COVID-19 Reveals an Unsurprising Harsh Reality: Health Care is Not Immune to Racial Injustice
RACISM AS A PUBLIC HEALTH CRISIS
By Vineet Kumar Sharma, MD, MS and Devjani Das, MD
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The United States has been severely hit by COVID-19, more so than any other nation, accounting for approximately one-third of all global confirmed cases. In the initial stages, New York City became the global epicenter of the pandemic. Amidst the devastation that wrecked New York City’s health system is a harsh reality: racial minorities are being disproportionately impacted. As of June 12, 2020, age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons were nearly five times that of non-Hispanic white persons. Hispanic or Latin persons have a rate approximately four times that of non-Hispanic white persons. Ageadjusted mortality rates per 100,000 people are just as appalling: as of June 10, 2020 African American had 92 deaths and Hispanic/Latin individuals had 74 deaths compared to 45 deaths reported for Caucasian Americans. While these statistics are damning, health disparities seen in minorities are
not new and have been highlighted further during the COVID-19 pandemic. Health disparities, as defined by Health People 2020, adversely affect groups who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, gender identity, sexual orientation or other characteristics historically linked to discrimination or exclusion. Social determinants of health (SDoH), which include racial inequalities, account for anywhere from 40-80 percent of all health outcomes, compared to traditional clinical care, which comprises approximately 20 percent. Despite this, the United States is the only developed country that spends more on health care than on social services. Given this, it should be of no surprise that Black and Hispanic Americans, along with American Indians, have higher infant mortality rates and that premature deaths from stroke and heart disease are highest among Black Americans. Additionally, chronic diseases, such as
asthma, diabetes, hypertension, obesity and preterm births are more prominent in minorities. (Amer Jour of Pub Health, CDC Health Disparities and Inequalities Report U.S. 2013, 2013 National Healthcare Disparities Report) There is no singular cause for racial inequalities seen in health care, but a contributing factor is implicit racial biases amongst health care providers towards people of color and/or specific ethnic backgrounds. Implicit biases may be universal amongst all individuals and subtle, but they do hinder any chance in developing a trusting patient-provider relationship, which is vital, particularly in the emergency setting. As the safety net of society, emergency departments (ED) serve as an interface between medicine and society. Our patients come to us when they have nowhere else to go, and as emergency providers we are often defined more by our ability to be their advocates than by the procedures we perform. However, the high volume and fast-paced nature of emergency
