June 3, 2020
When the shut-down orders began to sweep across America in mid-March, many of us in healthcare already knew the collateral damage coronavirus would cause to disenfranchised communities. Communities of color are not only experiencing disproportionate rates of infection and death, but also greater economic impact due to higher rates of unemployment and being in frontline low-wage jobs that put them at higher risk. In some American cities, African Americans make up the majority of both infections and deaths from coronavirus, despite being a population minority. African American deaths account for over 50% of coronavirus deaths in Philadelphia, while this community only makes up 40% of the total population.
The culprit for these glaring disparities? Longstanding racial and social injustices that have been swept under the collective rug for as long as America has existed. These have resulted in: higher mortality rates during childbirth for college-educated African American women; African American men who suffered the indignities of a research protocol that allowed them to become sick and die from syphilis, while there was known treatment; and a public health epidemic of gun violence that is more than 500 times likely to kill African Americans. Injustices in the healthcare system alone certainly can’t be singled out for causing these disgraceful outcomes– policies and practices have led to and sustained multi-generational poverty, lack of access to affordable, safe housing and healthy food; mass incarceration; and homelessness at disproportionately high rates for communities of color, as compared to their white counterparts.
And now a new series of events have led to further disenfranchisement of communities of color – racist acts perpetrated because people are doing everyday things while being black: jogging, birdwatching, and even breathing. These are not new issues, but have inflicted trauma, pain, and emotional anguish on communities for decades in ways we can no longer ignore as a country.
Healthcare organizations have an important role to play in the ecosystem that contributes to inequities and bias.
- We need to attend to our own employees’ mental health needs, particularly in times of crisis. This is a not a one-size-fits all approach, but rather an opportunity to identify multiple strategies to support individual needs, such as checking in with staff about their emotional health, developing opportunities to learn and value individual differences, and offering resources when appropriate.
- We need to make a conscious and systematic effort to address health disparities, including: collecting and analyzing data on race, evaluating differences in outcomes, and regularly discussing why disparities may exist.
- We need to challenge existing biases, including those that are unintentional or unconscious. For example, when data show that white health care professionals perceive African American patients as “difficult,” or are less likely to prescribe pain medications to African Americans, what contributes to those beliefs and how can they be combatted?
- We need to stand in partnership with communities of color when developing healthcare policies, including payment reform, clinical guidelines, and treatment protocols. We should be doing more listening to and less “doing to” and truly engage in care that reflects the unique preferences and determinants of health for diverse communities.
- Finally, we need to develop cross-sector collaborations that lead to holistic solutions for addressing the root causes of poverty and poor health, including diverse stakeholders such as the criminal justice system, environmental agencies, housing officials, and government organizations.
During this time in our history, the Health Care Improvement Foundation is taking this opportunity to reflect on our own programs and policies to ensure that we are supporting a healthcare system that’s just, equitable, and high quality. We are proud of our longstanding vision for a responsive healthcare community that fulfills the needs of patients and consumers to achieve better health. With programs focused on food insecurity, the opioid epidemic, prostate cancer, health literacy, and assessing community health needs, we are committed to working in partnership with all communities to combat bias and the issues that contribute to poor health outcomes. We will use our commitment to advance trauma informed practice to support diverse stakeholders who have not had a voice in sharing their needs and frustrations, and come to solutions together. We are ready to walk this path with all others seeking a more just, equitable healthcare system, though it might be challenging to traverse. We invite you to join us.