Covid-19’s Terrible Toll on Black Community Reflects Systemic and Interpersonal Racism in the U.S. by Maya Grabowsky, Guest Blogger
Many people were not familiar with the phrase “disparities in healthcare” until the early days of the Covid-19 pandemic when Black people had the highest rates of “infection and hospitalization and death” from the virus. See “The State of Black America and Covid-19 A Two Year Assessment, Black Coalition Against Covid,” p. 5. These higher infection rates were not because of our genetics. This unequal burden happened for a lot of reasons, including that a higher percentage of Black people work in essential service jobs, live in homes with more than one generation, live in more crowded houses, are incarcerated, or live in cities where it is hard to distance. Id. p.6. At its root, however, the greater impact of Covid in the Black community can be linked to historical and existing societal and social inequities that include: “exposure to environmental toxins, obesity, hypertension, diabetes, and chronic kidney disease.” Id. In addition, Black patients had worse outcomes because of historic structural inequities that have led to inadequate access to “housing, nutrition, credit markets,” health care, and the justice system. Id.
We can see the direct impact of historical inequalities in Covid-19 testing, treatment, and prevention. One doctor, Susan Moore, experienced racism during her Covid treatment. Dr. Moore went to I.U. Health North Hospital in Carmel, Indiana, with Covid-19 symptoms. She told the hospital staff that she was in a lot of pain and asked for medicine to treat her symptoms. The doctor at the hospital said he felt “uncomfortable giving her more narcotics” and “suggested that she should be discharged.” Dr. Moore said that she felt ignored and treated “like a drug addict” when the doctor dismissed her pain in this way. Dr. Moore posted a video on social media about the unfair treatment she received at the hospital. It was only after the video went viral that the hospital treated her Covid-19 symptoms. Unlike most Black patients, as a doctor, Dr. Moore knew what to ask for and what her treatment should look like. Other Black patients do not necessarily realize that they are being mistreated by medical professionals. Dr. Moore spoke to the chief medical officer at the hospital about the discriminatory treatment she received. She said that “this is how Black people get killed, when you send them home, and they don’t know how to fight for themselves.” Too often Black people are not taken seriously by doctors when they say they are in pain. Unfortunately, two weeks after she was admitted to the hospital, Dr. Moore died from Covid-19 complications. See “Black Doctor Dies of Covid-19 After Complaining of Racist Treatment,” New York Times, 12/23/2020, updated 12/25/2020.
Disparities have been documented for years in medicine. In 2020, the American Medical Association (AMA) recognized racism as an urgent threat to public health due to police brutality and systemic racism. The AMA House of Delegates declared “racism in its systemic, structural, institutional, and interpersonal forms…an urgent threat to public health, the advancement of health equity, and a barrier to excellence in the delivery of medical care.” See “AMA Board of Trustees pledges action against racism, police brutality,” The AMA voiced support for legislation to promote more equitable health policies and to encourage government and non-government organizations to increase funding to combat racism in health care research. They also are working to make medical education and healthcare anti-racist.
The U.S. Center for Disease Control followed in 2021 with a similar statement. In April of 2021 Rochelle P. Walensky, MD, MPH, Director, Centers for Disease Control and Prevention, said that “the pandemic illuminated inequities that have existed for generations and revealed for all of America a known, but often unaddressed, epidemic impacting public health: racism.” She declared that racism includes “structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects.” The CDC promised to study the effects of racism on public health, make new investments in minority communities, diversify its internal agency, and create a web portal called “Racism and Health.”
While some efforts are being made to reduce racial healthcare disparities, there is much work left to be done. The AMA implemented a set of “best practices” to improve the practice of medicine. The AMA says that its “anti-racist” approach includes strategies designed to prevent bad outcomes caused by bias (preventative strategies), and strategies to make up for past practices that caused harm (called “restorative” strategies). The AMA has said that these practices can be used by all medical institutions to combat racism. They recommend implementing anti-racism equity strategies through training and tool development, establishing unbiased structures, measuring impacts, amplifying marginalized voices, incorporating racial justice and health equity in existing health care innovation projects, and educating on health inequalities.
It is unfortunate that it took a worldwide pandemic and widely publicized cases of police killings to precede this development. However, this acknowledgment of past harms caused by the medical system and doctors due to bias and systemic racism is an important first step in addressing past harms and moving towards a medical system where equally appropriate quality care is provided to all.