These numbers may be shocking, but to those who study health disparities, they’re hardly surprising. “It was totally predictable that marginalized groups would experience higher infection rates,” says Eugene Richardson, an assistant professor of global health and social medicine in the Blavatnik Institute at HMS. “It’s almost a given.”
Early headlines noted more risk factors among populations of color, but the real reasons for these differences go far deeper than many news organizations initially reported.
“To say Black people are having worse outcomes because they have more diabetes and obesity and things like that suggests their personal choices are at fault,” Richardson says. Blaming the victims, experts maintain, ignores the social realities created by 400 years of U.S. history and exacerbated by the biggest wealth gap ever recorded.
A report published in June by Inequality.org, a project of the Institute for Policy Studies, stated that the combined wealth of this country’s 640 billionaires—$3.581 trillion—was more “than the entire Latino population combined.” The report, “White Supremacy Is the Pre-Existing Condition,” further noted that “total U.S. billionaire wealth is equal to 76 percent of all Black wealth combined.”
“Housing is health care. Being able to socially distance is really a privilege.”
This wealth gap existed before the pandemic but has worsened during it. Between March and June, the report notes, wealth held at the top increased by more than $637 billion, “the equivalent of more than 13 percent of all Black wealth.” As that was happening, 45 million nonbillionaires filed for unemployment, with many losing their health insurance along with their jobs.
Not that having insurance guarantees good health. “Leading a healthy life is not just determined by our access to personal health care services,” says Mary Bassett, the François-Xavier Bagnoud Professor of the Practice of Health and Human Rights at the Harvard T.H. Chan School of Public Health and a former commissioner of the New York City Department of Health and Mental Hygiene. “What some people refer to as the social determinants of health—housing, education access and attainment, low income despite working two or three jobs, environmental conditions, stress—these affect health in ways that are both direct and indirect.”
Shelter from the storm
Many health advocates say deficiencies in these social indicators are the result of a system rigged against communities of color. A 2019 white paper by the Urban Institute, an economic and social policy think tank, reports that the racial gap in home ownership is worse today than it was in 1968, when the Fair Housing Act made redlining, or designating Black neighborhoods as poor investments for lenders, illegal. Though redlining has been outlawed, its legacy remains in the form of persistently lower housing values in neighborhoods formerly redlined. Other issues continue to contribute to the problem, including unequal access to credit, particularly in the form of mortgages, and credit-scoring systems many researchers consider biased; higher interest rates for Black and Latinx people; and predatory lending practices that, during the 2008 housing crisis, led to more foreclosures, losses from which many Black and Latinx families have not recovered.

Home ownership matters because “it’s the principal source of intergenerational wealth transfer,” says Bassett. “Central to how many people get rich is inheriting from their parents.”
When owning is out of the question, renting is the only answer, but affordable units are often substandard and, Bassett maintains, “dilapidated housing may expose you to pest infestation, lead in paint or water, and overcrowding,” all of which can lead to health problems such as asthma, lead poisoning, heart disease, and neurological disorders, according to a 2016 Brookings report.
Gentrification and health care-related bankruptcies can also send people into unstable housing or homelessness, says Oni Blackstock, MD ’05, a primary care and HIV physician and former assistant commissioner of the New York City Health Department’s Bureau of HIV/AIDS Prevention and Control. This instability makes it harder to stay on prescribed medications, keep medical appointments, and maintain healthy levels of the stress hormone cortisol, which helps control inflammation, blood glucose levels, blood pressure, and sleep.
“Housing is health care,” Blackstock says. She points out that housing is still largely segregated, and communities of color live disproportionately in areas with higher levels of air pollution and other environmental issues that imperil overall health. Plus, people living in poverty tend to experience crowding at home. “Being able to socially distance is really a privilege,” she says.
Without a raft
Housing also adversely affects educational attainment, which remains significantly lower among people of color than among white people at all economic levels, according to data from the 2020 National Equity Atlas. Educational inequity combined with occupational discrimination, the decline in affirmative action programs, and budget-cutting around human services that might help level the playing field means workers of color often must take lower-paying, unskilled jobs that, according to Blackstock, allow for less social mobility. In this pandemic, such jobs have also increased workers’ chances of becoming infected, with Black and Latinx people much less likely to have jobs that can be done remotely.