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Social Work in Public Health

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Racial Disparities in Healthcare: How COVID-19
Ravaged One of the Wealthiest African American
Counties in the United States

Darius D.Reed

To cite this article: Darius D.Reed (2021) Racial Disparities in Healthcare: How COVID-19
Ravaged One of the Wealthiest African American Counties in the United States, Social Work in
Public Health, 36:2, 118-127, DOI: 10.1080/19371918.2020.1868371

To link to this article: https://doi.org/10.1080/19371918.2020.1868371

Published online: 28 Dec 2020.

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Racial Disparities in Healthcare: How COVID-19 Ravaged One of the
Wealthiest African American Counties in the United States
Darius D.Reed a,b

aDepartment of Social Work, Indiana Wesleyan University, Marion; bSchool of Social Work, Walden University

ABSTRACT
The COVID-19 pandemic swept the globe in January of 2020 causing mass
panic and extreme hysteria. While pandemics are not new, COVID-19 is
emerging as a public health crisis in nearly every household in America. In
this paper, I discuss how COVID-19 has ravaged one of the wealthiest African
American counties in the United States. Using Public Health Critical Race
Praxis (PHCR) I seek to examine how disparities exist in health care and public
funding is not equally distributed regardless of wealth and status for minor-
itized communities. Using PCHR’s framework I highlight many of the dispa-
rities that exist in health care for people of color during this global health
crisis and provide implications for improvement in federal, state, and local
funding in communities of color. This article advances scholarship on the
intersection between public health and social work particularly alluding to
the need for increased advocacy for marginalized communities.

KEYWORDS
Anxiety; COVID-19; public
health critical race praxis
(PHCR); social work; African
Americans; marginalized
communities

Introduction

First detected in Wuhan, China, a virus known as severe acute respiratory syndrome coronavirus (i.e.,
SARS-CoV-2) has presented not only an environmental-based risk but also a global response (The
Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, 2020). Since the
proliferation of this virus, public health officials have termed the subsequent disease as ”COVID-19”
(Centers for Disease Control and Prevention [CDC], 2020). Since sparking international recognition,
the field of social work practice and education has begun exploring its impact on different systems
(e.g., education, financial, health, population). As a result, under the Trump Administration, the
White House Coronavirus Task Force has commissioned key leaders within public health to combat
its upward progression within U.S. borders. Thus, this sparked social work to respond to the COVID-
19 pandemic with challenges faced across all levels, especially a public health perspective.

The mass hysteria presented by the COVID-19 pandemic impacted every sector of life across the
world. In the beginning stages of the virus many in the African American community felt that they
were immune from the virus, because media reports primarily showed White Americans contracting
the Coronavirus. The first publicized case of an African American testing positive was Donovan
Mitchell, guard for the Utah Jazz (Ellentuck, 2020). This dispelled the myth that African Americans
could not catch the virus. Since that time CDC data shows that African Americans have been
disproportionally affected by the virus at much higher levels than all other races in the United
States (Bouie, 2020). Undoubtedly, this swift change caused undue anxieties for many African
Americans related as well as health and safety concerns. Recognizing the anxiety-induced trauma
this presented for African Americans I explored how COVID-19 has affected the wealthiest African
American county in the United States.

CONTACT Darius D.Reed [email protected] 9205 Rice Avenue, Glenarden, MD 20706 .

SOCIAL WORK IN PUBLIC HEALTH
2021, VOL. 36, NO. 2, 118–127
https://doi.org/10.1080/19371918.2020.1868371

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The article will address how COVID-19 has ravaged one of the wealthiest African American
County in the United States and the mental health implications that may result from the fallout. It
will also address the taken for granted perspective of public health social workers and the potential
fallout that may arise due to the fluid and ever evolving public health crisis and its subsequent impact
on the mental health of African Americans. Moreover, as an African American social worker and
educator residing in Prince Georges County Maryland, I give voice to the unrealized repercussion that
this pandemic has imposed on frontline workers such as myself. In the section that follows, I will give
a brief literature review on the evolution of COVID-19 not only locally but also globally. In that same
vein, situate the racial disparities narratives within the theoretical framework of Public Health Critical
Race Praxis (PHCR) to further elaborate on gravity this pandemic imposes an already inequitable and
under-resourced healthcare system. Finally, I hope that by nuancing this virus’s impact; particularly,
among public health social workers will inform how to further interventions and policies in the event
of another global crisis, whether it be from a social work education or practice stance.

COVID-19

As stated earlier, in the article, this virus originated within the borders of mainland China. Since its
global appearance medical and social scientists have engaged in international deliberations to pinpoint
the exact evolution of SARS-CoV-2 since December 2019 (Holshue et al., 2020). Scientists have
hypothesized that the virus may be airborne thus allowing it to spread mainly from person to person,
through respiratory droplets (e.g., sneezing, coughing, bodily fluids) produced by an infectious
person(s). Other discussion involved that due to the configuration of the virus (e.g., spike proteins)
droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs
(CDC, 2020). Therefore, the Trump Administration, and the guidance of the U.S. Surgeon General,
Jerome M. Adams, they issued a list of recommendations to combat the spread of SARS-CoV-2 in the
U.S (CDC, 2020).

For context, the first confirmed case of SARS-CoV-2 in the U.S. was reported on January 31, 2020,
in Washington State (Holshue et al., 2020). Based on current data, there are now 1,602,148 confirmed
cases as of May 23, 2020; which exceeds cases reported in all other countries in the world (CSSE, 2020).
As a result of the ever-increasing numbers local and state governments instituted “shelter-in-place” or
“stay-at-home orders” in order to decrease the number of COVID-19 cases plaguing the continental
U.S. Understandably, such orders placed an undue economic and social burdens on the United States;
however, enacting such orders was for the safety and protection of all citizens. President Trump and
his cabinet encouraged individuals to wear face masks and engage in “social distancing” where people
practice at least a 6ʹ feet distancing from one another in order to reduce the surge in COVID-19 cases
(CDC, 2020).

Having given a thorough review of this virus’s origin, it would now be fair to take into considera-
tion The White House’s response toward treating the confirmed SARS-CoV-2 cases. Through the
regular and sometimes disorganized White House briefing, Trump’s White House COVID-19
response team presented the American population with conflicting health messages in regards to
the severity of its impact as well as potential “treatments.” In one breadth, Dr. Facui delivered sound
empirical knowledge speaking to the fluidity of the virus global progression; however, in the same not
being allowed to fully desegregate myth from the fact due to socio-political constraints. President
Trump initially down-played the severity of the virus, followed by reversing course and insisting that
Americans take the virus seriously, while in the same breath expressing that it would “blow over” soon
(Milbank, 2020). As a seasoned social worker this messaged presented numerous inconsistencies and
undoubtedly resulted in the high level of coronavirus cases.

SOCIAL WORK IN PUBLIC HEALTH 119

The county

Prince George’s County is located in the U.S. state of Maryland, bordering the eastern portion of
Washington, D.C. As of the 2010 U.S. Census, the population was 863,420, making it the second-most
populous county in Maryland, behind Montgomery County (United States Census Bureau, 2010).
Current estimates for the 2020 census place the county at a population of 909,327 Americans (US
Census Bureau, 2019). Long regarded as a symbol of Black wealth and excellence with a high
population of highly educated Black professionals, entrepreneurs and government officials, where
African Americans make up 65% of households and the median household income is 81,969 USD (US
Census Bureau, 2019). In many affluent African American communities outside of the Beltway (I-495
highway that splits Prince Georges County’s inner suburban communities from outer suburban
communities), median household incomes exceed 150,000 USD (Black Entertainment Television
(BET), 2017). In comparison communities inside the beltway closer to Washington DC boast
a median income of 55,000. USD Poverty in the county sits at just under 9% (US Census Bureau,
2019).

Theoretical approaches

Critical race theory (CRT) can be used to explore what it means to center race/racism throughout
our public healthcare system. Critical race theory brings from the margins the experiences of racial
and ethnic minorities and how these groups perceive acts of institutional and structural racism
(Delgado & Stefancic, 2012) to the center in terms of social work practice. For example, a central
theme of CRT is that race is permanently present in our everyday lives (Delgado & Stefancic, 2012).
Critical race theory allows for an intersectional critique of the various ways in which minority
groups can be oppressed (Delgado & Stefancic, 2012) in this instance inequalities in healthcare stand
out. Additionally, CRT challenges the current multicultural color-blind approach in social work
education as it relates to educating future public health social work practitioners about issues of
diversity, inclusion, oppression, discrimination, power, and privilege (Gutiérrez, 1990; Ortiz & Jani,
2010). Therefore, I argue that social work educators and practitioners must consider their own
positionality within the larger scheme of societal injustices and how racism manifests itself in social
work education, practice, and healthcare systems within the United States (Abrams & Moio, 2009;
Randolph, 2010).

Encompassed within this CRT methodological analysis are the four focal theoretical tenets of Public
Health Critical Race Praxis (PHCR) which are as follows: 1) contemporary racial relations, 2) knowl-
edge production, 3) conceptualization and measurement, and 4) action (Ford & Airhihenbuwa, 2010a,
2010b, 2018c, Gilbert & Ray, 2016). Each tenet supports the mode of translating the findings not only
qualitatively but also culturally while situating the experiences of African Americans in Prince Georges
County at the intersection of race, gender, class, and health, and politics within the current American
landscape. As pointed out by Carbado and Roithmayr (2014), “Existing literature shows a small
number of critical race theorists working at the intersection of CRT and the social sciences” (p. 150).

Critical race methodology (CRM)

The broader approach from which this paper emerges focused on the following three questions: 1)
How does death transcend wealth in the wake of a public health crisis? 2) What healthcare disparities
are present in predominately African American communities? 3) What are the implications of
continued healthcare disparities in minority communities? CRT proceeds from an understanding
that while structural racism is less visible than individual racism, it is just as, if not more, influential.
Unlike individual racism, structural racism is a systemic, historically rooted form of oppression that
cannot be eradicated simply at the level of individual attitudes or behavior. Indeed, the individuals

120 D. D. REED

operating within institutions may be, in practice, nondiscriminatory, but still operate within a larger
structurally racist context (Freeman, Gwadz, & Silverman et al., 2017).

Critical race methodology (CRM) operationalizes CRT and offers a way to understand the experi-
ences of people of color (Solorzano & Yosso, 2002). As a methodology, CRM uses counter-storytelling
as an analytical tool for understanding discourses on race and the intersections of other forms of
oppression. Counter-storytelling is a type of storytelling that acts as a form of resistance to standard or
majoritarian-stories. In this instance, I dispel the myth that healthcare is distributed equitably across
the continental United States. Grounded in CRT, which argues that the voices and experiential
knowledge of people of color must be recognized, counter-storytelling is a “tool for exposing,
analyzing, and challenging the majoritarian stories of racial privilege” (Solorzano & Yosso, 2002,
p. 32). Therefore, the next section which follows is a representation of the post-oppositional theorizing
(Bhattacharya, 2016) of the COVID-19 pandemic within the realm of social work and public health.

Analysis of data

According to the Johns Hopkins Center for Systems Science and Engineering (2020), there are 13,077
cases of Coronavirus in Prince Georges County (see Table 1), the most located in the Capital Beltway
area, which consists of the District, and nearby counties in Virginia and Maryland where, thus far, 477
people have died. When compared with the rest of the state (44,424 case, 2,207 deaths) Prince Georges
County represents 33% of all cases (CSSE, 2020). One may ask how does a county with high wealth
suffer from high cases of COVID-19 and death. The reality lies in the fact that many residents are
front-line workers exposed daily to the virus, and Prince Georgians disproportionately suffer from
underlying health conditions that make the virus deadlier (Chason, Wiggins, & Harden, 2020). Nearly
14% of adults in Prince George’s have diabetes, according to county health statistics, 36% are obese,
and 64% of the county’s Medicare beneficiaries suffer from hypertension rates above national and
statewide averages (PGC Healthzone, 2017). There are fewer hospital beds and primary care doctors
than in neighboring jurisdictions, which means residents are less likely to treat medical problems early.
The county also spends less on public health efforts than its wealthier neighbors (Chason et al., 2020).

Maryland’s first coronavirus death, announced March 18, was a Prince Georges County man in his
60s with underlying health conditions. The deaths that followed have been people from poor
neighborhoods inside the Capital Beltway and wealthy subdivisions outside of it, representing that
the virus transcends all income brackets and has no specific group that it will attach to. While it is true
that the majority of deaths from COVID-19 have been African Americans, one may ask why, when the
access to healthcare is readily available in 2020. The reality is that healthcare disparities remain in high
African American and minority communities. Despite high per capita incomes, Prince George’s
County spends less on health and human services than its neighbors. With 38.94 USD per capita in
general fund investment (see table 2), it falls behind others like Baltimore County, which spends 45.13

Table 1. Washington region COVID-19 cases.

Variable N %

Maryland
Prince Georges County
Montgomery County

13,077
9,432

27.98
20.18

Anne Arundel County 3,207 6.86
Charles County 956 2.04

Washington DC
DC

7,893 16.88

Virginia
Fairfax 8,734 18.68
Arlington 1,795 3.83
Alexandria 1,657 3.55

SOCIAL WORK IN PUBLIC HEALTH 121

USD; Anne Arundel, at 90.54 USD; Howard County with 109.37 USD; and Montgomery County with
224.25 USD (Maryland, 2019).

The disparities in COVID-19 cases speak to the broader health care disparities that are often seen in
minority communities, whether in the presence of absence of Coronavirus. Healthcare can be less
available and accessible in minority areas and also some mistrust of the health care system because of
past lived experiences. These disparities transcend all economic levels and platforms throughout the
county. Despite the concentration of wealth and education in the county, there remain pockets of
poverty, and grave inconsistency in the types of fresh food options that the county attracts, which plays
a role in the healthcare of African Americans. Lower quality foods equal higher health problems over
time. Moreover, despite its wealth 11% of residents do not have insurance, higher than state and local
averages. There are 477 primary care physicians in Prince George’s, fewer than half the 1,420 in
neighboring, more affluent and whiter Montgomery County (County Health Rankings, 2020), which
has about 20% more residents. To understand this disparity, you must first understand Tax Reform
Initiative by Marylanders (TRIM) which limited county tax revenue by capping property taxes in 1978.
Followed by the recession in the 1990’s which slashed funding for health and social services. The
trickle-down effect of such resulted in years of lower funding for services that are greatly needed in
a predominately African American and minority county.

Communities of color share common social and economic factors, already in place before the
pandemic, that increase their risk for COVID-19. While disparities in healthcare remain one of the top
reasons for Coronavirus cases in Prince Georges County, I would be remiss to not mention some of the
other factors that play a role in the high number of cases. One might be the housing conditions that
many African Americans in major cities reside in. Crowded living conditions represent a difficult
challenge that is the result of longstanding racial residential segregation and prior redlining policies for
African Americans and minorities in general. It becomes difficult to put social distancing practices in
place when multiple people reside in one residence, while potentially being exposed to the virus as
a result of essential jobs that may not provide protective equipment (PPE) to their employees. Some of
these essential positions could be environmental services, food services, transportation, and healthcare
services. These services represent positions that cannot be done remotely, therefore put many African
Americans and minorities in close contact with others who may have the virus. Lastly, stress is one of
the most pressing factors that play a role in the virus manifesting itself. Studies have proved that stress
has a physiological effect on the body’s ability to defend itself against disease. Income inequality,
discrimination, violence and institutional racism contribute to chronic stress in people of color that
can wear down their immunity, making them more vulnerable to infectious disease.

I would be remiss to not mention risk factors within communities of color that contribute to poor
health outcomes such as: poor nutrition, physical inactivity, obesity, high blood pressure, and
substance abuse. Noonan, Velasco-Mondragon, and Wagner (2016) state that access to healthy
foods is a frequent problem in poor African American communities. Many African American
communities are considered “food deserts” which, describe neighborhoods without easy access to
supermarkets that sell fresh produce and other healthy foods. Black neighborhoods have significantly
fewer supermarkets than white ones (Noonan et al., 2016) and Prince Georges County is no different
despite its wealth status. This in turn results in poor nutrition which leads to other health problems

Table 2. Health and human services spending
per capita.

General Fund Spending Per Capita

County
Prince Georges County

Baltimore County
$38.94
$45.13

Anne Arundel County $90.54
Howard County $109.37
Montgomery County $224.25

122 D. D. REED

such as obesity and high blood pressure, which could be deemed an underlying health condition
related to COVID-19. Substance abuse is also included as a risk factor due to its ability to decrease an
individual’s overall quality of life and lead to severe health problems. While these risk factors are
standard across the board in all communities, White individuals have the means and access to better
healthcare and services than many communities of color, thereby improving their overall quality of
life.

Given the role that public health social workers play in maintaining continuity of care for those
existing on the margins (e.g., African Americans, Asians, Hispanics, etc.). It is indictive of policy
makers and those in charge of governance understand the depth of healthcare disparities for people of
color. The lack of PPE, inconsistent access to healthcare due to lack of insurance or underinsurance,
chronic health conditions in communities of color, and crowded living conditions is not only
troubling, but indictive of the lack of governmental investment and oversight for communities of
color. As I now begin to discuss implications for social work research, policy, and education. It is
important to put into context just how broken the United States’ healthcare truly is. Regardless of the
socio-political climate, the author’s forthcoming discussion will support the depth of how present
systems monetize “life” within the United States.

Implications

The aim of this article is to establish the relevance of application in social work practice for addressing
social justice and healthcare disparities within the social ecologies of African-Americans at risk for
COVID-19 the following theoretical frameworks: Critical Race Theory, Critical Race Methodology,
and Public Health Critical Race Praxis. The data presented in this article elucidate the multiplicity of
ways in which healthcare disparities are present for African Americans in Prince Georges County. As
highlighted above, if genuine change is to occur within the field of public health social work, we must
begin respecting the meaning-making processes of potential public health social workers who have
direct access and knowledge to healthcare disparities that African Americans and minorities experi-
ence. This can occur through the incorporation of practice-informed research which explicitly
recognizes the interlocking barriers “minoritized groups” (Harper, 2012) must traverse. As pointed
out by Corley and Young (2018), “The daily lives of racial and ethnic minoritized groups continue to
be affected by a racist system of hierarchy and inequity that characteristically advantages White
Americans while creating detrimental outcomes for People of Color” (p. 318).

Social work research and practice

Social work practice and research are reciprocally connected. However, those connections are not
culturally nuanced for African Americans. For clarity, social workers are routinely engaging African
American clients; however, not in a matter which signifies cultural attunement from both a micro and
macro perspective. Cultural attunement is vitally important to improve health disparities for people of
color. Understanding the social ecologies of people of color can challenge stereotypes and improve
healthcare disparities. I strongly advocate for the development of practice-informed research, that is
explicitly attuned for African Americans and minorities regarding the healthcare disparities that are
present in the U.S. healthcare system.

The NASW Code of Ethics (2017) has three principles that directly align with prevention efforts to
address the social injustices present in healthcare today: “(a) social workers’ primary goal is to help
people in need and to address social problems, (b) social workers practice within their areas of
competence and develop and enhance their professional expertise, and (c) social workers challenge
social justice” (NASW Code of Ethics p. 2). One of the main functions of social work is advocacy.
Therefore, social workers should advocate for increased COVID-19 testing in communities of color.
The data reflects that African American and minority communities have been disproportionately
affected by high rates of death, therefore the need for additional testing is paramount.

SOCIAL WORK IN PUBLIC HEALTH 123

Moreover, social workers in the field of public health should understand one’s perceptions of
African Americans and minorities and how these perceptions shape interventions and service delivery,
how a lack of understanding of racial dynamics can negatively racialize minorities, and understanding
elicit bias and discriminatory behaviors and their role in the continued oppression of African
Americans and minorities. social workers in the field of public health should understand one’s
perceptions of African Americans and minorities and how these perceptions shape interventions
and service delivery, how a lack of understanding of racial dynamics can negatively racialize mino-
rities, and understanding elicit bias and discriminatory behaviors and their role in the continued
oppression of African Americans and minorities. There also needs to be research informed practice
where social workers are taking the best information available to them to impact and improve
healthcare practices for people of color in the United States. From the information gathered in this
paper social workers in practice need to focus on understanding the healthcare needs of African
Americans, ways to improve their access to care, and ending the long-standing systemic inequalities
that are contributing to these disparities.

Lastly, many healthcare interventions and strategies are structured based on dominant Eurocentric
theoretical interventions. African Americans and minorities are forced to exist, rather than under-
standing the oppressive and unequal structures of society that exist within these systems. Therefore,
social work practice should acknowledge race and its significance within therapeutic practice and work
to create interventions that consider how race plays a role in the overall healthcare of minorities. It is
essential for social workers in practice to view African Americans based on the cultural experiences,
thus helping the social worker to better understand how to effectively solve some of the systemic
inequalities.

Social work education

The social work profession, inclusive of public health in social work, lacks sufficient minority inclusive
research, interventions, models, and theoretical approaches critical to improve and develop social
work practice, research, and education. More specific data on race, age, socioeconomic, sex, and
geography are needed to understand the effects of race and class on healthcare inequalities. This paper
highlights the disparities that continue to exist regardless of improvements that have been made in
education and wealth for African Americans and minorities. Social work education programs should
continue examine the disparities that exist within education, health care, the economy, environmental
justice, criminal justice and voting rights from communities of color and improve knowledge for
future social workers entering the field or those who are already working in the field through
continuing education units.

Critical race theory posits that we should seek to understand the cultural context of all races when
developing interventions. Social work education programs are beginning to include CRT into its
educational framework. With African Americans dying at alarmingly high rates, research and educa-
tion should seek to understand the social, economic, historical, and …