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Stop blaming COVID-19 deaths on diabetes

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Stop blaming COVID-19 deaths on diabetes


Dr. Anthony Fauci has a clear message about why Black, Indigenous and Latino communities are suffering from COVID-19 more than other communities. The director of the National Institute of Allergy and Infectious Diseases calls it a “double whammy”: the combination of holding essential jobs and having high rates of comorbidities like diabetes. The first increases one’s chance of exposure to the virus, and the second increases one’s likelihood of developing complications and dying. This is an important message, but it comes with the risk of inadvertently holding people of color responsible for high rates of COVID-19.

Fauci recognizes that diseases like diabetes and hypertension stem from long-term social determinants of health, but less sophisticated observers sometimes blame them on people’s bad choices, whether eating too much of the wrong foods or exercising too little. Attributing high rates of COVID-19 to high rates of comorbidities opens the door to blaming people for being sick.

A history of blame and racism

History provides ample evidence of health disparities being blamed on specific and allegedly racial traits while ignoring the role of structural racism. As a historian of medicine who has spent the last 15 years reading and writing about the history of diabetes, I know that this has occurred even as the populations labeled most at risk of developing diabetes changed radically over time.

In the early 20th century, Jews were believed to have the highest rate of diabetes of any population in the United States. Medical writers, who often referred to diabetes as the Judenkrankheit – or Jewish disease – blamed it on the population’s “neurotic temperament” and love of “high living.” Few took into consideration the poverty, stress and feelings of dislocation recent Jewish immigrants experienced after fleeing European pogroms.

In the 1960s, when Native peoples were alleged to have some of the highest rates of diabetes in the world, the preferred explanation shifted to “thrifty genes.” According to this theory, Native peoples possessed a trait that had served early humans well by allowing them to store fat efficiently during periods of feast and thus survive periods of famine. But what had previously conferred an evolutionary advantage became a liability once calorie-rich foods became a steady part of the diet of Native peoples. Activists countered that white colonialists’ destruction of Native lands, lives and livelihoods had played the more important role in driving up diabetes rates. Unfortunately, the experts explaining the conditions that actually promoted the disease struggled to be heard.

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And in the 1980s, when the populations deemed most at risk of developing diabetes included – in addition to Native Americans – African Americans, Hispanic Americans and Asian Americans, a mélange of racial narratives emerged. In Black communities high rates of diabetes were blamed on bad lifestyle choices; among Native Americans on thrifty genes; among Mexican Americans on Native American ancestry; and among Japanese Americans on residual “psychosocial stress” attributed to years of confinement in internment camps.

Two competing narratives

Today, once again, we are watching two competing COVID-19 narratives begin to take hold. One explains high rates of the virus in communities of color by highlighting the tight connection between structural racism and poor health. It acknowledges the role of high unemployment rates, limited access to quality health care, inadequate housing, unreliable modes of public transportation, food insecurity and more. It recognizes that structural racism has a direct impact on bodies, producing high levels of chronic stress that then negatively affect the immune system’s ability to stave off infection and inflammation. In short, it insists that racism, not race, is a fundamental cause of ill health.

The other familiar and false narrative attributes disparities in COVID-19 infections and deaths to genetic differences or to high rates of comorbidities. As the history of diabetes shows us, this path continues to blame disease on the bodies and behaviors of particular racial groups rather than on the discriminatory policies and practices that are baked into the structures of everyday life.

High mortality rates from COVID-19 are not caused by high rates of diabetes and hypertension. They all stem from the same racial inequities that have plagued this country since European colonists wrought havoc upon Indigenous peoples and enslaved African peoples. If we can accept this truth, perhaps we will find the political will to tackle the structural racism that is the true reason health disparities exist.

Arleen Tuchman, Ph.D., is the Nelson O. Tyrone Jr. Chair in History and Affiliated Faculty in the Center for Medicine, Health and Society at Vanderbilt University .  

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