Understanding Race and Gender Health Inequities in COVID-19

https://doi.org/10.1177/08912432211001302
GENDER & SOCIETY, Vol 35 No. 2, April, 2021 168–179
DOI: 10.1177/08912432211001302
© 2021 by The Author(s)
Article reuse guidelines: sagepub.com/journals-permissions
STRUCTURAL GENDERED RACISM
REVEALED IN PANDEMIC TIMES
Intersectional Approaches to Understanding Race
and Gender Health Inequities in COVID-19
Whitney N. Laster Pirtle
Tashelle Wright
University of California, Merced, USA
The pandemic reveals; the novel coronavirus (COVID-19) pandemic has brought the historically rooted inequities of our society to the forefront. We argue that an intersectional
analysis is needed to further help peel back the veil that the pandemic has begun to reveal.
We identify structural gendered racism—the totality of interconnectedness between structural racism and structural sexism in shaping race and gender inequities—as a root cause
of health problems among Black women and other women of color, which has been amplified during the pandemic. We show that women of color occupy disadvantaged positions
within households, occupations, and health care institutions, and therefore face heightened risk for COVID-19 and lowered resources for mitigating the impact of the deadly
virus. Intersectional analyses and solutions must be centered to also reveal, we hope, a
new way forward.
Keywords: gendered racism; intersectionality; COVID-19; pandemic
Coronavirus did not create the stark social, financial, and political inequalities that define life for so many Americans, but it has made them more strikingly visible than any moment in recent history. Unfortunately, some of the
intersectional dimensions of these structural disparities remain undetected
Authors’ Note: We thank members of the Sociology of Health and Equity (SHE) Lab
for their feedback on paper concepts. We dedicate this piece to women of color whose lives
were lost in the pandemic. Correspondence concerning this article should be addressed to
Whitney N. Laster Pirtle, School of Social Sciences, Humanities and Arts, University of
California Merced, 5200 N. Lake Road, Merced, CA 95343, USA; e-mail: [email protected]
ucmerced.edu.
1001302 GASXXX10.1177/08912432211001302Gender & SocietyPirtle and Wright / STRUCTURAL GENDERED RACISM
research-article2021
Pirtle and Wright / STRUCTURAL GENDERED RACISM 169
and unreported. Kimberlé Crenshaw (2020) on her March 30, 2020, podcast
introduction to “Under the Black Light: The Intersectional Vulnerabilities
that COVID Lays Bare.”
The pandemic reveals. The fact that our unequal society produces
unequal health is not a new revelation; rather, the novel coronavirus
(COVID-19) pandemic has brought the historically rooted inequities of
our society to the forefront, and we have now all been forced to confront
the cold, bare, and persistent ugliness of unequal death (Pirtle 2020b). As
noted by Crenshaw (2020), the pandemic has the potential to lay bare
intersectional vulnerabilities. That is, if we choose to look more deeply,
the pandemic reveals that gender and racial oppression mutually shape
increased health burdens for women of color who are forced to bear the
brunt of the negative health effects of COVID-19.
By the time we revised this article, more than 400,000 Americans have
died from SARS-Cov-2, or coronavirus. Shortly after documenting
COVID-19–related mortality in the United States, scholars and politicians
alike quickly began to dispel the belief that everyone was at equal risk. In
April 2020, more than 80 Democratic U.S. senators called for the
Equitable Data Collection and Disclosure on COVID-19 Act, demanding
the release of race/ethnicity and other demographic data on COVID-19
rates. Then vice president–elect Kamala Harris stated on her website that
“Black people and other people of color are being infected and dying from
COVID-19 at alarming rates. Without the collection and publication of
data at the national level, we cannot fully understand the scope of the issue
and take appropriate action to help the most hard-hit communities. We
need to right the historical wrongs that have led to deep health disparities
for generations” (Harris 2020).
Since then, the Color of Coronavirus report from the American Public
Media (APM) Research Lab has assessed race/ethnicity breakdowns for
about 95 percent of the 315,000 deaths. They report that Black, Indigenous,
Pacific Islander, and Latinx Americans have an age-adjusted COVID-19
death rate more than 2.7 times that of White Americans (APM 2020).
Black and Indigenous groups are the hardest hit, with nearly one in every
800 Black or Indigenous person having died from COVID-19. The data
are unequivocal in revealing racial/ethnic health inequities, and there is
strong agreement that structural racism is a culprit (Garcia et al. 2020;
Pirtle 2020b; Williams and Cooper 2020).
While it is true that race/ethnicity data help us better understand and
address health disparities, we need to amend these calls to include
170 GENDER & SOCIETY/April 2021
disaggregated information on race and gender to right historical wrongs
as well. The erasure of women of color in public health data and public
policy efforts only reiterates the need for a comprehensive intersectional
analysis of structural disparities. We use theories about structural gendered racism to present an analysis of the intersectional dimensions of
these structural disparities that harm Black women and other women of
color to further help peel back the veil that the pandemic has begun to
reveal.
Structural Gendered Racism and Health Inequity
Crenshaw (1989, 140) first urged that “the intersectional experience is
greater than the sum of racism and sexism” and particularly that “any
analysis that does not take intersectionality into account cannot sufficiently address the particular manner in which Black women are subordinated.” Philomena Essed’s (1991, 31) cross-national study of Black
women supported this idea, revealing how gendered racism captures the
way that sexism and racism “narrowly intertwine and combine under certain conditions into one, hybrid phenomenon.”
Intersectionality teaches us that gendered racism uniquely shapes the
ways that race and gender-based systems of oppression intersect to create
multiple burdens for women of color, in ways that thinking through the
lens of only structural racism or only structural sexism cannot. For example, structural racism—or racial discrimination reinforced through inequitable social institutions and maintained and reflected in ideologies,
culture, and the distribution of resources (Bailey et al. 2017, 1453)—
impacts the health of people of color, such that they are more likely to
experience earlier onset of health problems and shorter life expectancy in
the United States (Bailey et al. 2017; Gee and Ford 2011). These racial
health inequities are exacerbated in the pandemic (i.e., Garcia et al. 2020;
Pirtle 2020b). Yet within groups of color, women face additional barriers
given structural sexism. Homan (2019) identified structural sexism—or
systematic gender inequality in power and resources reinforced in institutions, cultures, behaviors, interactions, and ideologies—as a cause of
women’s increased experience of chronic conditions. Yet the emphasis on
men’s heightened mortality from COVID-19 neglects gender-based social
determinants of illness, which Connor and colleagues (2020) identify as
gender-blindness. Even less acknowledged is that within gender inequality, women of color are more likely to face added burdens because of their
racial minoritized status.
Pirtle and Wright / STRUCTURAL GENDERED RACISM 171
Therefore, it is critical that we recognize intersectionality as a framework for health equity (Bowleg 2012), given the ways gendered and raced
systems together create “injuries of inequality”—or mental and physical
tolls shaped by in those social hierarchies (Watkins-Hayes 2019, 13). This
is especially needed now during a time in which the pandemic is exacerbating extant inequities for Black women (Lindsey 2020).
We here offer structural gendered racism, or the totality of interconnectedness between structural racism and structural sexism in shaping
race and gender inequities, as a root cause of health problems among
women of color in the pandemic. Women of color occupy disadvantaged
positions within households, occupations, and health care institutions, and
therefore face heightened risk for COVID-19 and lowered resources for
mitigating the impact of the deadly virus.
STRUCTURAL GENDERED RACISM IN THE HOME, IN
WORK, AND IN HEALTH CARE AND INCREASED COVID-19
VULNERABILITY
Bearing Violence and Burdens during COVID-19 Shelter-at-Home
Orders
The home is thought to be an intimate, safe place of refuge. For this reason, instructions to stay safe at home became a prominent COVID-19 public health recommendation. Although shelter in place was good for most,
these orders were not good for everyone. Intimate partner violence and
domestic violence during this pandemic create an additional public health
crisis (Connor et al. 2020), referred to as “a pandemic within a pandemic”
(Evans, Lindauer, and Farrell 2020). Burki (2020) reports that “Some 243
million women are thought to have experienced sexual or physical abuse at
the hands of an intimate partner at some point over the last 12 months.
Many of these women have been trapped with their abuser.” Instances and
reports of intimate partner violence and domestic violence have increased
dramatically as lockdown orders kept vulnerable women isolated (Taub
2020). Women’s shelters across the country also reported increases in service demands, resources expended, and beds filled (Bradbury-Jones and
Isham 2020). Black and brown women, in both rural and urban settings,
have expressed their concerns of having to shelter in place with an abuser
and the impact that it has on their own and their children’s well-being.
Intimate partner violence in the home was a key motivator for
Crenshaw’s (1991) development of structural intersectionality. She
172 GENDER & SOCIETY/April 2021
explained that women of color face burdens that are the “consequence of
gender and class oppression, and then are compounded by the racially
discriminatory employment and housing practices . . . that makes battered
women of color less able to depend on the support of friends and relatives
for temporary shelter” (Crenshaw 1991, 1246). Furthermore, legal clauses,
such as the marriage fraud provisions, meant women of color without
legal status were shamefully forced to choose between protection against
domestic violence or protection against deportation (Crenshaw 1991). All
of these interconnected structural vulnerabilities are heightened in the
time of health crises, given the increased stress and time in the home and
fewer outside supports.
Even in households without physical violence, the home still is not
always a place of refuge. Women of color have become overburdened
with invisible labor during the pandemic that can impact their well-being.
History repeats itself: “women disproportionately shoulder factors (e.g.,
social isolation, caregiving roles, resource insecurity) demonstrated in
past pandemics to increase the risk of mental health disorders” (Connor
et al. 2020, 4) and we can expect the same during COVID-19. Patricia Hill
Collins’s (2000) writing on othermothering describes the role overload
among Black women; during the pandemic, they are increasingly called
upon to care for families and whole communities without compensation
and support (Jackson 2020). The combination of care and distance-learning responsibilities along with the stresses of either working or being out
of work during this pandemic and isolation has had a profound effect on
women of color.
Finally, stay-at-home orders neglect those who are unhoused or facing
evictions. Black and Latinx women renters face higher eviction rates than
do men (Hepburn, Louis, and Desmond 2020), which is an additional
burden of structural gendered racism. Activists and scholars alike have
appealed to lawmakers to put a stop on evictions in the pandemic, drawing
links between eviction rates and increases in COVID-19 cases (Housing
Is the Cure 2020).
Disposable Lives and Essential Labor Shaped by Occupation and
Employment Stratification
Essential workers are those who conduct services that are essential to
continue critical operations, including those who work in health care fields,
education, child care, critical retail, and social services. These jobs are patterned by race because of historical structural racism in employment
Pirtle and Wright / STRUCTURAL GENDERED RACISM 173
(Yearby and Mohapatra 2020) and racial capitalism (McClure et al. 2020).
For example, Latinx workers account for 53 percent of the agricultural
workforce. Yet many of these same workers were excluded from receiving
financial aid packages through the Coronavirus Aid, Relief, and Economic
Security (CARES) Act, the largest economic relief bill in U.S. history,
because bill crafters excluded workers with undocumented status from
receiving aid (Yearby and Mohapatra 2020).
Not only does structural racism affect occupational status and protections, but structural sexism means work is patterned by gender too. A
recent New York Times exposé on essential workers in the pandemic
reported that one in three jobs held by women is designated essential
(Robertson and Gebeloff 2020), yet that does not mean they are compensated for their essential labor, even if one is a frontline health care worker.
The authors note that “of the 5.8 million people working health care jobs
that pay less than $30,000 a year, half are nonwhite and 83 percent are
women’’ (Robertson and Gebeloff 2020). Disaggregating by race and
gender reveals the particular vulnerability of women of color. For example, women of color make up two-thirds of home health care workers, and
Black women alone make up 30 percent of all licensed practical and vocational nurses (Yearby and Mohapatra 2020). Shamefully, home care workers, like agricultural workers, were not covered by the CARES Act
“because homecare industry advocates argued that there would be a
worker shortage if home health workers were included” (Yearby and
Mohapatra 2020, 7).
Structural gendered racism therefore shapes increased risk for COVID19 for women of color through their occupational status. The majority of
health care workers who have died during this COVID-19 pandemic were
women of color (Akhtar 2020; Jewett 2020). For example, nurses of
Filipino descent account for a shocking 31.5 percent of the workforce’s
COVID-19 deaths, yet they make up only 4 percent of the workforce
(Akhtar 2020). Women of color health care workers are less well compensated in their jobs, and now they are less well protected in combating
COVID-19. This is a cold reminder that it is not their lives that are
deemed essential and therefore valuable—rather it is their disposability
that is seen as valuable.
Opposite those who have been required to work throughout this pandemic are those who have been affected by loss of work and furloughing.
Families whose resources were already stretched now are experiencing
partial or complete loss of income and, thus, loss of health insurance for
those who had it through employment. Moen, Pedtke, and Flood (2020, 4)
found that young adult women experienced the highest increase in loss of
174 GENDER & SOCIETY/April 2021
full-time work during the pandemic, reporting that “for women in their
20s, the increase in unemployment appears to be more a function of race
and ethnicity than education. Black women without a college degree in
their 20s have a 12.4 percentage point increase in unemployment.” During
the pandemic, loss of work, income, and health insurance has had a direct
impact on one’s health, further increasing the risk for COVID-19 and the
complications that come with it.
Presumed Incompetent and Lacking Quality Health Care
Women of color experience institutional and interpersonal gendered racism in health care settings, in which provider biases based on race and
gender shape the quality of care and treatment. The race and gender discrimination within America’s health care system toward Black women, for
example, has rendered them both invisible and seemingly incompetent
(Cottom 2019; Sacks 2019). Informed from Collins’s work on controlling
images (2000), Tina Sacks (2019, 11) argues that “Black women experience the health care system in the context of pervasive negative stereotypes
about their race and gender, including angry Black women, mammy, welfare queen and prostitute.” Tressie McMillan Cottom’s (2019) harrowing
essay “Dying to Be Competent” intimately illustrates how Black women
are seen as incompetent, even over their own bodies while growing bodies
through pregnancy. This presumption contributes to the horrific statistics
that Black women have an infant mortality rate 12 times higher than white
women in New York City, for example (McLemore 2020). The gendered
racism is well documented even among middle-class Black women and
those with strong health care literacy, but whose pain was still seen as
invisible and often misdiagnosed (Sacks 2019). These gendered and raced
biases, unconscious or not, contribute to persistent health care inequities.
In her essay, “When the Country Sneezes, Black Women Catch the
Flu,” Dorrianne Mason (2020) tells us that the pandemic is exposing
that “our health-care system and health-care reform efforts have
always carelessly or purposefully excluded us.” For instance, investigations spurred in New Orleans after one parish hard hit by COVID-19
showed that 75 percent of elderly patients died at home in hospice,
compared with 4 percent at the national level (Waldman and Kaplan
2020). In the dozens of cases the authors investigated, all discharged
COVID-19–positive patients were Black. Not only did these decisions
make end-of-life care harder for the patients, it also meant that caretakers were more exposed—and because of our gender systems, the
majority of caretakers were Black women.
Pirtle and Wright / STRUCTURAL GENDERED RACISM 175
Recent news headlines describing Black women health care providers
dying from COVID-19 puts Black women’s presumed incompetence in
the pandemic into sharper perspective. Deborah Gatewood, of Detroit,
Michigan, was turned away from the hospital where she worked four
times before she died from the disease, once only given cough syrup (Kim
2020). Many are again outraged after another Black woman, Dr. Susan
Moore, filmed herself in the hospital and reported on mistreatment and the
rush to send her home: “This is how Black people get killed when you
send them home and they don’t know how to fight for themselves”
(Eligon 2020). Sadly, she died at another hospital after advocates pushed
for her transfer—though perhaps ‘murdered by the system’ is a more
accurate description (see, Roberts 2017). These Black women were not
trusted to understand their acute medical condition or their own bodies.
Conclusion
Structural gendered racism is the totality of interconnectedness of structural racism and structural sexism in shaping race and gender inequities.
Using an intersectional analysis, structural gendered racism is revealed as
a root cause of health problems among women of color and therefore has
directly impacted the risk of COVID-19 harms in the pandemic. We show
that through power differentials shaped by racialized and gendered systems, women of color occupy disadvantaged positions within households,
occupations, and health care institutions, and that this disadvantage lays on
more and more burdens that wear and tear at their bodies and minds.
Increased budgets for women’s centers and universal child care might
ease the stress and provide survivor support for women of color. Expanding
the CARES Act to agricultural workers and home health aides, regardless
of legal status, and introducing a federal moratorium on evictions would
provide more economic and housing support to women of color in the
pandemic. Acknowledging historical and contemporary bias in health care
delivery and implementing stronger support for doctors of color might
improve health outcomes for women of color battling COVID-19. All of
these interventions can take us only part of the way; dismantling harmful
systems of oppression remains the goal (Taylor 2017).
Radical healing means standing for social justice and envisioning possibilities for wellness, freedom, and dignity after COVID-19 (Lewis et al.
2020). Addressing fundamental inequities in the United States while paying attention to the intersection of race and gender would mean that
176 GENDER & SOCIETY/April 2021
women of color have a better chance of life and survival overall. Our
focus here is on women of color, and Black women in particular, given the
systematic erasure and neglect, and because, as the Combahee River
Collective (1986) told us half a century ago, “if Black women were free,
it would mean that everyone else would have to be free since our freedom
would necessitate the destruction of all the systems of oppression.”
The pandemic reveals. But as Arundhati Roy (2020) instructs, we can
use this as fuel:
Historically, pandemics have forced humans to break with the past and
imagine their world anew. . . . It is a portal, a gateway between one world
and the next. We can choose to walk through it, dragging the carcasses of
our prejudice and hatred. . . . Or we can walk through lightly, with little
luggage, ready to imagine another world. And ready to fight for it.
Let it reveal to us a new way forward that centers Black women and
other women of color so that we all can get free and live healthily (Pirtle
2020a; Taylor 2017).
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Whitney N. Laster Pirtle, PhD, is an Assistant Professor of Sociology and
MacArthur Foundation Chair in International Justice and Human Rights
at the University of California, Merced, where she directs the Sociology of
Health and Equity (SHE) Lab. She is a critical race, Black feminist scholar
currently studying disparities in Covid-19, racial formation in South
Africa, and racism on college campuses. Her co-edited volume Black
Feminist Sociology: Perspectives and Praxis is forthcoming with Routledge
Spring 2021.
Tashelle Wright is a PhD Candidate in Public Health at the University of
California, Merced (UC Merced). She is currently a TRDRP Predoctoral
Fellow and UC Merced Black Research Fellow. Her dissertation focuses on
intersectionality, oral health, and tobacco use disparities among underserved populations (i.e. older adults, Blacks, Hmong, and Latinx) in
California’s rural Central Valley.