Writing on July 20 in the Health Affairs Blog, two healthcare policy researchers described the need for federal healthcare authorities to address the lopsidedly devastating impact of the COVID-19 pandemic on communities of color in the United States.
Leana S. Wen, M.D. and Nakisa B. Sadeghi, in their Health Affairs Blog article, write in their article, “Addressing Racial Health Disparities In The COVID-19 Pandemic: Immediate And Long-Term Policy Solutions,” that “The devastating impact of COVID-19 is apparent, with nearly three million confirmed cases and more than 131,000 deaths in the US. Among those affected, communities of color bear the brunt of the pandemic. Health disparities in the COVID-19 crisis call attention to long-standing inequities that pervade the health care system and society at large,” they emphasize.
Leana S. Wen, M.D. is an emergency physician and visiting professor of health policy and management at the George Washington University’s Milken School of Public Health, where she is also a distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. She is an expert in public health preparedness and previously served as Baltimore's Health Commissioner. Nakisa B. Sadeghi is a medical student in the School of Medicine at the University of North Carolina at Chapel Hill.
Wen and Sadeghi note that “New federal data reveals that African Americans and Latinos in the U.S. have been three times more likely to contract COVID-19 than white residents and nearly twice as likely to die from it. Some counties with a majority of African American residents have almost six times the death rate compared to counties that are predominantly white. In some states such as Illinois, Latinos have nearly seven times the rate of COVID-19 cases compared to white people, while African Americans have the highest death rate. In California, Pacific Islanders face a death rate from COVID-19 that is 2.6 times higher than the rest of the state, while in South Dakota, the rate of COVID-19 among Asian Americans is six times what would be predicted based on their share of the population. Other minority communities are also disproportionately affected, including in New Mexico, where Native American people comprise about 11 percent of the population yet account for more than half of COVID-19 cases.”
The authors note that racially based health disparities during the COVID-19 pandemic exist on two levels. First, communities of color start out having a high likelihood of contracting the virus by living in urban areas and by “disproportionately working in higher-risk environments,” with Black and Latino American far less likely to be able to work from home. At the same time, communities of color are environments of higher rates of chronic conditions, including obesity, diabetes, and kidney diseases, all of which are risk factors for severe illness from COVID-19.
The researchers’ recommendations? Public health resources for COVID-19 should be targeted to communities of color; testing “must be made free, widespread, available without a physician’s prescription, and targeted to communities that are most impacted by COVID-19, namely communities of color.”
In addition, the researchers note, healthcare system leaders need to understand that “Mistrust of medical institutions and authorities among communities of color is related to a historical legacy of mistreatment and discrimination, such as during the Tuskegee experiment,” and as a result, when it comes to contact tracing efforts, “Every effort should be made to recruit contact tracers from the communities they serve and to deploy contact tracers based on community need. Using trusted contact tracers can also help to overcome language barriers that interfere with effective outreach to non-English-speaking people. This community engagement will also serve as an opportunity for employment in communities hardest hit by the economic impacts of COVID-19.”
The authors believe strongly that some of the leadership around these issues, including the establishment of “clear, directive guidelines to protect workers and to ensure that [such guidelines] are enforced,” must come from the federal Centers for Disease Control and Prevention (CDC), as “No local official has the time nor the workforce capacity to wade through thousands of scientific studies.”
Meanwhile, the authors write, “[T]he federal government should ensure that all patients who need medical care related to COVID-19 have access to it. The prohibitive cost of treatment for many Americans has been well-described: An analysis by FAIR Health found that insured patients who are hospitalized with COVID-19 can expect to pay up to nearly $75,000, while uninsured patients can pay an estimated average of more than $70,000 for a six-day hospital stay; communities with the highest rates of uninsurance, namely American Indian/Alaskan Native, Hispanic, and African American patients, bear the burden of these costs.”
