American Quarterly

The COVID-19 pandemic has been the context for public health institutions, epidemiologists, and a range of social scientists to make a public case for an idea concisely stated by the American Medical Association in November 2020: "Racism is a threat to public health."¹ While activists and medical historians have long noted inequalities of access and outcomes for patients as well as exploitative conditions for research subjects based on race, class, gender, sexuality, nationality, and disability, such a statement by the AMA reflects a shift in public discourse at an organization that has historically worked to entrench such inequalities through its advocacy against universal health care and an elitist approach to medical training.² At the moment of this public statement on racism, the intersection of the global pandemic with public activism against police violence created conditions for a reckoning with medical and health institutions' complicity in racially unequal life outcomes, which Ruth Wilson Gilmore centers as racism's production of "group-differentiated vulnerability to premature death."³ In the wake of the murder of George Floyd by Minneapolis police officer Derek Chauvin and the summer of Black Lives Matter protests that followed, the AMA Board of Trustees and other health officials made public statements about the health consequences of racism, the consequences of Trump-era xenophobia, and the historical discrimination against Black patients and doctors.⁴ Such statements of the causative relation of racism to poor health outcomes were echoed by other institutional authorities. The US Centers for Disease Control (CDC) clarified that not only is racism an interpersonal relation, it is a structural one, which requires addressing a full range of social determinants of health.⁵ The World Health Organization convened an expert panel in March 2021 to address the relationship between health inequalities in COVID-19 outcomes and "discrimination" based on race and ethnicity.⁶ [End Page 689]

At the same time that the Black Lives Matter movement spurred some public health experts and institutions to more directly address racial difference, both media discourse and scientific research on COVID-19 publicly highlighted inequalities in viral exposure, case rates, hospitalization rates, death rates, vaccine uptake, and other indicators of vulnerability. Recognition of widespread inequalities has also led social scientists and epidemiologists to set forth interdisciplinary analyses of COVID-19 as they relate to social phenomena ranging from housing segregation to occupational health to transportation inequalities.⁷ Although such innovative work has moved toward producing more contextual knowledge of race, in particular localities, industries, and legal contexts related to public health, much of the national-level reporting and data suffer from problems based on data sets that flatten the complexity of racial identity and fail to capture experiences of Indigenous and multiracial individuals. Based on large data sets collected by the CDC and state health agencies, the main data on racialized differences in health outcomes in the era of COVID-19 tends toward a "four food groups" model of minoritization, highlighting vulnerabilities experienced on a mass scale by Black, Asian American, Latinx, and Indigenous groups (with the category "Hispanic" still in use for Latinx in a number of studies). Notably, the "Native American" category often gets removed from the analysis due to a small sample, repeating a larger problem that exists in social science data that reproduce the absenting of Indigenous peoples in North America.⁸ Data on racial disparity have often been helpful in articulating certain stark differences, such as the significantly higher case and hospitalization rates among Black and Latinx people relative to population in the early phases of the pandemic.⁹ Although many media reports highlighted inequality facing Black and Latinx groups, the more comprehensive and critical data sets showed from an early stage that there were also unequal outcomes for American Indians and Asian Americans affected by the virus.¹⁰ Recent published data from the CDC put American Indian risks of hospitalization rates at triple those of whites and the death rate as the highest of all racial groups in the US.¹¹ When some data showed that Asian Americans experienced case and hospitalization rates similar to or lower than whites, breakdowns of the...