Host:
Hello and welcome to the podcast. In the coming weeks, we'll be learning more about coronavirus, not just about the virus itself, but of the response to the global pandemic that has shut down cities, forced people into their homes, and started a race to find effective treatments and therapeutics. In today's episode, we'll be talking to Spenser Darden, the Director of Diversity Initiatives and Community Engagement at West Virginia University. Spenser discusses the disproportionate impact of the coronavirus on black and brown communities in the United States, as well as the underlying factors that have led to health care and other disparities.

Host:
Much of the coronavirus data being collected throughout the nation lacks racial demographics, but the data that is available shows that the virus is infecting and killing people of color at disproportionately higher rates. A July 5th report from the New York Times shows Latinos and African Americans in the United States have been three times as likely to become infected with coronavirus as white residents are. Spenser Darden, Director of Diversity Initiatives and Community Engagement at West Virginia University, says the coronavirus did not create disparity, rather it highlighted disparity that already existed. Darden says because of the structural ways that black Americans are disadvantaged, they often experience disparities in terms of outcomes and access from everything to healthcare, housing, education, and job opportunities.

Spenser Darden:
One of the things that we know is that there are particular perceptions of different communities based on race, based on gender, based on these different things. So for the black community we know that, for a long time, there's been perceptions that black folks don't feel the same level of pain or that black folks... There's even some myths out there that black folks actually have physically thicker skin and therefore can sort of resist different things that white folks are unable to. So even though a lot of these things might sound nonsensical at their face, they really do inform how people engage with the black community. So we've seen sort of countless reports of black folks going to the hospital or going to their doctor reporting symptoms that are consistent with a COVID-19 diagnosis, and either not being treated adequately or being told that they're over-inflating the symptoms that they're experiencing. So in addition to some of these sort of things that we can paint as bias or as outright racism, we then also see some of these other issues in terms of access.

Host:
A 2014 National Institutes of Health study found that hospitals in predominantly black neighborhoods are more likely to close down than those in predominantly white neighborhoods. This makes it difficult for black Americans to access healthcare near where they live. Living in a rural area is also often associated with a lack of access to care.

Spenser Darden:
We know that communities of color, because of a lot of different reasons, don't have the same level of amount of access to healthcare resources, and so that has an impact on their availability to be accessed. So if I do not have the particular care available in my community, then there's a myriad of steps I have to go through in order to be able to have access to that care, whether that is securing transportation, whether I do have access to transportation but then have to take the time to go to a health care facility, questions about how long are my wait times and what impact will wait times have if I'm an hourly employee, for example, on my ability to collect a paycheck on that day. So it's a lot of different things that sort of compound on top of each other that have made the coronavirus, the COVID-19 pandemic, have a disproportionate impact on the black community.

Spenser Darden:
I want to say, when we say disproportionate, what it means is that the impact and the effects that we're seeing of the pandemic outweigh the expectations that we have based upon the percentage of the population that they represent, as well as the sort of percentage of sort of healthcare cases that we see.

Host:
Access is a really important part of the discussion when it comes to the differences and outcomes among different racial groups, particularly because of America's history of segregation. Darden says segregation is defined as state-sanctioned or state-supported separation of people based on race.

Spenser Darden:
For much of the 1900s, the country was advancing in the ways in which we created access to things, whether it was entertainment, healthcare, schools, those types of things. And while that was happening, that was happening in the context of segregation, meaning that it was an explicit policy to ensure that access to those things were top notch for white people and that therefore there was intentional development of white communities. So if you're familiar with the history of redlining, redlining was a federal policy adopted by the Federal Housing Administration in the 1930s, and it was a banking policy that determined viability of communities and therefore the likelihood to support mortgages, to be able to back mortgages. So there was a process through which the Federal Housing Authority, and the banks with which they worked, identified particular communities as either being good communities to invest in or being not good communities.

Spenser Darden:
There was a ranking system where green communities were the highest and red communities where the lowest, and it "just so happened" that the redline communities are those that were seen as being the least profitable to invest in or the least good type of community, all just so happened to be black communities. So the result of that, that strategic disinvestment or that decision, is that if you are setting up a business or if you're expanding your business, you want to look at the type of community that that business is going to be entering. And if what you're being told or what you've seen as you're doing your analysis of that community is that it's not a financially viable community, then you're not going to set up your business there. You're not going to invest in that infrastructure, you're not going to invest in that community and therefore, things like jobs never come to that community, or at least consistent types of jobs, and those kinds of things.

Host:
These types of strategic governmental investments, or disinvestments, become clearly divided among racial lines, but also along a rural and urban divide. School consolidations are one example of rural disinvestment. As schools exist in a particular community, businesses build around that school, and when a school is forced to close, the influx of community members around those businesses is taken away too.

Spenser Darden:
And so then what happens is that the businesses struggle, and because businesses are struggling then it becomes a less valuable or a less viable place for other businesses to come in and invest in. So the same process that occurs in terms of racial segregation and redlining occurs whenever we see these rural spaces, which are already at a different sort of risk for these things because of the lack of population density that's inherent to our communities, whether we're talking about West Virginia communities, Appalachia more broadly or throughout the United States. So this process of these policies being enacted to reward particular types of spaces or particular types of communities then get reinforced by being successful, which then makes it look like the other types of communities that are there are just less equipped to be successful in the same way, which is not true. We know that West Virginia, we know that rural communities, are vibrant communities, but we know that there's also been policies that have not supported their vibrancy in the ways that they've needed to be.

Host:
The for-profit model of hospitals in the United States poses particular challenges for people living in rural areas. As Darden explains, healthcare is not just for the good of the patient, it's also for the benefit of the investor in the health care system or in that particular hospital.

Spenser Darden:
With a lack of population density comes a lesser ability to turn a profit on the healthcare that's being provided. So part of the challenge then that we're seeing in West Virginia is closures of hospitals, first in the Northern panhandle and then down in Fairmont and Clarksburg, which actually creates this dynamic of the communities that need the most service and the communities that need the most investment are the ones who are being least served. So before, if I was living in Clarksburg, I would have a hospital very close to me, or I could go to Fairmont, but now potentially my closest hospital is now in Morgantown. So we read about these stories of I would go to the hospital and it was only a 10-minute drive and it was able to save my life because of early detection and therefore, early care. Whereas because of we don't have a very robust public transportation network across this country, that there's these other mitigating factors that help determine whether or not folks will have access to healthcare.

Spenser Darden:
For the black community, this is the dual sort of challenge of racial oppression, as well as economic oppression. That means that they have a lesser capability to be able to have access to these things in the first place. Again, not because of inherently who they are, but because of how we've developed our system of healthcare and our system of society, so you have these multiple factors that mean there's a compounding effect that occurs. So what we've seen within West Virginia, and around the nation more broadly, is that black communities have to work in a way that's different and more challenging than particular white communities in order to have access to this care because their communities were not invested in or strategically disinvested from. And then you have these other factors of potentially being rural of being not close to your closest healthcare facility or hospital, or having to figure out your ways to do that. So there's been a lot of challenge for the black communities, particularly rural black communities, as a result of this compounding factors of things like racism, and racial segregation, of living in rural locations, and then the bias that we referenced earlier that they experience once they do finally access healthcare.

Host:
Darden also emphasizes the legacy of how healthcare institutions have been utilized and weaponized against black and brown communities.

Spenser Darden:
[inaudible 00:10:43] folks are reading about, and our sort of first now coming to their understanding of the Tuskegee syphilis experiment, which was done in Alabama. The entire premise of the experience was either to allow, or to specifically infect, black men with syphilis to learn what are the effects on the human body of syphilis if it goes untreated, and so this did not happen that long ago, this is the legacy that my parents lived with, that their parents lived with. So there's even this other piece of it in terms of distrust towards healthcare institutions that come into it.

Spenser Darden:
So recently, Melinda Gates was talking about whenever we develop a COVID-19, either a treatment or cure, we should first give it to communities in Africa, which is a really sort of... It seems like a very sort of philanthropic, "In Africa where there's lower income communities and they don't have access to these things", but really what it looks like is a wealthy white person saying, "Let's test this thing on black people." So that legacy is very true as well of black communities having this sort of developed distrust.

Host:
Darden says the eugenics movement during the late 1800s aimed to understand why different races were different. Essentially, the movement tried to ascribe a scientific value to people in society as being more or less successful. This ultimately led to many harmful racial myths.

Spenser Darden:
So an example that came out of the eugenics movement are myths about black people as, "Oh, black people have an extra muscle in their calf that allow them to run faster", which is why you now see more black people in the NBA and in the NFL. They utilize health, sorry, medical research as a way to try to rationalize the societal complexes that they were creating, so there's a lot of these racial myths that existed. The eugenics movement is what allowed for mass sterilization, the United States sterilized over 60,000 people, the majority of whom were black and disabled. The last person that we sterilized in the United States was in California, California sterilized about 30,000 people of the 60,000, many of whom were native. So essentially what the purpose of the eugenics movement was, was to try to create a medical rationale for the superiority of white people. That's ultimately what it came down to.

Spenser Darden:
So you have this dual legacy of slavery, Jim Crow, segregation, you have state-sanctioned experimentation on the black community, you then have the eugenics movement that's also providing medical rationalization as to why white people are superior to everybody else, and then when there's a pandemic like this one, we say, "We don't know anything about this disease, but just trust the institution of medicine to do the right thing for everybody." So you can understand why there's some communities, black and brown communities in particular, who are a little bit hesitant to say "Yes, let me just trust this sort of burgeoning strain of science." So it's all of these things, these legacies that are being actualized now in the form of COVID-19.

Spenser Darden:
So then you have the lack of access because of being in disinvested communities, the lack of access because of being rural, like here in West Virginia, you then have these histories and legacies of the ways in which medicine has been weaponized against black and brown and immigrant people to legitimize the fact that racism was a biological factor, as opposed to a sociological factor, and now we say, "Okay, but trust healthcare". So there's a lot of these things that when you pile them on top of each other makes it so access is not just the problem, but it's also trust in the institution.

Host:
As the coronavirus emerged as a threat in the United States, racial disparities were exacerbated in a number of ways, particularly around those who were considered essential workers and those who were able to work from home. Many of the jobs deemed essential, such as grocery store workers and custodians, are accessible to people without specialized degrees or training. Because of that, Darden says these roles have a much more representative swath of the population.

Spenser Darden:
But the other thing that it means is, again, as we talked about earlier about strategic disinvestment and the ways that education have suffered as a result of it, we know that particularly affected communities, communities of color, black communities, who have been strategically disinvested from are the ones who are then mostly the ones who are accessing these spaces. So to put that another way, if I'm living in a community that has not left me with a bunch of opportunities to be successful, so it's not that I don't work hard and it's not that I don't value education, but rather there has been decisions that have been made, both intentional and unintentional, that have now had an impact on my ability to be successful in the way in which the United States defines success, which is going to college or to be innovative in particular ways or things like that, then what I'm going to look for is an opportunity that provides me stability. So a lot of these essential workers are people who have access to these stability-creating jobs and they're the ones who have been the first and foremost asked to put themselves in harm's way. So these are people that do things like food service, that provide custodial and janitorial services, that sort of keep the United States going. We see this in terms of migrant farmers as well, as being asked to continue doing that work.

Spenser Darden:
So what ends up happening is that the folks who have sort of the least financial capital, because of, very often, their social circumstances that have been created. They're the ones who are being asked to be willing to take on the most sacrifice.

Host:
Living in a rural area also impacts job choices.

Spenser Darden:
Your choice of jobs is going to be limited by capitalism. So for example, West Virginia doesn't have Trader Joe's, which Trader Joe's is an organization, for all of its flaws, that pays their employees well, that provides healthcare benefits, that provides paid time off. All of these are things that allow for folks to enhance their economic standing in the world. Because if I can take time off or if I can take sick leave, then I'm going to be able to do things that allow me to be healthier and therefore, make different choices. So if I don't have access to that, I only have access to an employer who pays federal minimum wage, does not provide healthcare benefits, and I can't work full time, then I'm going to have to take on the jobs that are accessible to me because of the community that I'm in and because of the things that are or are not available to me within that community.

Spenser Darden:
So as a result, we see these disparities in terms of who is being most exposed, that's the word, being most exposed to COVID-19, or potentially exposed. We see this in terms of disparity of where those people work and the types of jobs that they do.

Host:
Wearing a mask is one of the most important pieces of guidance from public health officials for preventing the spread of coronavirus. Masks, or homemade facial coverings, help eliminate the spread of droplets as we breathe and we speak. But here in lies the problem, covering your face has been associated with seeming threatening or untrustworthy.

Spenser Darden:
In our society, is that when somebody covers their face, they're viewed as being, in some way, threatening or as being somebody who is to be distrusted. We have this sort of best healthcare protocol of cover your nose, cover your mouth, ensure that we limit the spread of COVID-19, it then triggers in us, because we are social creatures, all of these other sort of reactions. So I might be able to see your eyes, but I can't tell if you're smiling and so therefore, what are you saying and what is your intention? So for communities of color, this has a different sort of implication than it does for white communities because, for folks of color, there is a lot of dynamics that are tied into this idea of trustworthiness.

Spenser Darden:
So going deeper into this, as we think about the civil rights movement and the 1950s and 60s, we know that they leveraged this idea of respectability as a way to prove that equal rights should be the rights of black folks as well. When I say respectability, I mean, nonviolent marching in the streets in ties and suits, of "Hey, we are fully human as well." So this idea of respectability is a lot around, what does it mean to be the right kind of person in our society? So for folks of color, they don't have sort of that same deference of being seen as belonging to proper society and so they have to do more very often in order to determine how do I help deescalate, I think, is the best word to say?

Spenser Darden:
So for black folks, for example, thinking about what is my facial covering going to look like? Because we know that there's particular colors that are associated with different forms of criminality and gangs. For Asian folks, there might've been a thought process of if, "I use a medical mask, then is that a class thing that I now have to think about in comparison to a cloth mask?" Now, as we have more access to medical masks, it seems like they're a little bit more plentiful, we can actually view that as, again, sort of this class status of I have access to this thing. So we use access to resources, we use financial sort of placement as sometimes an indicator of safety and trust and belonging and those kinds of things. So there's a lot of respectability politics even tied up into that as well.

Host:
Having to consider how a facial covering will be perceived by others is just one example of the many daily barriers people of color face. Implicit biases, microaggressions, and more blatant forms of racism can negatively impact the health of persons of color. As they navigate the world around them, they often experience elevated levels of the hormones associated with fight or flight. These stress hormones can cause changes in the body such as increased heart rate and blood pressure. If the stresses aren't eliminated, the underlying changes in the body remain, causing a weathering effect, which can lead to poor longterm health outcomes.

Spenser Darden:
Part of what we know is that public health looks at these social determinants of health, and they try to determine, are we able to learn something about the ways and the healthy ways in which people are able to lead their life? So this is things like access to healthy food, this is things like access to leisure activities, which access is not just physical access, it also means time. We also think about the ways in which people engage with them. There's a theory that's referred to as racial battle fatigue that talks about this added burden of stress that black and brown people experience as a result of racism, both over and covert racism. So over is explicit and it's intentional. Covert racism is things that are sort of embedded or there are assumptions or stereotypes that people may not realize that they're deploying in the course of their daily interactions. So it does have, exactly as you said, this weathering effect of having a cumulative stress related impact upon black and brown communities.

Host:
After initial reports were published about the impact of coronavirus on black communities, the West Virginia Department of Health and Human Resources launched free testing targeted at minority populations across the state. After initial testing, the state journal reported that West Virginia's data was comparative to national data in terms of positive cases and hospitalization rates.

Spenser Darden:
One of the things that we should be able to take away from the data that we're collecting around coronavirus is a few things. The first is asking the question of, where have these occurrences been concentrated and, as we think about the race of those communities or the prevailing races of those communities, how does that reflect the redlining that has occurred in our state as well? So what does that mean in terms of how we should think about strategic investment across the state? I think that sometimes we have this knee jerk reaction of wanting to invest in places where we think is going to be of most benefit, rather than thinking about how do we lift our lower communities? Whether that means lower income communities, whether that means our lower access communities, whether that means based upon school testing data that those communities are struggling a little bit more. I think that this coronavirus pandemic response should be able to inform strategic investment across the state.

Spenser Darden:
The other thing I want for us to think about and to remember is that there are black and brown folks throughout the state of West Virginia. I think very often we don't necessarily think about West Virginia as being a diverse state and we talk very much in terms of what it means to be rural and what it means to be a low income state without also thinking about, "Okay, as we think about race, as we think about racism in our state, how does that affect our residents as well?" So that should be an important thread that we continue to pull, that we continue to investigate on a little bit of a deeper level to help inform policy. Because ultimately that should be the outcome of the entire coronavirus pandemic nationwide is critically examining the way that we invest in our communities, which communities are being invested in? What type of investment is being made in them?

Spenser Darden:
You can hear this within the protest for black lives that's happening right now when they talk about defunding the police. What they're talking about is not saying not necessarily taking away the police altogether, although there are some people who are advocating for that position, but what they're saying is that there are very, very, very many ills that plague society that have been unfairly or unnecessarily placed upon police to fix. So what we're looking for, and what folks are looking for when they ask for a disinvestment from the police or they're asking to defund the police, is they're looking for an increase in funding within the communities that are most effected by policing in things like social services, in things like increased pay for teachers in those communities, increased access to affordable housing, the types of things that would allow for folks to be able to utilize their resources differently and allow for them to change the trajectory of their lives and their family's lives. So I would hope that sort of as we continue to move through COVID-19 and hopefully, move towards the end of COVID-19, we're able to think about policy and strategic investment and how it has an impact on our black and brown communities in the state.

Host:
A number of black individuals have died while in police custody over the past decade, but after the death of George Floyd in Minneapolis on May 25th, protests broke out in cities across the United States, sparking a national debate on policing and re-igniting the Black Lives Matter movement.

Spenser Darden:
I think it's telling that even in the midst of a global pandemic, in which we know that black folks are disproportionately contracting and dying of COVID-19, they are still saying that we need to talk about racism and racial intolerance, and we need to do so in coordinated ways, we need to be out here demonstrating. I think that that should really demonstrate to folks the urgency and the necessity of thinking about structures of race and racism. So for folks who are thinking about engaging in protests, there's a number of things that you can do to stay safe, and really it's just following the CDC guidelines, wear a mask, wash your hands, as you're able to socially distance. That's really the best recommendations that we can make.

Spenser Darden:
I think that even understanding that risk and even understanding that challenge, that it's important that we think about what it is that the messages being portrayed. And the message is that racism is not just individual bad people who happen to infiltrate otherwise good organizations, but rather that there is a structure to racism that is deeply embedded and deeply ingrained into the way our society is organized. Right now, the conversation seems to be centering around policing, but we need to think about the ways in which we educate people and how education reinforces racism. We need to think about the ways that our capitalist society reinforces racism. We need to think about the ways that all of these things that are structures within our society benefit from or reinforce this idea of there being superiority or inferiority across races.

Spenser Darden:
It's important for us to start thinking about that because our students are coming back in the fall, whether we're talking about WVU or we're talking about any of the K-12 counties around the state. As students return, understanding that the protests for black lives right now are not just simply in response to one bad decision made by one bad person in one place several states away. But rather it's a direct reflection of the ways in which black folks, and communities of color more broadly, are viewed as being both suspicious, as well as being not belonging. And as a result of that, people feel the need to demonstrate and to point out that injustice.

Host:
So how can white people become allies to help lead to better health outcomes and better outcomes in general for people of color?

Spenser Darden:
That's the main question that people are asking right, "As I'm becoming more aware of sort of the ingrained nature of racism, what do I do about it?" Because it can feel like it's too much, how can one person fundamentally reform all of education? How can one person fundamentally reform all of healthcare? It feels too big, but it's a couple of things.

Spenser Darden:
The first is that allyship is an ongoing process and by definition is an ongoing process. What ends up happening is that when folks are interested in becoming allies, and that means white people to communities of color, that means men to women and queer and non-binary folks, what happens is that they go through this binge of information where they really are engaged with information, with scholarship, with research, with think pieces, with TED Talks, they access it all, and then they feel like they've gotten enough information to be able to speak credibly about the issue. And that's what they're going to do is they're going to speak credibly about the issue and that's it.

Spenser Darden:
The problem is then that the act of being an ally is ongoing engagement with new information, is about having people challenge the things that you're saying in productive ways. So I think the number one thing about being an ally is not just doing sort of these initial levels of research. There's a bunch of reading lists that are going around of how to become an anti-racist, and 75 resources to do this, and 13 talks to watch, and 12 podcasts to listen to. A partridge in a pear tree. We have all of these things, but really then it's the next step, the active step of how do we hold ourselves accountable? How do we allow ourselves to hear critique of the ways in which we are not engaging in this process in the right way?

Spenser Darden:
So the example for this could be if I'm a white person and I am the one who is organizing these protests, and somebody says, "Hey, you should not be the main one organizing protests" how do I hear that as not a critique of me individually, but rather as an opportunity to say, "Who else is also doing this that I can elevate to be seen as an expert or that can be seen in these ways?" So it's this ongoing process of learning, of being open to critique.

Spenser Darden:
But I think one of the things that we can really learn and one of the things that we can do as West Virginians is really dive deep into our own history, because we know that a lot of our labor disputes related to the coal mines, a lot of our history, were entirely about access to fair and equal treatment, about being considered fully human. It was in this process of reclaiming our humanity that we've developed West Virginia, and our sense of individualism, and our sense of what it means to be a Mountaineer. That's a really important thing that I think if we are able to think about and examine our own history can help us become more empathetic to the same process that black folks are moving through right now, of trying to actively reclaim our history and our humanity, of trying to actively help people understand the ways in which we are being disadvantaged, that black folks are being disadvantaged, and how that disadvantaging is happening even with well-intended people in these different positions.

Spenser Darden:
So I think one of the main things we can do... Of course, I work at a university so I believe in education, but beyond that, it's about this active process of where can I learn more? How do I take what I've learned to other people around me? How do I make sure that I'm allowing others to hold me accountable and how do I do the same for those who I love and care about as well? But then it's also about continuing to be engaged, right. It's, "I'm going to have this critique that happens to me and I have a decision point, do I hear this critique or do I tell the person that I know more than them or whatever that sounds like and so therefore, I don't need to hear that feedback?" So yeah, so I think that's really important. And like I said, understanding our history as a state, in particular our labor history, is really instructive to understanding the protests that are going on right now in relation to racial justice.

Host:
If you're interested in learning more about West Virginia University's response to the COVID-19 pandemic, visit coronavirus.wvu.edu. Follow us on social at WVU Health on Facebook, Twitter, and Instagram. Make sure you subscribe to this podcast on your favorite podcast app to get the latest episodes as they're released.