As the child of Jamaican immigrants, I was fortunate enough to have the opportunity to trek across New York City to attend one of the most exclusive high schools in the country (Stuyvesant High School), and one of the country’s best historically black colleges (Hampton University). After serving as an Air Force physician, I intentionally worked in this nation’s poorest and most marginalized communities (except for a few years at a private clinic that didn’t take Medicare or Medicare patients). Having spent the majority of my education and career surrounded by non-white people and patients, I have seen the two Americas. So, when advocates of American exceptionalism extol this country’s healthcare as “the best in the world,” they are not referring to the system in which I work.
I work in the other one.
I treat patients who come to the doctor as a means of a last resort because they cannot afford the copay or the medicine. I work in clinics that have to allay the fears of people whose complaints have been discounted or ignored by other doctors. I work in places that not only have to follow up with treatment but must also coordinate rides and consider the price of prescriptions.
Now, because of the coronavirus, everyone is beginning to see America’s two separate and unequal healthcare systems.
Preliminary studies have shown that COVID-19 has hit black America at alarmingly higher rates, ProPublica reports:
As of Friday morning, African Americans made up almost half of Milwaukee County’s 945 cases and 81% of its 27 deaths in a county whose population is 26% black. Milwaukee is one of the few places in the United States that is tracking the racial breakdown of people who have been infected by the novel coronavirus, offering a glimpse at the disproportionate destruction it is inflicting on black communities nationwide.
In Michigan, where the state’s population is 14% black, African Americans made up 35% of cases and 40% of deaths as of Friday morning. Detroit, where a majority of residents are black, has emerged as a hot spot with a high death toll. As has New Orleans. Louisiana has not published case breakdowns by race, but 40% of the state’s deaths have happened in Orleans Parish, where the majority of residents are black.
Illinois and North Carolina are two of the few areas publishing statistics on COVID-19 cases by race, and their data shows a disproportionate number of African Americans were infected.
In a country with a great healthcare system for those who can afford it and a less-than-stellar one for everyone else, this is not unexpected. The factors that exacerbate COVID-19 also affect African Americans disproportionately. Because of poverty, medical biases and the availability of healthcare, asthma, heart disease, diabetes and compromised immune systems (cancer, HIV, lupus, etc.) affect black people at higher rates.
COVID-19 is forcing America to face this reality. It will be impossible to eradicate this menace if we don’t address and fix the five barriers to healthcare that I deal with every day:
Even with the passage of the Affordable Care Act, black patients are still more likely to be uninsured than their white counterparts, according to the Kaiser Foundation. Much of this is due to the fact that non-whites not only earn less money, but the black unemployment rate is usually twice as high as their white counterparts. Yet, the American insurance industry continues to tie health care to employment.
If this continues, we will continue to see higher rates in communities that are underemployed and underinsured because the cost of coronavirus testing prevents marginalized communities from seeking out testing. This doesn’t just affect black communities but America as a whole because it will continue to burden health facilities and spread throughout cities. The only way to completely neutralize the threat coronavirus poses to Americans’ health is to ensure that everyone can afford the testing, treatment and possible vaccines.
I work in the only facility for the indigent in Birmingham, Ala., the third-blackest city in the U.S. In Georgia, one of the states hardest-hit by coronavirus outbreaks, there are nine counties without a single doctor. But it’s not just Georgia and Alabama. Healthcare facilities are closing in rural and poor, non-white communities across America. Studies indicate that black patients are far less likely than white patients to be uninsured and twice as likely to live in a “healthcare desert”—a zipcode without a primary care facility.
Where will these people get tested? Who will treat those who test positive? Will we just let them die?
The reason that media outlets cite Michigan and Milwaukee’s rates of coronavirus infection is that most state departments of health either don’t disaggregate their data by race or don’t report it at all. In Mississippi, for instance, 20 counties have seen outbreaks in nursing homes, but the state refuses to release the data on which specific facilities were affected.
Considering the above-mentioned health disparities, how can we treat this illness if we don’t know where to go in order to fight it?
A 2016 study published in the Proceedings of the National Academy of Science found that “Black Americans are systematically undertreated for pain relative to white Americans.” Forty percent of first and second-year medical students believe that black patients have “thicker skin” than whites and a meta-analysis of two decades of research by the National Institutes of Health found that doctors were 22 percent less likely to prescribe pain medicine to black patients.
If researchers eventually find a vaccine, black patients may be more reluctant to take it unless hospitals and medical schools take measures to fix the inherent biases hidden in the system.
Many people wonder why a hospital wouldn’t have more beds than ventilators and why hospitals would close in a rural area where it has no competition. If the country is trying to eliminate the virus, why not just make all testing free?
Well, sickness pays.
The reason facilities are closing across the country is that hospital systems are being privatized and consolidated by large health corporations whose only motive is profit. Coronavirus tests are being developed by pharmaceutical companies whose goal is to make money.
Healthcare is not an American institution. It’s an American industry.
Americans are beginning to worry. Many are worried about the quality of care they will receive or if they can even find a place to treat their illness. For the first time in many white people’s lives, they face the possibility of being treated as second-class citizens. But physicians like me have seen it for years. Coronavirus has exposed it but what will our country do to fix it?
Hopefully, America will finally prove that all lives matter.