Black History Month amidst Two Crises

As the U.S., with the rest of the world, staggered to the end of 2020, two public health crises retained their places at the center of attention: COVID-19 and structural racism as the mechanism underlying a hive of health inequities, including everything from death due to gun violence to death due to COVID-19. In the setting of Black History Month, we can see this attention as one among many temporary acknowledgments by the majority culture of existing inequities. From the point of view of race theory, racial inequities can be seen as part and parcel of structural racism, where inequities in seemingly disparate social systems (housing, education, employment, health, incarceration) in fact feed one another, so that the presence of a racist structure in one realm manifests itself again in the superficially unrelated realm, compounding the problem of racism. The unfairly unequal treatments of classes of individuals in one realm (e.g., housing) coincide with worse outcomes in another (e.g., health), which in turn coincide with worse outcomes in another (e.g., job prospects). For a fine exposition of structural racism in the area of oral health, please see Patrick Smith's incisive Commentary.

COVID-19 is front and center in a number of articles in this issue. Two Commentaries—one on institutional distrust among African Americans in relation to COVID-19 and ethical implications (Best et al.) and the other on the ethnogeriatric implications of the pandemic (Rhodes)—start us off. Two empirical research papers examine COVID-19 in the U.S. The first examines the impact of COVID-19 on federally qualified community health centers (Simon et al.) and the other the association of social vulnerability with risk of COVID-19 mortality (Freese et al.). A third empirical research paper takes us to Wuhan China: The authors report on the lockdown policy in Wuhan after the outbreak in early 2020 (Wang et al.). Finally, the ACU Column provides a tight, on-the-ground report on managing COVID-19 care in long-term care settings.

Directly addressing African American and African health concerns and interests, a larger set of papers can be usefully divided into those establishing facts about existing inequities and those about possible progress against such inequities. The first set includes a randomized control trial on discrimination and depression in a particular population (Gresemer et al.), a study of Black/White differences in uptake of CT scans (Poghosyan et al.), and a risk-mapping analysis in informal Kenyan settlements (Bempah et al.). Of particular relevance in the context of the Black Lives Matter movement, Timmer and Nowotny address the relationship between policing and mental health, and ties between fatal law enforcement encounters and mental illness. On the positive side of the ledger, Ukoli et al., in a paper from Meharry Medical College, address the effect of a breastfeeding promotion on weight gain among African American infants. In a paper from Prairie View A&M University, Carden et al. report on the results of focus groups with minority group members about developing a mobile/online app to assist with diabetes management. Suen et al. present their work with low-income African American volunteers, who enhanced their skills as community health workers by being trained to deliver conmmunity-based hearing care. Harvey et al. present multi-year data from Western Kenya on the impact of interventions integrated with antenatal care on the use of maternal health services. The Literature Review by Darling et al. also contributes to reproductive care as it reviews prenatal care (PNC) delivery models designed to increase the use of PNC where needed. A second Literature Review, by Vick et al., concerns strategies promoting hydroxyurea adherence among patients with sickle cell disease. Finally, Sutton et al. conducted outreach in rural barbershops to increase hypertension awareness and treatment, and Schnitzer et al. ask whether a state transitional shelter might be the answer to eliminating racial inequities in housing for people with serious mental illness.

At least eight papers in this issue directly address mental health issues, including two previously mentioned. In addition, we hear from Weiss et al. about the...