The Covid-19 pandemic is teaching me that the world can change almost overnight when it faces a big problem.
When President Trump declared a national emergency, my medical practice shifted almost instantly from in-person appointments to telehealth visits. The Drug Enforcement Administration allowed doctors like me to prescribe buprenorphine, a controlled substance used to combat opioid addiction, after a telephone consult, a move experts have been seeking for years. The Department of Health and Human Services waived privacy constraints for telehealth visits, which have long tied up this type of medicine, allowing doctors to use commonly available platforms like FaceTime, Facebook Messenger, Skype, and Zoom to provide medical care.
And Congress quickly passed the CARES Act, a $2 trillion aid package to fight Covid-19 that included sending $1,200 checks to individuals and families who were most vulnerable to job loss and other financial stressors.
As a psychiatrist who treats opioid addiction and works at a minority-serving hospital, I am delighted by these long-sought changes. But I am also frustrated that they have happened so quickly. Frustrated because the U.S. has been facing an equally large and equally deadly problem — racism — for years and has done little to address it.
Black people are dying at alarming and disproportionate rates from Covid-19. In cities, the statistics are nothing short of tragic. In Chicago, for example, 70% of coronavirus deaths are among Black people, who make up only 30% of the city’s population. A similar pattern is seen in other cities and counties across the country.
Black and brown people have been seeking reparations to address the systemic injustices they have faced for decades. Yet there has never been an economic stimulus to address the impact of racism on health, quality of life, and advancement.
The country’s response to the new coronavirus does, however, suggest that we are taking steps toward addressing the damaging threat of racism.
First, though, we have to name it. Policy leaders across the country urged Trump to declare a national emergency because they understood the power of naming a crisis. In the same way, we need to declare that racism is a national emergency. It is a virus in the truest sense: a corrupting influence that spreads through communities and across the nation. Systemic racism has harmed — and killed — millions of Americans through its corruption of health care, criminal justice, and the economic marketplace.
Dr. Deborah Birx, who serves as the coronavirus response coordinator for the White House coronavirus task force, recently suggested that Black people are dying of Covid-19 at higher rates due to underlying medical conditions. She is right — if she means that the underlying condition is racism, not its manifestations like high blood pressure and diabetes. Racism has created inequality in access to health care, housing, wealth, education, and employment, all of which undermine health. It is time to name racism as the crisis it is.
Second, we must shift policy to address the circumstances of those affected by the crisis. For Covid-19, that means finding unique ways to care for patients. To address racism, we must do that and go even further. We must not only come up with new ways to reach patients who have been disadvantaged but must also address the dire circumstances that racism has created.
The first time I ever used telehealth was after Covid-19 had emerged as a nationwide threat. My patient, who was homeless, had been sitting in a park all day, waiting for my call. He knew if we didn’t connect, he would not be able to get the medication he needed to help him stay free from using heroin. He adjusted his life to meet health care’s demands. That’s not the way health care should be — it should meet patients where they are and address the circumstances they are in.
During that call, I didn’t stick to my usual script: Any problems filling your prescription? Any medication side effects? Any cravings or heroin use since the last visit? Instead, I talked with him about the challenges he was facing at the shelter. He asked about how to manage his day since he couldn’t stay inside. I also let him know where he could find a hot meal on a daily basis.
I wish our health care system would take a similar approach and see value in working on problems like housing and food insecurity. Some are calling this concept structurally competent care; it needs to become our new normal.
Third, we must deal with the economic consequences of the crisis. For Covid-19, that’s the thrust of the CARES Act. In Boston, where I completed my medical training, the median net worth of white families was more than $200,000. The median net worth of black families was $8. Undoing racism means passing something like the CARES Act to provide funds for those disadvantaged by racism.
I respect Dr. Anthony Fauci, a key member of the White House coronavirus task force, who acknowledged the role of health disparities in Covid-19. He has said that we must deal with these issues once we get beyond the pandemic.
But I disagree with him on that. We must deal with them now.
Morgan Medlock, M.D., is an assistant professor of psychiatry at Howard University College of Medicine in Washington D.C. and the editor of “Racism and Psychiatry: Contemporary Issues and Interventions” (Springer, 2019)
I live in western Canada. Although the virus was introduced by Chinese and Iranians returning to Canada the vast majority of deaths have been elderly white people. Disproportionately so relative to the makeup of the urban population. This is not systemic racism but rather due to demographics and the composition of care home populations. Perhaps other ethnic groups have more likelihood to care for their elderly at home. The point of this is that there are many variables involved which you ignore in your simplistic overview.
I am interested: what is an AA-specific genetic susceptibility? Sequencing of the entire human genome has clearly debunked this and paralleling theories, no?
Can one not postulate the root cause and not also promote and work on “medical studies [and] aid programs?”
And how were disparities born in the US?
Studies have compared the rates of certain comorbidities in immigrated Africans and African-Americans – the rates are lower in the former.
And it cannot be as simple as making a “choice” can it? The very folks in the Appalachia that were mentioned, or African-Americans who more commonly reside in low-income neighborhoods and food deserts don’t actually have the implied choices mentioned (like exercising on non-existent sidewalks, going to non-existent grocery stores, and eating non-existent healthy produce).
What if it is not about politics at all? Because it is not. And I don’t think the author even mentioned a president, a political affiliation, or any of the sorts.
The impact of racism on healthcare is well studied in social sciences. The increased rates of comorbidities in African-Americans exist because of an inequitable healthcare system that does not favor African-Americans OR poor individuals/families. Health disparities don’t exist just because a cloud of smoke hovered over every African-American or poor person and gave them a disease.
I believe the author is asking readers to dig deeper. Is it enough to say that comorbidities are the cause of higher rates of Covid-19 infections and deaths, as Dr. Birx stated, without addressing the root cause of these disparities? Simply, the unpolitical and scientifically proven answer is….no.
No need to apologize; I know I am not mistaken. I think to dismiss what the author is saying simply because of the word “racism,” is unfortunate. It is not the author’s sole responsibility to ponder or even attempt to prove any of the possible claims or hypotheses mentioned.
I am also always interested: why discuss statistics in absolutes? In a country where the predominant population is white, yes, more white people are poor. But, the percentage of poor individuals is what should be discussed when we refer to data regarding poverty. If there are 100 white people and 10 black people and 10 white people are poor (10% of whites) and 7 black people are poor (70% of blacks), is that not startling? Should it not be addressed just because more white people are poor than black people, in absolute numbers?
It seems that the only social etiology being ascribed to in the reply is poverty. But it should be clear, both poverty and inequity (begotten by racism and economic injustice) only perpetuate the “differences in BMI”, “differences in rates of substance abuse,” or many of the other disparities mentioned.
Again, the author (a female, not an assumed male – just Google her), is asking readers to dig deeper. The very “causes” mentioned have a proven root cause, with the exception of different blood types.
Regarding a primarily medical or moral issue – peruse the many publications that focus on wealth and its impact on health, social needs and the impact on health.
There was a time when a person running for president walked the streets of Harlem, Bedford Stuyvesant, Cabrini Green, Compton & Watts. Today, they don’t even fly over these areas. Black & Brown people have no voice with the politicians because they have no money to give them. History will look back on this era & wonder what type of people we were.
A well stated commentary! This has been an issue for decades, in fact centuries, and a topic well known in our own community, yet somehow seems to get re-discovered over and over again, during a “crisis” of other standing in this country. Racism indeed has been a Pandemic in this country and only exacerbated during other “public health crisis” and yet fails to be addressed massively once we are clear of a situation. Unless we openly address these health disparities among black and brown populations, this country will always endure a public health crisis, that will never go away unless addressed with the same vigor as Covid-19.
There is so much that we do not understand about COVID-19. But clearly the virus does not discriminate who it infects. There are hundreds of possible reasons why African Americans might be disproportionately affected ranging from nefarious medical discrimination to a naturally occurring AA-specific genetic or medical susceptibility. We don’t know. Clearly, we should try and find out when we can. But is that more important now than working on medical studies, aid programs, etc that will benefit everyone?
To label a statistic as a sign of racism when you/we have no clue of the true contributing factors, at a time when people of all races and ethnicities are sick and dying, is insensitive and strikes me as being motivated by politics rather than compassion.
I am interested: what is an AA-specific genetic susceptibility? Sequencing of the entire human genome has clearly debunked this and paralleling theories, no?
Can one not postulate the root cause and not also promote and work on “medical studies [and] aid programs?”
And how were disparities born in the US?
Studies have compared the rates of certain comorbidities in immigrated Africans and African-Americans – the rates are lower in the former.
And it cannot be as simple as making a “choice” can it? The very folks in the Appalachia that were mentioned, or African-Americans who more commonly reside in low-income neighborhoods and food deserts don’t actually have the implied choices mentioned (like exercising on non-existent sidewalks, going to non-existent grocery stores, and eating non-existent healthy produce).
What if it is not about politics at all? Because it is not. And I don’t think the author even mentioned a president, a political affiliation, or any of the sorts.
The impact of racism on healthcare is well studied in social sciences. The increased rates of comorbidities in African-Americans exist because of an inequitable healthcare system that does not favor African-Americans OR poor individuals/families. Health disparities don’t exist just because a cloud of smoke hovered over every African-American or poor person and gave them a disease.
I believe the author is asking readers to dig deeper. Is it enough to say that comorbidities are the cause of higher rates of Covid-19 infections and deaths, as Dr. Birx stated, without addressing the root cause of these disparities? Simply, the unpolitical and scientifically proven answer is….no.
Good points. And likely racism will persist in this country as long as the systems of economics allow (or even incentivize) it. Those who are of privileged status, unscathed by racism, easily convince themselves that racism is a chronic, thorny, but nonlethal problem, even though institutionalized racism leads to elevated mortality and morbidity in many ways. The sad fact is that most people who belong to “majority status” groups are most concerned with the preservation of their own belongings and way of life, and this creates a blunting of the empathetic outrage that is necessary to catalyze change.