Healthcare Disparities in the Days of COVID-19

Editor's note: This article was written prior to University of the Sciences' merger with and into Saint Joseph's University and does not reflect the current, combined institution. References to programs, offices, colleges, employees, etc., may be historical information.

Traveling on North Broad Street in Philadelphia reveals that there are healthcare facilities on every city block: pharmacies, hospitals, medical centers. Further, the Northeast corridor of the nation is home to perhaps the highest concentration of healthcare teaching centers in the nation. But there are also outsized rates of illnesses: hypertension, diabetes, heart disease, etc. And taking a closer look, most, if not all, of these illnesses impact communities of color harder than white neighborhoods.

Hypertension is such an example. The rates of hypertension in the city range from 23.3% to 45.4% in communities separated by only a few miles^1,2. Diabetes replicates this pattern with 6.2% exploding to 19.8%, again with only a few miles of separation^1,2. Perhaps one can imagine that the lower percentages are in predominantly white neighborhoods, and the higher percentages are in neighborhoods where people of color predominate. The map has a further healthcare indicator where life expectancy for men in one neighborhood is 64 years compared to 82 years in another^1,2. A Matter of zip codes? A matter of birth location? A matter of race?

Perhaps more telling is the access to care factors. In one Philadelphia predominantly white neighborhood, the ratio of physician to resident is 1:3121. Whereas in one predominantly black/brown neighborhood the ratio is 1:13142. What is happening here? Why these wide health disparities that seem to follow along racial lines? And, in the many discussions of health disparities, there are also the many social differences between races: education, shelter, employment, food.

So where does COVID-19 enter the picture?

In recent months, with the onslaught of demands for healthcare and closure of the economy, COVID-19 has revealed the depth of these gaps when comparing racial groups. Yes, all of us have felt the impact. Yet, one could argue that because of pre-existing health disparities, minorities have borne a larger share of the burden. We know for example that the presence of pre-existing medical conditions, especially in seniors, increases risks of poor outcomes from COVID-19. Consequently, minority populations have had a higher prevalence of COVID-19 with a higher mortality rate than whites.^3,4,5

In exposure to COVID-19, minority groups tend to live in more congested multigenerational quarters than do whites, making physical distancing more challenging. Similarly, employment circumstances offer the picture of more people of color working in front-line, lower wage occupations than whites.

These scenarios are cause to consider the many social factors that serve as a foundation for the higher prevalence of COVID-19 among populations of color.

However, surveying our current situation is incomplete without historical context. Populations of color have faced discrimination dating back to the postcivil war era. Movement through history will take us into a time when 4 million slaves were released from bondage with no resources for survival. With an under-resourced public health system, former slaves were literally dying in the streets⁶. Following reconstruction, the “Jim Crow” policies permitted legal discrimination in employment, housing, and social interaction. The infamous Tuskegee Experiment authorized by the U.S. public health department studied the course of syphilis in African American men. Conducted between 1932 and 1972, participants were offered free healthcare for the treatment of “Bad Blood.” These men were not treated with penicillin even when this antibiotic became available.⁷ You may also recall Henrietta Lax, a woman of color whose cell line was used without her consent for medical innovations in the treatment of cancer.⁸

These events have engendered a lifetime of mistrust for the healthcare system among populations of color. COVID-19 has resurrected and made prominent, once again, the peculiar relationship people of color have with our nation’s healthcare system.

So where do we go from here? Is there hope for redeeming this relationship? Absolutely!

COVID-19 has presented us with the opportunity for re-examination of the many issues that have led to healthcare disparities. Issues such as implicit bias, or myths about bodies of color, or taking inventory of the value our society places on bodies of color. And let us be clear, these are hard issues to address. We’ll be asking ourselves hard questions. But these questions and issues must be addressed if we are to move forward as an equitable and just society.

Finally, we must understand that the health and social inequities that have been in place for 400 years will not be erased tomorrow. This is a journey, a journey during which we are sure to falter at times. Yet if we continue with the sole objective of recognizing each other’s humanity, mindful of our own implicit biases, we are sure to be successful in “leveling the playing field” in healthcare. COVID-19 has laid bare our differences, but it has also laid the groundwork for constant learning and improvement. Let us not miss this awesome opportunity to embrace each other.

1. https://www.phila.gov/documents/close-to-home-the-health-of-philadelphias-neighborhoods/ (Close to Home: The Health of Philadelphia’s Neighborhoods, pg.12-13, Department of Public Health, City of Philadelphia; Urban Health Collaborative, Drexel University.) 
2. https://www.phila.gov/documents/close-to-home-the-health-of-philadelphias-neighborhoods/ (Close to Home: The Health of Philadelphia’s Neighborhoods, pg.50-51, Department of Public Health, City of Philadelphia; Urban Health Collaborative, Drexel University.)
3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769381 
4. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html 
5. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-covid-19-keyfindings-available-data-analysis/ 
6. https://www.nytimes.com/2019/09/13/podcasts/1619-slavery-healthcare.html 
7. https://www.cdc.gov/tuskegee/about/timeline.html

8. “The Imortal Life of Henrietta Lax, Rebecca Skoot, Crown Publishing, 2010