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Improving Health Equity for Black Communities in the Face of Coronavirus Disease-2019

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Improving Health Equity for Black Communities in the Face of Coronavirus Disease-2019 ISSN 2472-3878 PUBLIC hEALTH Open Journal PUBLISHERS Mini Review Improving Health Equity for Black Communities in the Face of Coronavirus Disease-2019 Charlotte Jones-Burton, MD, MS1; Kemi Olugemo, MD1; Judith R. Greener, PhD2* 1Women of Color in Pharma (WOCIP), Nonprofit Organization Management, Somerset, NJ, USA 2Inside Edge Consulting Group, 103 College Rd E # 203, Princeton, NJ 08540, USA *Corresponding author Judith R. Greener, PhD Managing Director, Inside Edge Consulting Group, 103 College Rd E # 203, Princeton, NJ 08540, USA; E-mail: [email protected] Article information Received: June 2nd, 2020; Revised: June 22nd, 2020; Accepted: June 23rd, 2020; Published: June 23rd, 2020 Cite this article Jones-Burton C, Olugemo K, Greener JR. Improving health equity for Black communities in the face of coronavirus disease-2019. Public Health Open J. 2020; 5(2): 38-41. doi: 10.17140/PHOJ-5-146 ABSTRACT The impact of coronavirus disease-2019 (COVID-19) in the U.S. to date is staggering and Blacks across the country are being infected and dying at rates far in excess of Whites. Although health disparities have been part of America’s reality for decades, the pandemic has exposed the failure of the healthcare system to adequately serve minority patients. There are immediate solu- tions that can help to balance the inequity now and position us well for the future. Five suggested solutions are described which focus on greater inclusion of Blacks in activities such as clinical trials, encouraging community-based resources and providing comprehensive racial data on COVID-19 cases. We are not all in the fight against COVID-19 together. Solutions must be adopt- ed to help to address the current disparities now as well as beyond the immediate crisis. Keywords Health disparities; COVID-19; Minorities; Health equity; Black communities. INTRODUCTION DISCUSSION y all measures, the impact of coronavirus disease-2019 (COV- Data released by the Centers for Disease Control and Prevention BID-19) in the U. S. to date is staggering and no racial group has (CDC) details the number of COVID-19 cases reported by state been impacted as severely as the Black community. Blacks across and demographic characteristics.2 Among those cases for which the country are being infected and dying at rates far in excess of race is specified, 30% mortality is shown for Blacks, although Whites and implicated are historical structural issues, current bi- they represent 13% of the U. S. population. Most troubling is the ases and shortfalls in the healthcare system. Immediate solutions, extreme imbalance on a state and city basis between Blacks and grounded in the community, are required to ensure more equitable Whites who have been infected and succumbed to COVID-19. For outcomes in the face of this pandemic. example, in Illinois, 42% of people who have died from the disease are Black, a group that makes up just 14% of the state’s popu- The Hispanic/Latino population, along with other un- lation.3 In Chicago specifically, over 70% of the deaths occurred derrepresented racial and ethnic groups, are also facing grave chal- among Black residents although they represent only about a third 1 lenges in the face of COVID-19. Data documenting the impact of of the population.4 the virus on Hispanic/Latino communities is not yet as developed as that available for the Black population. However, many of the Historical imbalances in wealth and opportunity have cre- structural issues, biases and healthcare limitations described below ated structural conditions that underlie both the racial imbalances also apply to this population and appropriate solutions will need to in coronavirus deaths and a healthcare system that promulgates be developed. the disproportional risk experienced by Black patients.5 Structural conditions are numerous; a partial accounting includes segregated cc Copyright 2020 by Greener JR. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. Mini Review | Volume 5 | Number 2 | 38 Public Health Open J. 2020; 5(2): 38-41. doi: 10.17140/PHOJ-5-146 neighborhoods that have insufficient services and funding, poor Apply the Lens of Distributive Justice and an Inclusive Well- access to healthy foods, disproportionate placement of toxic dump Rounded Perspective to Considerations of Scare Resource sites, overrepresentation in low wage jobs, and life stressors from Allocation institutional bias.6 Low socioeconomic status alone is a risk fac- 7 tor for total mortality. Focusing on healthcare specifically, Blacks An issue of current concern is the scarcity of medical resources in are less likely to be insured, more likely to have underlying health many cities, and guidelines are being created to help physicians eth- conditions, and face bias that prevents them from getting guide- ically make rationing decisions. An article by Dr. Ezekiel Emanuel line-appropriate treatment. Co-morbidities such as hypertension, and colleagues provided recommendations consistent with save- diabetes, obesity, renal disease and cardiovascular disease, along the-most lives principle; that is, save the life of the healthier patient 8 with underlying elevated levels of lipoprotein(a) [Lp(a)], are all that will be more likely to successfully recover.16 The authors, while risk factors for poor COVID-19 outcomes, and Blacks suffer from attempting to operationalize ethical values for the fair allocation of 9 a high prevalence of these conditions. In addition, data indicates scarce resources, were remiss in considering the challenges faced that a high proportion of COVID-19 patients die from complica- by Black patients, thereby promulgating existing inequities. tions related to heart failure and renal disease in particular.9,10 The first recommendation prioritizes patients with a rea- Conditions for Blacks exacerbate the links to increased sonable life expectancy. This is tied to structural conditions as well exposure and worse outcomes in the face of COVID-19. Many as current socio-economic status which disadvantages minority essential workers are Black, and they must continue reporting to patients. Assigning value to quantity versus quality of life is not work even though it means ongoing contact with the public. Black in the remit of medical practice. Public sentiment differs from the workers may have to take public transportation to and from work authors’ perspective; a PEW research study shows that U. S. adults and come home to multigenerational dwellings, making social are split on whether a scarce ventilator goes to a person most in distancing in general, and from older and more vulnerable family need or the one most likely to successfully recover.17 members, impossible. Black communities, especially those in states without Medicaid expansion, have less access to testing and medi- The second recommendation assigns COVID-19 in- cal care. terventions first to front-line healthcare workers designated as physicians and nurses. However, essential staff from critical in- Health disparities have been part of America’s reality for frastructure positions who face the same exposure risk, such as decades; however, the pandemic has exposed the failure of the transportation, food and sanitation workers, are disproportionately healthcare system to adequately serve minority patients. As such, minorities. A third recommendation prioritizes providing scarce COVID-19 is not an equal-opportunity disease. The fact that a resources to people who participate in clinical research of COV- higher number of individuals in the Black community are con- ID-19 vaccines and therapeutics as a tie breaker for people with tracting and dying of the virus exposes the country’s “deeply rooted similar prognoses. Minorities are often not given equal opportuni- 11 social, racial and economic health disparities” Changing this reality is a ties to clinical trials, and trust in research has been eroded through moral imperative. As Dr. Clyde Yancy, a researcher and physician historical unethical practices. A prime example is the paucity of at Northwestern University, states: “a 6-fold increase in the rate of death Black patients, typically less than five percent, in clinical trials of for African Americans due to a now-ubiquitous virus should be deemed uncon- new cancer drugs for conditions that disproportionately affect 4 scionable. This is a moment of ethical non-reckoning”. them.18 Solutions must be able to address these issues in the short Applying these criteria evenly to everybody does not rec- term as well as longer-term. In keeping with society’s crisis men- ognize that factors impacting health status are not evenly distrib- tality, once an acute situation resolves, root causes are forgotten uted. The adage – where the pain is, the power ought to be – speaks to along with the need to permanently address them. How can this the perspective of distributive justice.6 This asserts that it can be be prevented from continuing to occur? Many of the underlying ethically justified to give more resources to the least well off if this factors that have persisted would require policy or system changes is what is required for all individuals to reach the same level of that could take years. Included are such factors as cost of care, health. Focusing on the most vulnerable and underserved creates which may hinder patients from seeing a physician or having the a path toward health equity that will help everyone overcome this ability to access the most appropriate and effective medication; the pandemic. lower-value care Blacks receive compared to Whites; lack of pro- viders or clinics in the communities with high Black populations; Having Comprehensive Racial Data on COVID-19 Cases and a shortage of Black physicians, who have been found to en- gender greater trust and use of the health system among Black 12-15 The CDC data referenced earlier contains a partial accounting of patients.
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