COVID-19 and America’s Epidemic of Social Inequality: Lessons from Social Science ​

Although much of the early research on racial inequality in the United States was grounded on biological/genetic understandings of race, some key figures underscored the importance of social factors early on. Perhaps the most prominent was W.E.B. DuBois (1991 [1899]), whose pioneering research empirically demonstrated that social and structural factors—like color prejudice, residential segregation, lack of access to well-paying jobs, and lack of access to educational facilities—explain the divergent life outcomes between Black and white Americans. Nonetheless, it was not until the latter half of the 20th century that the study of racial disparities became a central focus for sociologists and other social scientists. Near the end of the last century, important works by Williams and Collins (1995), Link and Phelan (1995), Geronimus (1991), Braveman et al  (2011) and others offered compelling evidence for the undeniable importance of social factors in shaping the health of people (Adler 2010; Braveman et al., 2014). Yet, many social scientists have expressed renewed concern over the resurgence of biological understandings of race to explain disparities between groups (Morning, 2014; Zuberi & Bonilla-Silva, 2008; Zuberi et al., 2015). Drawing on some of the earliest scholarship on racial disparities, they highlight that racialization—the grouping of people into ordered categories within a taxonomy of races—is rooted in domination and social control (DuBois, 1920; Zuberi, 2001). Thus, to explain racial health disparities scientists must focus on mechanisms of domination (e.g., structural racism, discrimination, segregation, etc.) that produce differential health outcomes (see for example, Laster Pirtle, 2020; Morey et al., 2018; Phelan & Link, 2015; Stewart et al., 2020; Williams et al., 2019; Williams & Collins, 2016). Moreover, in line with the foregoing, Singu and colleagues (2020) have elaborated how various social determinants of health have impacted COVID-19 outcomes in the United States.

Other models, such as the biosocial approach seen in anthropological literature highlights similar patterns. Broadly, biosocial approaches have been used to understand holistic pathways that can explain observed connections with social and socioeconomic gradients. The biosocial model recognizes social and biological mechanisms’ role in social determinants of health (Dufor, 2006; Bharaian, 2016). In doing so, biosocial approaches highlight how environmental and cultural variables affect different communities. Further, this approach highlights broader aspects of societal lives by addressing how communities experience these variables and how these experiences, through stress, shape their health. For example, the weathering hypothesis attributes early onset of poor health in African Americans to the amount of early exposure to stress and consequent adverse outcomes. Because these stressful events are more likely to happen throughout the life course, they accumulate and increase the likelihood of disease onset and mortality in black individuals (Geronimus 2006). These understandings draw on larger issues of disparities in quality of life. These models present multiple theoretical perspectives that are valuable in our conceptualization of the relationship between various social conditions and COVID-19 disparities.  

Racial discrimination and structural racism limit marginalized groups’ access to important resources, such as adequate housing, education, and affordable and nutritious food (Bailey et al., 2017). For example, marginalized groups typically live in or near food desserts, low-income communities with limited access to healthy food (Singu et al., 2020). Without these key nutrients, marginalized groups are left more vulnerable to disease, and in the case of COVID-19, more susceptible to more severe cases and even death (Butler and Barrientos, 2020). Today, research shows that in highly segregated cities—like Chicago—Black and Latinx neighborhoods bear a disproportionate burden of COVID-19 deaths (Kim & Bostwick 2020). These neighborhoods are characterized by high poverty rates, ‘dismantled community capacity,’ and disenfranchisement (Kim & Bostwick, 2020). However, it is important to note that these vulnerable neighborhoods’ social conditions were produced over a long period. They are the products of social, political, and economic processes that reify race and consequently shape the health of racialized communities (Sewell 2016). In line with this view, Laster Pirtle (2020) posits that racial capitalism, or the mutually constitutive nature of capital accumulation and racialized exploitation, can explain the United States’ COVID-19 inequities. Thus, COVID-19 inequalities, like other racial health gaps, are products of social, political, and economic processes that perpetuate a racial hierarchy. Through this lens, one can see why racial inequalities in health persist over time.