WASHINGTON — Four months into a pandemic that has disproportionately devastated Black, Latino, and Native American communities, leading minority health experts within the Trump administration remain conspicuously quiet and have conducted minimal outreach to communities of color.
The directors of two federal minority health offices, as well as the government’s $336 million health disparities research institute, have not conducted TV or radio interviews since the pandemic began in early 2020. None has testified before Congress, or appeared at a White House coronavirus task force meeting or public press briefing.
In an interview, Eliseo Perez-Stable, the director of the National Institute for Minority Health and Health Disparities, applauded several Trump administration figures’ recent efforts related to Covid-19 and protecting vulnerable populations. But at the pandemic’s outset, he said, it was largely Anthony Fauci, the prominent infectious diseases expert, who filled the vacuum, urging action to address devastation among people of color.
“We’re acting on this,” Perez-Stable told STAT, referring to concerns about Covid-19 health disparities. “Could this have been done earlier? You know, you can always say yes. The only person who really had a voice at that table from our perspective was really Dr. Fauci.”
Felicia Collins, the director of the Department of Health and Human Services Office of Minority Health, has been on leave for much of June; a spokesman declined requests for an interview and would not specify when she’d return. Leandris Liburd, the director of an equivalent office within the Centers for Disease Control and Prevention, did not begin public outreach efforts until mid-June, according to a spokesman, who also declined requests for an interview. Liburd and Perez-Stable have served in their roles since the Obama administration, while Collins has held her post since early 2019.
In a range of interviews, scientists and policy experts inside and outside the Trump administration acknowledged that from the start, there have been few voices spotlighting minority health concerns to White House decision-makers — or serving in any public outreach capacity.
Outside experts say the relative silence underscores a flawed response that was particularly concerning at the pandemic’s outset, when leading scientists and administration officials failed to anticipate the toll the novel coronavirus would take on people of color. At a recent congressional hearing, the director of the Centers for Disease Control and Prevention, Robert Redfield, apologized to lawmakers for the agency’s inability to estimate the rates at which people of color became sick and died.
While there was no single figure who oversaw messaging on minority health issues during the Obama administration, many experts said the urgency of the Covid-19 pandemic and its disproportionate toll on people of color called for a more urgent response — and more aggressive efforts to spotlight minority health concerns to White House decision-makers.
This lack of advocacy is especially apparent amid a broader national reckoning over police violence and other systemic forms of racism in the U.S., including in health care, critics said.
“We’ve not observed any meaningful attempt by this administration to engage the African American community in shaping its response,” said Kristen Clarke, the president of the Lawyers’ Committee for Civil Rights Under Law. “At no point has this administration set forth a plan that speaks to the racial inequities that have existed from day one.”
Instead, many of the administration’s attempts at engagement have fallen to Jerome Adams, the surgeon general, and have appeared scattershot.
The White House’s outreach to minority communities and groups focused on health disparities has largely consisted of a pair of April conference calls led by Adams. Ben Carson, a surgeon who serves as housing secretary and is the only Black member of Trump’s cabinet, participated in one, but some participants later said they were unsatisfied. Clarke referred to the calls as “one-way White House briefings that just scratched the surface in terms of providing detail.”
Adams, the administration’s only high-profile Black health official, has taken flak for perceived racial insensitivity in comments he made in an April press briefing, when he counseled that Black and Latino Americans should “avoid alcohol, tobacco, and drugs.”
Courtney Cogburn, a professor of social work and researcher of racial health disparities at Columbia University, called Adams’ remarks “a bio-racist framing of health.”
“You’re suggesting that there’s something inherent about Black people that leads them to having higher rates of disease, when you don’t take an additional step to interrogate why those rates of disease are there,” she said. “In a whole swath of our population, you’re observing this pattern, and you’re essentially reducing it to individual choice.”
The administration has at times touted its efforts on minority health fronts: It circulated a fact sheet on outreach to the Black community and other historically marginalized Americans that highlighted the administration’s data-collection efforts. It also emphasized efforts to channel Covid-19 relief funding to hospitals that disproportionately serve low-income patients, though the administration only sent funds to Medicaid providers, which serve low-income Americans, in early June, after weeks of criticism. Federal officials have also been criticized for being slow to send funds to some hospitals in some communities, including to hospitals in the Southwest serving a heavily Navajo population.
And on May 1, the HHS Office of Minority Health announced $40 million in funding to conduct targeted public health outreach to minority communities; the funds won’t be disbursed until July.
When that program was established, there was no public announcement from high-level administration officials. Six weeks later, during weeks of protests over the police killing of George Floyd and other Black Americans, White House press secretary Kayleigh McEnany announced the program, from the White House podium — without mentioning its rollout date over a month prior.
The administration has also fallen short on lofty promises floated early in the pandemic to use epidemiological data to shepherd resources toward the hardest-hit communities.
In April, Adams pledged in an interview that the administration was “working with the CDC to make sure we’re collecting the data about all populations, but in particular looking at breaking it down by race and by age.”
Democratic lawmakers first called for a detailed racial breakdown of Covid-19 infections and deaths among Medicare beneficiaries in late March. Nearly three months later, and roughly four months after the country’s first documented case, Medicare officials have not released that data. On a nationwide level, Perez-Stable acknowledged, no such analysis exists.
No comprehensive estimate became available until mid-June, when a preliminary CDC analysis showed the Latino and Black communities accounted for 33% and 22% of the country’s early Covid-19 cases, respectively — both of which represent nearly double each group’s share of the population.
Redfield, the CDC director, acknowledged in a recent congressional hearing that the country’s system for collecting demographic information about race was fundamentally inadequate.
“I personally want to apologize for the inadequacy of our response,” Redfield told Rep. Barbara Lee (D-Calif.) when pressed about the administration’s inability to provide a detailed racial breakdown of Covid-19 infections and deaths. “It wasn’t intentional.”
Perez-Stable, however, called a weekly CDC mortality report “extremely helpful,” and said Brett Giroir, a top HHS deputy, was “attentive to the science and the minority health issues.”
The CDC has also been criticized for failing to require commercial testing partners, like private laboratories and local pharmacy chains, to submit demographic data along with the results of Covid-19 tests they’ve supplied around the country. Federal guidance requiring that data was only issued in early June, and does not fully take effect until August 1 — a delay that Trump administration critics and public health experts view as inexcusable.
“That directive from CDC should have come out months ago,” said Howard Koh, the assistant secretary for health during the Obama administration. “I just don’t understand why it took so long. Because we knew, when the crisis started to erupt, that it was going to expose the fault lines of health inequity yet again. This is what always happens.”
While some outside experts have blamed the federal government, others have cautioned that federal officials only wield so much power. It is state officials, said Vickie Mays, a UCLA health policy professor, who are most responsible for understanding and addressing the systemic barriers to care that local communities face.
“We kept talking about doing drive-through testing, and you would have said, who drives in New York [City]?” she said.
The same is true for the seemingly simple mandate of frequent hand-washing, she said — a task made difficult in poor communities where high water bills, or lack of access to clean water altogether, make compliance impossible. In particular, she cited statistics that show households in hard-hit Native American communities, particularly in the Southwest, are 19 times more likely than white households to lack running water.
“That was a state and local issue,” she said. “The federal government could have made some pronouncements, but I would have said it was the delay of states in recognizing: ‘Oh, who of my people can’t wash their hands frequently, and don’t have access to water?’”
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I should mention one more thing – I could not understand it, but there is a paper in pre print which gives a theoretical reason black people would be less likely to get Wuhan but more likely to get severely ill once they had – it had to do with the ACE2 receptor, which the paper claimed black people have fewer of.
About the ‘blacks have less access to health care” – I believe that 100%, as a generality – but access to medicine is not going to much effect outcomes when there is almost no medicine to be had at any price, or, as may have been true early on, the treatment was harmful – intubation was worse than just giving some supplemental oxygen, or so they said.
Early on, when the difference in death rates by race in the US was noticed, the death rates in very poor countries were not way out of line with the US, which was much lower than many fairly wealthy European counties – less access to health care did not seem to be the reason.
First comment – I know it has become commonplace to use the phrase, but this “people of color” thing is obnoxious. In any context except where you are not very, very directly talking about whites and everyone else, it does not even have meaning – which is well illustrated by the fact that Asians, for whatever reason, probably less resistance to face masks, are now reportedly at much lower levels of Wuhan infection than black people or Hispanics.
And, though a lot of Hispanics are infected, from what I read they are not at higher death rates so far, knock on wood – so, they are not “devastated” any more than white people or Asians .
Black people have much higher rates of death from Wuhan and that could be reported, and SHOULD be dealth with as a public health problem to be ameliorated if we can – we have a moral obligation to try – but, even there, bad as this disease is, I have to object to “devastated” – raising the alarm is great, but the death rates in any non-institutional setting seem to be less than 1% – and they are double the other group’s rates, not ten times – the headline seems very alarmist. If someone did not know the numbers, they would think the problem is far worse than it is.
The Latino death rate per capita is lower than that of whites and much lower than that of blacks. So it cannot be said that Latino community is being devastated. As discussed in my earlier post, blacks are dying at a higher rate because their infection rate is considerably higher than what be expected for their precentage of population. So far, about 33,000 blacks have died from total black population of 43 million.
I know there is a higher infection rate among black people, at least I have read it and my non-PC post above points out I see more black people taking their masks off in Walmart, so I believe it easily, but I have read that even the case fatality rate is higher for black people – which, when there is no treatment, does not seem to be caused by inadequate treatment.
I have read you can adjust for all the risk factors and still a black person after diagnosis was less likely to survive, not by 2 to 1 compared to white people but enough to make it worthwhile to try to improve the odds if we can.
It is unfortunate that even in scientific community, we avoid mentioning the role of genetics, lest be accused of racism. Both diabetes and obesity have a genetic element. I am middle eastern and have a BMI of less than 25, but am diabetic (controlled by strict diet and routine exercise) . The gene that kept my ancestors alive during feasts and famines over millennia made me susceptible to the disease. I may be more susceptible to Covid-19, too (above and beyond controlled diabetes). Of course we don’t know because we are afraid of even suggesting a genetic link. This is NOT suggesting that the lack of access to healthcare in minority communities is real. It is. But after controlling for that, we do need to look at genes too.
The primary difference in COVID impact on blacks and Latinos is their infection rate is considerably higher than would be expected for their percent of population. It is important to recognize infection rate is not affected by lesser access to medical care or by pre-existing medical conditions. Infection rate is driven by being in proximity of already infected people. So social distancing, masks, hand washing, and so forth will sall erve to reduce the likelihood of being infected. So to determine why blacks and Latinos have a disproportionate infection rate, these previous factors should be investigated.
Regarding death rate, once infected – blacks and whites have about the same likelihood of dying. This suggests mortality due to pre-existing medical conditions is about the same for both blacks and whites. Latinos have a high infection rate, but their mortality rate is considerably less than blacks and whites. I am guessing this is because Latinos on average are younger than blacks or whites.
The COVID Project race dashboard has demographic data for all the states that report race (most do). It is easy to back-up the above observations by examining infection rates and death rates for blacks, whites and Latinos.
In sum the main reasons more Blacks are dying is because they have a high infection rate. The Latino death rate from COVID is markedly less than blacks or whites
Is there really good data to back up your last statement, that Black die more because of a higher infection rate? I can not find anything solid enough, but I saw preprint papers which claimed there were theoretical reasons they would have a worse disease once they caught it. I have no idea if they are right, I did not even understand the theory, but there are differences in ACE2 receptor numbers which they said was at the bottom of it.
There isn’t a reply option to your last inquiry. If you look at
https://covidtracking.com/race/dashboard
You will see that (as a first order estimate) that the death rate for whites and blacks is approximately the same as their infection rate. This means the odds of dying once infected is about the same for either race. And the infection rate for blacks is higher so more blacks die. Latinos are much lower.
Look at states that have large populations of black and whites. And large populations of whites and Latinos. Like Arizona and New Mexico. It’s not exact, but the observation holds pretty well in a number of states.
All COVID 19 morbidity data needs to be looked at in context of underlying medical issues
There is not much difference between races if you control for
1 diabetes
2 obesity
3 age
4 renal failure
An understanding of this concept is critical for objective reporting on this topic
Thank you for your post, Michael. I was reading through the comments and couldn’t help but respond. I agree that there isn’t much difference when those things are controlled for. But the devil is in the details! The real question that this article highlights is why these things must be controlled for, as they are not natural outcomes based upon ones race (a social construct, albeit with real and objective social implications).
It is important to consider the reasons that co-morbidities (and therefore COVID-19) spreads in communities of color, in addition to access to clean, running water. I encourage those who would assume that either individual behaviors or community norms/values is behind the disproportionate impact to slow down, dig deeper, question, and to be open to answers that provoke a visceral reaction, an immediate disagreement.
Consider: Black and Latino/a people are 2-3 times more likely to be uninsured that white people (which impacts treatment for COVID-19 but also ability to treat or mitigate underlying conditions). These groups are also more likely to be exposed to environmental toxins (1.5x more likely to be exposed to small particle pollution, more likely to be exposed to endocrin-disruptors which has been shown to correlate to the likelihood of developing diabetes). These same communities are more likely to live in “food deserts”–locations where fresh fruit or produce is difficult to come by. These communities are often the location of highways and airports. And people in these communities are more likely to work in industries where their potential exposure to COVID-19 is greater and less likely to be able to work from home. They are more likely to be essential workers.
The real issue is not whether there is a difference between races–there is. But why. And the “why” is the point at which this issue must be addressed, where the policy change must occur. I know that I cannot accept that a country where black women are 3 times more likely to die in childbirth simply as a result of being black is an equitable one, one where life, liberty, and justice are truly accessible by all.
Note: I am aware that I did not include statistics for all of the above but I trust that if you (or anyone else) is truly interested in understanding this complex and multifaceted issue, you may do a quick search of the research. The factors that I mentioned above are invisible to us most of the time, unless we go looking for them. And while it may seem like a far stretch that all of these things are disproportionately impacting “communities of color,” it is important to bear in mind that these disproportionate outcomes are baked into the very fabric of this nation. For example, we cannot have a disproportionate impact of COVID-19 without a higher incidence of asthma, without higher rates of environmental/air pollution, without the disenfranchisement of entire groups of people, without oppression, without a failure to believe that the experiences of “people of color” are different, matter, and are as they say they are.
” I encourage those who would assume that either individual behaviors or community norms/values is behind the disproportionate impact to slow down, dig deeper, question, and to be open to answers that provoke a visceral reaction, an immediate disagreement.”
Have you applied this to yourself? Have you considered the fact that everybody may be better off if we all started ignoring skin color and simply treating everybody by how they act?
You seem to be focused on skin color. But is that the real problem? Are we making excuses for people instead of holding them accountable for decisions they made?
IMO – it is a mistake to focus on skin color. We should be focusing on the individual person – and how decisions that person makes affects them and their families.
Is it an anomaly that blacks are most successful when in the military – where race is disregarded and promotions are based purely on individual merit? Where people are held accountable for their actions and excuses are seen as BS?
With respect, I see a lot of discussion about underlying medical issues increasing the morbidity rate, which is certainly true. What I have not seen is a comparitive evaluation of underlying medical issues between whites and blacks that would actually show if one race is more apt to die from COVID. Most of the information seems to be anecdotal or implied. So I remain skeptical that it is a major influencer – all things being even. Can you shed some light here?
I might be wrong, but it seems the delta is primarily due to blacks being infected at a higher rate than would be expected based on population.
“The Trump administration doesn’t tolerate dissent of any kind, or any communication that doesn’t imply that the administration and especially Donald Trump are anything but flawless and omnipotent – period!”
And this makes him different from Obama – how?
“Any minority scientist,”
Ah yes – the old and tired ‘racism’ claims. Do you realize that the current definition of ‘racist’ is: ‘Disagreed with a liberal on any subject?’
Was there ever any question that this would be the case? The Trump administration doesn’t tolerate dissent of any kind, or any communication that doesn’t imply that the administration and especially Donald Trump are anything but flawless and omnipotent – period! Any minority scientist, irrespective of his/her credentials, or the absolute perfection of their statements, who dared to speak up, would either be fired on the spot, or “re-assigned” so deep that no one could ever find them. This has happened repeatedly and has been the clear and indisputable nature of this administration since it existed.
Another political article. The lives of ‘people of color’ are not more valuable than anybody else’s. And this article does not address the reasons that it is spreading in minority communities (with the exception of Asian communities).
What are those communities doing that’s different from what communities with lower rates are doing? What is the effects of co-morbidities on case severity and survival? Is the fatality rate higher for a minority with specific co-morbidities versus a non-minority with those same co-morbidities?
It is appearing that STAT is turning into just another rag pushing a political agenda.
Geez, Lev…experts…experts…experts.
And on a subscription services that’s supposed to be about science, you wind up giving voice to a “professor of social work.”
It doesn’t take a PhD to tell you why the virus affects minorities disproportionately. They are both behavioral and physiological reasons why.
Smoking, drug abuse, alcoholism, and obesity are significantly higher in these communities. In addition to the behavioral issues, we have high levels of asthma, hypertension, and CVD. Older members of the community with these co-morbidities are particularly vulnerable.
And the spread of the virus is exacerbated as much by cultural norms — such as large social gatherings like the funeral for a prominent and by all accounts laudable prominent African American citizen in Alabama that turned out to be a super spreader event.
“Voices” from the Trump administration — or any administration for that matter — could have done little to stop such infection waves, nor can any one administration solve the underlying root causes.
It will talk a wholesale cultural shift that isn’t coming anytime soon.
You know it, Lev…we all know it.
“What are those communities doing that’s different from what communities with lower rates are doing?”
And here comes the racial stereotyping !
Provide data that Smoking, drug abuse, alcoholism are more prevalent in the ‘Minority’ communities or zip it! Your ignorant use of a generic label to stereotype diverse communities betrays your ignorance. Stick to Breitbart!
“And here comes the racial stereotyping !”
Why are you liberals so obsessed with what color somebody’s skin is? I used the word ‘community’ for a reason – because unlike you – I know that all people with the same skin color are not alike. But _communities_ of people tend to have similar behaviors. And that those communities are not going to be composed solely of people with a single skin color.
Now care to describe this ‘racial stereotyping’ thing works? You seem to be an expert at it.
“Provide data that Smoking, drug abuse, alcoholism are more prevalent in the ‘Minority’ communities or zip it!”
When did I make that claim?
And I used ‘communities’ because we are all members of (usually) several communities. Communities are made up of people who all have something in common and regularly interact with each other. For example: you are a member of a community formed by everybody at your workplace, because you all have something in common and you all interact together for a common goal.
You seem to be rather desperate to see me as a racist. You are desperate to put me in some category so you can ignore my point of view.
And my point of view is that we all need to end this ‘race’ and ‘racist’ crap. All that does is divide us. All it does is create resentment when we should be focusing on what we all have in common. All it does is create ways for politicians to manipulate us.
Although I have a very ethnic name – my only ethnicity is: ‘American.’ What about you?
The BIA (Bureau of Indian Affairs) is the main govt agency overseeing the Reservations for such thingd as health, housing, education, etc. It is a FEDERAL agency, so centuries of neglect can be laid at the Feds’ doors. This regime has been cutting social services from its beginning, making things worse!!
I don’t understand why it came as a surprise that people of color were disproportionately hit. In every pandemic, the poor are the primary victims, because of their crowded living conditions, lack of access to health care and even basic hygiene. And it is the poor who are our “essential workers,” again the most easily exposed. Part of limiting disease lies in eliminating the injustice and inequality of poverty, whatever its skin color.
If you want to end poverty – then you need to change the habits and life decisions made by poor people. As lo9ng as we allow them to blame everybody but themselves for their life decisions – nothing will change.
And a good start would be to reform our social welfare systems so they start getting people out of poverty instead of created a poverty trap that’s very difficlut to get out of.