Dr. Bernard Ashby
According to surveys, many Americans are ready to get vaccinated against COVID-19, and the number is slowly rising. Many have noted that it isn’t rising fast enough among Black Americans. Here’s an even harder truth: while the COVID-19 vaccine is a godsend in many ways, it will not end much of the threat to Black Americans. In fact, racial disparities in deaths will likely increase when the vaccine is introduced to the public.
Let me explain. As a Black cardiologist, I know that unless American health care undergoes a paradigm shift to end racial injustice in health care, this vaccine that many call a beacon of hope, will not alone save my community. We must tackle deep, systemic issues related to bias, access to care and education before we can come close to joining the celebration.
Racial disparity in health care is not new
Racial disparities in vaccination rates are nothing new. During a recent flu season, fewer than four in ten Black adults were vaccinated, compared to roughly half of White adults, suggesting that distribution and communications strategies have been ineffective in reaching the community. Or as a recent Kaiser study put it, many of the barriers to vaccination are rooted in a “historic legacy of abuse and mistreatment by the medical system and ongoing racism and discrimination.”
Just how bad is the racial health gap? Life expectancy disparity rates are so appalling, that one study actually indicated that black males had improved mortality while in prison (while their white counterparts did not).
As for our current pandemic, the disproportionate toll on people of color begins at the front door. I’ve seen and heard Black Americans in my community get turned away when they present to the hospital with COVID-19 symptoms. They often don’t get tested even when they run a high fever or struggle to breathe.
When Black patients do show up at an emergency department that’s more willing to take them seriously, they’re likely to be served by underfunded, under-staffed, and under-resourced public hospitals with too many patients and not enough doctors and nurses.
In too many cases, Black Americans were sent home to die. This was the tragic experience of Dr. Susan Moore, a University of Michigan-educated physician who recorded videos of her fight with COVID-19, where she documented her second-class treatment. She begged for competent, compassionate care from her colleagues only to be sent home prematurely and ultimately dying of COVID-19 related complications. This unfortunately happens everyday in our country to Black Americans without a medical degree, recorded videos, or media attention.
Of course, COVID-19 isn’t the only disease that’s killing us at higher rates compared with White Americans. Cardiovascular disease and cancerare still killing more people of color compared with Whites in 2020, as they have in previous years. Heart disease kills Black Americans earlier in our lives and at much higher rates than Whites. For Black and Latino communities, diabetes is still an all-too-common potentially deadly scourge that, with proper disease management, can be avoided, managed and even eliminated. Black women die during childbirth 2 ½ times more often than White women, Black children have asthma at much higher rates than white children, and Black Americans are only half as likely to get mental health treatment compared with White Americans.
Unequal treatment:Black doctor’s COVID-19 death shows racial disparities in health care
While medical advances are helping improve overall health for Americans, their benefits are not affecting Blacks in proportionate numbers. Groundbreaking heart therapies are barely improving the rate of cardiovascular disease among Black Americans. The rise of so-called lifestyle medicine — nutrition education, healthy food access, weight-loss programs — hasn’t significantly reduced the incidence of diabetes in our community.
And during this pandemic, a vaccine alone won’t save Black lives.
Here are a few ideas that could:
Health care for every American is the first step toward ensuring Blacks as well as all U.S. citizens have equal access to quality care and treatment, during this pandemic and beyond. In the community I serve, I meet too many Black and Latino Americans who work multiple jobs, yet have no health care, or work in jobs where they’re the first to get laid off and lose their employer-provided insurance in the process. Black and Latino communities are among those hit hardest in this pandemic — and those suffering most from other chronic conditions — and expanding health care coverage that isn’t tied to a specific job can reverse generations of pain and suffering.
Time to address the right problems
Racial bias in health care is like racial bias everywhere else: No one talks about it, no one admits having it, yet it appears in a million passive-aggressive acts big and small. This starts in medical school where med students actually become more biased after training, one study showed, and go on to believe unfounded absurdities such as Blacks can handle more pain and have thicker skin. Medical professionals are not immune from bias and the sooner we health care professionals own up to that, the sooner we can fix this problem. U.S. health care also needs more racial diversity in leadership and among providers. While more than 82% of White patients say their doctor looks like them, only about a quarter of Black and Latino patients say their doctor shares their race or ethnicity. My field of cardiology in particular lacks diversity. While Black Americans account for about 13% of the population, less than 3% of cardiologists are Black according to the Association of Black Cardiologists.
Vaccines and racial disparity:America’s health system betrays Black people like me. But I got the COVID vaccine anyway.
To work toward more equitable health outcomes, policymakers at the state and federal levels must allocate enough resources for the places that need them the most. Safety net hospitals that serve sicker, poorer patients are already struggling to stay financially afloat during this pandemic. Without enough support, public and safety net hospitals are forced to cut their budgets, accelerating a downward spiral that is forcing rural and urban hospitals to close, making health care access harder for Black, Latino and rural populations.
Like all Americans, Black people are simply asking that our powerful, wealthy nation dedicate our resources to addressing the right problems. The COVID-19 pandemic is showing most of Black America that our nation needs a war on disease — which helps all Americans. (What we don’t need to continue is our failed war on drugs, which is disproportionately sending Black men to jail, devastating Black families, depleting the Black workforce, and undermining Black education.)
It’s true, COVID-19 vaccines will help us end the deadliest pandemic in more than 100 years. And we all should receive it. For Black people, though, it’s no panacea.
Our monumental health crisis will rage on.
Dr. Bernard Ashby is a Miami based Vascular Cardiologist, a health policy expert, and the Florida State Lead for the Committee to Protect Medicare