A Letter to Congress: Addressing the Health Disparities facing African-Americans under COVID-19

By National Urban League
Published11 AM EDT, Fri May 17, 2024

Dear Chairman Clyburn and Ranking Member Scalise:

On behalf of the National Urban League, the nation’s oldest and largest civil rights and direct services organization, we commend you for holding a member briefing on “An Unequal Burden: Addressing Racial Health Disparities in the Coronavirus Pandemic.” Established in 1910, National Urban League serves nearly 1.7 million people each year through our 90 affiliates in 36 states, the District of Columbia, and over 300 communities. Our mission is to enable African Americans and other underserved communities to secure economic self-reliance, parity, power, and civil rights. Today’s member briefing obviously concerns our civil rights mission—as seen through the lens of racial health disparities.

Although the effects of COVID-19 on the health of racial and ethnic minority groups are still emerging, current data suggest that Black and Latino communities bear a disproportionate burden of the illnesses and deaths due to COVID-19. The Centers for Disease Control and Prevention recently studied race and ethnicity data from 580 patients hospitalized with COVID-19 in [99 counties in 14 states] and found that 45 percent of individuals for whom race or ethnicity data was available were White, compared to 59 percent of individuals in the surrounding community. However, 33% of hospitalized patients were Black compared to 18% in the community and 8% were Latino, compared to 14% in the community.[i] These data suggest an overrepresentation of Blacks and Latinos among hospitalized patients.

Nationally, African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater. In 42 states plus Washington D.C., Latinx persons make up a greater share of confirmed cases than their share of the population. In eight states, it's more than four times greater. White deaths from COVID-19, by contrast, are lower than their share of the population in 37 states and the District of Columbia.

The reasons for this disparity are complex. People of color have jobs that require more intense contact with the public. One in three White Americans have jobs that can be performed from home. Less than one in five Black Americans and one in six Latinos have that same privilege.[ii] Second, Black and Latino communities are more likely to be employed as frontline workers (i.e., health care workers, grocery store cashiers, warehouse workers, and transit workers), which creates higher risk to viral exposure also increases their rate of exposure to the virus. Third, Blacks and Latinos are more likely to have preexisting health conditions that make death from viral infection more likely. For instance, Black Americans are 25 percent more likely than White Americans to have asthma[iii], 20 percent more likely to die of heart disease[iv], and 60 percent more likely to develop diabetes.[v] All of these comorbidities increase the chance of contracting the virus and the severity of the virus.

Additionally, the recent mass demonstrations protesting the police killing of George Floyd by four Minnesota police officers have spread across the nation, causing millions of Americans to take to the streets in disregard of social distancing protocols. While the Urban League believes peaceful protests are necessary in our continued fight toward civil rights and social justice, we are concerned that Black and Latino communities—the very communities that have been hit the hardest by the COVID-19 pandemic—will ultimately experience a resurgence of the coronavirus as a result of social action. The inevitable nature of mass demonstrations requires people to be in close proximity, thereby increasing the risk of community spread.

For years the National Urban League, through our affiliate movement, has served as a health navigator offering free referrals to local health services as well as culturally appropriate chronic disease prevention and management training in underserved communities. Our signature programs include Project Wellness, a program that aims to reduce racial health disparities and promote health and wellness equity. We have also partnered with Morehouse School of Medicine and adapted the “Power to Prevent” curriculum from the CDC to help affiliates across the country stand up and expand their own programs using a community health worker model. Through our curriculum, we educate individuals on how to make behavioral changes through diet and exercise that will lead to a healthy lifestyle and reduce health disparities. However, the League recognizes that individual changes can only do so much without addressing the systemic barriers that prevent better health outcomes in communities of color.

Accordingly, the National Urban League supports many of the policy solutions contained in the House-passed HEROES Act, H.R. 6800, which would undoubtedly reduce the racial health disparities that we are seeing within the COVID-19 public health crisis:

National collection and public reporting of racial disparities data. Tracking demographic data, including race and ethnicity, for those who have been tested, infected, hospitalized, recovered, or died from COVID-19 helps the public health workforce identify groups that may have a higher likelihood to experience severe illness from COVID-19 as the pandemic progresses. Collecting and reporting this data can help state and local agencies, health systems, hospitals, and health care providers provide access to testing, health care, and social services for diverse populations. Finally, the collection and reporting of this data can help policymakers prioritize and distribute resources based on anticipated need. Members of Congress have asked the CDC to provide this kind of data, but we still have not seen it.
Universal testing. One of the keys to reopening the economy is having enough tests to diagnose coronavirus infections, with the goal to quickly identify new cases, isolate them, and track down others who may have been exposed. It is vital that we ramp up testing and ensure that low income, Black, Latino, and other historically marginalized communities have access to this testing, especially since we know that these communities are bearing the brunt of this virus. As of this writing, only five percent of the U.S. population has been tested. This is not nearly enough.
Culturally competent contact tracing strategies that reach communities of color most impacted. In order to contain the virus, contact tracing is desperately needed to lower rates of exposure. Contact tracers must be trusted community messengers who are culturally competent and speak the languages of the communities they trace. Every community must have access to contact tracing resources in order for states to respond in a way that meets actual need. The National Urban League and its affiliates are poised to serve in this capacity, having over a century of experience providing localized services in historically underserved communities.
Ability to get paid time-off to get treated and prevent spread of coronavirus. Black and Latino workers are overrepresented in industries and jobs that make it impossible to work from home, and as a result, they are forced to take time off if they are exposed to the virus and required to self-isolate. Emergency paid leave is needed beyond the two weeks (80 hours) provided by the Families First Coronavirus Response Act.[vi] We are now four months into this global health crisis, and the risk of exposure remains with every trip to the grocery store or post office. Workers must be able to safely to take time-off without risking losing their livelihoods.
Treatment for all regardless of ability to pay. The jobless tally since mid-March, when the coronavirus pandemic took hold, has increased to over 40 million,[vii] and the U.S. is simultaneously surpassing 100,000 deaths, and almost 1.8 million coronavirus infections.[viii] Americans must be able to access medical treatment regardless of their ability to pay. This country has invariably attached insurance to employment, but with the unemployment reaching unprecedented levels amid a global health crisis, this must change.
OSHA regulations to protect essential workers. The Occupational Safety and Health Administration (OSHA), founded by Richard Nixon in 1970, was established under the basic proposition that no worker should have to choose between their life or their job.[ix] Bus drivers, grocery store clerks, pharmacists, postal workers, sanitation workers and countless other essential workers continue to make that brave choice every day so that our society continues to function amidst the COVID-19 pandemic. The Department of Labor must create OSHA regulations to ensure that essential workers are protected and can go to work safely every single day.
Medicaid expansion. Urban Institute researchers have forecast that an unemployment rate of 15% would result in an additional 8-14 million people enrolling in Medicaid, increasing overall Medicaid enrollment up to 29 percent.[x] People will continue to get sick and need treatment, but If Medicaid is not expanded, the cost of treating the uninsured will continue to be higher than the cost of Medicaid expansion.[xi] And without insurance, people are more likely to go without treatment, putting them at greater risk to contract the disease. Experts have stated that Black patients are more likely to delay care, and that socioeconomic status factors play an outsized role in influencing health outcomes and vulnerability to infection.[xii] Medicaid expansion is required to meet the growing need for access to healthcare services, and treatments.
Reduction in the use of excessive police force to reduce the incidence of death in Black men. Use of police force is one of the top six leading causes of death among young Black men, with Black men being killed at a rate 2.5 times higher than their White counterparts.[xiii] Now is the time for Congress to pass comprehensive legislation to hold police officers accountable for excessive force, maintain official data on police-community interactions, and properly train officers on the lawful use of force against civilians. Congress must implement a federal standard where any type of force will be a last resort in police interactions with citizens and de-escalation techniques be applied nationwide.
Funding for state and local governments to help pay for services provided by vital workers like first responders, health workers, and teachers. States are experiencing sharp declines in sales tax, fuel tax and other tax revenue compared with the same period a year ago which will ultimately impact local governments in the form of massive cuts to payroll and services. Many smaller cities of 100,000 residents or less are home to a significant African American and minority populations and are especially at risk of budget cuts as they typically have a narrower economic base than larger areas, have weaker infrastructure, and grossly inadequate health care facilities. They are desperately in need of liquidity to help prevent layoffs and the erosion of vital services.

The COVID-19 pandemic has exposed long-standing racial and ethnic health disparities that we have sought to eliminate for decades—we must act now to ensure these issues are not exacerbated to a point of no return. As we collectively work to respond to today’s unprecedented public health and economic crises, we must address the deep issues of inequality in future responses. The Health Equity and Accountability Act (HEAA) provides Congress with a comprehensive blueprint of policy solutions designed to respond to ongoing threats against the health and well-being of communities, build on the coverage gains made under the Affordable Care Act, and ensure access to affordable health care for all. The National Urban League calls on Congress to pass HEAA to reduce health disparities in communities of color, promote policies that encourage tangible outcomes of systemic change and improve quality of life for all Americans.

Sincerely,