When COVID-19 Disparities and Racial
Injustice Collide

Megan Brooks

June 16, 2020

For communities of color, COVID-19 has had a disproportionate burden in the US, but the lifelong burden of risk from injustice must not be overlooked, said Clyde Yancy, MD, kicking off the American College of Cardiology (ACC) webinar Healthcare Disparities and COVID-19: The Story Behind the Headlines.

As a black man, "my greatest risk of death is no longer COVID-19. It is the color of my skin," said Yancy, vice dean for diversity and inclusion, and chief of cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

After a moment of silence to support Black Lives Matter, Yancy delved into the statistics on COVID-19 in the black community, noting that the death rate for black Americans is at least 2.4 times higher than for whites. 

To put that into perspective, said Yancy, if black Americans had died of COVID-19 at the same rate as white Americans, about 13,000 more black Americans would still be alive. The same metric would be 1300 more Latino Americans and 300 more Asian Americans.

"I hope this is a pause moment for everyone. [These numbers] really help us understand the disproportional burden of deaths due to COVID-19 that aligns with race and ethnicity," he said. 

"The US has needed a trigger to fully address healthcare disparities and COVID-19 may be that bellwether event," he added, citing a recent viewpoint article he authored in JAMA, as reported by Medscape Medical News

Race: A Proxy for Other Ills?

Yancy also cited a recent report by management consulting firm McKinsey & Company stating that the COVID-19 pandemic is already "a generation-defining crisis, because it affects our social systems.

"It heightens preexisting structural challenges that black Americans face," he said. "But a trial like this can also be an opportunity. Our society can consider how we can respond to the COVID-19 crisis and fallout and find a way to fortify black communities and help them do more than simply recover.

"We can use the urgency of the pandemic to build more equitable systems that increase the long-term resilience of black Americans, communities, and institutions. As we progress toward this goal, the US economy could benefit to the tune of $1.5 trillion."

Also taking a "macro" view, webinar speaker Herman Taylor Jr, MD, MPH, director, Morehouse-Emory Cardiovascular Center for Health Equity, Atlanta, made the point that "race is a proxy for other ills that stand behind race, and it is necessary to make more fundamental changes beyond what we can do at the bedside to really see a retrenchment in disparities after COVID-19."

Taking the "bedside view," webinar speaker Johanna Martinez, MD, GME director of diversity and health equity, Zucker School of Medicine at Hofstra/Northwell, New York, said it's important to realize that while action at the national level, societal level, and within individual institutions is crucial, "what we as providers do at the bedside can actually make a difference."

Martinez noted that social determinants have a "tremendous" effect on an individual's overall health. Twenty percent of a person's health and well-being is related to access to care and quality of services. The physical environment, social determinants, and behavioral factors drive 80% of health outcomes, she said.

"We should routinely ask about people's social needs and their cultural preferences and incorporate these social needs into our treatment plans," said Martinez. "Not only is it important that we ask about social history in a systematic way, but if we do nothing with that knowledge, we've done nothing to improve the care of our patients," she said.

Summing up, Martinez said, "With the national dialogue around power and privilege so evident, we as physicians, irrespective of what race or ethnicity we are, should know that the 'MD' title alone carries power and privilege with it. And with each encounter and every decision that we make, we need to advocate for our patients."

Yancy, Taylor, and Martinez have disclosed no relevant financial relationships.

ACC: Healthcare Disparities and COVID-19: The Story Behind the Headlines. Webinar

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