dcyphr | Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics



Black American communities are suffering tremendously from the COVID-19 pandemic. Underlying health and social problems make the issues from the pandemic worse. The syndemic theory can help to understand what is happening. A syndemic is when multiple diseases concentrate in a particular community. The co-occurence of the diseases worsen the outcomes of the diseases. The syndemic often coincides with the social problems of that community. Social factors and history have especially caused this syndemic. Some factors include but are not limited to racism, discrimination in the work field, and health care disparities. Policies need to be implemented to combat structural racism, which is the root of the racial disparities.



Massive racial disparities are present in the COVID-19 pandemic. Black Americans make up a disproportionately high number of COVID-19 cases and deaths. Primary reasons are due to the higher number of underlying health conditions. These chronic diseases include diabetes, obesity, and hypertension. Other reasons include social factors, such as the greater lack of healthcare insurance. To understand this disparity, one needs to consider the historical and current factors that led to this syndemic.


Social and political factors have more impact on healthcare than an individual’s decision. Policies from history have caused the disparities. Researchers looked at the 677 counties that were disproportionately black with greater than or equal to 13%% of black Americans. 91%% of these counties are in the southern regions of the United States. Black Americans in these counties also have higher rates of unemployment and uninsurance. These counties also have high rates of people with underlying health conditions. All of these disparities worsened the situation when COVID-19 hit.


Many of the poor do not have insurance because of the lack of access to insurance. Many southern state governments refuse to allow for Medicaid expansion as part of the Affordable Care Act (ACA). Thus, the uninsured are likely to seek treatment too late because of the high costs of healthcare. 


There are also racial disparities in COVID-19 testing. Wealthier communities have a higher testing rate. But, poorer black communities have a higher rate of positive tests. The “drive-by” testing also assumes that one owns a private car. Medical providers often have racial bias. Some hospitals have refused to treat black Americans that have symptoms of COVID-19. 


Black Americans consist of a large percentage of low-wage workers in the healthcare field. The jobs include sanitation, nursing house workers, and laundry. Many of these jobs do not come with insurance or other benefits. Furthermore, black Americans are more likely to live in crowded public housing. Thus, many cannot practice social distancing. The jobs and living environment predispose many black Americans to COVID-19. These outcomes are due to the structural violence from racism. Black Americans are more at risk for disability or death from COVID-19, which has become a norm.


Politics contribute to these healthcare disparities. Counties that primarily voted for Trump in 2016 are less likely to practice social distancing. These counties often have more residents that dismiss climate change. The rejection of science has led to governors in these states to reopen the economy too early. As a result, black Americans are disproportionately affected by COVID-19 due to the aforementioned healthcare and social disparities. For example, in Dougherty County in Georgia, 69%% of the population is black. But, black Americans consist of 81%% of the COVID-19 deaths.


More data and tracking would give more precise information about racial disparities. But, the inequality is clear. The researchers urge people to act. At the very least, employers must offer insurance to healthcare workers and a living wage. Workers should also receive proper PPE and have a chance to be tested. Otherwise, the racial inequality will only continue on top of the syndemic.


Everyone does not have the same risk for COVID-19. Rather, racial health disparities often determine the outcome. The inequity stems from structural racism from past and present policies. The researchers urge readers to be aware of racism and to advocate for change.