Ageism and African Americans

Understanding the Combined Negative Impacts of Racism and Ageism

Several decades before “intersectionality” was first popularized, Lindsey wrote about the concept of “double jeopardy” to define and described the combined negative impacts of racism and ageism and race- and age-based discrimination of older Black adults and argued that Black older adults’ experience of ‘double jeopardy’ is reflected in poorer health profiles, higher rates of poverty, and fewer years of formal education compared with their age and race counterparts.  As the nation remembers the important work of Martin Luther King, and contemplates what still needs to be done, this adapted excerpt from “Ageism, Race and Ethnicity”, available from the Older Persons’ Rights Project (www.olderpersonsrights.org), provides a reminder of the challenges that older African Americans face in combatting ageism and racism.

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Several decades before “intersectionality” was first popularized, Lindsey wrote about the concept of “double jeopardy” to define and described the combined negative impacts of racism and ageism and race- and age-based discrimination of older Black adults and argued that “Black older adults’ experience of ‘double jeopardy’ is reflected in poorer health profiles, higher rates of poverty, and fewer years of formal education compared with their age and race counterparts”.[1]  Chatters et al. described Lindsey’s concept of “double jeopardy” as “foreground[ing] racism and ageism as prominent and highly ingrained beliefs systems and practices that produce and maintain systematic social exclusions and discrimination affecting older Black Americans” and went on to call for “linking Black race and older age” as a means for gaining “a more nuanced understanding of the social and life circumstances confronting older Black adults”.[2]

The Administration for Community Living (“ACL”) reported in 2018 that the African American older population was growing in line with general trends for America’s older population and that the non-Hispanic African American population age 65 and over was 4,587,094 in 2017 (9% of the older population in the US) and projected to grow to 12.1 million by 2060 (13% of the projected older population in the US for that year).[3]  Life expectancy at birth for African Americans (non-Hispanic) in 2017 was 71.5 years for men and 78.1 years for women, and life expectancy at age 65 was 16.2 years for men and 19.5 years for women.   Among the details on the lives and experiences of older African Americans presented in the report were the following[4]:

·         Education: The report noted a significant increase in educational attainment among older Americans, including African Americans, in recent years.  Between 1998 and 2018, the percentage of the African American population age 65 and over that had finished high school rose from 44% to 78% and the percentage of members of that group who had a bachelor’s degree or higher increased from 7% to 20%.  While these changes were impressive, older African Americans still lagged behind the figures for all older persons: 87% for high school graduation and 29% for receipt of bachelor’s degree or higher.

·         Family:  In 2018, 38% of older African Americans (non-Hispanic) were married, 27% were widowed, 17% were divorced, 5% were separated (including married, spouse absent), and 13% had never been married; and in that same year, 39% of African Americans (non-Hispanic) age 65 and over lived alone (36% of men and 41% of women).  35% of the African American grandparents age 60 and over living with their grandchildren had responsibility for them.

·         Economic Security:  Figures on income and poverty among older African Americans were sobering.  For example, households containing families headed by African Americans age 65 and over reported a median income of $43,705 in 2017, far below the comparable figure ($61,946) for all older households in the US.  Similarly, the median personal income for older African American men was $22,485 and $15,817 for older African American women in 2017, while comparable figures for all older persons in the US that year were $32,654 for men and $19,180 for women.[5]  The poverty rate for African Americans age 65 and older was 19.3% in 2017, which was double the rate of 9.2% for all older Americans.

·         Health:  According to the report, the top 5 leading causes of death for African American (non-Hispanic) men age 65 and over in 2017 were heart disease, cancer, stroke, diabetes and chronic lower respiratory diseases, and the top 5 leading causes of death for women in that age group were heart disease, cancer, stroke, Alzheimer’s disease, and diabetes.  39% of older African Americans reported having one or more disabilities as of 2017.  32% of older African Americans had both Medicare and supplemental private health insurance as of 2017, compared to 46% of all older adults, and 13% of older African Americans (compared to 7% of all older adults) were covered by both Medicare and Medicaid.

The American Psychological Association (“APA”) has noted that while African American older adults are living longer, as is the case with the general population of older adults, their experiences in older age differ from the white counterparts in many ways including significant health disparities, including lower life expectancies and an increased risk of chronic health conditions such as hypertension, diabetes, dementia, stroke, and cancer.[6]  The APA also reported that research has indicated that “African Americans—young and old—experience subtle and overt forms of racial discrimination” and that “African American older adults … [have] … experienced cumulative race[1]related stressors that negatively impact their physical and mental health”.   

The APA explained that “[r]ace-related stress occurs when an individual experiences or witnesses racist incidents that evoke social and historical experiences of racism” and that the exposure of African American older adults to cumulative experiences of racism “has resulted in limited access to resources such as education, employment, health care, housing, and political participation, contributing to health disparities and increased rates of mental health disorders such as depression, anxiety, and dementia”.  According to the APA, race-related stress among African American older adults has also been exacerbated by limited access to community resources (e.g., grocery stores, pharmacies, culturally competent health and aging service providers, transportation, housing, etc.) which has created significant barriers to the achieving of healthy and productive aging.

A 2019 study by the Pew Research Center found that a majority of Black adults said they had been discriminated against because of their race, but that the incidence varied significantly based on education: 81% of Blacks with at least some college experience said they had experienced racial discrimination while the percentage among Blacks with a high school education or less was 69%.[7]  College-educated Blacks were also more inclined to believe that their race had negatively impacted their ability to succeed than Blacks with a high school education or less.  Other studies suggested that these differences could be attributed to the fact that college-educated Blacks are more likely to work in predominantly white environments, thus increasing their exposure to race-related prejudices, and that college-educated Blacks may have a keener sense of awareness of racial discrimination due to their experiences in classes and professional organizations.  The study also found that Black men were far more likely than Black women to say that they had been unfairly stopped by the police.

In its 2021 report on the results of a survey among older African Americans with respect to their concerns and experiences relating to racism and discrimination, the research arm of AARP noted that the “consequences of racism for economic security are broad and recurring” and referred to observations by the Center for American Progress that “wealth is vastly unequally distributed across the United States … [and] … Black households have a fraction of the wealth of white households, leaving them in a much more precarious financial situation when a crisis strikes.”[8]  Williams and Wilson, both public health experts from Harvard, have continuously cited the wealth gap between white Americans and people of color in the US as being the most significant of the various stressors on people of color.  They noted that the wealth gap is 10 times larger than income inequality for African Americans and Hispanics and leads to constant insecurity and stress due to the lack of resources necessary to cope with the uncertainties of day-to-day life.[9]  Chonody and Teater also reported that people of color are likely to earn less money than white people and more likely to live in poverty, and that those who live in poverty lack the financial resources to access other resources necessary for physical and mental wellbeing, such as paid caregiving as a person ages.[10] 

According to AARP, historically discriminatory policies have made economic security difficult for many African Americans to attain.[11]  Along with other economists and sociologists, Williams and Wilson identified a range of factors that contribute to the wealth gap including isolation of people of color in impoverished neighborhoods, lack of access to steady jobs, lack of reliable health care, a dearth of family and community supports and inadequate educational opportunities (i.e., poor schools in the neighborhoods where people of color live and lack of early childhood education).[12]  For example, there is a large gap between people of color and white Americans with respect to educational attainment as measured by rates of high school and college completion.  Lower completion rates among people of color have been attributed to various factors, notably lack of opportunity and social structural barriers, and the studies have shown that these disparities reduce life expectancy and have a lifelong impact on income, wealth, health and mortality.[13]  Wilson called for addressing these issues through changes in governmental fiscal policies to redistribute resources, including reform of tax and welfare policies and new investments “to improve neighborhoods where people reside as well as the institutions that serve them”.[14]

Williams has also argued that racial and ethnic inequalities ultimately end up in the area of health and that health inequalities in the US are leading to faster lives and quicker deaths for people of color.[15]  On the same issue, Powell noted: “Health inequality is part of American life, so deeply entangled with other social problems—disparities in income, education, housing, race, gender, and even geography—that analysts have trouble saying which factors are cause and which are effect. The confusing result, they say, is a massive chicken-and-egg puzzle, its solution reaching beyond just health care. Because of that, everyday realities often determine whether people live in health or infirmity, to a ripe old age or early death.”[16]  The challenges for African Americans and other people of color were described by one public health expert as follows: “If you’re born a black man in, let’s say, New Orleans Parish, your average life expectancy is worse than the male average of countries that are much poorer than America.”[17]

Williams referred to studies showing that Black Americans contract serious diseases sooner than white Americans; the racial gap in life expectancy has been halved from eight years to four, but it would take another 30 years for the life spans to become equal, assuming that the average longevity of white Americans remains static; the longer that Hispanic immigrants live in the US, the less healthy they become; and standard measures of health (e.g., blood pressure and cholesterol levels) show that the bodies of African Americans at midlife have aged 10 years faster than those of white persons, a sign of premature aging that Williams attributes to an “onslaught of chronic, ongoing physical, chemical, psychosocial stressors”.[18]

Powell noted that inequalities in access to adequate health insurance, which provides people with the financial means to pay for their health care and remain free of conditions that would make it difficult for them to work and provide care to their families, have dominated the public discussion in recent years.  However, health insurance is just one of several related problems in the health area, and Powell pointed out that consideration also needed to be given to disparities in health itself (e.g., rates of asthma, diabetes, heart disease, cancer, suicide, drug abuse, smoking, accidents, violence, and other afflictions) and disparities in care (e.g., access to hospitals, clinics, doctors’ offices, skilled professionals, medical technology, essential medicine and proper procedures to deal with illness and disease).[19]  Access to basic primary care services is a problem for many Americans, regardless of economic or racial status, and public health specialists argue that poor patients often get worse health care and that African-Americans and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals due, at least in part, to “implicit bias” of health professionals toward those minorities.[20]  Solutions suggested by the experts that Powell consulted included earlier diagnoses of ailments, universal health insurance, better patient education, more preventive care, wider access to technology, stronger primary care, broader family- and sick-leave policies and social systems supporting health.

According to AARP: “Older African Americans are not a monolithic group with uniform opinions or experiences.  African Americans born in 1964, for example, the year the Civil Rights Act passed, will turn 57 years old this year.  In contrast, African Americans who are 75 or older were already 18 years old when the landmark legislation was signed into law.  On the other hand, those who are 45 … were born in 1976.  For these Generation X Americans, Martin Luther King Jr. and the civil rights marches were historic events, rather than events that occurred during their lifetime.”[21]  The point, according to AARP was that “[e]ach of these cohorts entered the world at a different point, but their experiences are linked and, unfortunately, in many ways very similar”, and AARP went on to report that four out of five (81%) African Americans aged 45 or older thought that racism was a big problem, and half reported that racial discrimination had negatively affected their well-being.[22]  Racial and age discrimination were both significant challenges for older African Americans; however, they were more likely to be adversely affected by racial discrimination given that 24% of the group said that age discrimination had negatively affected their well-being as compared to about half of the same group reporting that racial discrimination had that negative impact on them.[23]

The impact of racism on economic security among all Black Americans has been noted above, and it is not surprising that AARP reported that while nearly all older Americans (88%) felt that Social Security was important, having adequate Social Security benefits was important to an even higher percentage of older Black Americans (93%) across all subgroups including those aged 45-49 and 65 and over.[24]  Other economic concerns are also more urgent for older African Americans that the general population of all adults in the same age group.  For example, four out of five (82%) African Americans aged 45 and over believed that age discrimination in the workplace is extremely or very important, while the comparable percentage for all adults in the same age group was 69%.  In addition, older African Americans were more concerned about protection from consumer fraud and unfair financial practices.  Overall, AARP found that “older African Americans are more likely to report being affected by discrimination and economic issues, while all older Americans are more likely to focus on a broader set of societal issues” such as climate change, natural disasters and the opioid epidemic.[25]  As a result, older African Americans prioritized the economic health of their communities and ensuring that there were good employment opportunities and access to ongoing job training to maintain skills in their community.

A May 2021 article in The Washington Post reported on research that found that “[f]or Black workers, age discrimination is highest for the youngest, falls in middle age, and rises once more as workers near retirement”.[26]  The insights were based on experiments conducted at Texas A&M University and data from the Department of Labor independently reviewed by The Washington Post that confirmed the “Black workers are typically less likely to be hired than White workers with the same experience, but the gap closes in middle age”.  According to the article, this pattern of discrimination explains why unemployment among younger Black workers remained distressingly high (the highest levels of unemployment for any demographic according to the article), which means that White workers start their careers with a tremendous advantage in the workforce and eventually leads to wide disparities in accumulated wealth between typical White and Black families in America later in their lives. 

The article noted that many economists and labor markets experts were skeptical of the assertion that “hiring managers would actually prefer middle-aged Black workers over their white peers” and it was suggested that the results might be attributed to the fact that the research involved hiring for entry-level jobs.[27]  According to one economist with extensive research experience on Black Americans in the workforce, young White managers might find it easier to imagine a Black person their parents’ age doing certain medial jobs that they would never consider for their own parents.  Another possible explanation was that employers might perceive middle-aged Black workers to be a bargain since their lack of experience and qualifications due to difficulties in finding employment in their younger years could be used to justify paying them less.  In any case, even if there is a “middle-aged bump” in employers’ preferences for Black workers, older Black workers interviewed for the article reported that they were underpaid and under-promoted during the prime years of their careers and the data is clear that discrimination rises as Black workers near retirement age.  Economists reported that many employers avoid older Black workers because they are less educated and perceived as being vulnerable to well-documented health challenges due to the fact that they are more likely to have spent their time in physically demanding jobs.  Economists agreed that discrimination against Black workers over the course of their working lives results in their having few assets and income in retirement, pushes them into lower-quality jobs and makes them more likely to leave the labor pool entirely.

The relevance of Lindsey’s concept of double jeopardy for older Black Americans—the combined negative impacts of racism and ageism—was explored by Chatters et al. in their October 2020 article on how Black Americans fared during the Covid-19 pandemic and how looking at the situation with an understanding of the concept might have guided policies and actions to provide better protection to older Black adults during the emergency.[28]  The higher risks for coronavirus exposure for older adults in general have been well-documented[29], but what is often neglected are the supplementary risks confronting older Black adults due to long-standing race- and age-based inequities and social vulnerabilities including family and household composition, social isolation and loneliness, racial residential segregation, conditions in nursing homes and congregate living settings and the importance of participation in faith communities.  Exploring these risks leads to a better understanding of why the pandemic had a disproportionately negative impact on older Black adults in the US.

Chatters et al. presented data from APM Research Lab that found that as of September 2020 race and ethnicity was reported for 95% of the 171,000 Americans who had died of Covid-19 up to that time and that the mortality rate for Blacks was higher than the rate for Indigenous, Latinx, non-Hispanic whites and Asians (in relation to non-Hispanic whites the mortality rate for Blacks was 3.4 times higher).[30]  August 2020 data from the Centers for Disease Control and Prevention (“CDC”) painted a similar picture, showing that Black Americans had higher rates of Covid-19 deaths across all age groups, with differences being particularly significant among persons 65 years and older.[31]  The devastation caused by the pandemic among older Black Americans should not have been surprising given that they lived in two high-risk categories.  Chatters et al. explained that “[o]lder adults are at greater risk of death due to reduced immune function (i.e., immuno-senescence) and higher rates of comorbid health conditions such as hypertension, diabetes, and obesity” and “Black Americans, both young and old, experience poorer health profiles (i.e., diabetes, hypertension, asthma) and life circumstances (poverty, environmental pollution) that are associated with higher mortality rates from COVID-19”.[32]

Chatters et al. argued that the disproportional impacts of the Covid-19 pandemic among older Black Americans were associated with, and exacerbated by, various practices and policies that shaped the key life circumstances and access to resources for this group in ways that elevated their already high risks in relation to the virus.  According to the authors: “long-standing race- and age-based inequities and social vulnerabilities … [produced] … devastating COVID-19 related deaths and injuries for older Black Adults”.[33]  For example, they noted that “Black Americans are more likely than non-Hispanic Whites to reside in multigenerational and extended family households that include grandparents, cousins, aunts, and uncles” and this pattern of shared residence placed older Black Adults at higher risk of being exposed to, and contracting, the virus from members of the same household who were engaged in high-risk activities as essential workers during the pandemic (according to the CDC, Black Americans were much more likely to be employed as essential workers in jobs (i.e., bus drivers, grocery store clerks and nursing home assistants) that required daily travel and extensive interactions with others outside the home that raised the risk of being exposed to the virus and bringing it back into their households where it could be spread to vulnerable residents).[34] 

In addition to family and household composition, the authors identified several other preexisting circumstances among large numbers of older Black Americans that likely contributed to the challenges they faced during the pandemic.  For example, while living in multigenerational households carried significant risks as outlined above, it did provide emotional support and companionship, as well as ready access to family members who could perform activities and run essential errands outside of the house (e.g., to pick up groceries and prescriptions).  Older Black adults living on their own, without this type of support, were placed at risk from social isolation and loneliness, particularly given the restrictions on contact due to social distancing mandates.  This was a risk shared by all older Americans living on their own and the Pew Research Center found that only 59% of adults 65 and older had access to home broadband services in 2019 compared to 80% of adults under the age of 65; however, older Black adults were even less connected than their peers since the data showed that the percentage of Black Americans with home broadband services (69%) was significantly lower than the percentage among non-Hispanic white adults (79%).[35] 

Chatters et al. reported that “[b]lack older adults [were] more likely than their white counterparts to live in neighborhoods characterized by [racial residential segregation (RRS)]”, thus making them more vulnerable to the place-based risk factors associated with RRS that put them at increased risk for contracting the Covid-19 virus including “environmental exposures (e.g., air pollution), lack of health-relevant resources (e.g., Covid-19 testing and information, medical resources) and inadequate infrastructure (access to clean water, public transportation, and health food access).[36]  In addition, the authors wrote that older Black adults living in nursing homes were subject to “long-standing racial and ethnic disparities in financing, access, and quality that result in lower levels of oversight and clinical care in nursing homes serving communities of colors”.[37]  As a result, it was not surprising that evidence indicated that nursing homes where African Americans made up a significant portion of the residents (25% or more) were two times more likely to have Covid-19 cases than nursing homes in which the proportion of residents was at least 95% white.[38]  Another challenge for older Black adults during the Covid-19 pandemic was their inability to attend religious services and other activities within their faith communities due to social distancing restrictions, a devastating blow to their mental health and ability to combat isolation and loneliness given that research has confirmed the important role that the communities play in providing emotional support and sense of purpose and dignity to older Black adults.[39]

Aging and health care providers have an important role in identifying, managing and remediating the adverse physical and mental health impacts of a lifetime of racial and ethnic discrimination.  In connection with providing support and services to African American older adults, the American Psychological Association called on providers to listen with empathy in order to understand the impact of racism, including the intersection of racism with other forms of discrimination that will influence how individuals view their experiences; support strengthen and enhance resilience; celebrate culture; be aware and mindful of triggers; refer to culturally competent mental and behavioral health services and advocate for increased access to community and national resources for African Americans across the entire lifespan.[40]

Notes

[1] L. Chatters, H. Taylor and R. Taylor, “Older Black Americans During COVID-19: Race and Age Double Jeopardy”, Health Education and Behavior, 47(6), December 2020, 855 (citing I. Lindsey, Double jeopardy: The older Negro in America Today (National Urban League, 1964).  For further discussion, see S. Crewe, “The task is far from completed: double jeopardy and older African Americans” Social Work in Public Health, 34(1) (2019), 122.  With regard to ageism and intersectionality, see A. Gutterman, Ageism and Intersectionality (Oakland CA: Ageism Project, 2021).

[2] Id.

[3] 2018 Profile of African Americans Age 65 and Over (Washington DC: Administration for Community Living, October 2019) (sources for the data in the report included the US Census Bureau’s Population Estimates; Population Projections; Current Population Survey, Annual Social and Economic Supplement; and American Community Survey. Sources also include the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, and the Administration for Community Living’s State Program Report data).

[4] Id.

[5] The report noted that 13% of the older persons who received Title III Older Americans Act home and community-based registered services were African American.

[6] African American Older Adults and Race-Related Stress (American Psychological Association).

[7] M. Anderson, ”For black Americans, experiences of racial discrimination vary by education level, gender”, Pew Research Center (May 2, 2019) (incidents in which college attendees were most likely than those without college experience to experience discrimination included “people acting as if they were suspicious of them”, “people acting as if they were not smart” or “being subjected to slurs or jokes”).  See also Discrimination in America: Final Summary (National Public Radio, Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health, January 2018) (for many minority groups, individuals with higher education were more likely to report various forms of individual discrimination).

[8] AARP Vital Voices: Experiences of Racism and Discrimination in the African American Community (AARP Research, April 2021).

[9] K. Cooper, The costs of inequality: Faster lives, quicker deaths (The Harvard Gazette, March 14, 2016)

[10] J. Chonody and B. Teater, Social Work Practice with Older Adults: An Actively Aging Framework for Practice (Thousand Oaks CA: Sage Publications Inc., 2018), 46-47 (citing D. Williams and C. Wilson, “Race, Ethnicity, and Aging” in R. Binstock and L. George (Ed.), Handbook of Aging and Social Sciences, 5th Edition (San Diego CA: Academic Press, 2001), 160, 164 (“wealth captures an important dimension of the economic standing of individuals age 65 and older, and racial differences in wealth are much larger than those for income”).

[11] AARP Vital Voices: Experiences of Racism and Discrimination in the African American Community (AARP Research, April 2021).

[12] J. Chonody and B. Teater, Social Work Practice with Older Adults: An Actively Aging Framework for Practice (Thousand Oaks CA: Sage Publications Inc., 2018), 46-47 (citing D. Williams and C. Wilson, “Race, Ethnicity, and Aging” in R. Binstock and L. George (Ed.), Handbook of Aging and Social Sciences, 5th Edition (San Diego CA: Academic Press, 2001).

[13] Id. at 46.

[14] K. Cooper, The costs of inequality: Faster lives, quicker deaths (The Harvard Gazette, March 14, 2016)

[15] Id.

[16] A. Powell, The costs of inequality: Money = quality health care = longer life (Harvard Gazette, February 22, 2016)

[17] Id. (quoting Ichiro Kawachi, John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology and chair of the Harvard T.H. Chan School of Public Health’s Department of Social and Behavioral Sciences).

[18] K. Cooper, The costs of inequality: Faster lives, quicker deaths (The Harvard Gazette, March 14, 2016)

[19] A. Powell, The costs of inequality: Money = quality health care = longer life (Harvard Gazette, February 22, 2016) (quoting Ichiro Kawachi, John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology and chair of the Harvard T.H. Chan School of Public Health’s Department of Social and Behavioral Sciences).

[20] Id. (citing D. Williams and R. Wyatt, “Racial Bias in Health Care and Health: Challenges and Opportunities”, Journal of the American Medical Association, 314(6) (2015), 555).

[21] AARP Vital Voices: Experiences of Racism and Discrimination in the African American Community (AARP Research, April 2021).

[22] Id. (noting that women in the group were more concerned than men about racism and racial discrimination (83% vs. 78%), a difference that was attributed to women perhaps being more likely to report their concerns about racism, discrimination, and other well-being issues due to the intersectionality of gender and Black identity).  Specifically, 49% of the persons in the group reported experiencing racial discrimination and older African Americans were more likely than all older Americans to report that excessive use of force by police has negatively affected them (39% vs. 24%).

[23] Id. (noting also that older African American women disproportionately report being negatively affected by a wide range of issues, including racial discrimination, excessive use of force by police, affording healthcare, and mass shootings). 

[24] Id.

[25] Id.

[26] A. Van Dam, “For Black workers, age discrimination strikes twice”, The Washington Post (May 14, 2021).

[27] The article also noted that a shortage of Black people in positions with hiring authority contributes to the problems that Black workers experience when applying for new jobs since White recruiters are less likely to appreciate the skills and backgrounds that Black applicants can bring to their positions.

[28] L. Chatters, H. Taylor and R. Taylor, “Older Black Americans During COVID-19: Race and Age Double Jeopardy”, Health Education and Behavior, 47(6), December 2020, 855.

[29] For further discussion, see A. Gutterman, Covid-19 and Older Persons (Oakland CA: Ageism Project, 2021).

[30] The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S. (APM Research Lab, 2020)

[31] COVID-19 in racial and ethnic minority groups (Centers for Disease Control and Prevention, August 19, 2020). 

[32] L. Chatters, H. Taylor and R. Taylor, “Older Black Americans During COVID-19: Race and Age Double Jeopardy”, Health Education and Behavior, 47(6), December 2020, 855 (citing COVID-19 in racial and ethnic minority groups (Centers for Disease Control and Prevention, August 19, 2020)). 

[33] Id.

[34] Id. (citing COVID-19 in racial and ethnic minority groups (Centers for Disease Control and Prevention, August 19, 2020)). 

[35] Id. (citing Internet/broadband fact sheet (Pew Research Center, 2019)).

[36] Id. (citing D. Williams, J. Lawrence and B. Davis, “Racism and health: Evidence and needed research”, Annual Review of Public Health, 40 (2019), 105).

[37] Id. (citing T. Shippee et al., “COVID-19 pandemic: Exacerbating racial/ethnic disparities in long-term services and supports”, Journal of Aging & Social Policy, 32(4–5) (2020), 323). 

[38] R. Gebeloff et al., The striking racial divide in how Covid-19 has hit nursing homes, New York Times (May 21, 2020).  The authors also noted that “[o]lder Black adults living independently in low-income senior housing communities [were] also at risk for disproportionate impacts of Covid-19” due to their age, the widespread lack of rigorous cleaning protocols and social distancing measures and the higher rates of social isolation in senior housing communities in relation to community dwelling older adults. See
J. Graham, Seniors in low-income housing live in fear of COVID infection, Kaiser Health News (June 26, 2020).

[39] Id. (citing L. Chatters et al., “Social support from Church and family members and depressive symptoms among older African Americans”, American Journal of Geriatric Psychiatry, 23(6) (2015), 559 and H. Taylor, “Social isolation’s influence on loneliness among older adults”, Clinical Social Work Journal, 48(1) (2020), 140). 

[40] African American Older Adults and Race-Related Stress (American Psychological Association).