The refrain sounded familiar.
Speaking March 19 before the Kanawha County Commission, the Rev. Matthew Watts, a longtime pastor and public health advocate from Charleston’s West Side, asked whether COVID-19 testing could be prioritized for people on the West Side.
The neighborhood has one of West Virginia’s highest Black populations and one of the lowest life expectancies in the United States. Residents feared the unknown virus would wreak havoc.
The request would be made, Commission President Kent Carper told Watts, but Kanawha County had yet to test a single resident. Carper said he was unsure whether the state even had a testing strategy.
Watts and Charleston NAACP President Rick Martin had spent the better part of the past decade trying to tell anyone who would listen about the dire health disparities in West Virginia’s most impoverished communities — and how worse those disparities are for Black West Virginians.
Martin and Watts said they cited a 2018 report co-published by the Centers for Disease Control, the National Association for Public Health Statistics and Information Systems and The Robert Wood Johnson Foundation. Researchers measured health outcomes in all 67,148 census tracts in the United States. Of the 40 tracts with the lowest life expectancies in the country, five were in West Virginia.
Life expectancies for people in the town of Logan averaged second lowest in the nation at 56.9, 39% lower than the national average of 78.6. Hinton was ninth lowest at 60.4. The West Side neighborhoods in Charleston and Huntington tied for 27th lowest at 62.3. Salem ranked 39th at 63.1. The statewide average of 75.3 was slightly lower than the national average.
This indicates the intensity of the disparities facing poor communities in West Virginia, Watts argued.
“President Martin and I brought it to the attention of the governor, to his assistants, to the members of the Legislature and it basically fell on deaf ears,” Watts said during a Facebook Live address in May.
“We tried to make the case that this crisis existed long before the opioid crisis emerged. Opioids were exacerbating the problem,” said Watts, who has spent nearly two decades advocating for public health. “Our health crisis was already there and it was already there before COVID-19 ever showed up.”
COVID-19 has killed Black Americans at more than twice the rate of white people. If COVID-19 deaths were proportional to population, about 18,000 Black Americans would still be alive, according to the American Public Media Research Lab.
Black West Virginians compose an estimated 3.6% of the state’s population but account for more than 7% of the state’s positive COVID-19 cases. Less than 2% of West Virginians are Hispanic, but that group makes up 8% of the state’s positive cases.
“What COVID-19 is doing is magnifying the disparities that have existed for years. It is uncovering what many of us already knew and what was very well documented through a plethora of data,” he said.
Black West Virginians die of cancer, diabetes, heart disease and stroke at higher rates than white residents, according to the 2007 Minority Health in West Virginia report. That was the last report issued by the state on the subject.
“One of the key indicators of a population’s health is its infant mortality rate,” the report says. “[It’s] indicative of a society’s overall health, as well as maternal health and access to and quality of care for pregnant women and their children.”
Despite infant mortality rates dropping nationwide, “a significant disparity between African American and white infants has remained, with African American infants dying at a consistently higher rate than white infants in both the state and the nation,” the document reads.
One in three Black West Virginians lived in poverty when the report was published, almost twice the 17% of Caucasians and 18.1% of Asians who recorded incomes below the poverty line.
The party never mattered
Martin and Watts long have sought to persuade state legislators to run bills aimed at closing these disparities. The efforts largely have been unsuccessful.
In 2015, community leaders during the legislative session pushed for a bill that would have implemented a pilot program on Charleston’s West Side to study aspects of improving public health.
The bill passed both chambers unanimously. But former Gov. Earl Ray Tomblin vetoed it.
Carolyn Stuart, then director of the Herbert Henderson Office of Minority Affairs, didn’t support the bill. One lawmaker said it was due to a “turf battle” between the office and West Side leaders.
Watts said the Minority Affairs office, founded in 2012, traditionally has operated as what he described as a ceremonial office, holding events instead of addressing chronic minority health conditions.
Tomblin wrote at the time he vetoed the bill because “the focus on minority issues should not be local; it should be general and statewide.”
Dr. Rahul Gupta, commissioner for the state Bureau of Public Health from 2015 to 2018, said the bill was aimed at addressing disparities locally. The project would have delivered concrete findings that would have led to real solutions.
“We worked with everybody and anybody who was willing to work with us to show people the plight of the West Side as an example, not the only place in the state, but it’s an example of what’s happening,” Gupta said.
“The only guy that ever heard us, really, was Rahul Gupta,” Watts said. “He was the strongest ally that we had in terms of the public health department, but at the end of the day he couldn’t get them to move [on the issue].”
In 2016, advocates rewrote the bill to include a similar pilot project available for the largest Black communities in West Virginia. The bill would have created a 20-person minority health advisory team to oversee the projects.
The team would have been composed of professionals from the medical, public health, behavioral health, children and family health care fields, along with a number of other health and state agency workers.
The bill has been introduced every year since 2016 and has died each time before reaching the floor.
Just the word “minority” has stopped nearly all bills related to the subject, Watts said.
In the late 2000s, when Democrats controlled both chambers and Joe Manchin was governor, Kanawha County representatives told Watts not to bring them anything with the word “minority” in it because their colleagues wouldn’t pass it.
This past session, Watts and company again tried to get the 2016 bill introduced in the Senate. He was ready to drop the word so the bill could finally pass.
He said he tried to work with Senate Health Chairman Mike Maroney, R-Marshall, and his office to alter the bill. The title wouldn’t include the word “minorities” It would include a focus on maternal care. The legislation went nowhere.
Maroney’s office did not respond to requests for comment.
“It became obvious to me that the Senate Republicans wouldn’t even entertain the bill ... but even the Democrats ... they never really fought hard to try to get the bill on the agenda. I believe they just assumed the Republicans wouldn’t do it because it had the word minority in the bill,” Watts said.
Two days after Jim Justice was elected governor in 2016, Watts said, he called to take the new governor up on a campaign promise to see through a pilot project bill for the West Side. That bill passed, but the program it was intended to create was never implemented and appropriate funding was never allocated. Justice switched parties months later. His office did not respond to a request for comment.
“The theme is that no matter who produced the data, no matter who produced the reports, it was the same outcome and it didn’t matter whether Democrats or Republicans were in charge,” Watts said. “There was apathetic indifference.”
‘These deaths are socially determined’
Dr. Anthony Woart, founder and director of the Minority Health Institute at Marshall University, has worked in the field for two decades in West Virginia.
“When we talk about health disparities, we’re essentially saying that compared to their white counterparts, African Americans — and not just African Americans but all vulnerable populations, including poor whites — disproportionately will have these diseases, live with them and die with these various diseases,” Woart said.
West Virginia’s vulnerable communities lack access to health care, higher education and jobs that pay well. Public health experts say this goes hand-in-hand with poor health and poverty.
West Virginia ranked last in the nation in adults with a college degree, with slightly more than 14% of adults having a college education, according to the 2007 report.
Low educational attainment leads to low-paying jobs. Years of low and stagnant wages lead to income levels below the poverty line. That creates minimal opportunities for quality health care.
The disparities likely are wider today, Woart said. High infant mortality rates, he said, are a direct reflection of the limited health care Black mothers receive.
“These deaths are socially determined, meaning that these are families or mothers that do not have access to health care while they’re pregnant or access to health care after they have the baby,” Woart said.
Data from 2015 to 2017 quantify the severity of the problem, said Dr. Cathy Slemp, who served as state health officer for more than a decade. The numbers show county-by-county disparities in income, education and general health.
Nearly half of residents in some counties report an annual income of less than $15,000 while 7% of people in those counties make more than $75,000 a year, Slemp said. Half of people lacked a high school diploma and 10% obtained college degrees.
Closing the disparities would require increasing access to health care, education and wages.
“[Changing] the structure means that everybody has access to equal housing. Everybody has access to employment. Everyone has access to a better income level,” Woart said. “These complexities will continue to drive the disparities … unless we address those structural issues we are just putting a Band-Aid on the problem.”
Four days before Watts appeared before the Kanawha Commission, about 100 congregants from Black Baptist churches across North Central West Virginia gathered for an annual pastor celebration.
An outbreak followed. Viola York Horton, 88, and minister Rick Hood, 62, died after attending the event. Many more were hospitalized and tested positive for the virus.
The community couldn’t get tested until Romelia Hodges, a churchgoer who attended the event with her 10-year-old daughter, organized a small team to get them tested. Hodges said she believed the state and the local health department left them out to dry.
Black people frequently lack access to primary care physicians, Hodges said. Distrust of the medical community also played a role. That partly comes from the lack of representation in the medical field, advocates and experts say. Abuses such as the Tuskegee experiments also are a factor.
“It may not be an environment that you feel comfortable in, or there are inequities and racism that is actually unintentionally in the health care system,” Slemp said.
“Sometimes people don’t necessarily know how to deal culturally with Black women, Black males or minorities, and so it comes to, ‘I don’t want to go to the doctor because no one looks like me,’” said LaDawna Walker, Minority Health Coordinator for the Bureau of Public Health at Marshall.
The Office of Minority Health in the state health department moved from Charleston to Huntington in 2018. Woart, Walker and Dr. Georgiana Logan now operate the institute from Marshall’s Minority Health Institute. The minority health office wasn’t created until 2014 — four years after Gupta started championing it.
After years of inaction, advocates said the office needed to be moved to Woart’s institute.
“That office has historically lacked the funding and the resources to be able to do more for the people of color, whereas disparities clearly exist, not just for people impoverished in West Virginia, but especially for people of color,” Gupta said.
When Walker was hired to help lead the office in 2018, she found an empty cupboard.
“There was no paper trail, meaning there was no documentation of what was done in the previous years so I had to start from scratch,” Walker said.
The office secured a $25,000 state grant in February to study health disparities, such as diabetes, hypertension and obesity, in Kanawha County, Walker said.
‘It’s past time’
Economic justice alone is strong enough to right decades of neglect and inaction on poverty and minority health, Watts said.
His plan, called the 20/20/20 Economic Justice and Equity Movement, would send $250 million in federal coronavirus money to the 240 census tracts in West Virginia with a poverty rate of 20% or higher. The feds allocated a total of $1.25 billion to West Virginia.
“With the preponderance of evidence, there is really little need for further discussion about the disparities. Everybody knows what they are,” Martin said. “I think it is now time for some transparent accountability as it relates to the implementation of action and resources to fund those plans.”
The governor instead has sent the money elsewhere, such as to pay for paving roads. West Side advocates see an old pattern forming anew.
“It is totally unconscionable that this plan cannot receive some attention and gain some traction from the governor and our legislators … it speaks volumes to the lack of sensitivity, care, concern for economically disadvantaged communities of color,” Martin said. “COVID-19 just totally illuminated the lack of action and the lack of needed resources to target these health disparities in the African-American community and the poor communities. We’re sick. We’re dying prematurely and there’s really no substantive plan with resources attached to address the issues.”
“It’s time,” he said. “It’s past time.”