Racial Capitalism Within Public Health-How Occupational Settings Drive COVID-19 Disparities

Abstract

Epidemiology of the US coronavirus disease 2019 (COVID-19) outbreak focuses on individuals' biology and behaviors, despite centrality of occupational environments in the viral spread. This demonstrates collusion between epidemiology and racial capitalism because it obscures structural influences, absolving industries of responsibility for worker safety. In an empirical example, we analyzed economic implications of race-based metrics widely used in occupational epidemiology. In the United States, White adults have better average lung function and worse hearing than Black adults. Impaired lung function and impaired hearing are both criteria for workers' compensation claims, which are ultimately paid by industry. Compensation for respiratory injury is determined using a race-specific algorithm. For hearing, there is no race adjustment. Selective use of race-specific algorithms for workers' compensation reduces industries' liability for worker health, illustrating racial capitalism operating within public health. Widespread and unexamined belief in inherent physiological inferiority of Black Americans perpetuates systems that limit industry payouts for workplace injuries. We see a parallel in the epidemiology of COVID-19 disparities. We tell stories of industries implicated in the outbreak and review how they exemplify racial capitalism. We call on public health professionals to critically evaluate who is served and neglected by data analysis and to center structural determinants of health in etiological evaluation.

Keywords: COVID-19; capitalism; health disparities; occupational health; racism; work.

Figure 1

Distributions of percent of predicted lung function (National Institute of Occupational Safety and Health Spirometry Longitudinal Data, 1999) and hearing (National Health and Nutrition Examination Survey, 2005–2006) under race-based correction conditions among Black and White workers, United States. A) Distributions of lung capacity among Black workers; B) distributions of hearing among Black workers. C) Distributions of lung capacity among White workers. D) Distributions of hearing among White workers. These distributions represent how they would be measured to evaluate compensation. The solid curves are the conditions currently in practice: race-specific equations for lung function and the race-neutral absolute threshold for hearing. The dashed lines are the counterfactual conditions: elimination of race “correction” for lung function and addition of White decrement “correction” for hearing. The vertical lines show the thresholds for initial compensation. Those workers to the left of the line would be eligible for compensation.