As many know by now, Surgeon General Jerome Adams landed in the doghouse after last Friday’s White House’s coronavirus briefing. His offense: advising people of color to follow the pandemic-busting guidelines we’ve all heard hundreds of times in the past month—wash your hands, keep your distance, stay home if you can—plus one new guideline, avoid alcohol, tobacco, and drugs.

When he gave that piece of advice, Dr. Adams had just shared last week’s horrific statistics confirming that COVID-19 has hit communities of color much harder than white communities. The reasons for this disparity vary slightly with geography but boil down to structural inequality, which affects people’s overall state of health, access to medical care, and ability to isolate themselves. So far, so good, as there’s no disputing the disproportionate harm of COVID-19 to communities of color or the reasons for it. There’s also no disputing the importance of reaching out to those communities, especially as the pandemic wreaks havoc in southern states with large African American and Latinx populations.

Where Dr. Adams went wrong, according to his critics, was in “singling out” these populations when he advised them to avoid alcohol, tobacco, and drugs. Since his entire speech that day was directed to communities of color, Dr. Adams also “singled out” Black and Latinx people for hand-washing, social distancing, and checking in on older relatives, but that was okay—at least until Dr. Adams referred to those older relatives as “abuela,” “granddaddy,” “big mama,” and “pop-pop,” which also offended some people on Twitter, though I’m still not sure why. It’s just feigned folksiness, which political figures been dishing out for centuries.

No, Dr. Adams’s major crime was suggesting that people of color avoid alcohol, tobacco, and drugs without explicitly saying that the advice applied equally to white people, though he did make that clarification later. In offering the advice, according to PBS reporter Yamiche Alcindor, he conveyed “the idea that behaviors may be leading to these high death rates.”

That’s quite a leap, especially given how much care Dr. Adams took to explain that the high death rates result from the greater prevalence of chronic diseases such high blood pressure and asthma in communities of color. And from the unavailability of telecommuting and greater population density in communities of color. And from poverty so stark it deprives people of basic necessities, such as running water for hand-washing, which is much more prevalent in communities of color than in white communities. In fact, Dr. Adams said explicitly that it’s perennial hardship and deprivation faced by people of color that explain their greater suffering and mortality from COVID-19, not their behavior.

Check for yourself; I’ve appended the text of his speech below.

Behavior, however, is all we have to combat the virus right now, and there’s nothing wrong with spelling out which behavior is helpful and which to avoid. Alcohol, tobacco, and some drugs can all weaken the immune system of the lungs in a way that makes us vulnerable to respiratory infection—and not just cumulatively. Most people know this about tobacco and drugs that are smoked or vaped, but few know it about alcohol, and fewer still know that drinking too much need not be habitual to cause immune system damage. A single binge will do it. In addition, the disinhibiting influence of alcohol or other drugs can undermine vigilance about hand-washing, social distancing, and other preventive measures. With the jury still out on the question of whether even moderate drinking is healthy, the advice to “avoid alcohol, tobacco, and drugs” is every bit as sound as the advice to wash your hands, wear a mask, and keep six feet away from other people.

In short, as you can see below, Dr. Adams did not say, imply, or even hint that anyone is dying of COVID-19 because they drink, smoke, and take drugs. He explained to people of color how they can reduce their unfairly oversized risk of catching and spreading the virus. One of those ways is avoiding alcohol, tobacco, and drugs. That’s it. But why introduce the topic now, rather than at an earlier briefing? Is this caution somehow more urgent for people of color?

The short answer is no. Though consistent, reliable statistics on alcohol use among different ethnic and racial groups are notoriously hard to come by, we do know for sure that people of color drink less overall than white people. That said, with the exception of Asian Americans, people of color may be more vulnerable to problems with alcohol, such as binge drinking, alcohol dependence, and alcohol-related illnesses such as cirrhosis of the liver. Or they may not be; it really depends on which study you look at. One reason for the uncertainty is the small sample size of many studies; another is the extreme variability within ethnic and racial groups. For example, in Latinx communities, many men and teenaged boys binge-drink, while almost half of all women don’t drink at all. Things don’t break so neatly along gender lines in Native American communities, but there are still a lot of people at the extremes of drinking behavior: alcohol dependence and complete abstinence. The following chart from the US government’s Substance Abuse and Mental Health Services Administration (SAMHSA) gives a clearer picture.

As you can see, white people drink the most overall and have generally high levels of heavy drinking, while people of other ethnicities show more mixed drinking behavior. For example, in the previous month, only 38.4 percent of Native Hawaiian/Pacific Islanders drank anything, compared to 57.7 percent of whites,[4] but roughly two-thirds of them binged and/or drank heavily. So general statements about drinking tend not to be very useful.

A more important reason for uncertainty about the relationship between alcohol use and race or ethnicity is failure to consider a crucial variable: class. As a famous Gallup study found, across all ethnic groups, as income and educational level rise so does the percentage of people who report regular drinking. At the same time, poverty and related forms of deprivation such as housing insecurity promote binge drinking and alcohol use disorders. In other words, you’re more likely to drink if you’re well-off, but you’re more likely to suffer from drinking problems if you’re poor—and I shouldn’t have to explain to anyone that African Americans, Native Americans, and Latinxs are historically over-represented among America’s poor. Moreover, very recent research shows that the already strong association between poverty and alcohol use disorders is more pronounced among African Americans than among whites.

So, yeah, I can see why the surgeon general might worry about drinking in communities of color, might suggest people avoid it, along with smoking and drug use, during this pandemic.

That said, though I don’t think that suggesting people avoid alcohol, tobacco, and drugs implies that they are “responsible for their plight,” as University of Buffalo professor Henry Louis Taylor, Jr, told NBC News a couple days ago, I agree that Dr. Adams missed an opportunity to further explain that the disproportionately heavy burden of disease borne by communities of color includes alcohol use disorders—not at the time of his initial remarks but afterward, once it became clear that his comments had excited controversy and misunderstanding.

Still, I found that controversy and misunderstanding exasperating. As someone fighting to change the economic system responsible for the greater suffering of communities of color, including addiction, I don’t don’t see how it furthers that cause to listen carelessly when the surgeon general speaks and attack him for something he didn’t say. I think it makes the left look reckless, reactive, and reflexively opposed to anyone associated with the Trump administration. I believe it would have been much more powerful for progressive scholars and activists to build on Dr. Adams’s remarks, to assert that last week’s COVID-19 statistics outlined systemic racism so clearly that everybody perceived it and condemned it, regardless of their political commitments. Think of the people not “in the choir” who might have been receptive had Dr. Taylor’s remarks been framed as expansion, rather than rebuke.[5] Instead, in forums such as Yahoo, they fell into the same partisan camps and made the same arguments we’ve all heard a million times before.

Finally, I know I haven’t discussed the thorny question of how useful it is to suggest anyone avoid alcohol, tobacco, and drugs. But that’s a large, complex topic, especially at a time when people are under so much stress, and I’ve had enough of large, complex topics for one post. So for now I’ll just note that the media are trending the other way, which may exacerbate alcohol problems in susceptible people. I’ll try to keep an eye on that and report back soon.

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Transcript of remarks by Jerome Dr. Adams, taken from an NBC news video of the April 10, 2020 briefing. Dr. Adams’s remarks begin at 28:20.

Good afternoon, everyone. I started off the week talking about the challenges that lie ahead, and I want to finish the week by reiterating what you’ve heard. Mitigation works. It definitively and quantitatively is working, and I want to say ‘thank you’ to America for your efforts to help flatten the curve and save lives.

But, at the president’s direction, yesterday I met with two thousand Hispanic leaders from their communities, and today the vice president led a phone call that I was on with hundreds of African American leaders, including Reverend Jesse Jackson, including Derrick Johnson of the NAACP, including the National Medical Association and the Black Nurses’ Association, to talk about some of the alarming trends we’re observing regarding the impact of COVID-19 on communities of color.

And you’ve heard the stats. In New York City, Hispanics represent the majority of deaths. In Milwaukee County Blacks are twenty-five percent of the population but fifty percent of the cases and seventy-five percent of the deaths.

So what’s going on? It’s alarming, but it’s not surprising that people of color have a greater burden of chronic health conditions. African Americans and Native Americans develop high blood pressure at much younger ages. It’s less likely to be under control and does greater harm to their organs. Puerto Ricans have higher rates of asthma, and Black boys are three times as likely to die of asthma as their white counterparts.

As a matter of fact, I’ve been carrying around an inhaler in my pocket for forty years out of fear of having a fatal asthma attack. I hope that showing you this inhaler shows little kids across the country that they can grow up to be surgeon general one day. But I more immediately share it so that everyone knows that it doesn’t matter if you look fit, if you look young; you are still at risk for getting and spreading and dying of corona virus.

The chronic burden of medical ills is likely to make people of color especially less resilient to the ravages of COVID-19, and it’s possible, in fact likely, that the burden of social ills is also contributing.

Social distancing and teleworking we know are critical–and you’ve heard Dr. Brooks and Dr. Fauci talk about how they prevent the spread of coronavirus, yet only one in five African Americans and one in six Hispanics have a job that lets them work from home. People of color are more likely to live in densely-packed areas and in multi-generational housing situations, which create higher risk for the spread of a highly contagious disease like COVID-19. We tell people to wash their hands, but a study shows that 30 percent of the homes in the Navajo Nation don’t have running water so how are they going to do that?

In summary, people of color experience both more likely exposure to COVID-19 and increased complications from it. But let me be crystal clear. We do not think people of color are biologically or genetically predisposed to get COVID-19. There is nothing inherently wrong with you. But they are socially predisposed to coronavirus exposure and to have a higher incidence of the very diseases that put you at risk for complications from coronavirus.

But, as the vice president shared on the call this morning, this history–and I want you to hear me say this–does not have to be our nation’s future. We’re taking steps now in the midst of the COVID-19 pandemic to reach, connect, and strengthen all communities impacted by this disease, especially our communities of color. More details will be forthcoming, but we are actively working, as the vice president and CDC director laid out today, data collection, targeted outreach to communities of color, and increasing financial, employment, housing, social and health support so that everybody has an equal chance to be healthy.

And I want to close by saying that while your state and local health department and those of us in public service are working day and night to help stop the spread of COVID-19 and to protect you regardless of your color, your creed, or your geography, I need you to know: you are not helpless, and it’s even more important in communities of color that we adhere to the task force guidelines to slow the spread.

Stay at home, if possible. If you must go out, maintain six feet of distance between you and everyone else, and wear a mask if you’re going to be within six feet of others. Wash your hands more often than you ever dreamed possible. Avoid alcohol, tobacco, and drugs.

And call your friends and family, check in on your mother–she wants to hear from you right now. Speaking of mothers, we need you to do this, if not for yourself, then for your abuela. Do it for your granddaddy. Do it for your big mama. Do it for your pop-pop.

We need you to understand, especially in communities of color; we need you to step up and help stop the spread and protect those who are most vulnerable. This epidemic is a tragedy, but it will be all the more tragic if we fail to recognize and address the disproportionate impact of COVID-19–and an array of other diseases and risk factors–on communities of color.

The task force and this administration are determined not to let that happen. The president, the vice president have said, “We will not let that happen.” We can’t fix these issues overnight, but I promise you we will work with your communities to quickly and meaningfully move the needle in the right direction. Nothing less than the fate of our families and friends–my family and friends–depends on it.

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[4] If you’re thinking that’s low, you’re not familiar with the way people actually drink in the US, which is not your fault, as the media promote the myth that everyone drinks except a handful of zealots. For the real story, see Tipsy Demography and Two Views of Alcohol Abuse.

[5] Let me make absolutely clear that I agree with Dr. Taylor’s assessment of the causes and dynamics of substance abuse in communities of color. My only dispute is with how he and other experts responded to Dr. Adam’s advice to mitigate COVID-19 risk by avoiding alcohol, tobacco, and drugs.