Racial Disparities Propagate Adverse COVID-19 Health Outcomes
By Felicia Hipps
Amid the novel coronavirus (COVID-19) pandemic, the California Pan-Ethnic Health Network (CPEHN), in partnership with other advocacy groups, is urging California Governor Gavin Newsom to declare racism a statewide public health crisis through an executive order.
“We have to call out and recommit to opposing anti-Black racism—the most egregious and long-standing racism in our country,” Cary Sanders, Senior Policy Director at CPEHN, said.
This announcement comes as the Centers for Disease Control and Prevention’s COVID-19- Associated Hospitalization Surveillance Network report that people of color and minorities make up a disproportionate share of COVID-19 hospitalizations relative to their population or total hospital visits.
Margalynne Armstrong, associate professor at Santa Clara University School of Law, suggests that present disparities could be attributable to clinical history. Armstrong said minorities and people of color have long endured medical mistreatment and neglect, which may have resulted in both skepticism and apprehension regarding clinical trials and the medical community generally.
Armstrong emphasized a recent example of mistreatment, the Tuskegee Syphilis Experiment, which was conducted by the United States Public Health Service until its condemnation in 1972. In this study, physicians observed symptom progression over 40 years among a cohort of 399 African American individuals with syphilis. They were altogether denied medical treatment and were not prevented from transmitting syphilis to their families.
“Because of the historical situation and Black communities’ knowledge, you have additional hesitation to be in relationships with medical professionals because they are not trusted,” Armstrong said. “The kinds of treatments that are given to Black patients are often less aggressive or less effective than others that are more readily used to treat white patients. That’s something that’s still going on.”
Accordingly, programs such as the All of Us initiative aim to uplift marginalized communities that have been disproportionately impacted by clinical and socioeconomic disparities. Established by President Barack Obama in 2015, All of Us is currently recruiting 1 million volunteers from diverse demographics to contribute genetic data and health information to close the information gap. Recent efforts leveraging these data have focused on racial equity with regard to the COVID-19 pandemic and ongoing vaccine trials.
Dr. Esteban González Burchard, professor of lung biology and bioengineering at the University of California, San Francisco, currently serves as a clinical advisor for All of Us. Within this capacity, he works to increase race, ethnicity, gender, geographic and socioeconomic diversity in clinical research.
“If you don’t have the data, you just don't know what genetic risk factors predispose one group to another group,” Burchard said. “It’s like driving without a gas gauge. You just don't know.”
Burchard explained that genetic differences are overlooked as European Americans predominate pharmaceutical trials. Both he and Armstrong agree, disparities in representation limit the efficacy and future availability of a potential coronavirus vaccine and other drug therapies for Black and minority patients.
Burchard said COVID-19 is being politicized and science is being disregarded, both of which are dangerous for public health.
“The virus does not know Republican or Democrat, and the virus is ruthless,” Burchard said.
Michelle Oberman, professor at Santa Clara University School of Law, said improvements must be made on a granular level to reestablish trust and confidence among underserved individuals.
“Most doctors haven’t really sat with what drives and complicates and compromises the health status in their Black patients, or what role they individually might have in the past contributed to alienation and distrust,” Oberman said.
She advised that the dynamic of the doctor-patient relationship should be reconsidered.
“When you meet with a patient, you don’t have them undress, you sit face-to-face with their clothes on. Here’s the way that you ask open questions, rather than the yes and no,” Oberman said.
Oberman said the legal community may hold the key to combating systemic racism in health care delivery and beyond, with policy and advocacy initiatives similar to All of Us.
“Start with a sense of what the whole looks like, and before you get totally devastated by how much is broken, find your little corner and start hammering,” Oberman said. “Start local. Start small. Start by listening and set attainable goals, and you’ll see changes in individual lives.”
(Editor's Note: This article was originally published in the October 2020 [Volume 51, Issue 1] edition of The Advocate.)