In the early days of the pandemic, an unsettling trend began to emerge, one that has endured and been magnified as COVID-19 cases continue to rise: minorities in the United States, specifically Black, Latino and Indigenous populations, are far more likely to die following infection.
According to the APM Research Lab, Indigenous people are approximately 3.3 times more likely to die from COVID-19 than non-Hispanic White populations, while both Latino and Black populations are 2.7 times more likely to die. These trends, while thrown into harsh light since the United States saw its first surge of coronavirus infections in March 2020, are nothing new.
Health disparities between minority and White populations have existed for decades, and the causes are deeply entangled in longstanding social and economic divides that put certain populations at a substantially higher risk for life-threatening conditions.
Prominent among the health issues disproportionately affecting minority populations – and contributing to elevated mortality rates – are matters of the heart, such as cardiovascular disease and hypertension. The Office of Minority Health, a division of the U.S. Department of Health and Human Services, reports that Black Americans are 40 percent more likely to have high blood pressure than non-Hispanic White Americans and are 20 percent more likely to die from heart disease. Despite that, only 44.6 percent of Black adults with hypertension are likely to have their blood pressure under control, as opposed to 50.8 percent of their White counterparts.
In light of this data, the question is no longer whether disparities exist; they do, and they’re illustrated in our society more clearly than ever. The question is why do they exist, why do they endure through generations and, ultimately, how do we stop the cycle?
Physical and Social Inequities
The American Heart Association identifies seven factors that make up an individual’s cardiovascular health, known as “Life’s Simple 7”: smoking status, BMI, diet, cholesterol, physical activity, blood pressure and blood glucose. In theory, maintaining ideal levels of all seven factors will decrease an individual’s risk for developing cardiovascular disease or suffering from early mortality.
But in a 2018 edition of “The Journal of the American Heart Association,” Dr. Eduardo Sanchez published, “Life’s Simple 7: Vital But Not Easy,” in which he states that, “Items easy to list are not as easy to achieve…It will likely take individual and socioecological (population-level) efforts to achieve and maintain high [cardiovascular health].”
Dr. Nicole Redmond, a medical officer with the National Heart, Lung, and Blood Institute, has dedicated her career to advancing research that addresses health disparities across racial and ethnic lines. The complexity of the issue, she says, arises when evaluating the extent to which physical and social determinants allow minority populations to engage in activities that promote cardiovascular health.
“No one is born with cardiovascular disease,” Dr. Redmond said. “You’re born in normal health, and your environment starts to determine the evolution of your cardiovascular health over time. We see evidence that Black Americans accumulate risk factors like obesity and hypertension earlier in life and at higher levels.”
First, there are physical factors, such as the neighborhood and environment in which a person is raised, their proximity and access to healthy food options and, if those resources aren’t located in walking distance, the availability of transportation to reach them.
“There’s also been a lot of attention on how our housing policies have created ongoing neighborhood segregation and disinvestment in neighborhood resources,” Dr. Remond said. “It’s one thing to say we know physical activity is important for heart health, but how accessible is physical activity for people who don’t feel safe going for walks, or who live in neighborhoods without sidewalks? And if they have to walk somewhere to get groceries, but the only thing they can reasonably walk to is a convenience store, their food options will be limited. All these things are related.”
Additionally, Dr. Remond says these determinants must be considered alongside income and poverty, which “impacts your ability to attain health-promoting resources” that not only include healthy foods, transportation and safe neighborhoods, but subsequently, education and healthcare.
To put this in perspective for New Orleans, unaddressed repercussions of redlining, a practice which systematically denied funding and services to neighborhoods with a majority of Black residents, continue to put Black citizens at financial and environmental disadvantages. Based on data compiled by American Community Survey, The Data Center (formerly known as Greater New Orleans Community Data Center) reports that median income for Black households in New Orleans is $24,813, compared to $69,852 among White households. That puts Black households at a 32 percent poverty rate, and White households at 10.3 percent.
And while redlining was formally ended by 1968’s Fair Housing Act, The Data Center’s 2018 report, “Rigging the Real Estate Market: Segregation, Inequality, and Disaster Risk,” details the ways in which Black New Orleanians continue to dwell in underdeveloped neighborhoods with fewer resources and lower levels of elevation, where they are more vulnerable to natural disaster, as a result of the economic divide created by decades of disenfranchisement and racial segregation.
“Factor in living on the coast, where a hurricane can affect infrastructure, transportation, power grids, food and clean water, you start to see all these differential health impacts on a larger scale,” Dr. Redmond said.
In light of how these disparate circumstances fall along racial lines, the physical factors required to maintain cardiovascular health using the “Life’s Simple 7” model become all the more difficult for minorities to achieve.
And then there are the social factors which, when compounded with the physical determinants, further widen the health gap minorities must overcome.
Dr. Tammuella Singleton is a pediatric oncologist who practices in both New Orleans and Slidell, and she describes how social determinants such as stress – which in the case of minorities is fueled by racial bias, microaggressions and discrimination – can lead to poor cardiovascular health. Both she and Dr. Redmond relate this chain of causality to the “fight or flight” survival response.
“When you’re stressed, your heart rate goes up. Your blood pressure climbs a little higher. Your cholesterol levels increase, and you probably eat more and retain a little more fat,” Dr. Singleton said. “Self-preservation is the first law of nature, but that fight or flight response was only designed to be there when we needed it. From a biological or physiological standpoint, it was never meant to exist indefinitely, for days, weeks, months or years on end. Stress is a significant contributor to heart disease, and when you compound that with poor dietary options, a lack of daily exercise, and add them to the stress of just being a Black American, now you have a recipe for disaster.”
Dr. Singleton notes that many of these stress-inducing social factors might begin to affect a person’s health before they even realize they’re experiencing them. For reference, she describes her first experience at Xavier University, an HBCU, after receiving early and secondary education at public schools where she was a minority.
“It was a release,” she said. “It was like I exhaled. All this time, I didn’t even know I was under this pressure, but for the first time, I knew that if one of my peers didn’t like me, they just didn’t like me. It wasn’t because I was Black. These are stresses accumulated just existing in the world as a minority, and specifically as a Black American. Even as a physician, these are things I didn’t spend time thinking about. But I do now.”
Awareness and Action
It has taken years of inequality – and stagnation in addressing it – to reach a point where the hearts, bodies and minds of minorities are at a distinct disadvantage. In turn, it will take years of work to undo it, and there are many dominoes that must fall if the health gap and all related racial divides will ever be mended.
“It can be overwhelming when you think about how deep this runs, but it’s important that we first have awareness as a community,” Dr. Singleton said.
Part of that awareness means acknowledging that inequities in health and access to care can exist on both macro and micro scales, across states, cities, neighborhoods and streets. The New Orleans chapter of the American Heart Association reports that “a person living in the zip code 70112 is five times more likely to die from heart disease than those living in the neighboring zip code 70113.”
Another, more critical part, is that once your awareness of an issue has been raised, Dr. Singleton says it’s important not to look away, no matter how uncomfortable it may be. That’s especially true for higher-income, non-minority households–because no matter how aware a minority household is of health disparities, that doesn’t give them access to healthy foods, healthcare or geographical equity. Those who have benefited from and perpetuated such divides – even unknowingly – must be part of the solution, at both the individual and community levels.
“A great place to start would be to connect with your local American Heart Association,” Dr. Singleton said. “Find out what programs are having a significant impact in our local communities, where you can see what’s happening. Maybe you can help to provide additional healthy foods at Second Harvest, or support organizations like Liberty Kitchen. That’s something you don’t have to go far to accomplish. Everyone can find something, some way, to get involved.”
In New Orleans, ongoing initiatives at the American Heart Association include the establishment of safe spaces for minorities to engage in physical activity, in addition to providing healthy foods and addressing affordability. Meanwhile, local organizations like Heart N Hands are actively engaging young girls–a minority demographic itself–in fitness and wellness activities. In 2020 alone, Heart N Hands provided more than 400 schoolchildren with fresh fruit in a collaborative effort with No Kid Hungry and hosted an in-person and virtual “Running for the HEART” 5K to both fundraise and stimulate physical engagement. Supporting any such organizations through donations or voluntarism could yield tremendous effects in helping to expand their reach and impact.
While there’s a long road ahead, with many more disparities to address along the way, taking that first step on an individual level can begin the process of incremental – and eventually, monumental – change.
“New Orleans has a heart and a soul, and it has a large Black population,” said Dr. Singleton. “We need to partner together and focus on all angles to figure out how we can all live better lives in our city and our state. It starts with awareness and attention. It’s going to require some difficult and uncomfortable conversations, but if we are thoughtful and deliberate in what we do, we can still change the quality of life for these individuals and allow them to make a significant impact on their health.”