Medical Examiner

Racism Is a Pandemic

We need to treat it like the same public health emergency that COVID is.

A crowd of socially distanced protesters wearing masks and holding signs
Activists gather for a Black Lives Matter protest in front of the Hall of Justice in Los Angeles. Frederic J. Brown/Getty Images

When two colleagues and I started examining infectious mortality rates during the early 20th century, we were looking for regional differences in how the United States handled influenza, tuberculosis, and other kinds of infections. Of course, we were especially interested in that era’s deadly pandemic. The 1918 flu had killed on a scale that’s hard to fathom: an estimated 50 million people worldwide, and half a million in the U.S.

To get a detailed look at infectious disease mortality in that era, we digitized and carefully checked old public health records, linked them to census population estimates, and categorized the causes of death. We didn’t believe the results. We discovered that white mortality during the 1918 flu pandemic was still lower than Black mortality, up to that point, had ever been. This wasn’t only true in the South, but in every region of the United States. This wasn’t about regional public health—it was about racism.

We knew that, in cities at the time, Black people were forced to live in intensely segregated housing, often under threat of violence and often in intense poverty, in both the North and the South. But as three white researchers—I worked alongside James Feigenbaum, an economist at Boston University, and Christopher Muller, a sociologist at Berkeley—we were accustomed to reading papers and hearing scholarly presentations that treat the 1918 pandemic as an unprecedented experience in terms of biology but also in terms of cold, hard death rates. It had never occurred to us that the same death rates might also represent an ordinary experience for a large segment of the population.

Our first thought was that we might have made a mistake. We examined the data every which way and found the same result each time: Racial inequality in the early 20th century was more deadly than the 1918 flu. We had begun our project hoping that regional differences in death rates would hint at which of the sweeping social changes of that era had been particularly consequential in saving lives. But it turned out that regional differences in death rates could simply be explained by racial inequality—they were higher in the South simply because the urban Black population was greater there. It wasn’t until the 1930s that Black mortality in total declined to the level of white death during the 1918 flu pandemic, as new water and sewage infrastructures, general improvements in living standards and nutrition, and, eventually, technologies like vaccines gradually lowered mortality rates across the board.

This spring, while recovering from my own COVID-19 infection, I wondered whether the same thing would still be true today. I found it unfathomable that the disaster unfolding around me that spring in New York, where my parents live and where I had become sick, could bear any resemblance to more typical life in the United States. And yet, thinking about how the 1918 results had stunned me, I wanted to see for myself. As life ground to a halt in the midst of another cataclysmic pandemic, how did the toll of this one compare to that of the more ordinary, ubiquitous catastrophe? Will white mortality during the coronavirus pandemic still be less than what Blacks experience routinely, without any pandemic? I began to work out equations and search for data.

Nobody can predict the final toll of COVID-19, so as I created my mortality models, I went the other way around, asking, how many extra white deaths would need to happen—from COVID directly, hospital avoidance, and economic deprivation—for white people to die at the rate that Black people did when their mortality rates were lowest?

Black American mortality was at its lowest ever in 2014, before the opioid crisis fully took hold. That year, Black age-adjusted mortality was 1,061 deaths per 100,000. (Mortality comparisons are almost always adjusted for age because otherwise the comparison mostly just tells you which population is older). For white mortality to reach that same level, 400,000 extra white deaths would need to happen in 2020. That’s more than quadruple the current official coronavirus death toll for white Americans, so far (about 93,000 deaths).

Put differently: Say the entire white population of the United States experienced excess deaths on par with the COVID death rates that New York City residents (of all races) faced this spring. White people would be dying at the rate the Black people did in 2014, the lowest-mortality year ever recorded, experiencing the loss at close to the rate that Black people do all the time.

If the Black population did not experience a single death due to COVID-19, if the pandemic only affected white people, Black mortality in 2020 would probably still be higher than white mortality.

This is a thought experiment. In reality, of course, COVID has hit Black populations hardest, and the inequality in death rates is likely to greater than it has been in many years. Racism is making Black Americans, along with indigenous and immigrant populations, most vulnerable to the pandemic. But the hypotheticals give us an important perspective on the reality: Racism gave Black people pandemic-level mortality long before COVID.

And it is racism that is killing Black people. “Mortality modelers” like me know that there are an awful lot of reasons one person might live longer than another. But when we see that one group in a society consistently dies at younger ages than another, we can look for trends. America excludes Black people from mechanisms of generating wealth, consigns them to the worst schools, confines them to neighborhoods with more pollution and more poverty, targets them with routine violence by state authorities, and treats them with suspicion and hostility when they seek medical care. There is no mystery in those early deaths.

To stop COVID-19, we shut down the world. While masks and social distancing are controversial, public support for so dramatically reorganizing our work, family, and social fabric in order to save lives is striking. Polls throughout the pandemic show that, in general, the prevailing public fear has been that we will “return to normal” more quickly than is safe. Even workers who lost wages to shuttered workplaces supported keeping them closed, according to a Pew Research Center poll in May. Our efforts to stop COVID may not be enough, and they may pale in comparison with what other countries are doing. Still, they aren’t nothing. They show how profoundly and quickly individuals can change their way of life, and even that bureaucracy can drop useless rules in the name of keeping people alive.

When it comes to combating racism, we have plenty of proposals that are as bold and transformative as those that shut down and reformed our daily lives to stop the spread of COVID-19. The Movement for Black Lives proposes defunding the police—and replacing its budget with a radical expansion of social services—to address staggering disparities in police violence and freedom sacrificed to the criminal justice system. Scholars have developed detailed proposals to redress centuries of violence and exclusion that have prevented equal Black participation in public and economic life. They have envisioned plans ranging from a congressional plan to distribute reparations to individual descendants of slaves to community land trusts designed to compensate for the theft of Black wealth.

Yet the typical response to sweeping proposals to address racial inequality is that they are not realistic. Even milquetoast school integration plans and social welfare programs—which white people also typically benefit from—are viewed with deep suspicion.

What would happen if we treated racism like we treat COVID-19? Less than a year ago, the idea of halting global travel and moving most schools and workplaces online would have been unfathomable. This spring, we did it in a matter of weeks. Old ideas about what is realistic shatter when we honestly confront the magnitude of what is at stake.

It is time we honestly confront the magnitude of racial inequality in the United States: a pandemic’s worth of death, every single year. Once we do that, our question about radical proposals to combat racism should shift from what is politically palatable to, simply, what will work.