Ala Stanford is a doctor, but right now her office is a parking lot, a street corner, the sidewalk outside of a Philadelphia Baptist church. Stanford leads a mobile unit of doctors who are bringing free Covid-19 testing to the neighborhoods in Philadelphia that are being hit hardest by the virus: underserved black communities. Across the United States, black Americans are contracting and dying of Covid-19 at wildly disproportionate rates, and in some areas, they aren’t being tested for the virus nearly as frequently as their white peers, either.
Stanford and her cohort, who call themselves the Black Doctors Covid-19 Consortium, are dedicated to combating the much discussed but poorly addressed crisis where it lives, armed only with nasal swabs, educational materials, and personal protective equipment. They’re able to pay for those necessities because this week they successfully raised more than $100,000 on GoFundMe. Money for lifesaving medical treatment during a pandemic is coming not from government coffers but from the whims and wallets of the internet.
The Centers for Disease Control and Prevention has found that several racial minority groups account for a disproportionate number of the Covid-19 cases and fatalities in the United States, but the black community in particular is suffering. In Wisconsin, a state that is only 6 percent black, black people account for about half of its Covid-19 deaths. In Chicago, black people account for 70 percent of deaths due to Covid-19 but make up only 30 percent of its population. In Richmond, Virginia, all but one of the people who have died of Covid-19 were black. “I’ll tell you the first thing I said when I saw the disparities in fatality rates,” says Louis Penner, a professor emeritus at Wayne State University who studies racial disparities in health care. “I said, ‘People are surprised?’”
Anybody who is paying attention knows that the gulf between the health statistics of white and black Americans has existed for decades, or, really, centuries. Covid-19 is just the latest manifestation of an old and ugly trend. The explanation for it is at once simple—racism—and incredibly complex. Structural inequalities have kept black Americans significantly poorer than their white counterparts, and economic disparity creates health disparities, especially during a pandemic. Black people (and other minority populations) tend to live in more polluted, more densely populated areas, have more people per household, and are overrepresented in settings where people are unable to effectively social distance, like prisons and homeless shelters. They disproportionately work jobs currently considered essential, yet also are far less likely to have paid sick leave, enough savings to take time off, or a grocery store nearby enough to stock up easily.
Many of these factors, from living in food deserts to lacking health insurance, add up to mean that black communities also suffer at higher rates from acute and chronic medical conditions. “My colleagues knew this was going to be an issue months ago, as soon as we started hearing that preexisting conditions like obesity, diabetes, chronic pulmonary and cardiovascular diseases are all risk factors for dying of Covid-19,” Penner says.
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On top of creating the black community’s ongoing health crisis, systemic racism is also a barrier to treatment. According to Shervin Assari, a health inequality researcher at Charles R. Drew University, one of the only historically black medical schools in the nation, while white people prefer to get their health information from medical providers and the media, black people rate health-related information they receive from family members and churches more highly. The reason for this isn’t poor education (although it’s another structurally unequal factor), it’s due to longstanding and justified mistrust. “We found that racial prejudice amongst physicians affects how they interact with black patients,” Penner says. “Even in very short, highly structured interactions between physicians and patients, black patients pick up on this and react to it.”
Black patients tend to get poorer care and have worse health outcomes than white patients with the exact same illnesses, so it’s little wonder that some struggle to put much stock in medical advice now. “You do not necessarily follow what the system which has been oppressive is asking of you,” Assari says. “If you do, you are ‘acting white,’ which there is some stigma around.” In fact, according to Stuart Grande, a medical sociologist at the University of Minnesota, patients tend to do better when matched with a physician whose race matches their own. It’s not a matter of some ghoulish white physicians deliberately underserving their black patients, it’s the subtler things: finding the patients’ symptoms credible, pursuing more aggressive forms of treatment, and the patient’s willingness to trust in and carry out a doctor’s recommendations. That’s why efforts like Ala Stanford’s, bringing black doctors to care for the black community, are so valuable.
The cause of health disparities—past and present—are too layered and old to solve easily. According to Penner, they’ve existed since Reconstruction, right when black health was no longer a matter of profit. “The elimination of health disparities requires multilevel solutions across almost all of the institutions in the United States,” Assari says. “In a short time, like four months in response to Covid-19, it is almost impossible to prevent a major racial gap. It is extremely sad.” Many, including National Institute of Allergy and Infectious Diseases director Anthony Fauci, have said there is little that can be done now about the “unacceptable” disparity apart from providing all patients with the best standard of care. Still, some officials, like New York governor Andrew Cuomo, have committed to ramping up testing in minority communities hit hard by the virus, and Stanford’s isn’t the only group working to get Covid-19 testing and educational outreach where it’s needed most. Penner says improving the financial well-being of these communities would also provide fast help. “You’re not going to suddenly improve educational opportunities,” he says. “There is no easier short solution than improving socioeconomic status.”
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The long-term solution is, of course, to dismantle structural inequalities, which may well take too long for anyone alive today to see the benefits. Fortunately, technology-based interim solutions may help improve outcomes for individuals, if not totally erode the barriers to health equity. “If there was one thing that could be done immediately, it’s for every hospital to do internal audits to make sure everyone is getting the same quality of care,” Penner says. “They have the data, they ask about race, they ask about income. Is the will there? I don’t know.” Grande envisions leveraging telemedicine and creating apps in partnership with the black community. “Clinicians are too damn busy to go back to school to learn how to be better,” Grande says. “If we can intervene with an app or some sort of electronic record, we could cut through the bullshit: overcome access challenges, money availability, lack of trust.” Technological interventions could, in the future, allow doctors to not only ensure that all patients are receiving the same standard of care, but that they’re receiving it in a way that suits their economic needs and communication preferences.
All the sources WIRED spoke with agree that no matter what is done now, minority groups—particularly black and Latinx communities—are still going to suffer higher rates of illness and death due to Covid-19. It is unacceptable, but it is real. “We need to move past disparities as a topic of interest and move towards action,” Grande says. “Covid is highlighting major, major gaps in the current health care system and exacerbating issues we’ve known have existed for generations, but now we’re seeing them play out in immediate, tangible ways. There’s a lot of work to be done, and I’m really hopeful.” The Covid-19 pandemic has made more people aware of one of the ugliest aspects of inequality in America; hopefully it will motivate change for the better. If not, the next time there’s a health crisis primarily weathered by America’s most vulnerable communities, nobody gets to be surprised.
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