It has long been established that blacks have higher rates of diabetes, high blood pressure and heart disease than other groups. African Americans also die at higher rates than whites from cancer, kidney disease, diabetes, heart disease and stroke.

Poverty alone doesn’t account for the racial differences in health. Studies have found that an implicit bias on the part of health care providers often results in poorer treatment of black patients. Many medical schools now incorporate the concept of implicit bias in their curricula to help new practitioners guard against allowing unconscious biases affect their treatment of patients.

In recent years, there also has been increasing acceptance in medicine of a concept called weathering which holds that the stress of living as a member of a minority in itself takes a toll on the body, weakening one’s cardiovascular, neuroendocrine and immune systems.

“Over time, those systems get dysregulated, cells biologically age faster and lead to early onset of hypertension, diabetes and other chronic conditions,” said Arline Geronimus, a public health scholar at the University of Michigan whose research introduced the notion of weathering. “It makes you much more vulnerable in a pandemic to infectious disease.”

Narrowing the Gap

States responding to Stateline said they were conducting more testing in areas with high concentrations of coronavirus infections, which often are low-income and predominately African American neighborhoods.

Virginia, Michigan, South Carolina and Tennessee have created a combination of walkup testing sites and mobile units to provide access to residents who don’t have cars.

North Carolina and South Carolina reported increased testing of non-symptomatic residents in predominantly black communities by working with community leaders, local physicians, retail stores and health clinics.

Both states also reported surging contact tracing capacity in underserved, predominantly black counties and communities. South Carolina reported increasing its contact tracing staff from 20 to 600, with the potential of adding another 800 workers as needed. Most will be deployed in predominantly minority counties and neighborhoods.

New York said it has established 24 temporary testing sites in churches in minority communities in the New York City region and is providing free testing to public housing residents in the city.

In an interview with Stateline, Michigan Lt. Gov. Garlin Gilchrist — who leads the task force on coronavirus racial disparities created by Gov. Gretchen Whitmer, a fellow Democrat — said the state’s mobile units will go to hot spots in southeastern Michigan, which includes Detroit. They will provide testing in nursing homes, homeless shelters and neighborhoods otherwise identified as having a high likelihood of mass infections.

Gilchrist said Michigan also has committed to test “every person incarcerated in Michigan, which is overrepresented by blacks and Latinos.”

New York and North Carolina reported offering temporary housing to ensure a safe environment with the necessary supports (private room and bathroom, adequate food and water, and access to medication) for residents in low-income communities who are asked to quarantine.

Gilchrist said Michigan has provided such housing for frontline health workers and intends to provide such facilities in low-income communities in the Detroit area as well.

Starting next month, Maryland plans to repurpose its existing health care navigator network, originally created to help people sign up for Affordable Care Act health plans, by hiring 30 new social workers to serve 50,000 people in 24 minority communities across the state.

Working closely with COVID-19 testing centers, Maryland’s health navigators will help residents who test positive find emergency housing, temporary cash assistance to replace lost wages and social services for other family members while they quarantine.

Underwood, Virginia’s diversity and equity officer, who leads a coronavirus health equity working group, said along with the testing the state conducts in vulnerable communities, it is distributing personal protection equipment.

In Richmond, Chesapeake and Harrisonburg, she said the state delivered 20,000 masks and 20,000 bottles of hand sanitizer to doorsteps in hard-hit, heavily African American communities. The state was preparing to repeat those activities in Roanoke, Petersburg and parts of Northern Virginia, she said. The state also plans to supply every inmate with two masks.

New York said it had delivered a million cloth masks and 100,000 gallons of hand sanitizer to public housing in New York City.

Trusted Leaders

Many of the states said they are reaching out to trusted institutions in minority communities, both to gather information about the needs of that community and for help in spreading accurate information about the virus, about safe practices and where to seek help if needed.

States said they have enlisted churches in minority communities, historically black colleges and universities, and elected officials from those areas.

Mississippi said it is using Head Start programs to help disseminate coronavirus-related information to its clients. Tennessee has enlisted the help of Meharry Medical College, a historically black medical school in Nashville, to run its testing in the city and help with COVID-19 outreach.

South Carolina has created public service video messages delivered by black state leaders, including Democratic U.S. Rep. James Clyburn, Columbia Mayor Steve Benjamin and the state’s chief epidemiologist, Dr. Linda Bell.

Patrick H. Johnson, a senior vice president at Meharry involved in the pandemic response, said one challenge health officials face in working in minority communities is gaining the trust of those who have historic reasons for being skeptical of outside authorities. He praised the state for turning to trusted partners like Meharry.

“There’s a pride in the African American community when they hear Meharry is running all the testing sites,” Johnson said. “And it makes a big difference when they see these people look like me, they talk like me and they’re not treating me any differently.”

Johnson mentioned a technological innovation that authorities are introducing as they ramp up contact tracing in minority communities. The telephone numbers respondents will see, he said, will be from trusted community organizations.

“Most of the people aren’t going to pick up the phone from an 800 number they don’t recognize,” he said. “We have the technology though, so the number they’ll see will be from an organization they’ll trust, like Meharry or a community-based clinic. They’re more likely to pick up when they see that.”