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. Author manuscript; available in PMC: 2024 Dec 17.
Published in final edited form as: Rehabil Psychol. 2023 May;68(2):112–120. doi: 10.1037/rep0000495

We Still Cannot Breathe: Applying Intersectional Ecological Model to COVID-19 Survivorship

Mana K Ali Carter 1, Lakeya S McGill 2, Rachel V Aaron 2, Megan M Hosey 2, Eva Keatley 2, Mayra L Sanchez Gonzalez 2
PMCID: PMC11650656  NIHMSID: NIHMS2025170  PMID: 37166940

Abstract

Purpose/Objective:

Individuals with historically oppressed identities, such as disabled or racialized minorities, face inequities across all societal institutions, including education, criminal justice, and healthcare. Systems of oppression (e.g., ableism, racism) lead to inequities that have ultimately contributed to disproportionate rates of COVID-19 morbidity and mortality in the United States. In the midst of the COVID-19 pandemic, increased public attention regarding police brutality toward Black people and the reinvigoration of the national Black Lives Matter (BLM) movement further highlighted the detrimental effects of oppressive systems and the urgent need to promote equity in the United States. The disproportionate number of COVID-19-related deaths and police brutality are inextricably connected, as both are products of oppression toward minoritized communities. The co-occurrence of the pandemic and BLM movement protests also creates an opportunity for critical discourse on the intersection of ableism and anti-Black racism specifically within the field of rehabilitation psychology.

Research Method/Design:

The overarching goals of this review are to apply the Intersectional Ecological Model with the addition of the chronosystem to illustrate how systems of oppression lead to health disparity in COVID-19 survivorship and to provide recommendations to promote health equity.

Conclusions/Implication:

As the COVID-19 pandemic shifts to an endemic and efforts to eliminate oppressive systems continue, rehabilitation psychologists have an ongoing, evolving, and shared responsibility to employ socially-responsive solutions to promote optimal functioning for patients, families, and communities.

Keywords: COVID-19, survivorship, Intersectional ecological model, ableism, anti-Black racism

“I cannot breathe,” the chilling words of George Floyd before he died unjustifiably under the knee of a White police officer, was a call to action in the Black Lives Matter (BLM) movement. This phrase has evolved into a powerful metaphor for smothered opportunities and pervasive inequities in the United States across all social institutions, including education, criminal justice, and healthcare. This metaphor also can be applied to the simultaneous emergence of the coronavirus disease 2019 (COVID-19) pandemic, which has deepened longstanding economic, environmental, and health inequities in minoritized communities. The co-occurrence of the COVID-19 pandemic and the BLM movement heightened the public’s awareness of the injustices faced by minoritized communities and led to increased action for health equity (e.g., mobilization to address COVID-19 vaccination disparities (Strully et al., 2021). However, the risks for infection, hospitalization, and death from COVID-19 are still disproportionately higher in disabled and racially minoritized communities (COVID-19 Provisional Counts—Health Disparities, 2022; Gleason et al., 2021; Iqbal et al., 2021; Levy et al., 2022; Tung et al., 2021; Turk et al., 2020). The risks for lasting trauma and grief from the pandemic in disabled and racially minoritized communities are parallel in gravity (Lund et al., 2020).

Such patterns of COVID-19-related morbidity and mortality necessitate that the field of rehabilitation, including rehabilitation psychology, systematically address health disparities in COVID-19 survivorship. In doing so, we must conceptualize survivorship outcomes as resulting from the transactional relationship between systems of oppression and multiple minoritized identities, specifically race and disability (Telhan et al., 2020). To this end, the Intersectional Ecological Model (Levine & Breshears, 2019) will be used to illustrate the relationship between oppression and health disparities in COVID-19 survivorship and to provide recommendations to promote equity. We will specifically focus on the intersection of ableism and anti-Black racism, given the collision of the COVID-19 pandemic and the BLM movement in the United States.

Intersectional Ecological Model: Brief Review

The Intersectional Ecological Model posits that an individual with multiple minoritized identities experiences disproportionate oppression as a result of the interaction between intersecting identities with oppressive systems (Levine & Breshears, 2019). In this model, Levine and Breshears (2019) incorporated seminal work on intersectionality by Black feminists (Crenshaw, 1991; Guy-Sheftall, 1995). These authors argued that the impact of systemic oppression on an individual must be contextualized with a nuanced understanding of how intersecting marginalized identities are mutually defining (Crenshaw, 1991). Furthermore, the authors incorporated Bronfenbrenner’s Ecological Systems Theory (Bronfenbrenner, 1975, 1977, 1992), which posits that individuals are situated within, and therefore impacted by, an ecological environment composed of interdependent embedded systems and subsystems (i.e., microsystem, mesosystem, exosystem, macrosystem). The result of combining the Intersectionality and Ecological Systems Theories is the establishment of a framework—the Intersectional Ecological Model—for use in the rehabilitation psychology field to consider multiple systems in the understanding of injustices faced by disabled individuals with multiple minoritized identities. For this review, we add the chronosystem (Bronfenbrenner, 1975, 1977, 1992) as we consider the impact of the co-occurrence of the COVID-19 pandemic and surge in the BLM movement. Ultimately, this understanding can be used to drive interventions to improve the lives of the disabled community.

Intersectional Ecological Model: Focus on Ableism and Anti-Black Racism

Levine and Breshears (2019) used discrimination to illustrate the application of the Intersectional Ecological Model to multiple minoritized identities. At the confluence of the COVID-19 pandemic and the BLM movement, our paper expands on this work by applying the model to COVID-19 survivorship and related health disparities. We focus on the intersection of ableism and anti-Black racism directed toward people from the African diaspora, including Afro-Latinx. Racism is discrimination based on the social construct of race, which refers to the devaluation and prejudicial categorization of individuals based on phenotypic characteristics (Haeny et al., 2021). Ableism is discrimination and social prejudice against people with disability (cognitive, mental, sensory, and physical) and chronic medical conditions (Bogart & Dunn, 2019). Ableism and racism manifest at the individual (i.e., beliefs and attitudes), interpersonal (i.e., between individuals), institutional (i.e., organizational policies and practices), and structural (i.e., overarching systems across institutions and society) levels, and therefore, they are embedded in each ecological system (Andrews et al., 2022; Saucier, 2000). Ableism and racism are systemically maintained by social structures of power (including greater access to resources and more influence in societal decision-making) and create disadvantage, lack of privilege, and oppression (Andrews et al., 2021).

Historically, ableism and anti-Black racism have shaped the narrative about health disparities by explaining differential health outcomes as inherently related to Black racial identity and ability status. This narrative consequently, perpetuates health inequities through the lack of acknowledgment of, and accountability for, the systems of oppression that have given rise to health inequities in the first place. Disability has been used to devalue, disenfranchise, and exploit disabled individuals. Andrews et al. (2019) documentation of disability history highlights the systemic devaluation and exploitation of disabled individuals in healthcare, ranging from nonconsensual medical experimentation to the institutionalization and systematic extermination of disabled individuals. Within the disability community, Black individuals have experienced additional adverse consequences resulting from anti-Black racism, another system of oppression. In Black communities, ability status has been used to suggest inferiority as highlighted by the misguided phrenological studies linking physical attributes or developmental conditions to poor moral and social functioning (Leeds, 2020) and to innate limited intellectual functioning (Madhere, 1995).

The devaluation of Black disabled individuals in healthcare is illustrated in several instances throughout history with examples including a 1917–1924 federal vocational rehabilitation program that consistently limited access to essential medical treatment and accommodation among Black veterans of World War I (P. Lawrie, 2018; P. R. D. Lawrie, 2020). An additional example is the disproportionate representation of involuntary rates of sterilization of Black disabled women during the Eugenics movement (Stern, n.d.). It is oppressive systems of ableism and anti-Black racism, not individuals’ identities (i.e., race and ability status), that lead to adverse health outcomes (Dressler et al., 2005; Kaplan & Bennett, 2003; Mitra & Shakespeare, 2019). Thus, recognizing and challenging these intersecting systems of oppression must be at the forefront of health equity initiatives in order to block their perpetuation.

Intersectional Ecological Model: Focus on Health Disparities in COVID-19 Survivorship

The co-occurrence of the COVID-19 pandemic and the BLM movement brings awareness to the accelerated morbidity and mortality of disabled and Black communities. COVID-19-related hospitalizations and deaths are 2.1 and 1.6 times higher, respectively, in Black individuals when compared to Whites (CDC, 2022). Additionally, COVID-19-related deaths are 2–3 times higher for disabled individuals than nondisabled people (Convention on the Rights of Persons with Disabilities (CRPD) ∣ United Nations Enable, 2022; Qi, 2021). Black disabled individuals are vulnerable to health inequity (CDC, 2018, 2019; Magaña et al., 2016), which contributes to the increased risk for poor health outcomes (CDC, 2018, 2021).

Disparities in health outcomes stem from systems of oppression—ableism and anti-Black racism—via social determinants of health (Emerson et al., 2011; Frier et al., 2018). The disproportionate negative impacts of COVID-19 on disabled and Black individuals are examples of the impact that systems of oppression have on these communities separately. Although we can use this data to infer the compounded effect for people with intersecting identities, the dearth of systematically collected data on the impact of COVID-19 on Black disabled individuals makes it challenging to understand the scope of the impact on this community (Young, 2020).

Intersectional Ecological Model: Applications to Subsystems

Recognizing the compounded effect of COVID-19 on Black disabled individuals, rehabilitation psychologists are in a prime position to conceptualize and treat the exacerbated and residual physical, mental, and social challenges that may persevere through COVID-19 recovery (Brigham et al., 2021; Hosey & Needham, 2020; Vannorsdall et al., 2022) in the context of intersectionality. Applying the Intersectional Ecological Model (Levine & Breshears, 2019) to illustrate health disparities in COVID-19 survivorship, we will highlight the intersection of Black racial identity and disability and their interaction at each subsystem (i.e., microsystem, mesosystem, exosystem, and macrosystem). Along with this model, we will consider their interaction from the chronosystem perspective.

Microsystem

The microsystem refers to the institutions or settings experienced by the individual through direct interactions across activities, social roles, and/or interpersonal relations (Bronfenbrenner, 1975, 1977, 1992). The World Health Organization acknowledged and supported the key role of rehabilitation care in the management of COVID-19 survivorship (Pan American Health Organization, 2020). Unfortunately, the major and necessary shift to remote tech-enabled rehabilitation care (telehealth) impacted access to care for survivors with intersecting identities differently. The shift to telehealth care both facilitated access to and identified barriers to accessing care among racially minoritized and disabled individuals. For example, although the majority of individuals in the United States own a smartphone, Black and disabled adults are less likely than White and nondisabled adults to have access to other technology, such as a laptop or desktop computer and home broadband internet, that would ensure equitable access to tech-enabled care (Atske & Perrin, 2021; Perrin & Atske, 2021).

Furthermore, members with other intersecting identities within Black and disabled communities (e.g. members with sensory disabilities, members with less education irrespective of disability type, non-English speakers, older adults) have additional barriers, including lower levels of digital adoption and higher risk of having an inaccessible digital experience (Friedman & VanPuymbrouck, 2021; Ward-Sutton et al., 2020). For instance, consider a Spanish-speaking Afro-Latinx male with a history of a brain injury who is discharged from acute inpatient rehabilitation after contracting COVID-19. Due to social inequities, this individual has a higher risk of experiencing technology inaccessibility (e.g., lack of access to assistive technology and internet) (Perrin & Atske, 2021). Inaccessibility is further compounded by infrastructure barriers including lack of language-concordant care or technological barriers in the systematic incorporation of interpreters during telehealth appointments (Verduzco-Gutierrez et al., 2021). Thus, technology inaccessibility might prevent participation in more convenient telehealth medical appointments (Kolakowsky-Hayner & Goldin, 2020), or access to more appropriate rehabilitation services (Verduzco-Gutierrez et al., 2021).

Although telemedicine might have generally improved access to care for individuals with existing access, it appears to have created further disadvantages for individuals who were already excluded from the health system (Harden et al., 2022). Unless intentionally addressed, the underconsideration of equity when creating and implementing telehealth policies has and will continue to deepen COVID-19 intervention disparities and will exacerbate longstanding health disparities for Black disabled individuals.

Mesosystem

The mesosystem refers to the interrelationship among microsystems in which the individual actively participates (e.g., family, health services, work) (Bronfenbrenner, 1975, 1977, 1992). The pandemic exposed competing challenges among microsystems that had compounding negative effects on the lived experiences of Black disabled individuals (Jashinsky et al., 2021; Nolan, 2022). We illustrate the mesosystem through the dynamic relationship between the systems of health and family.

The shifting dynamics in family and health systems differentially impacted Black disabled individuals. The sudden shift to telehealth care and visitor restrictions due to COVID-19 resulted in significant changes in the availability of supportive services for Black disabled individuals (Irani et al., 2021). For example, visitor restrictions were especially harmful to the Black and disabled communities because they limit the involvement of supportive members (e.g., family, caregivers), many of whom serve important advocacy roles, in the care of Black disabled individuals (Hugelius et al., 2021). Indeed, multiple epidemiologic studies (Gleason et al., 2021; Turk et al., 2020) reveal that COVID-19 was the leading cause of death among individuals with intellectual and developmental disabilities (IDD). Moreover, when these individuals were hospitalized, they are less likely to receive critical care interventions. There are no data specifically relating to the intersection of Black individuals with IDD, though anecdotal reports suggest compounding racism and ableism contribute to lower access to care (Ross, n.d.). For Black disabled individuals, the limited access to health advocates threatened to increase testimonial injustice, the provider’s dismissal of a patient’s reported symptoms or experiences, due to the provider’s prejudice rooted in ableism and racism (Langton, 2010). This led to detrimental patient outcomes (Norton et al., 2020; Peña-Guzmán & Reynolds, 2019).

In addition, changes in health systems (e.g., availability of “non-emergency services,” such as routine chronic health management) increased the risk that Black disabled individuals would lose their independence, which simultaneously increased the demands of care needed within the family system (Irani et al., 2021). For example, consider a Black woman with chronic pain whose medical appointments for pain management were not considered urgent during the COVID-19 pandemic. Before the pandemic, she already faced biased care and resource barriers stemming from pervasive discriminatory social systems. This was then exacerbated by the COVID-19 pandemic, increasing her risks for under-treatment, functional impairment, and symptoms of anxiety and depression (Ndao-Brumblay & Green, 2005; Nolan, 2022).

Overall, for Black disabled communities, the pandemic’s impact on the mesosystem, including increased caregiver demands and disrupted access to routine health management, will increase reliance on already strained healthcare services. This added burden will likely lead to additional disability, morbidity, and mortality.

Exosystem

The exosystem refers to environments and structures that are external to individuals but impact them directly, such as the healthcare system (Bronfenbrenner, 1975, 1977, 1992). The exosystem has an inherent risk for discrimination because individuals who are most impacted by structural and systemic oppression are typically not included in decision-making about policies that impact their lived experience. Institutional and organizational policies surrounding access to COVID-19 healthcare exemplify the impact of the exosystem on Black disabled individuals.

Attitudes surrounding ability status and Black racial identity led to Black disabled individuals being targeted for care denial on formal and informal healthcare provision guidelines (National Council on Disability, 2021). For example, as health systems were stretched to capacity during the pandemic, COVID-19 “crisis standard of care” (CSC) protocols were implemented by several states. CSC protocols follow national guidance set forth by the National Academy of Medicine (NAM) for use by state health institutions to establish and implement standards of care in the context of scarce resources (Institute of Medicine, 2012). NAM guidance incorporates the principle of “fairness”—consideration toward vulnerable groups (Association of American Medical Colleges, n.d.); however, review of CSC protocols has shown bias against Black and disabled individuals (Hick et al., 2022; Tracie, n.d.).

Most CSC protocols included decision-making algorithms that considered the likelihood of benefit from intervention using markers that are rooted in historical and contemporary inequities. Common markers included number of chronic illnesses, severity of acute illness, or predicted 1- to 5-year survival. These markers are biased as they ignore the systems of oppression that have led to chronic illness and lower lifespan (e.g., social determinants of health) in the Black community and rely on assessment tools that were developed without adequate representation (Hick et al., 2022; Tracie, n.d.). Moreover, measurement devices, such as pulse oximeters which may have been used to inform decision-making about care priorities, underestimated the severity of low blood oxygenation in Black individuals (Fawzy et al., 2022; Sjoding et al., 2020). Furthermore, the lack of clinical guidance in many healthcare systems resulted in providers’ latitude to make decisions based on personal interpretations of the likelihood of benefit from intervention. These decisions were both inconsistent and subject to provider biases (Andrews et al., 2021; Clark et al., 2020; Cleveland Manchanda et al., 2020). Although there is no specific data on how CSC impacted Black disabled individuals, we hypothesize based on intersectionality theory that the adverse effects were likely compounded when individuals with these intersecting identities entered the health system.

Macrosystem

The macrosystem refers to the culture and society that surrounds and influences the exo, meso, and micro systems (Bronfenbrenner, 1975, 1977, 1992). It includes implicit and explicit attitudes toward ability status and racial (Black) status that create the social, political, and financial contexts for survivorship. Societal attitudes function to shape opinions, which impact all levels of society’s functioning (e.g., public policy).

Historical and contemporary societal attitudes about disability and race create major barriers to health equity and full-inclusion of Black disabled individuals (Andrews et al., 2019; Bogart & Dunn, 2019; Milner & Franz, 2020). For example, disability-specific attitudes have shaped the definition and treatment of disability, resulting in the persistently influential medical model of disability, which perceives disability as a biomedical problem to be fixed (Milner & Franz, 2020). Disability is frequently erroneously equated to poor quality of life, highlighting the systematic devaluation of disabled individuals (Andrews, 2019). One contemporary example of the influential force of the medical model in shaping COVID-19 survivorship is the disproportionate funding of COVID-19 biomedical research compared to other areas such as those related to re-integration of individuals into valued life roles (Stucki et al., 2007).

Anti-Black racial attitudes are also deeply internalized by health-care providers and policy-makers and are an influential force in health outcomes and inequity (Milner & Franz, 2020). For example, in the earliest and deadliest phase of the pandemic, COVID-19 cases were higher in counties with a higher percentage of Black residents, and this relationship was stronger when community-level implicit and explicit racial attitudes were higher (Cunningham & Wigfall, 2020). It is hypothesized that racial attitudes lead to the maintenance and perpetuation of systemic forms of racism that result in negative health outcomes (Lee et al., 2015; Leitner et al., 2016). Furthermore, given these implicit and explicit anti-Black attitudes, healthcare leaders and policy-makers may be less motivated to implement policy changes that would support survivorship for the Black community.

Although specific research on attitudes toward Black disabled individuals is limited, we infer that there are compounding effects for individuals with these intersecting identities. Some examples of evidence can be seen in the disproportionately higher rates of disability in Blacks and the greater morbidity and unmet healthcare needs in the Black disabled community (Horner-Johnson, 2021). In the context of the COVID-19 crisis and the absence of change regarding discriminatory attitudes embedded in the macrosystem, survivorship cannot be optimized for Black disabled individuals without significant change.

Chronosystem

The chronosystem includes events and transitions that occur over the course of life, and that can occur within the individual’s life (e.g., graduation, marriage) or externally to the individual (e.g., a pandemic, social movements) (Bronfenbrenner, 1975, 1977, 1992). Although the chronosystem is not included in the Intersectional Ecological Model (Levine & Breshears, 2019), we believe it is necessary to incorporate this system given its powerful force in shaping an individual’s lived experiences. The COVID-19 pandemic and the BLM movement both function within the chronosystem. For instance, the COVID-19 pandemic deepened the negative impact of pre-existing social determinants of health and, in conjunction with the BLM movement, raised awareness about the significant disparities experienced by Black individuals, including those with intersecting identities, across all sectors of society. Furthermore, because the pandemic is occurring against the backdrop of historical and contemporary forms of social injustice, mistrust and demoralization have deepened in minoritized communities due to additional confrontation with implicit and explicit ableism and racism present at all levels of the ecological system.

Unfortunately, there have been several challenges in genuine efforts to reduce health disparities in the rehabilitation psychology field. In addition to the under-recognition of the intersection of ableism and racism, neglecting the interdependence of the ecological systems (i.e., micro, meso, exo, macro, chrono) can lead to missed efforts in implementing interventions to support COVID-19 survivorship that integrate solutions across all levels of the ecological systems.

Recommendations to Promote Health Equity in COVID-19 Survivorship

The field of rehabilitation psychology is founded on optimizing survivorship and quality of life (Dunn et al., 2016). In response to recent events, there have been calls to action for rehabilitation psychologists to understand and dismantle systems of oppression (Lund et al., 2020; Telhan et al., 2020). As a field, we must continue to wield our individual and collective power and responsibility to advocate for change at all levels of society (i.e., micro, meso, exo, macro). Furthermore, we emphasize the importance of affecting change beyond the microsystem level (i.e., individual-level solutions), as dismantling systems of oppression requires multilevel interventions (Bhattarai et al., 2020).

Own Our History

Optimizing survivorship for Black disabled patients can only be accomplished when we own the history of racism and ableism that has shaped our daily lives and recognize how these systems of oppression have been maintained and perpetuated by our country and the field of psychology, broadly speaking. Psychologists and trainees can explore the racial and disability makeup of their geographic region, as well as social determinants of health statistics available through service organizations such as the Centers for Disease Control and Prevention or the United States Census Bureau. Furthermore, keeping abreast of equity, diversity, and inclusion communications and initiatives within American Psychological Association (APA) will clarify responsibilities of the field to address systemic oppression. For example, the Apology to People of Color for APA’s Role in Promoting, Perpetuating, and Failing to Challenge Racism, Racial Discrimination, and Human Hierarchy in the U.S. (2021) describes the field’s role in the oppression of racially minoritized communities and resolutions to right this wrong (American Psychological Association, 2021).

Foster Self-Awareness

Psychologists and trainees must explore their own identities, background, and personal biases continuously and regularly. This is necessary because, regardless of personal identity we are all subject to bias, which negatively impacts health outcomes (VanPuymbrouck et al., 2020). Implicit bias assessments (i.e., Implicit Association Test) (Greenwald et al., 2009), continuing education, and experiential learning are means for increasing awareness of personal biases. It is important to cultivate curiosity and awareness of the spectrum of personal identities that can compound discrimination against Black disabled patients, whether those identities are ones personally shared by the provider or not. Frameworks such as the ADDRESSING model (Hays, 2008) can prompt thinking about the range and impact of personal identities including but not limited to minoritized gender identities, sexual orientation, educational background, and household income.

Adopt a Social Justice Orientation

Psychologists and trainees should adopt a social justice orientation. Social justice for psychological and physical safety entails adherence to the following tenets (Hytten & Bettez, 2011): distributive (i.e., distribution of limited goods and resources equitably), procedural (i.e., equitable input of groups within decision-making), and communitarian (i.e., processes that guide decision-making). Social justice, as a central value in professional psychology, can be achieved through embedding structural and systemic core competencies in training programs and scholarly activities as a measure of performance. This can support health equity by closing the gap between the conceptualization and measurement of oppression (Hardeman et al., 2022) and move the rehabilitation psychology field beyond individual-level solutions (Bhattarai et al., 2020). Moreover, psychology training programs can utilize the Scientist–Practitioner Advocacy Training Model (Mallinckrodt et al., 2014) to bring a social justice lens to the examination of the impact of inequitable social contexts on the lived experiences of individuals (e.g., patients, research participants, trainees, colleagues) with intersecting minoritized identities. The Public Psychology for Liberation Training Model (Neville et al., 2021) also offers a path and commitment to cultural humility and the generation of translational knowledge, for and with minoritized communities, to conceptualize and dismantle systems of oppression.

Espouse an Empowerment- and Strengths-Based Perspective

To resist oppression, individuals have drawn from their personal, familial, community, and cultural strengths. Being aware and sensitive to identity makeup paves a path to tackle barriers and allows for the incorporation of unique individual and cultural strengths and values into wellness. One way to strengthen community resilience and trust is to provide economic and instrumental support to community-led programs, particularly within communities that have been disproportionately affected by current events (the chrono-system). Psychologists can utilize outreach, create and advocate for pathways for diverse leadership and staff, and include businesses by and for minoritized groups in organizational operations. Furthermore, at the microsystems level, strategies like motivational interviewing, collaborative planning, and shared decision-making help build trust, capitalize individual strengths, and dismantle barriers toward survivorship (Ali & Mickens, 2018). Creating equitable opportunities and strengthening relationships with communities that bear the greatest health, social, and economic burden is key to fostering trust and reducing bias and stigma. Notably, the establishment of trust with minoritized communities is only impactful if there is an emphasis on sustainability.

Employ a Stakeholder-Driven Framework

The Intersectional Ecological Systems Model emphasizes interconnectedness among people and societal systems. This spirit of interconnectedness can be extended to the creation of stakeholder-driven approaches that foster partnerships with Black disabled community members, policy-makers, and advocates—recognizing that these stakeholder groups are not mutually exclusive—to impact change in society. Furthermore, the spirit of interconnectedness emphasizes the necessary and critical importance of including Black disabled individuals in positions of power to affect structural change. This includes, although it is not limited to, the inclusion of Black disabled individuals in the development and execution of research and the dissemination of knowledge (Crowley et al., 2021). Aligned with this intention, we echo the recommendations proposed by Bhattarai et al. (2020), whose authors include women of color with disabilities, for rehabilitation psychologists to promote equity at the population level, including the involvement of stakeholders.

Unfortunately, it is commonly the case that individuals from minoritized communities are underrepresented in theoretical models and research, both as participants and as scholars (Borno et al., 2020). Baldwin (1972) summarizes this matter in stating, “if one really wishes to know how justice is administered in a country, one does not question the policemen, the lawyers, the judges, or the protected members of the middle class. One goes to the unprotected—those, precisely, who need the law’s protection most!—and listens to their testimony.” This may be increasingly important in work related to long COVID, where consulted stakeholders are predominantly highly educated, healthcare workers, middle-aged, and White individuals who are advocating a biomedical model with no apparent attempts to reach out to groups most disparately affected by the disease (Examples: Carson et al., 2021; Gorna et al., 2021).

Incorporate a Nuanced Conceptualization of Black Disabled Individuals

Understanding the lived experiences of Black disabled individuals and contextualizing them within the forces of the ecological environment is a necessary step toward addressing systems of oppression. A nuanced conceptualization of the lived experiences of Black disabled individuals can be embedded throughout the continuum of psychology-related activities (i.e., education, research, practice, and advocacy). This can be achieved through the incorporation of models of understanding, such as the Intersectional Ecological Model.

Focus on Improving the Measurement of Racism and Ableism

One concern of prevalence statistics and research is the medicalization of multiple minoritized identities instead of recognizing that they also are influenced by social and political forces. This miscategorization leads to incomplete education and misdirected interventions. When individuals with minoritized identities are included in the research, their multiple identities are represented additively (e.g., Black, disabled, gay, man) rather than as intersecting (e.g., Black disabled gay man), leading to an oversimplified understanding of their lived experiences (Bowleg, 2008; Johnson, 2020). Thus empirical research faces challenges in closing the gap between the conceptualization and measurement of racism and ableism for the purpose of achieving health equity (Hardeman et al., 2022; Hardeman & Karbeah, 2020).

Researchers can consider various methodologies that can be utilized to validly measure systems of oppression. For this recommendation, we elevate the work of Harden et al. (2022). They highlight qualitative and quantitative methodologies that capture the “multifaceted and systemic properties of structural racism as well as other systems of oppression,” with the ultimate goal of achieving health equity (Hardeman et al., 2022). In brief, the authors highlight theory-driven methodological approaches to expand the measurement of oppressive systems. These include methodologies that (a) utilize new data sources that capture data on structural systems of oppression, (b) measure systems of oppression as a system rather than as a sum of individual parts, (c) incorporate intersectionality, and (d) employ qualitative and community-based participatory research.

Conclusion

The right to breathe—and to do so equitably—is a reminder that every human has a fundamental right to the highest standard of health and respect. The simultaneous world events of the COVID-19 public health crisis and BLM movement in the United States galvanized discussion around systemic inequities targeting individuals and communities with identities that face historical and contemporary oppression. Intersectional Ecological Systems Theory helps to create a nuanced understanding of how systems of oppression contribute to creating layers of inequity and the impact that current events have on the lived experiences of Black disabled individuals. Application of this theory by rehabilitation psychologists can foster opportunities for social justice and emancipatory practice. It can enhance our appreciation for lived experiences, which is necessary for building strengths-based relationships with our patients, colleagues, and communities. Through this lens, we can promote COVID-19 survivorship for Black disabled individuals by creating nuanced conceptualizations, advocating for the rectification of systemic structures of oppression (e.g., health policy), and creating multilevel interventions that build trust and incorporate the individual and community strengths of Black disabled individuals.

Impact and Implications.

Disabled and Black communities continue to face inequities across all societal systems. The COVID-19 pandemic and simultaneous Black Lives Matter Movement protests brought systemic inequities faced by disabled and Black communities to the forefront of the nation’s attention, creating an opportunity to explore the intersection of ableism and anti-Black racism on COVID-19 survivorship. This paper uses the Intersectional Ecological Model to illustrate how systemic oppression contributes to inequity in COVID-19 survivorship for Black disabled communities. Rehabilitation psychologists can leverage the information in this paper to foster socially conscious clinical practice, research, training, and advocacy.

Acknowledgments

Research reported in this publication was supported by NIH 3R01AG046149-08S1 (MLSG), the NIH K23HL155735 (MMH), K23HD104934 (RVA), and T32HD007414 (LSM postdoctoral training). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Footnotes

The authors are frontline clinical psychologists, working directly with patients with COVID-19 during the earliest surges of the pandemic through the present. The authors witnessed firsthand the life-threatening nature of the disease and the decentralization of Black, disabled, COVID-19 survivors in public health and societal discourse. We strive for cultural humility and acknowledge the diversity that we lack across other identities that are subjected to discrimination and oppression. Mana K. Ali Carter identifies as a Black, cisgender woman without a disability, and a board-certified licensed rehabilitation psychologist. Lakeya S. McGill is a postdoctoral fellow and licensed psychologist who identifies as a Black, cisgender woman with a learning disability, and first-generation college graduate raised in a rural community in the Southern United States. Rachel V. Aaron is a psychologist who identifies as a White, cisgender woman without a disability, from the Southern United States. Megan M. Hosey is a psychologist who identifies as a White, cisgender woman with a chronic medical condition. Eva Keatley identifies as White cisgender woman third-culture kid who was born and raised outside the United States and trained as a psychologist with a rehabilitation and neuropsychology focus. Mayra L. Sanchez Gonzalez is a psychologist who identifies as a first-generation immigrant, cisgender woman without a disability, and first-generation college graduate.

References

  1. Ali MK, & Mickens M. (2018). Treatment engagement and multicultural considerations. In Maragakis A & O’Donohue WT (Eds.), Principle-based stepped care and brief psychotherapy for integrated care settings (pp. 449–460). Springer International. [Google Scholar]
  2. American Psychological Association. (2021). Apology to people of color for APA’s role in promoting, Perpetuating, and failing to challenge racism, racial discrimination, and human hierarchy in the U.S. Retrieved October 19, 2022 from https://www.apa.org/about/policy/racism-apology [Google Scholar]
  3. Andrews EE (2019). Disability as diversity: Developing cultural competence. Oxford University Press. [Google Scholar]
  4. Andrews EE, Ayers KB, Brown KS, Dunn DS, & Pilarski CR (2021). No body is expendable: Medical rationing and disability justice during the COVID-19 pandemic. American Psychologist, 76(3), 451–461. 10.1037/amp0000709 [DOI] [PubMed] [Google Scholar]
  5. Andrews EE, Ayers KB, Stramondo JA, & Powell RM (2022). Rethinking systemic ableism: A response to Zagouras, Ellick, and Aulisio. Clinical Ethics, 18(1), 7–12. 10.1177/14777509221094472 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Andrews EE, Forber-Pratt AJ, Mona LR, Lund EM, Pilarski CR, & Balter R (2019). #Saytheword: A disability culture commentary on the erasure of “disability”. Rehabilitation Psychology, 64(2), 111–118. 10.1037/rep0000258 [DOI] [PubMed] [Google Scholar]
  7. Association of American Medical Colleges. (n.d.). COVID-19 crisis standards of care: Frequently asked questions for counsel. Retrieved September 18, 2022, from https://www.aamc.org/coronavirus/faq-crisis-standards-care [Google Scholar]
  8. Atske S, & Perrin A (2021). Home broadband adoption, computer ownership vary by race, ethnicity in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/ [Google Scholar]
  9. Baldwin J. (1972). No name in the street. Joseph. [Google Scholar]
  10. Bhattarai J, Bentley J, Morean W, Wegener ST, & Pollack Porter KM (2020). Promoting equity at the population level: Putting the foundational principles into practice through disability advocacy. Rehabilitation Psychology, 65(2), 87–100. 10.1037/rep0000321 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bogart KR, & Dunn DS (2019). Ableism special issue introduction. Journal of Social Issues, 75(3), 650–664. 10.1111/josi.12354 [DOI] [Google Scholar]
  12. Borno HT, Zhang S, & Gomez S (2020). COVID-19 disparities: An urgent call for race reporting and representation in clinical research. Contemporary Clinical Trials Communications, 19, Article 100630. 10.1016/j.conctc.2020.100630 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Bowleg L. (2008). When Black + Lesbian + Woman = Black Lesbian Woman: The methodological challenges of qualitative and quantitative intersectionality research. Sex Roles, 59(5–6), 312–325. 10.1007/s11199-008-9400-z [DOI] [Google Scholar]
  14. Brigham E, O’Toole J, Kim SY, Friedman M, Daly L, Kaplin A, Swarthout M, Hasselfeld B, Lantz-Garnish M, Vannorsdall T, Agranovich A, Raju S, & Parker A (2021). The Johns Hopkins Post-Acute COVID-19 Team (PACT): A multidisciplinary, collaborative, ambulatory framework supporting COVID-19 survivors. The American Journal of Medicine, 134(4), 462–467.e1. 10.1016/j.amjmed.2020.12.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Bronfenbrenner U. (1975). The ecology of human development in retrospect and prospect. https://eric.ed.gov/?id=ED128387 [Google Scholar]
  16. Bronfenbrenner U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. 10.1037/0003-066X.32.7.513 [DOI] [Google Scholar]
  17. Bronfenbrenner U. (1992). Ecological systems theory. In Vasta R (Ed.), Six theories of child development: Revised formulations and current issues (pp. 187–249). Jessica Kingsley Publishers. [Google Scholar]
  18. Carson G, Carson G, Sigfrid L, Olliaro P, Norton A, Paparella G, Matulevics R, Gillesen A, Horby P, Hastie C, O’Hara M, Suett J, Moore S, Vaux R, Habarugira JM, Boily-Larouche G, Clark E, Hart P, Golding J, … Long Covid Forum Group. (2021). Research priorities for Long Covid: Refined through an international multi-stakeholder forum. BMC Medicine, 19(1), Article 84. 10.1186/s12916-021-01947-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. CDC. (2018, March 28). Disability and Health Data System (DHDS). https://www.cdc.gov/index.htm [Google Scholar]
  20. CDC. (2019, October 25). Adults with disabilities: Ethnicity and race. https://www.cdc.gov/ncbddd/disabilityandhealth/materials/infographic-disabilities-ethnicity-race.html [Google Scholar]
  21. CDC. (2021, November 24). Racism and health. https://www.cdc.gov/healthequity/racism-disparities/index.html [Google Scholar]
  22. CDC. (2022). Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html [Google Scholar]
  23. Clark E, Fredricks K, Woc-Colburn L, Bottazzi ME, & Weatherhead J (2020). Disproportionate impact of the COVID-19 pandemic on immigrant communities in the United States. PLoS Neglected Tropical Diseases, 14(7), Article e0008484. 10.1371/journal.pntd.0008484 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Cleveland Manchanda E, Couillard C, & Sivashanker K (2020). Inequity in crisis standards of care. New England Journal of Medicine, 383(4), Article e16. 10.1056/NEJMp2011359 [DOI] [PubMed] [Google Scholar]
  25. Convention on the Rights of Persons with Disabilities (CRPD) ∣ United Nations Enable. (2022). https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html [DOI] [PubMed] [Google Scholar]
  26. COVID-19 Provisional Counts—Health Disparities. (2022, August 3). https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm [Google Scholar]
  27. Crenshaw K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1300. 10.2307/1229039 [DOI] [Google Scholar]
  28. Crowley DM, Scott JT, Long EC, Green L, Giray C, Gay B, Israel A, Storace R, McCauley M, & Donovan M (2021). Cultivating researcher-policymaker partnerships: A randomized controlled trial of a model for training public psychologists. American Psychologist, 76(8), 1307–1322. 10.1037/amp0000880 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Cunningham GB, & Wigfall LT (2020). Race, explicit racial attitudes, implicit racial attitudes, and COVID-19 cases and deaths: An analysis of counties in the United States. PLoS ONE, 15(11), Article e0242044. 10.1371/journal.pone.0242044 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Dressler W, Oths K, & Gravlee C (2005). Race and ethnicity in public health research: Models to explain health disparities. Annual Review of Anthropology, 34(1), 231–252. 10.1146/annurev.anthro.34.081804.120505 [DOI] [Google Scholar]
  31. Dunn DS, Ehde DM, & Wegener ST (2016). The foundational principles as psychological lodestars: Theoretical inspiration and empirical direction in rehabilitation psychology. Rehabilitation Psychology, 61(1), 1–6. 10.1037/rep0000082 [DOI] [PubMed] [Google Scholar]
  32. Emerson E, Madden R, Graham H, Llewellyn G, Hatton C, & Robertson J (2011). The health of disabled people and the social determinants of health. Public Health, 125(3), 145–147. 10.1016/j.puhe.2010.11.003 [DOI] [PubMed] [Google Scholar]
  33. Fawzy A, Wu TD, Wang K, Robinson ML, Farha J, Bradke A, Golden SH, Xu Y, & Garibaldi BT (2022). Racial and ethnic discrepancy in pulse oximetry and delayed identification of treatment eligibility among patients with COVID-19. JAMA Internal Medicine, 182(7), 730–738. 10.1001/jamainternmed.2022.1906 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Friedman C, & VanPuymbrouck L (2021). Telehealth use by persons with disabilities during the COVID-19 pandemic. International Journal of Telerehabilitation, 13(2), Article e6402. 10.5195/ijt.2021.6402 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Frier A, Barnett F, Devine S, & Barker R (2018). Understanding disability and the “social determinants of health”: How does disability affect peoples’ social determinants of health? Disability and Rehabilitation, 40(5), 538–547. 10.1080/09638288.2016.1258090 [DOI] [PubMed] [Google Scholar]
  36. Gleason J, Ross W, Fossi A, Blonsky H, Tobias J, & Stephens M (2021). The Devastating impact of Covid-19 on individuals with intellectual disabilities in the United States. NEJM Catalyst Innovations in Care Delivery. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0051 [Google Scholar]
  37. Gorna R, MacDermott N, Rayner C, O’Hara M, Evans S, Agyen L, Nutland W, Rogers N, & Hastie C (2021). Long COVID guidelines need to reflect lived experience. The Lancet, 397(10273), 455–457. 10.1016/S0140-6736(20)32705-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Greenwald AG, Poehlman TA, Uhlmann EL, & Banaji MR (2009). Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology, 97(1), 17–41. 10.1037/a0015575 [DOI] [PubMed] [Google Scholar]
  39. Guy-Sheftall B. (Ed.). (1995). Words of fire: An anthology of African-American feminist thought. The New Press. [Google Scholar]
  40. Haeny AM, Holmes SC, & Williams MT (2021). The need for shared nomenclature on racism and related terminology in psychology. Perspectives on Psychological Science, 16(5), 886–892. 10.1177/17456916211000760 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Hardeman RR, Homan PA, Chantarat T, Davis BA, & Brown TH (2022). Improving the measurement of structural racism to achieve antiracist health policy. Health Affairs, 41(2), 179–186. 10.1377/hlthaff.2021.01489 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Hardeman RR, & Karbeah J (2020). Examining racism in health services research: A disciplinary self-critique. Health Services Research, 55(S2), 777–780. 10.1111/1475-6773.13558 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Harden JK, Blauwet CA, Silver JK, Sholas MG, Rasheed Z, & Verduzco-Gutierrez M (2022). Health and health care disparities related to rehabilitation and COVID-19. PM&R, 14(2), 273–279. 10.1002/pmrj.12775 [DOI] [PubMed] [Google Scholar]
  44. Hays PA (2008). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (2nd ed.). American Psychological Association. 10.1037/11650-000 [DOI] [Google Scholar]
  45. Hick JL, Hanfling D, & Wynia M (2022). Hospital planning for contingency and crisis conditions: Crisis standards of care lessons from COVID-19. The Joint Commission Journal on Quality and Patient Safety, 48(6–7), 354–361. 10.1016/j.jcjq.2022.02.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Horner-Johnson W. (2021). Disability, intersectionality, and inequity: Life at the margins. In Lollar DJ, Horner-Johnson W, & Froehlich-Grobe K, (Eds.), Public health perspectives on disability (pp. 91–105). Springer. [Google Scholar]
  47. Hosey MM, & Needham DM (2020). Survivorship after COVID-19 ICU stay. Nature Reviews Disease Primers, 6(1), Article 1. 10.1038/s41572-020-0201-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Hugelius K, Harada N, & Marutani M (2021). Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. International Journal of Nursing Studies, 121, Article 104000. 10.1016/j.ijnurstu.2021.104000 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Hytten K, & Bettez SC (2011). Understanding education for social justice. Educational Foundations, 25, 7–24. [Google Scholar]
  50. Institute of Medicine (2012). “Crisis standards of care: A systems framework for catastrophic disaster response: Volume 1: Introduction and CSC framework” at NAP.edu. 10.17226/13351 [DOI] [PubMed] [Google Scholar]
  51. Iqbal FM, Lam K, Sounderajah V, Clarke JM, Ashrafian H, & Darzi A (2021). Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis. EClinicalMedicine, 36, Article 100899. 10.1016/j.eclinm.2021.100899 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Irani E, Niyomyart A, & Hickman RL (2021). Family caregivers’ experiences and changes in caregiving tasks during the COVID-19 pandemic. Clinical Nursing Research, 30(7), 1088–1097. 10.1177/10547738211014211 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Jashinsky TL, King CL, Kwiat NM, Henry BL, & Lockett-Glover A (2021). Disability and COVID-19: Impact on workers, intersectionality with race, and inclusion strategies. The Career Development Quarterly, 69(4), 313–325. 10.1002/cdq.12276 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Johnson C. (2020). States won’t collect LGBTQ data on COVID-19—And advocates aren’t happy. https://www.washingtonblade.com/2020/04/01/states-wont-collect-lgbtq-data-on-covid-19-and-advocates-arent-happy/ [Google Scholar]
  55. Kaplan JB, & Bennett T (2003). Use of race and ethnicity in biomedical publication. JAMA, 289(20), 2709–2716. 10.1001/jama.289.20.2709 [DOI] [PubMed] [Google Scholar]
  56. Kolakowsky-Hayner SA, & Goldin Y (2020). Sex and gender issues for individuals with acquired brain injury during COVID-19: A commentary. Archives of Physical Medicine and Rehabilitation, 101(12), 2253–2255. 10.1016/j.apmr.2020.08.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Langton R. (2010). Miranda Fricker epistemic injustice: Power and the ethics of knowing. Oxford, Oxford University Press, 2007. Hypatia, 25(2), 459–464. 10.1111/j.1527-2001.2010.01098.x [DOI] [Google Scholar]
  58. Lawrie P (2018). Race, work, and disability in progressive era United States. In Rembis M, Kudlick C, & Nielsen KE, (Eds.), The Oxford handbook of disability history (pp. 229–246). Oxford University Press. [Google Scholar]
  59. Lawrie PRD (2020). 4. Salvaging the Negro: Vocational Rehabilitation and African American Veterans, 1917–1924. In Lawrie PRD (Ed), Forging a laboring race: The African American worker in the progressive imagination (pp. 109–134). New York University Press. 10.18574/nyu/9781479857326.003.0005 [DOI] [Google Scholar]
  60. Lee Y, Muennig P, Kawachi I, & Hatzenbuehler ML (2015). Effects of racial prejudice on the health of communities: A multilevel survival analysis. American Journal of Public Health, 105(11), 2349–2355. 10.2105/AJPH.2015.302776 [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Leeds M. (2020). Phrenology, physical anthropology and ethnology: Nineteenth-century race science and the foundations of eurocentrism. History. https://digitalcommons.calpoly.edu/histsp/52 [Google Scholar]
  62. Leitner JB, Hehman E, Ayduk O, & Mendoza-Denton R (2016). Blacks’ death rate due to circulatory diseases is positively related to Whites’ explicit racial bias. Psychological Science, 27(10), 1299–1311. 10.1177/0956797616658450 [DOI] [PubMed] [Google Scholar]
  63. Levine A, & Breshears B (2019). Discrimination at every turn: An intersectional ecological lens for rehabilitation. Rehabilitation Psychology, 64(2), 146–153. 10.1037/rep0000266 [DOI] [PubMed] [Google Scholar]
  64. Levy BL, Vachuska K, Subramanian SV, & Sampson RJ (2022). Neighborhood socioeconomic inequality based on everyday mobility predicts COVID-19 infection in San Francisco, Seattle, and Wisconsin. Science Advances, 8(7), Article eabl3825. 10.1126/sciadv.abl3825 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Lund EM, Forber-Pratt AJ, Wilson C, & Mona LR (2020). The COVID-19 pandemic, stress, and trauma in the disability community: A call to action. Rehabilitation Psychology, 65(4), 313–322. 10.1037/rep0000368 [DOI] [PubMed] [Google Scholar]
  66. Madhere S. (1995). Beyond the bell curve: Toward a model of talent and character development. The Journal of Negro Education, 64(3), 326–339. 10.2307/2967212 [DOI] [Google Scholar]
  67. Magaña S, Parish S, Morales MA, Li H, & Fujiura G (2016). Racial and ethnic health disparities among people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 54(3), 161–172. 10.1352/1934-9556-54.3.161 [DOI] [PubMed] [Google Scholar]
  68. Mallinckrodt B, Miles JR, & Levy JJ (2014). The Scientist–Practitioner–Advocate model: Addressing contemporary training needs for social justice advocacy. Training and Education in Professional Psychology, 8(4), 303–311. 10.1037/tep0000045 [DOI] [Google Scholar]
  69. Milner A, & Franz B (2020). Anti-Black attitudes are a threat to health equity in the United States. Journal of Racial and Ethnic Health Disparities, 7(1), 169–176. 10.1007/s40615-019-00646-0 [DOI] [PubMed] [Google Scholar]
  70. Mitra S, & Shakespeare T (2019). Remodeling the ICF (SSRN Scholarly Paper No. 3404195; ). https://papers.ssrn.com/abstract=3404195 [DOI] [PubMed] [Google Scholar]
  71. National Council on Disability (2021, October 26). 2021 Progress Report: The impact of COVID-19 on people with disabilities. https://ncd.gov/ [Google Scholar]
  72. Ndao-Brumblay SK, & Green CR (2005). Racial differences in the physical and psychosocial health among Black and White Women with chronic pain. Journal of the National Medical Association, 97(10), 1369–1377. [PMC free article] [PubMed] [Google Scholar]
  73. Neville HA, Ruedas-Gracia N, Lee BA, Ogunfemi N, Maghsoodi AH, Mosley DV, LaFromboise TD, & Fine M (2021). The public psychology for liberation training model: A call to transform the discipline. The American Psychologist, 76(8), 1248–1265. 10.1037/amp0000887 [DOI] [PubMed] [Google Scholar]
  74. Nolan SL (2022). The compounded burden of being a black and disabled student during the age of COVID-19. Disability & Society, 37(1), 148–153. 10.1080/09687599.2021.1916889 [DOI] [Google Scholar]
  75. Norton A, Wilson T, Geller G, & Gross MS (2020). Impact of hospital visitor restrictions on racial disparities in obstetrics. Health Equity, 4(1), 505–508. 10.1089/heq.2020.0073 [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Pan American Health Organization. (2020). Rehabilitation considerations during the COVID-19 outbreak (p. 22). [Google Scholar]
  77. Peña-Guzmán DM, & Reynolds JM (2019). The harm of ableism: Medical error and epistemic injustice. Kennedy Institute of Ethics Journal, 29(3), 205–242. 10.1353/ken.2019.0023 [DOI] [PubMed] [Google Scholar]
  78. Perrin A, & Atske S (2021). Americans with disabilities less likely than those without to own some digital devices. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/09/10/americans-with-disabilities-less-likely-than-those-without-to-own-some-digital-devices/ [Google Scholar]
  79. Qi F. (2021). Track disability in COVID-19 statistics. Nature, 596(7872), 343–343. 10.1038/d41586-021-02233-y [DOI] [PubMed] [Google Scholar]
  80. Ross W. (n.d.). The terrible toll of COVID-19 on people with intellectual disabilities. AAMC. Retrieved October 12, 2022, from https://www.aamc.org/news-insights/terrible-toll-covid-19-people-intellectual-disabilities [Google Scholar]
  81. Saucier G. (2000). Isms and the structure of social attitudes. Journal of Personality and Social Psychology, 78(2), 366–385. 10.1037/0022-3514.78.2.366 [DOI] [PubMed] [Google Scholar]
  82. Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, & Valley TS (2020). Racial bias in pulse oximetry measurement. New England Journal of Medicine, 383(25), 2477–2478. 10.1056/NEJMc2029240 [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Stern AM (n.d.). Forced sterilization policies in the US targeted minorities and those with disabilities—and lasted into the 21st century. Retrieved August 7, 2022, from https://ihpi.umich.edu/news/forced-sterilization-policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st [Google Scholar]
  84. Strully KW, Harrison TM, Pardo TA, & Carleo-Evangelist J (2021). Strategies to address COVID-19 vaccine hesitancy and mitigate health disparities in minority populations. Frontiers in Public Health, 9, Article 645268. 10.3389/fpubh.2021.645268 [DOI] [PMC free article] [PubMed] [Google Scholar]
  85. Stucki G, Cieza A, & Melvin J (2007). The international classification of functioning, disability and health (ICF): A unifying model for the conceptual description of the rehabilitation strategy. Journal of Rehabilitation Medicine, 39(4), 279–285. 10.2340/16501977-0041 [DOI] [PubMed] [Google Scholar]
  86. Telhan R, McNeil BA, Lipscomb-Hudson KM, Guobadia AR, Landry EL, & Landry MD (2020). Reckoning with racial trauma in rehabilitation medicine. Archives of Physical Medicine and Rehabilitation, 101(10), 1842–1844. 10.1016/j.apmr.2020.07.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  87. Tracie A (n.d.). Crisis Standards of Care during COVID-19: Summary of state actions (p. 3). [Google Scholar]
  88. Tung EL, Peek ME, Rivas MA, Yang JP, & Volerman A (2021). Association of neighborhood disadvantage with racial disparities in COVID-19 positivity in Chicago. Health Affairs, 40(11), 1784–1791. 10.1377/hlthaff.2021.00695 [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. Turk MA, Landes SD, Formica MK, & Goss KD (2020). Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis. Disability and Health Journal, 13(3), Article 100942. 10.1016/j.dhjo.2020.100942 [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Vannorsdall TD, Brigham E, Fawzy A, Raju S, Gorgone A, Pletnikova A, Lyketsos CG, Parker AM, & Oh ES (2022). Cognitive dysfunction, psychiatric distress, and functional decline after COVID-19. Journal of the Academy of Consultation-Liaison Psychiatry, 63(2), 133–143. 10.1016/j.jaclp.2021.10.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  91. VanPuymbrouck L, Friedman C, & Feldner H (2020). Explicit and implicit disability attitudes of healthcare providers. Rehabilitation Psychology, 65(2), 101–112. 10.1037/rep0000317 [DOI] [PMC free article] [PubMed] [Google Scholar]
  92. Verduzco-Gutierrez M, Rydberg L, Sullivan MN, & Mukherjee D (2021). In this for the long haul: Ethics, COVID-19, and rehabilitation. PM&R: The Journal of Injury, Function, and Rehabilitation, 13, 325–332. 10.1002/pmrj.12554 [DOI] [PMC free article] [PubMed] [Google Scholar]
  93. Ward-Sutton C, Williams NF, Moore CL, & Manyibe EO (2020). Assistive technology access and usage barriers among African Americans with disabilities: A review of the literature and policy. Journal of Applied Rehabilitation Counseling, 51(2), 115–133. 10.1891/JARC-D-19-00011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  94. Young D. (2020, August 7). Black, disabled, and uncounted. National Health Law Program. https://healthlaw.org/black-disabled-and-uncounted/ [Google Scholar]

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