(The COVID-19 pandemic creates an opportunity for the healthcare sector to address longstanding racial disparities and begin to rebuild trust in historically underserved communities, experts say.)
The novel coronavirus has proven not to be the great equalizer some initially thought. Research indicates vulnerable communities including seniors, LGBTQ+ people, people of color, and women and girls continue to face undue burdens from the pandemic. Nationally, Black Americans have died from COVID-19 at more than twice the rate of white Americans. In 42 states and Washington, D.C., Hispanic and Latinx people make up a greater share of confirmed cases than their share of the population, and states with significant Native American populations report disproportionately higher positive cases within Native communities.
For those familiar with racial and social justice challenges within the healthcare sector, this comes as no surprise. Centuries of systemic racism has led to disparities in access, research and treatment, ultimately contributing to poorer overall health among Black, Brown and Indigenous communities, many of whom harbor deep-set distrust in healthcare systems as a result.
As the world locks arms in the fight against the pandemic — and the Black Lives Matter movement draws renewed attention to systemic inequalities of all kinds — the U.S. healthcare industry has an opportunity to respond like never before. The healthcare sector has a responsibility to address the longstanding racial disparities highlighted by COVID-19 and ongoing conversations around social justice. In doing so, healthcare companies, insurers and providers can begin to reestablish trust within historically underserved communities and publicly commit themselves to a system that serves everyone equally.
“The moment we’re in creates a positive perfect storm with the potential to fast-track change,” said Ilze Melngailis, senior director of the Business Council for the U.N. and Private Sector Engagement at the U.N. Foundation “You have the momentum of the Universal Health Coverage declaration which all 193 U.N. member states signed in 2019, including the U.S., signaling a global commitment to deliver quality health care equitably to all of the world’s citizens. Add to that the spotlight on painful disparities here at home this year, and prominent leaders from business, civil society and local government taking bold new stands against inequality, you have the potential for a transformative race to the top."
“Healthcare is something everyone needs but not everyone has access to. Compounded with that, there’s a deep level of distrust,” said Darren Martin Jr., CEO of Bold Culture, a communications firm focused on multicultural marketing.
Studies of U.S. patient outcomes show that people of color, particularly Black people, receive less care across income levels. As such, they are less likely to report trust in healthcare systems and more likely to forgo regular visits to a physician. For some, avoiding the doctor is a behavior passed down through generations, based on historical disparities and negative experiences of the past.
“Some innately feel [visiting a physician] is not something they have a positive or storied experience with, because they haven’t had access to proper care or may have seen their family’s own relationship with healthcare as negative or non-existent,” Martin said. “Companies need to recognize there is a gap and take immediate and long-term steps to improve that. You’re really reshaping generational mistrust, which is a large feat.”
Black Americans are three times more likely to die of asthma and 25 percent more likely to die of cancer compared to their white counterparts. Studies show that Black patients are also far less likely to be treated adequately for pain: According to one widely cited survey, half of responding white medical students and residents thought Black patients’ skin was “thicker” and their nerve endings “less sensitive” than that of white patients, highlighting the need for better training of providers to root out systemic biases.
And after decades of using Black bodies for medical research — often without consent, such as in the infamous Tuskegee syphilis experiment, in which Black men were forcibly exposed to syphilis and denied treatment — medical trials now chronically underrepresent Black people. In a 2018 analysis, ProPublica found that in trials for 24 of the 31 cancer drugs approved in the past three years, less than 5 percent of the subjects were Black. Similar patterns can be found in heart health, asthma therapy and, more recently, COVID-19 clinical trials.
In terms of access, Black Americans are nearly twice as likely to be uninsured compared to white Americans.
These inequalities add up to poorer health outcomes, more negative perception of the system and more distrust. “When we say ‘historical disparities,’ we think of something that’s already happened and we’re looking to develop reparations for, but this is still happening,” Martin told us.
Black, Native American, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women, according to the U.S. Centers for Disease Control and Prevention (CDC). These racial disparities increase further for mothers over the age of 30 and are even higher in U.S. cities like New York and Washington, D.C.
“It is one of the most poignant and unacceptable health disparities … and it can be fixed,” said Melngailis of the Business Council for the U.N. “We know how to prevent maternal mortality — it's not a medical challenge. It's a social and an access challenge, and one requiring leadership.”
For those with little access to healthcare, a single experience of feeling unseen or unheard by medical providers can catalyze a lifetime distrust of the system, said Carmen Villar, vice president of Social Business Innovation at Merck.
“If mothers have a poor experience, immediately that kills the trust and their view of the system, and it can prevent them from ever returning,” Villar told us. “We also know that in the U.S. and in many cultures, women are often making decisions for the family about health care. If a mom has a bad experience, she may not bring her family back to receive care, because she doesn’t want them to be disrespected.”
Merck for Mothers, part of Merck’s Social Business Innovation portfolio, wasestablished in 2011 to address maternal healthcare disparities and improve outcomes for mothers. It’s a concrete example of ways in which a healthcare company can identify an area the system is failing and take meaningful steps to move the needle in the opposite direction, Melngailis said.
Along with Kenya, Nigeria and India, the U.S. is a key focus area for Merck for Mothers. Its Safer Childbirth Cities initiative supports community-based organizations in U.S. cities with high maternal mortality rates, with the aim of reversing these trends.
Having launched in 2018 in 10 cities, including Atlanta, New Orleans and Philadelphia, the initiative plans to expand to 10 more cities this year. “The focus is quality of care and respect for women,” Villar said. “This is important, because without this kind of community engagement on the front lines, you don't have trust.”
The COVID-19 pandemic has laid healthcare racial disparities bare, and the resurgence of the Black Lives Matter movement following the murders of Ahmaud Arbery, Breonna Taylor and George Floyd, to name just a few, only serve to amplify the conversation. The meeting of these moments offers challenges, but also opportunities for healthcare systems to address their historical shortcomings and begin to do better.
“This is a great time for healthcare companies to reach out to the community,” Martin said. Leaning on his expertise in communicating authentically with multicultural communities, he suggested a three-point plan for short-term action.
First, support Black healthcare providers: Though studies show Black patients’ outcomes improve when they see Black doctors, only 4 percent of practicing U.S. physicians are Black. Next, help to finance community-based organizations that already doing the hard work to address systemic inequalities in the communities you serve. And, finally, ensure your staff is educating themselves about diverse cultural experiences on a regular basis, “not a one-off, but something that happens every month or two,” Martin said.
“It will take some time,” he told us. "Many industries, healthcare included, want to get things done immediately. They want to say they solved the problem. And it’s just not possible. We're talking about decades and centuries worth of distrust and systemic barriers that need to be uprooted. The industry is going to have to put in a sustained effort around reshaping its commitment to diverse communities.”
As the race for a COVID-19 vaccine continues, the healthcare sector is challenged to be mindful of critical gaps and make certain that historically underserved communities are not left behind. It won’t be easy. In these times of extreme nationalism, there may be resistance to making a vaccine universal, and given generations of distrust, it will take work to ensure that when a vaccine is available, people of all backgrounds are ready and willing to take advantage of it. Only by embracing its responsibility to care for all equally will the healthcare sector truly begin to deliver on its potential. Lives are at stake, and the time to act is now.
This article series is sponsored by GCI Health and produced by the TriplePundit editorial team.
Image credit: Matheus Ferrero/Unsplash