Understand disparities in healthcare treatment.
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It's Sunday, so we're continuing our weekly series that analyzes the racial disparities exposed by COVID-19. I hoped this series would feel like old news after a while because I was hopeful COVID-19 rates would decline.
But, as we watch some states reach their all-time highs, it's clear that this global pandemic is here to stay. Which also means that unless more action is taken, the disparities in testing and treatment will persist. Today we isolate these differences and how they've been pervasive in our healthcare system for decades.
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Nicole
TAKE ACTION
See if your city or state has an equity task force to support those most vulnerable in your community. If not, contact your local officials to ask why.
Sign the petition from the Black Lives Matter movement demanding the collection and release of more racial demographic data related to COVID-19: https://blacklivesmatter.com/demand-racial-data-on-coronavirus/
GET EDUCATED
Racial disparities in treatment started well before COVID-19.
Note: This is our third installation of the series analyzing how systemic and interpersonal racism impacts the disproportionate impact of COVID-19 on communities of color. As we focus on disparities in treatment today, it's important to remember that this is not the sole, singular issue causing disparities of COVID-19. And although we're looking at in isolation for the sake of this newsletter, solving it alone won't solve everything. I say this not to be pessimistic, but to emphasize how pervasive and interconnected racism is in all aspects of our society. It's recommended you read our previous emails in the series:
Racism as a public health crisis
Protect essential workers
Understanding the full scope of the impact of COVID-19 was greatly limited in disproportionate access to testing. And although state and city–level data on COVID-19 and racial / ethnic backgrounds varies widely, initial reports are clear. In NYC, two-thirds of the 30 ZIP codes with the highest rates of testing were either whiter or wealthier — and frequently both — than the city average population (via NYPost). NPR found that testing sites are disproportionately found in white neighborhoods in 4 of the 6 biggest cities in Texas (via NPR). Initial rollouts of the partnership between the Trump administration and major drugstores (Walgreens, CVS, Target and Walmart) was also inequitable: out of the 63 sites, only 8 were in Black neighborhoods (via Vox). Inequitable testing doesn't just prevent individuals from quarantining and caring for themselves more difficult. It prevents local governments and healthcare providers from adequately preparing for a spike in cases, leaving the system weakened based on this lack of information.
Beyond testing, many cases of disparities in treatment are causing people to die, evident in stories like this Deborah Gatewood (via Blavity) and Jason Hargrove (via Time) in Detroit, two Black frontline workers that were both turned away from the hospital multiple times before dying of COIVD-19 at home. These stories are especially unsettling to read because in Michigan, 40% of the people that have died from COVID-19 are Black, although only consisting of 14% of the population (via Michigan state COVID-19 data). But these stories aren't unique to Detroit, like the stories of Reginald Relf (via NYTimes), Gary Fowler (who was never officially tested for COVID-19) (USA Today), and Rana Zoe Mungin (via UMass).
But treatment disparities, too, have a deep history. One study of 400 hospitals in the U.S. showed that black patients with heart disease received older, cheaper, and more conservative treatments than their white counterparts. Black people were also less likely to receive coronary bypass operations, and discharged earlier from the hospital than white patients—at a stage when discharge is inappropriate (via American Bar).
“Race doesn’t put you at higher risk. Racism puts you at higher risk.”
Camara Phyllis Jones, epidemiologist and family physician in Scientific American
If you spend time on social media, you may have seen the viral TikTok video by Oregon-based OBGYN Dr. Jennifer Lincoln where she talks about the differences in care (watch video and learn more on Buzzfeed). In it, she states that "a 2016 study showed that 50% of medical students and residents who were studied thought that Black people couldn't feel pain the same way because they had thicker skin or their nerves didn't work the same way," which surprised many, but is absolutely true (read the full study here). The study makes the claim that these perceptions are likely to influence how doctors support pain management for Black people, which was also noted in the study (via American Bar).
Note: The video goes on to discuss how these false perceptions are rooted in the days of slavery. We'll discuss this in depth in another newsletter, but this NYTimes article is a powerful explanation of how physical racial difference between Black people and white people were used to justify enslavement.
These points illuminate that disparities in healthcare aren't just caused by structural factors, but individual ones as well. The study stresses that the implicit biases of physicians and health care providers are a contributing factor to these differences in treatment. And when physicians were given the Implicit Association Test (IAT)—a test that purports to measure test takers’ implicit biases by asking them to link images of black and white faces with pleasant and unpleasant words under intense time constraints—"they tend to associate white faces and pleasant words (and vice versa) more easily than black faces and pleasant words (and vice versa)" (American Bar).
You can take the test for yourself for free on the Harvard website, but know that it's not designed to be an individual assessment (via Vox). I recommend taking the test more to understand what implicit bias is, and how the aggregated data can inform research.
The CDC updated their recommendations for supporting racial and ethnic minorities to include implicit biases, citing that healthcare providers should "provide training to help providers identify their implicit biases, making sure providers understand how these biases can affect the way they communicate with patients and how patients react" (quote from CDC website, insight from NYTimes).
As Congress works to pass a bill creating a federal task force to address COVID-19's disproportionate impact (via Kamala Harris' website), cities across the country have started to implement their own health equity task forces (see work from Boston, NYC, Houston and Michigan). But is it too little too late? Even if testing locations can grow to keep up with demand, and be placed in accessible locations for everyone, implicit biases may not be able to be solved in just a training or workshop. However, as the devastating impact of COVID-19 persists, we can only hope this critical attention will help to combat the scope of its impact on marginalized communities.
There are countless other examples of disparities in healthcare treatment in specific contexts – like maternal health and traumatic brain injuries, for starters – that we will unpack in future newsletters.
KEY TAKEAWAYS
Existing disparities in our healthcare system exacerbate how we test and treat COVID-19 for specific populations
These disparities are structural and individual, showing that our relationship to racism at all levels influences how we can take care of those most marginalized
Efforts are underway, but it's unclear if it's enough to combat the rampant spread of the disease
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