Although reported on for decades, racial disparities in the healthcare system have lacked much attention and discussion on a large scale. But as the nation continues to be consumed by the COVID-19 pandemic, there is a growing conversation surrounding those who are most vulnerable to the virus — primarily Black Americans.
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The APM Research Lab reports that Black Americans are dying of COVID-19 at a rate more than twice that of white Americans. As researchers work to understand why they are more at risk for this virus, other disparities impacting the health of Black Americans are being magnified.
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Lack of Insurance Coverage
A lack of insurance is one of the largest contributing factors to the current state of healthcare for the Black community. The 2019 U.S. Census Bureau report, which covered the year 2018, put the uninsured rate among African Americans at 9.7 percent and at 5.4 percent among white Americans.
Jamila Taylor, PhD, the director of healthcare reform at the Century Foundation, says these numbers stem from African Americans having lower-wage jobs that don’t offer health insurance coverage, as well as a lack of education about coverage provided to their communities.
With African Americans being one of the most economically disadvantaged demographics, Dr. Taylor says, “we have large numbers of African Americans in this middle ground where they don't fall within the threshold to meet the traditional Medicaid standards for how much money they make.”
For those who don’t qualify for insurance coverage, finding affordable services can be a challenge when paying out of pocket. But even for those who do, there are other issues affecting the health and wellness of Black Americans before they even seek medical attention.
Representation in Clinical Trials
Clinical trials are often lacking in diversity. The African American Health Engagement Study concluded that in 2018, 87 percent of African American participants believed they were not well represented in clinical trials. This could be partially related, among a variety of other factors, to the history of abuse of Black people by scientists and doctors, such as the infamous Tuskegee Syphilis Experiment, which resulted in decades of mistrust in medical professionals.
Taylor explains that the history of racism can dissuade Black Americans from participating in clinical trials. She urges researchers to be inclusive of communities of color and ensure informed consent so they are taken into account when medical advances are made.
“It's important for us to be a part of these trials in terms of ensuring that these interventions work, and that they work for us and for our community,” she says. “But I also think that the research community has to recognize the value in being inclusive in their trials.”
Even as progress is made toward overall patient treatments, studies have shown instances where African Americans still aren’t receiving sufficient care. Monika Goyal, MD, an associate division chief of emergency medicine at Children’s National Hospital, led a study published May 2020 in Pediatrics that reveals Black patients were more likely to be discharged home in significant pain than their white counterparts.
“Pain is not treated equally or equitably in the emergency department setting,” says Dr. Goyal. “We found that Black children were less likely to receive opioids compared with white children, even after we adjusted for injury severity and pain intensity.”
Taylor says long-standing research has connected these issues to the effects of racism, which can be seen structurally in how policies are developed and implemented in the United States.
“Residential segregation, for example,” she explains. “We still have neighborhoods that are concentrated with minority communities. They have less access to healthcare, and when they do have healthcare providers, they’re more likely to receive lower quality care.”
Closing the Gap
As COVID-19 sheds a greater light on the state of healthcare in the Black community, we have an opportunity to minimize many of the current disproportionate numbers. Goyal explains that interventions to achieve health equity can be developed only once we understand the drivers that lead to these disparities.
Taylor proposes a universal healthcare system where everyone gets affordable coverage not based on employment, zip code, or other contributing factors.
“We have the ACA, which has been revolutionary in ensuring that we have more people insured and covered,” says Taylor. “I think we could build on that if we had a public option, similar to Medicaid or Medicare, that would be available to anyone that needed it.”
The Center on Budget and Policy Priorities estimates that Medicaid expansion as part of the ACA resulted in a 39 to 64 percent reduction in annual mortality rates for adults age 55 to 64 who gained coverage.
Taylor says continuing those efforts, and expanding quality and nondiscriminatory care, will lead to closing the gap in healthcare.