The country is grappling with an unprecedented public health crisis in COVID-19 while it also struggles with another long-standing health care emergency. The systemic racial injustices that plague our country are visible within the COVID-19 landscape, which has disproportionately affected communities of color—Black and Latino patients in particular. Data from major cities have shown the brutal effects of the coronavirus on minority populations.
But even as COVID-19 shines a glaring light on health inequities and disparities, the effects of racism on American health care and public health remain pervasive throughout our culture and require a reckoning by physicians and scientific leaders.
The eruption of protests and civil rights movements following the death of George Floyd has incited a long-overdue nationwide introspection and necessitated a reconciliation of our values with our actions. As a physician, public health official, and communicator, I considered retreating from the conversation, using science and apolitical objectivity as a bulwark and excuse for silence.
But the respect afforded our profession bears with it an obligation to add to the chorus of voices speaking out against the glaring disparities and injustices laid bare, and to remain silent is to condone. We are inherently political actors, our silence often as loud as our words.
All Strata of Care
Inequities in health care among racial minorities take many forms. Minority communities have higher rates of chronic disease, maternal and child morbidity and mortality, and overall costs of care, all in part a result of diminished access to health resources. Structural racism compounds the health effects of poverty by concentrating its harm in racially segregated neighborhoods with limited health care options.
The direct and indirect effects of racism saturate all strata of medical care, and are linked to disparities in treating disease and the documented disenfranchisement among patients and physicians.
Black and Latino patients are taken to different emergency departments compared with their white neighbors. (JAMA Netw Open. 2019;2:e1910816; https://bit.ly/37lvMj8.) Black patients in the emergency department are markedly less likely to get an ECG for chest pain than non-Black patients, and they have a 66 percent greater chance of not receiving pain medicine for a long bone fracture than white patients. (Acad Emerg Med. 2007;14:149; Ann Emerg Med. 2000;35:11.)
Black infants in the United States are more than twice as likely to die as white infants, a tragedy intertwined with rising rates of preventable deaths among their mothers, whose pregnancy-related mortality has climbed to nearly four times that of white women. Black patients are more likely to die whether disease strikes when it is early and treatable or late and serious. (N Engl J Med. 1999; 341:1198; https://bit.ly/30z8LIq.)
A Social Contract
The task of confronting structural shortcomings and biases within medicine seems overwhelming at times, but we must begin by recognizing the existence and impact of racism within our own institutions. The medical community must seek more opportunities to ensure the voices of people of color are heard.
Recruiting and hiring physicians and administrators of color, funding and amplifying research on the health issues in underrepresented communities (particularly research by those who are from such communities), training medical professionals to recognize implicit biases that prevent some patients and their families from being truly listened to, and engaging in the national discourse to raise awareness of these issues. These reforms must be part of a broader overhaul of the system that makes health care more accessible and equitable for all.
We cannot practice good medicine without taking into account those social factors and contexts that are inextricably linked to our patients' outcomes and our own profession. Our obligation to our patients and the progression of medicine extend beyond the walls of the emergency department, a social contract inherent in our medical school diplomas that compels us to advocate for the conditions that lead to the best health outcomes for all.
We must recognize that what we say as doctors is still held as intrinsically meaningful by the public, amplified by the eroded but still present trust in which our profession is held. We cannot simply choose to ignore injustices that exist because the failure to recognize the structural violence, racism, and discrimination in our society is to sacrifice what dwindling moral footing the profession of medicine holds in the public's eye.
Dr. Pescatoreis the chief physician for the Delaware Division of Public Health and an emergency physician in New Jersey and the host with Ali Raja, MD, of the podcast EMN Live, which focuses on hot topics in emergency medicine:http://bit.ly/EMNLive. Follow him on Twitter@Rick_Pescatorew, http://bit.ly/EMNLiveandread his past columns athttp://bit.ly/EMN-Pescatore.