And Scene: Setting the Stage of Contemporary Black Health and COVID in America

I recall attending a nutrition lecture in medical school about vitamin D. The lecturing physician discussed differences in vitamin D levels amongst blacks and whites in America. During that lecture, the teacher inferred that white skin was an evolutionary advantage because of the ability of the sun to more easily penetrate paler skin, leading to the synthesis of vitamin D, as opposed to black skin in which the sun has to traverse more wavelengths to initiate vitamin D synthesis. We engaged in a somewhat heated conversation in the middle of class about how this information was being presented to a mostly white class. I will never forget that day. There were many days like this throughout my medical education. The overwhelming message was that black folks portend worse outcomes across the board. Interestingly, this was always presented in a way that made it seem as if black folks were inferior to other counterparts. Information presented in this manner affirms whiteness as good and healthy, while blackness is affirmed as negative and unhealthy.

In truth, relative to many conditions such as obesity, cancer, and heart disease, black people do, in fact, portend worse outcomes. It has nothing to do with inferior genetics but everything to do with racism and classism in America.

COVID deaths among blacks and Hispanic/Latino persons in American is multifactorial.In casting the scene of contemporary black health in America, we must stage accordingly, lest we perpetuate false ideologies with dangerous consequences. Health inequalities have always existed in America. Given the history of white medical education at the expense of black bodies, black folks don’t trust the medical system. Trusting a health authority leads to better compliance with medical advice and subsequently improved health outcomes. Black populations tend to fare better when attended by black doctors because there is a level of trust relative to cultural identities.Hispanic/Latino and black populations suffer a greater prevalence of metabolic conditions such as diabetes, obesity, and hypertension. These are both environmental and racism-related issues. Literature suggests that perceived stress from racism is associated with an elevation in C-Reactive Protein, a marker used to assess inflammation within the body. Racism is a documented chronic stressor that not only has been shown to affect the people experiencing racism but it also affects the genes passed down to the children of that marginalized group. Numerous human studies reveal that chronic stress is accompanied by a reduction in natural killer cell activity. Natural killer cells are an immune cell type responsible for killing viruses and have been shown to be remarkably reduced in cases of severe COVID infection. There is also reduced activity in other immune cells as well, caused by chronic stress. Chronic stress is associated with the alteration of immune function and negative effects on natural and specific immunity. In one particular study, perceived racial discrimination forecasts higher cytokine levels. Cytokines in this case were pro-inflammatory cell messengers, not anti-inflammatory.Our environment accounts for much of the influence upon our health. In Black and Hispanic/Latino communities in America, there are numerous factors that create a different picture of health through targeting of the subconscious mind. In these communities, there is a disproportionate amount of junk food advertisements. Many leading health experts believe that advertisements are the cause of obesity. The power of suggestion on the human mind has been proven time and time again to be a central player of influence upon our daily actions. According to the Rudd Center for Food Policy and Obesity, Hispanic and black youth are disproportionately targeted with junk food ads including sugary drinks, fast foods, and candy. At the crux of our health, what we eat is pivotal — period.Redlining policies enforced by the government have also led to disparities in health care in America. Redlining is a system that forced black folks to live in neighborhoods that were also zoned for waste dumps, factories, and liquor stores. Many of these zones are also pollution hotspots. The social and environmental literature is replete with connections between environmental pollution and risks of chronic disease, including cancer.Lack of access to care must also be staged here as it’s one the largest culprits involved in current COVID discrepancies among ethnicities. There is a general lack of medical providers in black communities, a fact reflected in the quality of care towards black patients. With such expensive health insurance rates, lower income minority groups are disadvantaged. According to one study, 19% of black Americans are uninsured, and over 30% of Hispanic/Latino people are uninsured, compared with 13% of white Americans. The use of emergency medical services such as emergency rooms have become the primary care office for many due to lack of insurance and costly insurance coverage. It’s a privilege to work remotely and many black and Hispanic/Latino folks in America work non-managerial service jobs; occupations where it’s impossible to work remotely which lends to increased exposure risk to COVID.When we can view the entire stage, we are able to clearly see the factors that play a role in the current pandemic crisis that is disproportionately affecting Black and Hispanic communities. Genes are not the issue, the social and physical environment is the issue in these communities, and if we are ever to address this inequity we must factor in this reality.Asia Muhammad is a Naturopathic Doctor in St. Louis, MO. She values the power of lifestyle modifications to achieve optimal health. She has a special interest in gastroenterology, mind-body medicine, and stress management, as increasing research demonstrates the role of stress in disease. Asia received her Doctorate in Naturopathic Medicine from Southwest College of Naturopathic Medicine in 2014 and completed a three year independent residency at Arizona Digestive Health. She received her BS in Chemistry and Biology from Middle Tennessee State University in 2010. In her spare time, she enjoys connecting with her community to provide nutrition and exercise education.