RIM Blog

In the United States alone, COVID-19 has claimed tens of thousands of lives. And though it is no respecter of wealth, social status, or national boundary, initial claims that “We are all in this together!” have fallen flat. Such universalizing claims have proven unable to camouflage the extreme inequality in suffering, just as history would suggest (De Waal 2020).

This essay appears at a critical moment, in the throes of a public health crisis, wherein four decades of racialized fiscal austerity have proven to be fundamentally corrosive to any notion of public health and, by extension, social life (see Ahlberg et al. 2019). In response, we offer brief comments here in the form of a plea for more policy-oriented scholarship, particularly that which documents and theorizes the myriad connections between marketplace actors and racial inequality (and its intersection with other forms). We offer these comments as members of the Race in the Marketplace Research Network, which conducts and mobilizes marketplace research to that end. Given editorial limits, we restrict comments to a few topics and limit their scope to the United States, where ethnic and racial inequality are acute, particularly in health.

Illness, Care, and Mortality

Initial data strongly suggest that COVID-19 has exploited and exacerbated long-standing racial disparities in illness, care, and mortality for people of color (POC), who experience worse health outcomes than comparable whites at every life stage. Racial disparities persist when controlling for various forms of human and cultural capital (e.g., education) and health behaviors. They persist even in organizational settings that feature standardized access and protocols, such as government agencies. Research identifies mutually reinforcing systems of racial inequality operating in every domain of social life as a fundamental cause of racial disparity (Phelan and Link 2015). Research also shows a pronounced antiblack bias among care providers (Sabin et al. 2009), which has implications for the validity and timeliness of diagnosis, appropriate treatment, consumer satisfaction, and subsequent trust.

By mid-May 2020, nearly 92,000 Americans had died of COVID-19. The available data show disproportionate mortality among POC. The rates per 100,000 people in each respective ethnoracial group are 50.3 for Blacks, 22.7 for Asians, 22.9 for Latinx, and 20.7 for Whites (APM 2020). These rates vary widely by state, with Blacks accounting for the highest share of confirmed cases and deaths in most states where data are available. Latinx individuals make up the highest share of confirmed cases in a few states. Data on American Indian or Alaska Natives are limited but show disproportionate shares of confirmed cases and mortality in New Mexico and Arizona, respectively (APM 2020).

Unfortunately, since the onset of the pandemic, simply measuring the extent of racial disparity has proved needlessly challenging. Many health (and other) agencies fail to collect or disaggregate data by race. Scholars and practitioners have long noted that color- and gender-blind data understate disparity and hinder action to eliminate inequality (see Grier and Schaller 2019). Health care is an important consumer service. Whether offered by public or private institutions, it is situated in an expansive network of government agencies, service providers, intermediaries, and consumers that, together, compose a health care system. Marketing and consumer research have an obvious disciplinary interest in exploring that system in pursuit of improvements to health outcomes and consumer satisfaction. Moreover, health care is also a matter of social justice, and marketing and consumer research also have a disciplinary interest in investigating the health care system in pursuit of fairness and equity. To that end, policy-focused marketing and consumer research must grapple with racial inequality, individual bias, and institutional racism.

Economy

People of color, already the most vulnerable to illness, also suffer disproportionately from pandemic-induced layoffs, wage cuts, and hours reductions without adequate support. As states loosen or lift shelter-in-place restrictions, falsely pitting “the economy” against public health, policy research must explore differential access to resources for recovery. Racialized disadvantage is often built into institutional routines for distributing resources that may appear to be race neutral. To wit, mortgage credit underwriting commonly determines creditworthiness based on formulas that ignore the impact of persistent housing segregation, racial steering, and redlining on current borrowers’ financial portfolios (Perry 2019). Meanwhile, minority-owned businesses, which are notoriously undercapitalized, must apply for pandemic recovery funds administered by private banks whose racially discriminatory practices are long standing and well documented. Bone, Christensen, and Williams (2014), for example, use an audit study to demonstrate how bank lending officers routinely favor white loan seekers by providing them with more thorough answers to queries and more unsolicited information in the application process.

Policy research should also help illuminate the economic implications of sheltering in place. These restrictions are engendering new marketplace and home practices that require a theoretical lens capable of incorporating gender, race, and social class. In the marketplace, the accelerated shift to online retail has obvious implications for the digital divide. Yet for many services, such as health care, education, and even religious worship, the implications are multifaceted, as they are for racially biased treatment at retail. Shelter-in-place restrictions have also reorganized home life by repurposing space. However, gender, race, and social class simultaneously structure access to health-supportive resources at the community level, which has implications for how homes can be reordered. Consider that POC are more likely than Whites to live in multigenerational households and to care for highly vulnerable seniors. In addition, nursing homes and elder care facilities are racially segregated, and those serving primarily POC are commonly of lower quality (Mack et al. 2019).

Racism and Xenophobia

The United States, like many nations, has a long history of racism and xenophobia associated with public health. For instance, in 1900 local and federal health officials planned to quarantine and forcibly vaccinate San Francisco’s Chinese population. Fortunately, a federal judge halted it on Fourteenth Amendment grounds (see Lanham 2020). Current press accounts suggest that people of Asian descent in the United States are once again targets of stigmatized harassment and violence. Unfortunately, similar instances of COVID-19 related racism and xenophobia abound across the globe. African immigrants and expatriates have been targeted in China, migrant workers in India and the Middle East, and Asian tourists in Europe and Israel (Shropshire 2020). As Wooten and Rank-Christman (2019) note, research must investigate the implications of stigmatized identity cues, particularly for coping with and confronting racism and xenophobia. Policy research should help us understand what coping practices and systems of mutual aid marginalized communities are mobilizing to address this pandemic by exploring how ethnoracial identity, community, and sociality are related to health and well-being.

Conclusion

COVID-19 has made plain that the past 40 years of racialized austerity, against an even longer history of racism, has brutally undermined everyone's public health and positioned ethnic and racial minorities to suffer the worst effects of every public crisis. This extreme inequality can end, or at least be substantially lessened, with the political will to enact long-needed policy reforms. This commentary highlights the need for relevant policy research that can help move the country toward equity by engaging with the impact of racism and other forms of inequality.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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References

Ahlberg, Beth Maina, Hamed, Sarah, Thapar-Björkert, Suruchi, Bradby, Hannah (2019), “Invisibility of Racism in the Global Neoliberal Era: Implications for Researching Racism in Healthcare,” Frontiers in Sociology, https://www.frontiersin.org/articles/10.3389/fsoc.2019.00061/full.

APM Research Lab (2020), “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S,” (May 20), https://www.apmresearchlab.org/covid/deaths-by-race.

Bone, Sterling A., Christensen, Glenn L., Williams, Jerome D. (2014), “Rejected, Shackled, and Alone: The Impact of Systemic Restricted Choice on Minority Consumers’ Construction of Self,” Journal of Consumer Research, 41 (2), 451–74.

DeWaal, Alex (2020) “New Pathogen, Old Politics,” Boston Review (April 2), https://bostonreview.net/science-nature/alex-de-waal-new-pathogen-old-politics.

Grier, Sonya A., Schaller, Tracey King (2019), “Operating in a Constricted Space: Policy Actor Perceptions of Targeting to Address U.S. Health Disparities,” Journal of Public Policy & Marketing, 39 (1), 31–47.

Lanham, Andrew (2020), “American Racism in the Time of Plagues,” Boston Review (March 30), http://bostonreview.net/race/andrew-lanham-american-racism-time-plagues.

Mack, Deborah S., Jesdale, Bill M., Ulbricht, Christine M., Forrester, Sarah N., Michener, Pryce S., Lapane, Kate L. (2019), “Racial Segregation Across U.S. Nursing Homes: A Systematic Review of Measurement and Outcomes,” The Gerontologist, 60 (3), e218–e231.

Perry, Vanessa G. (2019), “A Loan at Last: Race and Racism in Mortgage Lending,” in Race in the Marketplace: Crossing Critical Boundaries, Johnson, Guillaume D., Thomas, Kevin D., Harrison, Anthony Kwame, Grier, Sonya A., eds. Cham, Switzerland: Palgrave Macmillan, 173–92.

Phelan, Jo C., Link, Bruce G. (2015), “Is Racism a Fundamental Cause of Inequalities in Health?” Annual Review of Sociology, 41 (1), 311–30.

Sabin, Janice A., Nosek, Brian A., Greenwald, Anthony G., Rivara, Frederick P. (2009), “Physicians’ Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender,” Journal of Health Care for the Poor and Underserved, 20 (3), 896–913.

Shropshire, Kitty (2020), “Hate in the Time of Coronavirus,” Fair Observer (May 7), https://www.fairobserver.com/coronavirus/kitty-shropshire-covid-19-hate-crimes-xenophobia-sinophobia-far-right-news-91555/.

Wooten, David, Rank-Christman, Tracy (2019), “Stigmatized-Identity Cues: Threats as Opportunities for Consumer Psychology,” Journal of Consumer Psychology, 29 (1), 142–51.