Rapid Assessment of Covid Evidence (Race)
Continuing Health Equity Research Beyond the Series
Dados Bibliográficos
Much has been written in the Rapid Assessment of COVID Evidence (RACE) series about the COVID-19 pandemic’s collateral consequences and disproportionate impact on Black and brown people, the working class, and the poor. With this final issue of the series, we review our efforts and the reasons for embarking on this work, lessons learned, and future directions. With over 10,500,000 children1 having lost primary caretakers during the pandemic and with the global life expectancy having dropped by 2 years,2 the disabling impact of COVID-19 is still ongoing, and its totalizing effect will be researched from this moment on.Reflecting on what has been written and is still yet to come, we are struck by how the central premise that motivated this series at the beginning still holds so true at this juncture. The beginning of this pandemic was centuries in the making, and it is a challenge to say which historical and/or contemporary colonial, white supremacist, patriarchal, or antilabor event was more relevant than any other in defining the trajectory of our planet since March 2020, as SARS Coronavirus-2 began to spread rapidly across the United States and the world. In the end, all events culminated in a system ill-prepared and ill-intentioned when it came to disaster and crisis preparedness. The system showed itself to be fully committed and fundamentally designed to maintain a counterproductive and, as some would argue, destructive control over people’s lives. Not surprisingly, the system was destructive even for those it claims to serve and benefit, so much so that there is not a clear sense of whether the destruction was a deviation from normal or whether the experience was just another rotation around the sun. Maybe it has been both. In this introduction to the final installment of the series, we pay respect to and mark this pivot point in our work by taking stock of what has happened and what will guide us as we move forward.In January 2022, members and affiliates of the UCLA/Charles R. Drew University of Medicine and Science COVID-19 Racism and Equity Task Force began publishing findings from a variety of projects across various issues of Ethnicity and Disease, and we called this series the Rapid Assessment of COVID Evidence (RACE). Through this work, we contributed to the resistance story of the pandemic and leveraged our position to consistently raise awareness on racism and its role and impact. Racism, as we defined it for this project, is the “state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability” that produces and maintains increased harm and death for those marked “nonwhite” through ideas and practices enacted on a structural level and felt on a cellular one.3,4In this series, we have published articles that covered the range of our Task Force research. We discussed what is needed to identify and monitor disparities in a pandemic along with the essential characteristics of a system that is able to do that. We discussed disaster management and the role of health communications when a crisis perpetuates.5 We used social media data published on Twitter by state health departments during the rollout of vaccines and discussed implications for engagement and equity.6 We also focused on issues of reproductive justice and sexual and reproductive health needs during the pandemic.7 In the previous issue, we focused on surveillance-related harms and published our pilot data on the development of an equity-based scoring system to assess the potential for surveillance-related harms.8Continuing our investigations into racism and its specific impact on health, this issue presents our qualitative data on the destructive intersections between the criminalization of immigrants and the COVID-19 pandemic response and impact. Sharif et al9 amplified a resounding consensus that the pandemic facilitated opportunities to expand the oppressive practices across the immigration system (eg, immigrant jails) and toward persons with precarious immigration status within community contexts via inadequate protections. Ultimately, the experiences reinforced the prevailing sentiment that the lives of immigrants, particularly Black and brown persons, are fundamentally disregarded. Although COVID inequities and the strategies used to address them are shaped by social context, few COVID dashboards include indicators of social context (eg, residential segregation). Nwankwo et al10 tested the feasibility of using the novel Project REFOCUS (PR) COVID dashboard to understand the context of COVID in 6 diverse pilot communities. PR differs from most dashboards in that in addition to monitoring COVID it also tracks key indicators of racism, resilience, stigma, and the social determinants of health. The findings of Nwankwo et al10 demonstrate that the inclusion of such indicators provides richer understandings of the context of COVID inequities. Across all of these articles and each of the issue’s introductions, we have strived to present and elaborate on ideas and conduct inquiries that demonstrate the extent to which COVID-19 epidemiology was determined along racialized lines and how these trends connected to racism and its devastating impact on our lives.The Task Force came together to both document and act against the structural racism undergirding the crisis. The practice of research—and what that means for the knowledge it creates, sustains, and evolves—has been discussed critically by many who have debunked the myth of objectivity and instead have shown the centrality of politics and power to any endeavor concerned with the collection and synthesizing of information and reporting of its significance.11-14 Could our research practice be in service of dismantling racial inequity, or would it continue in the tradition of reifying it? Decolonizing scholars have led many of these introspective and in-depth conversations. In the Integrated Methods article,15 we attempted to articulate ideologically and analytically what this endeavor and practice are rooted in such as through public health critical race praxis (PHCRP). In this series, we aimed to disseminate vital information as it would be reviewed through a peer review process and to be timely enough to be relevant to urgent questions and needs across communities.Throughout the crisis, the act of research has been our ritual with each other, our intentional engaging in a set of ideas that emerged out of a moral commitment to the solidarity needed to overcome the struggle and sacrifice being asked of our communities, colleagues, and ourselves. The evidence from prior epidemics (eg, the HIV epidemic) suggested that racism would pervade the crisis discourse and would be a barrier to diagnosis, care, biomedical solutions, and adherence to mitigation strategies, especially among members of racialized, marginalized populations.16-18 We acted out of deep concern for what would unfold, given these historical precedents. Research emerged as our “sword” to wield in the face of all the injustice we were witnessing; we named the process of our practice storytelling and continued reflecting on the Indigenous traditions this word comes from. One of our COVID Storytelling participants, a Marshallese organizer whose insights we discuss below, set the tone for the importance of storytelling and the remembrance of stories told through generations when she started her interview with the statement, “Before I can explain my work, it’s important that I explain the history of my people.” The way that storytelling connects us to history and place, and therefore to our roots, is the power this method holds and what we have attempted to embody.Although we have disseminated a significant number of findings using various media (eg, manuscripts, reports, blogs, videos, infographics, webinars, and presentations), we continue to analyze data and will be sharing the findings throughout the next few years. In this introduction, we highlight 2 examples of this upcoming work from data gathered through the COVID Storytelling Project. We present high-level summaries of preliminary findings of more recent analyses and briefly outline the problem and findings for each of these studies, described below.The data come from focus groups with Asian American and Pacific Islander (AAPI) and LGBTQ+ communities. Fourteen people participated across 3 focus groups. Each focus group consisted of 3 to 6 participants. In Study Profile 1, we used a thematic analysis and present 2 preliminary themes of experiences of LGBTQ+ communities within AAPI communities represented by community-based experts from social justice–oriented organizations dedicated to serving these communities. In Study Profile 2, we used a narrative analysis and present a preliminary theme that comes from a deeper analysis of 1 participant’s contributions, a Marshallese organizer who focused our attention on the alarming disproportionate rates of COVID-19 infection and death seen among the Marshallese community throughout the pandemic. A more detailed explanation of the methods used to analyze the qualitative data was included in the Integrated Methods paper published earlier in this series.15 In these preliminary analyses, participant quotes are reported verbatim, except when they have been shortened as indicated by the use of ellipses.Throughout the COVID-19 pandemic, AAPIs have experienced a surge in targeted acts of discrimination and violence largely as a result of racist media and political discourse regarding the origins of the virus.19 This situation is a continuation of a racist history during which AAPIs have experienced race-related discrimination and scapegoating linked to disease since the arrival of the first immigrants from the Asian continent.20 However, some groups within the AAPI communities experience racial discrimination at greater rates than others, such as those who identify as female and nonheterosexual and/or non–gender conforming.21,22From the data on the AAPI and LGBTQ+ communities, 2 preliminary themes were identified: (1) the politicization of COVID-19 exacerbated existing social and health inequities for individuals with multiple marginalized identities and (2) COVID-19 has amplified the critical role of community and sense of belonging. Here, we describe these themes in more detail with supporting evidence. The theme of the politicization of COVID-19 exacerbating existing inequities emerged through the discussions about blame and stigma against Asian American communities beyond the pandemic and how these issues intersected with discrimination and a lack of inclusivity for those who also have minoritized sexual and gender identities and/or are undocumented. Infusing political agendas in the management of the COVID-19 pandemic perpetuated historical racial ideas of threats (ie, biological sources of disease) within the context of ongoing anti-LGBTQ+ fervor. This 2-pronged legacy resulted in conversations among participants about criminalization associated with their dual identities. A focus group participant who serves both AAPI and LGBTQ+ communities said the following:For the second theme of how the pandemic amplified the critical role of community and sense of belonging, the source of the theme was conversation about feelings of isolation, fear of abuse and violence from families, and lack of a sense of belonging. Across all focus groups, participants shared how they responded to these feelings by recognizing the significance of social support and affirming each other’s existence for mental health purposes. COVID-19 related responses, such as layoffs and stay-at-home orders, forced LGBTQ+ people to live in abusive situations cut off from community social support and affirmation. One participant who works for an LGBTQ+ organization shared the importance of community as a form of mental health care:Our preliminary thematic findings from the focus groups with AAPI and LGBTQ+ communities reinforced that taking an intersectional approach to understanding the impact of the pandemic continues to be essential for identifying injustices for communities experiencing multiple sources of structural inequity. Future work in this area would benefit from highlighting the reality of these struggles, prioritizing community-based solutions and strategies for building solidarity across issues. We plan to share the full thematic analysis of these focus groups in upcoming work, including discussions of the role of community health workers and their essential perspectives and more work on criminalization, health, and the pandemic.The Marshallese community was disproportionately impacted by the COVID-19 pandemic. In Benton and Washington counties in Arkansas, 1.5% to 3% of the population are Marshallese people; however, 19% of COVID-19 cases and 38% of deaths occurred in the Marshallese community.23 The Marshallese community had higher rates of infections (8,390 per 100,000), hospitalizations (765 per 100,000), and deaths (130 per 100,000) than all other racial groups in Benton and Washington counties.24 Data describing the magnitude of this problem across the nation were incomplete; much of the racial data were neither gathered nor prioritized.25-27 As a result, the extent of the problem is still not fully appreciated.Yet, as the Marshallese organizer explained, there are many reasons to believe that the problem is worse than what has been documented, given the historical disenfranchisement of the Marshallese community as part of their colonial relationship dating back to 1944 when the United States gained administrative military control of the island. In 1986, the Compacts of Free Association (COFA) went into effect reflecting a series of treaties between the United States and the Republic of Marshall Islands and other Micronesian islands. Holding “legal non-immigrant” status in the U.S., the treaties allowed for exclusive military use (including nuclear dumping) and occupation in the Pacific in exchange for resources to be directed toward education, health care, and infrastructure. These benefits, however, have been denied since the passing of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which removed many federal benefits, including health care. These legal rights were reinstated for the Marshallese and other COFA communities in December 2020. This ongoing colonial relationship has resulted in decades of organizing and advocacy by the Marshallese and other Pacific Islander communities for redress to historical harms and access to care needed to address their health issues, many of which are linked to the environmental exposure to nuclear waste.28,29Preliminary thematic data was obtained through a narrative analysis of stories told by a Marshallese organizer about issues of education, access, equity, and justice for the Marshallese community in the state of Washington and across the diaspora of the United States. Our expert shared her incisive testimony of her people’s experiences, and the preliminary theme was the historical injustices committed against the Marshall Islands through the state-sanctioned violence of nuclear testing, which created many crises and shaped the pandemic response.The organizer’s stories foregrounded the importance of analyzing the US-based pandemic response and the impact of COVID-19 on the Marshallese community through the radioactive destruction and contamination of the Marshall Islands by the US military and the subsequent health and migration consequences of being exposed to nuclear waste. Before she began sharing vital information on why her people have migrated and the lack of benefits they have in the United States (such as health insurance), she provided critical historical context.From there, she went on to describe reasons why her people migrated (eg, opportunities for education), the intergenerational health consequences of being exposed to nuclear waste (eg, cancers), and their inability to be eligible for Medicaid in the United States, a violation of agreements made between the two nations. Before the pandemic, the Marshallese were having to organize for more accountability from the US government with regards to health insurance. Although health insurance was granted during the pandemic, the challenges to obtain this benefit perpetuated distrust. The organizer reiterated that the original treaties between her ancestors and the United States were the foundation of the problem. She stated, “But that’s just another promise (medical coverage) that we’re hoping they will keep because there’s been so many promises given and not even kept by the US government to our people.” She was very clear in her stories that issues of COVID-19 health inequity were connected to this history and that the pandemic was being managed in a way that eroded trust.She described an incident in which a group of Marshallese workers were fired after their human resources department received a phone call from a local public health agency that stated that workers had tested positive for COVID-19 but had gone to work anyway, a claim that the employees contested as untrue. The organizer remarked how the details of this incident spread and that “all the Marshallese community, they just stayed home. Nobody went and got tested. There was a loss of trust.” She had been doing language translations at local testing sites, and she remarked that there was a sharp decline in testing after the incident, even among those who had tested once.The preliminary findings of this case study suggest that the pandemic is a continuation of a historical record of being untrustworthy. This status of untrustworthiness has adverse health consequences in times of crisis. In the description of this case study, we have not covered the sophisticated and rich and the range of sources of support that within the Marshallese community and other communities in the context of these Future work would benefit from highlighting this reality and the ongoing efforts to attention to the health inequity experienced by this We plan on sharing the full narrative analysis of these including this organizer’s and those of other focus group in upcoming there was a of solidarity within the stories shared across the a in our commitment to our findings across our Task Force information gained through a social justice praxis and in a timely is Research on racism is with so much The research and process are between efforts to and these ideas from even existing and of social justice work that the that we can the planet through to that do not challenge or of significance of this and of is to us to the in which we when language is on the what language is used to our when and are with and are we we to those on the we to guide those who in work and a way our community or even in what we are and/or how we are it? do we these findings toward an on these and they the ideas to with each other on paper and the analysis also was also needed for the ideas to to each other and for the to and, be of of in this series through the use of methods and as not the we dedicated articles to qualitative which was a challenge for many in are because the data are in the of the participants, which are given through the more to word The analysis also can be very given the of and consensus on The that was was and to process because many of the members connected with the stories being addition to working through the in the we that through the peer review process is on and These have been very during the pandemic. We to the many who critical on the development of these to that evidence in service of social justice we that we are motivated by our respect and for the many individuals who are out there for social justice and the within our and we are for their commitment to our We the many throughout this pandemic who and with and this series has the work we will all do together has because the pandemic and our have made our analysis and have set a more clear for the work and to the for the was provided in part by the The do not the of the We the at the for the Study of Racism, and the of of for administrative and support and members of the COVID-19 Task Force on Racism Equity for on earlier of this
Coronavirus disease 2019 (COVID-19 · Criminology · Development economics · Economic growth · Equity (law · Infectious disease (medical specialty · Life expectancy · Pandemic · Political science · Population · Premise · Preparedness · Race (biology · Sociology · Child and Adolescent Health · Demography · Food Security and Health in Diverse Populations · Gender Studies · History · Law · Medicine · Public Health Policies and Education
Decolonizing Educational Research
Black Sexuality, Social Construction, and Research Targeting ‘The Down Low’ (‘The DL’)
Are HIV/Aids Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans?
Golden Gulag
The Anxiety of Being Asian American
An Equity-Based Scoring System for Evaluating Surveillance-Related Harm in Public Health Crises
What Happens When the Crisis Seemingly Never Ends? Perspectives in Health Communication
A Qualitative Analysis on Sexual and Reproductive Health Needs and Issues During Covid-19 Using a Reproductive Justice Framework
Contextualizing Inequities in Covid Vaccination Trends Among Project Refocus Pilot Sites
Barely Tweeting and Rarely About Racism
They Don’t Care If We Live or Die”
Compact of Free Association Migrants and Health Insurance Policies
Variation in Reporting of the Race and Ethnicity of Covid-19 Cases and Deaths Across US States
Integrated Methods for Applying Critical Race Theory to Qualitative Covid-19 Equity Research
Potential Impact of Covid-19–Related Racial Discrimination on the Health of Asian Americans
Racism and Stress-Related Growth Among Asian Internationals
Discrimination Experiences during Covid-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders
Global and National Declines in Life Expectancy
Decolonizing Methodologies
Structural Racism and Health Inequities
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