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Class, Race, Coronavirus, And Cuisine

Why NPR's attack on Sen. Bill Cassidy over disproportionate black COVID deaths is culturally ignorant
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As someone who listens to a fair amount of NPR in the car, I can tell you that if there’s a race, sex, gender, or immigration angle to any story, NPR is going to find it and run with it. I haven’t been listening to any NPR since the lockdown began, because with nowhere to go, I’m never in my car. I wasn’t surprised, though, when a reader sent me a link to the interview NPR’s David Greene did with Sen. Bill Cassidy, the Louisiana Republican, on the subject of why a wildly disproportionate number of black Louisianans dead of Covid-19. Blacks make up 32 percent of the state’s population, but a whopping 70 percent of coronavirus deaths. Why?

Sen. Cassidy, who is a physician with extensive experience working in the state’s public hospital system, tried to explain to Greene. Excerpt:

GREENE: Can you tell me what is being done to help the black community in your state right now, which, you know, it clearly is being disproportionately hit by this disease?

CASSIDY: Well, I think it’s, first – clearly, there’s been a surge of ventilators, of medical equipment to all folks, particularly in southeast Louisiana because that’s where we had the peak first. I worked in the Charity Hospital system for 25 years as a physician, and 80% of my patients were African American. That was just the demographic makeup. And so some things in your report, I’m not quite sure people of whatever race are less likely – at least of African American race are less likely to go to the hospital. Again, that was my practice, and I did not see that.

But if you’re going to look at the fundamental reason, African Americans are 60% more likely to have diabetes. The virus likes to hit what is called an ACE receptor. Now, if you have diabetes, obesity, hypertension, then African Americans are going to have more of those receptors inherent in their having the diabetes, the hypertension, the obesity.

So there’s a physiologic reason which is explaining this. Now, as a physician, I would say we need to address the obesity epidemic, which disproportionately affects African Americans. That would lower the prevalence of diabetes, of hypertension. And that’s what would bring benefit.

GREENE: Well, I mean, as we heard in that report, I mean, some underlying health conditions and disparities are part of the issue here. But I mean, we heard Congressman Cedric Richmond say, as well, that this is rooted in years of systemic racism. Aren’t there other forces at work here?

CASSIDY: Well, you know, that’s rhetoric, and it may be. But as a physician, I’m looking at science. And the science…

GREENE: You’re saying that’s just rhetoric? I mean, there are more uninsured African Americans compared to other populations in your state. Doesn’t that play a role in people…

CASSIDY: You know, they said minorities. African – we’ve done the Medicaid expansion. Now, intuitively, it might be. But again – I don’t want to seem insensitive at all. Again, I’m a physician. This was my practice. But as a physician, I approach it more – OK, what is the physiology? And the physiology is that if you have an ACE inhibitor – excuse me, an ACE receptor, that’s where the virus hits.

Read or listen to the whole thing. Cassidy tries to tell him the scientific reasons why this is happening, but Greene keeps trying to pin it on racism. It’s infuriating. This is exactly the kind of interview or segment that would make me turn off the radio, or listen to a podcast.

Let’s do a deeper dive on these numbers. From the New Orleans Advocate:

Of the coronavirus deaths recorded in Louisiana thus far, more than half have occurred in Orleans and Jefferson Parishes, both of which have large African-American populations: New Orleans is 59% black; Jefferson, 23%. Other parishes that have been early hotbeds of COVID-19 are heavily African-American, including St. John the Baptist Parish, which has the highest per-capita death rate of any U.S. county and is 58% black.

We now know that coronavirus was circulating among the big crowds at Mardi Gras in New Orleans, on February 25. Those three parishes where the worst of the virus deaths have been — Orleans, Jefferson and St. John the Baptist — are all Greater New Orleans. If you live in one of those parishes, you are more likely to have been exposed first, before anybody was social-distancing, and more likely to have died. Those parishes are all majority black. Furthermore, Louisiana’s three largest cities — New Orleans, Baton Rouge, and Shreveport — are all majority black cities. It stands to reason that coronavirus spread would have moved first, and fastest, in the cities, which are more densely packed.

Second, look at this graphic from the Advocate about Louisiana’s comorbidity factors with coronavirus:

Hypertension is high blood pressure. According to the statistics, Louisianans are more likely to be subject to high blood pressure than other Americans, and black Louisianans slightly more likely to have it than whites. But the hypertension stats in the Bayou State are massive for people who have less than a high school education — that is, the poor. Over half the adults in Louisiana without a high school degree suffer from hypertension.

Let’s look at obesity in Louisiana. Here are the stats. My state is a fat state. Among whites here, 33 percent of adults are obese (I think I would be counted in that number, alas). But 46.2 percent of black adults are obese — a big difference.

How about diabetes? Black adults in the Bayou State have about 50 percent higher rates of diabetes than do whites.

So, why are blacks dying in disproportionate numbers from COVID in Louisiana? The virus hits hard people who have diabetes, hypertension, and obesity. Hypertension levels between blacks and whites are about the same, but blacks have far more obesity and diabetes than whites. That’s a big reason.

The other big reason is that because of Mardi Gras, the virus took hold first in New Orleans, and spread quickly in the crowds. Two of the three parishes that make up Greater New Orleans are majority black, including Orleans Parish, the heart of the city. Mardi Gras was February 25. The state closed all public schools on March 16. On March 22, Gov. Edwards sent down his Stay At Home order, which closed non-essential businesses. So people who had caught the virus at Mardi Gras had a month to pass it around before serious social distancing started.

I haven’t seen any reporting on whether social distancing practices have been more followed among whites than blacks, and if that might account for the disparity.

The point is, if you want to make this a story about racism, you really have to go out of your way. But trust NPR to find the progressive talking point on just about any story.

Now, having said that, it is the case that all over America, not just in Louisiana, black folks are more likely to die of Covid than whites. 

Why? The linked story (from the Washington Post) makes the familiar point that black Americans have greater comorbidities:

Elected officials and public-health experts have pointed to generations of discrimination and distrust between black communities and the health-care system. African Americans are also more likely to be uninsured and live in communities with inadequate health-care facilities.

As a result, African Americans have historically been disproportionately diagnosed with chronic diseases such as asthma, hypertension and diabetes — underlying conditions that experts say make covid-19 more lethal.

Critics of the public-health response have cited confusing messaging about how the virus is transmitted, such as an early emphasis on overseas travel, and have noted that some public officials were slow to issue stay-at-home directives to encourage social distancing.

Even then, some activists argued, black people might have been more exposed because many held low-wage or essential jobs, such as food service, public transit and health care, that required them to continue to interact with the public.

I wonder to what extent social class and geography has to do with this. I grew up in the rural South, and let me tell you, the diet of country people — black and white — is not what you would call healthy. What people call “soul food” is delicious, but heavy on pork fat and salt. The thing is, in the South, country white people and country black people eat the same kind of food. I’ve told a story in this space before about reheating a mess of turnip greens in the kitchen at work in Dallas once, and having a co-worker — a black woman from Indiana — walk in with an astonished look on her face. She could smell the greens from her desk, and wondered who was cooking them. She told me flat-out that she had no idea white people ate greens. I told her this was normal for me, that I grew up in a greens-cornbread-and-pork-chops culture.

It was an interesting cross-cultural moment. My co-worker had been born and raised up north, but also raised on the food of her poor rural Southern ancestors who migrated. She assumed that she was eating “black” food — which, in her context, she was — but it was really rural Southern cuisine. Up North, where many Southern blacks migrated, they took that food culture, and it was perceived, and received, up there as “black.” I wonder to what extent the disproportionate deaths of black folks up North are related to the food they eat — and their ancestral roots in the rural South.

There’s a really funny book that came out in the 1980s — White Trash Cooking — that’s probably too un-PC to be published now. It’s the food of poor Southern white people, compiled by a man, the late Ernie Mickler, who was raised that way. It’s an amusing book, but Mickler writes not to make fun of his people from the outside, but to say, “This is how we are, ain’t it a hoot?” Somebody gave me a copy of the book when it came out, and I still have it. I was looking through it this morning, and all that food — man, if you want to create a people that’s more susceptible to diabetes, hypertension, and obesity, feed them that stuff.

Again, this is how generations of country white people grew up. If you look at the blurbs page, you’ll find comments like this:

“The is the most delicious cookbook I have encountered — and it seems my diet in childhood was all White Trash! So may beloved old recipes have turned up. Bless you!”

Know who said that? Helen Hayes, a native of Washington DC, which was in her childhood culturally a Southern town. Harper Lee raves about it as “a sociological document of such beauty.” There’s also a blurb from Sen. Fulbright of Arkansas, praising the cuisine. “White trash” is the joke, but the cooking is the peasant cuisine of Southern whites. In the introduction, Mickler writes:

But the first thing you’ve got to understand is that there’s white trash and there’s White Trash. Manners and pride separate the two. Common white trash has very little in the way of pride, and no manners to speak of, and hardly any respect for anybody or anything. But where I come from in North Florida you never failed to say “yes ma’m” and “no sir,” never sat on a made-up bed (or put your ht on it), never opened someone else’s icebox, never left food on your plate, never left the table without permission, and never forgot to say “thank you” for the teeniest favor. That’s the way the ones before us were raised and that’s the way they raised us in the South.

The point is, Mickler appropriates the term “White Trash” the way gay people (and he was gay, by the way) would later appropriate the term “queer”: in a celebratory fashion that took the sting out of the insult. If you read the recipe book as a sociological document, as Harper Lee did, you will learn how country people of the American South traditionally ate.

For me, it’s fascinating, because it captures my own young culinary life as a transitional generation, as America grew richer and more cosmopolitan. My parents were born in 1934 (dad) and 1943 (mom), into rural Southern poverty. I was born in 1967, into the lower-middle class (Daddy was the first one in his family to go to college, which he did on the GI Bill). The kind of food in this cookbook was, I guess, about 60 percent of what we ate. Unlike my parents in their childhood, I had television, and like everybody else we knew, our family ate a lot of processed stuff sold on TV.

Now, if any of my beloved yuppie children saw that cookbook, they would feel like they were reading a cookbook from some foreign people. It wasn’t their mother’s cuisine — she grew up in the Dallas suburbs. The only one in our house who eats greens and fatback is … me. Philip and Barbara Bess once invited me to meet them for lunch at the Old Country Store in Lorman, Miss., where Arthur “Mr. D.” Davis serves soul food. It’s heaven on earth for such as me — it’s the traditional food of the Deep South. Here is Mr. D.:

If you want to get food like all the old people in the South ate, you almost always have to go to a restaurant where black people are in the kitchen. They are the main ones keeping the heritage going.

Why do I bring all this up? Because I am wondering to what extent black folks all over the country still eat the traditional soul food diet, with lots of grease, salt, pork, sugar, and carbs. It is delicious, but it is not healthy, and it would contribute to the comorbidities.

Maybe that’s beside the point, or at least not quite the point. Obesity is exploding, and it is concentrated among both low-income whites and blacks.  Obesity is tied to diabetes and hypertension. I don’t know that poor whites eat soul food anymore, but it is an established sociological fact that people on the lower end of the socioeconomic scale eat much less healthy food. You can say that it’s a matter of not being able to afford better, and you’d be right. But if you were honest, you’d have to recognize that people who have become accustomed to a diet high in fat, sugar, and simple carbs do not like healthier food. To them, it doesn’t taste good. A lot of these commentators assume that poor people eat bad diets only because they have no choice; they don’t give them agency, which is a mistake.

Here in Louisiana, you run into people all the time who are solidly middle class, or even upper middle class, who have the money to eat healthier, but who won’t do it because they were raised on high-fat, high-carb food, and that’s what tastes good to them. In the past, I’ve cooked for my folks vegetable dishes that would be considered delicious by people at my Dallas or Philadelphia dinner table, but which they thought were flavorless. This is not because they are bad people, but because to them, vegetables required more fat and salt to have an appropriate flavor. Unsurprisingly, in Louisiana, obesity is not as strictly confined to the lower income levels as it might be elsewhere in the country. You can’t blame poverty for non-poor people choosing to eat food that makes them unhealthy. I am a yuppie type who has a much healthier diet than many people, but if I have to choose between going to Sonic for a double cheeseburger, and going somewhere else for a salad, that sure enough requires an exercise of willpower. And if I’m forced to choose between a salad and pork chops, cornbread, and greens — forget about it, I’m going with the soul food. I have the money to eat as healthy as I like, but that’s just the way the cornbread crumbles. Guess who is about 40 pounds overweight? Me! I think I technically qualify as obese. If I get coronavirus, I will suffer more because I am overweight, and I am overweight because of my diet and my lack of physical activity. Society didn’t force me to be this way. I’m lazy, and I like to eat things that are not good for me. It happens.

What I want to know is this: do we have socioeconomic class data on Covid victims? 

I know the liberal media always and everywhere want to blame white supremacy for all the social ills that beset the African-American community, but there might be more to it in the case of Covid deaths. This could be a lot more tied into socioeconomic class than race. And we should factor in Maybe not, but shouldn’t journalists at least consider this before hopping on top of their hobbyhorses and galloping toward their preferred conclusions?

One last thing that these liberal journalists may not be considering. I have a kinsman who lives up in the country. He is obese and has a lot of health problems, including diabetes. He won’t stick to his prescribed diet. Despite him having a target on his back, he is not taking this Covid thing seriously. He thinks it’s all overblown. I love him, and am really, really worried about him, but he’s a grown man with a strong will, and he’s going to do whatever he wants to do. I hope and pray that the virus passes him by, but if he gets it, it will be because he has not done social distancing like he was supposed to, and if, God forbid, he dies, it will be because he has all the comorbidities.

He is a working-class white man, not poor. And he’s damn sure not stupid. What he is, is deeply set in his ways. He’s going to live the way he wants to live, and to hell with the rest of you. You can call that pride, or you can call it grit — he really doesn’t care. That’s the kind of stubbornness that is a virtue in some circumstances, a vice in others — but it is what it is. He has just as much agency in all this as his black working-class neighbors.

If my kinsman becomes a statistic, the fact that his behavior made him more susceptible to the virus, and his comorbidities made him more likely to die of it if he gets it, will be part of the story. Nobody on NPR is going to care, because he’s a white working-class man, and his death would not fit a simplistic liberal narrative. No NPR host is going to confront Sen. Bill Cassidy about what he isn’t doing to help working-class white people who are dying of Covid. Whatever one might say about class in this country, the fact is that my kinsman has chosen, for whatever reasons, not to change his diet to lose weight, to make his hypertension and diabetes less onerous. And for whatever reason or reasons, he is choosing not to observe strict social distancing. So I pray for him, and hope for the best, but if this virus takes him, it’s not going to be the fault of Bill Cassidy, or anybody else. And like I said, it’s not going to occur to the liberal media to blame Republican politicians, because my kinsman — a white, working-class, Southern male — doesn’t fit into a preferred victim demographic.

UPDATE: Reader Lee Podles, who lives in Baltimore:

Our well-thumbed White Trash Cooking I and II have provided occasional delights when my wife throws dietary caution to the winds and makes a batch of Russian Tea Cakes, which have nothing to do with Russia and everything to do with the South and its love of all things sweet. (These particular temptations seem to be a relative of Mexican Wedding Cookies.) Baltimore is not the deep South, but those cookies were a favorite of my childhood.

Blacks and poor whites (and some not so poor whites) preserve the eating habits of 19th century America, as documented in that necessary book, The Great Cornflake Crusade. Mr. Kellogg tried to cure America of its dyspepsia and obesity by his sanitoria and a cornflake diet. Some of us learned; but most didn’t, and America is fat.

I am especially amused by the implication that a racist conspiracy is keeping brussel sprouts and kale from black neighborhoods. If people wanted fresh vegetables and salads and tofu, stores would provide them; but it takes self-discipline to change eating habits, and blacks (and poor whites) are constantly told that nothing they do is Their Fault; it is Society’s fault, or Racism, or whatever. The poor are Victims; and they have no agency. They are acted upon, and do not act.

In Baltimore poor blacks are not practicing social distancing. Community leaders have tried to convince them, but the populace have decided that they are immune to coronavirus; it is a White Man’s disease. The open air drug markets of my acquaintance are still flourishing, although I notice some dealers are wearing masks and gloves as they peddle fentanyl-laced heroin. The Baltimore police are under a consent decree that they will not break up groups of black men who are not obviously breaking the law by shooting at each other (The police wisely turn a blind eye to the drug dealing; interrupting it may cause a riot.) As the governor’s order for social distancing may not have the force of law, all the police can do is pull up to the drug markets and broadcast a warning to keep 6 feet way and not form a group. The police are ignored, and drive away to find a church that has more than 10 people in attendance.

The population of Baltimore is falling; but the white and Asian population is increasing. Simple math leads to an interesting conclusion about the effects on the black population of generations of liberal Democratic governance of the city.

Reader Hannahbet:

I live in a minority-majority neighborhood. Everyone hosts parties in their front yards, and for some this happens every weekend. It’s something I usually love about where I live—because the high number of recent immigrants from Mexico means the intergenerational social fabric is on display all the time. But no one seems to be on lockdown here. Pickup basketball across the street hasn’t abated since the lockdown. I’ve been bracing for headlines that COVID-19 is disproportionately impacting minorities—knowing that racism is going to be the label the media gives it here locally, but also that my neighborhood hasn’t ever truly locked down.

I also received an e-mail from a white reader in Texas who talked about how none of his black friends are taking the crisis seriously, and none are changing their behavior to protect themselves.

UPDATE.2: A reader writes:

I grew up, as I’ve probably mentioned too many times, in rural Western Pennsylvania, not the home of Soul Food.  When I was first out of college in 1999 I was hired by Adelphia Cable to work in their call center, an awful job in many ways, wonderful in others.  I worked the 3 p.m. – 11 p.m. shift and most of my coworkers were black Americans from the little city of Blairsville, PA.  Some were from other communities that stretched toward Pittsburgh.
One day we were talking food, as I love to eat, and I brought in “side meat” and soon we were swapping recipes and food lore.  Most of them had grandparents or great-grandparents who were part of the Great Migrations north, others had been, like me long-term western Pennsylvanians, but the one thing we quickly discovered was a shared culture of eating.  The rural people of this country until at least my childhood preserved much of the cooking of the late 18th and early 19th century.  American working and lower middle class.  Tempered by local ingredients and tastes and immigrant groups.
The food of my ancestors was a mix of Palatinate German filtered through York and Lancaster County, Pennsylvania before it crossed the mountain, the food of London and Northern Ireland and the Native American dishes the first settlers adapted mixed together, and like you, my childhood eating was leavened with unhealthy doses of American Processed Boxed and Canned Garbage.
My wife and I still eat like farmers from 19th century Armstrong County, PA, even if we don’t work like they did, and we mix it up with modern cooking and her families mix of Slovak, Bohemian, and Lebanese dishes.
When we moved to Montana we decried the loss of liver pudding and scrapple, and behold, those Moravians and Germans and Scotch-Irish who came to North Carolina in the mid-18th century brought them with them and we enjoy them here.  Although Southerners ruin their sausage by adding the unnecessary hot pepper.
My wife posted a picture to face book a few nights ago of our supper cooking, lovely cakes of fried mush sizzling in butter, soon all our new Southern friends were discussing not having eaten them since their Grandmother passed in 1960 or 1980.  We make them the way my Pennsylvania Dutch and Irish grandmother did, and in my 20’s I discovered my Dad’s mother’s family tradition of eating a certain type of noodle on potatoes goes back to 18th Century Germany, and my Mother’s mothers potatoes were just Irish champ passed down from Ulster.  So it goes, and good on you for celebrating.  We will eat foodie and gourmet and international with the best of them, but I’ll never despise or turn my back on the peasant food of my ancestors.
Throughout my moves around American and traveling about working in pipe organ construction on thing I’ve found more constant than most others is the deep rural strain that binds much of the country together.   Many things we assume are unique to our region and our “people” are just part of the fussy, antsy, restless rural world of our covered wagon driving rural ancestors.  Many things turn out not to be a North Carolina thing or a Montana thing or a Pennsylvania thing but a rural American thing – and of course there are those things that are unique, but Russian Tea Cakes, ate’em by the ton as a kid, and they were a favorite of my Great-Grandfather, born 1870 died 1861 his family had been in our county since the 1780’s.
Food can bind us together in healthy and unhealthy ways.
Thanks for reminding us of the good that links us all, of all races, and regions, and at least in the past classes, and screw NPR’s wokeness.