Report ties COVID-19 deaths to poverty, systemic policy failures

People who lived in the nation’s poorest counties have died from COVID-19 at nearly twice the rate of people in wealthier counties, according to a new report released Monday.

And death rates in poor counties compared to those in wealthy ones grew even more sharply over the last year, in a series of successive COVID waves, states the report, produced jointly by the UN Sustainable Development Solutions Network (SDSN) and the Poor People’s Campaign.

At a press conference Monday morning the Rev. Dr. William Barber II, co-leader of the Poor People’s Campaign, called the findings “shameful.” The press conference was livestreamed from Washington, D.C.

“We cannot say, based on the research, that this is because of individual choices or behaviors,” Barber said. “COVID-19 did not discriminate, but we did. And our discrimination created terrible blind spots that produced the burden of death on so many families that did not have to experience it.”

COVID-19 data doesn’t systematically track information about the incomes or occupations of people who have fallen ill or died from the pandemic. The study instead compares the overall wealth or poverty in a county with that county’s COVID-19 death rate.

The nation’s more than 3,000 counties were sorted based on the collective income of each county and sorted from most wealthy to least wealthy into 10 groups of counties relatively equal in size. The counties were compared on the basis of their COVID-19 death rates as well as other demographic information.

Overall, in the poorest counties, where median incomes ranged from $12,000 to $46,000 a year, COVID-19 death rates were more than double those in the wealthiest counties, with median incomes of $90,000 to $142,000 a year, said Alainna Lynch of SDSN.

In setting a threshold for defining who is poor or near-poor, the report uses $28,000 for a single person and $54,000 for a family of four. Those numbers are twice the federal poverty guidelines, which researchers say don’t sufficiently measure poverty in the U.S.

“What this allows us to see is both the true extent of poverty and economic insecurity, which we don’t always see because of those definitions,” said Shailly Gupta Barnes, policy director for the Poor People’s Campaign.

When the counties are sorted by the percentage of people whose incomes are below the report’s poverty threshold, the least-poor counties, with 8% to 19% of people who had incomes below that cut-off point, had about half the COVID-19 deaths as the poorest counties, where between 42% and 94% of people had incomes below the report’s standard.

Marathon County in central Wisconsin falls between those two extremes. The county’s median income of $62,000 a year is higher than in many other places, the report observes. At the same time, one in four residents of the county has an income below the report’s poverty threshold. The county’s COVID-19 death rate is 342 per 100,000 population, according to the report.

“At times, our county’s rate of hospitalizations and COVID deaths and hospitalization led the state,” said Bruce Grau, a coordinator for the North Central Wisconsin chapter of the Poor People’s Campaign.

The report includes the following excerpt on North Carolina’s Wayne County:

Wayne County is a rural county in Eastern North Carolina. Approximately 42% of its residents live under 200% of the poverty line, nearly half of the county is rent-burdened, and its uninsured rate (12.6%) is more than two and a half times the uninsured rate in the wealthiest counties of the country. Its residents are 53% white, 30% Black and 11.8% Hispanic or Latino. During the pandemic, it had a death rate of 302 out of 100,000.

Nationwide, death rate gaps were even larger in more recent phases of the pandemic. In the third wave, from late 2020 to early 2021, “death rates were four and a half times higher in low-income counties than they were in high-income counties,” said Lynch. And death rates were five times higher in low-income counties in the surge of the delta variant, which began in mid-2021, and three times higher during the omicron variant’s surge in late 2021 and early 2022.

“One of the main points in this report is that practices before COVID-19 created the conditions for unequal pandemic outcomes,” Lynch said. Well before March 2020, the U.S. was “lagging behind other high-income countries around the world” when it came to measures of population health such as life expectancy, she added.

Vaccine rates don’t explain the difference, said Lynch. There is, however, evidence of racial difference, she added: counties with a larger proportion of people of color had higher death rates, a pattern especially visible in the South and Southwest.

Barber called attention to the report’s data showing that, in raw numbers, many more white people have died from COVID-19 than other groups. But the study’s data showed that among people of color, a larger percentage died. Both details are important, he said: “We have to tell both stories.”

The report also adds further impetus for the Poor People’s Campaign planned June March on Washington to draw attention to the issue of poverty and income inequality in the U.S. Barber renewed the organization’s call for President Joe Biden as well as other leaders to meet with the campaign and “put addressing poverty and low wealth at the front and center of our nation’s moral agenda.”

The report’s findings confirm other research that has shown the link between poverty and COVID-19, says Tiffany Green, a University of Wisconsin economist who researches the impact of race and economics on health.

“This is not about individual behavior,” Green said in an interview. “It’s about what kinds of social conditions place people at risk.”

Early in the Wisconsin pandemic, outbreaks occurred in the meatpacking industry in Brown County. “And because of the way our occupational system is structured, they were disproportionately likely to be Hispanic immigrants,” Green says. “And they were working under conditions that were not properly regulated, that were not safe, when it comes to trying to prevent COVID.”

For people with lower incomes, “They’re more likely to work in these industries that are not protected,” she adds. “And so it’s not surprising that these are the folks that would be disproportionately affected.”

That’s a central point of the report as well.

“Too often, we blame the poor for what are really systemic policy decisions that are outside their hands, decisions that are made for poor communities, but decisions they would never make themselves,” said Gupta Barnes, the Poor People’s Campaign policy director.

She listed the minimum wage, access to health care, paid family leave and child care for workers, and access to enough food and to clean water at work and child care. “These are all policy decisions, choices — meaning that policymakers decide these questions, not the people whose lives are impacted by those decisions,” she said.

And who died in the pandemic “was also a policy choice,” Gupta Barnes said. “It was a choice to not see poverty — whether it was white, Black, Latina, native, indigenous, or all of the above. It was a choice to have these death rates, and to not prioritize the poor across race, across geography, in the worst public health crisis in this country.”

Erik Gunn is a reporter for the Wisconsin Examiner which first published this report.