A POOR PEOPLE'S PANDEMIC REPORT

This project aims to explore the disproportionate effects of COVID-19 on poor communities in the US by connecting data about COVID-19 deaths at the county level with other demographic characteristics. In doing so, it offers an initial analysis of the deadly community-level consequences of poverty, economic insecurity, and systemic racism. Although data gaps obscure a more detailed analysis of person-level outcomes, combined with other research, these results highlight the characteristics of some of the communities that were most impacted by the pandemic.

Out of more than six million deaths worldwide, COVID-19 has killed more people in the US than in any other country, with nearly one million deaths so far (John Hopkins University & Medicine, March 2022). Although it is one of the richest countries in the world, the US has a death rate (deaths per 100,000 people) higher than other high-income countries, and the US death rate ranks among the highest 20 of countries worldwide (WHO, March 2022). 

Those who worked in person assumed greater risk of contracting COVID-19 than those who worked from home. However, there is limited data available on COVID-19 outcomes by job or income. Where it does exist, that data is not linked to other crucial demographic data like location, race, age, gender, and ability. Without this intersectional analysis, unequal impacts can easily be obscured (Lynch et al. 2020). Limited and inconsistent reporting of COVID-19-related deaths undermines agencies’ and policymakers' ability to develop an effective public health response. 

Available data suggest that the impacts of the pandemic are far more extensive and unequal than accounted for in the official narratives. Some estimates indicate that as many as 18.2 million people died worldwide due to excess mortality between January 1, 2020, and December 31, 2021, or more than three times as many as the reported 5.94 million COVID-19 deaths in the same period (Wang et al. 2022).

In the US, the pandemic was debilitating, resulting in an estimated 1.2 million increase of people living with disabilities, totaling one in four adults living with disabilities in the US. All faced inaccessible and inadequate healthcare resources during the pandemic, as well as higher rates of unemployment, and over-representation in low-wage positions (Roberts et al. 2022; CDC, 2020; Adler et al. 2021; Kinsella, 2022).

People over the age of 65 experienced the greatest loss of life, comprising 75% of COVID-19 deaths in the US - or -1 in 100 older Americans died, compared to 1 in 1,400 people under the age of 65 (Bosman et al. 2021). While the greatest number of deaths have been among non-Hispanic white people, the rates of COVID-19 cases, hospitalizations, and deaths have been higher among people of color: American Indian or Alaska Natives are 3.1 times more likely to be hospitalized, Black or African Americans are 2.5 times more likely to be hospitalized and 1.7 times more likely to die, and Hispanic or Latino persons are 1.5 times more likely to get COVID and 2.3 times more likely to be hospitalized (CDC, 2022).

Men are more likely to die from COVID-19 than women, with death rates for men 1.6 times as high as the death rates for women, though women, especially women of color, have experienced a disproportionate economic burdens during the pandemic (Reeves & Deng, 2021).

Crises do not unfold independently of the conditions from which they arise. The pandemic exacerbated preexisting social and economic disparities that have long festered in the US, including a deeply divided society, widespread poverty, a weak social safety net, inadequate living conditions, and a lack of trust in science that predated COVID-19 (Wilson, 2020; Perry, Aronson, & Pescosolido, 2021; Center on Budget and Policy Priorities, 2022).

The US ranked well below other advanced economies on measures of happiness and well-being ranking #16  globally in the  2022 World Happiness Report  (Helliwell et al, 2022). Additionally, the US ranked #32 in the  latest SDSN Sustainable Development Report  with poor performance on inequalities, education and health outcomes, responsible consumption, and production and insecurity.

Before the pandemic, there were approximately 140 million poor and low-income people in the US, accounting for over 40% of the population and including more than half of the children in the country (SPM) (Barnes, 2019).

Nearly half of all renters were rent burdened in the US, nine percent of people did not have health insurance, with wide variations by racial and ethnic groups: 22% of Native Americans people, 20% of Hispanic people, and 11% of Black people, 7.8% of white people, and 7.2% of Asian people did not have health insurance in 2019 (Lynch et al. 2021; Artiga, Hill, & Orgera, 2021). These pre-existing disparities in healthcare access, wealth distribution, and housing insecurity yielded disastrous effects once the pandemic hit the US. COVID-19 compounded these gaps in access and delivery, creating a public health emergency that caused increased harm to populations based on their class, race, gender, geography, and ability. 

Income and wealth information are not systematically collected for people who have died or fallen ill from COVID-19 in the US. While death rates in counties like Mingo County are high, there is currently no systematic way to know the poverty status of those who died from the virus. Despite this data gap, various efforts have been made at the national, state, and county level to estimate the effects of COVID-19 on people living in poverty. Research at the county level shows that rural poor counties experienced the highest cumulative COVID-19 cases per 100,000 residents from September 2020 to January 2022 (Dobis, Krumel, & Sanders, 2022).

Other research has found disparities in COVID-19 deaths across multiple identities: 'disproportionate burdens' fell on those who were low-income, are people of color, have less education or are veterans (Seligman, 2021), on people in counties that are less resourced (Karmakar et al., 2021), or where fewer people had high school diplomas (Khanijahani, 2020; Stokes et al. 2021; Feldman & Bassett, 2021). This research also found substantial connections between COVID-19 outcomes and race, which is expanded on below. Other research connected job loss to people who were poor, finding that poor people experienced disproportionately higher rates of job loss, in particular Black women were greatly impacted by unemployment (Office of Human Services Policy, 2021; Jones, 2021). The maps below display some of these connections.

This report analyzes how deaths from COVID-19 overlap with income, different pandemic phases, race, and other factors, by analyzing community-level (county) data. Poverty here is defined as people living below 200% of the official poverty measure. Official poverty measures are far too low and outdated: thresholds for 2019 were $13,300 for a single-person household and $25,926 for a two-adult, two-child household (OPM).  Double those amounts are used in this analysis, thereby including both “poor” and “low-income” populations (Barnes, 2019).

There is also a racial dimension to the COVID-19 phases. Research from the Kaiser Family Foundation has shown that during the initial wave, Indigenous, Hispanic, and Black populations had more cases and deaths than white populations. These gaps close somewhat by the summer of 2021. However, during the Omicron phase, more people of color were impacted, potentially due to more risk of exposure with in-person work, transportation, and housing, as well as lower access to social services such as quality healthcare, safe childcare, etc. (Hill & Artiga, 2022). 

Prior to the pandemic, the US was an outlier among high-income countries due to overall decreasing life expectancy. The pandemic extended that decline, worsening the racial gap in the process: "Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic white populations, respectively” (Woolfe et al. 2021, p.1; Andrasfay & Goldman, 2021; Arias et al. 2021). Other research showed that there were significant differences in years of life lost for Black and Hispanic populations, indicating that younger Black and Hispanic people were more impacted by COVID-19 than their white peers (Bassett, 2020; Xu, 2021).

However racialized health impacts were not limited to deaths from COVID-19. During the Omicron phase, Black adults were nearly four times more likely to be hospitalized than white adults and experienced increased excess death risks due to healthcare resource disparities. For instance, stroke rates went up generally, resulting in Black people having double the risk compared to white people (Taylor, 2022; Muñoz-Price, Nattinger, Rivera et al. 2020; McKay, 2022).  Moreover, Feldman & Bassett found that “If all racial and ethnic populations had experienced the same mortality rates as college-educated non-Hispanic white populations, 71% fewer deaths among racial and ethnic minority populations would have occurred (2021).”

Counties that have disproportionately more Black residents (defined here as more than 13.4%) had a significantly higher COVID-19 death rate than counties that did not. Collectively, the group of counties with larger Black communities experienced 32 more deaths per 100,000 than counties that were not predominantly Black.

There is a significant body of research that connects these disproportionate outcomes to racism across multiple systems (CDC, 2022, “Health Equity Considerations and Racial and Ethnic Minority Groups”; Hill & Artiga, 2022; Tan, deSouza, & Raifman, 2021).

Counties that had larger than average Asian communities (defined as more than 5.7%) collectively had 66 fewer deaths per 100,000 people than counties that had smaller Asian communities. Differences were small but significant in predominantly Hispanic communities, and not significantly different across predominantly white and Indigenous communities (note that these communities are not mutually exclusive).

The map below shows how the approximately 1000 counties in the poorest decile intersect with COVID-19 death rates and counties with the highest percentage of people of color. Nearly 73% of counties with the lowest median income, and 76% of counties with the highest percentage of people living in poverty, are located in the southeast and southwest of the US.

These counties are home to 15% of Black people, 13% of Hispanic people, 9% of all white people, 2% of all Asian people, and nearly 30% of Indigenous people. If poverty was experienced equally by race, we would expect these figures to be 10% for every racial group. 13% of uninsured people live in counties in this decile, and approximately 49% are poor or low income. Compared with the highest income decile, rent burden is one of the few dimensions where there are small differences with the lowest income decile, indicating just how housing insecure the US is during a time when the major public heath direction was to ‘stay home.’

Hinds County, Mississippi is another county in the poorest 10th of communities in the US. Olivia Womack grew up in Jackson, Hinds County, and is a college student at the University of Mississippi. During the pandemic, Olivia lost more than 20 members of her family, 11 of them in 2020, including her grandmother, aunts, uncles and cousins. Hinds County has a COVID-19 death rate of 320 deaths per 100,000.

 Nearly half  of the people in Mississippi are poor or low-income, or a total of 1.3 million of its residents. Before the pandemic, nearly 360,000 people (12.4%) were uninsured and 7.5% of people were unemployed.

Mississippi has not expanded Medicaid under the Affordable Care Act and health care continues to be a contentious issue. The current challenge to Roe v. Wade emanated from a Mississippi law that would make abortion illegal after 15 weeks of pregnancy. Bills around postpartum Medicaid expansion and children’s epilepsy medication have passed one chamber of the state Congress only to be vetoed in the other. Danyelle Holmes, an organizer with the Poor People’s Campaign who is also from Hinds County, says of these contradictions, “People will fight like hell for the unborn, but people who are living are dying.”

In the 363 counties (top 10%) with the highest death rates, the population is 56% white, 21% Hispanic, 16% Black, 4% Indigenous and 1% Asian, which is significantly less white, less Asian, more Black, and more Indigenous than counties with lower death rates (Hispanic percentages did not change significantly). These counties have a poverty rate of 45%, which is 1 ½ times higher than in counties with lower death rates. Median incomes are on average $23,000 less than counties with lower death rates. The population across these counties accounts for approximately 2% of the US population, or 7.5 million people.

In the Bronx, New York the COVID-19 death rate (538 per 100,000 people) is an example of one of these counties with the highest 10% of death rates in the country (Johns Hopkins University & Medicine, March 2022).

The Bronx is diverse: of its 1.4 million people, 55% are Hispanic, 29% are Black, 9% are white and just under 5% are Asian. The Bronx has the largest concentration of Hispanic communities in the city, predominantly Dominican and Puerto Rican (NYC Planning, 2021).

It is one of the more than 1000 counties in the poorest 10th of communities in the US, consisting of nearly 31 million people. Over 50% of people living in the Bronx are living in poverty and almost 10% do not have access to health insurance.

According to Dr. Jim Fairbanks, who has lived in the South Bronx for more than 50 years, one reason why the county was hit so hard was because its residents “are the essential workers who were servicing the rest of Manhattan and the city’s wealthy.”

In addition to the public health impacts of COVID-19 that have affected communities disproportionately by race and income, the economic impacts of the pandemic show similar inequalities, with poor and low-income people, people with disabilities, women, and people of color bearing the brunt of these shocks. While US billionaires increased their wealth by $2.1 trillion, or by 70%, many Americans faced eviction, hunger, and record unemployment (Collins, 2021; Moore, 2021; Eviction Lab, 2022; Auginbaugh & Rothstein, 2022). 

As this report reveals, though COVID-19 doesn’t discriminate, US society does. Some of the impacts of this discrimination are evidenced in who bore the deadliest consequences of the pandemic. However, a lack of a robust monitoring system for understanding these impacts across class, race, gender, ability and more prevents a detailed accounting of the disparate impacts of the pandemic.

For example, the Centers for Disease Control (CDC) has released racial breakdowns of deaths at the county level, but has excluded information for counties with fewer than 100 deaths (CDC, 2022, “Provisional COVID-19 Deaths by County, and Race and Hispanic Origin”). As a result, data on deaths that is disaggregated by race is available for 81% of counties in the highest earning decile, but only 34% of counties in the lowest earning decile. The methods and systems used to assign race are also notoriously faulty and conceal important differences through broad racial categories.

Other included measures included in this report like median income and the percent of people living below 200% of the poverty line, are imprecise measures because, among other things, they do not take into account variation in costs of living across the US. County-level estimates are limited in that they cannot describe which people in the county were impacted, and as no county is wholly made up of one race or class, significant nuances and insights may be missed. During the pandemic, occupation became a vital datapoint that sorted people into those who could stay home and minimize risk, and those who could not, sometimes to provide services to those who stayed home. However, these key characteristics are not captured by official reporting and monitoring. 

There is much research left to do to account for varying COVID-19’s varying impacts across communities. This will require input from residents, academics, faith communities, policy makers, andmore. One such approach may be a comparative analysis across communities that took different approaches to the risks of the pandemic. On the San Carlos Apache Reservation, in Gila and Graham counties, Arizona, the  Apache Tribal Emergency Response Commission  (TERC) established a COVID-19 response team to assess community needs (San Carlos Apache Tribe Emergency Response Commission, n.d.). They shut down the reservation and implemented strict mitigation measures that were better suited for their members and living conditions, including mask mandates, testing and quarantine protocol. According to Vanessa Nosie, a member of the San Carlos Apache and TERC, one of their main goals was to protect their elders: “They hold our history, prayers and traditions. If we lose our elders, we lose who we are. If we had not established our own health care and our own protocol, we would have lost many more of our people.”

COVID-19 fully exploited preexisting cleavages in US and global society which have not yet been fully or adequately addressed. Globally, epidemiologists warn of new variants, as communities in the Global South still lack access to the vaccine. In the US, failing to consider how poverty intersects with race and other characteristics created blind spots in our public policies.

Those hardest hit communities - where the percent of people living in poverty is high, where median income is low, and where many residents are Black, Indigenous, and/or Hispanic, - are more likely to face eviction as protections expire across the country (Block, 2021). The expanded Child Tax Credit, which reached over 60 million children, reduced food insecurity, and reduced racial inequities among poor children, has also expired (Curran, 2021; Parolin et al. 2021; Shafer et al. 2022) . Research suggests that even the Paycheck Protection Program was poorly targeted, and flowed primarily to business owners and shareholders (Autor et al. 2022). Millions remain uninsured and on the verge of losing their access to Medicaid in the coming weeks. And while the various support programs have ended, both COVID-19 and its economic impacts continue.

As this pandemic report reveals, poverty was not tangential to the pandemic, but deeply embedded in its geography. After its first wave, COVID-19 became largely a “poor people’s pandemic,” with poor communities grieving nearly two times the losses of richer communities. The lack of analysis on this issue is driven in part by not employing an intersectional analysis that might uncover how people experience poverty and COVID-19 in connection with other identities like race, gender, ability, and age. It also reflects a long-standing aversion to appreciating the full extent of poverty and economic insecurity in the US.

Poverty and widespread inequality increases vulnerability to crises. While vaccines will prevent the worst impacts of COVID-19, they will not inoculate against poverty. However, living wages, shared economic prosperity, and inclusive welfare programs can address root causes that made the US vulnerable to such massive losses of human life. Likewise, ensuring universal and affordable health care, housing, water, access to utilities, quality public education, and guaranteeing a robust democracy will establish a more equitable foundation upon which we can build back better from the pandemic.

These are the lessons we must carry forward from the past two years: to target the root causes of inequality such as poverty and discrimination, repair the harm, and leave no one behind. 

The  UN Sustainable Development Solutions Network  (SDSN) mobilizes scientific and technical expertise from academia, civil society, and the private sector to support practical problem solving for sustainable development at local, national, and global scales. The SDSN has been operating since 2012 under the auspices of the UN Secretary-General. The SDSN is building national and regional networks of knowledge institutions, solution-focused thematic networks, and the SDG Academy, its flagship online education initiative.  SDSN USA  is a network of knowledge institutions across the United States, builds pathways towards sustainable development in the United States by mobilizing research, outreach, collective action, and global cooperation.

Launched in 2018 with a historic wave of nonviolent civil disobedience, the  Poor People’s Campaign: A National Call for Moral Revival  is a national campaign to address the interlocking injustices of systemic racism, poverty, ecological devastation + denial of health care, militarism & the war economy, and the false moral narrative of religious nationalism. Drawing on the history of moral fusion movements, the Poor People’s Campaign is made up of over 40 state coordinating committees, over 200 partner organizations and thousands of religious leaders, bringing together the nation’s 140 million poor and low-income people across race, ability, religion, gender and sexual orientation, region, and issue. The Poor People’s Campaign’s moral “Third Reconstruction” agenda is rooted in the needs and priorities of the 140 million, as well as our deepest Constitutional and moral values. It is anchored by  Repairers of the Breach  and the  Kairos Center for Religions, Rights, and Social Justice .

 Howard University  is a private, doctoral university classified as a high research activity institution and a Historically Black College and University (HBCU) located in the nation’s capital. Howard is a community of more than 11,000 undergraduate, graduate and professional students representing 53 states and territories. Since 1867, the University has long held a commitment to the poor and disadvantaged persons in American society and throughout the world. The goal is the elimination of inequities related to the intersections of race, poverty, ethnicity, gender, socioeconomic and political circumstances that undermine peace, prosperity, and sustainable development.

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