Race Isn’t a “Risk Factor”
Stop deciding which patients can get access to Covid medicine based on the color of their skin.
As the country continues to battle a surge of COVID-19 cases, many authorities are turning to new antiviral treatments, which can aid people diagnosed with the virus who are at high risk of falling seriously ill.
The problem is, there’s a shortage of these medicines, forcing governments to ration them. Authorities are understandably trying to direct their limited supply of these life-saving treatments to those who need them most.
But in New York, those authorities have decided that the color of one’s skin is one way to define that need. The New York State Department of Health recently released a memorandum authorizing oral antiviral treatment for patients who meet five criteria. One of these is for someone to have “a medical condition or other factors that increase their risk for severe illness,” and the memorandum specifies that being of “Non-white race or Hispanic/Latino ethnicity” qualifies. Their justification for listing race and ethnicity is “longstanding systemic health and social inequities that have contributed to an increased risk of severe illness and death from COVID-19.”
New York isn’t the first governing authority to try to use race as a proxy for need when it comes to battling COVID-19. Earlier this year, Vermont, one of the whitest states in the country, opened up vaccine eligibility to racial minorities before white people (though it’s important to note that the state did authorize the vaccines for people over 50 and the immunocompromised first).
The problem with using race as an approximation for need is that there isn’t any evidence that race itself has any impact on COVID-19 severity. The virus doesn’t care about the color of one’s skin.
Proponents of these racial interventions would argue that race works as a proxy for factors that do make someone more vulnerable to severe illness. It’s true, for instance, that the obesity rate in America among African Americans and Hispanics is significantly higher than the rate among whites. But what makes someone more vulnerable to COVID-19 is not their race, but their obesity, which, as the CDC notes, impairs the immune system and decreases lung capacity. There’s no reason to use race to roughly approximate the presence of causal factors like obesity rather than just using those factors themselves.
Consider another example: years of data collection have shown that the white suicide rate is several times higher than the African American and Latino suicide rates. Would it, therefore, make sense to target suicide prevention treatment at whites because being white must be a risk factor for suicide? It would not, because race isn’t what causes suicide.
With both suicide and COVID-19, health officials would be better off targeting factors that directly cause suicide and severe illness instead of using race as a rough proxy for them. For suicide, those targets might be depression, drug use or mental illness. For COVID-19, the targets would include age, preexisting illnesses, and obesity.
Some would argue that even if we take into account all of these causal factors, we won’t be able to capture everything that race purports to capture. But for all the factors that the category of race appears to represent, it is often misleading. The New York memo, for instance, prioritizes those who belong to a “non-white race or Hispanic/Latino ethnicity,” and yet Asian Americans have as a whole fared significantly better than other groups, including white Americans. This is probably due to the average Asian American health profile—the group has the lowest rates of obesity by far. The causal factors are simply more precise.
Unfortunately, distributing COVID-19 treatments according to race carries multiple risks. For one, it would present a scenario where I—a young, healthy, vaccinated person—would be prioritized for treatment over a white person who is older, not as healthy, and unvaccinated, even though they are at far greater risk of serious illness. This moral problem is present anytime we make policy based on broad racial generalizations or profiling: some people in urgent need of help will be denied it, and those who aren’t will be offered it.
But there’s also a larger political and social problem presented by the way governing authorities, usually progressives, insist on legitimizing certain forms of racial discrimination through the distribution of scarce government resources.
Research has long shown that racial division is one of the reasons it’s difficult to build public support for wealth redistribution in America. One recent study found that non-black participants in an experiment were more likely to associate poverty with African Americans than whites. The team also found that this association helps predict opposition towards economic redistribution, likely because people think that redistribution would benefit African Americans more than non-African Americans.
Similarly, the perception that our social welfare programs benefit minorities at the expense of non-minorities has for years undermined support for, among other policies, universal health care, which almost every rich country except for the United States has attained. While it’s regrettable that people oppose policies simply because they think beneficiaries will be of a different race, progressives need to remain practical if we want to see substantial policy achievements.
Just imagine the resentment that someone might have if a loved one was denied life-saving treatment because they had the wrong skin color and died as a result. Furthermore, imagine the backlash that would come once the reason for these deaths becomes public and makes its way through the media. Should we really be pursuing policies in the middle of a historic pandemic that would further divide Americans and risk pushing white Americans to the right? The answer, both morally and practically, is no.
The progressive dream has always been to build a society where everyone can meet their basic needs. By continuing to cling to the social fiction of race and mistaking correlation for causation, those pushing race-sensitive policies could undermine the social solidarity needed to win the social and economic rights we’ve long been denied.
Zaid Jilani is a frequent contributor to Persuasion. He maintains his own newsletter where he writes about current affairs at inquiremore.com.
It's like Democrats are trying to get their asses handed to them in the midterms.
Another fine piece, Zaid. Poor and working-class whites are, or should be, the natural allies of people of color. But progressives, well-meaning progressives, often come up with ideas that almost immediately pit the two groups against each other. Is this just rich white liberal guilt? Are the people who make these kinds of decisions oblivious to the trend among working class white voters? Which is rightward? It is, as you point out, not only immoral but really dumb from a political perspective, to give Covid medicines or treatments based on skin color. Maybe, in addition to the criteria you cite, income level would be another way to distribute these medications. It's true that there is a much higher level of poverty among African Americans than whites, but there are plenty of poor white people, and blanket policies like the one you criticize here fail to take into account that poor white people and poor black people have a lot in common--including poor health. Pitting them against each other--which benefits some politicians--is a trap progressives should avoid. Thank you for this.