Racial Disparities in Health Care

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A recent New York Times article written by Roni Caryn Rabin discusses Dr. Marcella Nunez-Smith’s goals of addressing racial gaps in health care. Dr. Nunez-Smith is a practicing internist and scientist. She directs several research centers and acts as an associate professor of internal medicine, public health management at Yale University. She has been appointed by President-elect Joseph R. Biden Jr. to lead a new federal task force, an act introduced by Senator and Vice President-elect Kamala Harris aimed to combat racial and ethnic disparities in our nation’s COVID-19 response.

Dr. Nunez-Smith grew up in the United States Virgin Islands, where she saw the harmful repercussions that limited health care has on a community. Racial health disparities, fueled by underlying social and economic inequalities, have been made even more distinct by the pandemic.

The Centers for Disease Control and Prevention data indicates that Black, Latino, and Native Americans are infected with COVID-19 and/or hospitalized at disproportionately higher rates than white Americans. Additionally, the death rate of these groups is nearly three times higher. Dr. Nunez-Smith emphasizes:

“We cannot overstate the disproportionate impact.”

There are many contributing factors for these numbers including living in crowded households, the ability to work from home, and underlying health problems due to limited access to medical care, that increase the risk of severe COVID-19. Dr. Nunez-Smith states:

“What’s needed to ensure equity in the recovery is not limited to health and health care. We have to have conversations about housing stability and food security and educational equity, and pathways to economic opportunities and promise. There are people whose jobs require them to leave their homes, and if we don’t have a message to them, that’s our failure.”

JAMA Network Open recently published a study that found Black patients were more likely to test positive for COVID-19 than White patients. However, they had a lower mortality rate after hospitalization. Researchers suggest that neighborhood characteristics may explain the disproportionately high out-of-hospital COVID-19 mortality rates among Black individuals. They explain:

“This may be because of pervasive social inequalities that increase the difficulty in implementing social distancing in Black and Hispanic communities. Black and Hispanic patients are associated with a lower neighborhood SES and are more likely to work in occupations that are not amenable to working remotely compared with White patients.”

These findings support the notion that Black and Hispanic populations are not inherently more susceptible to having poor COVID-19 outcomes than other groups. Existing structural determinants including housing inequality, access to care, employment, and poverty that are more pervasive in Black and Hispanic communities are likely causes of COVID-19 ethnic disparities. Dr. Gbenga Ogedegbe, the director of the division of health and behavior at New York University’s Grossman school of Medicine reviewed these findings and states:

“We hear this all the time — ‘Blacks are more susceptible.’ It is all about the exposure. It is all about where people live. It has nothing to do with genes.”

Another article published in JAMA Network Open presents a data analysis which demonstrates the inequitable allocation of COVID-19 testing relative to the disease burden between Black and White communities in St. Louis, MO. They suggest that testing needs to be increased relative to the disease burden in order to ensure that not just the most symptomatic cases are identified in an area. Researchers opine the reasons for undertesting in certain communities are likely existing disparities in the health care infrastructure, access to health care, and mistrust of the health care system, which all stem from structural racism within the system itself.

Dr. Clyde W. Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine speaks on Dr. Nunez-Smith’s plan to combat the racial disparities in COVID-19 response in the United States. He states:

“Yes, it will be hard, and we will need to take iterative steps, but begin is exactly what we should do, and considering the link between poor health, poor education, poor housing and poverty, a case can be made to target economic development in the most vulnerable communities as an important first step.”

Racial gaps in the United States health care system are prevalent and precipitate the disparity of the COVID-19 response. The new federal task force aims to address the underlying structural issues within the system to promote health care equity among all racial, ethnic, and socioeconomic groups. The attorneys at Abramson, Brown & Dugan believe everyone is entitled to adequate health care. If you or someone you know has been harmed as a result of medical malpractice, contact us today

Kevin Dugan
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