The other morning, I chatted with my neighbor (from six feet away!) while he was walking his dog past my house. He is an ICU nurse here in New Orleans and mentioned that the very sick COVID-19-positive people in his ICU aren’t necessarily elderly, but are people with diabetes, high blood pressure and higher BMI.
The Centers for Disease Control agrees with my neighbor. Their COVID-19 website cites “higher risk for severe disease … for people of any age with serious chronic medical conditions (such as heart disease, lung disease, or diabetes).” My neighbor and I discussed the fact that these diseases are all very common here in New Orleans. He pointed out that high levels of poverty here and a lack of access to health services lead to higher rates of these exact diseases in the poor and African American communities.
The Louisiana Department of Health also agrees with my neighbor. According to statistics available on their website, in 2018 the number of diabetes deaths in Louisiana for African Americans was twice as high as for whites (and these statistics are both higher in Louisiana than they are for the U.S. as a whole). Heart disease deaths and numbers of people with asthma were also higher for African Americans in Louisiana than for whites. In 2017, people in Louisiana in the lowest income brackets (under $15,0000 per year in most cases) had higher percentages diabetes, stroke, heart attacks, heart disease and asthma, and typically the lower your income, the higher your chances of having those diseases. According to County Health Rankings, Orleans Parish has a lower average household income than Louisiana and the United States as a whole. These disparities exist within areas of Orleans Parish, with very different life expectancy across neighborhoods.
The serious implications of this deplorable state of affairs are obvious: We are very likely to see disproportionate numbers of poor people and people of color get sick and die from COVID-19 in New Orleans and Louisiana — and across our nation. Indeed, in a recent piece in Forbes, Katya Fels Smyth raises deep concerns about health disparities in the United States and COVID-19. As she reminds us, rates of diseases like asthma, diabetes, and hypertension are not higher in the black population because blacks are somehow physiologically different from other people. It’s because African Americans and the poor have less access to preventive medicine, and research has also revealed startling, widespread racial bias in health care even for middle-class and affluent people of color.
As we face the COVID-19 pandemic, we must be clear-eyed about health inequities in Louisiana and across the country, the institutionalized practices and policies that have caused them, and the very real ways they are playing out in who gets the sickest and who dies. Community members and researchers in Louisiana have always been leaders in health justice. And yet Louisiana consistently has among the worst health outcomes and most pronounced health inequalities in the nation. Programs and organizations in our state and all over the U.S. that focus on health equity are underfunded and under-resourced.
Those chickens are coming home to roost now. We are quite literally in a fight for lives. We must pay attention to issues of income inequality and race as the pandemic unfolds over the next weeks and months. Will this crisis finally spur us to direct the necessary resources toward addressing health disparities in our state and our nation? Isn’t it time to right the historic inequalities present in our health care system? We have the power to face those questions with courage, with real action, and with the knowledge that every person has the right to health.
Amy E. Lesen is an associate professor and researcher in the Minority Health and Health Disparities Research Center at Dillard University in New Orleans.