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January 19, 2021

Despite COVID-19’s Toll on People of Color, Many Don’t View Racism as a Factor in Health Outcomes

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2021;2(1):e210036. doi:10.1001/jamahealthforum.2021.0036

Although racial and ethnic minority groups have been disproportionately affected by coronavirus disease 2019 (COVID-19), fewer than half of US adults view racism as playing a role in health outcomes among people of color, according to findings from a new survey from the RAND Corporation, funded by the Robert Wood Johnson Foundation.

The findings are from an ongoing national study of attitudes, views, and values around health equity and race in the time of the COVID-19 pandemic among individuals with lower or middle incomes, with a particular focus on communities of color. The current survey is the second of a series of 4 planned over the course of a year.

“It really struck us that—despite the virus’s spread across the country to all types of communities—there’s not a consensus view on the effects of systemic racism. Respondents see the impact of low incomes and living in a rural community on a person’s health, but race isn’t viewed with the same gravity,” Katherine Grace Carman, PhD, senior economist at RAND Corporation and the lead author of the report, said in a statement from RAND.

Questions from RAND’s COVID-19 and the Experiences of Populations at Risk survey focused on respondents’ experiences related to the pandemic; how they perceived the disproportionate effects of COVID-19 on different groups; whether their views about health actions and investments are changing, including the role of the government vs the private sector; and how values about freedom, racism, and other issues may be related to their views on the pandemic and expectations about responses. The researchers invited a sample of 7010 individuals to participate in this survey, and 4066 (58.0%) completed the first survey (fielded from June 29 through July 22, 2020); of those 4066, 3098 (76.2%) completed the second survey (fielded from October 9 through November 2, 2020).

Views of the link between race and health remained largely unchanged between the first and second surveys despite the well-recognized disproportionate effect of the COVID-19 pandemic on people of color. Only 42% of those surveyed said they believe that systemic racism contributes to poorer health outcomes—such as higher rates of diabetes and COVID-19 deaths—among people of color compared with White people. About one-third disagreed, and about a quarter were neutral.

Black respondents were much more likely (69.4%) than White respondents (33.2%) to say that systemic racism affects the health of people of color, according to a RAND summary of key findings.

The researchers found a slight increase since last summer (from 20.8% to 24.6%) in whether those surveyed were willing to risk their own health to return to prepandemic “normal life.” However, Black and Hispanic respondents were likelier (68.5%) to have more cautious views about taking health risks to move about freely compared with White respondents (53.4%).

A substantial proportion of respondents—more than 70% overall—said they agreed with the idea that “the coronavirus outbreak can be an opportunity for our society to make positive changes,” with Black and Hispanic respondents slightly more likely (72.5%) than White respondents (69.3%) to hold this optimistic view. More than one-third (36.9%) of respondents said they believed improved access to health care is the most important priority for positive change, followed by 15% of respondents who viewed reducing income inequality as the highest priority.

Nearly two-thirds of respondents overall agreed with the statement that “It is the obligation of the government to ensure that everyone has access to health care as a fundamental right.” White respondents were less likely (60.4%) than respondents of all other races or ethnicities (74.1%) to endorse this view, the researchers noted.

More than two-thirds (68%) of Black respondents reported lower trust in government compared with 53.6% of Hispanic and 52.4% of White respondents.

“Our leaders need to understand that we have a lot more work to do to educate people about the root causes of inequities and then enact policies to ensure better health for all,” said Carman.

Results from the third survey will be released in the spring. Release of findings from the fourth and final survey is planned for this summer.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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