Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
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In this episode of AMA’s COVID-19 update, host Todd Unger and AMA’s Chief Health Equity Officer Aletha Maybank, MD, MPH, discuss the latest in health equity news, including celebrating the work in health justice and policy of Congressman John Lewis, and his call to stand up and redeem the soul of the nation.
Learn more at the AMA COVID-19 resource center.
- Aletha Maybank, MD, MPH, chief health equity officer, AMA
Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we're discussing the latest in health equity news with Dr. Aletha Maybank, AMA's chief health equity officer in New York. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Maybank, John Lewis was making headlines long before he passed away on July 17. Can you take a moment to put his death in context for us and tell us about the op-ed piece he wrote shortly before he died?
Dr. Maybank: Yes. Well, thanks, Todd. Yeah, it's been quite a week, and we've had some amazing opportunities to celebrate his life that had been very public, but John Lewis, for me as a physician and as an advocate and a justice person, has really, like, he rose to the task of what it means to fight justice using his own life many times, but also just having this perseverance and this commitment and in the space of health justice and advocacy and policy. I mean, he was at the forefront of many key opportunities in this country.
I remember a lot of work around gun violence and the work that he did there, but his call, it is phenomenal that he wrote this piece prior to his passing and that it's published for us all to get that message and be inspired, but his marching orders were to really answer the calling of your heart and stand up for what you believe. That is truly what the work of health equity and health justice is about is to not be silent and to speak up. Hopefully, many of us are absorbing that message and moving it forward, especially at a time now.
Unger: Your role is chief health equity officer, and you read those words, what's it actually mean to you, and how do you take that into the future?
Dr. Maybank: Yes. Well, for me, what's really helpful about it is that it contextualizes my work. I am standing on the shoulders of so many others before me that have opened doors so that I could be here to do what I am doing today, others who had to fight in ways that I don't have to fight, to be on the front lines literally and crossing a bridge where you're encountering police officers. Now, that is happening today in many cities across the country, but to be attacked by dogs, that's a whole 'nother level of fighting for justice. I feel if folks did that, and for my right to vote, as John Lewis did, then I have an obligation, one, to vote, I think we all do, for the fight that that was, but then an obligation to continue this work forward. It helps me recommit and stay committed. It allows me to know that this is the right path. This is the right path for myself, and this is the right path for the country.
Unger: Well, let's turn our attention to a couple of key pieces of research that have come out recently from JAMA that are about data is something that you've been speaking about for many months. The question is are we underestimating the impact of COVID-19 on Black and Latinx populations? Can you talk about the first study?
Dr. Maybank: Thanks, Todd, for the question, and just really great to see JAMA publishing articles as it relates to racism in this way and data. This article is really comparing weighted and unweighted population data to assess the inequities as it relates to COVID-19 by race and ethnicity as it was reported by the Center for Disease Control, the CDC. It was a group of researchers who are out of the FXB Center for Health and Human Rights at the Harvard School of Public Health. Their critical finding really is that the CDC's weighted data distributions to examine COVID-19 by race and ethnicity do underestimate the excess burden of COVID-19 among Black and Latinx individuals.
That's really concerning because data is really important in how we distribute funds in this country. Data is a tool for change, and so we need to ensure that the data is accurately reflecting what is happening. This means that the methodologies, the ways in which people look at and analyze the data are very important. In this particular situation, because they controlled for geographic distribution of basically where people live, so by race and ethnicity, you also ended up controlling for segregation, which is a major driver for unequal health outcomes within this country. It really shows to us that it's critical that the methods that we use have an anti-racism lens, and this is important for researchers and editors and publishers to build that skillset.
Unger: Let's turn our attention to a second study. There have been questions about the role that poverty plays in COVID-19 infections and related deaths. Can you talk about the latest news in that area?
Dr. Maybank: Yes. Thanks, Todd. This is a piece that was published in JAMA, again, from some lead doctors that were at NYU. They looked at data from counties surrounding and inside of Atlanta, Boston, Chicago, Detroit, LA, Miami, a whole bunch of cities across the country, and they looked at COVID-19 infections as well as deaths per 100,000 people. They tested the associations with percent below poverty, the county level income and the percent that were living in the county of racial and ethnic minority groups.
The conclusion that they came up with as the article states, and I'll say exactly what the article states, is that "while the excess burden of both infections and deaths are experienced by poor and more diverse areas, racial and ethnic disparities in COVID-19 infections and deaths exist beyond those explained by differences in income." This is really important. This is a critical point because, oftentimes, folks in this work and what we hear is that, "Well, this is really about socioeconomic status and income. It's not really about race." This type of analysis shows us that it is about race. We see this play out with other opportunities as well as, for example, maternal death.
In places like New York City and, really, across the country, the reality is if you were a Black woman, your likelihood of dying during childbirth is still higher than that of a white woman who doesn't even have a college degree. There's something that shows that there's something particular about race and racism of why these things exist and happen. Also important is that the article points out as what we mentioned before about the ability to have data is that there's just not enough data to really fully assess the impact of structural racism and the drivers on this particular dataset.
Unger: Well, we continue to learn more about that. We're also seeing inequities in terms of access to care specifically around COVID-19 testing. Can you talk about that?
Dr. Maybank: Yes. There was a really comprehensive analysis that was published by FiveThirtyEight and the ABC News of affiliates earlier this week. It says, "Want to COVID test? It's much easier to get one in a wealthier white neighborhood." The article points out, and we all know we're almost at the 4 million mark, or we are at the 4 million mark, with cases across the country, and the demand for tests are growing. This is really how it should be really from a public health management perspective, but our ability to respond is really hard.
Their analysis is a really comprehensive analysis looking across all 50 states using data that's provided by Google Maps, a pretty comprehensive data set as well, and they were able to assess where testing sites are based on the city and the county and the state, and then also able to pull data from city and state health departments as well. The reality, really, and bottom line is that accessing a test is really difficult, especially in communities that have Black and Latinx people. The demand is higher. The wait time is higher. It's just harder to get a test. This is really reflective of all the longstanding inequities and inequalities that are deeply rooted in all of our systems and the realities, again, of our segregated, residential living situations and our segregated health care in this country.
Unger: Yeah. That kind of delays in testing create a terrible cycle because when you don't know what the results are or you disable the contact tracing and any of the kind of elements that we need to bring that under control there, that's just not present.
Dr. Maybank: Absolutely. The Department of Health and Human Services, they did release a comprehensive strategy to address testing recently really targeting federally qualified health centers, which definitely there are lots that are located in lower income communities that have Black and Brown people, but also focusing on supporting private public partnerships with folks like CVS and Walgreens who also have lots of locations and space, actually, literal space within many of these communities.
What's happened is that some docs across the country have taken this testing issue into their own hands. They highlight a story of Dr. Ala Stanford, who is a pediatric surgeon and well-respected. She and another group of doctors called Black Doctors COVID Consortium took a van and drove around Philadelphia and able to accomplish testing that way and delivered and issued more than 7,000 tests. Definitely, hats off to her and the team for doing that, but the reality is, is that that's not going to meet the need of what is there across the entire country. We still have a lot of work to do on that front.
Unger: Well, Dr. Maybank, thank you so much for being here today and sharing your perspective and your overview of the latest news and research. Thank you to the team at the Center for Health Equity. You are an inspiration, too. That's it for today's COVID-19 update. We'll be back on Monday with another update. For health equity information and resources on COVID-19, go to ama-assn.org/COVID-19. Thank you for joining us, and stay safe.