The COVID-19 pandemic has brought to the surface the direct relationship between poverty, race, and disease in former slave societies like Brazil and the United States. The public health consequences of the pandemic for African descendants in both countries have exposed fraught state relations with their populations of color. The pandemic has also demonstrated how state legitimacy is greatly dependent upon the state’s response to its people during health crises. Historically, public health has been an important political arena in which the poor and the enslaved have contested their right to health as illustrated by the cholera epidemic of 1855–56 in Brazil.
When cholera reached Brazil and the Caribbean by mid-1850s it had already made thousands of victims throughout the first half of the nineteenth century in Europe and the United States. News of the disease in Europe had been published in the Brazilian press as early as 1849, with physicians trying to calm the population about the improbability of it affecting a country with warm weather and a sparse population. However, when the Portuguese vessel The Defender arrived from the cholera-infected city of Porto to the Brazilian northern province of Pará, the disease did not take long to affect the country from north to south and take thousands of lives with it. The vessel’s name was a painfully ironic reminder that there was not yet a clear defense against cholera. The English physician John Snow’s 1849 hypothesis about cholera’s oral-fecal transmission through contaminated water only gained support after the 1860s. Meanwhile, its victims underwent an ordeal of symptoms that ranged from mild discomfort at first, to acute diarrhea and vomiting, to finally an intense collapse of their bodies while retaining their mental function throughout the suffering.
In spreading through the coast and then interior of Brazil, cholera exposed the racial and class vulnerabilities of a nation–state built from the exploitation of the enslaved. The Brazilian empire (1822–89) had established its central power by the late 1840s and had just abolished the slave trade in 1850. However, health issues showed that legitimating the state’s presence among its populations would prove to be a constant battle. As it strikingly killed more slaves and the poor than elites, popular rumors soon developed about the disease being an attempt from the upper sectors to get rid of the populace. Even some physicians considered the correlation between poverty, slavery, and infection in their medical works and official reports. Despite their unsurprising prejudice against the “unhygienic manners” of the poor, some physicians also acknowledged the populace’s inadequate living conditions as a possible reason for the higher incidence of cholera among them. In urban areas, the poor often lived in small, humid, and unventilated spaces with high concentration of people. In the rural areas, slave owners were to blame for the cholera victims amid their overworked, poorly fed, and poorly dressed captives. Hence, social inequality and its racial component provided hints about one’s probability of contracting the disease.
The growing popularity of a slave healer named Pai Manoel during the cholera epidemic in the Brazilian Northeast showed the importance of the popular classes in shaping understandings of health rights. Pai Manoel gained many supporters—mostly slaves and the free(d) poor—in the province of Pernambuco as he allegedly had found a cure for cholera in 1856. His growing fame even made the Public Hygiene Council of Pernambuco investigate his methods. The fact that Pai Manoel later received official permission to practice healing at the province’s capital Navy Hospital demonstrates the state’s attempts to adapt their health measures to popular claims. Even though his patients were limited to the enslaved and free people of color, the state sought negotiation with the popular sectors as a preventative measure to violence during the cholera epidemic. This shows how the populace helped shaped sociopolitical understandings of health expectations and obligations, particularly during a time when official medicine had not found a cure (or a clear explanation) for the disease. Their struggles also provide a potent example that the historical wounds of racial inequality still mark official shortcomings in health assistance that deeply affect their descendants in the Americas.
In the modern-day United States, the COVID-19 pandemic has revealed the fragility of the state’s legitimacy among the poor because to date there has been no national implementation of health care as a right. Systemic economic and racial inequalities have exacerbated the impact of the disease in poor communities. Low income has been associated with diseases such as diabetes and heart disease, which increase vulnerability to the virus. African American communities, in particular, have been hit hard. As of April, a Center for Disease Control and Prevention analysis has revealed that black people constituted one third of the hospitalizations across 14 states when they were accounted for only 18 percent of the population in the areas under study. Weak safety nets, such as those among many African Americans and Latinos, also pose higher risks regarding access to adequate healthcare. Unemployment filings skyrocket while federal relief has taken longer to reach the destitute and cover their needs. For all these reasons, African American civil rights activists have been developing online campaigns, petitions, and online platforms aimed at creating plans for relief and recovery. They have targeted legislators and the private sector for investment and accountability. Organizations such as the N.A.A.C.P and the National Urban League have also sent letters to legislators with policy recommendations and have developed social mobilization via telephone and virtual town halls. African descendants in Brazil have also been facing similar problems and seeking similar solutions.
Photo of a Brazilian Slum by Rafael Fragoso. “Free Favela Stock Photo,” courtesy of freeimages.com
Currently, because Brazil faces a recession along with the pandemic, the health of the popular classes is once again in an extremely vulnerable position. Constitutional rights include healthcare, education, and safety for citizens. Yet, those in slums—who are believed to be around 13 million—are having to face this crisis with poor housing and lack of adequate sanitary living conditions, a similar reality to the poor of color facing cholera in the 1800s. Lack of access to water, for example, has prevented slum dwellers from washing their hands according to the advice of varied health organizations. Residents have then been seeking solutions amongst themselves, through the mapping of the most vulnerable areas in their marginalized communities and petitioning to political representatives. Similarly, after studies have revealed the potential health risks for African descendant populations in urban areas, local black organizations such as the Black Movement (Movimento Negro) and the Commission for Racial Equality from the Brazilian Association of Criminalist Lawyers (Comissão de Igualdade Racial da Associação Brasileira dos Advogados Criminalistas, Abracrim-ES) have written petitions for better and quicker state decisions to protect the health of the lower classes. Hoping to ease popular anxieties, local officials in the Brazilian Northeast—one of the most impoverished regions in the country—have been trying to maintain federal aid for poor families in defiance to president Jair Bolsonaro’s funding cuts. Meanwhile, ICUs in public hospitals have reached 70 percent or more of their capacity with COVID-19 patients, and Brazilians have died without assistance because of lack of beds in its public health system. As a plausible solution, the country looks into potential partnerships between the public and private health sectors. Those who greatly depend on the public health services in Brazil are the poor, of whom 75 percent are African descendants. Lack of adequate funding for the current national free and universal Unified Health System (SUS) also threatens its 140 million beneficiaries.
COVID-19 has unveiled the intrinsic relationship between the health of the state writ large with the health of its low-income populations. It has brought attention back to neglected social and racial gaps. A lesson it leaves for countries marked by inequality may be that there can be no real economic and social prosperity if the civil and health rights of its poor citizens are not seriously respected.
 Charles E. Rosenberg, The Cholera Years: the United States in 1832, 1849 and 1866 (Chicago, 1962), 101–114. Deborah Jenson and Victoria Szabo, “Cholera in Haiti and Other Caribbean Regions, 19th Century,” Emerging Infectious Diseases 97, no. 11 (2011), 2130–35, https://wwwnc.cdc.gov/eid/article/17/11/11-0958_article. Peter Baldwin, Contagion and the State in Europe, 1830–1930 (New York, 1999), 37–122. Kaori Kodama, et al., “Mortalidade Escrava Durante a Epidemia de Cólera No Rio de Janeiro: Uma Análise Preliminar,” História, Ciências, Saúde-Manguinhos 19 (2012), 59–79. Peter Vinten-Johansen, et al., Cholera, Chloroform, and the Science of Medicine: A Life of John Snow (New York, 2003),168, 199–230, 393–94. Dr. Marinho, “A Cholera-Morbus e Sua Influência Sobre o Brasil é Mais que Improvável,” Jornal do Commercio, Jan. 15, 1849, ed. 15, p. 2, 3. Dr. Joaquim D’Aquino Fonceca, “Coleção dos Trabalhos do Conselho Geral de Salubridade—Clima e Tísica Pulmonar- 4º Ano, 1849”, print. Jan. 16, 1849, Secretaria de Saúde Collection, Box no. 9, Jordão Emerenciano State Archive, Recife, Pernambuco, Brazil. “ Cólera- Relatório do Dr. Tomaz Antunes Abreu, 1856,” print, p. 2. Secretaria de Saúde Collection, box no. 9, Jordão Emerenciano State Archive.
 Kodama, et al., “Mortalidade Escrava Durante a Epidemia de Cólera No Rio de Janeiro: Uma Análise Preliminar, 62.”Ariosvaldo da Silva Diniz, “As Artes de Curar Nos Tempos Do Cólera,” in Artes e Ofícios de Curar No Brasil: Capítulos de História Social (Campinas, 2003), 355–85. Kodama, et al., 63. “Cólera- Relatório do Dr. Tomaz Antunes Abreu, 1856,” print, p. 2. Secretaria de Saúde Collection, Box no.9 , Jordão Emerenciano State Archive.
 Da Silva Diniz, “As Artes de Curar Nos Tempos Do Cólera,” 355–85. Rosilene Gomes Farias, “Pai Manoel, o Curandeiro Africano, e a Medicina No Pernambuco Imperial,” História, Ciências, Saúde-Manguinhos 19 (2012), 215–31, https://www.scielo.br/scielo.php?pid=S0104-59702012000500012&script=sci_abstract&tlng=pt.
 Mary Gerisch, “Health Care as a Human Right,” American Bar Association, Human Rights Magazine 43, no. 3, https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/health-care-as-a-human-right/.
Ibid. Ibram X Kendi, “Stop Blaming Black People for Dying of the Coronavirus: New Data from 29 States Confirm the Extent of the Racial Disparities,” Atlantic, Apr. 14, 2020, https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/. Audra D. S. Burch, “Why the Virus Is a Civil Rights Issue: ‘The Pain Will Not Be Shared Equally,”’ New York Times, Apr. 19, 2020, https://www.nytimes.com/2020/04/19/us/coronavirus-civil-rights.html. Philip Alston, “US Covid-19 Failing the Poor, Says UN Expert,” United Nations-Human Rights, https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=25798&LangID=E. “US: Address Impact of Covid on Poor,” Human Rights Watch, Mar. 19, 2020, https://www.hrw.org/news/2020/03/19/us-address-impact-covid-19-poor. Aimee Pichi, “20 Million Americans Still Waiting for Their Stimulus Checks,” CBS News, May 15, 2020, https://www.cbsnews.com/news/stimulus-check-delays-payment-status-not-available/.
 Hamilton Ferrari, “2011 a 2020: a Pior Década da História da Economia Brasileira em 120 Anos,” Correio Braziliense, June 23, 2019, https://www.correiobraziliense.com.br/app/noticia/economia/2019/06/23/internas_economia,764945/2011-a-2020-a-pior-decada-da-historia-da-economia-brasileira-em-120-a.shtml. Luiz Franco, “Coronavírus: Sem Plano do Governo para Favelas, Moradores e Organizações se Juntam para Controlar Contágio,” BBC Brasil, Mar. 29, 2020, https://www.bbc.com/portuguese/brasil-52032709. Isaac Ribeiro, “COVID-19, Após Reportagem Sobre Morte de Negros, Entidades Cobram do Estado,” A Gazeta, Apr. 29, 2020, https://www.agazeta.com.br/es/cotidiano/covid-19-apos-reportagem-sobre-morte-de-negros-entidades-cobram-o-estado-0420.
“Conflito Entre Bolsonaro e Governadores se Acirra com Crise do Coronavírus,” O Globo, Mar. 21, 2020, https://oglobo.globo.com/brasil/conflito-entre-bolsonaro-governadores-se-acirra-com-crise-do-coronavirus-1-24319742. Carlos Madeiro, “Governo corta 158 mil do Bolsa Família em meio a covid-19; 61% são do NE” UOL, Mar. 20, 2020, https://noticias.uol.com.br/politica/ultimas-noticias/2020/03/20/governo-corta-158-mil-do-bolsa-familia-em-meio-ao-covid-19-61-sao-do-ne.htm?cmpid=copiaecola. “Cortes no SUS e Teto de Gastos São Desafios no Combate ao Coronavírus,” IG, https://economia.ig.com.br/2020-03-21/cortes-no-sus-e-teto-de-gastos-sao-desafios-no-combate-ao-coronavirus.html.Bruna Lima and Maíra Nunes,“Proposta para Criação de Fila Única de Leitos de UTI Ganha Força,” Correio Braziliense, May 5, 2020, https://www.correiobraziliense.com.br/app/noticia/brasil/2020/05/02/interna-brasil,850549/proposta-para-criacao-de-fila-unica-de-leitos-de-uti-ganha-forca.shtml. Carlos Madeiro, “Negros São 75% Entre os Mais Pobres; Brancos, 70% Entre os Mais Ricos,” UOL-Cotidiano, Nov. 13, 2019, https://noticias.uol.com.br/cotidiano/ultimas-noticias/2019/11/13/percentual-de-negros-entre-10-mais-pobre-e-triplo-do-que-entre-mais-ricos.htm?. “Diretrizes Estratégicas,” Ministério da Saúde, https://bvsms.saude.gov.br/bvs/pacsaude/diretrizes.php.