In the first wave of the pandemic, testing was critical to help people navigate their COVID-19 risk and to take appropriate steps to seek treatment or prevent spread. But a new study by Yale researchers finds that, due to structural racism, the populations most at risk for contracting and dying from COVID-19 — Black, Indigenous, and LatinX populations— had less access to COVID-19 testing centers. Structural racism is defined in the study as “the historical, economic, political and interpersonal factors resulting in poor outcomes for racial minorities.” The study appeared in the February 23 edition of the American Journal of Public Health.
The researchers generated a list of the 20 most segregated cities in the U.S. using the dissimilarity index — the most commonly used index of separation between two groups. From this list, they selected Chicago, New York City, Houston, and Los Angeles, the four most populous cities in the country. Of these, Chicago was determined to be the most segregated. They then superimposed a map of testing sites over a map of Black and White population data and found that testing sites were concentrated in White neighborhoods. The most dramatic patterns were observed in Chicago where the number of testing sites decreased by more than 3 percent for each single percentage increase in the Black population and by 5.6 percent for each single percent increase in the Hispanic population. Similarly, they found that in NYC, Houston, and L.A., the number of testing sites decreased between 1 and 2 percent with each single percentage increase in the Non-Hispanic Black and the Hispanic population as well.
Using census data, lead author and MD/PhD student in epidemiology Emmanuella Asabor, MPhil, said “We zoomed in as close to the neighborhood-level as possible.” This close-up view was critical, she said, because segregation lines are not always clearly defined at the county and state level where a lot of public health departments and other entities are collecting the majority of their COVID-19 data. The researchers cite a theory of segregation from sociologist and legal scholar Monica Bell in their work, who has identified four steps to segregation: separation, concentration, subordination, and domination.
The Link Between Place and Race
“Place and race are inextricably linked,” Asabor said. “And there’s a well-documented ‘neighborhood effect,’ where people’s interactions with and within their neighborhood can influence health outcomes. This effect is a consequence of the role that segregation plays in creating magnified social disadvantage for minority communities who are subject to externally motivated clustering in stigmatized enclaves.”
The findings, said Asabor, underscore the need for a public health response that is not race-blind and does not rely on existing social and economic structures which are themselves unequal due to systemic racism. “Public-private partnerships will not work when there is much less direct commercial investment in certain neighborhoods,” Asabor said.
As new variants emerge and COVID-19 vaccines continue to be rolled out, said Asabor, it’s crucial that the government adopts a “race conscious” approach that takes into account systemic racism. “When we take racism into account, we have a much better chance of equitably distributing care,” Asabor said.
Yale researchers who contributed to this study include Joshua L. Warren, PhD, associate professor of biostatistics, and Ted Cohen, MD, DPH, MPH, professor of epidemiology (microbial diseases).