By Eliza Ossolinski
The shocking, life-altering consequences of COVID-19 are a novelty to some; the feelings of confusion, anger, and panic related to a global health scare are brand-new and intimidating to certain groups. While no pandemic is ideal, having never experienced these conditions before is a luxury. To be astonished by a seemingly apathetic government and the quasi-apocalyptic lack of healthcare, information, and supplies is a nod to one’s privilege. Fear and uncertainty reside within everyone these days, and public figures proclaim messages of “coming together,” “one world,” and the like. However, one part of a pandemic that is not universal, and never will be, is the racism, xenophobia, and bigotry that tags along. Minority populations that are disproportionately affected during public health scares are ostracized and demonized. The racist and xenophobic histories of the United States and Canada prove that the current discrimination against Chinese and Asian Americans during COVID-19 could be considered routine behavior.
The HIV/AIDS epidemic that struck the United States in the 1980’s is a perfect example of institutionalized discrimination that spread into the attitudes of general society. Even before the start of the epidemic, LGBTQ+ citizens had to protest to be recognized in government and healthcare initiatives – consider the riots at Stonewall. The Reagan administration was notoriously conservative and against “big government,” which led to not only budget cuts to the NIH and CDC, further blocking the ill from healthcare access, but a discriminatory attitude towards the LGBTQ+ population. Tasleem Padamsee, PhD, a sociologist specializing in public health, writes, “The social conservatives who helped elect [Reagan] recoiled from a disease publicly associated with gay men… the administration blocked congressional appropriations for AIDS-related programs and impeded the CDC’s attempts to mount prevention campaigns.” The US government did not take official action to raise awareness for the epidemic until 1987, whereas most developed countries had done so at least one year before. At the start of this epidemic (the most vital time for successful intervention and prevention), those who had fallen ill and already had limited healthcare were cut off even more. This epidemic highlighted the government’s lack of care for MSM, or men who have sex with men.
As all public health crises in the United States go, those who are of lower socioeconomic status are disproportionately affected. As HIV/AIDS mostly affected MSM, the limited research and care was mostly provided to white, upper-class men. MSM of racial minorities and women living with HIV were often overlooked. Padamsee writes:
Women were considered only as HIV vectors or ‘pass-throughs’ and blamed for the infection of men and children. Prostitutes were a particular focus of blame, despite the distinct lack of evidence that prostitution had much to do with the spread of HIV in Western nations. Infected mothers in ‘AIDS Baby’ cases likewise received condemnation but little policy help. (Padamsee)
This lack of healthcare and education led to increased infection and death and continued cyclically. Likewise, social ostracization increased: the isolating effects of this illness created such great stigma that the affected would often not seek healthcare. This implicit and explicit bias still exists to this day: Donald Trump’s 2019 Ending the HIV Epidemic: A Plan for America fails to address and rectify the effect of implicit bias and discrimination on healthcare access. A report from the American Journal of Public Health states:
Black and Latino/a persons, especially men who have sex with men (MSM) and transgender individuals, disproportionately experience health care services that are of lower quality, are more expensive, have limited availability because of limited access to Medicaid or no Medicaid expansion, lack cultural responsiveness … and fail to provide population-focused health services. (Andrasik)
Even forty years after the peak of the epidemic, the United States government still refuses to provide adequate healthcare for minorities with HIV, subsequently increasing infection rates and social stigma.
The opioid epidemic in the United States follows a similar pattern within healthcare accessibility/quality and societal regard that is disproportionately negative towards minority populations. Although it is no secret that addiction is a stigmatized disease within American society, it is apparent that this discrimination varies incredibly between different racial groups. From Nixon’s War on Drugs to current mass incarceration of black people for nonviolent drug-related offenses, the disparity between drug stigmas by race has been relevant for decades. The opioid crisis, which has gained attention in the public eye for the past few years, is a great case study of racial bias within healthcare and society. The use of buprenorphine, an opioid, has recently been introduced as a method of recovery from opioid addiction. BMT, or buprenorphine maintenance therapy, was approved by the FDA in 2002 and is now a widely used treatment method. However, like all healthcare services, those of lower socioeconomic status (who are disproportionately racial minorities), have less access to this type of care. Patients who are treated in primary care settings, who are majority white, are often more easily able to hide their addiction and treatment, whereas patients in an outpatient setting are not able to do so, exposing them to much greater chance of discrimination. A study published in 2018 noted these differences, stating “that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment,” along with “by funding and regulating services differentially so that some populations have access to primary care based BMT and others do not, cities, states and the Federal government codify who is deserving of qualified services and who deserves only the bare minimum” (Hatcher). The societal perception between white and nonwhite patients perfectly mirrors the great irony within the War on Drugs: cocaine is glamorous, but crack is criminal.
An essential lesson within the human experience is that history repeats itself. Yet, sometimes repetitions occur so quickly that the initial incident can hardly be considered history. The xenophobia against Chinese Americans and Asian Americans during COVID-19 is almost a carbon copy of the results of the 2003 SARS (Severe Acute Respiratory Syndrome) in Toronto. In February of 2003, a Canadian woman who had been traveling in Hong Kong became infected with the virus. She returned home and subsequently spread the virus to family members. While receiving medical treatment, the virus spread throughout the hospital, and the number of affected people increased exponentially. A modern method for avoiding social and public health disruption during an outbreak is the use of statistical population analysis to divide the public into groups. Author Harris Ali credits this “medical surveillance” technique to Europe in the 18th century during the outbreak of leprosy. He describes the separation of groups as measures “used to define the notions of ‘normality’ and ‘pathology’ as applied to groups within the population.” Ali clarifies the definition of medical/health surveillance, stating “health surveillance involves the tracking of health events or health determinants through the continuous collection of data. Once the data are collected, they are analyzed and interpreted, with the results being used to make decisions about issuing advisories, alerts, or warnings.” Of course, the separation of the “normal” and “pathological” leads to the stigmatization of the affected group.
The separation and subsequent discrimination of a group of people is a multi-step process. Ali references the work of Link and Phelan, describing the five characteristics of stigmatization. They are as follows: marks, cultural stereotyping, “us-them” separation, status loss/discrimination, and the power differential. Firstly, the “pathological” are “marked” by the normal; there is a clear and complete separation between the healthy and the ill. Cultural stereotyping adds in racism to the “marks,” wherein characteristics of the disease are associated with the racial group affected, subsequently suggesting the infection occurred as a result of the undesirable cultural aspect. Next, empathy dissolves, and any sense of unity is replaced with the “us-them” attitude. As a result of the building stigma, the affected begin to lose any clout they had in the first place; this results in further lowering socioeconomic status. Lastly, the power differential comes into play, and the affected have officially become less powerful than the “normal.” This makes lots of sense with both the SARS and COVID-19 outbreak (and most other outbreaks as well); racial minority groups, who are already disproportionately affected by crises, are even further stigmatized. Because both the SARS and COVID-19 outbreaks were spread from China to white North American countries, the physical appearance of being Chinese (or East Asian in general) was/is an automatic “mark,” no matter the actual health status of the individual. SARS brought forward a xenophobic, anti-globalist attitude in Toronto, which many researchers suspect was always present but underlying. For example, Ali describes how an earlier instance of migration was completely blown up by media, painting Chinese migrants as parasites and criminals. He states, “this perception of immigrants as a threat to public health undoubtedly served as a backdrop to, and subtly influenced, the response to Chinese Canadians during the SARS crisis.” This racist attitude was not limited to the general population of Canadians; public officials “openly suggested that the SARS crisis in the city was the result of federal immigration policy” (Ali). Exhibiting racist and xenophobic tendencies in the name of public health, which one might think (or hope) is an antiquated practice, is alive and well in North America.
The United States is no stranger to racism and xenophobia either, and the COVID-19 outbreak has only served to aggravate its white supremacist nature. A New York Times article by Sabrina Tavernise and Richard A. Oppel Jr. highlights different experiences of Chinese and “other Asian-Americans — with families from Korea, Vietnam, the Philippines, Myanmar and other places … [who are] lumped together with Chinese-Americans by a bigotry that does not know the difference.” They recount a story from Yuanyuan Zhu, a young Chinese American woman living in San Francisco, where she was threatened and assaulted on her walk to the gym. The authors describe:
She noticed that a man was shouting at her. He was yelling an expletive about China. Then a bus passed, she recalled, and he screamed after it, “Run them over.” She tried to keep her distance, but when the light changed, she was stuck waiting with him at the crosswalk. She could feel him staring at her. And then, suddenly, she felt it: his saliva hitting her face and her favorite sweater. (Tavernise)
This twenty-six-year-old woman was spat on in a racist outrage in America’s arguably most liberal city. Almost comically mirroring the bigotry of Canada’s public officials, President Trump was photographed with notes for a nationwide address wherein “corona” was crossed out and replaced with “Chinese,” announcing to the country and the world the status of the unstoppable disease and the demons who caused it. As this shameful “history” has repeated itself in less than two decades, it is valid to wonder how long it will take for the gap to disappear entirely.
Considering historical cases of epidemics within majority-white countries, the stigmatization of Chinese and Asian Americans during COVID-19 is nothing surprising. In the United States and other countries, the parts of the population belonging to a racial minority are already disproportionately of lower socioeconomic classes, leading to all kinds of disparities in between themselves and their white counterparts. This injustice is the norm, even without the threat of a public health crisis. However, these disparities are exacerbated during times of disease outbreak due to not only increased economic and political strain, but also severely heightened social stigma. This divergence works cyclically: the more marginalized a group is, the more likely they are to be of a lower socioeconomic class. The less access they have to education and healthcare resources, the more likely they are to get sick. The higher chance of being affected increases infection rates and increases social stigma. This all cycles back to the beginning with a group even more alienated from society. The COVID-19 pandemic has created what is presented as a more intense skepticism surrounding globalization. World leaders, particularly of rich white countries, spew racism in the name of homeland security. Marginalized people are berated for not working hard enough, as if it is actually realistic to die in a higher socioeconomic class than the one in which you were born. These ideas are all white supremacy dressed up in vague, euphemistic language. As stated at the beginning of this paper, to have COVID-19 be the first event to completely shake one’s world up is indeed a privilege. It might be pessimistic to assume the world will return to these same racist, greedy societies after the pandemic ends. However, history does repeat itself, and recently the gaps between repetitions grow shorter and shorter. How long will it be until the gaps disappear entirely? Or are we already living in a gapless era, a constant echo of the past?