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In Alabama, racial disparities in health outcomes predate the pandemic

In Alabama, doctors and nurses are seeing record numbers of hospitalizations associated with COVID-19. The state has reported more than 1,300 deaths since the pandemic began. But certain regions and populations within the state are faring far worse than others -- and huge health disparities among Black residents are causing even more dire results. Stephanie Sy reports on a tragic legacy.

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  • Judy Woodruff:

    There's been a great deal of attention on the spike of COVID cases in states like Florida, Texas, Arizona, and California.

    But other states are struggling with it profoundly, too, like Louisiana and Alabama.

    Alabama doctors and nurses are seeing record numbers of hospitalizations associated with COVID, more than 9,000 as of today. The state has reported almost 1,400 deaths since the pandemic began. And there are nearly 75,000 cases.

    Stephanie Sy has a report tonight on how the virus has hit especially hard in a county in the central part of the state, and how huge health disparities among Black residents are leading to even worse outcomes.

  • Stephanie Sy:

    A 90-degree July afternoon deep in Lowndes County, Alabama, is nothing like a walk around heaven. But the mourners came anyway to pay their respects to a pillar of the community, dead at the age of 50 from COVID-19.

  • Robert Leonard:

    We're here for the home-going service of Pamela Sue Rush, New Mount Lily Baptist Church, Hayneville, Alabama.

  • Pamela Rush:

    And we got no heat and stuff in the house. My daughter cry every morning and say, it's cold in the house.

  • Stephanie Sy:

    Pamela Rush was first featured on the "PBS NewsHour" in 2018 in a report on extreme poverty, showing the squalid conditions she was living in, no sewage system and a trailer home she worried was making her and her children sick.

  • Pamela Rush:

    I need to get out of this house, because there's mold and stuff in there, and it's bad on your health.

  • Stephanie Sy:

    Animals were getting in, she lamented, showing the trap cages.

  • Pamela Rush:

    I got diabetes, and I don't need to get bit by no animal.

  • Stephanie Sy:

    She couldn't have known then that a much bigger risk lay ahead. The tragedy of Pamela Rush's life and death has deep roots. Her neighborhood was built on former slave quarters, and the abject poverty she experienced can be traced back to the legacy of slavery in the Southern Black Belt, so named for the fertile soil that lay the foundation for cotton plantations.

  • Catherine Flowers:

    I was devastated.

  • Stephanie Sy:

    Catherine Flowers is a cousin of Rush's and an environmental justice activist who enlisted Rush in her advocacy work.

  • Pamela Rush:

    Hi. My name is Pamela Rush. I'm from Lowndes County, Alabama. And I live in a mobile home with my two kids.

  • Stephanie Sy:

    In June of 2018, Rush and others testified before a congressional committee as part of the revived Poor People's Campaign.

  • Pamela Rush:

    They charged me over $114,000 on a mobile home that's falling apart.

  • Catherine Flowers:

    I was devastated, because we did not get a chance to get her out of that trap that she was in and to let her benefit from the work that she had been doing all this time to move her family from the home that she was staying in.

  • Stephanie Sy:

    Pamela Rush's is only one of the lives claimed by the pandemic in Lowndes County.

    Terrell Means is the county coroner.

  • Terrell Means:

    My average calls a week would be one or two before the COVID and everything, but after COVID came, it started picking up, five to seven a week.

  • Stephanie Sy:

    So far, 537 cases and 26 deaths from COVID-19 have been documented in this sparsely populated place of less than 10,000 residents.

    The virus has infected one in 17 people there, the highest infection rate in Alabama and one of the highest in the country.

    Like Rush, many people here have diabetes, which experts say puts them at higher risk of death from COVID-19.

  • George Thomas:

    Anyone in your family has a history of diabetes?

  • Elvis Harrison:

    Yes.

  • George Thomas:

    OK. Has anyone ever said whether you might be diabetic?

  • Elvis Harrison:

    No.

  • Stephanie Sy:

    Dr. George Thomas, the only doctor in the county, suspects 60-year-old Elvis Harrison has it.

  • George Thomas:

    We can let before you leave if you do have diabetes.

  • Stephanie Sy:

    Harrison takes the test and gets results on the spot.

  • George Thomas:

    You are a diabetic, OK? And we do need to start you on some medicine.

  • Elvis Harrison:

    So, I was kind of surprised that I did have it, because I got rid of most of the cookies and I got rid of the candies. I guess I will just have to stick with the fruit.

  • Stephanie Sy:

    Dr. Scott Harris is the state's top health officer.

  • Scott Harris:

    Alabama is not the healthiest state to begin with. And our African American population disproportionately suffers from a number of chronic health problems.

    And when they have a serious systemic infection, then it just makes it that much more difficult for them.

  • Stephanie Sy:

    Throughout the nation, the pandemic has had an outsized impact on African Americans, but, in Lowndes County, history may help explain why.

  • Scott Harris:

    This is a map that shows a pictorial representation of the 1860 Alabama census.

  • Stephanie Sy:

    African Americans are represented in blue and whites in red.

  • Scott Harris:

    So, all of these blue segments here represent enslaved people.

  • Stephanie Sy:

    Dr. Harris says, if you look today at where the most people in Alabama have chronic health conditions, it matches where the most slaves lived during the 1860 census.

  • Scott Harris:

    The legacy of these enslaved people in Alabama in the Black Belt is still felt today in the health disparity that we have.

    The African-American population in Alabama make up more than a third of COVID-19 cases. And they make up over 45 percent and approaching half of all deaths.

  • Stephanie Sy:

    Founder of the Equal Justice Initiative, Bryan Stevenson says lingering trauma also affects health.

  • Bryan Stevenson:

    Lowndes County saw lots of Black people lynched, pulled out of their homes, beaten, tortured, drowned, hanged. And that creates trauma. It creates an emotional injury, a psychological injury.

    And then you combine that with a lack of employment and then, most critically, a lack of health care, and you make an already vulnerable population more vulnerable when it comes to COVID.

  • Stephanie Sy:

    There's no hospital in Lowndes County today. And there wasn't one in 1965, when Dr. Martin Luther King Jr., the late John Lewis, and more than 3,000 supporters passed through on their way to Montgomery.

    But the gains of the civil rights movement have not reversed the downward trajectory in Lowndes County.

  • Bryan Stevenson:

    We have failed to acknowledge the role of injustice, inequality and bigotry in creating many of the conditions that continue to make us sick.

  • Stephanie Sy:

    But there are finally signs that times are changing. Since 1940, a Confederate monument had stood in the Hayneville Town Square in Lowndes County. It bore the names of Confederate soldiers whose families owned slaves, among them Pamela Rush's ancestors.

    In the wake of the protests against the killing of George Floyd, the monument came down in June.

  • Catherine Flowers:

    To be quite honest, I never thought I'd see it in my lifetime. That history that that monument represented was very, very strong and represented the terror that was inflicted upon our family.

  • Stephanie Sy:

    Terror perpetuated by systemic racism that put Catherine Flowers' cousin Pamela at great risk when COVID-19 came to Lowndes County.

  • Pamela Rush:

    It is hard. I can't — I couldn't buy my children the stuff, what they need.

  • Stephanie Sy:

    That soft-spoken voice in front of members of Congress somehow echoes louder in her passing.

  • Catherine Flowers:

    I have to make sure that, in Pamela's memory and for her children's future, that we dismantle these structures that kept her trapped.

  • Stephanie Sy:

    America's reckoning with racism will come too late for Pamela Rush, but perhaps it will arrive in time for Biance and Jeremiah, left too soon without a mother.

    For the "PBS NewsHour," I'm Stephanie Sy.

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