Systemic Inequality, Sustainability and COVID-19

Seela Aladuwaka, Barbara Wejnert, Ram Alagan, Seela Aladuwaka, Barbara Wejnert, Ram Alagan

• Publisher: Emerald Publishing Limited
• Year: 2022
• Print ISBN: 9781801177337
• eBook ISBN: 9781801177344
• Topic: Social Sciences
• Subtopic: Human Rights
• Index: Social Sciences

The global spread of COVID-19 has led to devastating effects on countries worldwide in terms of population health, economy, politics, and sustainable development. Systemic Inequality, Sustainability and COVID-19 provides an opportunity to engage in a critical dialog on the consequences and interactions of COVID-19 with social inequalities and environment management.

The pandemic has shattered personal lives, families, businesses, countries' health systems, education, economy, and sustainable development. COVID-19's impact is most visible among disadvantaged populations as the pandemic amplified the already profound social inequalities and problems of environmental justice existing in developed and developing countries alike. Understanding that it is critical to determine the scope, magnitude, and scale of pandemic effects on the most vulnerable groups and environmental sustainability, this book addresses the impact of COVID-19 on countries' development, exploring the consequences and interactions of COVID-19 with social inequalities and sustainable development.

Taking a global perspective, this edited collection is vital to understanding countries' progress and development during and after the pandemic in this extraordinary moment in human history.

PART I
HEATH AND SOCIAL INEQUALITY AND COVID-19

Social Determinants of Health Disparities and COVID-19 in Black Belt Communities in Alabama: Geospatial Analyses

Seela Aladuwaka, Barbara Wejnert, Ram Alagan and Manoj Mishra

Abstract

The COVID-19 pandemic has impacted every community across the globe, but the global COVID-19 data show that the United States remains the most affected country where well over 666,000 people died, and approximately 40 million citizens became ill due to the virus' spread by mid-2021 (CDC, 2021). It is also noteworthy that extreme racial disparities in rates of COVID-19 cases and deaths are high in the United States, specifically among African American population. This situation is particularly evident among African American population in Alabama's Black Belt. Subsequently, COVID-19, racial disparities, and health inequalities have become central to the national and regional conversation. This chapter examines the associations between COVID-19, social determinants of health, and the systematic health disparity in African American population in Alabama's Black Belt region using Geographic Information Systems and the concept of uneven spatial development. Understanding the relationship between COVID-19 and these disparities within a spatial context vital to developing pathways to overcome the pandemic's effects and combat the systemic discrimination in this region. The derived policy recommendation could apply to other regions experiencing social inequality and health disparity.

Keywords: COVID-19; GIS; uneven development; African American community; inequalities; Black Belt region

Introduction

The COVID-19 global pandemic has exceeded 228 million cases and is approaching 4.7 million deaths worldwide (worldometers.info, 2021). Not only has the global pandemic affected every aspect of human existence but also altered and transformed human relationships, economy, and politics around the globe, the tragic cost to human lives and diminished health conditions for millions foreshadow weakness in global public health. The enormous societal and economic costs underline the magnitude of current and future challenges.

Undoubtedly the pandemic has left scars worldwide; however, the United States remains the most impacted country, reaching over 45 million cases and 721,000 COVID-19 related deaths in October 2021 (CDC, 2021; worldometers.info, 2021). In the United States, it is also noticeable that racial disparities in rates of COVID-19 cases and deaths are substantial. Several scholars and policymakers underscore that African Americans are most affected compared to other ethnic and racial groups. This group includes African Americans living in southern states, especially in the Black Belt region.

The Black Belt region is located in the southeastern part of the United States, and it extends from Virginia on the Atlantic coast to the state of Texas in the mid-south part of the country. The name Black Belt refers to the black, rich soil in this region, historically known for its economic dependency on agricultural production and long history of enslaved labor of black people who used to work on the southern plantations. It is also a region of low social and economic development, high poverty level, and profound health inequalities. This region is home to a large African American population.

In Alabama, the Black Belt region passes through the south-central part of the state in the east-west direction. As in other Black Belt counties, most of Alabama's Black Belt countries residents are African Americans; for example, in Green County, 81% of the population are African Americans, in Summer County 71%, in Wilcox 72%, and in Lowndes 75%. A large part of Alabama's Black Belt residents lives in rural communities (41%). Alabama's Black Belt region is unique by its cultural, socioeconomic, historical, and political characteristics, with vibrant and deep intersecting social and cultural heritage layers. Nevertheless, it is also a region marked by a high concentration of poverty, substantial discrepancies in economic opportunities, racial inequality, and health disparities. This region also exceptionally high in cardiovascular diseases, obesity, cancer, diabetes, and other chronic diseases. Many scholars claim that the root causes of these health issues are mainly systematic racial discrepancies in economic, social opportunities, and health protection (e.g., Lopez, Hart, & Katz, 2021). The current COVID-19 pandemic worsened these health disparities.

The severe effects of COVID-19 on African American communities in Alabama's Black Belt region indicate the pandemic's interactions with socioeconomic inequalities, the process called the effect of Social Determinants of Health (SDH) on health disparity. According to the World Health Organization (2021, p. 1), SDH are “the non-medical factors that influence health outcomes.” These include “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” According to the US Department of Health and Human Services (2020a), several indicators measure aspects of SDH, including economic stability, education, general wellbeing, access to healthcare, housing quality, food quality, and the conditions of the surrounding natural environment. The American College of Cardiology Magazine (2020) explains that the SDH influences the level of mortality, morbidity, life expectancy, health care expenditures, socioeconomic status, and functional limitations of the community. Socioeconomic status is perhaps the central concept that determines the velocity and strength of effects of social determinants on people's health (Stringhini et al., 2017). The socioeconomic status is controlled by income distribution, financial and other resources, and economic and professional opportunities. The SDH, therefore, are not uniformly distributed across states or countries; instead, they are dispersed unequally, leading to the unequal spatial development of communities where underrepresented minority communities encounter hardships without essential economic, social, and health support systems.

Indeed, in the United States, the pandemic and its recovery further highlight disproportionate impacts of COVID-19 on historically marginalized communities, including African Americans. In Alabama's Black Belt counties, African Americans experience significantly higher infection rates, hospitalization, and deaths than the more privileged, usually white population (Lopez et al., 2021). Even though the explanations of root causes of health disparities rarely address economic and racial inequalities and uneven geographical (spatial) development of a region, the outcomes of the COVID-19 pandemic illustrate the magnitude of SDH's destructive effect on African American communities, including in the Black Belt region of Alabama (Maness et al., 2021). The high level of poverty, low standards of living, deprived socioeconomic conditions, shortage of economic opportunities, limited economic resources, and the limited number of health care facilities led to a higher number of COVID-19 cases and deaths in Alabama's Black Belt communities. Unsurprisingly, scholars argue that an “increase [in] the possible exposure to, and higher death rates from, COVID-19 among African American people across the United States” attest to the effects of systemic racism (Maness et al., 2021, p. 18). Such statements are consistent with the US Department of Health and Human Services (2020b, p. 28) definition of health disparity as “a particular type of health difference that is closely linked with social, economic, and environmental disadvantage.” Health disparities, therefore, adversely impact people of color in the United States. They have systematically experienced obstacles in obtaining high-quality health care support because of their racial or ethnic characteristics, religion, socioeconomic status, geographic location, and other socioeconomic causes linked historically to discrimination and exclusion.

Indeed, Alabama's Black Belt region has some of the highest health disparities in the nation that result from a long-standing low social and economic development and limited economic and social resources, magnified by prolonged racial discrimination. Specific discrepancies in available resources and opportunities include deficiency of proper public transportation, low number of ownerships of private cars that could transport family members to medical facilities, limited educational opportunities, a limited number of medical personnel per population's size, and limited number of health centers and hospitals across Black Belt counties. Studies have shown that the unequal distribution of resources and limited access to health care facilities have lasting effects on the community's health, especially those living in poor social and economic conditions (Rollston & Galea, 2020). The health care inequality, low access to nutritious food, unemployment, low access to transportation, and poor living conditions augment the impact of SDH on outcomes of COVID-19 across Black Belt communities.

Additionally, the deep division in public attitudes between pro and anti-vaccination stems from mistrust of government, misleading social media information, and countrywide political divisions, further enlarges the profound impacts of the COVID-19 pandemic on minority communities in Alabama, regardless of readily available COVID-19 vaccines. According to the Alabama's COVID-19 Dashboard Hub (2021), although 6.3 million Alabama received COVID-19 vaccine doses, only 4.2 million in Alabama have been fully vaccinated (Alabama Department of Public Health, 2021). Hence, despite the significant advancements in health care in the United States, the disparity in vaccination rate augments the uneven effects of COVID across Alabama's population (Alabama College of Osteopathic Medicine, 2020; Alabama Department of Public Health, 2021).

Moreover, most of the minority communities impacted by COVID-19 are front-line service workers, also called essential workers, with limited opportunities to work remotely, e.g., employed in sales, restaurants, transportation, grocery shops, and other in-person customer services. Thus political, cultural, historical, and economic factors and personal hesitance to vaccination have played a significant role in high COVID-19 infection rate and in making a recovery unwieldy across counties of Alabama (Alabama College of Osteopathic Medicine, 2020; Alabama Department of Public Health, 2021). Unsurprisingly, health disparities are brought to the center of public and policy discussions nationally and in Alabama, and it is expected that recovery from COVID-19 in the Black Belt region would be more challenging than in other Alabama's regions. The Black Belt communities need a sustainable solution, argue health experts from CDC (2021) and the Alabama Department of Public Health (2020), to protect minority populations from health catastrophe.

The rural-urban division marked by uneven spatial development and unequal distribution of health care facilities and medical centers enlarges the existing disparities. The majority of rural communities in Alabama Black Belt counties where predominantly African Americans live are located far from health care centers. Rural populations, therefore, experience higher levels of severe illness and death during the COVID-19 pandemic in part due to insufficient access to primary health care facilities – a tragic outcome of residency in less affluent areas. Also, hospitals are being closed at alarming rates across the Black Belt region. Archibald (2019) observed that out of over 12 hospitals closed in Alabama since 2000, the majority were in rural communities. Therefore, the concept of uneven spatial development offers an additional critical lens to examine the systemic health discrepancies in the Black Belt region that led to uneven outcomes of...

Table of contents

• Cover
• Series Title
• Editorial Advisory Board
• Title
• Copyright
• Dedication
• Contents
• List of Figures and Tables
• About the Contributors
• Preface
• PART I HEATH AND SOCIAL INEQUALITY AND COVID-19
• PART II ENVIRONMENT, SUSTAINABILITY, AND COVID-19
• Index