Good Medicine health care disparities
It’s past time to talk about
health care disparities
Black infant mortality
is more than twice that
of white infants, regardless
of mothers’ educational or
Death from all causes is nearly
twice as likelyin Black men and
women, compared to white men
and women, even when controlled
for level of education.
The average life span
of Black Americans is about
75 years, compared to 79 years
for white Americans.
by CHRISTY JERZ ’97 and THOMAS L. SCHWENK, M.D.
The statistics above from the Centers for Disease Control and Prevention are sickening, but they are not new. Long-standing structural racism has caused stunningly large disparities between white people and people of color. These inequities in health and health care have recently been exposed by the COVID-19 pandemic and brought to the forefront by the Black Lives Matter movement.
In Nevada, white residents comprise 48% of the population, yet only 28% of COVID-19 cases, per Nevada Health Response. This unequal case distribution is reflected nationwide.
According to a New York Times article, “The Fullest Look Yet at the Racial Inequity of Coronavirus,” which uses federal data from the CDC: “Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties.”
Not only are members of minority communities more at risk of contracting the virus, they are also more likely to die from it. According to the CDC, Black Americans account for 13% of the U.S. population, but nearly 25% of COVID-19-related deaths.
It would be a mistake to attribute these health care disparities to skin color itself.
The reason the rates of serious infection and death from COVID-19 are so much higher in people of color is not color itself but because of where and how these patients are forced to live. The underlying pathology is the systemic racism that leads to psychosocial, behavioral and sociodemographic risks.
“The conditions in which people live, learn, work and play contribute to their health,” notes the CDC. “These conditions, over time, lead to different levels of health risks, needs and outcomes among some people in certain racial and ethnic minority groups.”
Living conditions can make it harder to stay healthy. Densely populated housing contributes to the spread of illness and is often the result of historical lending discrimination, such as “redlining,” a government-backed practice that denied mortgages or renovation loans based on neighborhood or race.
Due to educational and economic disparities, people of color are far more likely to perform “essential” jobs, such as meatpacking plant workers, grocery clerks, housekeepers or bus drivers, which cannot be performed remotely and do not provide sick leave.
Reliance on public transportation exposes people to higher risks of infection and makes it more difficult to seek care for an illness.
On average, racial and ethnic minorities earn less than their white counterparts, and job applicants with “Black-sounding” names are less likely to get invitations for interviews than are those with “white-sounding” names, despite identical resumes.
Members of minority populations are punished at highly disproportionate rates. Black people are incarcerated at more than five times the rate of whites and are more likely to die at the hands of police.
High stress and stress hormone levels in Black mothers, linked to daily experiences with racism, is directly related to a 50% higher rate of preterm birth, lower birthweight babies and 2.3 times higher rate of infant mortality.
Systemic racism creates disparities in every area of society: wealth, employment, housing, health care, politics, education and the criminal justice system. So while COVID-19 doesn’t discriminate on the basis of skin color, long-standing structural inequality holds these unequal outcomes in place.
All of the faculty, care providers and students with UNR Med and our clinical practice, University Health, witness dramatic disparities in health risks and health care outcomes based on race and ethnicity. Every day we see the differences that have been demonstrated by the COVID-19 pandemic, whether we’re physicians, physician assistants, speech pathologists, nurses, social workers, community health workers, psychologists or other health care providers.
In dealing with the results of pervasive, deeply entrenched consequences of structural racism, what can a medical school like UNR Med do about them?
As physicians and health care professionals, we are challenged to understand the lives of our patients and the ways social injustice affects their health and well-being. While we alone cannot solve the many disadvantages and deficiencies experienced by our patients, we cannot ignore them either. These deficiencies in education, housing, transportation, employment, nutrition and more lead to clinical challenges that are ours to solve.
Here are few ideas we are currently exploring:
• We are experts in curriculum development, teaching and medical education. We could develop an entire course in health disparities and structural racism to teach students about the source of these disparities, how to be more aware of them and underlying risk factors in their patients that lead to poor health care outcomes.
• We are experts in research. We could develop clinical research studies recruiting patients of color who have traditionally been excluded from research in the past. We could focus specifically on new clinical approaches to improving health promotion, managing chronic disease and engaging with patients who have suffered from unethical clinical research in the past that caused them to purposely avoid seeking medical treatment.
• We are experts in clinical care. We could expand our already excellent programs in teaching about implicit bias, and improve the clinical care experience for patients of color with special programs for traditionally underserved communities. We could expand the capacity of our Student Outreach Clinic to serve even more highly disadvantaged patients.
• We are experts in faculty development. We could enhance our already robust holistic approaches to faculty recruitment and development, so minority physicians and educators can thrive, serve as role models and advisors and train a more diverse workforce.
• We are committed to community engagement. We could make an even more concerted, conscious effort than we already do to identify promising students from underserved middle and high schools and provide special experiences that expose these students to health care professions. We could become more active in organizations working to provide better housing, jobs, child care and transportation for minority Nevadans.
As health care professionals, we traditionally think of our role as serving our communities and our society one patient at a time. That will always be our strength. Although we are not experts in working at the community or population level, we can and should become more appreciative and supportive of those who do.
Structural racism may not be a code we enter on the charge form when we care for a patient, but it is a contributing “diagnosis” for most — perhaps all — patients of color. We need to become more sensitive, more aware and more knowledgeable about how to take that diagnosis into account in all of our professional roles.