Public Health Emergencies: Coronavirus and Systemic Racism : Short Wave Across the country, demonstrators are protesting the death of George Floyd and the ongoing systemic racism that is woven into the fabric of the United States. The protests come in the middle of an unprecedented pandemic that is disproportionately killing people of color — particularly black Americans. We talk to public health expert David Williams about how these two historic moments are intertwined.

Coronavirus And Racism Are Dual Public Health Emergencies

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Hey there. So for the next few days, we're centering black scientists and academics on our show, highlighting their expertise, experiences and how they're processing both the pandemic and the protests. Yesterday, we celebrated #BlackBirdersWeek. And tomorrow, Saturday, we have an episode from our friends at NPR's Code Switch that puts this moment into historical context. Be sure to check that out. All right. Onto the show.


SOFIA: You're listening to SHORT WAVE from NPR.

For over a week, there have been protests around the globe in response to the death of George Floyd and the ongoing systemic racism that is woven into the fabric of the United States, racism that has led to countless public health crises in black communities. For many, these protests have raised additional public health concerns. We're in the midst of a coronavirus pandemic - the potential for transmission from close proximity and loud chanting to potentially being jailed in close quarters inside.

In both of these public health crises, systemic racism and the coronavirus pandemic, black Americans are dying at a disproportionately high rate. So in order to understand all of this from a public health standpoint, what the risks are and how public health experts are weighing them, naturally, we called up David Williams.

DAVID WILLIAMS: I am a professor of public health and African and African American studies at Harvard University.

SOFIA: And for over 30 years, David's spent his time researching...

WILLIAMS: The social influences on health - race and ethnicity, socioeconomic status, stress, health behaviors, religious involvement - factors outside of the traditional medical domain that we would think of but, nonetheless, very consequential for health.

SOFIA: What I'm saying is David is kind of a big deal in this field. And it's this large body of knowledge and expertise that led the little smarties over at The Washington Post to reach out to him for an op-ed about the coronavirus and race.

WILLIAMS: I think in general, most Americans are unaware that racial disparities in health exist. And then what we saw early with the coronavirus is we were seeing these striking racial disparities in health in one U.S. city after another.


WILLIAMS: And then people are now understanding it. But then they are misattributing what the causes are. So people are thinking, well, the higher underlying conditions reflects the bad behavior of populations and not really recognizing it reflects the poor living conditions, the low economic status and the high levels of stress.


SOFIA: So today on the show, two public health crises that are disproportionately killing black people in the U.S. - systemic racism and the coronavirus pandemic.


SOFIA: So three weeks ago, you wrote an opinion piece in The Washington Post, saying that the coronavirus is hitting black Americans especially hard. And the root of that is systemic racism that manifests across multiple areas - from residential segregation to income and education - and that that in turn leads to health disparities.

WILLIAMS: Yes, that is absolutely correct. I think of the coronavirus as a tutorial on racism because it illustrates the multiple pathways by which racism can have consequences for health. One of the pathways is that racism, through its institutional structural mechanisms, like residential segregation, creates access to opportunity in American society. Where you live, for most Americans, determines where you go to school and the quality of education you receive. Where you live determines the quality of your neighborhood environment. Where you live determines even the quality of city services that you have access to. So in many profound ways, place, your zip code is a powerful predictor of the factors that drive health.

SOFIA: Yeah. You know, the other thing that was really interesting to me is the role that stress related to racism actually manifests in the body. Tell me a little bit about that, about that physical response.

WILLIAMS: Yes. So stress is, in general - is a powerful driver of health. And racism affects stress for populations of color in two ways. First, it leads to higher levels and greater clustering of traditional stresses. And I think of things like unemployment or the death of a loved one or financial economic stress. Those are all things that African Americans and other persons of color experience at higher rates.

But in addition to that, the direct interpersonal experience of discrimination, being treated by a particular individual badly or unfairly, also has negative consequences for health. What the research has shown is that those experiences create negative emotions. And then those negative emotions in turn creates change in physiological processes - changes in heart rate, changes in blood pressure, changes in the secretion of stress hormones - that leads to underlying physical health problems.

For example, research has found that higher levels of everyday discrimination leads to higher levels of high blood pressure. It leads to higher levels of inflammation. And high levels of inflammation puts you at risk for virtually every chronic disease. Pregnant women who report everyday discrimination give birth to lower birth weight infants. Community residents who report everyday discrimination have poorer sleep. And then poorer sleep leads to worse immune function. And so there are multiple pathways by which discrimination has direct negative effects on health.

SOFIA: Your piece explains how coronavirus will affect the black community in more widespread ways than higher mortality rates. What are some of those long-term effects, those more widespread ways?

WILLIAMS: Sure. Coronavirus is providing not only higher rates of of illness, greater severity of illness and higher death rates, but the coronavirus is also worsening economic conditions and raising economic stress for populations that were already doing poorly before the virus. So in many ways, the high levels of stress have only been made even more stressful by the coronavirus.

SOFIA: Yeah, yeah. So, David, you wrote this piece about three weeks ago. I mean, how would you update that piece now? Is there anything you'd change or update?

WILLIAMS: I think one of the things I did not talk about in that piece was about the effect of one particular type of discrimination. And that is how persons of color are treated by the police. So that death in Minnesota of a young man in the prime of life who, in a very unimaginatively difficult way to experience, to imagine, was killed in broad daylight with a police officer keeping his knee upon that man's neck for nine minutes. It is just heartbreaking. It's heart-wrenching.

And it has led to a movement across the United States of communities coming together and saying, enough is enough. We have gotten to the point where we can no longer tolerate such behavior that is literally killing people. And what makes that behavior particularly bad for populations of color and especially African Americans and especially African American men is that we see ourselves in that experience. We see a - we imagine that that could be me.

SOFIA: Yeah, yeah. You know, I mean, that's a thing I wanted to talk about. What are you - when - you know, when you're watching this protest, David, what are you thinking? Because, you know, on one hand, you know, people feel like they have to go out there and protest this. But that puts you at risk for catching coronavirus. So, I mean, how do you weigh that?

WILLIAMS: It is a challenge because everyone feels we have to do something. This is unacceptable. We have to raise our voices. We need to to have those in power listen to the pain, understand the suffering and decide to do better in the future. So it's a moment when we have to act. At the same time, the pandemic still rages. And standing shoulder to shoulder with others is not really wise in this moment. I think there are some individuals I have encountered, even within my own family, who no longer can watch the news because watching the protests, watching the pain, watching the suffering is too much, is causing traumatic stress that they no longer want to experience.

SOFIA: Yeah.

WILLIAMS: And then there are others who feel, even at the risk of their health, this is a moment when they cannot be silent, when their voice has to be heard and feel compelled to go out. And then there are others like myself. I have not gone out and actively participated in the protests, but I have provided money to support some of my students who are out there on the frontlines. And they are creating care packages to give to persons who are protesting - resources like water and raisins and gloves and masks so that they can keep themselves safe. So I think in many ways, we are all trying to do the same thing of trying to communicate that this is unacceptable in our country, and we need a better future.

SOFIA: Given the nature of protesting in general - right? - I think there is concern out there that protesting could contribute to this, you know, second wave of the virus, of a new wave of infections. And it's also happening as many states are opening up. So how do you see that?

WILLIAMS: It is a public health challenge. And it is one public health challenge upon another. Many states are opening up, and many of us in public health think they are opening up prematurely. So that will put individuals at higher risk. And then when we have hundreds and thousands of people marching together in close proximity to each other, conditions are being created that could worsen the pandemic. So as a public health professional, I am concerned.

At the same time, as a black man in America, I understand where people are coming from. I understand the pain. I understand the anguish. I understand the frustration. And I understand the commitment of some that are saying, I am even willing to give my life for this cause because having my voice be heard at this moment in history is more important than anything else right now.

SOFIA: Got it. Got it. So, David, what are your concerns and fears in this moment? And what are your hopes?

WILLIAMS: I will tell you my big concerns is that from the leadership of the United States, there is a tendency of some in leadership to not hear the pain, to not hear the suffering, to not empathize with the challenges that people are marching for. And they are calling for us to come together and work to create a better future together. That tone deafness is something I worry about.

The good news for me - it's refreshing to me to see the international dimensions of the protests, one, and also to see domestically, the extent to which young and old, persons of different racial and ethnic backgrounds are working together to say, enough is enough. We can do better. We want to do better. We are calling on our leaders to create a new day, a day of new opportunity, a day of equality, a path to justice for all and equality for all. So that is very encouraging. And that's the kind of movement it will take for us to see the change that is necessary for us to see.

SOFIA: I'll tell you what, David Williams. I appreciate your time so much. Thank you for coming on the show. I really appreciate it.

WILLIAMS: It certainly has been a pleasure working with you today.


SOFIA: Today's episode was produced by Rebecca Ramirez, edited by Geoff Brumfiel and Leah Donnella and fact checked by Emily Vaughn. And remember - look out for a special Saturday episode from NPR's Code Switch podcast that we're dropping in our feed tomorrow, which - if you're not already subscribed to Code Switch, what are you doing? Get on it. I'm Maddie Sofia. And this is SHORT WAVE from NPR. Stay safe out there.


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