Understanding race in a pandemic

Sasheenie Moodley // Dr. Ebony Hilton explains that there is a painful intersection between the Covid-19 pandemic and the Black Lives Matter protests in the United States. That is, pandemic and protest are part of the same disease thread—racial prejudice and racial adversity.

Dr. Ebony Hilton is an anesthesiologist and associate professor at the University of Virginia. In 2013, she became the first Black female anesthesiologist to graduate from the Medical University of South Carolina. Most recently, she has co-authored We’re Going To Be O.K.—a delightful book that aspires to teach all children about COVID-19. I recently had the privilege of meeting Dr. Hilton. She shared a presentation—supported by a plethora of undeniable socio-medical studies—on racial health disparities in the United States. I describe her argument, as I understood it, below. Dr. Hilton was kind enough to proof read this article before submission.

This article strives to achieve two things. First, I hope to share Dr. Hilton’s insights (to the best of my ability) in a new community, on a new platform. Her argument is thoughtful and salient. Dr. Hilton certainly made an impression on me. It is important to note that this article focuses on Black individuals. Admittedly, there are many more marginalized groups facing similar challenges in the United States. This is beyond the scope of this article. Second, in sharing Dr. Hilton’s presentation, I hope to emphasize a harsh truth: poor health is (often, although not always) a consequence of racial adversity and trauma earlier in life.

Studies show that Black individuals are not more violent than White individuals. Studies also show that Black individuals do not commit more crimes than White individuals (even though Black people are “arrested” more often). Yet violence and trauma are repeatedly inflicted on Black bodies. This seemingly incessant victimization leaves many Black individuals in a constant state of unrest. One result of this is that Black individuals have higher (sustained) levels of stress hormones like cortisol, epinephrine, and norepinephrine. This stress, in turn, leads to poor health outcomes. Black communities suffer from more chronic disease (diabetes, hypertension, heart failure, renal dysfunction, pregnancy complications, cancer, obesity) than any other racial group. Moreover, stress during childhood negatively impacts both neurobiology and neural development. The healthcare realm does not often provide reprieve when Black individuals seek treatment for these diseases. Studies show that implicit and explicit bias negatively affects how healthcare providers treat (and diagnose pain and infection in) Black individuals young and old. There are extreme and uncomfortable racial disparities when it comes to hospital treatment and perception (although many physicians are determined to fight this reality).

In 1995, Dr. Vincent Felitti and Dr. Robert Anda developed the Adverse Childhood Experiences (ACE) study based on work with (White) middle-income families in California. The CDC and Kaiser Permanente were responsible for this study, which is known as one of the largest studies on the later effects of childhood abuse and neglect. The researchers observed that adversity in childhood would (more often than not) manifest as problematic behaviors or health challenges among White individuals later in life. These challenges include obesity, diabetes, stroke, cancer, alcoholism, smoking, drug use, and suicide. There were ten original adversities: household dysfunction (substance abuse, parental separation, mental illness, battered mothers, criminal behavior), neglect (emotional and physical) and abuse (emotional, physical, sexual). The ACE study effectively proved that early adversity has lasting impacts. Sara Robinson—the Director of Child and Family Outpatient and Crisis Services at Region Ten in Virginia—reminds us that “time does not heal all wounds.” In time, scholars have explored more adversities among more racial groups—including Black communities—in different states. These adversities include racism, sibling abuse, violence outside the home, bullying, exposure to deportation, and poverty. The scholarship on ACE echoes what Dr. Hilton explains: pandemic and protest are part of the same disease thread.

Based on this empirical data, Dr. Hilton suggests there is a link between protest violence and poor health outcomes in Black communities today. She explains that there is a painful intersection between the Covid-19 pandemic and the Black Lives Matter protests. That is, pandemic and protest are part of the same disease thread—racial prejudice and racial adversity. Author Germany Kent echoes this: “at present we are facing two pandemics in the United States. The first is coronavirus, and the other is racism.”

Perhaps the most obvious example of this is that the risk of dying at the hands of police or COVID-19 is comparable for Black men and boys in the United States. Over the life course, 1 in every 1,000 Black men can “expect” to be killed by police. This translates to 96 deaths per 100,000 Black men and boys. Right now, 1 in every 1500 Black People has died from COVID-19. This translates to 67 deaths per 100,000 Black people. The latter statistic includes all Black individuals—it might be greater if the data were focused on Black men and boys specifically. Moreover, we know that COVID-19 affects those with pre-existing conditions (hypertension, diabetes, obesity) more viciously. These data are worrying, if not extremely disturbing.

To complement these quantitative statistics, it is important to consider the social impact of pandemic and protest. Indeed, we should ponder the social impact of racial prejudice and racial adversity. Many Black bodies are quite literally stuck between a rock and a hard place.

So, what do we do about this? Or perhaps the better question is: what can we do about this? It might serve us to channel some empathy and compassion. We might ask ourselves some serious questions. I am curious about what remains after violence, protest, pandemic, and pain. What endures beyond these interactions? What lies beneath the surface?

What does it mean when a daughter sees her father shot in the front seat? What is she thinking when she comforts her handcuffed mother in the back of a police car? What kind of person does this little girl become? Is she afraid? Is she brave? Does she feel connected to the agents in her social world? Or is she threatened by them? Is she a team player? Does she work toward that corner office position to gain some distance from others? Does she grow up to be a paramedic who is murdered in her home?

What about the woman who sees a policeman suffocate a man on the ground? Does she lie awake at night wondering if she could have helped? As time passes, will she call the police when she needs help? What stories will she tell her children, and her children’s children? Will she talk about the day she saw a man die?

If it is too taxing to chew on these questions, perhaps we can just introspect. In doing so, we might reflect on our personal bias and prejudice—and ask ourselves how these beliefs influence our (re)actions. Why do I want to phone the police when I see someone different to me? Does this person really pose a threat to me? What kinds of people do I perceive as menacing? Where do my perceptions come from?

There is an inextricably complicated relationship between what Black individuals “face” and what Black individuals “feel” in this country. The media shows us that Black individuals “face” violence, adversity, and prejudice. These are branches of deeply rooted structural (and institutional) racism. Through community conversations and social media, we have learned that Black individuals “feel” fear, anxiety, and pain. (Although social scientist Donald Polkinghorne reminds us that we can never know exactly what another person “feels” regardless of what they communicate or share). Over time, these feelings more than likely manifest as chronic diseases or poor health outcomes. It seems to me that Black individuals must survive (and try to thrive) in the space between what they “face” and what they “feel.” Is this fair? Is this just? Is this the kind of world we want to live in?

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