Health Equity

AMA COVID-19 daily video update: How the pandemic amplified disparities within health care

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.


Featured topic and speakers

AMA Chief Experience Officer Todd Unger speaks with AMA Chief Health Equity Officer, Aletha Maybank, MD, MPH,  on updates regarding COVID-19 including health equity as it relates to the COVID-19 pandemic and the disease's impact on racially marginalized groups.

Learn more at the AMA COVID-19 resource center.

Transcript

Unger: American Medical Association's COVID-19 update. Today we're discussing health equity as it relates to the COVID-19 pandemic. I'm joined today by Dr. Aletha Maybank, the AMA's chief health equity officer, talking to us from New York City. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Maybank, the initial data coming out of the states is painting a pretty alarming picture in terms of health disparities. Can you tell us what you're seeing?

Dr. Maybank: Hi, Todd. Good afternoon. Good to be with you. We have been seeing, and I think our alarms had been triggered over a month ago when we recognized, when the data was coming out as a relates to cases and deaths, that a lot of the data was not reporting out on or the states weren't reporting out, CDC was not reporting out on race and ethnicity.

And for us who are in the equity space, just overall, not even just health equity, that was really concerning because what we understand, historically in our country and also just what we understand even in recent history, that for the most part, if our health as black and brown communities shows that it's worse, we have lower life expectancies, there was this realization and awareness and curiosity about, so what's happening as it relates to COVID?

There really were somewhat predictions by folks who are in the health equity space that this was going to definitely impact the black community, but other racially marginalized groups, potentially, immigrants, Latinx, Native Americans. Part of this is from experience of knowing what has happened in previous disasters such as Katrina and the disproportionate impact that it had on black folks. Also, H1N1 of the data as it relates to that as well. So, there was an organizing that started to happen across the country, where health equity leaders started to really voice the concern. You saw the Twitter flow, putting out the message. Then you started to see op-eds from many different folks and leaders across disciplines about the importance of reporting out on this data. We put out a New York Times op-ed about two weeks ago now.

Also, calling upon Health and Human Services [HHS] and its sub-agencies to release the data as well as state and local health departments. We sent a letter to HHS in partnership with the American Academy of Pediatrics, American Academy of Family Physicians, the National Medical Association, National Hispanic Medical Association, the Association of Indian Physicians and the National Council of Asian-Pacific Islander Physicians as well. That letter definitely generated a lot of attention and response back from HHS, to really see that physician organizations were paying attention to this. They definitely heard advocacy from other folks even before us, but I think the physician letter also sparked something else.

Unger: Let me ask you a question.

Dr. Maybank: Sure.

Unger: What's the obstacle in getting that data? Why are we in this position where you're having to be so vocal about getting it in the first place?

Dr. Maybank: Yeah, I think it's a great question. There are many factors that are prohibiting us from having that data just even before, pre-COVID. Really not all systems have been consistently collecting racial and ethnicity data. They're not standardized necessarily to collect it in consistent ways, even though there's guidance and there are other opportunities to follow the path of how this data is collected. I think the other part, there is a central form that CDC has, but folks also are not necessarily taking the time out to fill out race and ethnicity data, and what also makes it harder usually, is that you're supposed to ask the individual, what is their race and ethnicity? They're supposed to be able to self-report and self-identify, not have somebody else identify.

So, you can imagine a time of emergency, if you have not thought about how to do that beforehand, it's not going to be the default for folks to fill out that information.

Then this weekend, we have some family members that have tested positive for COVID, even passed away and we felt it was important that several of us, including myself, go for testing. We called the state up earlier in the week, got an appointment for a drive through tests, and I'm paying attention to every aspect of what it's like to go through this testing center.

It was very clear, there's nothing and no way for them to have collected race and ethnicity data information, right. There are gaps at many levels. Then, the other reality is, even if all those pieces were perfect that I've mentioned, there are gaps with black and brown folks being able to actually access testing.

One, there's just, there's not enough testing. Two, we're not clear what's happening when folks are going to the health care institutions and getting turned away. Oftentimes across the country, the public health messaging has been to stay home. If you have symptoms, and they're mild, you stay home. If they're severe enough you go to the emergency room. So, there are many people who are probably staying home for sure, that we're going to have under-counting.

But in addition to that, there have been several stories over the last, news stories over the last week highlighting black folks going back to the ER three to four times and getting sent back home, even when they have symptoms, and dying in their homes. So, there are things related to clearly institutional racism and bias that has always existed and still exist to this day, and it just really exacerbates itself, really shines a light during this time.

Unger: When you think about getting the data that you need, why is that so important about going forward? What are you going to do with that, and how do we help solve these health disparities?

Dr. Maybank: Yeah, I think with data—I mean, most folks in public health and in health care would say, you can't really address what you can't measure and we need the data in order to have complete comprehensive public health responses and approaches and strategies on how to help promote the health, how to help set up an emergency preparedness system, but response systems, not just for the folks that it's really obvious for, for those who are marginalized in our communities in our society.

We need that data in order to track trends over time, to see what's happening. Data, as we know in the census, is a prime example of this is an important part of where funding goes, how funding is distributed and redistributed. If we don't have the data, there's a chance that we won't be able to figure out where funding needs to go, and how it needs to be allocated to the communities that are suffering the greatest burden from COVID in the country.

Unger: Well, we are already seeing a lot of disparities in some of what would be considered the underlying conditions associated with really bad outcomes in COVID. Going forward, how do we address those disparities in whether it's hypertension or diabetes and other ones along those lines?

Dr. Maybank: Sure. That's the messaging out there and what the science is telling us and what the data is telling us, right? That those who have these underlying conditions that you just mentioned are more likely to have severe consequences of COVID. Fortunately, we're working on hypertension and chronic diseases at the AMA. We have some large efforts around that, but again, this is a framing, and narrative issue that I think is absolutely important for where we go for policy and advocacy, as well as how that advocacy also leads to funding.

What I mean is underlying conditions in terms of health and physical health of those that are mentioned are absolutely important and critical to know, so we're clear that black people in this country are more likely to suffer from those particular underlying conditions. But we also have to look at the underlying conditions of the communities in which they live, the realities of them having to be frontline workers and essential workers often at disposal. We have to look at the situations around housing and how in many of our urban areas, housing is overcrowded, right?

All of these conditions, these are also underlying conditions that contribute to the severity and the experience that black people are going through, are all a result of structures, policies, laws that had been put in place. So that, when we think of solutions, our solutions can't just be at the downstream parts of this in terms of COVID and what's happening in the health care system. It's important. I'm not saying it's not important. It's critical. We have to focus on the health care system.

Unger: Yeah. Would you say that a lot of these concepts around social distancing are just not practical?

Dr. Maybank: Yeah, they are. I mean it doesn't, social distancing, physical distancing. I've talked about wearing the face masks and the challenges of that, based on the experience of many black men and their experience with police. There are already stories of where folks had been arrested for having them on as folks have been arrested for not having them on. There's that. There's hand-washing, the quality of water in certain communities isn't great. In Native American communities, they don't even have running water in some places. We've heard, and actually in some public housing developments across the country that running water's shut off. So, the ability to wash your hands becomes very difficult, and the ability to stay home.

All these really important public health measures, really have to be nuanced for communities so that they have a sense of what they do and have some sense of power to do something for their own lives and their own realities and not be ignored and not be invisible and made invisible by many of our system structures and messaging.

Unger: What are you hearing from physicians of color, many of whom are treating vulnerable populations, about their experience during this pandemic?

Dr. Maybank: We had a conversation a couple of weeks ago with some of the groups that I mentioned earlier, and also talking to physicians within my network. I mean, the reality is, as you mentioned, more likely to see patients who are racially marginalized and so they're dealing with that kind of reality and how to address their concerns, how to address the social needs within the context of all that. How do families grieve and dealing with the emotional aspects of going through COVID and being ignored? They're also then dealing with their own realities, of being many first-generation physicians of color who may not have the backbone or the foundation of wealth that many other physicians that are white have, as well as medical students have, in terms of having generational wealth and being able to figure out ways to potentially survive easier during this time.

I'm not saying this experience is easy for anybody. It's not, when you have to expose and put yourself at risk every single day on the front line. But there are conditions, as I mentioned before, that are underlying that actually help these physicians feel the weight of COVID even further. We know that there are, the Native American physicians especially, are very stretched, stretched pretty thinly across reservations, and there's a great burden of disease on Native American reservations that is really not talked about that much at all.

For Latino physicians and black physicians, the private practice, solo practice is the backbone of physician work in the community. Many folks are having to lay off, having to shut down or lay off their staff, and they're just figuring out how to survive and support their staff as well as still support their patients, as well as still support themselves and their own families.

Unger: Well, Dr. Maybank, thank you very much for your insights and your continued work in health equity. That's it for today's COVID-19 update.

For more information and resources about COVID-19, like our new Health Equity Resource Center, please go to ama-assn.org/COVID-19. Thanks for being with us today.