How psychologists can combat the racial inequities of the COVID-19 crisis

As the coronavirus pandemic continues to spread, it is becoming disturbingly clear that people of color are bearing the brunt of the disease in the United States. Media reports show stark disparities in COVID-19 deaths among African Americans and Latinos in New York Cityopens in new window, the Midwestopens in new window and Louisianaopens in new window, and among American Indian and Alaska Native (AIAN) communities like the Navajo Nation. 

There is also emerging, although incomplete, data on the racial disparities of COVID-19. On April 17, 2020, the Centers for Disease Control and Preventionopens in new window released COVID-19 case data on 14 states showing that African Americans — who make up less than 13% of the U.S. population — comprised 30% of COVID-19 patients whose race was known. The Johns Hopkins University Coronavirus Resource Centeropens in new window also analyzed state-by-state data on coronavirus deaths in 29 states and found that African Americans accounted for about 34% of COVID-19 deaths in those states. 

Asian Americans and Latinos also accounted for a disproportionate number of cases and deaths in some regions. The Kaiser Family Foundationopens in new window found that in six of 26 states, Hispanics made up a greater portion of cases compared to their share of the total population. Similarly, Asian Americans made up a higher share of cases or deaths relative to their share of the total population in a few states.  

Meanwhile, the Indian Health Serviceopens in new window (IHS) documented 18,391 cases from IHS, tribal and urban facilities as of April 22, 2020. However, these data may be incomplete as IHS has historically been underfunded and not all AIAN people access services through these facilities. In their analysis, the Kaiser Family Foundation found that AIAN people were a much larger percentage of confirmed cases compared to their share of the total population in New Mexico (37% versus 9%) and Arizona (21% versus 4%).

All states should be tracking COVID-19 data on testing, cases and deaths by race and ethnicity among other critical categories. Incomplete data is a major impediment to understanding the magnitude of the crisis our nation faces. Comprehensive surveillance and data gathering will help to determine which communities are in most need.

The psychological impact of the pandemic on communities of color could be immense and deserves greater attention, says Alfiee Breland-Noble, PhD, a researcher on mental health disparities and founder of the AAKOMA Project, a nonprofit that works to alleviate the mental health concerns of youth of coloropens in new window. “It is vital for people of diverse backgrounds to just acknowledge that we are in an unprecedented time and name the real toll and disparate impact that our world's drastic changes have had on us in order to begin the coping and adjustment process,” she says.

Even in nonpandemic times, the psychosocial stress of racial discrimination contributes to poorer health quality and higher rates of chronic health conditions for communities of color (Williams and Mohammed, 2013opens in new window; Williams et al., 2019opens in new window). The CDC has warned that co-morbid underlying conditionsopens in new window including diabetes, asthma, severe obesity or cardiovascular disease increase risk for COVID-19. 

The intersection of race with age and poverty also heighten risk for COVID-19. Older African Americansopens in new window have been particularly affected by the disease. A CDC summaryopens in new window found African Americans ages 65 and up accounted for 28.2% of COVID-19 hospitalizations as of April 18, 2020. An analysis of COVID-19 cases by zip code in San Franciscoopens in new window showed that poorer Latino neighborhoods are disproportionately burdened. One contributing factor: Preventative measures like handwashing and physical distancing are functions of privilege. Far too many people of color are forced to live in areas with concentrated racialized poverty, some with inadequate sanitation or access to health care. Risk is also higher for those working low-wage jobs where they have less control over personal space or whom they encounter. 

Asian Americans, meanwhile, face another challenge: They have become targets of a rising tide of stigma and xenophobia due to stereotyping language that characterizes COVID-19 as a “Chinese virus” or “Kung flu,” which could lead people to hide symptoms of illness to avoid discrimination. They may not seek health care when they need it and may further isolate themselves, which comes with its own health risks.

Psychologists can play a major role in countering these disparities — efforts that will also help flatten the curve and safeguard the entire nation’s public health. Psychological research suggests that psychologists respond by: 

Understanding your place

When reaching out to communities of color, all psychologists should understand history and your place within it. Psychologists should seek to understand their own “positionality,” a term referring to one’s place in the racial and sociocultural hierarchy. We all have our own biases and prejudices, but to break the cycle of inequality and discrimination, we need to show cultural humility. Psychologists also need to be mindful of how systemic discrimination has contributed to distrust of health providers among people of color. “Psychologists should recognize that for many communities, the stigma associated with mental health services is not only real, it is powerful,” says Anita J. Thomas, PhD, executive vice president and provost of St. Catherine University, who researches approaches to culturally affirming counseling with African American families.

Be a partner, not a savior

Communities of color are not monolithic — each boasts its own unique diversity, history and strengths. A desire to "rush in" or "save" communities could be potentially harmful, although well-intentioned. Acknowledge the inherent resilience of the communities you are seeking to support and build from there. For example, for AIAN communities, psychologists will need to partner with faith, community and local leaders to combat the coronavirus. Iva Greywolf, PhD, president of the Society for Indian Psychologists, and Sharon Houlahan, a doctoral psychology intern in Alaska, recommend checking in with tribal leaders, healers and elders to determine the existing strengths psychologists can elevate up to mitigate the spread and impact of COVID-19 in Native American communities.

Encourage the use of bystander intervention against stigma, xenophobia and discrimination

Bystander intervention, which teaches third parties to intervene when they witness harassment or negative attention, is a powerful tool to circumvent and prevent escalation (Sue et al., 2019). Bystander intervention models have been used to prevent sexual assault, rape, racial harassment and binge drinking. When someone is a victim of a trauma, it is not empowering to tell them they must report it or go after their perpetrator. In fact, it could backfire and retraumatize victims. Sherry Wang, PhD, an assistant professor of counseling psychology at Santa Clara University, encourages psychologists to provide psychoeducation on why bystander intervention is so important during this crisis.

Be an advocate

Ask your representatives to push for equity in policies developed to combat the epidemic such as comprehensive surveillance and data-gathering (PDF, 150KB)opens in new window that tracks the impact of the coronavirus by race and ethnicity, age, disability, income and other factors. Also needed is better access to testing and care regardless of insurance coverage, and paid sick days or leave for those caring for family members.