The National Coalition on Health Care held a virtual conference with health care leaders on October 1, 2020. The impact of COVID-19 on communities of color was a major theme of the conversation. To date, the US has had over 275,000 COVID-19 deaths and over 14 million cases – numbers that are rising every day. A disproportionate number of COVID-19 related deaths are among Black, Hispanic, and Native American communities. The Centers for Disease Control most recently estimated that Black and Hispanic Americans die at a rate of almost three times that of White Americans, after adjusting for age. People of color in nursing homes or long-term care facilities are especially vulnerable. “Covid-19 has been a stress test for our healthcare system and how well we do with health equity,” said Dr. Sachin Jain, President and CEO of SCAN Group and Health Plan.
We have failed this stress test, and the reasons for this failure are systemic and wide-ranging.
Astounding health and economic disparities pre-date the pandemic; existing disparities have only been further exacerbated by the pandemic. Systemic underinvestment and discriminatory practices such as redlining mean that Black communities are more likely to be densely populated, lack healthy food options and recreational spaces, and have lower access to health care services. These conditions contribute to higher rates of chronic conditions, including obesity and kidney disease, among people of color – conditions that exacerbate the severity of COVID-19 disease. According to Brookings, Black Americans represent about one fourth of all public transit users and a large share of essential workers, such as 30% of bus drivers and 20% of food service workers. These jobs often cannot be done from home, increasing exposure risk. Furthermore, these jobs were hardest hit by the recession.
The impact of the pandemic on communities of color goes far beyond health care. The pandemic is also a criminal justice issue, for example. Overcrowding has made poorly prepared prisons and jails epicenters of the pandemic, which has a disproportionate impact on people of color. Prisons and correctional facilities have had high numbers of cases and have had to grapple with a shortage of masks and medical equipment. One study found that the case rate for prisoners was 5.5 times higher than the US population case rate. Despites calls to reduce the number of people in jails or prisons in the early days of the pandemic, few states took steps to do so. Incredibly, 80% of those who died from the virus in Texas county jails had never been convicted of a crime. Since Black Americans are more likely to be incarcerated or held in jail because of cash bonds, the high case rate in prisons has a significant impact particularly on Black people.
The solutions to these historic problems must be multi-faceted, extensive, and focused on upstream social determinants. Dr. Anand Parekh, Chief Medical Advisor of the Bipartisan Policy Center, stated at The Path Forward event that we must “learn the lessons that come out of the crisis that we are in right now… [and] make sure we invest in public health and fund and address social determinants of health.”
Our health care system should be more pandemic-resistant. In doing so, we can avoid exacerbating health disparities and help close existing ones. In the short-term, the federal government should extend substantial support to the states for public health efforts, economic stimulus and unemployment, and vaccine delivery. In addition, the federal government should create automatic triggers that adjust the Federal Medical Assistance Percentage (FMAP) based on economic markers. The states that receive the additional federal funds for Medicaid purposes must maintain Medicaid eligibility, thus helping to ensure low-income Americans continue to receive healthcare during economic downturns. Creating these funding triggers for recessions would make sure that low-income communities are protected without delay. Longer term solutions include investing more in minority communities to improve access to healthy foods, education, transportation, healthcare services, and housing, as well as reforming the criminal justice system.
Further, the medical and public health establishment must continue its work to rebuild its trustworthiness. The medical community has a long history of mistreating communities of color. For example, black patients are less likely to have a trusting relationship with their physicians and medicine, in part due to heinous examples of exploitation and discrimination (such as the Tuskegee syphilis study and the maternal mortality epidemic that disproportionately impacts Black women). The science of vaccine development may prove to be a relatively simple task compared to building the solidarity and trust necessary to make them effective.
There is light at the end of the tunnel. As Dr. Beverly Malone, President and CEO of the National League for Nursing, expressed at the Path Forward event, “this is an opportunity to make a difference and reimagine.” We must use the lessons we have learned from the pandemic to address deep seated inequities in health. Only by taking these inequities seriously will our health care system, economy, and communities return stronger and more resilient than they were before.