Abstract
The chapter begins by characterizing the COVID-19 disparities affecting BIPOC populations and summarizing research putting these disparities in historical context. It then presents a model explaining why these disparities arise. This background information grounds a discussion of why these disparities constitute inequities, and what justice requires in these circumstances. The analysis focuses primarily on obligations during pandemic but acknowledges that obligations do not end when pandemic does. It considers alternative conceptions of justice, focusing on questions about whether it is permissible to take race and ethnicity into account in pandemic response initiatives.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Agency for Healthcare Research and Quality. 2020. 2019 National Healthcare Quality and Disparities Report, December.
Arias, Elizabeth, Betzaida Tejada-Vera, Farida Ahmad, and Kenneth D. Kochanek. 2021. Provisional Life Expectancy Estimates for 2020. Vital Statistics Rapid Release report no. 015. https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf.
Biden, Joseph R., Jr, 2021. Executive Order on Strengthening Medicaid and the Affordable Care Act. January 28. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/.
Blumenshine, Philip, Arthur Reingold, Susan Egerter, Robin Mockenhaupt, Paula Braveman, and James Marks. 2008. Pandemic Influenza Planning in the United States from a Health Disparities Perspective. Emerging Infectious Diseases 14 (5): 709–715.
Braveman¸ Paula A. 2012. Health Inequalities by Class and Race in the US: What Can We Learn from the Patterns? Social Science and Medicine 54 (5): 665–667.
Braveman, Paula A., Shiriki Kumanyika, Jonathan Fielding, Thomas LaVeist, Luisa N. Borrell, Ron Manderscheid, and Adewale Troutman. 2011. Health Disparities and Health Equity: The Issue is Justice. American Journal of Public Health 101 (Suppl. 1): S150.
Brown, Steven. 2020. The COVID-19 Crisis Continues to Have Uneven Economic Impact by Race and Ethnicity. Urban Wire: The Blog of the Urban Institute, July 1. https://www.urban.org/urban-wire/covid-19-crisis-continues-have-uneven-economic-impact-race-and-ethnicity.
Bruce, Lori, and Ruth Tallman. 2021. Promoting Racial Equity in COVID-19 Resource Allocation. Journal of Medical Ethics 47: 208–212.
Cheng, Vincent C.C., Susanna K.P. Lau, Patrick C.Y. Woo, and Kwok Yung Yuen. 2007. Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection. Clinical Microbiology Reviews 20 (4): 683.
DeBruin, Debra A. 2021. Speed Should Not Overrun Ethics in Vaccine Rollout. Star Tribune, January 29. https://www.startribune.com/editorial-counterpoint-speed-should-not-overrun-ethics-in-vaccine-rollout/600016774/?refresh=true.
DeBruin, Debra A., and Jonathon P. Leider. 2020. COVID-19: The Shift from Clinical to Public Health Ethics. Journal of Public Health Management and Practice 26 (4): 306.
DeBruin, Debra A., Mary Faith Marshall, Elizabeth Parilla, Joan Liaschenko, J.P. Leider, Donald J. Brunnquell, J. Eline Garrett, and Dorothy E. Vawter. 2010. Implementing Ethical Frameworks for Rationing Scarce Health Resources in Minnesota During Severe Influenza Pandemic, 38. https://www.health.state.mn.us/communities/ep/surge/crisis/implement.pdf.
DeBruin, Debra A., Joan Liaschenko, and Mary Faith Marshall. 2012. Social Justice in Pandemic Preparedness. American Journal of Public Health 102: 586–591.
Franco-Paredes, Carlos, Nazgol Ghandnoosh, Hassan Latif, Martin Krsak, Andres F. Henao-Martinez, Megan Robins, Lilian Vargas Barahona, and Eric M. Poeschla. 2021. Decarceration and Community Re-entry in the COVID-19 Era. The Lancet Infectious Diseases 21: e12.
Gostin, Lawrence O. 2007. Why Should We Care About Social Justice? Hastings Center Report 37 (4): 3.
Heslin, Kevin C., and Jeffrey E. Hall. 2021. Sexual Orientation Disparities in Risk Factors for Adverse COVID-19-Related Outcomes, by Race/Ethnicity—Behavioral Risk Factor Surveillance System, United States, 2017–2019. Morbidity and Mortality Weekly Report (MMWR) 70 (5) (February 5): 149–154. https://www.cdc.gov/mmwr/volumes/70/wr/mm7005a1.htm.
Hodge, James G., Jr., Dan Hanfling, John L. Hick, and Jennifer L. Piatt. 2021. Diminishing Disparities in U.S. Crisis Standards of Care: Medical and Legal Challenges. EClinicalMedicine—The Lancet 34: 3.
Holt-Lunstad, Julianne, 2020. The Double Pandemic of Social Isolation And COVID-19: Cross-Sector Policy Must Address Both. Health Affairs Blog, June 22. https://www.healthaffairs.org/do/10.1377/hblog20200609.53823#:~:text=Immediate%20effects%20of%20social%20isolation,emotional%20or%20overeating%2C%20may%20increase.
Hutchins, Sonja S., Kevin Fiscella, Robert S. Levine, Danielle C. Ompad, and Marian McDonald. 2009. Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic. American Journal of Public Health 99 (S2): S261–S270.
Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, vol. 1. Washington, DC: The National Academies Press.
Kinlaw, Kathy, Drue H. Barrett and Robert J. Levine. 2009. Ethical Guidelines in Pandemic Influenza: Recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Medicine and Public Health Preparedness 3 (Suppl. 2): S185–S192.
Leider, J.P., Debra DeBruin, Nicole Reynolds, Angelica Koch, and Judy Seaburg. 2017. Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review. American Journal of Public Health 107 (9): e1–e9.
Maness, Sarah B., Laura Merrell, Erika L. Thompson, Stacey B. Griner, Nolan Kline, and Christopher Wheldon. 2021. Social Determinants of Health and Health Disparities: COVID-19 Exposures and Mortality Among African American People in the United States. Public Health Reports 136 (1): 18.
Michaels, David, and Gregory R. Wagner. 2020. Occupational Safety and Health Administration (OSHA) and Worker Safety During the COVID-19 Pandemic. Journal of the American Medical Association 324 (14): 1389–1390.
Miller, Sarah, Laura R. Wherry, and Bhashkar Mazumder. 2021. Estimated Mortality Increases During the COVID-19 Pandemic by Socioeconomic Status, Race and Ethnicity. Health Affairs 40 (8): 5.
Mueller, Amber L., Maeve S. McNamara, and David A. Sinclair. 2020. Why Does COVID-19 Disproportionately Affect Older People? Aging 12 (10): 9959–9981.
Nalbandian, Ani, Kartik Sehgal, Aakriti Gupta, et al. 2021. Post-acute COVID-19 Syndrome. Nature Medicine 27: 601–615.
Persad, Govind. 2021. Allocating Medicine Fairly in an Unfair Pandemic. University of Illinois Law Review 2021 (3): 1085–1134.
Quinn, Sandra Crouse, Supriya Kumar, Vicki S. Freimuth, Donald Musa, Nestor Casteneda-Angarita, and Kelley Kidwell. 2011. Racial Disparities in Exposure, Susceptibility, and Access to Health Care in the US H1N1 Influenza Pandemic. American Journal of Public Health 101 (2): 285–293.
Schmidt, Harald, Lawrence O. Gostin, and Michelle A Williams. 2020. Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines? Journal of the American Medical Association 324 (20): 2023–2024.
Schmidt, Harald, Dorothy E. Roberts, and Nwamaka D. Eneanya. 2021. Rationing, Racism and Justice: Advancing the Debate Around ‘Colourblind’ COVID-19 Ventilator Allocation. Journal of Medical Ethics 48 (21): 126–130.
Sederstrom, Nneka, and Jada Wiggleton-Little. 2021. Acknowledging the Burdens of ‘Blackness’. HEC Forum 33: 19–33.
Singu, Sravani, Arpan Acharya, Kishore Challagundla, and Siddappa N. Byrareddy. 2020. Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States. Frontiers in Public Health 8: article 406.
Taubenberger, Jeffery K., David M. Morens, and Anthony S. Fauci. 2007. The Next Influenza Pandemic: Can It Be Predicted? Journal of the American Medical Association 297 (18): 2025.
Valles, Sean A. 2020. The Predictable Inequities of COVID-19 in the US: Fundamental Causes and Broken Institutions. Kennedy Institute of Ethics Journal 30 (3–4): 191–214.
Van Spall, Harriette G.C., Clyde W. Yancy, and Keith C. Ferdinand. COVID-19 and Katrina: Recalcitrant Racial Disparities. European Heart Journal 41 (36) (September 21): 3390–3393.
Will, George. 2021. Pursuing Equity Over Equality Reveals the Nation's Moral Regression. The Washington Post, July 30. https://www.washingtonpost.com/opinions/2021/07/30/pursuing-equity-over-equalityreveals-nations-moral-regression/.
Wrigley-Field, Elizabeth. 2020. US Racial Inequality May Be as Deadly as COVID-19. PNAS (Proceedings of the National Academy of Sciences of the United States of America) 117 (36): 21854–21856.
Wrigley-Field, Elizabeth, Mathew V. Kiang, Alicia R. Riley, Magali Barbieri, Yea-Hung Chen, Kate A. Duchowny, Ellicott C. Matthay, David Van Riper, Kirrthana Jegathesan, Kirsten Bibbins-Domingo, and Jonathon P. Leider. 2021. Geographically-Targeted COVID-19 Vaccination Is More Equitable and Averts More Deaths Than Age-based Thresholds Alone. Science Advances 7 (40): eabj2099. https://doi.org/10.1126/sciadv.abj2099.
Acknowledgment
I would like to thank the members of the Minnesota COVID Ethics Collaborative for rich discussions of equity matters in COVID-19 response over the course of this pandemic. I would like to especially acknowledge JP Leider, PhD, for conversations about these issues (and many others in the ethics of disaster response) over the course of several years. While I certainly benefitted from their thoughtful engagement, my views in this chapter are my own. These colleagues have not reviewed or endorsed the analysis I provide in this chapter, and all of the errors herein are mine.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
DeBruin, D.A. (2022). Addressing Pandemic Disparities: Equity and Neutral Conceptions of Justice. In: Boylan, M. (eds) Ethical Public Health Policy Within Pandemics. The International Library of Bioethics, vol 95. Springer, Cham. https://doi.org/10.1007/978-3-030-99692-5_10
Download citation
DOI: https://doi.org/10.1007/978-3-030-99692-5_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-99691-8
Online ISBN: 978-3-030-99692-5
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)