Inequity in Massachusetts: COVID-19 in the Bay State


COVID-19 is affecting Bay Staters unequally. Here's how.

People socially distance in line at a Massachusetts grocery store
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Shoppers socially distance themselves at a Massachusetts grocery store

In recent weeks, Massachusetts has emerged as a major center of COVID-19 infections in the United States. The state has more confirmed cases — more than 46,000 — than any state but New Jersey and New York. At least 4,360 people in the state have died of the virus, though analyses suggest the true number is far higher.

Gov. Charlie Baker has closed the doors of schools and non-essential businesses, and issued guidance encouraging residents to stay at home as much as possible. However, while the rules apply to everyone, it increasingly seems that the outcomes are not so evenly distributed: Early data and an abundance of anecdotal evidence suggest that low-income populations and people of color are feeling the impacts of the coronavirus at rates far higher than average.

“We’re seeing horrifyingly disproportionate impacts of COVID-19,” said Elizabeth Henry, president of the Environmental League of Massachusetts.

Race and ethnicity data have been released for about 2,700 of the patients that have been hospitalized for COVID-19 in the state. Of that group, slightly less than half have been identified as black, Asian, Hispanic, or a member of another minority group. Yet in Massachusetts as a whole, just 22% of residents identify as something other than white, according to census data.

Minority groups, it seems, are significantly over-represented among the sickest patients.

“That is a pretty big concern that frankly the governor should be talking about every day,” said Maddie Ribble, director of public policy for the Massachusetts Public Health Association.

How did this situation come to be?

First, low-income populations and people of color are statistically more likely to have underlying conditions such as diabetes, high blood pressure, and obesity that worsen a COVID-19 infection. They are also more likely to live in areas with high levels of air pollution; Boston’s Chinatown sits at the intersection of two interstate highways, for example, and the city of Chelsea, which has the highest infection rate in the state, is bisected by major commuter road Route 1. And a recent study from Harvard University concluded that living in high-pollution areas can increase the risk of death from COVID-19.

At the same time, members of these groups often live and work in conditions that make them more likely to contract the virus. They are more likely to live in densely populated areas, where by-the-book social distancing is difficult to achieve. And they might work as supermarket cashiers, home health aides, or hospital cleaning staff, deemed essential and coming in contact with potential virus carriers each time they go to work.

“It is pretty clear that low-income people and people of color are more likely to work in front-line jobs where they cannot work from home like white collar office workers,” Ribble said.  “They are exposed to hazards daily.”

Furthermore, there are obstacles preventing some of the most vulnerable populations from seeking medical help. Immigrants may have language barriers preventing them from understanding available resources. Undocumented immigrants, in particular, may worry about possible legal repercussions to seeking assistance. 

The governor and the state attorney general have both been working to address some of the most urgent situations caused by these inequities. Testing sites have been opened specifically for first responders, health care workers, and grocery store employees. Unemployment applications and text alerts have been made available in Spanish.

Attorney General Maura Healey has collaborated with local businesses to launch a website where healthcare workers and first responders can find information about personal protective equipment, safe housing, access to testing, and emergency child care. Healey has also made information about workers' rights, immigrant rights, and public health resources available in several languages.

Advocates, however, agree that more must be done.

“We think the governor is working really hard to address the situation, but we really do want to see more attention and more urgency to those issues,” Ribble said.

To begin with, more information needs to be collected and made public, he said. Race and ethnicity data is available for fewer than half the confirmed COVID-19 cases and deaths, and no details about income level, language, or occupation have yet been released. If efforts to address the disproportionate impacts of the pandemic are to be made, more details about those effects are needed, Ribble said.

“We need to talk about the data honestly and make a commitment to act on it,” he said.

In the short-term, it is imperative that families in need continue to have access to food assistance, said Catherine Drennan, director of public affairs at the Greater Boston Food Bank. The economic downturn that has accompanied the pandemic has driven record demand at the state’s food pantries, she said: Demand has surged more than 50% and, in March, the food bank distributed more than 8 million pounds of food, the highest one-month total in its history.

At the same time, however, the federal government is pushing ahead with its plans to make it harder to receive benefits from the Supplemental Nutrition Assistance Program (often referred to as SNAP or “food stamps”). Healey and 22 other attorneys general nationwide are asking the government to suspend these plans, a move Drennan says is essential.

“SNAP was designed to expand and retract based on the economic situation,” Drennan said. “This is a time when we need to expand it and we need to break down those barriers to access it.”

Furthermore, the state should be looking for ways to provide targeted cash assistance to families taking a financial hit right now, said Phineas Baxandall, senior policy analyst at the Massachusetts Budget and Policy Center. Though the federal government is providing “recovery rebates” to most households, 57,000 residents are ineligible because they live in a home with someone who does not have a social security number, often because they are immigrants. In addition, people over 16 who are claimed as dependants are also ineligible for any money. The state could provide cash to those families that are left out of the federal program, Baxandall suggested.

Providing cash assistance to families in need has often been an unpopular strategy because some people worry this kind of benefit will reduce the incentive to work or the recipients will spend their money unwisely. The coronavirus crisis, however, may have helped reshape some of this received wisdom, Baxandall said.

While this crisis has made people isolate and separate spatially, it has also shown us how much we are connected to each other and share a common fate,” said Phineas Baxandall. “There’s nothing like infectious disease to show how we are all in this together.”

Additionally, as the state emerges from the pandemic it must do more to address the fact that transportation pollution — and the health problems it can cause — is higher in low-income and minority neighborhoods, Henry said. Investing federal recovery money and state funding to switch to electric public transit vehicles, build out electric vehicle charging options, and improve bicycle and pedestrian infrastructure can both drive job creation and help improve health outcomes, she said.

“It’s really clear that cleaning up the transportation sector once and for all has to be a part of how we recover,” Henry said. “It behooves as all to be thinking through COVID-19 and what we want the world to look like on the back-end so we’re not just re-building the status quo.”