Showing the Government CARES – Using Prior Crises to Support Minority Communities
By Lexi Wung Associate Editor, Vol. 26
At the beginning of my second year of law school I tested positive for COVID-19. I spent my first week of classes isolating in remote apartment housing on Michigan’s north campus. Aside from mild symptoms and lingering fatigue, I was able to quickly recover from the disease. The moment that I found out that the individual I had come into contact with had tested positive, I was able to quickly and efficiently secure testing at two different facilities in Ann Arbor. While I was in isolation, a doctor at the University of Michigan called me every few days to check in on my symptoms.
My experience with COVID-19 is vastly different from the experiences of many minorities in the United States. I am privileged to attend a university that provided housing, food, and access to healthcare at no cost. Other people of color aren’t as fortunate. The United States government has failed minority Americans in the fight against COVID-19. But what must change in order to provide the appropriate level of care to all citizens regardless of race, ethnicity, or socioeconomic status?
COVID Statistics in Minority Populations
Information pertaining to COVID-19 cases, hospitalizations, and deaths from the Centers for Disease Control and Prevention (CDC) show alarming disparities among minorities in the United States.[1] Compared to White Americans, Black or African Americans are 2.6 times more likely to become infected, 4.7 times more likely to be hospitalized, and 2.1 times more likely to die from the disease.[2] Similar data is reported for Hispanic or Latino persons and American Indian or Alaska Natives.[3] Asian Americans are 10% more likely to become infected and 30% more likely to be hospitalized, but there is no marked increase in mortality rate from the disease compared to White Americans.[4]
Put into context, “If [minority Americans] had died of COVID-19 at the same actual rate as White Americans, about 20,800 Black, 10,900 Latino, 700 Indigenous, and 80 Pacific Islander Americans would still be alive.”[5]
It is important to note that these statistics are only those that are reported to the CDC. White neighborhoods have greater access to COVID-19 testing sites,[6] so the number of positive cases in minority communities is likely underreported. As compared to historical data, at least 200,000 more people have died since March of this year, which suggests that the COVID-19 death toll is much higher than reported.[7]
Sadly, it comes as no surprise that minorities have been disproportionately affected by the COVID-19 pandemic. Underlying medical conditions, disparities in basic healthcare, and unemployment are only a few of the factors that have contributed to the asymmetric impact of COVID-19 on minority communities.[8] At the root, structural racism has enabled COVID-19 to disproportionately affect communities of color.
How can the law enact change in the response to COVID-19 in minority communities?
The last time the United States (or the world, for that matter) experienced a pandemic on the scale of COVID-19 was the 1918 Flu Pandemic. In the 21st Century, the COVID pandemic and the associated public health crisis are unprecedented.
Given the purpose of this post, I won’t venture into the many ways that the U.S. government has failed in its response to COVID-19. Instead, I will attempt to analyze the U.S. government’s response to previous crises that have disproportionately affected minority communities. In doing so, I hope to highlight the successes and failures of past policies that may aid in correcting the government’s failure to provide equal care and resources to minority communities.
Government Response to the HIV/AIDS Epidemic
The U.S. has the largest population of individuals living with HIV among Western industrialized nations, totaling over a million people.[9] Since the 1980’s, research has shown that the largest indicator of government response to the HIV/AIDS epidemic was based on the controlling political party at the time.[10] The controlling political party influenced how scientific data was employed, the focus on minority populations, and budget allotments in the fight against HIV.[11]
At the beginning of the HIV/AIDS epidemic, the federal government’s response was nearly glacial. While the federal government stalled, local governments mobilized. In San Francisco, localities funded preventative education initiatives, support services, and community-based research projects.[12]
Following public outcry, the federal government acted. Federal agencies were the main actors. The Food and Drug Administration promoted condom awareness.[13] The CDC encouraged HIV testing and mandated partner notification programs. Congress allocated $30 million to help states purchase AIDS drugs.[14] The CDC made grants to community organizations to increase HIV/AIDS prevention efforts in targeted communities.[15]
When George H.W. Bush assumed the presidency, the largely reactive response evolved into a more proactive approach. Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act (CARE Act).[16] The CARE Act established agencies, organizations, and funding structures to enable local governments to provide health care to HIV/AIDS patients.[17] The act also provided prescription drugs, transportation, case management, and other services to individuals with HIV/AIDS.[18]
Other notable legislation included the protection of Americans diagnosed with HIV/AIDS under the American with Disabilities Act, which prohibited discrimination and required the government and businesses to make reasonable accommodations to individuals with HIV/AIDS.[19] Congress also authorized the Housing Opportunities for People with AIDS Act (HOPWA).[20] The success of this program demonstrated how access to basic housing can improve health outcomes.
When Bill Clinton took office he prioritized bringing HIV/AIDS experts and advocates to the forefront of policy making. Clinton created the Presidential Advisory Council on HIV/AIDS which conducted research and issued official public health recommendations to local and federal agencies.[21] The administration also increased federal spending on HIV/AIDS between 9.7% and 15.5% each year, for a total increase of 73% – or $4.87 billion, by the end of his term.[22]
While the government response to the HIV/AIDS epidemic is still ongoing, the federal and local response within the first decade of the epidemic showcased mechanisms that could serve to support minority communities. Federal spending, regulatory programs, and access to healthcare and housing can have a large impact on health outcomes. While the effectiveness of a federal response is largely reliant on the administration in office, local governments can mobilize to quickly provide resources during a crises.
Government Response to Hurricane Katrina
Although not an epidemic, the response to Hurricane Katrina demonstrated how governments may address a different kind of crisis. In response to natural disasters, the U.S. largely relies on a “market-based approach” for recovery.[23] This approach causes affected individuals to rely on private insurance payment and savings for the bulk of the recovery, while the government and privatized charities provide a safety net.
The government’s response via federal financial assistance, the Federal Emergency Management Agency (FEMA), and small business loans (SBA) all advantaged the largely white middle class.[24] The process of requesting financial assistance from the federal government required education, time, skill, and knowledge of resources available. Small business loans were awarded predominantly to white business owners but not to people of color as many minorities did not qualify for SBA disaster loans, which are awarded primarily based on credit score.[25]
The response to Hurricane Katrina in different wards of New Orleans varied drastically based on the racial demographic. White residents of New Orleans were more likely to return to their homes and keep or obtain new jobs.[26] FEMA trailers were unequally distributed to majority white communities.[27] In largely minority communities, the Association of Community Organizations for Reform Now (ACORN) and local organizations had to fight in court to keep houses from being demolished without notice to residents or homeowners.[28]
Federal lawsuits by residents of New Orleans displaced by the hurricane alleged misinformation, inadequate procedures, and benefit discrimination.[29] Receiving FEMA support required filing as members of a household rather than individuals.[30] Many disaster victims were unable to receive FEMA assistance because they shared the same address as another applicant.[31] This administration’s prejudice forced single parents and individuals who lived in multiple family homes to have to fight for benefits.
Local charities and community organizations were much better suited to assist marginalized communities in the aftermath of Hurricane Katrina. Local organizations responded directly to these communities and the unique challenges they faced. As compared to the dissemination of information by federal organizations, non-government organizations were able to disseminate information to minority communities in a more efficient manner following Hurricane Katrina.[32] Organizations like the Salvation Army were more successful than government programs due to their ability to respond to individual concerns without dealing with the bureaucratic inefficiencies that plagued the federal agencies.[33] The Salvation Army was also more likely to coordinate with other service providers and the government to offer a multi-faceted approach to providing relief.[34] The use of local charities and community organizations partnered with federal agencies could prove useful in the future.
How can the HIV/AIDS epidemic and Hurricane Katrina inform the government’s response to COVID-19?
These historical examples demonstrate what the federal government can do, presently and in the future, to guarantee the welfare of minority communities during and in the aftermath of the COVID-19 pandemic. The government’s response to the HIV/AIDS pandemic demonstrated the success that could be had when government agencies collaborate with local organizations, and how the Presidential administration can either worsen or alleviate the impacts of public health crises on minority communities.
The Hurricane Katrina crisis shows how federal regulatory programs can either succeed or fail based on their understanding of the community and the ways in which distribution of resources are structured. The federal government’s response to Hurricane Katrina also shows how programs can unintentionally discriminate by catering to majority white communities.
The current governmental response to COVID-19 has been wholly inadequate to communities of color. Although not exact reflections of the unique COVID-19 landscape, the U.S. government should look to previous public health crises and natural disasters to develop solutions to support and protect minority populations.
“The strength of a health system is inseparable from broader social systems that surround it… health protection relies not only on a well functioning health system with universal coverage, but also on social inclusion, justice, and solidarity. In the absence of these factors, inequalities are magnified and scapegoating persists, with discrimination remaining long after.”[35]
[1] Hospitalization and Death by Race/Ethnicity, Centers for Disease Control and Prevention, (Aug. 18, 2020), https://www.cdc.gov/coronavirus/2019-ncov/COVID-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.
[2] Id.
[3] Id.
[4] Id.
[5] The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S., APM Research Lab, (Sept. 16, 2020), https://www.apmresearchlab.org/covid/deaths-by-race#counts.
[6] Matthew Vann et al, White neighborhoods have more access to COVID-19 testing sites: ANALYSIS, abc news, July 22, 2020,https://abcnews.go.com/Politics/white-neighborhoods-access-covid-19-testing-sites-analysis/story?id=71884719.
[7] Denise Lu, The True Coronavirus Toll in the U.S. Has Already Surpassed 200,000, N.Y. Times (Aug. 12, 2020),
https://www.nytimes.com/interactive/2020/08/12/us/covid-deaths-us.html.
[8] See Ruqaiijah Yearby & Seema Mohapatra, Law, structural racism, and the COVID-19 pandemic, Journal of Law and the Biosciences, June 29, 2020 (arguing that racial disparities in COVID-19 infections and deaths are a result of structural racism causing disparities in outcomes).
[9] Tasleem J. Padamsee, Fighting an Epidemic in Political Context: Thirty-Five Years of HIV/AIDS Policy Making in the United States, 33 Social History of Med. 1001, 1002 (2018).
[10] Id. at 1003.
[11] Id.
[12] Id. at 1005.
[13] Id. at 1006.
[14] Id.
[15] Id.
[16] Id. at 1009.
[17] Id.
[18] Id.
[19] Id. at 1011.
[20] Id.
[21] Id. at 1012.
[22] Id.
[23] Jennifer Seidenberg, Cultural Competency in Disaster Recovery: Lessons Learned from the Hurricane Katrina Experience for Better Serving Marginalized Communities, in Berkeley Library Resources, (n.d.),
https://www.law.berkeley.edu/library/resources/disasters/Seidenberg.pdf.
[24] Id. at 8.
[25] Id. at 11; also see Thomas Frank, Disaster Loans Entrench Disparities in Black Communities, E&E News (July 2, 2020), https://www.scientificamerican.com/article/disaster-loans-entrench-disparities-in-black-communities/.
[26] Id. at 9.
[27] Id.
[28] Id. at 9.
[29] Id. at 12.
[30] Id.
[31] Id.
[32] Id. at 18.
[33] Id. at 19.
[34] Id.
[35] Delan Devakumar et al., Racism and discrimination in COVID-19 responses, The Lancet, April 1, 2020, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30792-3/fulltext
