[AAS Podcast] Season 2, Episode 1: "COVID-19 in Black America"

Friday, Feb 19, 2021

In our inaugural new episode, Ebun and Mae take a deep dive into questions about the impact of COVID-19 on communities of color. From cultural responses to lockdown and the need for a government response to creating a more just and inclusive public health system, our host break down multiple dimensions of the pandemic and point toward some resources to learn more.

 

Introduction

Centers for Disease Control and Prevention, “COVID-19 Racial and Ethnic Health Disparities”

  • Holmes L, Enwere M, Williams J, et al. “Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges.” Int J Environ Res Public Health. 2020;17(2):4322. DOI: https://doi.org/10.3390/ijerph17124322 

 

The Culture of __

 

The Breakdown 

Prof. Sharrelle Barber 

Prof. Sharelle BarberDr. Sharrelle Barber is a social epidemiologist whose research focuses on the intersection of "place, race, and health." Through empirical evidence, her work seeks to document how racism becomes "embodied" through the neighborhood context and how this fundamental structural determinant of racial health inequities can be leveraged for transformative change through anti-racist policy initiatives. Dr. Barber’s research is framed through a structural racism lens, grounded in interdisciplinary theories (e.g. Ecosocial Theory and Critical Race Theory) and employs various advanced methodological techniques including multilevel modeling and longitudinal data analyses. Her articles and commentary appear in leading publications, including the Lancet Infectious Disease, the American Journal of Public HealthSocial Science and Medicine, and The Nation. A member of the Health Justice Advisory Committee for the Poor People’s Campaign, Dr. Barber is committed to using her scholarship to make the invisible visible, mobilize data for action, and contribute to the transnational dialogue around racism and health inequities.

 

Prof. Keith Wailoo 

Keith Andrew Wailoo is Henry Putnam University Professor of History and Public Affairs at Princeton University where he teaches in the Department of History and the School of Public and International Affairs. The current President of the American Association for the History of Medicine (2020-22), he is an award-winning author on drugs and drug policy; race, science, and health; genetics and society; and history of medicine, disease, health policy and medical affairs in the United States. Wailoo is currently working on several book-length projects: a history of addiction in the United States.; a history of how pandemics past and present transformed life in the United States; and Poisoning Master — a story of enslavement, drugs, the law, and racial hierarchy, set in 1850s Tennessee on the cusp of the Civil War and focusing on the trial of an enslaved girl, a nurse accused of murder. Wailoo  joins Dr. Anthony Fauci and others as a recipient of the 2021 Dan David Prize, an award endowed by the Dan David Foundation and headquartered at Tel Aviv University. 

 

See, Hear, Do


Podcast Transcript

[background music playing]

Ebun Ajayi: I am Ebun Ajai.

Mélena Laudig: And I am Mélena Laudig.

Ebun: And you are listening to the Official Podcast of Princeton University's Department of African American Studies.

Mélena: Now, it has been a minute since the podcast last aired in the fall of 2019. So, we wanted to just quickly bring you up to speed. 

Ebun: The aim of this podcast is to address questions and themes spanning African-American and Black diaspora studies through engaging interviews with scholars and activists as well as our own takes on Black culture and cultural production. You will get a sense of how this works in our inaugural episode focused on Covid-19 and Black America.

Mélena: Our goal is to inspire listeners to seek more, to get out there, and read books by our guests, and follow some of our recommendations on what to listen to, watch and do.

Ebun: So here is the rundown. Our first segment, The Culture of, gets us into our topic through discussions about popular culture today. The main segment, The Breakdown, will be a conversation with academics and activists about the episode's issue. The third and final section, See, Hear, Do., will give you all some recommendations of where to turn next to keep learning more. We will see how this works as we go. Right, Mae?

Mélena: Right. Now, let us shift to the topic on everyone's mind, always, Covid-19. Considering, in particular, its resonance within the Black community and the United States.

[background music playing]

Ebun: Episode 1: Covid-19 and Black America.

Mélena: Since the early days of the pandemic, statistics have shown a disparate impact of Covid-19 on Black communities. For example, one study of selected states and cities with data on Covid-19 deaths by race and ethnicity showed that 34% of deaths were among non-Hispanic Black people. Even though this group accounts for only 12% of the total US population. 

Ebun: Numbers tell a story but not the whole story. Our episode today aims to look behind them and consider the variety of ways in which Covid has [(2:00)] impacted Black America. Our special guests will be Keith Wailoo, the Henry Putnam University Professor of History and Public Affairs at Princeton University, and Sharrelle Barber, Assistant Professor of Epidemiology and Biostatistics at Drexel University.

Mélena: Professors Wailoo and Barber will deal with big questions. Has Covid caused or merely revealed underlying health disparities? What are the legacies of vaccination and medical skepticism in the Black community? And finally, how might we approached... and finally how might we approach data in a way that tells a story about structural conditions rather than bolstering harmful essentialist stereotypes about people of color?

Ebun: But first, we have some views of our own on the culture of Covid-19.

[background music playing]

Mélena: Now, a pandemic is a serious thing. And something we will explore extensively during this episode are the disparate effects Covid-19 has had on the Black community.

Ebun: Yeah. It is never all doom and gloom. As people have been forced to stay home, missing out on public events, and sometimes unable to work. A lot of creative energy has filled the void.

Mélena: In our society, literally, anything merits a cultural response. So we should not be surprised that the coronavirus pandemic has garnered a lot of attention.

Ebun: Right. Especially considering the fact that millions of people have had to suffer through it or have some other personal connections to the virus.

Mélena: Yeah. And there were some really cool songs that have come out of this Covid moment. That is why we are calling this segment, The Culture of Covid. Now Ebun, what have you been listening to?

Ebun: Well, for starters, Cardi B has the song/remix/meme. I really do not know where it came from...

Mélena: [laughs]

Ebun: ...but it is hard to miss. And if you watch the video on YouTube, it was just very entertaining and catchy.

Mélena: It really is.

Ebun: [laughs]

Mélena: So back in March of 2020, Cardi B posted with the New York Times called "Profanity-laden Forty-Six-Second Video" on her Instagram expressing her fear about [(4:00)] the developing pandemic. And within a week a DJ based in Brooklyn, New York had remix the video into a song that loops the phrase 'the coronavirus is getting real.' 

Ebun: Yeah. You know, I can definitely relate to Cardi's fear and realization that the pandemic was becoming a huge threat to our everyday lives.

Mélena: Yeah.

Ebun: On the other hand, there is this hip-hop artist named Dax. And he has this really cool song called Coronavirus that is very meaningful but totally different from Cardi B's approach.

Mélena: Ebun, let us let our listeners hear a little bit of it.

Ebun: For sure.

[rap music playing]

Rapper: We are part of the remedy, we on the same team, and Corona is the enemy. Stay home, be safe, and look out for each other.

Ebun: Isn't that so cool?

Mélena: It is. And it seems like a lot of people have found that meaningful because it has over 2.5 million views on YouTube.

Ebun: That is a lot. And you know, what stuck out to me about this song is Dax's ability to convey the sense of urgency that we need to deal with this pandemic.

Mélena: Yeah. And he does not shy away from the fact that the pandemic is a big deal and that we need all hands on deck to be able to fight it.

Ebun: I agree 100%. He starts up the music video with an image of something that he tweeted back in January of 2020.

Mélena: Which was before any of us thought that we would still be dealing with this pandemic.

Ebun: Right. And the tweet reads "Since the World Health Organization will not say it. I will. The coronavirus is a global emergency." His lyrics discussed the day-to-day implications of the pandemic, from fighting people for tissue paper to the strain on healthcare workers, and the impact of the pandemic on the stock market.

Mélena: Yeah. And he even uses his lyrics to highlight the fact that violent hate crimes against Asian-Americans have increased during this pandemic. He urges us to stand together in fighting the virus "Before discrimination of Asians become something we let pass." 

Ebun: And this really shows that he is not messing around. And he is trying in every way possible to use this platform to inform the public.

Mélena: Ah-hmm. And Dax's message is so unique because the public has received [(6:00)] so much misinformation throughout this period. 

Ebun: Or you know, let us be honest, a lack of information.

Mélena: Exactly. Especially at the beginning of the virus. I remember our government was not providing the information that people needed and so many of us were confused about, you know, best practices for fighting covid.

Ebun: Right. For a while, let us say through early March. We really were not hearing the concrete facts and recommendations that we needed to hear. Even when health officials got the media time and the platform that they needed to reach us. There was already so much confusion amongst everyday people because of all the conflicting voices that have been prevalent for so long.

Mélena: Yeah. And I think that because of that period of, in your words a lack of information, some kind of unexpected voices rose to the forefront to raise public awareness. People like Cardi B and Dax used their platforms to say what needed to be heard.

Ebun: And that is exactly what we see happening here with Dax's song. This is the culture of covid. The culture of covid consists of grassroots movements where people everywhere are using whatever influence they have to create the societal change that we need to see.

Mélena: Now, this might sound cheesy, but it... it really shows that in the worst of times when we are not receiving leadership that we need, the Black community steps up.

Ebun: Yes. And our community tries to come together. That is what I really got from Dax's song.

Mélena: So obviously, this is a new year and there is a new administration in the White House. But I really think that the influence of singers like Dax and Cardi B is here to stay.

Ebun: And you know, that could be a really good thing.

Mélena: Ah-hmm.

Ebun: Now, on the flip side, it gets bad when influencers use their power in seemingly negative ways. But again, it could be good. 

Mélena: Totally, this has been a good talk, Ebun. I love how we just, you know, analyze that song.

[laughs]

Ebun: Yes, girl. We gotta go deep with it. This has been the culture of Covid with May and Ebun.

Mélena: In our next segment, we will be considering the coronavirus pandemic from a different lens.

Ebun: We have the honor of interviewing Princeton University Professor Keith Wailoo and Drexel University Professor Sharrelle Barber, [(8:00)] who will provide their perspectives on covid-19, race and racism.

Mélena: You do not want to miss it. We will be back after a short break with The Breakdown.

[background music playing]

Ebun: Our first guest today is Dr. Keith A. Wailoo. Dr. Wailoo is the Henry Putnam University Professor of History and Public Affairs at Princeton University. His books include Pain, a political history published by Johns Hopkins University Press in 2015. And Dying in the City of the Blues, Sickle Cell Anemia and the Politics of Race and Health, which was published by the University of North Carolina Press in 2001 and received numerous awards including the Lillian Smith Book Award for nonfiction and the William H. Welch medal for the best book in the history of medicine.

Mélena: Today, we are also featuring Dr. Sharrelle Barber, Assistant Professor of Epidemiology and Biostatistics at Drexel University. As a social epidemiologist, Dr. Barber focuses her research on the intersection of place, race, and health, and has been featured in the American Journal of Public Health and Social Science in Medicine. Her work is funded by National Institutes of Health, The American Heart Association, and the Robert Wood Johnson Foundation. She currently serves as the national advisor and coordinator for the Poor People's Campaign Covid-19 Health Justice advisory committee. Professors Barber and Wailoo, welcome to the show.

Ebun: Yes. Thank you so much for coming on. To start, could you please tell us a little bit about your work and how it intersects with conversations about Covid-19? And just more generally what brings you here today? Professor Barber, would you please start for us? 

Dr. Sharelle Barber: Sure. Um, so I do... I am a social epidemiologist by training and my work um, is um, really at the intersection of place, race, and health. And I examine the role of structural racism and shaping racial inequities. Um, mostly some of the United States but also in Brazil. And so as the pandemic has emerged, I have been doing work with colleagues to really help shape the conversation around, [(10:00)] the ways in which racism, shaping the racial inequities that we are seeing particularly among Black Americans, um, but also other racialized- marginalized racial groups. And have done some work um, in Philadelphia to really document what those Covid-19 rates and also desk look like across uh, neighborhoods in Philly. Really paying attention to some of our most segregated disinvested communities. Um, and in addition to that um, have also been doing some work um, with the Poor People's Campaign um, and which is a uh, national movement uniting poor folks across racial lines. Really trying to advocate for just an equitable um, policies with regard to covid-19 both with regard to um, uh, the Health Access issues etcetera also as well as economic relief. So um, that is kind of what brings me here today. Um, so thank you so much for having me.

Ebun: Thank you. Thank you so much for being here. And that really is awesome. Professor Wailoo, will you please continue next?

Dr. Keith Wailoo: Sure. And it is great to meet you, Dr. Barber. Um, so I teach here at Princeton in the Department of History and in the School of Public and International Affairs. Um, my background is in a field called The History in Sociology of Science. In History, I teach a course that attracts students from Race and Ethnicity Studies, History, History of Science and Public Policy called race, drugs, and drug policy in America. My research focuses largely, but not exclusively on the history and intersection of questions of race and identity as they inform issues of health and medical care. So in the covid-19 crisis, I have drawn on a kind of rich understanding of the history of epidemics, pandemics, and the social and political dynamics surrounding disease to try to use the past to shed light on the kinds of inequalities and the kinds of [(12:00)] challenges that we confront today not just in the US but globally. So I write about a wide range of topics, book called How Cancer Cross the Color Line. Another book on the history of sickle cell disease called Dying in the City of the Blues. I will not bore you with all of those but that is what I do. 

Ebun: Awesome. Thank you.

Mélena: We are so excited to have your expertise today. Um, and we will go ahead and dive into our first question which is about sorting out the causes and effects of this pandemic. So based on your research, what do underlying health disparities among African-Americans have to do with Covid-19, and how can we parse out the causes versus the effects. Um, Professor Barber, if it's okay? we will start with you.

Dr. Barber: Sure. Um, so um, that question is it's a complex one is what I'll say, but I'll kind of walk you through how I've been talking about it again with colleagues around the country as well as with my students. Um, actually did a lecture earlier today um, thinking about you know, why have we seen these racial inequities emerged within the pandemic. And so the base for how I've been thinking about this start actually with critical race theory. That racism, white supremacy, and um, the structures that uphold those things are really what shape, what we in public health called the social and structural determinants of health. And so an understanding of what's happening in the pandemic has to start with our country's inception with which is with the enslavement of Africans from West and Central Africa as well as the expulsion of indigenous peoples. And the ways in which uh, racism has been created systems and structures that uphold that racial hierarchy and perpetuate racial inequity. So, that's a mouthful but I'll break it down. So in this pandemic what we saw-- one of the-- I think linchpins of the pandemic is what we see among essential workers. For example, um, they have are disproportionately Black, a Latino um, and other marginalized racial groups who are um, the most exposed during this pandemic and the least protected, [(14:00)] you know. They were some of the... and not just the frontline healthcare workers were talking about, the folks in the grocery stores as well as individuals who uh, drive public transportation, etcetera. It has taken a long time for us and still we're not at the ade- adequate levels of getting personal protective equipment, the kinds of working conditions that are conducive to being healthy and staying safe, as well as making sure that they have the economic relief necessary such as paid sick leave, etcetera.

Dr. Barber: And you know again, the reasons that they are in these professions or these occupations to begin with have to do with limited access to education and oppor- job opportunities. Again, all structured by racism. And in the work that we've done in Philadelphia, we say well those- those essential workers live somewhere and in our segregated cities across the country that's in oftentimes crowded housing conditions because of lack of affordable housing that increases spread within families as well as communities. And those same communities have also lacked access to healthcare, access to um, food, etcetera. And they're the same communities that have always had poor health outcomes. So for example, in the Philadelphia-- the city of Philadelphia, what we see are widespread life expectancy differences between some of the most segregated communities and the least segregated communities are the more affluent areas upwards of 20 years. Also, chronic conditions that are very high. So these same communities that are on a breeding grounds for the pandemic also um, residents in those areas also have the higher levels of chronic conditions which make the Covid-19 pandemic much more detrimental in those communities. And so the cycle continues, right?

Mélena: Ah-hmm.

Dr. Barber: And um, that's one of the ways we're thinking about this. And then lay on top of that, a tiered healthcare system which denies access to millions of individuals disproportionately Black and Brown, and you get uh, a situation where folks don't have adequate access to [(16:00)] testing, treatment and now the vaccine. And that amplifies transmission, amplifies death within our communities. And it's playing out for Black Americans, is playing out among Latino Americans as well as other populations that have experienced different forms of racism. The final thing I'll say is that we talk often about the higher rates of death among Black Americans and other marginalized racial groups but it's not only that. There were also Black Americans and other racialized, marginalized racial groups are also dying at younger ages. And so there's data at the Harvard that showed that blacks between the ages of thirty-five and fifty-five are dying at 7 to 9 times higher rates than their White counterparts.

Mélena: Wow.

Dr. Barber: Alright. So we're losing moms and dads and uncles in these-- in among Black Americans and other groups. And I think that's another layer of this...

Mélena: Mmm.

Dr. Barber: ...of this pandemic that we have to pay attention to the higher rates and that younger ages. So I'll stop there because I know there's so much that can be delve into but I think again, it is the interlocking systems of racism and oppression that are-- have come together in the perfect storm really to make it so that we have these higher rates and higher deaths in our communities.

Ebun: That's really helpful. Especially, you know, you showing us that pre-existing conditions can be a variety of things even beyond health like housing for example. So thank you for that. Dr. Wailoo, how about you? Can you expand on that?

Dr. Wailoo: Well, Dr. Barber was just incredibly comprehensive about the different factors that explain the differential both illness experience, but also mortality in Black communities and uh, communities of color. What I would add is um, to her list of um, residential segregation, congestion in urban settings, which kind of speed the- the frightful efficiency of the spread of this um, coronavirus. You could also add things like multi-generational households, uh [(18:00)], which explain why it is that you also have a particular kind of disparities um, affecting African-American communities. And I would also add that the comorbidities that is to say the kinds of illnesses that make African Americans more vulnerable to Covid-19 are themselves, the product of the structural inequalities that Dr. Barber describes. So for instance, asthma rates in urban settings, which themselves are a byproduct of the- the-- in which urban life is configured and the way exposure to um, environmental agents increase those likelihoods of asthma. And those likelihoods then in the context of coronavirus put one at increasing risk for uh, for mortality. So you have this as she said, the layering of uh, structural inequalities that explain what it is that we're experiencing and battling right now.

Ebun: Right. And Professor Wailoo, you talked a little about morbidity and about these underlying issues that are going on that are coming to light. So, could you go a little bit more in depth about the difference between morbidity and mortality? And just explain these disparities statistics.

Dr. Wailoo: Right. Uh, well, I mean, Dr. Barber is probably in a better position to give you the sort of the- the epidemiological definitions as much as me. Um, mortality refers to death rate and morbidity refers-- could[?] lead to illness uh, rate. So, morbidity is a kind of a general measure of the scale and the scope and the weight of illness in a community. So asthma morbidity is a kind of factor that creates a layer of vulnerability so that when something like the coronavirus or any other kinds of pulmonary pathology strikes, it puts one at increasing risk of adverse effects and death mortality. Uh, so, that's the...

Ebun: Mmm.

Dr. Wailoo: ...general way I would characterize those. So, you know, there's just [inaudible] physics have been shifting quite a bit, but [(20:00)] I- I seem to-- remember early on uh, some of the sharpest racial disparities where in places like well, certainly New York and New Jersey but also states like Wisconsin, which I believe had something like about the 6 months in, you know, six percent of the population was African-American throughout the state. But something like eighteen percent of the cases and slightly higher than that in the mortality where African-Americans. So, you start...

Ebun: Wow.

Dr. Wailoo: ...you would see these sort of differences. Now, I could be wrong because those numbers-- I could be-- those numbers have actually, there's disparities have reduced in some places and remained in others.

Ebun: [inaudible]

Dr. Wailoo: So, while it's tempting to sort of paint the United States with a broad brush, it's clear that some of those kinds of disparities between population level, infection rate, and mortality have varied widely and yet they have persisted. The one thing...

Ebun: Yeah.

Dr. Wailoo: ...I would also add is we're beginning to see in the early rollout of vaccinations exactly these kinds of-- these kinds of disparities replicated once again. So for instance, I was just looking at some data from the Kaiser Family Foundation that pointed out in a state like Mississippi which has a thirty-eight percent black population. The- the cases in Mississippi right now are around thirty-eight percent of the cases are African-American, but the death rate is more in the mid-forties and yet the vaccine rate at this particular stage is-- it, African-Americans represent fifteen percent. That's one five percent of the population vaccinated.

Ebun: Wow.

Dr. Wailoo: So, when you look at the differences and you can see this in states, like Mississippi, you can see this in states like Delaware. You can see it in states like Nebraska that is you have this um, gap between population [(22:00)] level, illness level, death level, and vaccination rates.

Ebun: Mmm. And we will definitely come back and talk- talk about this vaccine issue some more later on the conversation. That's really important. Thank you for bringing that up. And just Dr. Barber, is there anything else that you would like to add in terms of the statistics that we're seeing and um, morbidity, mortality things like that.

Dr. Barber: And you know, I think that you know, the only thing that I would add is that this idea of um, you know, the difference between morbidity and mortality and- and making sure that you know, we've kind of made it painted in some ways is black and white picture that it's you get Covid and you die um, and mortality has become you know, one of the- the markers or the statistics that we focus on. But I think the issue of Covid-19 morbidity is also really critical because there are folks who are having widespread complications with Covid um, and we don't-- I don't, I have not seen and I have to do some research on this on what those statistics look like in terms of morbidity due to Covid-19. But that's gonna have long-term consequences for health of populations. Particularly again, and those consequences will be felt disproportionately among black Americans and other marginalized racial groups. So, I think we've also as we think about mortality due to Covid-19, we also need to be considering what morbidity looks like and long-term morbidity trends as well.

Ebun: Thank you. Thank you.

Mélena: And that brings us to our next question. Um, mostly on data for just one more question, Dr. Barber. We know that structural racism is a key analytic in your work. So, can you talk a little bit more about the role of data in determining or even predetermining which patients receive care in hospitals? And then how that connects back to structural racism as a framework?

Dr. Barber: Right. So, in some of the- the uh, algorithms if you will or decision points within healthcare systems, and if-- you know, we use um, kind of a markers of or indicators that would suggest how likely a person is to survive. And early on and I think there have been modifications in these [(24:00)] indicators. Those things were for example, underlying chronic conditions, which we again know are shaped by these broader structural factors including structural racism which would then put black Americans and other marginalized racial groups at a disadvantage when it comes to making decisions about, for example, life-saving treatments, you know, such as ventilators etcetera, right? So, again within this-- within the algorithm or within the decision points are is embedded. You know, racism because of the ways in which what the indicators that are used in those decision points are structured by structural racism. So again, it creates this vicious cycle. And then the other thing I'll just say about just within the healthcare system. We know from past research, past work that you know, unequal treatment and discrimination is prevalent among uh, black Americans and other people of color with-- once they enter into the um, healthcare system. So, I think that's another way that racism enters into that, the encounter with the healthcare system and medical professions. And again, all of this has been-- is compounding what we're seeing with regard to both deaths as well as rates due to C`ovid-19.

Mélena: Wow. Thank you for breaking that down.

Ebun: Yes. So, we talked and uh, we talked about what's going on in terms of the statistics with African-Americans. And Dr. Wailoo, little earlier on you also talked about this specifically with vaccines. So, just going a little bit deeper into the African-American community. You talked a little bit about the types of connections that you see happening right now between race and Covid. And could you connect this back to things that have happened historically during earlier pandemics or just things that are going on in the past?

Dr. Wailoo: So, I think it is often the case that we try to connect the current health crisis to a legacy you might say. See, it as a by-product of history. And so, there is a long history of experimentation and the kind of management of health among enslaved people. There is the kind of the history of formal legal [(26:00)] racial segregation that um, shaped unequal access to healthcare because healthcare institutions themselves were segregated. Uh, that legacy carried forward officially into the 1960s. And what you have seen really since the 60s is the development of what you might call informal processes that shape differential access to health uh, and health opportunities. So, you might-- you could pick at any particular moment in this history, you know glaring examples whether it's the experimentation on um, African-American women. Let's say in the development of new surgical or medical or gynecological techniques. You could talk about you know, as many people often point to the Tuskegee syphilis study, which uh, sort of emerged in the 1930s and really formally ended in the 1970s. This kind of example of untreated syphilis among African-American men in Macon County, Alabama. You can find multiple examples, right?

Ebun: Mmm.

Dr. Wailoo: And there's often this argument that these particular events have fostered distrust in Black populations uh, so much so that they kind of you know, are skeptical about medicine in general and health authorities. What I think is important to understand is that while you know, there may be particular events. There is a long-standing kind of structural problem and a challenge that really shapes healthcare in America with regard to people of color African-Americans, Latinos, ethnic and racial minorities that is played out once again in this really quite unprecedented global calamity that is Covid-19. So, so, I'm not one of the scholars who points specifically back to any one event and say...

Ebun: Mmm.

Dr. Wailoo: ...this is uh, a replication. So, if we have inherited racial residential [(28:00)] segregation for a wide range of reasons having to do with racism and with structural inequality, then it is sadly true that that inherited system will produce new forms of inequality when a global pandemic strikes. And so historically, what I study is that phenomenon, that sad phenomenon of how whether it's yellow fever in the 1790s, or cholera in the 1830s, influenza pandemic. You see you might say new chapters in this history of race and inequality play out. Uh, some actually seeming to privilege African-Americans uh, and but most uh, seeming to um, create adverse and extensive morbidity and mortality in Black populations primarily as a result of these structural um, structural forms of inequality.

Ebun: Right, right. Thank you so much. Well, I think we see all the statistics that are interesting but it's really important to understand why things are the way they are and really put it in context. So, thank you for explaining that.

Dr. Wailoo: Ah-hmm.

Mélena: And since we've talked a little bit about medical skepticism, let's- let's talk about the flip side. So, we've seen that in many cities across the US, black Americans have an experienced equal access to the vaccine and I believe you talked a little bit about that earlier, Dr. Barber. And just last week there was a New York Times article that reported that in cities like New York and Philadelphia wealthy White individuals have been signing up to get vaccines and low-income in Black neighborhoods, which has significantly limited Black residents opportunities to be vaccinated in these same areas. So, Dr. Barber, how might we approach remedying this piece of the public health crisis? That is-- this, you know, system of unequal vaccine distribution.

Dr. Barber: Thank you so much for that question. I think what else said because I'm locally in Philadelphia. You know, it is-- that is just that what we're seeing is a form of white privilege play out very starkly. Um, and um, I have been [(30:00)] talking and had conversations with community revident- resident, excuse me, who are outraged by the ways in which um, certain groups are taking up space for the communities that have been most directly impacted, you know by this pandemic. And it's an also unfortunate that a lot of decision-makers, not just politicians are making the claim with Blacks just don't trust the vaccine or there's hesitancy so they don't really want it anyway. So, you know, it's- it's- it's okay that this is happening and I just don't think that that's the case. I think hesitancy and mistrust is definitely one factor.

Mélena: Ah-hmm.

Dr. Barber: But there are plenty of Black Americans in these cities that are ready to take the vaccine, ready to be vaccinate, and don't have the access. And so, I again, this is just a very visible display of White privilege when individuals who've never stepped foot in these communities do so in order to access it um, a vaccine. So what do we do about it?

Mélena: Ah-hmm.

Dr. Barber: You know, I think that what the problem really is, is that no one or I have not seen many, I will say that no one. I have not seen many plans for equity and distribution, right? And so we kind of got the vaccine, distribute it to states, states then distributed those vaccines to local governments. But I- I have yet to see a full-fledged comprehensive vaccine distribution plan that considers racial and economic equity...

Mélena: Ah-hmm.

Dr. Barber: ...that engages communities, right to say, how can we create access points for the vaccine? And also how do we overcome the barriers of um, mistrust? Right?

Mélena: Right.

Dr. Barber: So, my position is this, it is the onus or the responsibility of communicating clearly about the vaccine because there are-- uh, there's Kaiser Foundation show that folks just kind of want to know. They don't know enough about the vaccine to make an informed decision.

Mélena: Ah-hmm.

Dr. Barber: So, it is up to public health officials and leaders to provide information. So, individuals can make informed decisions. So it's the education about the [(32:00)] vaccine, allowing forms for people to ask clear questions because there are some valid questions. For example, our communities disproportionately have chronic conditions, their questions, like will this vaccine interact with my hypertensive medications or my um, insulin injections. Very valid medical...

Mélena: Mmm.

Dr. Barber: ...questions that people...

Mélena: Ah-hmm.

Dr. Barber: ...just want answers, too. Right?

Mélena: Right.

Dr. Barber: And so, I think we need to have a clear communication strategy and explanation of what the vaccine does and doesn't do, what we know and what we don't know. And then improving access to make sure that throughout this distribution process the communities who've been most impacted have access to the vaccine. And this is-- this includes I think, I've seen some um, schemes that you know, kind of do it by neighborhood or zip code, also among essential workers who are again most exposed and have been least protected. And making sure again that there are-- the barriers to get the vaccine are eliminated. One final barrier that I'll mention is this the idea that much of the dish[?] uh, the sign-up for vaccines is done online.

Mélena: Ah-hmm.

Dr. Barber: And so, we've got to again address the digital divide[?].

Mélena: Right.

Dr. Barber: That certain communities or some communities don't have access to be able to sign- up for you know, an appointment to get the vaccine. So, there's so many things. But again, you have yet to see a clear comprehensive plan that plugs all those holes in this broken infrastructure for the time being. Um, and make sure that in our communities are, are able to have access.

Mélena: Thank you so much for- for clearing up what's a very complicated system and hopefully rollout starts going smoothly. 

Ebun: Thank you, Dr. Barber. You brought up today good points there. And especially, talking about access, I think access really is the key. And I'd say going back to when all this first started when we're still in the process of developing the vaccine. Everyone was super excited that you know, the vaccines come and it's all going to be over but it really hasn't gone exactly as we thought it would have gone in terms of how it's been distributed. So, we definitely are kind of stuck in a tight position. And so, we're trying to figure out where to move forward from there. So, thank you for touching about them really explaining [(34:00)] that. And Dr. Wailoo, you know, going off everything that- that Professor Barber brought up, you know, what is the discussion amongst you and your fellow scholars about how we, like what we do now and how we move forward from this position?

Dr. Wailoo: Yeah. Um, so, I would add a couple of things to the helpful once again summary from Dr. Barber. There's a recent pretty good editorial in the Journal of the American Medical Association which points out that you know, one of the things that we're seeing right now with the vaccine is new disparities that are explained by differences in time, technology, and trust. And I think it's a pretty good three-part explanation. Time being, you know, the amount of time that one has to actually use this technology-based website sign-up system, to refresh one's browser, to navigate the way to actually get into the system, differential access to the technology itself, the digital divide, and then we talked a little bit about trust. And one of the things that they pointed out and I think we're at risk for um, experiencing this right now is that we- we are now moving from a system where at least in some states there was an emphasis on equity as being an important factor in distributing vaccine. But the-- what's recently happened really in the last month or so is a new focus on urgency getting as many shots into many people as fast as possible. And one of the dangers in moving towards a fast distribution system is that it has-- it increases the risk of increasing inequality. And so, one of the things that you see playing out in some states is an attempt to deal with uh, the distribution challenges by perhaps emphasizing ZIP code or partnering.

Dr. Wailoo: And these are the things that haven't yet been done, partnering with local institutions, paying attention to the groups that have been disproportionately affected, or [(36:00)] in some ways simplifying the process. That is to say, you know, the more complex we make the process for registering, signing up um, or even things like uh, transportation, right? Things you take-- you and I might take for granted as in I have an appointment and I'm just going to go and show up. This is not as easy for people that don't have access, who have-- are working, and who also uh, may not have as easy access to transportation. So, having a state design a system that pays attention to these kinds of disparities, I think is really crucial for making sure that the vaccine doesn't become yet another basis for reproducing inequalities. And the other thing that I want to say about vaccines is, you know, we tend to think of vaccines as like literally the magic bullet, the thing that's gonna...

Ebun: Right.

Dr. Wailoo: ...solve this problem. It won't. The vaccine is just another part of the public health toolkit. So, one of the things that we continue to have to do is to really do targeted marketing about that very questions that Dr. Barber mentioned, right? Every community has very specific questions. I have diabetes medication and I'm taking, how will this vaccine interact with it. You need reassurance at very very specific community-based level in order to answer these questions. And the last thing I'll say is, too often um, as Dr. Barber also mentioned, there's been this sense that well, Black folks just don't trust the healthcare system. That's just an easy out.

[crosstalk]

Dr. Barber: [inaudible]

Dr. Wailoo: That's a way of really getting outside. That's a way of escaping responsibility...

[crosstalk]

Ebun: Absolutely.

Dr. Wailoo: ...for trying to do something in a proactive way to address the needs of a community.

Ebun: Absolutely. Thank you, Professor Wailoo. Those really important things you said. And I just want to follow up a little bit because you know, touching off with what really brought us here to this question is that I think a lot of people are a little bit disheartened right now with the way that things are going in our nation, and really just in terms of this pandemic, and how bad [(38:00)] it's gotten, and then how it's not going away as quickly as you thought, you know, as from the perspective of historian, have there been things that have happened in our history um, that have maybe not gone as planned? And- and I ask you this to wonder like should we feel like, you know, the world is ending type of thing or- or is this something that we really can bounce back from, is this something that might make us strong on the long run? How would you be listen[?] for in the historical perspective?

Dr. Wailoo: Yeah. That's a really great question. Um, there are moments uh, where that seem as dire as this.

Ebun: Right.

Dr. Wailoo: Uh, one of the examples that historians of medicine often point to is uh, the cholera epidemics in the 1830s, 1840s, and 1860s where you had a similar sense that you know, this was a uh, a calamity uh, coming from overseas uh, that was wreaking havoc half of mostly in poor communities. But it's really as a result of this experience that we produced things that we take for granted today like the idea of a city having a Board of Health. [laughs] That the idea that you know, prevention of disease, we should depend on the existence of a public health system. So, one of the things that we've had in the US over the last thirty or forty years is a complete decimation of the idea of investing in public health. That is to say...

Ebun: Wow.

Dr. Wailoo: ...building a system that is able to, in a very proactive way, really cater to the health and well-being of communities. And so, one of the silver lining uh, possibilities in the coronavirus is that once we get past the epidemic itself, and once the mortality rate starts to come down, and once then- then we can start to ask how do we build a healthcare system that addresses some of the most glaring questions of inequality, but also that really cares for and pays attention to the population of [(40:00)] our nation. And the fact is that the origins of public health in the nineteenth century come out of these recurring epidemics...

[laughs]

Dr. Wailoo: ...where over the course of decades what we committed ourselves to as a society is creating a system not a medical care system, but a public health system that was concerned about you know, housing, and hygiene and you know, clean cities, and ensuring the health of the population. So, if you look at it in that long view...

Ebun: Ah-hmm.

Dr. Wailoo: ...you might say, you know, our goal is to not just get through this calamity but to get to a point where we begin to think in a much more proactive way about what it means to build healthy cities and a healthy community.

Mélena: Thank you. Thank you. Dr. Barber, do you have anything you want to add?

Dr. Barber: Absolutely. That was um, um, great um, Professor Wailoo. And you know, the things that I would add, you know as a social epidemiologist, I think this uh, pandemic again has shown those glaring inequities. Um, and also these struct-- those structural drivers-- are structural and social determinants of health. And I think this also makes us reimagine things like work, you know in terms of this, you know, who we have deemed essential in this moment, who has literally made it so that our economy could- could continue. It's those workers that are not even making a living wage.

Mélena: Ah-hmm.

Dr. Barber: It's those workers who have been in, you know, in conditions that are-- that just again increase exposure. And this came, I wanna just share a story that you know, this really has been on my mind and really my heart after last week. So, as a follow-up to a data brief that my colleagues and I at Drexel produced called Covid and Context where we were laying out and documenting the racial inequities with regards or the inequities with regard to segregation in Philadelphia. We decided to you know, follow up by having a series of community conversations and interviews. And last week we um, spoke with a woman who resides in West [(42:00)] Philadelphia. That's one of the harder-hit places in the city. Um, and she talked about her son...

Mélena: Ah-hmm.

Dr. Barber: ...who is a maintenance worker um, in one of the local hospitals. And he's been doing this work for many years you know, on barely a living wage. Um, one of those quote-unquote[?] invisible I think frontline workers that have been you know, on the frontline since the very beginning of this pandemic, not really having a choice to stay at home or not go into work because literally, the lives of individuals depend on it. And she was telling us about her son and she said, you know because of the shortages within the hospital in addition to his normal maintenance jobs, he is also have been asked to bag-- help bagged bodies as they come out.

Mélena: Mmm.

Dr. Barber: And when I consider that, consider the fact that there is invisible labor...

Mélena: Yeah.

Dr. Barber: ...that is happening that we don't even know about that. We haven't [inaudible] really scratched the surface of the ways in which we have literally deemed these workers unworthy...

Mélena: Mmm.

Dr. Barber: ...of adequate pay living wages...

Mélena: Ah-hmm.

Dr. Barber: ...you know, etcetera. But he has been asked to bag the bodies. And not just one or two, it is a literal procession of bodies that on a daily basis he's asked to do. And you know, so what would it mean for us the value the lives of these workers...

Mélena: Mmm.

Dr. Barber: ...disproportionately Black and Brown but also for White folks. What would it mean in this country to allow them to have the conditions to live healthy lives and thriving lives in communities that also are healthy and thrive?

Mélena: Yeah.

Dr. Barber: What would it mean to reimagine our society in such a way that when a pandemic like Covid-19 hits again that we don't have this level of devastation? And so that's what I've been really as uh, as someone who is committed to this work as a social epidemiologist, but tired to the kind of just documenting it. Really thinking about how we disrupt these systems. How do we make it so that that worker, that young man, or any other person like him, the essential workers, the [(44:00)] essential people in our society are cared for...

Mélena: Mmm.

Dr. Barber: ...in the same way that folks who have privilege are- are in our country. And so, I think that is the question. So, and I think we have an opportunity if the death that we've all had to bear witness to can speak to us and move us. We actually have an opportunity to reimagine our world anew...

Mélena: Wow.

Dr. Barber: ...you know. And to really rethink about. And you know, think about what it means for everyone to be healthy and to thrive. And that's my hope...

Mélena: Mmm.

Dr. Barber: ...in this moment, is that we don't go back to normal.

Mélena: Right.

Dr. Barber: That we take this moment seriously, and we move all of forward. Because literally, our collective lives depend on it.

Mélena: Wow. I really, really appreciate you sharing that story. It puts everything in perspective and thank you for asking those questions to definitely things that are pressing and that we should keep on our minds and work towards. So, kind of related to what you were just talking about, Dr. Barber, I'm wondering if you have any um, organizations that come to mind. I know you work with the Poor People's campaign, but organizations that are helping fight racialized health disparities on the ground um, that you would point people towards if they're you know, seeking to donate or get involved.

Dr. Barber: Absolutely. So, you know one locally in Philadelphia and Pennsylvania um, put people first, which is an organization that's linked up with the Poor People's campaign. And actually, they- they do organizing across racial lines, but really among those who have been most dispossessed. Um, and one of their biggest thing is healthcare as a human right, right?

Mélena: Mmm.

Dr. Barber: Um, and- and really thinking about how we fight for that both in the urban settings in Pennsylvania but also in our rural areas. And connecting the dots and- and showing the ways in which healthcare has been denied to as far too many people. So that's one locally. And I will say that the Poor People's campaign for me has been you know, at the forefront of these issues even prior to the crisis of helping us think about these interlocking injustices including you know, access or access to healthcare and other things. And they have um [(46:00)], organizers in forty-five states and across the country. You know, even the Black Lives Matter movement, if you really think of-- you look at what their platform is, it is about police brutality, absolutely. But they also push us to be thinking about these broader structural issues as well.

Mélena: Ah-hmm.

Dr. Barber: And so, I think supporting those kinds of movements in the Grassroots organizations, doing the work on the ground, pushing us forward who've already reimagined and been fighting for a better world...

Mélena: Ah-hmm.

Dr. Barber: ...in a more just world. I think that's who we needs on line within this moment and join- join forces with really to kind of push us forward.

Ebun: Thank you, Dr. Barber. And Professor Wailoo, would you have-- would you recommend any historians or organizations, things like that, that people should go to if they want to learn more or get involved, listen, etcetera.

Dr. Wailoo: Well, I think um, you know, particularly because we're right here in Princeton and often um, don't really pay attention to our neighbors to the south in Trenton, uh, there's a wide range of Trenton-- particularly, let's say food distribution. I mean, the kinds of you know, day-to-day realities of how you cope uh, with the- with the crisis like this are being managed by organizations that aren't specifically focused on Covid-19. They're focused on getting food to the poor uh, to getting kids fed before they um, either go to school in person or you know, they go to school online. And so, I guess I would advocate just for kind of general engagement with civic organizations in our backyard. Uh, if one is interested uh, from the standpoint of Princeton getting involved with Trenton.

Ebun: Thank you so much. And thank you so much both Professor Barber and Professor Wailoo. It's been a pleasure and an honor speaking with both of you and we are so appreciative of the work that you're doing.

Dr. Wailoo: Thank you.

Dr. Barber: Thank you so much for the invitation. And thank you uh, Professor Wailoo. It's been great to be in conversation.

[background music playing]

Dr. Wailoo: Ah, likewise. I learned a lot. Thank you so much.

Dr. Barber: Same.

Mélena: Now, on for our closing segment, [(48:00)] See, Hear, Do, where we provide you with a few additional resources. If you want to learn more about and more deeply engage, the topics from today's conversation. Ebun, you were telling me earlier about this super cool website created by students, right?

Ebun: Yes. There are two things I think people will find interesting. The first is a virtual exhibition curated by five undergraduate Mellon scholar interns at the library company of Philadelphia. It's called Deja Vu, We've Been Here Before, Race, Health and Epidemics. And as the title suggests, it traces how epidemics have historically affected Black communities in America and demonstrates of the relationship between racial disparity and health inequality is longstanding.

Mélena: So, the project basically provides a virtual museum experience. If you're like me and you miss those times when we could safely visit museums, you'll love the fact that you can peruse and study archival materials related to race and health from your laptop or phone. And the exhibition covers fascinating topics from the connection between physical space and disease to the way that print culture has narrated the history of health in the African diaspora. So, definitely take a few moments and head on over to www.librarycompany.org/dejavu.

Ebun: And don't forget to check out our show notes for the links to everything we share. The second resource I wanna share is a documentary, Milwaukee In Pain Impact of Covid-19 in the Black Community. This is directed by Milwaukee native, Theo Rogers. Rogers uses the film to explore how the effects of systemic racism and covid-19 have compounded to produce what he called "A pandemic on top of a pandemic".

Theo Rogers: I wanted to get to the nitty-gritty of the story and a lot of these issues come from, you know poverty. A lot of these issues come from lack of education. A lot of these issues come from health, from mental health, and different things of that nature. It's not only are you losing people but you're losing your job. You're losing your source of income. You're losing your morale.

Ebun: Milwaukee In Pain [(50:00)] is now streaming on Amazon Prime for listeners who want to learn more.

Mélena: One additional resource I wanna note before we wrap up is a syllabus on The History of Anti-Black Racism and Medicine created by three Ph.D. candidates, Antoine S. Johnson, Elise A. Mitchell, and Ayah Nuriddin. Here is Antoine and Ayah to tell us more.

Antoine Johnson: Antoine Johnson, Ph.D. candidate at UC San Francisco. I'm studying HIV and AIDS among- among African-Americans in the San Francisco Bay Area from the disease's 1981 identification throughout the 1990s.

Ayah Nuriddin: Uh, my name Ayah Nuriddin. I am a Ph.D. candidate in History of Medicine at Johns Hopkins University. Uh, my work looks at the ways in which African-Americans used Eugenics and Racial Science to make arguments for racial equality from the late nineteenth century through the 1970s.

Antoine: We came to the idea of creating the syllabus during a virtual happy hour session, which we've been doing um, every Friday since March. Um, and Ayah and Elise and I uh, were just having conversations about the um, statements going out and support of um, in solidarity with Black people and their allies throughout the country after the murders of Breonna Taylor and George Floyd. I just asked, you know, impass--[?] passing[?] if I and Elise would like to put together an anti-Black racism in American Medicine syllabus.

Ebun: Yeah. I think that covers a lot of it. It's sort of began as a very organic conversation out of a lot of the kinds of concerns and frustrations we've had do you know, sort of doing Black history and being in the history of medicine where those fields sort of are not always in conversation. Um, and I think in this particular moment with- with Covid and with the, you know, murders of George Floyd and Breonna Taylor that we were thinking a lot about the legacy like the impact of racism on you know, sort of being in the profession of the history of medicine, but also thinking about how [(52:00)] there's all of this work that really does bridge that gap. But sometimes scholars are not in conversation with each other. And so the syllabus emerged out of that kind of a conversation and- and sort of a hope that you know, we could you know, fill some of the gaps and- and get people sort of talking across subfields um, about these really, you know, important and timely issues.

Antoine: Yeah. Um, one of the books that are stuck with me from the first time, you know, I saw the cover and- and the title is a Medicalizing Blackness by Rana A. Hogarth. And something that Hogarth um, points out and you know, she doesn't address HIV and AIDS, but she does address, you know race um, racialized science. You know, like things that say, oh African-Americans are more prone to you know, say heart disease or something like that. And or Black people are more susceptible to diabetes. And you know, she- she challenges that notion. You know, she says, "Well, how are you defining Black, or you just solely basing it on the, you know, descendants of the transatlantic slave trade? Are you including African and West Indian immigrants? Um, you know, are you including folks of mixed heritage? Um, like so- so, what is black and how well, how do you come to these conclusions?" You know, like people avoid those conversations.

Ayah: There's so much work on- on the syllabus that has been absolutely crucial to my own work. Um, this-- that's-- that I wouldn't have been able to do my dissertation without. And I think because of you know, me, Antoine, and Elise all having kind of different areas of specialties, we get a lot of different work from a lot of different sort of corners of Black studies in the history of medicine. Um, one of my personal favorites that I always return to that's on the syllabus is um, a book called Medical Apartheid by Harriet Washington um, about the history of experimentation on- on Black people. You know, from the colonial period basically through to the present. And every time I return to this book, it gets-- I get new insights from it [(54:00)]. Um, and it's so thorough and meticulous. And I'm building a quart of like I've use it for courses before I'm working on a syllabus for a different course now that assigns multiple chapters from this text because it is so rich. Um, and not everything on the syllabus is- is that long I should be clear. But um, it is a really really useful and insightful text.

Ebun: I definitely need to check out here at Washington's Medical Apartheid.

Mélena: Same. Now to close us out today, we asked Dr. Keeanga-Yamahtta Taylor, Assistant Professor of African-American studies at Princeton University and the author of the Pulitzer Prize finalist Race For Profit: How Banks in the Real Estate Industry Undermined Black Homeownership. To share a snippet from her recent New Yorker article Black America has reason to question authorities. Here is Dr. Taylor now.

Dr. Keeanga-Yamahtta Taylor: The skepticism among the Black public is not rooted in the same kind of anti-scientific sentiment that has motivated those small communities that reject vaccines in general. Instead, Black concerns are enmeshed within a history of Black healthcare that is replete with acts of cruelty and depravity and has cause Black communities to regard the healthcare professions with [inaudible] suspicion. More important, racism in the provision of medical treatment in the United States is tainted the way is that healthcare professionals view Black suffering and symptoms and black bodies more generally. It is easy for African-Americans to generalize about the ineptitude, callousness, and duplicity of officials from those at local schools to those in the federal government. And is not unreasonable for Black communities to have questions about the vaccine or about the safety of the schools to which they send their children. It should be expected given the long history and contemporary expression of racism and inequality in this country. This doesn't mean that African-Americans won't take the vaccine or eventually feel comfortable returning their children to school but both will require a credible public campaign and the implementation of safety measures that don't dismiss the Black public's concerns [(56:00)], but rather seek to overcome them with trustworthiness, transparent-- transparency, and accountability.

Ebun: Powerful words. And with that our inaugural episode, Covid-19 In Black America has come to a close.

[background music playing]

Mélena: My name is Maylina[?] Ladic[?], a Ph.D. student in Religion and African-American Studies at Princeton University.

Ebun: And I'm Ebun Ajai, a Princeton University undergraduate student in the School of Public and International Affairs.

Mélena: And behind the scenes, we have Mikee McGovern[?], a Ph.D. candidate in History of Science In African-American Studies helping out as associate producer. And our ship is steered by Ellie O. Jaio[?], the department computing support specialist. With artistic support from Anthony K. Gibbons Jr., our Communications and Media Specialists.

Ebun: Thank you to the Department of African American Studies, Princeton University and you all for tuning in. We will catch you next time.

[background music playing]

[END]

 

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