The Real Racial Disparity: COVID-19, the Surgeon General, and Public Health Messaging

David Malebranche
6 min readApr 22, 2020


“Wash your hands more often than you ever dreamed possible. Avoid alcohol, tobacco, and drugs and call your friends and family, check in on your mother. She wants to hear from you right now. And speaking of mothers, we need you to do this, if not for yourself then for your abuela, do it for your granddaddy, do it for your big mama, do it for your pop-pop. We need you to understand, especially in communities of color, we need you to step up and help stop the spread so that we can protect those who are most vulnerable.”

These were the words of Surgeon General Dr. Jerome Adams during the White House Coronavirus Task Force briefing on April 10th, 2020. It was one of the few times Dr. Adams has come to the podium since these daily events began, and coincided with the release of new data demonstrating the stark racial/ethnic health inequities in new cases and health outcomes due to COVID-19 among Black and Latino communities.

What was telling about his remarks was how they were eerily consistent with previous messaging towards racial/ethnic health inequities in this country. Public health campaigns for our so-called “underserved” and “hard to reach” populations often highlight personal accountability and individual level behavior as the only target of change if we are expected to successfully address these disparities. “Just Say No” to smoking crack, “Wrap it up” to prevent HIV transmission and many others often emphasize the message “if you just stopped engaging in x or y behavior,” your outcomes would be different.

Contrast that to the approaches for epidemics and health disparities that disproportionately impact white people, which are often packaged in a broader contextual framework to ensure that individual level blame is placed on a predatory disease process or someone else’s depravity — just not the victims themselves. Alcoholism is clinically defined as a disease that people fall prey to instead of it representing a depraved personal behavioral choice (as with crack or marijuana use), and opiate addiction is always the fault of that overenthusiastic clinician who prescribed too many oral narcotics to a hapless casualty of a surgical procedure.

During the same April 10th remarks, the Surgeon General also stated:

“But let me be crystal clear. We do not think people of color are biologically or genetically predisposed to get COVID-19. There is nothing inherently wrong with you, but they are socially predisposed to coronavirus exposure and to have a higher incidence of the very diseases that puts you at risk for severe complications of coronavirus.”

While he ensured that we didn’t misinterpret his comments to mean that Black and Latin people are genetically wired to get COVID-19, his words suggest that being “socially predisposed” to a viral pandemic is something that just spontaneously materializes out of thin air. The history of how structural racism and discrimination in the United States influences adverse health inequities among Black and Latin people is well documented. Yet political figures (and some public health officials) seem to cower at the prospect of having a transparent discussion about this reality, scratching their heads as they say, “we are uncertain why these racial/ethnic health inequities exist.” As a Black internal medicine physician who has been practicing for twenty years, I have seen firsthand the injurious consequences of this history play out for patients in our communities. I am also clear that these outcomes are not simply the fault of poor individual level behavioral choices. Even when personal behaviors do play a part, they rarely emerge in a vacuum. Context matters.

When Dr. Adams implores Black and Latin people to “do it for your big mama,” “abuela,” or “pop pop,” he is implying that if we just engage in more responsible behavioral choices and make sacrifices on behalf of our family members, our health inequities will miraculously disappear. Doing this ignores the longstanding systemic scourges of medical, environmental, housing, and political racism, current xenophobia and anti-immigration policies, and how decades of structural policies impacting Black and Latino communities have made our bodies rife for exploitation when a new virus decides to takes a stroll through our neighborhoods. There’s only so much physical distancing, wearing masks, and hand-washing one can do to end a pandemic if they are not coupled with broader public health interventions as well.

Instead of just telling us to avoid alcohol, tobacco, and drugs — perhaps it would be more fruitful to tell us exactly how our federal government plans to help us protect our communities from this deadly virus. Tell us exactly how you are arranging to get our local healthcare workers more personal protective equipment so they can continue to save lives without killing themselves. Tell us how you will mandate that landlords and mortgage lenders provide a reprieve for monthly housing payments. Tell us how you will implement more robust coronavirus testing initiatives in our neighborhoods. Tell us how you will provide financial support to small Black and Latin-owned businesses to help them weather the storm of this crisis and continue to provide essential services to our people. If you are hesitant to even acknowledge that these larger structural issues exist and what you aim to do to remedy them, your pleas for us to simply engage in healthier individual level behaviors may fall on deaf ears. Even if you are “one of us.”

When we see mobs of predominantly white protesters demonstrating against stay at home orders, gathering with guns and signs outside capital buildings in our nation’s cities — do we lecture them about how their personal selfish acts of not physical distancing and not wearing masks will not only put their own health at risk, but the health of countless others as well? Do we admonish them to do it for their “Grammie” or “Mee-Maw,” or utilizing any other European ethnic term of endearment they may use for their elders? Do we lather them with media empathy and narratives attesting that the cure shouldn’t be worse than the disease? Or do we make excuses that their narcissistic behavior is simply because they are red-blooded Americans who are frustrated and want to go back to work, their livelihoods, their “freedom,” and move past the horrible mental trauma these temporary public health restrictions have put on them?

Answering these questions with transparency will help explain why racial/ethnic health inequities continue to persist in this country, and likely will linger with other health conditions long after we have moved past the COVID-19 pandemic of 2020.

John F. Kennedy once said in his historic 1961 Presidential Inauguration address:

“Ask not what your country can do for you — ask what you can do for your country.”

This would be a great quote for today, if not for the fact that America was built on the backs of Black people who have been “doing” for this country since the first slave ships arrived in 1619 and continues to be built on the backs of Latin immigrant workers today.

Dr. Adams, we are well aware of what we can do as individuals to help our country combat this pandemic. We need to also hear what our country plans to do for us as well. Time for you to step up and do more to help protect those of us who are most vulnerable.