The COVID-19 Pandemic Sheds Light on Racial Disparities in the United States Healthcare
It is no secret that the public health crisis of Coronavirus Disease 2019 (COVID-19) has had devastating effects worldwide. One of the most alarming aspects of the COVID-19 pandemic in the United States is the disproportionate effects experienced by marginalized groups such as Black/African American, Hispanic, and Asian individuals. Racial disparity in this country is no stranger and the recent events of COVID-19 have made racism in the United States healthcare more prominent than ever before. The Institute of Medicine (IOM) defined racial disparities in the healthcare system as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”
The medical impacts of COVID-19 indicated the need to recognize the role that racism plays in United States healthcare to improve the health outcomes of disadvantaged populations. As society is slowly transitioning out of a pandemic and emerging data comes to light, it is important to discuss how COVID-19 revealed that American healthcare is flawed and is in dire need of reform.
The collateral damage of COVID-19 Pandemic
COVID-19 harmed many but did not harm equally. A cohort study revealed that in comparison to white COVID-19 patients, Black/African-American COVID-19 patients are more likely to die in the hospital or be discharged to a hospice within 30 days of entry. This tragedy can be explained by racism paired with the presence of comorbidities (such as chronic lung diseases, diabetes mellitus, heart conditions, renal diseases, obesity, etc.), quality of treatment received, and hospital segregation.
Injustice and inequity have existed in the United States healthcare system for decades, and COVID-19 data has only affirmed that. In a recent research article, Cato T. Laurencin and Aneesah McClinton, discuss that the black immunity myth—a belief that black individuals are immune to COVID-19 due to their genetic makeup and melanin—is a potential cause of worse treatment outcomes for POC individuals. Myths like these are far more common than people realize and are clearly detrimental to people of color as they will not receive the medical care they need.
Why is healthcare different for people of color when doctors take an oath to treat their patients equally?
There are many layers to this issue but at the surface level, it can be attributed to implicit preference and biases that affect a person’s understanding and decisions when providing medical care to patients of different racial/ethnic backgrounds.
When a catastrophic outbreak like the COVID-19 pandemic occurs, it magnifies the racism experienced by marginalized groups that have always lurked in medicine. While following the course of the virus, an unfortunate reality is exposed. When looking at COVID-19 hospitalization rate ratios of minority groups compared to white individuals, Hispanic and Black/African American individuals were 2.8 to 2.9 times more likely to be hospitalized than white people despite those communities being a minority population. 21.8% of COVID-19 cases in the US were African Americans and 33.8% were Latin X, despite the fact that these groups make up only 13.2% and 18.7% of the US population.
Why is that?
The disproportionate death rates can be attributed to biases against certain racial/ethnic groups and social determinant factors such as socioeconomic status, education, environment/geography, access to healthcare, access to food/ shelter, fear of receiving treatment due to immigration status, etc. Social determinants of health can be considered as non-medical factors that may positively or negatively influence a wide range of health outcomes. To improve health outcomes of different racial and ethnic groups, it is critical to identify social determinants and how they contribute to health inequities. The subsequent list provides brief examples of social determinants that limit health equity as well as invite the idea of racial disparities in health care:
1. Socioeconomic status
The association between socioeconomic status (SES), race, and ethnicity are closely interlaced within each other. SES is a huge determinant in many aspects of life. It governs your access to education and healthcare, level of income, employment status, housing, and overall determines how you will live and die. As reported by the US census, Black/African American Individuals represent 13.2% of the US population yet 23.8% of the poverty population. Similarly, Hispanics made up only 18.7% of the US population but 28.1% of the poverty population. It’s clear that people of color tend to have a lower SES which was extremely detrimental to their safety during the pandemic. Social distancing has been heavily emphasized in these times and those who have low SES likely did not have the privilege of working from home and protecting themselves from the virus.
Not having the privilege of accessing education can affect your health outcomes. A study conducted from 1997-2017 by the Urban Institute, revealed that adults from all ethnic, racial, and geographic backgrounds that are less educated showed poorer health outcomes compared to individuals with higher education. Education is a major piece of SES and because of that, some individuals do not have the opportunity of pursuing higher education. In turn, this affects their health directly through knowing when to seek medical treatment and making healthy lifestyle choices or indirectly by having better jobs that have higher incomes.
Geography undoubtedly plays a role in an individual’s health experience, as it influences their environment, accessibility to healthy foods, the proximity of health services, and the viruses they are exposed to. The geographic distribution of past infectious diseases including the spread of Polio, Smallpox, and the Spanish flu is related to population movement & density, migration, and global travel. Similarly, COVID-19 shares the same disease diffusion properties however unlike past diseases, we have advanced technologies that allow us to see that this crisis goes far beyond the scope of epidemiology.
Recent data shows that cities having a large population of people of color are subject to higher rates of COVID-19 infections ultimately leading to geographic racism. As claimed by sociologist Loïc Wacquant, these cities suffer from “territorial stigmatization” as they are thought to be a place that is mainly composed of poor people, minorities, and foreigners. The concept of territorial stigmatization is the notion of when a physical region is linked to contamination or disease and that this contaminant can be spread to residents in these particular spaces which causes people to avoid and fear these areas. At its core, the belief behind place-based stigma in regard to COVID-19 suggests that certain demographics in an area are the source of a virus- an inherently racist ideology.
While COVID-19 is an unprecedented crisis that hurt everyone, it had a much stronger negative effect on people of color. The disparities they experienced in their everyday lives subject them to disproportionate burdens of hospitalization and death rates. Racism is a serious public health threat as defined by Dr. Rochelle Walensky, Director of the Centers For Disease Control (CDC), and must be treated quickly and with strong coordinated efforts. Reducing health disparities in the US requires a broad range of efforts by all sectors. In an upcoming article, I will discuss what interventions need to be done to reduce health disparities for marginalized groups.
Written By Kaitlyn Bernard
Edited By Ann-Christine Noll
Last Updated: 07/20/2021