The Brain Architects Podcast: COVID-19 Special Edition: Creating Communities of Opportunity

While the current coronavirus pandemic is affecting all of us, it isn’t affecting all of us equally. Some communities—especially communities of color—are feeling the brunt of the virus more than others, in terms of higher rates of infection as well as economic fallout, among many other ways.

In this third special COVID-19 episode of The Brain Architects podcast, host Sally Pfitzer is joined by Dr. David Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, and Professor of African and African American Studies, Harvard Faculty of Arts and Sciences. Dr. Williams discusses ways in which the coronavirus pandemic is particularly affecting people of color in the U.S., and what that can mean for early childhood development. He also pinpoints the importance of creating “communities of opportunity” that will allow all families to thrive—both during and after this pandemic.

Episode Transcript

(00:00):
Welcome to Brain Architects, a podcast from the Center on the Developing Child at Harvard University.

(00:06):
I'm your host, Sally Fützer. Since our last podcast series was released, things have changed drastically as a result of the coronavirus pandemic.
During this unprecedented time, we'd like to share resources and provide guidance that you may find helpful.
So we're creating a series of podcast episodes that address COVID-19 and child development.
This episode is the third in our series, and our guest today is Dr. David Williams, the Florence Spray Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health,

(00:36):
and Professor of African and African American Studies, Harvard Faculty of Arts and Sciences. Thanks for being with us today, Dr. Williams.
Thank you. It's good for me to be here with you.
And just so our listeners know, we're recording this podcast today on a video call, so the sound quality may be different from what you're used to hearing when we typically record this podcast in the studio.

(00:57):
So the data that's coming out now that we've been seeing continue to reinforce the research that you've been doing for many years around racial disparities, and we're seeing that this virus is disproportionately affecting people of color.
What are you seeing now in terms of the data?
We are seeing in multiple states more than half of all deaths from the coronavirus African American.

(01:22):
And in virtually every state, the percent of deaths of African Americans who die from the coronavirus exceeds is larger than the percent of African Americans in the population of that state.
So there is a disproportionate negative impact on African Americans in New York City. We see a similar pattern for Hispanics.

(01:44):
I think the important point I would like to make at the outset is that, first, this is not a surprise.
Second, this reflects a longstanding pattern not just for coronavirus, but for virtually all of the leading causes of death, and that this pattern does not reflect failures on the part of the individuals, the families, and the communities that are experiencing such disproportionate losses.

(02:13):
I think a lot of times when we're hearing about this data coming out, there's a missing component where people are hearing this is disproportionately affecting communities of color, but there's not a lot of talking happening right now around the why.
So could you share a little bit more about what the underlying causes of this disproportionate impact actually are?
Sure. Before we talk about the underlying causes, I think it's also important to emphasize that when we see one group in our society disproportionately affected, it affects all of us.

(02:46):
It is about all of us. We are all connected. And higher rates of death for one population affects the entire profile and the entire risk for all of the population.
In terms of what are the causes of these patterns, we've known for a long time many of the culprits. Number one, I would mention, is lower income, lower education, lower occupational status in virtually every country of the world.

(03:18):
Persons of lower levels of education and income have higher rates of disease and death than those who are better off than they are. And when we say race and ethnicity in the United States, we are talking about groups that really vary dramatically in economic resources.
I'll give you two numbers that makes this very concrete. If we look at the latest income data for the United States published in 2019 by the US Census Bureau, we find that for every dollar of household income, white households receive African-American households receive 59 cents.

(03:54):
That 59 cents to the dollar figure is identical to the racial gap in income in 1978. Most of my students think we've made a lot more progress than that. And as bad as the income gap is, it dramatically understates racial differences in access to economic resources.
Because income captures the flow of resources into the household, it tells us nothing about the economic reserves that households have to cushion shortfalls of income. We get that from data on wealth.

(04:25):
And the latest report from the Federal Reserve Board indicates that for every dollar of wealth, white households have African-American households have 10 cents and Latino households have 12 cents.
So we are looking at groups that disproportionately, economically disadvantage number one, and in multiple ways that raises their health problems and challenges that they will face.

(04:51):
COVID-19 really illustrates this phenomenon very powerfully. What we know is that minorities have earlier onset of disease, earlier onset of chronic conditions, so hypertension, diabetes, heart disease, all occur at younger ages.
And part of this is driven by the lower economic status and higher levels of stress. Also persons of color disproportionately in jobs, where they have to go to work in order to get paid.

(05:23):
They are working in jobs that don't provide benefits, often don't provide health care benefits, which lowers their access to medical care.
In New York City, for example, the hardest hit area of the pandemic, 60% of the essential workers in New York City are persons of color.
Research also documents that in disadvantaged communities, even if you get access to primary medical care, many of those primary care providers do not have admit and privileges at the best, academically based or private health care systems where the best specialists are.

(05:59):
So that those populations are also limited in their access to public care.
And more generally, there is at least one study since the COVID-19 epidemic has begun that looked at data from multiple states and that reported for testing for COVID-19 that African Americans with the same symptoms as whites showing up requesting a test were less likely to get the test.

(06:26):
So we also have evidence of the persistence of discrimination in terms of access to tests, in addition to the fact that most of the test and sites are in suburban communities, and there are fewer tests and sites in central city communities that have a larger underrepresented minority population.
So COVID-19 is a perfect storm in terms of having a disproportionate negative impact on disadvantaged populations in the United States.

(06:57):
A lot of what you're describing reminds me of that saying that a person zip code has more to do with their health outcomes than their genetic code does.
What does that mean and how does it relate to this current situation?
I think it's important to recognize that the challenges these communities face are long standing and it didn't happen by chance.

(07:18):
They're not random events.
They actually reflect the successful implementation of social policies.
So we had social policies implemented in the United States with residential racial segregation being one of the most profound of them in terms of its far reaching negative effects that still persist today that restricted where persons could live based on their race or ethnicity.

(07:43):
And that has had a dramatic effect in reducing access to opportunities, opportunities in early childcare, good early childcare environments, access in good early education, access to employment opportunities,
opportunity in terms of the quality of neighborhood and housing environments and whether it's easy or difficult to get exercise safely in your neighborhood.

(08:11):
Whether it's easy or difficult to even have access to good quality primary care in your neighborhood.
So across a broad range of factors that drive opportunity and success in society, we have large segments of our population restricted by these historic inequities.
Just to illustrate how powerful some of these effects are a national study led by Harvard economists showed that if we could eliminate residential segregation in the United States overnight,

(08:43):
we would completely eliminate or erase black white differences in income in education and in unemployment and reduce black white differences in single motherhood by two thirds, all of those differences driven by opportunities linked to place.
So what we need to think is how can we create communities of opportunity, communities with high quality early childhood programs where every child is given a fighting chance to be successful, not only prepared for school,

(09:16):
but also prepared for good health, a good foundation for health for the rest of their life.
What can we do to reduce childhood poverty? What can we do to enhance employment opportunities for parents because one of the ways we can improve outcomes for children is by enhancing opportunities for their parents.

(09:37):
How can we improve housing and neighborhood conditions?
The good news is there are examples of programs in the United States that are doing these things right now, and many of the studies show that these problems not only work, but they will save society money.
So there's a range of opportunities of things we could do now to make a difference.

(09:58):
And when we take care of all of us and all of us have the opportunity, we not only build a more educated, a more productive workforce, we not only enhance the economic productivity of our society and the global economic competitiveness of our nation,

(10:19):
but we also do something more that is profound, and that is we take care of all of us. We all in this together, and what hurts one of us hurts all of us.
So it's in our best interest to work together to create a society that provides opportunity for everyone.
You mentioned stress as a factor contributing to the racial disparities in outcomes.

(10:44):
Do you mind talking a bit more about how stress can affect communities and long-term health?
Sure. I want to talk a little bit more about the fact that minorities, African-Americans, Latinos, Native Americans have higher rates of underlying chronic conditions.
And so the question is why? Is it their fault? Is it all linked to the bad choices that they are making?

(11:09):
What the research points to is that you're looking at populations that are experiencing higher levels of stress.
In some of my own work, I have found that most of the common stressors, stressors like the loss of a loved one, unemployment, financial difficulties, violence in the neighborhood,
all of these occur at higher levels among African-Americans and among U.S.-born Latinos.

(11:34):
But not only do they have higher levels of the individual stressors, but they have greater clustering of stressors.
So if you have one, you are more likely to have multiple.
And what research is pointing out that living on the conditions of high levels of chronic stress leads to physiological dysregulation across multiple biological systems.

(11:59):
And there's a body of research suggesting that at the same chronological age, racial ethnic minorities may be biologically older than whites in the United States.
And it reflects the exposure, higher levels of exposure to psychosocial as well as physical chemical stressors.

(12:21):
Let me give a practical example of the physical chemical stressors.
There's one recent study done by researchers at Harvard University documenting that persons who live in areas with higher levels of air pollution, which are disproportionate minority,
those persons, if they get COVID-19, it's more severe and they're more likely to die.
So that the air pollution, this chemical stressor has a negative effect in terms of adversely impacting health.

(12:49):
In addition to higher levels of the chronic stressors, one of my areas of research has also been looking at the stress of racial discrimination.
And I have developed measures to capture discrimination.
One of them that's very widely used around the world is called the everyday discrimination scale.
It captures minor indignities, being treated with less courtesy and respect than others, receiving poorer service than others at restaurants or stores.

(13:15):
And what the research documents that these little indignities accumulate and adversely impact physical health, mental health, the quality of sleep.
It predicts earlier onset of multiple chronic diseases and even adversely impacts how individuals access and utilize medical care.

(13:37):
Because if you've been treated badly in multiple domains of society, then you become less trusting of even the healthcare context.
So what emerges is a picture of the accumulation of negative experiences of chronic stress that have long-term negative impacts on health.

(13:58):
And the challenge though is that most Americans are unaware that racial ethnic disparities even exist.
So raising awareness levels is really important because if we don't even know a problem exists, we're not mobilized to even address it.
And so maybe COVID-19 provides us an opportunity to become more informed and hopefully to become more committed to working together to create a better future for all.

(14:29):
So we've talked a lot about racial disparities in physical health related to COVID-19, but could you talk a little bit more about other ways in which people of color might be disproportionately impacted by this pandemic?
COVID-19 is an unprecedented challenge that we are all facing together as a society.
And this unprecedented challenge is a physical health problem, but it's going to produce large-scale economic devastation, which we have touched on to some degree.

(15:00):
But it also will have large-scale negative emotional consequences.
And one of the things that we really need to think of is how do we provide support for all communities, but especially those who already suffer disproportionately from the economic effects, those who are suffering disproportionately from the loss of loved ones.

(15:23):
When we say that African Americans and Latinos experience in higher rates of death, that's people losing mothers and fathers and grandparents and brothers and sisters.
So this is a community that also will be experiencing higher levels of grief and loss in addition to all of the negative effects of the pandemic.
So we really need to think of how can we enhance the access to emotional resources that health people call and how all of us as individuals, even as we socially distance, we do not emotionally distance.

(15:58):
That we do reach out to others and be supportive and be helpful so that people can still have that sense of caring from others and that sense of emotional support from others.
I'm imagining that many listeners might be wondering what they can do and how we might be able to help change this for the future.

(16:19):
Sure, I think when it comes to stress in the environment, there are things that individuals who are suffering now can do that can protect them from some of the negative effects of stress.
So for example, even the research on stress in general, but also research on discrimination in particular points out that individuals who are embedded in close knit emotionally supportive relationships, the quality of social ties can reduce at least some of the negative effects of stress on health.

(16:57):
There's some research suggesting that higher levels of religious involvement can also protect individuals from some of the negative effects of stress on health.
So there are things that can be done at the individual level.
At the same time, what can we do to create environments where stress levels are lower?
How can we create high quality neighborhoods so we reduce the levels of neighborhood stress?

(17:23):
How can we promote greater civility and respect of others as a value so that we reduce the occurrence of discrimination in the first place?
How do we make workplaces more friendly and more stress free than they currently are today?
So I think we do need to think of the high level policy solutions that creates environments that are low in stress, even as we empower individuals to more effectively cope with and deal with the stress as they face.

(17:52):
I really appreciate you taking the time. I know it's incredibly busy and I know that there's a lot of people asking for your time. So thank you so much for the opportunity to interview you.
You're very welcome.
I'm your host, Sally Fitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu.

(18:16):
We're also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram at Developing Child Harvard.
Brandy Thomas is our producer and Charlie Gibney is our producer and audio editor. Our music is Brain Power by Mila from freemusicarchive.org.
This podcast was recorded at my dining room table.