For Black Americans, Covid-19 is another brutal reminder of the racist legacy of the American healthcare system. A disproportionate number of the 500,000 Americans who have died of coronavirus are Black. Yet African Americans and other people of color have struggled to access vaccines.
Racism corrupts every facet of the US healthcare system. Discriminatory practices barred the entry of Black candidates into medical, nursing, dental, pharmacy and other professional healthcare programs. Segregated medical facilities and unjust treatment within medical facilities continue to plague Black patients.
Two recent examples illustrate these failures. David Bell, a 39-year-old public safety worker, died in the parking lot of Barnes-Jewish hospital, in a suburb of St Louis, Missouri, after visiting the emergency department on three occasions complaining of chest pains, and being sent away with ibuprofen.
Dr Susan Moore, a 52-year-old physician, died from Covid-19 at her home in Indianapolis, Indiana, after being denied pain management and proven Covid-19 treatment plans readily available to other patients. Instead, she was ignored in her room for hours and ultimately sent home to her death.
While diagnosable diseases were the immediate cause of death, the more appropriate co-morbidity in both cases is racism. Both Mr Bell and Dr Moore sought help from hospitals who failed to listen to their concerns, failed to uphold the core values of medicine and public health, and played to tropes which disbelieve Black people about their symptoms and their pain.
The US recently crossed the first anniversary of the first documented Covid-19 case and coronavirus-related deaths. In St Louis, the first person to die from Covid-19 was a Black nurse. Recent data show a persistent racial disparity in Covid-19 cases and deaths. The Covid-19 death rate for Blacks is 166 per 100,000 people. The rate is 160 for American Indians or Alaskan Natives, 141 for Latinos, 132 for Native Hawaiians and other Pacific Islanders, 116 for Whites, and 87 for Asians. It is imperative that we use our understanding of medical racism to inform vaccine distribution.
It is tempting to view diversity as the solution to medical racism. Black physicians represent just 5% of doctors in the US; increasing Black doctors’ visibility in the healthcare profession, however, will not and cannot solve racism. Part of rooting out racism is to address how healthcare professionals are trained and the extent to which they understand health disparities and their connections to racism and the social and political determinants of health. Understanding these determinants and how racism exacerbates them offers medical professionals with a better foundation for establishing trust and building an equitable system for vaccine registration and allocation.
Others have proposed color-blindness as the solution, believing that if we take race out of the equation it solves racism. But equitable vaccine allocation cannot adopt a race-neutral approach. It must reflect our knowledge of where communities of color live and their unique challenges in accessing traditional health and social services. That means implementing programs to increase education and establish trust, providing comprehensive outreach and registration that is varied (online, socially distanced in-person and phone registration systems), and identifying and eliminating barriers to reaching vaccine appointments.
The lack of equity in treatment and vaccination must be named and addressed as we rely on the healthcare system’s integral role in the emergency preparedness response during Covid-19. The healthcare system, particularly hospitals, was and remains the main site for testing, treatment and the initial allocation of Covid-19 vaccines. However, not everyone has equal access to healthcare institutions, even after the enactment of the Patient Protection and Affordable Care Act (ACA) and Covid-19 economic relief laws.
When the ACA went into effect in 2010, over 40 million people were uninsured. By 2016, the ACA was able to reduce the number of uninsured non-elderly individuals by 20 million; since 2017, however, the number of uninsured has grown, reaching 28.9 million in 2019. Many people lack insurance because of high costs or employment that doesn’t provide insurance. Those at highest risk of being uninsured are communities of color, working families earning low wages, and those who reside in southern and western states. The 12 states that have yet to adopt Medicaid expansion under the ACA are heavily concentrated in the south, with high concentrations of Black residents.
These Covid-19 missteps contribute to a nightmare all too familiar to Black communities and other communities of color. The historical memory of medical maltreatment did not begin with the Tuskegee study, but is rooted in chattel slavery, where the healthcare system was established based on race, class, and experimentation on Black bodies. What followed was an imbalance of investment and spending in sick-care over preventive-care services and programs, thereby creating an impenetrable citadel of inequality.
That legacy remains today. The experience of Covid-19 is another reminder why we cannot tolerate these dynamics. We must hold systems accountable and re-imagine a healthcare system that results in healing justice rather than perpetuating injustice.
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Keon L Gilbert is an associate professor in the College for Public Health and Social Justice at Saint Louis University. Ruqaiijah Yearby is a professor of law at Saint Louis University. Amber Johnson is a professor of communication at Saint Louis University. Kira Banks is an associate professor in psychology at Saint Louis University. Each author is a co-founding director of the Institute for Healing Justice and Equity
