Disease Pandemics, Prejudice Pandemics

Part 1: How disease outbreaks contribute to the spread of ethnic prejudices.

Posted Jun 28, 2020

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Millennium Gate in Vancouver, BC
Source: Suman Chakrabarti/Wikimedia (Creative Commons Attribution License v. 2.0)

Most of my research on culture and mental health has involved either China or the Chinese community in Canada. My dissertation, my master’s thesis, even my undergraduate honors thesis all had this focus. Over the years, I have worked with numerous colleagues and students of Chinese origin. As such, I was alarmed—but unfortunately, not surprised—to hear reports about increased prejudice against East Asians in Canada as the COVID-19 crisis began to unfold.

Earlier this month, a team of psychologists at the University of Alberta1, in collaboration with the non-profit Angus Reid Institute, released survey results suggesting these anecdotes reflect widespread experiences. Of 516 Chinese-origin participants, 50% reported being insulted and 43% reported being threatened or intimidated for reasons linked directly to COVID-19. One-third of the participants reported frequent exposure to racist content on social media. A full four-fifths believe Canadians blame people of Chinese ancestry for the disease.

The SARS outbreak of 2003

Last week, I described a research study that rapidly analyzed large archival datasets to better understand COVID-19 spread. In-depth research is neither conducted nor reported quickly, however, and it may be years before we really understand the scale and impact of pandemic-related prejudice. What we can do instead is look back at studies conducted during previous disease outbreaks. One example is the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS).

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A possible mask-wearer crossing the street in Toronto
Source: Arturo Castaneyra/Unsplash

I remember SARS well. Although largely limited to East Asia, there was also a notable outbreak in Toronto, the major city near the suburb where I grew up. There was no shortage of fear about how bad things could get. At the time, I was also at the tail end of dissertation data collection at two hospitals, one in China (Changsha) and the other in Toronto. No sooner were my final participants collected than first one hospital, and then the other, was closed to research. A couple of my Chinese-Canadian colleagues expressed concern about potential prejudice.

In the end, around 8,000 SARS cases were reported worldwide, with around 900 deaths. These numbers seem negligible in comparison with the mounting toll of COVID-19. Recall, however, that for several months there was profound uncertainty as to how readily SARS would spread. In the two studies I’m about to describe, there was no way for the participants to anticipate what we now know with hindsight.

As I read the cross-cultural literature on the SARS response, I was struck by the many parallels with our current situation. This was especially the case during those few months of uncertainty and mounting fear in the spring of 2003. As I learned, prejudice against East Asians during this time was well documented. Several researchers observed links between prejudice and media reports linking "Chinese culture" to unhealthy practices. These reports had consequences.

New York City’s Chinatown

In the summer of 2004, medical anthropologist Laura Eichelberger spent six weeks conducting research in New York City’s Chinatown. She interviewed 37 people who had spent the majority of time living or working in Chinatown during the 2003 outbreak. She also interviewed public health officials and representatives of Asian American organizations who lived and worked outside of Chinatown.

Krisztina Papp/Unsplash
Chinatown, NYC, in better days
Source: Krisztina Papp/Unsplash

She found widespread consensus that other people were avoiding Chinatown and those who lived or worked there. One respondent described the experience of “coughing while Asian”: “In the news, the images of Asians in facemasks made people want to avoid Chinatown. It was really noticeable on the trains: if there was an Asian coughing on a train, people would look at them nasty, and move away.” (p. 1289)

Many respondents described members of the press being surprised at the lack of panic. Journalists were even observed searching for rare opportunities to take pictures of people wearing masks. The reaction of local organizations to all this was mixed. Some organized to fight stigma. Others tried to downplay the situation out of concern that publicity would just reinforce the link between Chinatown and SARS.

Not all stigma came from outside the community, however. Some respondents told of how they would avoid particular streets rumored to have SARS cases. Prejudicial beliefs about "Chinese culture" were replicated inside Chinatown, with concern expressed about people from poorer, more rural, or more traditional backgrounds. While respondents generally did not avoid at-risk people and did not avoid recent travelers, they did avoid recent immigrants.

Hong Kong’s Amoy Gardens

In the end, New York City’s Chinatown reported precisely zero cases. Instead, there was an outbreak of fear and prejudice against a minority group with tenuous links to a disease originating thousands of miles away. The same cannot be said for Amoy Gardens, a residential complex in Hong Kong. Not only was Hong Kong the second-hardest hit city, with 1,755 confirmed cases and 299 deaths, Amoy Gardens held the record for the greatest single-day increase in confirmed cases.

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Amoy Gardens, Hong Kong, four years later
Source: Hoising/Wikimedia (GNU free license, v. 1.2)

Cultural psychiatrists Sing Lee and Arthur Kleinman, along with several colleagues, conducted an in-depth study of Amoy Gardens during the outbreak. They started with two one-hour focus groups with 15 residents followed by a brief self-report questionnaire completed by 903 of the 4,896 residents. Amoy Gardens has 19 blocks but 135 of the 329 cases and 22 of the 42 deaths were in Block E. The researchers supplemented their work with two detailed case studies of Block E inhabitants.

A strong majority of the respondents reported severe impacts from living in Amoy Gardens during the SARS outbreak. Consequences included being refused treatment, being asked to resign their job, social shunning, or being put on unpaid leave. Four respondents in ten moved out of the complex during the outbreak. Stigma was highest in Block E and diminished with increasing distance. Many people who lived in other parts of Amoy Gardens reported avoiding Block E and its residents.

A strong majority of the survey respondents also reported physical and psychological distress during and after the outbreak. Symptoms included persistent low mood, irritability, insomnia, chest discomfort, and headache. Respondents understood these symptoms as resulting from fears of contagion, uncertainty about SARS transmission, the sudden drop in the value of their apartments, the experience of strict quarantine when imposed, and the experience of stigma itself.

Conclusions

Cultural psychology covers many approaches. In my previous post, I described studies with thousands of participants across dozens of societies. This represents the cross-cultural tradition of international research and it certainly has its place. But you also learn a lot from talking to individual people about their lives in specific communities. Although associated more with social sciences such as anthropology and sociology, I believe there should be a place here for cultural psychology as well.

Cultural psychology also has a tradition of research on fundamentals: the cultural foundations of human psychology; the psychological foundations of culture. I look forward to describing some of this work in future posts. Cultural psychology should also engage with pressing social issues, however. These might be issues that emerge suddenly, such as COVID-19. They might also be longstanding issues, such as ethnocultural or other prejudices.

Postscript

One contribution of cultural psychology is the application of a systematic, scientific approach to social problems. The same can be said for several other fields. This approach can raise concerns, however. If we better understand when and why people express prejudice we may seem to draw closer to justifying the prejudice. My brain made me do it, or my upbringing, my friends, my circumstances. I will pause here, as this topic deserves its own post.

Notes

1If you read this article during the first couple of days you wouldn't have seen the joint credit to the psychologists at the University of Alberta. Many thanks to my colleague Kim Noels, who directs the Intercultural Communication Lab at the U of A, for alerting me to this error. You can find some more coverage of the study here.

References

Eichelberger, L. (2007). SARS and New York's Chinatown: the politics of risk and blame during an epidemic of fear. Social Science & Medicine, 65, 1284-1295.

Lee, S., Chan, L. Y., Chau, A. M., Kwok, K. P., & Kleinman, A. (2005). The experience of SARS-related stigma at Amoy Gardens. Social Science & Medicine, 61, 2038-2046.