As we continue our ongoing campaign to encourage and ramp up COVID-19 vaccination, an important part of the conversation includes addressing the disproportionate impact of COVID-19 on Black communities, as well as the impact of centuries of medical inequity in America on Black Americans’ psyche and trust.
We engaged Dr. Joseph West, an epidemiologist, population health and data analytics leader with over 15 years of experience in healthcare, research, and enterprise consulting and a member of the Sage Collective Leadership Team, to discuss these topics and more.
According to CDC data, COVID-19 disproportionately impacts Black or African American, Non-Hispanic persons at a rate of 1.4x times more than the impact on White, Non-Hispanic persons. What long standing health and social inequities are at play here to put such groups at increased risk of getting sick and dying from the virus?
JW: Several long standing factors, including behavioral, clinical, pharmacological, and socioeconomic, are associated with an increased risk of illness and mortality. Diet, lifestyle, discriminatory medical treatment and access, and environmental hazards such as neighborhood segregation and social isolation are key determinants of risk.
Severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (COVID-19) causes a significant inflammatory immune response in infected individuals. COVID-19 has magnified the increased risk for this response among persons with pre-existing medical conditions such as obesity, diabetes, heart disease, COPD and asthma.
Seniors, for example, over the age of 70 and mostly male, are particularly vulnerable to infections due to a declined immune system, comorbidities, frailty, and potentially inappropriate polypharmacy.
Especially when thinking about readiness in public health emergencies overall, how do we begin to tackle these challenges and create better equity in our health systems? What might it look like to create better-prepared (equipped, informed) systems and a better-resourced population?
JW: Seniors have been especially vulnerable to public health emergencies like COVID-19, accounting for more than 70% of all COVID-related deaths in many states. 39% of Covid-19 deaths have occurred in nursing homes, and another 20% of deaths have occurred in long-term care and assisted living facilities.
Over the past few years, there have been quite a few studies, including those conducted by the CDC, highlighting these facilities’ vulnerabilities to Legionnaires’ disease and bacteria in water and air systems. Yet, these risks went wholly ignored during the pandemic, especially in the early stages. Underfunding, poor oversight, discriminatory regulation, and ill-prepared workforce stifle public health emergency preparedness for racially and economically under-resourced communities overall.
Seniors prefer to age gracefully and vibrantly in their own homes and communities. An equitable and protective system invests in the equipment, social support, and infrastructure to make this a safer, more viable reality.
Outside of continued social distancing measures and strict mask wearing, rollout of the COVID-19 vaccine is one of our strongest and most direct defenses against the pandemic. Staying cognizant of the mistrust bred by health and social inequities at play, how do we begin to position vaccination as a component of readiness, and control/agency/choice, especially for the older African American community, in order to help combat the disproportionate impact of COVID-19 on the community?
JW: Vaccination is an individual choice. When the coronavirus is no longer front-of-mind, other infectious diseases like the flu will continue to threaten seniors and their caregivers’ lives. Vaccination is the primary measure used to abate infectious disease risks during epidemics and pandemics. Studies have demonstrated the efficacy of most vaccines like the influenza vaccine to reduce the chances for pneumonia, hospitalization, and death in elderly persons.
However, to ease fears and mend distrust, public health officials must employ what I define as the Three-Cs approach.
Compassion. Vaccine hesitancy is rooted in medical mistrust among Black Americans. From the infamous U.S. Public Health Service Study at Tuskegee from 1932 to 1972 to the racial eugenics movement, to more recent evidence of discriminatory access to pain medicines and advanced treatments, Black Americans feel these are not “isolated events.” Public Health officials have to be prepared to face and address this distrust with a significant degree of competent compassion.
Clarity. Messaging regarding risks for COVID-19 and the potential side effects of the COVID-19 vaccines has been mismanaged in communications to the Black, Hispanic, and under-resourced communities. Delivering a more unmistakable message regarding access, patient experiences from the community, and vaccine efficacy stories may go a long way towards uptake.
Consistency. Healthcare providers remain incredibly inconsistent in delivering care and practices that close gaps in quality of care and access. Ability to pay, where one lives, language, structural racism, and age remain essential determinants of health outcomes. Medical and public health officials have to continue to challenge our fragmented and unbalanced health care system to instill confidence in the vaccine, the delivery systems, and persons providing the jab.