key: cord-0953278-gbqacbvl
authors: Gaynor, Tia Sherèe; Wilson, Meghan E.
title: Social Vulnerability and Equity: The Disproportionate Impact of COVID‐19
date: 2020-06-22
journal: Public Adm Rev
DOI: 10.1111/puar.13264
sha: 16002c3bbe688d18723caa3845aed86f33fdbf54
doc_id: 953278
cord_uid: gbqacbvl

As the architect of racial disparity, racism shapes the vulnerability of communities. Socially vulnerable communities are less resilient in their ability to respond to and recover from natural and man‐made disasters when compared to resourced communities. This essay argues that racism exposes existing practices and structures in public administration that, along with the effects of COVID‐19, have led to disproportionate infection and death rates of Black people. Using the Centers for Disease Control's Social Vulnerability Index (SVI) authors analyze the ways Black bodies occupy the most vulnerable communities, making them bear the brunt of COVID‐19’s impact. Findings suggest that existing disparities exacerbate COVID‐19 outcomes for Black people. Targeted universalism is offered as an administrative framework to meet the needs of all people impacted by COVID‐19. This article is protected by copyright. All rights reserved.

people globally and 110,562 people within the United States, infected 6.4 million, and touched disproportionate impact is also evident at the state level. In Illinois, Black people represent 14% of the state's population, yet 41% of those who have died from COVID-19 (reported as of May 3, 2020) (IDPH 2020). Black people comprise 14% of the Michigan population, but 40% of COVID-19 related death cases (APM Research Lab 2020; DeShay 2020; Michigan.gov 2020).

As Figure 1 highlights, this trend can be seen across the majority of states reporting race-based COVID-19 data.

[Insert Figure 1 About Here] A community's ability to respond to and recover from a disastrous event rests upon social and economic resources. Being able to carry out the recommended practices in order to -flatten the curve‖ and slow the spread of COVID-19, requires individuals and communities access to the privileges that afford such a response. Blow (2020) illustrated in his April 2020 New York Times opinion piece, the privilege of social distancing is not an option for many in the Black community. Black people comprise large percentages of the essential workforce and frontline jobs including workers in grocery and courier delivery, postal service, public and urban transport, and healthcare (DeShay 2020). Therefore, for those who are working, they are less able to engage in social distancing practices, as for many, social distancing would mean no income (Penderson & Favero 2020). Further, the PEW Research Center (2020) revealed that Black survey respondents are twice as likely to know someone who has been hospitalized or died from COVID-19. These disparities underscore the presence of institutional racism in existing public systems (e.g. housing, industrialization, healthcare, public education, employment patterns, among many others) and the failure of systemic public administration to address the race-based inequities that left communities vulnerable to heightened COVID-19 impacts. This article is protected by copyright. All rights reserved.

To explore the relationship between social vulnerability and the disparate impact of COVID-19, we focus our investigation on Cuyahoga County, Ohio and Wayne County, Michigan as each have the largest Black population in their respective state. Specifically, we explore the proposition that Black people are more likely to live in communities that are deemed socially vulnerable; therefore, more likely to be infected by or die from COVID-19. Our proposition is rooted in a history of social science research that considers that marginally situated people -specifically Black -are left in the most vulnerable communities without necessary resources to mobilize or shift circumstances. These communities have been stripped of its resources and are, often, in areas where residents are more likely to be exposed to environmental hazards (Wilson 2012; 2010; Mays, Cochran and Barnes 2007) . At the intersection of being in highly vulnerable communities, being exposed to environmental injustices, and racism, is a perfect storm with Black communities at the center of the COVID-19 pandemic (Gupta 2020;

Taylor 2020). Therefore, we consider the role racism has played in the creation of socially vulnerable communities and its implications for strengthening equitable public management and emergency relief approaches in local responses to COVID-19.

Nationally, the response to COVID-19 has been a patchwork of public officials updating their knowledge base and leveraging resources where possible. In both Ohio and Michigan, the governors reacted quickly with stay at home orders issued to take effect on the 22 nd and 23 rd of March, respectively. This universal approach was intended to slow the transmission of the virus, however, did not consider that businesses deemed essential are occupied by a, largely, Black labor force. Policy makers, alternatively, could have created an approach that acknowledged that laborers deemed essential were more vulnerable to infection and proceeded accordingly. This article is protected by copyright. All rights reserved.

In 2007, shortly after the signing of the Pandemic and All-Hazards Preparedness Act of 2006, the CDC created the Social Vulnerability Index based on U.S. Census data from 2000and is updated with both the Census and the American Community Survey. The SVI is a database and mapping tool designed to aid public health and disaster management officials with identify communities with higher vulnerabilities before, during, and after a disaster or emergency crisis (Flanagan et al. 2011) . Data used to determine the SVI are based on 15 variables across four individual and community measures: 1) socioeconomic status, 2) household composition and disability, 3) race, ethnicity, and language, and 4) housing and transportation. The SVI produces a score, on the scale from 0 to 1 (lowest to highest vulnerabilities), for each US county and census tract.

Considering the nascency of COVID-19, data consist of an amalgamation of several sources selected because they are up to date and verifiable. We compared the SVI of Wayne and Cuyahoga counties with their respective COVID-19 confirmed cases and deaths. We recognize there is limited demographic data on COVID-19, as the CDC, the federal government broadly, and states are not all sharing race specific data. Our findings are preliminary and simply show a relationship that requires further investigation when more robust data are made available.

For COVID-19 data, we use the State of Ohio's COVID-19 dashboard, the State of Michigan's Coronavirus data source, the CDC Data and Surveillance Site, John Hopkins Coronavirus Data Resource, AWS COVID-19 Data Lake for hospitalization, and Github. We focus on data that uses both laboratory confirmed cases and presumed cases; as well as, a true case fatality rate. For consistency, we also emphasize data that explores testing capacity because the information is integral to producing the most holistic evidence, even as we accept that all data at this time are incomplete. This article is protected by copyright. All rights reserved.

Other than the clear limitations for epidemiological and public health reasons, we know that no local, county, state or federal government entity has produced a uniform collection of race data in COVID-19 reporting (Wolfe 2020). The methods for racial transparency have been ad-hoc since the government was called out in early April for their failure to report racial demographics on people impacted by COVID-19. The government's formal reply was a report that suggested that -black populations might be disproportionately affected by COVID-19‖ (Garg 2020). This analysis does not suggest causality, but rather trends and trajectories in the available data.

The two counties were selected because they have similar compositions on racial, financial, and industrial histories. Both of these counties have embarked on a re-creation post Great Recession that hit the midwestern region hard -stifling their resilience. Cuyahoga County, is in the Northeastern part of Ohio and home to Cleveland. The SVI score for Cuyahoga County is 0.6552 indicating moderate to high levels of vulnerabilities. Wayne County is a densely populated area in Southeast Michigan that is known for its ties to the auto industry through Detroit. While it is home to multinational conglomerates, it is also one of Michigan's most vulnerable communities plagued with a SVI score of 0.8682 marking it a highly vulnerable community.

Beginning with vulnerability allows us to observe baseline susceptibility of a community to any disaster, we are then able to adapt that susceptibility to COVID-19. The SVI considers that vulnerable populations are more disadvantaged in disasters; therefore, gives more insight into just how vulnerable these populations are when considering the ways COVID-19 spreads.

Densely populated communities are impacted because people have less room to socially distance. SVI indicators are most informative as we consider the transmission of COVID-19. This article is protected by copyright. All rights reserved.

Seven of these indicators: 1) population over 65, 2) single parent households with children under 18, 3) household structures with more than 10 units, 4) more people than rooms, 5) no vehicle available, 6) percent population below poverty, and 7) percent minority population directly interact with vulnerable populations (i.e. age) as well as create difficulty in social distancing and shelter-in-place orders. Table 1 shows the social vulnerability indicators for the two counties. On the surface these communities are pretty similar for scales of presumed social vulnerability.

Thus, perhaps, both communities are almost equally as vulnerable to the virus.

[Insert Table 1 About Here]

These data do not show that either community is more exponentially vulnerable to the virus than the other, but that both have vulnerabilities. Wayne County has a higher population of underrepresented people by 10%. However, that 10% shift does not account for the differential in infections and deaths due to COVID-19 that separates these communities (see Table 2 ). Wayne County has eight times the number of total infections and sixteen times the number of deaths as Cuyahoga County. Both of these communities are vulnerable, but only one, Wayne County, has 2213 deaths because of COVID-19, of which 1255 are in Detroit.

[Insert Table 2 About Here]

In addition to social vulnerability, we examined the hospitalization and hospital capacity in these communities. Hospitalization rate was considered because the CDC indicated that hospital capacity was going to be the factor that crippled the healthcare system (Garg 2020; This article is protected by copyright. All rights reserved.

it relates to this goal sets a baseline metric for COVID infection and death rates. Having this baseline allows administrators to closely examine the gaps in infection and death rates specific to vulnerable groups. This baseline, while not an overall measure to evaluate the success of an implemented strategy, offers insight into the severity of the problem being addressed. Having this information makes it easier for administrators to, third, identify populations whose measures are below the baseline metric. Collecting and examining race-based data -in a uniform, institutionalized, and systemic manner -allows for the identification of existing COVID-19 inequities as they relate to individuals living in socially vulnerable communities. Data highlighting racial inequity helps administrators, fourth, understand how existing structures advance or limit vulnerable populations from achieving the universal goal. Having a clear understanding of the communities that are more socially vulnerable and the policies and practices that have, over time, allowed these communities to remain and/or grow in this vulnerability enables decisions to be made in such a way that considers and perhaps addresses the structural and systemic barriers that have exacerbated COVID's impact on Black people.

Lastly, the development and implementation of targeted strategies that aid the collective in meeting the universal goal is required. This may include, but is certainly not limited to: extending stay at home orders allowing frontline workers to remain at home with pay, decreasing their chances of viral exposure; strengthening the quality of healthcare systems in socially vulnerable communities; and developing equitable and accessible transportation systems that ease one's ability to access quality healthcare providers.

Preliminary data reveal that Black life is extremely susceptible to the impacts of the COVID-19 pandemic (Deslatte, Hatch and Stokan 2020). Racism, for Black people, under the conditions of COVID-19 operates as a comorbidity (Austin 2020). In a just society, race would

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Burials On New York Island Are Not New, But Are Increasing During Pandemic.‖ NPR.Org

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Public Data Lake for Analysis of COVID-19 Data.‖ Amazon Web Services (blog)

Opinion | Social Distancing Is a Privilege.‖ The New York Times

Assessment of Social, Economic, and Geographic Vulnerability Pre-and Post-Hurricane Harvey in Houston

Ethnic Differences of the Presence and Severity of Coronary Atherosclerosis