Author: Leilani White
At the height of the pandemic and throughout the surge in Black Lives Matter protests, news story after story covered their take on the COVID disparities in Black communities. We learned that out of all non-white groups, Black people are dying from COVID at higher rates than non-whites.
Indeed, underlying health conditions prevalent in Black communities play a role in this. In 2016, a public health review found that "current mortality disparities are evident in cardiovascular disease, cancer, diabetes, and infant mortality." Historically, these differences have been incorrectly attributed to genetic predisposition. The concept has been deeply woven into medical education and practice, despite now being widely argued against. More recently, a second proposed reason for healthcare disparities for Black people has taken center stage: socioeconomic differences. The idea focuses on the disparity existing in Black communities, such as income, residential location, and many others that intrude on the ability to receive medical care.
In either of these cases, it is easy to shift blame towards an external source. Misattributing disparity with biology leaves the responsibility up to nature. While socioeconomics undoubtedly plays a role in healthcare access, this is still too simple an answer, as it points only to the socioeconomic systems. When this happens, blame and responsibility can fall on the population experiencing the disparity. This way of framing the conversation is flawed because it displaces us from the equation. Thinking of our future healthcare careers as simply treating the pathologies of marginalized communities allows us to place blame on "the system" for reinforcing racist structures. As future healthcare providers who will treat these people, we must consider our role in this process. Providing medical care is not where it stops. We need to understand the system we will be practicing in, including how we perpetuate racist practices in our healthcare careers.
In a 2017 BMC Medical Ethics journal review, Chloe Fitzgerald et al. evaluated 42 studies on the presence of implicit bias among healthcare providers. It found that "healthcare professionals exhibit the same levels of implicit bias as the wider population." People are not spared from racism when they become patients, just as our own implicit bias does not leave us when we go to work. This suggests that there is a responsibility to be actively aware of how our bias manifests in patient interactions.
Despite having some of the relatively worse health outcomes, improvements in disparities for Black people were among the lowest improvement rates. According to the 2021 National Healthcare Quality and Disparities Report: "Since 2000, disparities have narrowed for only about 8% of measures for American Indian and Alaska Native populations, 2% of measures for Asian populations, 3% of measures for Black populations, 4% of measures for Hispanic populations, and 10% of measures of Native Hawaiian/Pacific Islander populations." Even more disturbing, this 3% increase was measured in a range of 20 years.
The results of this study are a reminder that while racial disparities have been more heavily exposed by the pandemic, brought into the limelight through protests and through the media, this is not a new trend. It is a mistake to misplace blame on a virus for the differences in mortality rate that we have witnessed between Black people and people of other racial categories. We need to look internally. Let's not forget that while it will still be our job to treat our patient's illness, we have an opportunity to help prevent illness ourselves. While training to be and eventually practicing as patient advocates, we must pay attention to how medicine can perpetuate racism, and we must continue to do so when the media coverage dies down.