ABSTRACT

People of color are over-represented relative to their shares of the total population in coronavirus infections, hospitalizations, and deaths. The same is true for people living in over-crowded multi-generational households. Because people of color are more likely to live in multi-generational households than are Whites, the pandemic is having a double whammy effect in communities of color throughout the U.S.

Strikingly, health officials considered neither race nor living arrangements in the phase-one vaccine rollout. In what essentially constitutes a race-blind strategy, they prioritized instead age—adults 75 or older (subsequently expanded to those 65 and older)–and occupation–essential health care workers–in vaccine administration.

Critically, even this very limited phase-one rollout ignores racial disparities in vulnerability to the deadly virus. Due to a legacy of discrimination in all walks-of life, Black older adults are three times more likely to live in poverty than White older adults are. They are also more likely to live in structurally deteriorating housing and dangerous neighborhoods that compromise their immune systems and adversely affect their health and well being in other ways. Moreover, non-white essential workers are more likely than their White counterparts are to live in multi-generational households. All of these factors increase the risk of infections in these households.

Multi-generational households take on multiple configurations. Consider these three types, which illustrate the complexity of such living arrangements among people of color.

Prioritize High-Risk Demographics in Vaccine Rollout

People of color are over-represented relative to their shares of the total population in coronavirus infections, hospitalizations, and deaths. The same is true for people living in over-crowded multi-generational households. Because people of color are more likely to live in multi-generational households than are Whites, the pandemic is having a double whammy effect in communities of color throughout the U.S.
Strikingly, health officials considered neither race nor living arrangements in the phase-one vaccine rollout. In what essentially constitutes a race-blind strategy, they prioritized instead age—adults 75 or older (subsequently expanded to those 65 and older)–and occupation–essential health care workers–in vaccine administration.

Critically, even this very limited phase-one rollout ignores racial disparities in vulnerability to the deadly virus. Due to a legacy of discrimination in all walks-of-life, Black older adults are three times more likely to live in poverty than White older adults are. They are also more likely to live in structurally deteriorating housing and dangerous neighborhoods that compromise their immune systems and adversely affect their health and well being in other ways. Moreover, non-white essential workers are more likely than their White counterparts are to live in multi-generational households. All of these factors increase the risk of infections in these households.

Multi-generational households take on multiple configurations. Consider these three types, which illustrate the complexity of such living arrangements among people of color.

• Some are headed by an older adult (single, divorced, or widowed) or adult couples (married or cohabitating) with an adult biological child (two generations) and, in some instances, a biological grandchild (three generations) living in the household.
• Others are made up of younger married or cohabitating couples who are taking care of an aging parent or parent- in-law (two generations) and their own biological child or children or some other relative (three generation) also may be living in the home.
• Then there are households where grandparents—oftentimes it is a single, divorced, or widowed grandparent—are taking care of a biological grandchild or multiple grandchildren due illness, institutionalization, or death of the biological parent(s) (missing generation).

Essential workers can be present in any of these multi-generational households. Family members who have moved “home” to escape the risks in larger cities and to reduce expenses as well as non-relatives also can be present. Overcrowding is often a defining characteristic.

We use the incidence of over-crowded living conditions, known incubators for virus spread, to illustrate the problem with the current vaccine rollout strategy. The U.S. Census Bureau considers overcrowded any household with more than one occupant per room (excluding bathrooms).

Using this definition, overcrowded conditions existed in 4% of U.S households (4.8 million) and 3% of North Carolina households (107,619) in 2019. Disaggregating the data by race, overcrowded conditions were much less likely in White households than non-White households in both the U.S. and N.C.

Overcrowding was especially high among Hispanics (11.8%)—almost twelve times higher than the rate of overcrowding for non-Hispanic Whites in the U.S. (1.4%) and in N.C. (1.0%). Hispanics accounted for 38% of all overcrowded households in the U.S. and 29% of all overcrowded households in N.C.

Looking across all race/ethnic groups, compared to their distribution in the total U.S. and N.C. populations, Whites are grossly under-represented and Asians, Blacks, Hispanics, and every other non-white group (including some other race and mixed race households) are either at population parity (Blacks nationally) or over-represented in households experiencing overcrowding—a condition that likely amplifies coronavirus exposure and transmission.

The next phase of vaccine administration must take into account the effects of overcrowded living arrangements because of the increased risk of exposure to and spread of COVID-19. In such situations, the priority target for vaccinations must be every individual in the household. Until we align vaccine rollout with the true demography of high-risk exposure and transmission, the battle to harness the pandemic will continue and the deadly virus, unfortunately, likely will continue to overcome lives and compromise the economic viability of our nation and the state of N.C.

About the Authors

James H. Johnson, Jr. is the William Rand Kenan, Jr. Distinguished Professor of Strategy and Entrepreneurship in the Kenan-Flagler Business School and Director of the Urban Investment Strategies Center in the Frank Hawkins Kenan Institute of Private Enterprise at UNC-Chapel Hill.

Jean Milliken Bonds is a Professor of the Practice, Impact Investment and Sustainable Finance in the Kenan-Flagler Business School and the Department of Public Policy at UNC-Chapel Hill.

Allan M. Parnell is a Senior Research in the Kenan Institute’s Urban Investment Strategies Center and Vice President of the Mebane, NC-based Cedar Grove Institute for Sustainable Communities.

The Kenan Institute serves as a national center for scholarly research, joint exploration of issues, and course development with the principal theme of preservation, encouragement, and understanding of private enterprise.

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