The word “health” conjures everyday personal decisions — what we eat, how much we exercise or sleep or how often we go to the doctor — things that appear to be under our control. But instead of looking at what we choose to eat, what if we put the onus on the types of foods we have access to and the quality of the foods we can afford? Instead of looking at how much we exercise or sleep, what if we examined how many and what kinds of jobs we work, how much they pay us and the impact this has on our quality of life? Instead of looking at how often we go to the doctor, what if we paid closer attention to who has insurance and the quality of the care we receive?

This pivot in framing causes the conversation to shift — from one that centers around our own individual behaviors, to one that highlights the collective behaviors of communities and the systems they support. These are known as “Social Determinants of Health” — an increasingly vital body of international study that examines the conditions that surround and shape us, conditions that, when looked at honestly, are seen to produce highly inequitable and unfair realities.

These inequities have long been here — much of Charlottesville and its surrounding counties were literally built on them. But as the COVID-19 pandemic has swept through our communities, we’ve seen them heightened and exacerbated as never before on unparalleled levels. 

Inequalities in health status in the U.S. are large, persistent and increasing. Research documents that poverty, income and wealth inequality, poor quality of life, racism, sex discrimination and low socioeconomic conditions are the major risk factors for ill health and health inequalities … conditions such as polluted environments, inadequate housing, absence of mass transportation, lack of educational and employment opportunities and unsafe working conditions are implicated in producing inequitable health outcomes. These systematic, avoidable disadvantages are interconnected, cumulative, intergenerational and associated with lower capacity for full participation in society. … Great social costs arise from these inequities, including threats to economic development, democracy and the social health of the nation.

National Association of County and City Health Officials, 2002

Our health district consists of about 250,000 people in Charlottesville and the counties of Albemarle, Fluvanna, Greene, Louisa and Nelson. African Americans make up 13.7% of that — or 34,186 people — while White residents make up 81.5% — or 203,372 people.

If the COVID-19 cases were equally distributed, out of the 325 total people who have tested positive so far, 44 would be African American and 264 would be white. But in actuality, 99 African Americans have tested positive — representing 30.4% of the total cases, or more than two times the proportional rate — along with 193 white people, representing about 59.3%. This points directly back to the broken and inequitable state of our Social Determinants of Health. 

The rate of African American hospitalizations due to COVID-19 is even higher, at nearly four times the proportional rate. Currently 23 white people, or about 37.7%, have been hospitalized, alongside 32 Black people, or about 52.5%. If the systems were equitable, however, 49 white people would have been hospitalized, and just eight Black residents would have been hospitalized. 

These racial inequities are occurring all across the country — in Richmond, where African Americans make up 47.8% of the population, they have at least 73.5% of the positive cases. And though our health system is perhaps the most obvious place to look in the midst of a global health pandemic, in fact all of our systems are broadcasting sweeping injustices, proving just how interconnected one’s job is to one’s food, and one’s kids are with one’s sense of social inclusivity, and one’s trauma is with one’s physical health. Now imagine if these were all under siege at once, and in fact, had been for generations. 

Over the next five weeks, we’ll use these Social Determinants of Health as our foundational framework and guideposts to bring you stories of how the COVID-19 crisis has impacted some of our African American communities. 

A key structural construct of our ecosystem is that we’re prevented from experiencing each other’s hardships. The pandemic has brought lots of talk and acts of “togetherness,” and yet, as we see now more than ever, our communities are also filled with injustices that often occur in segregated and isolating realities. With this series, we aim to bring you detailed accounts of these long-standing and interconnected systems and the stories of community members waging daily battles, on micro and macro levels, to change and overthrow them.

I. Determined to Work

Salon. Credit: Credit: Sahara Clemons

On March 23, Gov. Ralph Northam stepped up to a press conference podium in Richmond. Flanked by two large signs reading, “Do your part, stay at home,” Northam declared thousands of businesses closed. “We are taking additional actions to keep Virginians safe,” he said.

At the time, there were 254 cases of COVID-19 in Virginia, and six people had died. Northam said the pandemic was going to hit Virginia hard in the coming weeks and social distancing was key. He’d already closed schools and just signed Executive Order 53, listing more than a dozen business categories as “essential” and allowed to stay open. They included grocery stores, pharmacies, medical and electronic retailers and both of Marcus Jones’s jobs.

II. Determined to Be Nourished

The Meal Plan. Credit: Credit: Sahara Clemons

Every Friday since Charlottesville started responding to the COVID-19 pandemic, Rosa Key has been on Hardy Drive. “Come get a bag of groceries!” she hollers. Key knows most of the Black residents or their parents. “Oh, you’re Mary’s boy,” she says when a young man tells her his last name. 

Key, 64, grew up in Charlottesville, spending some of her youth in Albemarle and Nelson counties, but mostly in the city. Her aunt and uncle worked for J.F. Bell Funeral Home. Her daughter and grandson live in Westhaven. And ever since schools and businesses shut down, Key has helped the PB&J Fund and Charlottesville City Schools (CCS) distribute thousands of bags of food to residents here. She’s been involved in the city’s food justice movement for more than two decades and was a part of the Urban Agriculture Collective of Charlottesville (UACC) when it formed in 2007. Now she works as a Community Advocate for the Food Justice Network (FJN).

III. Determined to Stay

Tired of Healing My Wounds. Homelessness and the threat of homelessness have taken on new meaning in the wake of COVID-19 and stand in stark relief when those situations pose an immediate public health risk to those experiencing it and the people they interact with. Eviction Notice explores the fear and grief that arise due to unstable housing, often caused by market pressure and gentrification. As unemployment continues to rise, we anticipate the further destabilizing of Black neighborhoods and other vulnerable communities. This piece asks, “what will it take for us to be unburdened by this cycle?”. Credit: Credit: Sahara Clemons

Matthew Murphy needed to clear his head. The week before the response to the COVID-19 pandemic hit Charlottesville, the 43-year old took a job as a housing navigator at The Haven day shelter. All day every day, he has worked the phones, trying to find housing for people without any. The Haven finally has funding to pay for peoples’ first month’s rent and security deposits. Now, they have a different problem: landlords.

“You see, but don’t hear people’s reservations,” said Murphy about his conversations with landlords. “They’re never going to say, ‘No, we won’t do that for these people’ or ‘We don’t want to rent to these people.’ But that’s basically what they’re saying. We’re seeing it.”

IV. Determined to Thrive

School Daze. Credit: Credit: Sahara Clemons

Last September, Rachel Gregory went to the doctor. She was working at a local assisted-living facility and for months her left hip had been hurting. Since she was 17 years old, Gregory, like her mother before her, has worked in nursing and geriatric care.

“I love the joy of seeing their faces when I get them up in the morning or put them to bed,” she said of her patients. “The satisfaction of taking care of someone else, making sure they’re clean, they’re fed, they’re taken care of — it’s what I would want someone to do for my family.”

V. Determined to Be Free

The Lesson. Credit: Credit: Sahara Clemons

Stacey Washington feels blessed these days. She’s 41 years old, has six healthy children — five adults and an 11-year old — and three grandkids. She works for the city of Charlottesville’s Office of Economic Development and makes a decent amount of money. She’s got some savings and a place to live. 

“Don’t get me wrong, I won’t complain because I have a place to live, but I would like a nicer place,” said Washington. “I feel I deserve it, and I can afford it.”

Epilogue. A Conversation with Charlottesville Mayor Nikuyah Walker

In closing the Determined series, we wanted readers to hear from Mayor Nikuyah Walker. Born and raised in Charlottesville, and having devoted much of her life to serving others, Walker is in a unique position that affords her daily conversations with the region’s most determined residents, and those who are often not prioritized by our systems and structures. She is also the only Black official on either the City Council or the Board of Supervisors.

In this conversation, we discuss many of the Social Determinants of Health that the series investigated  — from the role of employers and the role of the University of Virginia, to that of affordable housing, and why she votes ‘No’ on some development projects. Walker also shares her thoughts behind the recently raised topic of removing school resources officers from Charlottesville City Schools, speaking about the broader role of education, and where it can better serve Black students.

A man looks off camera, wearing a hoody with a beard

Jordy Yager

Jordy Yager is a freelance journalist raised in Charlottesville, who earned his M.A. in journalism from Boston University. For six years, he covered Congress and the federal government in Washington, D.C. Since 2013, Jordy has focused on issues of equity and racial disparities in his hometown.

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Sarad Davenport

Sarad Davenport is the content manager and digital strategist for Vinegar Hill Magazine.