“Hispanic community makes up more than half of coronavirus cases in Southwest Michigan county” was the headline in the newspaper that caught my eye in August 2020 – that infamous year that the nation went into lockdown to prevent the spread of what was still a new and emerging virus.
It shocked me to realize that only three counties west of my Southcentral Michigan home, Latinos were contracting COVID-19 at higher rates than the rest of the population. Yet, little to nothing was being done to address this rise in cases until Hispanics/Latinos made up 52 percent of cases in Van Buren County despite only comprising 11.7 percent of the population. It angered me to learn that during the initial surge of COVID-19, Hispanics/Latinos, people like myself and my family, were five times more likely to die from COVID-19 compared to white people across the nation. I remember frustratingly asking myself, “given that the coronavirus can affect virtually anyone, why does this disparity exist?” The answers I came across reflected the common themes that exist among minority health disparities, such as poor access to health care, essential-worker occupation status, unsafe working environments, and crowded housing.
However, it is important to recognize that these disparities are not a product of individual choices as many often believe, but rather stem from exclusionary policies and intentional discrimination deeply rooted in our nation’s history. To prevent and reverse the effects of health disparities, we need more than what medicine and public health can provide. Rather, we need to travel back in history to understand how current-day disparities came to be, including the disproportionate effects of COVID-19 in the Hispanic/Latino community.
Latinos have a longstanding history of holding jobs crucial to this nation’s development and the economy. In the early 1900s, Mexican immigration increased due to the demand of the agricultural and railroad industries, resulting in many immigrants working as low-wage laborers. However, their arrival was not celebrated but was marked by racism as they were labeled as racially inferior and less intelligent than white people which also influenced the types of jobs that immigrants could access. These sentiments then led to their poor treatment, such as being seen as sources of infection, despite their instrumental work in the labor force.
When a typhus outbreak occurred in 1916 in Los Angeles County among 22 Mexican railroad workers, all efforts to address the outbreak were aimed at improving Mexicans’ personal hygiene rather than addressing the poor working and living conditions, reminiscent of the treatment of the disproportionate numbers of COVID-19 in the Latino community. Rather than focusing on ensuring that there was proper personal protective equipment for essential workers or centering efforts on providing adequate housing for quarantining, most interventions involved “fixing” prevention behaviors such as wearing masks and maintaining social distance.
Crowded and substandard housing as a predictor for negative COVID-19-related outcomes also has its roots in history. In the 1930s, the Home Owners’ Loan Corporation (HOLC) offered insured mortgages for homeowners. However, to determine if homeowners could qualify for the mortgages, neighborhoods were designated as non-risky or risky, with those being deemed risky labeled red. Not coincidentally, these redlined areas mapped onto neighborhoods where Black and foreign-born residents primarily lived, thus preventing and dissuading homeowners from buying homes in these areas. This discriminatory practice led to homeowners living in these redlined areas unable to access these government-backed loans, which led to people of color often being unable to independently own homes and thus crowding multiple people under one roof. Although redlining was deemed illegal after passing the Fair Housing Act in 1968, we still see its effects due to government disinvestment in historically redlined neighborhoods, which has manifested as poorer health outcomes in its habitants. Thus, the disproportionate number of cases due to COVID-19 is not due to Latinos living in multigenerational homes by choice but likely a result of being segregated into redlined areas with limited economic opportunities and crowded homes that prevented them from properly quarantining and maintaining social distance.
Finally, an important policy that impacted the Hispanic/Latino community was the longstanding “public charge” rule. Historically, this rule had prevented people from immigrating to the United States from its enactment in 1891, when immigration was booming in America, by identifying people who were likely to rely on government benefits. This exclusionary policy underwent several iterations and, in 1996, barred legal immigrants from accessing public benefits. However, after five years of this exclusionary policy, benefits were again reinstated for immigrants.
In February 2020, the rule underwent a significant change under the Trump administration. Again, it would evaluate an immigrant’s ability to apply for U.S. residency or citizenship by determining if the applicant was “likely” to rely on assistance programs, such as Medicaid. This led to a chilling effect on the Latino community. Many people dropped their benefits and avoided accessing health care services for fear of being considered a “public charge.” This had significant implications during the pandemic as this ruling contributed to reduced access to medical care and decreased acceptance of COVID-19 vaccines, further perpetuating health inequities.
Through these examples, we see how to understand the disparities we witness today; it is imperative to go back in time and understand the historical context. Medicine can help with symptoms and public health with prevention, but only history can help us to dismantle structural racism by first identifying it and than pulling out its roots. To prevent a disproportionate burden of disease among the Hispanic/Latino community, as we saw in the pandemic, we must tackle discriminatory policies, such as the “public charge” rule, provide quality housing, support communities’ economic well-being, and create safe working environments starting with what we know of the past. Then, hopefully, through acknowledging our past, we can create a more equitable and just future.
Grecia Quiroga is a medical student.