August 17, 2021
From Marxist Sociology
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After roughly three years of sticking to a text-only format, we at the Marxist Sociology Blog are experimenting with something new: a podcast!

For our first episode, MSB editor Barry Eidlin sat down (over Zoom) with Elizabeth Wrigley-Field, assistant professor in the sociology department and Minnesota Population Center at the University of Minnesota. She spoke with us about some fascinating new research of hers regarding COVID, racism, and mortality in the U.S. You can find the podcast recording below, or keep scrolling to read the transcript.

Barry Eidlin  00:04

So hello. Welcome to the first attempt at an experiment here at the Marxist Sociology Blog. After about three years of being all writing, all the time, we are trying out something new here with our first ever podcast episode. I can’t say for sure if this is going to be a recurring feature of the blog, but we’re going to give it a try.

My name is Barry Eidlin. I’m an assistant professor of sociology at McGill University, and one of the commissioning editors here at the Marxist Sociology Blog. We are the official blog of the Section on Marxist Sociology of the American Sociological Association. You can find us online at www.marxistsociology.org.

So, we’re talking about COVID today. The COVID pandemic has upended all of our lives. On the one hand, even for those of us not directly touched by the virus, in terms of those who have been infected, or have had friends or loved ones infected and hurt and even killed by the virus, it has forced us apart from each other. It has highlighted and exacerbated existing inequalities, exposing the divides between those who can work from home and those who either have been forced to put themselves in harm’s way by going into work, or who have seen their livelihoods destroyed because they cannot go into work.

It has laid bare the profound gaps in our care infrastructure, shouldering parents with the impossible burden of caring for their children while proceeding as if everything at work is basically normal, when it is anything but.

On the other hand, the pandemic has blown a huge hole in the logic of fiscal austerity that has loomed large over the political landscape of the past several decades. It has provided an object lesson and the power of what government can do when there is political will.

Against the constant mantra of “we can’t afford it,” we saw that indeed, we can come up with trillions of dollars to direct towards human needs, the same way we can come up with trillions of dollars to fund endless wars, or to provide tax cuts for the rich. While the actual policy responses both in the US and abroad have been far short of what’s necessary, they’ve also been at a level both in size and scope that would have been unimaginable for social policy just a few years ago, particularly in the US.

Needless to say, at the same time as these pandemic-related contradictions and life changing events have created so many personal and political problems to solve, they’ve also generated tremendous amounts of new scholarship, as we academics have dug into trying to understand this new world around us just as it has unfolded.

And that brings us to today’s interview. We’re honored to have with us today as our first guest Elizabeth Wrigley-Field. She is an assistant professor in the sociology department and Minnesota Population Center at the University of Minnesota. Her research focuses on racial inequality, historical infectious disease, and COVID-19 mortality in the United States, which is what she’s going to be talking about today. She’s also a demographic methodologist, who developed new methods of shifting between micro and macro level perspectives.

We’ve invited her here today to discuss some exciting new research of hers related to the COVID pandemic and two papers in particular. One of them is a thought experiment of sorts, comparing black mortality and life expectancy at its best against white mortality and life expectancy in a pandemic. And the other is a more policy focused intervention trying to assess the most equitable means of vaccine distribution.

So, Elizabeth Wrigley-Field, welcome to the inaugural experimental episode of the Marxist Sociology Blog podcast!

Elizabeth Wrigley-Field  04:25

Thanks, Barry, I am honored to be the subject of a Marxist Sociology Blog experiment

Barry Eidlin  04:32

Actually, I should start off by thanking you for suggesting the idea of doing this podcast as it really was your idea in the first place. I made it seem like we had this great idea that “why don’t we branch out into podcasts?” but what actually happened was that I wanted you to do the sort of boring usual thing and just have you write up a piece on your research, but then you suggested, “why don’t we do an interview?” and so here we are. So thank you for thinking of the experiment in the first place!

Elizabeth Wrigley-Field  05:02

Yes, it is a melding of minds.

Barry Eidlin  05:04

Yes, is a mind meld if there ever was one for sure. So anyway, let’s let’s dig in. And I want to start with the first paper, which is one that was published in the Proceedings of the National Academy of Sciences. And this one is measuring black mortality and life expectancy at its peak against white mortality and life expectancy in a pandemic. So first of all, I just want you to start at a basic level, and briefly state the key findings of the study.

Elizabeth Wrigley-Field  05:35

So, the backdrop to this study is something that I found earlier when I was studying the 1918 flu. And this was with two collaborators of mine, James Feigenbaum and Chris Muller. And we did this study of historical infectious disease in the early 20th century. And we found this really striking what we thought was a regional story, where the South is really different from everywhere else.

And in the course of exploring that we realized, this is not really about region, per se, or rather, what it is about region is about the way that racism is encoded into regions, because what we had really found was a story of tremendous racial inequality. The thing that we found that really was stunning to me, was that black mortality in every other year before the 1918 flu was more than white mortality was in the flu. And this was looking specifically at infectious disease mortality and looking specifically in cities. So that was the kind of boundaries around that claim.

But in other words, we found that this level of mortality that we treat as just completely historically unprecedented, the 1918 flu pandemic, it’s almost literally off the charts, we sometimes leave it off charts, because it distorts the graph scale, the mortality is so high that year, so unlike every other year. And what we found is that well, okay, but the white version of that experience was just the year-in, year-out experience for black people living in cities. And that was stunning to us, we actually didn’t believe it. At first, we checked the results, many, many, many different ways until we were totally satisfied that it was true.

And so that that was the backdrop. And so in the early phases of the COVID pandemic being recognized in the United States, it occurred to me to wonder, could it be possible that the same thing would be true this time around? In other words, could it be possible that white mortality during this pandemic would be more than black mortality has ever been up until now?  And I was at a disadvantage in trying to answer that question. Because when I started thinking about this, it was May of 2020. And so of course, I had no idea how much mortality is there going to be in the COVID pandemic in the United States, for white people or for anyone else.

And so I decided to go the other way around and ask, well, how high would white mortality have to be from the COVID pandemic, in order for white mortality in 2020 to rise to the levels of the best-ever black mortality? And what I found is there’s…

Barry Eidlin  08:40

Meaning the lowest?

Elizabeth Wrigley-Field  08:42

Wait, what? Did I say something in reverse?

Barry Eidlin  08:45

No, no, no, no, no, I just want to be clear to our listeners that when you’re talking about the best-ever black mortality, you’re talking about the lowest ever.

Elizabeth Wrigley-Field  08:51

Yes, the lowest ever, that’s right. I wanted to double check, because I often do reverse things out loud, which is a terrible trait in a statistics teacher and demographic modeling teacher, which I am. But I like to think it keeps my students on their toes.  But yeah, so the lowest ever black mortality, also white mortality, was in 2014. So it was before the opioid pandemic crisis really took hold. And so 2014 black mortality was what I used as my benchmark. And the question is, well, how many white people would have to die in 2020 to look like the black population’s mortality in 2014.

Barry Eidlin  09:38

And so then I guess we’re going in a bit reverse order. I was going to ask you where the research came from, but what did you find?

Elizabeth Wrigley-Field  09:51

Yeah, so I was taken aback by these results. So I found that to get the same age-adjusted death rates of the black population in 2014, and I can say a little bit more about what that means, but this is kind of like the workhorse mortality measure, the white population in 2020 would have had to have at least around 400,000 excess deaths in the COVID pandemic.

And in order for white life expectancy to plummet down to the best-ever level of black life expectancy would take between 700,000 and one million excess white deaths in 2020. You get those ranges because it depends on exactly what ages those extra deaths are happening at, and so I looked at that under some different kind of plausible assumptions.

But those numbers basically are really high. And so we don’t have the final mortality figures for 2020 yet, so we don’t have the reality to benchmark that against. But from what we do know, kind of piecing together the excess mortality that we had in October, and some other statistics that we know about 2020, my guess is that the white excess mortality is going to be maybe 300,000, maybe as high as 350,000, but not 400,000.  All of this is a way of saying that, even in this completely devastating past year, white mortality, I believe, will turn out to have been less than black mortality has ever been in the United States.

Barry Eidlin  11:34

Wow, really shocking findings. So what were you expecting to find? Did you have much in the way of expectations? I mean, you had this expectation from the 1918 pandemic, but what was your expectation going in?

Elizabeth Wrigley-Field  11:50

I didn’t have a number, but I also was really floored that it was so high. And, you know, part of the context of that is, you know, I started working on this in May, and I got the bulk of the analysis together in June of 2020. And so if you think about what that time period was, like, we had all just had our lives majorly affected by this pandemic. We all by that point had taken on board the idea that this was this once in a century, unprecedented experience that was going to really radically change our lives.  And so to also take on board the idea that well, what that mortality level is going to mean in the white population is maybe something like the year-in, year-out reality for black people in the United States. That was a very sobering idea.

Barry Eidlin  12:56

Yeah, absolutely. I wanted to get a few of these technical things out of the way before we dig into some of the significance of the findings. So first of all, you did mention this age structure adjustment, so if you could just briefly talk about how you had to adjust the age structure for the two groups.

Elizabeth Wrigley-Field  13:20

Yeah, so if you make mortality comparisons between two populations, and you don’t adjust for age, most of the time, all your comparison is going to tell you is which population is older. Because mortality is so sensitive to age, and it increases so much as we get older. And that’s true for all mortality. And it’s really true for COVID mortality. And in the United States, the white population is a lot older than populations of color. At the national level, it’s about 10 years older, on average. And so that actually makes a big difference to mortality.

So in the population as a whole, white people die at a higher rate than black people do every year. And what that reflects is that age difference. So what you want to be able to do is make a kind of apples-to-apples comparison, where you’re comparing people who are the same age as each other, but still reflecting that in a single number. And the main way that we do that is called age standardization.  Basically the way that works is that you just take the age-specific death rates, so the death rates for black and white 40 year-olds and 45 year-olds, and so on and so forth. And you just weight them according to the same set of weights. The weights that I used are the age structure of the United States as a whole.

Barry Eidlin  14:40

Okay, so that was one technical thing and then the other one, just for those of us who are less versed in quantitative data analysis, can you just explain briefly why it was that you needed so many more deaths to create this, I guess, racial parity for lack of a better term in terms of life expectancy, as opposed to mortality rates? Why do you need the 700,000 to one million excess deaths versus the 400,000?

Elizabeth Wrigley-Field  15:08

Yeah. So mortality rates are telling you how many people are dying in a certain amount of time, like over the course of the year. And life expectancy is telling you, if you took everyone from birth, and then they all experienced these death rates over their lives, how long would they live?  A consequence of asking that kind of question, how long would they live, is that deaths that happen at young ages matter more than deaths that happened later.

And this makes some intuitive sense, if you think about it. So if someone dies as a 10 year-old, they might have many, many decades of life that they would have had, if they hadn’t died. If someone dies as an 80 year-old, they might have, you know, a decent amount of life left, but it’s not going to be many, many decades. And so the 80 year-old’s death is going to have a smaller impact on life expectancy than the 10 year-old’s death is. And because COVID deaths, and deaths in general, tend to happen at older ages, it takes more of them to amass this big difference in life expectancy.

The black-white life expectancy gap is really driven by young ages, both infant and childhood, and then also young adult and adolescent ages. And so it doesn’t take such a large number of deaths at those ages as it does at old ages to equal the same life expectancy difference.

Barry Eidlin  16:40

I see some parallels maybe with the wealth gap in that you have to build up a certain advantage over time, so whites have a sort of built-in advantage with life expectancy, and it takes a lot more to reverse that piled-on advantage over many years.

Elizabeth Wrigley-Field  16:58

Yeah, and there’s always a lot of debate about what’s the right metric. And some in some contexts, I think life expectancy can be really misleading, because it does weight deaths in a way that can be really counterintuitive.  On the other hand, there’s a sense in which I think it is the most human measure, because our lifespan is something that we really care about. It is very meaningful when people die young. And that is the nature of the deaths that we’re talking about when we talk about black-white disparities.

Barry Eidlin  17:35

So yeah, people who had their life ahead of them and are taken away from us.

Elizabeth Wrigley-Field  17:41

Yeah, that’s exactly right.

Barry Eidlin  17:44

Okay, that’s really helpful on the on the technical side of things. And I really appreciate you being able to explain that for a broader audience.  Another thing I’m interested in is if you could break down the aggregate findings. I’m particularly interested to see how these main results vary when you factor in other variables like income, education, region, location, which, obviously, is previewing some findings from your second paper, but for now, we’ll just focus on this, what you found when you broke down the general results.

Elizabeth Wrigley-Field  18:20

So in this study, I did not look at any covariates at all. I was making this descriptive argument. And I was using it to make this kind of ethical argument about how we should respond to these disparities. But I think the question about “what is the relationship of these disparities in survival to inequality in economic outcomes?” is a really important question and also a really complicated one. Some things that we know in general are that racial disparities exist at all points in the socio-economic spectrum. They’re often largest when people are more disadvantaged. That’s not always true, but that’s typically true, and that’s true for most health outcomes.

There are surprisingly few studies that have tried to do systematic decompositions of the total racial disparity in mortality into economic components. There’s a very good study by Michael Geruso who finds that if you just decompose the black-white life expectancy gap into things like income, education, some basic socioeconomic variables, you can statistically account for around three-quarters of that life expectancy gap. Does that mean that if you simply equalized economic outcomes that you would reduce the black-white life expectancy gap by three quarters? No, it does not. Because some of those income gaps and education gaps and other SES [socio-economic status] gaps are reflecting the way that we sort people. And the sorting mechanisms are also related to how we sort people by health. They’re related to how we then sort people into neighborhoods that have different levels of toxicity, how we treat people differently as agents of the state, as police, and all of these other things. So that’s not to say that all the work is happening through economics, but it tells us that these are actually very tightly linked.

Barry Eidlin  20:37

Absolutely. I was going to ask a bit more about the across-group differences if you include the covariates, so if you’re comparing, like, rich blacks with poor whites, what that was like. But part of the hallmark of great research is that it spawns more great research. So I guess you’re laying out yours or another scholar’s future research agenda.

Next, can you tell me a bit about what the reaction has been to these findings so far, what you’ve heard back?

Elizabeth Wrigley-Field  21:22

I got a lot of reactions. So we haven’t really talked yet about the argument that I made around these findings in my piece. But I tried to use them to make a very pointed argument, which is that, in response to the COVID pandemic, we shut down the world. Sometimes there’s a skeptical reaction when I say that, because I think a lot of us, myself included, have the vantage point of thinking about all the things that we could have done, but didn’t do as a society to make the pandemic safer, and to make it liveable for it to be safe. And there’s so much that wasn’t done.

But if you can just abstract from that a minute and think about all that was done, it’s really astonishing. For me, it was about ten days in March 2020 that really radically reoriented all of my plans for the next two years of my life. So I use that to say, this is how we respond to this threat of mass death. Well, why don’t we have the same response to the same scale of deaths happening year in and year out for black people in the United States?

And there’s this way that when you propose radical change to combat racism, you get this kind of immediate response of like, “Oh, that’s not realistic,” or “Well, we have to go kind of slowly and step by step.” And I believe that the pandemic should really blow that response out of the water. Because we have seen that we can completely upend the way that our workplaces are organized, the way we think about our family life, our movement patterns, all these aspects of our daily life, to save lives, if we decide to.

So it makes it very clear that when it comes to racism, we have decided not to do that. That’s the argument I made. And I have gotten a lot of feedback that that argument, for some people, really affected the way that they think, and for some people was very validating. Because if you just think about the slogan, Black Lives Matter, to me the core of this argument is to say, let’s actually reflect on how little we have, as a society, acted as though black lives do matter. And here’s this stunning way to see that anew.

Barry Eidlin  24:12

Because you’re showing that black lives don’t matter, and you’ve got the data to show it.

Elizabeth Wrigley-Field  24:20

Yeah, exactly. And so it should force us to think, well, if we actually were going to act as though Black Lives Matter, what would we have to do?

Barry Eidlin  24:29

Exactly. I know that this is asking you to speak beyond what your data actually show, but I would like you to talk a little bit about what you think is actually driving this massive disparity in mortality and life expectancy?

So at one level, the answer is obvious, in that it’s a clear example of how racism works in society. And we could sort of leave it leave it there. But I’d like to hear you unpack how you think racism works more explicitly. And I’m asking this because I often get a sense that people have trouble really thinking through the systemic part of systemic racism. It’s a phrase we throw around a lot, but it’s often hard to unpack what that actually means.

So on the one hand, we’re sociologists, we understand that race is a social construct with no material basis in genetics or reality. So these differences are not arising from some sort of inherent genetic difference. But on the other hand, I think we tend to sort of conflate racism or racial discrimination with acts of individual prejudice, sometimes maybe backed with power, depending on who’s talking.

So by that measure, we might understand systemic racism as sort of individual black people getting treated differently and worse, repeatedly, in a bunch of different types of social interactions over time, and they all add up together to this massive disparity in mortality. But I suspect that there’s something deeper going on. Would you say that’s accurate in this case? And if so, how would you explain what’s actually going on behind these headline findings that you’ve got?

Elizabeth Wrigley-Field  26:34

Yeah, I think what’s tricky about answering this question is that the answer to “How does this work?” is “Well, it works through everything.” So we, in the United States, distribute health through the market to an extraordinary degree, even relative to other countries. And then we also have crystallized through generations of accumulated racism, vast, vast disparities in wealth that people start out their lives with.

And then that structures everything. It structures where you live. Where you live structures what kinds of toxic exposures will be in your water and in your air, and in your home, in paint. It structures what kind of schooling you’ll have access to. So all of those things matter before you even enter the labor market yourself, where there’s of course a huge stratifying force that will affect the rest of your life. So all of those things, I think, are hugely consequential to health and some of the major mechanisms where health stratification is probably playing out.

But I also don’t want to set that up in any way as an alternative to the kind of day-in, day-out experience of being treated worse by almost everybody and by every social institution. Because I think that that is also really baked into all of these processes. And that matters to health as well. Sometimes I think it’s likely that it matters in some very direct ways.

And so one of the things that’s a big open question for me is where do we want to focus on changing things? Is it inside the medical system? Is it outside the medical system? That’s a tricky question to answer. There’s an incredible study by Marcella Alsan and some of her colleagues where what they did is they set up a health clinic in Oakland, and they got a bunch of black male doctors. And then they also had a bunch of white and Asian male doctors, and black male patients were randomized to have a doctor who was black or who was not black. And the patients who saw black doctors were so much more likely to embrace seeking more healthcare, having preventative health care, getting things like flu shots, getting diabetes screenings, some of the things that we think actually matter.

Alsan and her colleagues argue that the difference is so great that simply having more black male doctors could actually close 19% of the cardiovascular health gap between black and white men, which is just astonishing. You just never ever, ever see effect sizes like that ever. So that’s a totally stunning finding. But where I’m going with this is you could look at that and say, okay, well this is happening, this stratification is happening through the health system. And so that means the key is to provide more black doctors. And we understand that there’s all of these reasons about racism, why there aren’t more black male doctors. And we can talk more about what some of those are, if you want, but we understand that that’s about racism.

On the other hand, you could say, well, okay, but the context in which it really matters, if you get your preventative health screenings, for things like cardiovascular disease, is a context in which you’re likely to have cardiovascular disease. Because the whole rest of your life is set up in a way that puts you at risk, that subjects you to toxic stress every day. That leaves you without enough sleep every day. And so you know, which of these is the key? Is that even the right question? Or is that even an answerable question? So that’s why I think the question about like, “what are the pathways here?” I find tricky, because it really does feel like well, the answer is that it’s all of the pathways.

Barry Eidlin  31:06

Yeah, it is a tricky question. But I think it is helpful to talk about some of these concrete things that you laid out. Obviously, we can’t just say there’s definitely one thing that’s the key to everything, but you provide some great concrete examples that go beyond just saying “this is racism,” actually unpacking what we mean when we say that.

So wrapping up our discussion of the first paper, you just laid out this powerful argument you have, and then you have this really fantastic last line of the paper that reads, “our imagination and social ambition should not be limited by how accustomed the United States is to profound racial inequality.” So to close out the discussion, I’d like to hear you talk more about what it would look like to not limit our imagination and social ambition.

Elizabeth Wrigley-Field  32:14

I wrote the paper last summer, and I live in Minneapolis. So I was writing this after having participated in the uprising for justice for George Floyd. I certainly never expected my own police precinct to burn down. I was amazed and inspired when it did. And I never expected “defund the police” to become a slogan that would so quickly have resonance for so many people and for abolition to become a kind of serious discussion in much larger pockets of the mainstream than it had been.

So one of the things that was really on my mind when I was writing this is thinking about how, in terms of policy discussion, how much the left sometimes shoots itself in the foot or muzzles itself before we ever even say what we want, because we just assume that we can’t have it. And that’s our starting assumption. So then we try to figure out, well, what’s the palatable version that’s a little step forward?

I don’t know all of the things that need to happen to right these wrongs. I truly don’t. But the thing I felt the most, I mean, I can imagine things, I’ve started thinking a lot about what would health reparations look like? We think a lot about reparations for slavery, and there are some very detailed and really inspiring and impressive and I think very convincing proposals that are all based around wealth being the key. And that makes sense, because wealth is the major way that power is organized. If you asked me what the single best proxy for someone’s power is, I would say their wealth. And that makes sense as a way to try to right the wrongs of racism.

But I’ve also started thinking about issues like, if wealth is the proxy for power, maybe the proxy for freedom is time. And if we think about all of these deaths as just the theft of all of this time that people should have had in their lives, that they won’t have, most for the people who die of course, but also for their loved ones, who don’t get to have that overlap in life. You know, what would it look like to try to make that right?

I think at a minimum, we could think really radically about what healthcare should look like. And what would it mean to have a mass infusion of training new black medical workers, and creating new medical centers all across the United States, we can think about mass environmental cleanups, we can think about all kinds of things.

But the part that I feel the most committed to is actually none of these specific policy ideas, but rather the radical scale of action, and the idea that, just in the same way that a lot of us thought we should do whatever it takes to try to keep people safe from COVID, we should say we have to do whatever it takes to try to stop these deaths that happen from racism every year.

Barry Eidlin  36:13

Great, I think there are few demographers who are able to get the tears welling up in the audience, but you do a great job of that.

So just as a reminder to people listening, we’re here in conversation with Professor Elizabeth Wrigley-Field, sociologist and demographer at the University of Minnesota.

I want to move on to this other paper you wrote, which is, as I said, much more policy oriented. It’s more of a report, right? Could you talk a bit just about what the brief was for the report, what the purpose was? It’s really about this question of equitable strategies for vaccine distribution. So whereas the first one is this thought experiment, using COVID to think more broadly about racism in U.S. society, this one is much more focused on COVID itself, and how do we fight it with our vaccination strategy? So can you just talk a bit about the context of what you were asked to do, what was the problem that your research was trying to solve.

Elizabeth Wrigley-Field  37:02

So where this came from, I led a Minnesota and California research team. I’ve been part of an ongoing research team with a really great guy named JP Leider, that’s using death certificate data to look at COVID deaths in Minnesota. And then there’s a similar team in California, that has death certificate data there. And that’s significant because most states actually have not made these data available to researchers. So there’s a lot about COVID that we could know that we don’t, because the data just aren’t there. And so here’s two states where they are. And very different states demographically.

And in most states, including these two, the way that vaccination unfolded was heavily age-based. In Minnesota, that was almost exclusively true. So everyone did health care workers and long-term care residents first, and that was the right thing to do. And then after that, in most places, including here, there was an age cutoff, and then it sort of proceeded by age. And then some states started to incorporate other dimensions of risk before others. So here in Minnesota, from January to March, the situation was basically if you’re 65+, you’re eligible. If you’re younger than 65, you’re not eligible, unless you’re a healthcare worker.

And we used the death certificates from Minnesota and California, to look at who was actually at risk of COVID, to evaluate what it means to have this age-based vaccination eligibility. So the first thing we argue is that age-based vaccine eligibility in the context of the United States systematically prioritizes lower-risk white people above higher-risk people of color.

Again, this goes partly back to those age compositional differences. So for example, let’s say you were going to take out all of the deaths in 2020 that happened above age 65. In Minnesota, in the white population, you would have taken out two-thirds of the deaths. For populations of color, you would have taken out less than half. So just on a basic level, to say we’re going to get rid of these deaths that happen at old ages means prioritizing white deaths. And the numbers are actually very similar in California despite a very different population structure.

Similarly, we show that even if age-based eligibility is justified based on mortality levels, it still ends up prioritizing white lives. So if we’re saying that people who are above 65 should be eligible for vaccination because their mortality risk is so great, that’s certainly true. But people of color in Minnesota have higher mortality at age 50 than the state aggregate at age 65, and they had to wait three months longer for vaccine eligibility. So that’s what we mean about this system has been prioritizing white people, even when people of color who were not eligible were at higher risk. From that setup, we tried to evaluate how well you could do with other kinds of schemes that try to use geographic risk in different ways to set up alternative eligibility structures.

Barry Eidlin  40:49

So tell me more about that. You settle on geographical targeting, and if I recall correctly, you have different ways of getting at geographical targeting. So maybe start by talking a little bit about that and we can continue on from there.

Elizabeth Wrigley-Field  41:20

Sure. So the reason we started really focusing on geography is that we have these populations of color, who at middle ages are at really, really high risk for COVID mortality. And they’re the same kinds of mortality levels that white people are at much older ages, but they haven’t been vaccine eligible. So the question is, how do you make them vaccine eligible?

Well, there’s three ways you could go. You could drop the eligibility for everyone to middle ages. But there’s a lot of problems with doing that when you have vaccine scarcity. So we’re thinking not about now, but in the situation of a few months ago, if you went down to age 50, very quickly, which some states did, you run the risk that really low risk people, relatively speaking, use up all the vaccine. And the high-risk people, whether they’re relatively younger people of color, or they’re old people of any racial group, can’t get access, even though they’re eligible. Because there’s not enough.

Barry Eidlin  42:28

Yeah, it’s the white professors with cell phones and high-speed internet who are going to snag all the appointments.

Elizabeth Wrigley-Field  42:37

Exactly. And so that’s one strategy. It’s a bad strategy. Another strategy is that you could directly target eligibility to race. Some places have done this. And the CDC, actually, kind of backdoor recommends this, because they use something called the Social Vulnerability Index, which is a measure that they developed to try to measure which places are at high risk, and it directly encodes into the index whether populations are non-white, and whether the dominant language is not English.

So that is a viable strategy that places have used. It’s also a very controversial strategy. It’s not clear that it’s legal. It’s also, of course, very politically controversial. And there was also, I think, a fear that it could reinforce fears that the vaccine was a part of a eugenics program. I think those fears are not so strong now. But if you’re thinking back to January, when people didn’t really know other people who had been vaccinated yet, and this thing was very, very new. And we’re thinking about how are we going to reach people now? I think the idea of saying we’re going to target this toward black people, for example, would have made a lot of people justifiably quite fearful of it in ways that could have been very counterproductive.

So for all of those reasons, we recognized that it would be very good to have an alternative that is not directly race-based. And so what we looked at is, if you use geography as a kind race-neutral on its face proxy for risk, how well can you actually do? And then as you said, we used a couple of different strategies for identifying high risk geographies, such as, for example, looking at economically deprived metro areas, which in both of these states, California and Minnesota, is really where the action is for COVID mortality. In California, the next worst places are the economically deprived, more rural areas. Not that rural, but you know, non-metro areas. In Minnesota, where places really are rural, it’s not that at all, it’s kind of normal places in the metro area. So there’s not the same distribution. But in both places, it’s these economically deprived metro neighborhoods, in the big cities, where COVID risk was really extraordinarily high.

Barry Eidlin  45:33

Okay, and so basically, the idea is that by targeting these metro areas, that’s really where you get the most bang for your buck, so to speak, given vaccine scarcity?

Elizabeth Wrigley-Field  45:47

Yeah. And so we look at scenarios where, for example, you’d said, okay, in economically deprived metro areas, when the rest of the state is eligible at age 65, in those areas, you’ll be eligible at age 55, because that’s where your mortality is higher than the state aggregate for 65? If that had been the rule, how much better would you do? And the answer is that you would do better, but you would not do as better as if you did direct racial targeting.

Part of that is because these neighborhoods are not that big. These really economically deprived metro areas, it’s actually not that many people that live in them. And so directing a lot of vaccines there would not have changed the overall aggregate rates by all that much. But to me, that also is kind of tragic, because it’s also highlighting that this is not that many people whose risk was really extraordinary. It would not have taken that many vaccines to really prioritize them and make sure that they have access. And we should have done that. And our states did not do that.

Barry Eidlin  47:07

So it’s a fairly small gesture that could have had these dramatic results.

Elizabeth Wrigley-Field  47:17

Yeah, it’s not that it would have made a really great difference in the overall state mortality rate. It could have made a noticeable difference, but not a huge one. But for those people, I think we have good reason to think that those are people whose risk was really high in 2021, who should have been protected, and they weren’t.

Barry Eidlin  47:49

Yeah, that’s a really important point. So my follow up to this is related to the question I asked about the other paper about the sort of mechanisms or pathways of systemic racism. The way that you’re talking about this geographic targeting is mainly as a sort of more politically palatable proxy for getting at the real underlying problem, which is racism. So to what extent would you say that it’s really a proxy that you’re just doing as a next best option? Or do you see it as really targeting one of the key mechanisms through which systemic racism is working? Or is it some combination of those?

Elizabeth Wrigley-Field  48:42

I do want to say both, I mean, so I think that one way to frame this question is, why were people of color at such high risk? And there’s a lot of debate about how much of that is happening. So in any infectious disease, there’s the risk of exposure, and then there’s also your vulnerability if you’re exposed…

Barry Eidlin  49:04

…given an infection.

Elizabeth Wrigley-Field  49:06

Yeah, exactly. Differences could be driven by either one. And there’s a lot of debate for COVID about which one is really doing the work. There were a bunch of studies that came out last summer on very different populations that were very convincing, arguing that the action is really an exposure. I’ve also seen some pushback that seems convincing, that argues the other way, and I think we’re going to be arguing about this for a long time.

On the exposure side. I think that workplaces are really key. And “workplaces” means not just where you yourself work, but also where do the people that you live with work? Where do people who they come in contact with through work, who do they also live with? So there’s this tight intermingling because our economy and our residences are so segregated together. They have this way of really concentrating risk. And then that’s even more true for populations who live in multi-generational households, where you tend to have patterns of contact where the young people are at great risk of spreading the disease, because they tend to have more social contacts. And the older people are not as much at risk of spreading it, but are at more risk if they get it, and having the two groups living together is very dangerous in a context like this.

So I would characterize most of that as being about exposure. Then on the vulnerability side, there’s co-morbidities, right? And so there’s a whole picture of all of the ways that your experience of American capitalism as a person of color, put you at bodily risk that then get compounded in the pandemic, or have all these extra risks attached to them, should you be exposed to COVID. But vulnerability can also look like if you come down with COVID, and you call 911 because you can’t breathe, do the paramedics believe you and take you to the hospital? Or do they say that’s just an asthma attack, and leave you, as happened to a number of people in New York last spring, where I was at the time, including some people who then died?

So that’s not that’s not part of our stereotypical picture of what vulnerability given exposure means. But that is part of vulnerability: do you have access to care? And that’s also been structured by racism in very dramatic ways.

Barry Eidlin  52:03

Completely. So that’s some really key findings that you got from from this comparative Minnesota-California research. I’d like to hear what has come of this. So were you able to shift vaccine distribution strategies in any way as a result of your research?

Elizabeth Wrigley-Field  52:29

Yeah, this is kind of a mixed bag. On the level of shifting state policy, no. On the level of shifting health system policy, yes. And in Minnesota, that matters, because we had an extremely decentralized vaccine distribution plan. So basically, the state set these really broad eligibility guidelines, but then within those guidelines, all of these individual health systems, like this network of hospitals, for example, they all had the freedom to set their own criteria for who they would prioritize and how they would do outreach to them.

So JP Leider and I started presenting some of these results around late January to two health systems here in the state. We only had an early version of the results then, but we had these key points about why age-based eligibility alone prioritizes lower-risk white people above higher-risk people of color, and the results made a big impact on some of the health systems.

That actually was a little bit surprising to me, because I’m a demographer, and you know, saying that age structures matter is sort of the demographer’s platitude. But the people who we were talking to are experts in individual level health in a way that I’m totally not. But some of these points about, how, for example, you know that age really matters, and you know that race matters to COVID. But you haven’t actually recognized that there’s a tradeoff between the two, because the white population is older than populations of color. And that means there’s a tension here. Those were actually new ideas to them.

And so we started working with some health systems and weighing in on their plans. So I would say that these results had an impact at the margins, but not in central reorganization of the vaccine distribution, nothing like that.

Barry Eidlin  54:37

Yeah, so we sociologists have still not stormed the Winter Palace, unfortunately.

So, this has been really fascinating this discussion. I’ve been just talking with Elizabeth Wrigley-Field, sociologist at the University of Minnesota. Is there anything else you want to add about sort of some global remarks about the key takeaways from this research and maybe something about what lies ahead?

Elizabeth Wrigley-Field  55:07

Oh, gosh, I don’t know. What a year it’s been. In terms of what lies ahead in research, I think there’s a lot that we’re going to be trying to unravel about COVID for quite a long time. And one piece that is particularly of interest to me right now is this idea that, as you know, what we’ve been talking about just now is all about deaths that were recorded as COVID-related. But there’s also a lot of deaths that were not recorded as COVID-related. And there were more deaths among people of color that happened in 2020 in excess of what would have been expected than there were for white people. So understanding whether that was because people of color were less likely to have their COVID diagnosed? Was that because having other aspects of the medical system shutting down was particularly disadvantageous to people of color? Or what was it? So that’s a near-term target, I’m actively working on that, and so are many other people.

There’s things like that, but I think there’s also a set of bigger-picture kind of things that are at stake. For me, I think the finding that white mortality last year was probably still not as high as black mortality always is, every year…

Barry Eidlin  56:39

…at its best.

Elizabeth Wrigley-Field  56:40

…yes, at its best, that was a reorienting finding for me. And I think this question of just grappling with all of the time that is being taken from people out of their lives that they should have, and that their loved ones should have with them. And thinking, trying to figure out, well, what are the things that would make the biggest difference to start to try to undo that and make it right for the next people? Who that hasn’t happened to yet? I think that is really the question that I hope to be working on for a long time.

Barry Eidlin  57:31

That’s a great way to end things for this discussion. I’m sure there’ll be plenty more to come. But for now, I really want to thank you for your time. Professor Elizabeth Wrigley Field from University of Minnesota. Thank you for this inaugural episode of may be a recurring feature the Marxist Sociology blog podcast. So thank you very much for being with us.

Elizabeth Wrigley-Field  57:51

Thank you, Barry.

Barry Eidlin  57:55

Thank you for listening to this episode of the Marxist Sociology Blog podcast. I’m your host, Barry Eidlin. Thanks to the Section on Marxist Sociology of the American Sociological Association for sponsoring the blog and this podcast, and thanks to our editor in chief, Mike McCarthy. For more accessible summaries of current Marxist sociological research, check us out online at www.marxistsociology.org. Until next time, stay inquisitive, and never underestimate the power of the organized working class.

Elizabeth Wrigley-Field is an assistant professor in the sociology department and at the Minnesota Population Center at the University of Minnesota.

This interview is based on Elizabeth Wrigley-Field, “US Racial Inequality May Be As Deadly as COVID-19,” Proceedings of the National Academy of Sciences, 117(36), 21854-21856 (2020), and Elizabeth Wrigley-Field et al, “Geographically-targeted COVID-19 vaccination is more equitable than age-based thresholds alone,” https://doi.org/10.1101/2021.03.25.21254272 

Image: Workers at an Amazon fulfillment center in Staten Island, N.Y., protest conditions in the company’s warehouse in March, 2020 (Bebeto Matthews / Associated Press)




Source: Marxistsociology.org