COVID-19 Pandemic ‘Unveiled’ Preexisting Racial Disparities in Health Care

In a discussion regarding racial disparities and impediments to getting more people of color vaccinated, Laurie Zephyrin, MD, MPH, MBA, vice president of the delivery system reform at The Commonwealth Fund, explained some of the key factors, including health care access, trust in medical institutions, and unequal treatment by the health care industry.

During a session at the Society for Advancing Business Editing and Writing Healthcare 2021 virtual symposium, Zephyrin explained how striking the data have been around the inequitable impact of coronavirus disease 2019 (COVID-19) on people of color.

“From November of 2020, we see these disparities persist. Black people, American Indian or Alaska Native people, and Hispanic people are 2 to 3 times more likely to have COVID-19 and are almost 3 times more likely to die from COVID-19,” Zephyrin said.

In this way, race and ethnicity have become risk factors for other underlying conditions that affect health, including socio-economic status, access to health care, and exposure to the virus, such as in people’s places of work. Zephyrin explained that looking at these risk factors, it is important to understand the structural components that have caused these inequities.

“We have to really highlight and understand structural racism and the impact of structural racism on where people live, where people work, their ability to access health care, and how people are treated when they get health care,” Zephyrin said.

Additionally, some of the common practices that have helped some populations stay safe during the COVID-19 pandemic have been less available to people of color, such as working from home, Zephyrin explained.

“When we think about how social distancing is really key to prevention and protection, people of color are less likely to be able to work from home due to not having jobs that provide that flexibility,” Zephyrin said. “There are a lot of inequities in these social determinants of health.”

Similarly, people of color are less likely to have jobs that would allow them sick leave or provide them with health insurance. Specifically, a lack of access to health insurance is a clear contributing factor to the extent to which people of color have been more impacted than White people by the effects of the pandemic.

“If we talk about insurance coverage, we know that Black and Hispanic people are more likely to be uninsured than Whites in our country, where we have insurance based, in many cases, on employment, and many people have jobs that may not offer insurance coverage,” Zephyrin said.

Then within the health care system itself, there exists implicit and explicit biases that affect how people of color are treated, promoting a racial empathy gap.

“As a health care provider myself, I know that providing health care is really about establishing trust and connection. It’s about being able to put yourself in other people’s shoes and understand that. It’s really important to build that trust in order to provide equal care,” Zephyrin said.

In terms of vaccine distribution, nearly 13 million people have received at least 1 dose of the vaccine, and where data are available, racial disparities are found to persist in relation to who is receiving the vaccines, as more White people have been vaccinated than people of color.

Zephyrin explained that historical mistrust and bias in treatment is a critical component to understanding why some of these disparities exist and continue to persist. These issues also contribute to vaccine hesitancy, which is a real concern for people of color.

“We can look at decades and centuries of examples of mistreatment. From Tuskegee, where medication that was available was withheld from Black men, and they were essentially in a natural experiment around the impacts of syphilis, which not only impacted them but their families and offspring as well. And it took decades before that study was stopped,” Zephyrin said.

Additionally, there has been a history of nonconsenting experimentation without anesthesia on Black and indigenous people, which has contributed to the mistrust people of color have toward the medical system in the United States.

However, these issues around mistrust among people of color toward health institutions are also based on problems that occur in the present day.

“We can also look to modern day glaring examples and glaring inequities from unequal treatment and the biased and individual systemic racism that can result in racial stereotyping based on false beliefs. You know, Black people feel less pain than White people, and those types of stereotypes,” Zephyrin said.

There are also additional data on people of color receiving less and lower quality health care services than White Americans, including in the treatment of cancer, HIV, prenatal care, and preventive treatment.

“There are vast research studies that talk about that. There are even data around how Black people are more likely to have unnecessary limb amputations, as opposed to having limb-saving surgeries or procedures. So, when we think about unequal treatment and unequal coverage, that results in unequal outcomes,” Zephyrin said.

However, these issues do not just persist because of the identification of race in a social or cultural context, but rather due to the systems and structures that have been established that continue to generate preexisting inequities.

Failures in outreach are also a problem, Zephyrin noted. People have real questions about the vaccine regarding its safety for those with comorbid conditions and other health care concerns. These types of questions can be answered through organizing townhalls that provide people with the opportunity to ask professionals they trust the questions that will help them address concerns.

“People have real questions about the vaccine that can be answered, and there are a lot of efforts that are addressing that, and we need to continue those and build upon those. We need to make sure that people can access vaccines where they feel comfortable and that people can hear about getting a vaccine from people that look like them in the medical profession and in the science profession,” Zephyrin said.

Zephyrin explained that in many ways, the COVID-19 pandemic has brought more attention to the racial disparities within the health care system due to their being more plainly visible.

“It’s unveiled now. I think for people that have more awareness to this work, it wasn’t a surprise. Early in the pandemic, there wasn’t a lot of data, but there was suspicion that this must be playing out differently in different communities. When the data started coming out, in terms of these vast inequities, then the questions came as to why because it wasn’t just race. It goes back to the systems and the structures,” Zephyrin said.

REFERENCE

Zephyrin L, Ungar L. Racial disparities and impediments to getting people vaccinated. Presented at: Society for Advancing Business Editing and Writing Healthcare 2021; February 11, 2021. Accessed February 11, 2021.