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Amid the rising deaths, infections, and possible economic implosion of the COVID-19 pandemic, our country’s most pressing need is to save lives and arrest any plunge into a prolonged recession or depression. The crisis is already hitting major social and economic systems, yet black Americans will experience a disproportionate share of the disruption—from morbidity and mortality to unemployment and bankruptcy.
McKinsey analysis shows that black Americans are almost twice as likely to live in the counties at highest risk of health and economic disruption, if or when the pandemic hits those counties. 1 1. Counties’ risk of disruption related to the pandemic is measured by comorbidities that predispose residents to complications associated with COVID-19, poverty rates, population density, number of hospital beds, and the share of residents in severe housing conditions (characterized by overcrowding, a lack of access to kitchen and plumbing facilities, and rent burdens). For each of these indicators, we ranked counties into 10 deciles, with each decile representing 10% of the population, and assigned a decile score for that indicator. Then, we created a combined index score based on the individual decile scores, and assigned a final, combined decile score to each county. Each indicator is equally weighted. Age was not included. This analysis does not include epidemiological forecasting. Counties do not have to have identified cases of COVID-19 to qualify for this analysis. Sources include: 2017 CMS-LDS Medicare FFS data and DRG 835/837 data © 2020 DR/Decision Resources, LLC. All rights reserved. Reprinted with permission. Reproduction for non-commercial use is permitted if attributed; American Community Survey, 5-year estimates 2013 - 2018. Poverty status in the past 12 months; U.S Census Bureau. 2010 Census. Population, Housing Units, Area, and Density; American Community Survey, 5-year estimates 2013 - 2018. Total Population; CMS Hospital Compare and Medicare Provider Cost Reports; Robert Wood Johnson Foundation, US Department of Housing and Urban Development, Comprehensive Housing Affordability Strategy. To assess disruption, we evaluated five indicators: underlying health conditions, poverty rate, number of hospital beds, percentage of people in severe housing conditions, and population density. This integrated health and economic perspective describes which counties are likely to take a “one-two punch” due to the pandemic and could get trapped in a vicious cycle of economic instability and poor health.
In addition, we found that 39 percent of all jobs held by black Americans—compared with 34 percent held by white Americans—are now threatened by reductions in hours or pay, temporary furloughs, or permanent layoffs, totaling 7 million jobs. 2 2. McKinsey Global Institute analysis.
Indeed, the pandemic underscores the consequences of the structural disparities that have persisted in this country for centuries while presenting an opportunity to invest in building more equitable systems that will benefit society overall. In this article, we outline some of the key findings from our report on COVID-19 and black America.
Places at highest risk
Because the situation continues to evolve, projections are necessarily, at best, probabilistic. Even so, our analysis suggests that black Americans are 1.4–1.8 times as likely to live in counties at highest risk of disruption from the pandemic (exhibit). Thirty percent of the country’s population lives in these high-risk counties, compared with 43 percent (17.6 million) of black Americans. The counties in the highest-risk decile are home to only 10 percent of the US population as a whole—but to 18 percent of the black population.
Risks to health and lives
Nationally, black Americans are not only more likely to be at higher risk for contracting COVID-19 but also have lower access to testing. In addition, they are likely to experience more severe complications from the infection; black Americans are on average about 30 percent likelier to have health conditions that exacerbate the effects of COVID-19. 3 3. Centers for Disease Control and Prevention; includes cardiovascular disease, asthma, diabetes, chronic kidney disease, hypertension, and obesity.
Unfortunately, black Americans are overrepresented in nine of the ten lowest-paid, high-contact essential services, which elevates their risk of contracting the virus. Thirty-three percent of nursing assistants, 39 percent of orderlies, and 39 percent of psychiatric aides, 4 4. McKinsey Global Institute analysis, US Bureau of Labor Statistics, and the National Center for O*NET Development. are black. Black workers are putting their lives and health on the line to provide goods and services that matter to our society.
Although little testing data are available, as of April 4, ten of the 16 states where 65 percent of black Americans live were below the median testing rate for the country as a whole. 5 5. Most recent data: The COVID Tracking Project (State by State), April 7, 2020, covidtracking.com. Black Americans were already twice as likely as their white peers to die from diabetes, hypertension, and asthma—all risk factors that exacerbate COVID-19 symptoms. 6 6. Victor R. Fuchs, “Black Gains in Life Expectancy,” JAMA, November 2016, Volume 316, Number 8, pp. 1869–1870. Even black Americans who do not need care for COVID-19 are likelier than white Americans to suffer from the pandemic’s secondary effects on our overloaded medical system, including delayed—but necessary—medical procedures. 7 7. Summary Health Statistics: National Health Interview Survey, 2018.
Risks to livelihoods and economic futures
As the impact of the pandemic moves from health to economic consequences, black Americans will likely sustain more damage across every stage of the wealth-building journey. 8 8. For more on black Americans and the wealth-building journey, see Nick Noel, Duwain Pinder, Shelley Stewart III, and Jason Wright, “The economic impact of closing the racial wealth gap,” August 2019. Crucially, 39 percent of jobs held by black workers (seven million jobs in all) are vulnerable as a result of the COVID-19 crisis compared with 34 percent for white workers. 9 9. McKinsey Global Institute analysis; ‘Vulnerable’ jobs are subject to furloughs, layoffs, or being rendered unproductive (for example, workers kept on payroll but not working) during periods of high physical distancing. Forty percent of the revenues of black-owned businesses are located in the five most vulnerable sectors—including leisure, hospitality, and retail—compared with 25 percent of the revenues of all US businesses. 10 10. Analysis of 2012 Survey of Business Owners. Forty-eight percent of black survey respondents 11 11. Survey respondents from McKinsey’s March 27–29, 2020 Consumer Survey. report regularly using food-assistance programs, compared with 31 percent of white respondents. Such services are likely to come under significant strain and interruptions as a result of the pandemic. 12 12. McKinsey COVID-19 Consumer Survey, March 29, 2020.
There is an immediate opportunity to protect black Americans and their communities from the worst effects of the COVID-19 crisis. These interventions should target the places where black people live, work, and do business.
To identify and mitigate disparities, it will be critical to track the damage and the recovery from the pandemic along racial lines. Relevant information includes (but is not limited to) rates of infection, access to healthcare providers and testing, jobs lost, and small business loans allocated. In addition, stakeholders could also identify and patch gaps in services normally provided by the public education system and increase resources for the most affected students and families.
Training and deploying community health workers, which are common in places where the need for healthcare significantly outstrips supply, could increase access to health services. 13 13. Nellie Peyton, “Using lessons from Ebola, West Africa prepares remote villages for coronavirus,” Reuters, March 25, 2020, reuters.com. Community health workers help connect patients to both health and social services, build trust in healthcare systems, and reserve capacity for licensed healthcare workers to treat the most critical cases. Community and faith-based organizations can use their roles as hubs to organize the workers, share information about the virus, encourage preventive measures such as environmental and personal hygiene and physical distancing, and distribute personal protective equipment (PPE) and sanitary equipment to the homes of essential workers. These organizations can also provide targeted, wraparound support to people with high-risk comorbidities.
Black workers are putting their lives and health on the line to provide goods and services that matter to our society.
Stakeholders could deliberately support the most vulnerable workers, including black Americans. Some employers are finding creative solutions that keep people employed, and this could be supplemented with job-matching and reskilling programs that can efficiently redeploy talent even during a macroeconomic contraction. Employers could also maintain a commitment to equity when they downsize. Support programs that provide direct and in-kind forms of liquidity (such as straightforward cash assistance, short-term extensions for financial obligations, and loan and interest forgiveness) could help sustain families in financial distress.
Community development financial institutions (CDFIs), churches, and nonprofits could help black-owned businesses and residents to access recovery funds. Similarly, new financial products and programs such as community rainy-day funds could fortify the resilience of communities. Corporations could make a point to work with black-owned businesses.
Recovery, rebuilding, and reimagination
COVID-19’s outsized impact on the black community reflects public health and socioeconomic disparities that have long been intertwined. The pandemic is an opportunity to invest in addressing structural challenges to help black Americans recover and to build and sustain more equitable communities.
Investments in public health, digital infrastructure, institutions of public education, and economic development planning should continue long after the COVID-19 pandemic subsides. In particular, stakeholders could consider setting national goals to improve health equity and create plans to meet those goals.
Support for black homeowners and businesses could be a priority to ensure that black families do not lose their assets and resources. That kind of support could include protection from bankruptcy, insolvency, and eviction, all of which will disproportionately affect black Americans as part of the pandemic’s fallout. Institutions could also support equity in compensation and career progression. These types of assistance speak less to protection and more to providing the opportunities and stability required to help black families build a resilient economic foundation.
The COVID-19 pandemic is already a generation-defining crisis. Because it affects all social systems, it heightens preexisting structural challenges that black Americans face. But a trial can also be an opportunity. Our society can consider how we can respond to the COVID-19 crisis and fallout to fortify black communities and help them do more than simply recover. We can use the urgency of the pandemic to build more equitable systems that increase the long-term resilience of black Americans, communities, and institutions. As we progress toward this goal, the US economy could benefit to the tune of $1.5 trillion. 14 14. Nick Noel, Duwain Pinder, Shelley Stewart III, and Jason Wright, “The economic impact of closing the racial wealth gap,” August 2019.