The Summer 2022 issue of Ethnicity & Disease has just been published! It includes two articles from the Rapid Assessment of COVID Evidence (RACE) Series. We are so delighted that Ethnicity & Disease is an open access journal. That means that anyone can read the papers published in this journal for free simply by visiting the journal’s homepage.
The purpose of the RACE Series is to share the results of research conducted by the COVID Task Force on Racism & Equity (i.e., Task Force) over the course of the pandemic. Concurrent with the publication of the scientific papers, we are pleased to share a guest blog (see below) co-authored by Erin Manalo-Pedro and Adrian Bacong as well as the next episode in our “Task Force Talks” series, which comprises short documentaries based on interviews conducted by Bita Amani (Task Force lead chair) in conversation with community members, especially community organizers. The short videos are produced and distributed publicly on behalf of the COVID Task Force on Racism & Equity.
Both the blog below and the current Task Force Talk shed light on United States colonialism as the root cause of the disproportionate impact of COVID among Filipina/o/x populations in the United States. The companion video, which is entitled “TASK FORCE TALKS: Filipinx Stories Too Often Overlooked,“ was produced by Katherine Nasol, who is policy director of the Bulosan Center for Filipino Studies at the University of California at Davis. Katherine identifies as “a Filipina scholar-activist invested in care for immigrant communities & Black, Indigenous, and people of color. Her life’s work is to use storytelling, grassroots organizing, & community-centered research to build people power.” The video is based on a January 2021 interview that Bita Amani conducted with Katherine Nasol as part of the Task Force Talks series.
TASK FORCE TALK: Filipinx Stories Too Often Overlooked A short documentary by Katherine Nasol, Founding Member and Policy Director of the Bulosan Center for Filipinx Studies
The title of the companion blog (see below), “From Colonialism to COVID-19”, provides a complementary set of insights as those the critical health educator and global health scholar Collins Airhihenbuwa offered about the link between COVID-19 and US anti-black racism. This highlights opportunities for coalition-building across communities to address the myriad of ways the historical workings of white supremacy remain impactful today. We encourage you to share all three of these companion resources—this issue of the RACE Series, the blog below and the video—widely.
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FROM COLONIALISM TO COVID-19: OVERLOOKED CONNECTIONS TO HEALTH INEQUITIES
by Erin Manalo-Pedro and Adrian Bacong
June 1st, 2020. Rhea, a Filipina immigrant and retired registered nurse, sighed as she reflected on a recent phone call. Her former coworker from a county jail in California had called to relay that yet another of their coworkers was infected with COVID-19--the third employee diagnosed that week. Clearly, the nursing unit at the jail was overworked and critically short staffed. Another nurse on the unit had also quit, citing the unbearable stress of the pandemic. Rhea’s coworker described a growing sense of fear, uncertainty, and low morale among the staff because of the rising number of COVID-19 cases among people who were incarcerated, the lack of personal protective equipment for the medical staff, and further violence by police amidst the recent protests against police violence in the wake of George Floyd’s murder.
As Rhea hung up the phone, she contemplated her former coworker’s request: is she willing to come out of retirement to work at the jail again? Twenty years of memories working as a registered nurse for incarcerated individuals flooded her mind. Why was she a nurse? She justified the long hours in unsafe conditions because it paid enough to put her children through college in the States and send remittances to her family abroad. Back home in the Philippines, her mother, peers, and even the government had encouraged this path to become a nurse and pursue the American Dream as a “modern day hero.” Yet now, at 63-years-old and a year into retirement, she found herself chronically fatigued, managing diabetes, hypertension, and chronic pain, and stressed about whether she should risk her own safety to alleviate the coronavirus-induced healthcare shortage.
Rhea’s story reveals many of the overlooked connections between colonialism and health inequities among Filipinx/a/o American (FilAm) healthcare workers. Early on in the pandemic, nearly one-third (31.5 percent) of COVID-19 deaths among US nurses were FilAms, even though FilAms comprised just 4 percent of the nursing workforce. FilAm activists and scholars pulled together various data points to connect these COVID-19 mortality disparities to the overrepresentation of FilAms in the health workforce (e.g., Kanlungan, Imperialism to Inpatient Care, PSST Podcast). A complex combination of infrequently examined exposures (e.g., colonial history) and misleading health indicators (e.g., English proficiency, racialization as Asian) obscures FilAm health needs, as argued by Sabado-Liwag and colleagues. In November 2020, COVID-19 mortality among California health workers was 1.1% for Asians as a whole compared to FilAms at 6.4%, a typical oversight within aggregated data.
As “outsiders within” (i.e., social groups historically excluded from but now within academia), FilAm scholar-activists knew there was a bigger story. Community organizer and scholar-activist Katherine Nasol contextualized this common story among FilAm healthcare workers in the most recent episode of Task Force Talks, which is a video series produced by the UCLA/Charles R. Drew University of Medicine & Science COVID Task Force on Racism & Equity. Nasol stated, “This historical legacy [of colonialism] has led to so many of our loved ones dying.”
The story behind Rhea’s presence in the US started with the American occupation of the Philippines. In 1898, Spain ceded the Philippines to the US through the Treaty of Paris, although revolutionaries would continue their fight against the US. In the early 1900s, the US developed a new educational system, modeled after Indian boarding schools. American-style nursing schools were established to direct high numbers of Filipinas into an area of labor needed by the US. Even after the Philippines gained independence in 1946, Filipina nurses were recruited to address labor shortages in the US through specialized visas. FilAm nurses, like Rhea, are still entangled in the remnants of this colonial system.
Uncovering these overlooked connections to health inequity requires decolonizing methods that advance community members’ self-determination. Whose stories matter? In the latest issue of the Rapid Assessment of COVID Evidence (RACE) Series, Dr. Amani and colleagues offer a valuable qualitative storytelling framework to guide epistemological position, theoretical perspective, methodology, methods for data collection, and embodied practice for health equity. They push us to think about not only whose experiences are not being captured, but also to reflect on how we tell stories. A defining way in which they operationalize studying structural racism is to think about how racism is about interlocking oppressions.
For example, Rhea’s precarity is tied to the precarity of those who are locked up. People in carceral settings–who are disproportionately Black and brown–have been disproportionately susceptible to COVID-19 with little to no ability to safely distance, quarantine, or isolate and limited access to personal protective equipment and testing. One estimate of the COVID-19 burden among the prison population found a cumulative case incidence 3 times that of the general population and double the standardized mortality rate. The pandemic exacerbated existing concerns about poor ventilation, aging infrastructure, and inadequate healthcare for incarcerated individuals. These factors create unsafe conditions for people who are incarcerated and the workers whose livelihoods depend on the carceral system. This illustrates how racial capitalism maintains inequities by entangling marginalized individuals in complex systems of oppression.
We all need to understand historical context and how it connects to today’s health inequities. This blog centered the experiences of FilAm healthcare workers to illustrate how transnational histories can inform immigrant health research. The conditions in which we live are influenced by systemic factors that work across multiple levels of influence to shape decisions, policies, and practices that reveal whose lives have historically been valued. Which connections to health inequities are still overlooked? Advancing racial health equity may seem daunting, yet numerous stories remain untold. May recovering these stories and their historical connections guide our approaches to today’s public health challenges and future freedoms.
