A pandemic exacerbates a pre-existing death and grief gap
As of today, approximately 991,940 people in the United States have died of COVID-19 (ref: CDC COVID data tracker). These nearly one million people held many vital roles in their communities, including as parents and caregivers. A recent study published in The Lancet Child & Adolescent Health estimates that 5.2 million children in 21 countries lost a parent or a caregiver during the first 20 months of the pandemic. Specific to the United States, last fall the CDC published a study that revealed that from April 2020 through June 2021 over 140,000 children lost a caregiver with the largest burden falling on the shoulders of children of color. In their modeling, 1 child in the US loses a parent or caregiver in every 4 COVID-19-associated deaths. Stated another way, every time someone dismisses a few deaths due to COVID-19 as an overreaction, they are diminishing a few children losing a caregiver. Even worse is the breakdown of these losses. While ~1 in 500 children has lost a mother, father, or grandparent, the weight of this loss is not evenly distributed - White children account for 35% of these losses (White persons are 61% of the US population) and racial and ethnic minorities account for 65% of these losses (these populations represent 39% of the US population).
Much attention has been given as to whether or not this disease directly causes morbidity and mortality in children, without much regard given as to how this disease indirectly creates morbidity and mortality in this population. The answer to the latter lies in how the loss of a caregiver at a young age affects subsequent development and progression through the stages of life. I was today-years-old when I learned that I qualify as an orphan by the United Nations Children’s Fund (UNICEF) definition which defines orphanhood as the death of one or both parents. They include the loss of one parent in their definition because these children have an increased risk of mental health problems, abuse, unstable housing, and household poverty, which answers our question. YES, this pandemic will have lasting effects for decades including those directly tied to the creation of a multitude of orphans. Of note, this coincides with a time when 23% of households in America are single-parent homes (as a child of a single-parent home I give a shout-out to all single parents out there!).
One way to mitigate the lasting effects of this childhood trauma is to invest in our children (our future) as they reconcile with and acclimate to this newfound loss. The time is ripe for our nation to prioritize mental health services including but not limited to strengthening and expanding all mental health services, including virtual options with an extension of services beyond arbitrary, invisible state boundaries. Easy access point-of-care services geared towards this population include pre-established grief and bereavement camps, as well as mental health first aid camps for kids affected by COVID-19. The idea of creating a national Office of Bereavement has been tossed around for some time and I believe that now is the moment for this lofty idea to find a permanent home in the White House as we have the perfect pairing of a President who intimately knows loss and grief and a country who likewise has endured such loss and is starting to come to grips with it.
My job lies at the intersection of life, death, and public health. Just as gun violence, substance use, and infectious diseases are public health problems, so is bereavement. I have seen more than enough deaths come after a loss (or losses) of a loved one. Are these potentially preventable deaths? Had we as a society been able to better plug these individuals into grief resources and counseling would they still be alive? It’s a question I often find myself asking. From my vantage point, aside from one institution that offered grief services to all, obtainment of these services has been equally dismal across the board (disclaimer: stated with zero insight into what services were available, accessible, and offered). All around, we need to be doing better with respect to the field of mental health. Needed grief services should not be grant-limited - they should be freely accessible for all. These are the basic early steps needed to help heal a nation.
Like everything we do and every new initiative we undertake, these services need to be equitable. Historically, they have not been. I had the privilege of volunteering at a bereavement camp that changed my relationship with grief and loss and noted at the time I was one of a handful of faces at the camp that was brown-skinned. Being much younger, I didn’t think much of it. Through my years of medical training and, now, practice, I have seen day-in and day-out the racial death gap face-to-face - watching Black Americans die at higher rates than White Americans at nearly every age.* It wasn’t until I was creating this site that I learned about “The Racial Grief Gap” - the logical extension of the racial death gap into grief in remaining, living loved ones, which in America has mostly been studied without properly including Black and Brown people, who often also share collective grief.
It is natural and very easy to stop our actions where our job requirements end - to not allow the momentum of our passions to carry forward outside of the office. For me, it would be to stop at the death and not consider the lingering grief. However, this is a topic I care deeply about. I see fatal outcomes of people poorly navigating grief. I regularly hear the grief in the family left behind, some of which have had multiple family members come to our offices. I have lived through the loss of a parent at a young age and know how much weight that carries as you grow and develop and try to relate to your peers (who often don’t “get” grief). Back in college, as a psychology major, I opted not to pursue a PhD in psychology largely due to how underfunded and undervalued the field was. I find myself nearly two decades later dealing with the ramifications of this still undervalued and underfunded system both professionally and personally - we all are (whether you recognize it or not). To that end, if you or someone you know is doing work in this area, I would love to support you and amplify your voice - just contact me.
*allow me to be explicit in saying that it is not the social construct of race that is killing us but rather the compounding effects of racism in every system.
