Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors.
The recent shooting of Jacob Blake in Kenosha, Wisconsin by a police officer, following many unnecessary deaths of Black men and women at the hands of law enforcement, has ignited a powder keg of pent-up frustration over accumulated racial injustices. These tragedies come on top of entrenched inequities highlighted by COVID-19. Hospitalizations were highest among those with chronic diseases that are common among Black communities. So, it is not surprising that the death rates from COVID-19 are more than twice as high for Black Americans than for their white counterparts.
As we slowly move from the response to recovery phase of the pandemic, these communities are also being hit by a powerful, one-two knockout punch: Not only are they the most likely to be affected by the impending economic downturn, but their health is now threatened by foregone clinical care.
The confluence of these factors is deeply concerning. But for many of those working to address health equity, the current focus on race is also an opportunity to build momentum for existing efforts. Disparities in health outcomes by race are well documented. For example, Black women in New York State are approximately three times more likely to die in childbirth than white women. Health care professionals are learning more about their implicit or unconscious biases in delivering care and developing strategies to address them.
Attempts to improve the quality of, and access to, clinical care by race are important, but they are not enough. The growing movement for change being expressed through protests across the U.S. is rooted in a need for larger reform. Racism needs to be tackled head on in all spheres of our lives.
Health care knows this. Extensive research has shown that the greatest impact on health outcomes is made by drivers of health, also known as social determinants of health.
Consider the example of stable and affordable housing, which leads to better health of residents. Yet policies over decades have led to segregated neighborhoods with people of color disproportionately living in overcrowded and run-down homes. And the discrimination continues to this day. A three-year investigation by Newsday, published in 2019, found "evidence of widespread separate and unequal treatment of minority potential homebuyers and minority communities on Long Island." Black testers experienced disparate treatment by real estate agents 49 percent of the time.
Accessible, healthy food helps treat chronic diseases, such as diabetes. Unfortunately, segregated neighborhoods often are food deserts (underwhelmed with healthy food options) and food swamps (overwhelmed with unhealthy food choices, like fast food restaurants). So instead of food improving health in these communities, it makes them sicker.
Well-functioning public safety allows individuals to walk in their neighborhoods for exercise and go pick up medications from the pharmacy as well as trust the police to report acts of domestic violence. But if your community regularly experiences police brutality, how comfortable will you be to leave your home or call them for help?
So, what can health care leaders do?
First, we need to empower ourselves with data that allow us to identify social risk at the patient and community level. Many health systems and health care companies are combining patient-level clinical data and community-level socioeconomic information with advanced analytics to develop a social risk score at the point of care. This allows providers to identify, prioritize, and address non-clinical factors, such as food insecurity, that are affecting their patients and to improve their health outcomes.
A community-level social risk score can inform how health systems make strategic investments to enhance the health of a community. In addition, it can help identify vulnerable neighborhoods in advance of the next pandemic. This will allow the health care delivery system to prepare for testing and other much-needed services in these high-need communities.
Second, it is critical that we join the struggles of those not in health care who are also fighting racism.
For example, when an education equity coalition asks you to join them to help address the fact that Black boys made up 25 percent of all students suspended out of school at least once in 2015-16 while only accounting for 8 percent of all students—you join them. The same students are likely to be unfairly labeled as emotionally disturbed by their schools and sent to our emergency department instead of being cared for appropriately at the school. We cannot only treat the downstream effects of racism but need to actively begin to address its root causes.
We know what leads to bad outcomes in poor communities during times of crisis. Now, we must decide if we have the courage to make the needed changes to confront the causes and effects of racism before the next pandemic.
Ram Raju, MD, is the former senior vice president and community health investment officer at Northwell Health. He previously served as the president and CEO of NYC Health + Hospitals and as CEO for the Cook County Health and Hospitals System in Chicago.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Ram Raju, MD, argues that, in the wake of accumulated racial injustices as well as entrenched inequities highlighted by COVID-19, there is a need and an opportunity for health care leaders to confront racism. – UHF President Tony Shih