Racism in U.S. health care

How racism in US health system hinders care and costs lives of African Americans

By Tamika C.B. Zapolski and Ukamaka M. Oruche

Photo by Joe Raedle/Getty Images.

As the COVID-19 pandemic swept across the U.S., the virus hit African Americans disproportionately hard. African Americans are still contracting the illness – and dying from it – at rates twice as high as would be expected based on their share of the population.

In Michigan, African Americans are only 14% of the population, but account for one-third of the state’s COVID-19 cases and 40% of its deaths.

In some states the disparities are even more stark. Wisconsin and Missouri have infection and mortality rates three or more times greater than expected based on their share of the population.

Speculation has suggested these disproportions are due to several factors: African Americans are more likely to live in poor neighborhoods, work at riskier occupations, and have more underlying health conditions and limited access to health care. But similar inequities exist in African American communities with above-average wealth and health care access. Staggering rates of COVID-19 occurred in Prince George’s County, Maryland – the nation’s wealthiest African American enclave. Comparable white communities were relatively unaffected.

As experts in clinical psychology and psychiatric nursing, we know this elevated risk for African Americans is not uncommon. It is true regardless of income, education level, or health care access. And it is true for other things besides COVID-19. African American women are more than twice as likely to die from childbirth than white women. Even if the African American women were educated and wealthy, they were more likely to die from childbirth than uneducated and poor white women.

Racism: the root cause

An analysis by the National Academy of Sciences found African Americans receive poorer quality care than white patients across all medical interventions and routine health services – even when insurance status, income, age, co-morbid conditions, and symptom expression were equal. Experts point to racism as a root cause for these disparities. Indeed, the American Academy of Pediatrics has outlined how racism impacts health outcomes for African American children. We suggest the same is true for COVID-19 outcomes among African American adults.

Other barriers negatively impact the health of African Americans. That includes implicit bias – attitudes, thoughts, and feelings existing outside of conscious awareness – as patients and providers communicate with each other.

Implicit bias from a doctor or nurse affects the quality and quantity of information shared with the patient about health conditions and treatment plans. The worst case scenarios: when providers withhold critical information about a health condition; when they don’t include the patient’s voice during decision making about care; and when they don’t refer the patient for further tests or specialty care. Implicit biases from health care workers can result in patients being less likely to understand their health conditions, which is necessary for patients to manage an illness effectively.

Averse interactions with physicians lead to long-lasting consequences for the patient, including unequal treatment and disparate health outcomes. And when it comes to ineffective patient-provider interactions, African Americans suffer the most.

Location, location, location

The location of hospitals, clinics, and other health care facilities are often a barrier to care. Transportation – or the lack of it – impacts the patient’s ability to receive services. African American patients have noted the frustration when health care facilities are not close to their homes. To get there, many of them rely on public transportation. The result: missed or cancelled appointments, sometimes due to policies regarding late arrival times by patients.

Differences also exist between African American and white patients in the length of wait time for appointments and the ability to schedule follow-up appointments. This can result in delayed health care – which leads to poorer health outcomes for illnesses, including COVID-19.

Recommendations for addressing racism

Consumers who are well informed about their health and confident in managing their care have better outcomes virtually across the board: in HIV-AIDS, cancer, diabetes, cardiovascular disease, and mental health conditions such as schizophrenia.

That said, here are three recommendations to address racism and reduce racial disparities in health care services:

1.      Health care professionals need to become more aware of their implicit bias. Identify the problem, as the saying goes, and you’re halfway to solving the problem. One way to become more aware: take the implicit bias test here.

2. Doctors and nurses need to be attentive and collaborative when communicating with patients. Empower the patient by encouraging questions and letting them express opinions. When patients believe the providers are there to support them, they manage their illness better. They also have a better perception of quality care. Ultimately this leads to improved health outcomes.

3.     Hospitals, clinics, and doctor’s offices should provide more flexibility in delivering services. Telehealth – when doctors and patients communicate online, instead of an in-person visit – should be one of those services. They should also restructure scheduling policies, emphasizing shorter wait times and more slack if patients are late.

Health inequity for African Americans is not a new phenomenon. COVID-19, however, shined a light on the problem. Racism is not isolated to health care services, and it remains pervasive throughout our society. But by taking the tangible steps outlined here, providers can begin to solve the problem.

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Tamika C.B. Zapolski is an Associate Professor of Psychology at Indiana University Purdue University ( IUPUI)
Ukamaka M. Oruche is an Associate Professor & Director of Global Programs at Indiana University Purdue University ( IUPUI)

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Bold policies urged to address inequities highlighted by COVID-19

Congressional Black Caucus Foundation forum reflects strong impetus to cure structural deficiencies highlighted by virus' effect on black community

By R. T. Andrews

“Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.” ― Samuel Johnson

There is a growing sense of urgency in the black community these days that is long overdue. The catalyst, of course, is undoubtedly the sobering realization that the novel coronavirus, which is no respecter of persons in general, is killing black people at a disproportionate rate that can neither be denied or ignored.

Wherever statistics about the rate of COVID-19 infection, hospitalization and morbidity are being compiled, the results show alarming and outrageous disparities between the black and white communities.

In some places, Ohio and Michigan among them, state-sponsored task forces are gathering to study the data, ascertain the causes, and propose solutions. But the reasons why African Americans are disproportionately being felled by the disease are not really in dispute. When there are massive inequities going in, there will be massive inequities coming out.

Equality is an aspirational goal in the United States, one that has been effectively on the wane since at least 1981 and the inauguration of Ronald Reagan. The hollowing out of the middle class has pushed millions of Americans close to the brink of financial ruin. The mortgage meltdown of 2008, which had consequences so predictable — including the loss of roughly half of the hard-fought wealth of black families — that its onset can only be described as criminally reckless, deepened the structural deficiencies in the black community brought on by decades of government policies and private actions.

“There is nothing wrong with black people that ending racism won’t solve.” — Andre Perry, Brookings Institution

Governmental task forces like the one initiated by Ohio Gov. Mike DeWine have been, with some exceptions, typically been a time-honored way of kicking problematic political cans down the road. This current pandemic is going to change our society in ways most of us have not even begun to contemplate. There will be no magic switch that turns the economy back on, that restores the time lost, especially by our youth.

We understand the Chinese word for crisis to be comprised of the characters representing “danger” and “opportunity”. In the danger black Americans especially face today may lie the opportunity to push the bold solutions necessary to redress the historic inequities the country has never fully committed to resolve.

“Capitalism is like a wolf. Government is like the dentist. The question is, will the dentist [i.e., public policy] sharpen or smooth the wolf’s teeth.” — Dr. Julianne Malveaux

In the danger black Americans especially face today may lie the opportunity to push the bold solutions necessary to redress the historic inequities the country has never fully committed to resolve.

Menna Demessie, Vice President of Research & Policy
Analysis, Congressional Black Caucus Foundation Inc

An awareness of this possibility of serious structural reform was evident in the online 90 minute panel discussion hosted today by the Congressional Black Caucus Foundation [CBCF]. Serious scholars, including several from this region — Menna Demessie of the CBCF is an alumna of Western Reserve Academy and Oberlin College; Darrick Hamilton, who directs the Kirwan Institute at Ohio State University, is also a Oberlin grad, and Brookings Institution fellow Andre Perry hails from Pittsburgh —  were among those in lively debate about the advocacy of visionary, even radical goals, to meet the urgency of these times.

Andre M. Perry, Ph.D.
Brookings Institution 

For example, Perry from Brookings argued cogently that to deal with the structural inequalities faced by black people requires both medium and long-term objectives. He said that broadband service should be a public utility, much like highways and public parks. He also advocated for universal health care and a federal job guarantee program. He addressed long-standing myths that the sorry state of black America is a reflection of individual choices as opposed to the structural choices of this nation. “Policy works for white people,” he argued. “There is nothing wrong with black people that ending racism won’t solve.”

OSU’s Darrick Hamilton’s assessment was much the same. “Wealth begets wealth”, he noted. He suggested that most wealth in America was created with the active aid of and investment by government in [white] people, citing government giveaways and programs in finance and home ownership [land grants, federally backed mortgages, etc.], education [e.g., the G.I. bill]. He argued forthrightly that public power is immense, strong, and fully capable of addressing the nation’s needs.

“Government can do good,” he said, suggesting that much of the virulent pushback from Senate Majority Leader Mitch McConnell and his ilk was their desire to avoid recognition of government’s potential by the majority of Americans.

Congresswoman Terri Sewell, D-AL

Congresswoman Terri Sewell, D-AL, was the first speaker. She spoke of the systemic disinvestment in black communities and how that is reflected in the differential outcomes being produced by the virus. She outlined the death rates for African Americans in several states far outstripped their share of the population in those states: in Alabama, 45% of deaths, only 27% of population; in Louisiana, 70% vs. 32%; in New York, 17% vs. 9%; and in Michigan, 40% vs. 14%.

Julianne Malveaux, Ph.D.

The economist Julianne Malveaux said that every catastrophe puts a face on the mirror of our inequality. She pointed out the degree to which the essential workers of our nation are people of color. African American women, for example, are six percent of the labor force, but comprise 20% of medical assistance workers. If they don’t show up, people will not be served.  She identified many other arenas where service workers are disproportionately black and on the front lines, including bus drivers.

In discussing the many differential aspects of our economic system, Malveaux touched on one sore spot that has not been widely discussed. Referencing the trillions of dollars in aid that has been spent in bailout packages, she was dubious that the wealthy corporations who have received the lion’s share of the aid will participate when the country has to pay it back.

Malveaux used a stark simile to describe the relationship between government and capitalism. “Capitalism,” she said, “is like a wolf. Government is like the dentist. The question is, will the dentist [i.e., public policy] sharpen or smooth the wolf’s teeth?”

Salene Hitchcock-Gear, President of
Prudential Individual Life Insurance

The town hall, the second in a series being presented by the Congressional Black Caucus Foundation, was underwritten by Prudential Insurance. Salene Hitchcock-Gear, president of Prudential Individual Life Insurance, addressed the question of COVID’s effect upon hundreds of thousands of small businesses, and underscored the importance of such companies having clear succession plans in place.

The entire program, “Understanding the Economic Outcomes of COVID-19 & the Stimulus Package for Black America”, is available on Facebook here, and is well worth watching. The first CBCF program, focused on the 2020 Census, can be viewed here.

The next panel discussion, scheduled for May 14, 2020 from noon-1:30PM EDT, will focus on current water governance and workforce challenges, and how to ensure safe, affordable services exist for marginalized communities. Registration is available here.

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Last Updated May 1, 2020 @ 1207.

Coronavirus poses special challenges for Black Americans

Disease highlights inequities in society, economy

By Myron Bennett

Special to The Real Deal Press

This past Tuesday State Senator Sandra Williams [D-21, Cleveland] hosted a 30-minute virtual town hall meeting to provide critical information and respond to questions about the impact of the COVID-19 pandemic on the black community. Dr. Charles Modlin,  a kidney transplant surgeon, urologist at the Cleveland Clinic, where he is also founder and director of the Minority Men's Health Center, served as Senator Williams’ health expert co-host.

Modlin provided information concerning who is most at risk for contracting coronavirus, how to reduce risk, coronavirus testing availability, and general health recommendations. He emphasized the need to follow public health practices including regular hand-washing and social distancing. He noted that testing, while available, requires a doctor’s order in Ohio. (Though he mentioned only the Cleveland Clinic system as a testing site, both University Hospitals and The MetroHealth System also provide testing in Cuyahoga County.)     

Dr. Charles Modlin (Feb. 2020]

Both Williams and Modlin said that this pandemic is of special concern for the Black community. because data is showing that in many urban areas Black Americans are contracting and dying from the virus at disproportionately higher rates than others.

In Milwaukee County Wisconsin, which is one of the few places in the country tracking infection and death by race, by last Friday African Americans made up almost half of the County’s 945 cases and 81% of its 27 deaths.  The county's population is only 26% black.

By the end of last week in Michigan, African Americans made up 35% of cases and 40% of deaths resulting from coronavirus infection. The state’s population is 14% black. Detroit has emerged as an epicenter of infection and death.

Though New Orleans Louisiana does not report  cases by race, 40% of the state’s deaths have happened in majority black Orleans Parish. Illinois and North Carolina, which report infection and death by race, each report a  disproportionate number of African Americans afflicted by COVID-19. These results illuminate the disproportionate destruction the coronavirus is inflicting on black communities across the United States.

One reason for such high rates is that many black people do not have a primary care physician who can write an order for the coronavirus test when patients note symptoms. Other reasons for high rates include that black urban neighborhoods and homes are densely populated, making social distancing difficult; and many African Americans work in low paying service industry jobs that are deemed essential, and accordingly are putting their health at risk for community  service and/or economic reasons.                                  

This crisis magnifies and illuminates the systemic inequities and structural racism that Black communities constantly face. While Black Americans are contracting and dying from the coronavirus at disproportionately higher rates than any other group and are also being disproportionately impacted economically and educationally. 

Racism continues to be America’s greatest sin, even during a time of worldwide crisis. Our country’s historic implementation of policies that exacerbate racial inequity in healthcare access has resulted in poorer health status and health outcomes for Black Americans. Epidemic levels of chronic disease [hypertension, diabetes, asthma, heart disease] put black people at risk for contracting coronavirus and having disastrous outcomes. Whenever America is faced with disaster, Black communities suffer the most.

The current crisis demands black leadership equivalent to the moment. Political, medical, spiritual, social service, educational and business leaders must heed the call to serve, protect and save our community from this crisis. The souls and futures of black people in America depend on it.

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As a reminder, each of us as individuals and community members must regularly:   

• Wash our hands frequently and thoroughly (20 seconds, minimum)

• Adopt alternatives to the handshake

• Avoid contact with sick people

• Avoid touching our own eyes/nose/mouth

• Stay home if you or someone in your home is feeling sick

• Avoid listening to and spreading myths and conspiracy theories

Myron Bennett is a former health commissioner for the City of Cleveland. Currently he works as an independent public policy consultant and focuses largely on issues related to public health and community  and economic development.

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Africa could see 300,000 deaths from COVID-19 this year even in the best-case scenario, according to a new report this week from the U.N. Economic Commission for Africa, writes the Associated Press. In the worst-case scenario, over 3 million people could die on the continent.