The past few weeks have been a time of deep reflection and action for Americans across the country.
Following the death of George Floyd, people of every background in cities large and small have taken to the streets demanding change and for the dismantling of systemic racism.
These incredible events for equality and social justice are taking place against the persisting backdrop of a global pandemic. By mid-June, more than 2 million cases were reported, and more than 114,000 people lost their lives to COVID-19. The pandemic has changed the way we live and work. It also has forced many of us to think more intently about the inequalities that have been exposed and exacerbated during this crisis, and how we can create a more equal future.
As healthcare workers have fought tirelessly to save the lives of so many impacted by COVID-19, they are now advocating for the fair treatment of their patients, colleagues, families and community members. The social media hashtag #WhiteCoats4BlackLives has captured healthcare workers marching, kneeling and holding signs in solidarity, sparking conversations about how the healthcare system can better address racial disparities and play its role in correcting broader inequalities in the U.S.
Racial disparities in healthcare have been a subject of research for decades.
In 2002, The Institute of Medicine published the report “Unequal Treatment,” which found “racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled.”
The report led to authorization from Congress for the Agency for Healthcare Research and Quality to report annually on national and state healthcare disparities. Despite the official investment in continued studies, progress has been slow.
The spread and treatment of COVID-19 serves as an unfortunate example of racial disparities in the U.S. As of June 8, 47% of COVID-19 cases and 54% of deaths have been in disproportionally black counties. Despite representing just 13% of the total U.S. population, blacks account for 24% of the deaths recorded by the 44 states and territories where race is disclosed. Reports also indicate similarly disproportionate impacts for Latinx and indigenous populations.
The disproportionate impact of COVID-19 on communities of color is not an indication of any genetic susceptibility to the virus, but rather the result of pervasive racial disparities in access to care and treatment over time. The health disparities between white and minority communities are clear, but the underlying structures are ignored.
A recent article by the Washington Post dug deeper into how COVID-19 is exposing health disparities. It noted that "examining underlying conditions is helpful for understanding the health implications an outbreak like the coronavirus, but health conditions tell only part of the story.” To better understand the racial disparities within healthcare, it is necessary to understand what our patients face outside of health systems.
For example, in the District of Columbia, where I live, the virus has spread along racial lines, with COVID-19 cases and deaths impacting the majority non-white wards 4, 5, 7 and 8. Similarly, these residents face poverty and food deserts—interconnected issues that are tied to the historical distribution of resources and can lead to decreased nutritional health and increased rates of obesity and heart disease.
So, where do we go from here? The demonstrations of the last few weeks are a manifestation of people across the U.S. saying, "I see you and I hear you." But, how can we, as healthcare professionals, do the same?
An article published by The Commonwealth Fund in 2018 suggests that "health care professionals must explicitly acknowledge that race and racism factor into health care,” as a first step to correcting disparities. It also identifies specific tactics and strategies health systems have used successfully. The report calls for engaging communities to collaboratively confront their specific challenges.
One example, a study from the Greensboro Health Disparities Collaborative, found racial bias training and direct intervention programs were successful in closing a 10% treatment completion rate gap for cancer patients. In the study, both black and white patients benefited from the increased assistance in the scheduling and comprehension of treatments—and the racial disparity diapered.
Racial disparities in healthcare can be addressed but we must prioritize understanding them, acknowledging them and commit to eradicating them.
To make permanent and impactful change in the healthcare system, the Annual Review of Public Health created six actionable suggestions:
- Monitoring healthcare disparities routinely
- Committing to the identification and elimination of health care disparities
- Using formal structures and processes to identify healthcare disparities and corresponding breakdowns in care processes
- Intervening appropriately based on the care processes and the emerging literature on successful interventions
- Implementing, assessing and modifying the intervention
- Ensuring the sustainability of the intervention
We can see the problems in front of us—in both the disproportionate impact of COVID-19 on black communities and the disparities in overall health outcomes in our country. As clinicians and healthcare workers, we must understand that these actions are long-term investments in the health and well-being of our patients and communities.
We each have a role to play and we must act now.
Adam Brown, M.D., MBA, FACEP, is the president of emergency medicine and co-chair of the Diversity and Inclusion Committee at Envision Healthcare.