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“Explicit discrimination and overt stereotypical thinking have plagued and penetrated the health care and research systems so profoundly, that it is now difficult to root out every aspect that has been planted in it throughout time,” writes VOX ATL teen staff writer Amy Pham.

Art illustration by Amy Pham

COVID-19: Where’s The Vaccine For Systemic Racism in the American Health Care System?

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Life has been a rollercoaster this past year. For many of us, including me, school is fully virtual; teachers harass us about video cameras, assignments and deadlines only through a webcam. Long-time local businesses are calling it quits due to the lack of customers, the amount of Americans at bread lines are becoming record-breaking and the economic, racial social and class divide in our country continues to unravel itself from its fragile, brittle skin.

As numbers of hospitalizations and cases continue to rise and reach highs, the coronavirus pandemic continues to ravage the world. 

The pure dismissal that some groups in this country have for this pandemic is unbelievable. The safety precautions set by medical professionals and experts to protect and preserve lives seems to threaten their rights so much that they have to hold rallies to protest and blatantly disregard the fairly undemanding advice that health organizations promote, so people can stay safe and not contract COVID-19

It all just seems surreal. Nevertheless, their fight has not stopped the vicious, rigorous virus. 

COVID-19 Statistics in BIPOC communities

As of now, nearly half a million Americans have died from coronavirus disease, and statistics along with news articles of hospitalizations, deaths and cases continue to flood our screens. The reality is hard to ignore as Black, Indigenous and People of Color (BIPOC) are being affected by the pandemic at a disproportionate rate, specifically the Black, Native American and Latino/Hispanic communities. According to The Covid Racial Tracker, 116 white people are dying per 100,000 Americans, and a staggering 176 black people and 170 indigenous people are dying per 100,000 Americans. The institutionalized racism through legalized policies in history and health inequity for marginalized people has become a set system deemed as “normal,” which, as a result, has produced these disheartening statistics. 

The CDC has recognized this issue and highlighted the prime factors that have contributed to the increased risk of BIPOC communities contracting the disease at a rate higher than white people. Among these factors are discrimination and racial bias in health care systems. Whether it is intentional or not, it inherently plays a large role in the administration of care and how patients react to it. In June 2020, Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard T.H. Chan School of Public Health, told USA Today, “Studies have shown that even the most well-intentioned physician or medical professional demonstrates unconscious bias in caring for others.” 

However, the CDC is leaving out the innuendo that has fundamentally caused the gruesome conditions that BIPOC have to continuously endure in these communities: Systems and historical impacts. 

Historical Implications of Racism in Modern Times

Historically, the American health care system is one that has been ridden with an extremely dark background in medicine and research. Scientific data was once used to justify intolerance and prejudice towards racial, ethnic and marginalized groups such as felons and people with disabilities. From research in support of Eugenics and Social Darwinism in the past, the partiality experienced by these groups has not changed. In regards to the statistics of the pandemic, it is not the “biology” of the race to blame, but the inadvertent racism towards it that has been the cause. 

In an interview with Dr. Camara Jones, a family physician, epidemiologist, activist and adjunct professor at Emory Rollins School of Public Health and Morehouse School of Medicine, told VOX ATL, “We in this country are ahistorical. We act as if the present, we’re disconnected from the past, and it is as if the current distribution of advantage and disadvantage were just a happenstance. The reason [white people], they don’t understand that their so-called ‘normal’ is built off on a whole mountain of unfair advantage … if they don’t go into the history and understand this mountain of unfair advantage over in terms of wealth accumulation, over centuries, over generations, if they don’t understand that people don’t just happen to fall into disadvantage, but what were the initial historical injustices that started there? And what are the things even today, the laws, what are the customs that are keeping people way down?” 

Although it may not be as apparent, legal or severe, explicit discrimination and overt stereotypical thinking have plagued and penetrated the health care and research systems so profoundly, that it is now difficult to root out every aspect that has been planted in it throughout time. Even though the pandemic draws attention to the issue, it is one that has been continuous in America for centuries. 

What does this say about the American health care system?

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There needs to be a reform. There needs to be a system where people are not more likely to die based on the harmful stereotypes highlighted in a published medical textbook and taught in accredited establishments. Those who have authority on the information and education that is being fed to the next generation of health care workers and researchers need to acknowledge that race and socioeconomic status do not define someone’s response to pain, or their lung capacity and the need for a percentage for a “race correction factor” in certain medical devices like the spirometer

“Why are we as physicians to, when we talk to another health care provider, describe their age, race and sex,” Dr. Jones said. “Some people say it helps you identify the patient in the emergency department … really what it does is that it might affect what we think is going on, it might affect how quickly we come to see the patient, it might affect what we even consider we should do about it, it affects our care and all of that.” 

Other concrete circumstances that increase their chances of catching COVID are also due to unjust, institutionalized factors such as the disproportionate rates of BIPOC working low-paying essential jobs and concentrated living areas stricken with high poverty. Although several other factors contribute to their increased vulnerability, the inadvertent, as well as the transparent discrimination and racism displayed throughout this ongoing pandemic, is disappointing yet not surprising. 

Health care providers also need to recognize that this kind of thinking could be the source of origin for unequal access to fundamental resources due to factors out of their control (ie, redlining, environmental racism, the bias in hiring agencies, transportation to jobs, etc.), and ultimately leads to inequalities and higher-than-normal rates of infection, disease or contagion in the first place.  

Race is not biological, it is simply a social construct, and people need to start treating it like what it is. There is no reason that BIPOC should still be receiving the substandard quality of care in the hands of a medical professional trained through years and years of practice. 

“What does this thing, this variable called race, actually measure?” asked Dr. Jones. “Because if you ask most people on the street, and even in science, they might say well it measures some combination of social class, culture and genes. But in fact, it’s only a rough proxy, a rough stand-in for social class, and it’s only any kind of proxy for social class because of structural racism. 

She continued, “It’s rougher for culture within any so-called racial group that many, many cultures, many dietary practices help release like that. It’s meaningless for genes because we have mapped the human genome and we know that there’s no basis for racial subspeciation, but it precisely captures the social classification of people, the social interpretation of how each of us looks in a race-conscious society. So why is race such a good predictor of health outcomes? It’s because it’s measuring the substrate on which racism operates day to day.” 

She added, “It is that social classification and then all of the ways that opportunity is structured based on race in this country, all of the ways that value is assigned in this country based on race, that socially assigned race is the substrate on which racism operates day-to-day.” 

As these COVID-19 statistics continue to show that Black, Indigenous and Latino/Hispanic people still suffer mortality rates upwards of three times the rate for white people, we need to start addressing what is truly the root cause of the inequities. 

What can future generations interested in public health and medicine do to deter these biases and unjust systems?

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According to Dr. Jones, to be able to combat these systems and unintentional biases young people need to be “actively anti-racism,” not to be confused with, “actively anti-racist,” as that alludes to one being against another person. But, to truly combat it, we need to be in opposition with the systems that illustrate or justify the impact, rationale or basis of racism. 

In the case of reviving public health and medicine from these broken, unfair systems, Dr. Jones said that we need to ask and address, “Is there something different going on by race, language, immigration status, or ZIP code? … [Health workers] need to review all of the data, don’t just look at this one patient and what happened today, and say ‘Oh, maybe something weird,’ but look at all of the data that you have, over the week, the past month, over all of the providers, and say, is there something differential going on in terms of outcomes, as well as in terms of opportunities. Did we do the same thing for [all] people, as well as did they all have the same kind of outcome? … If we see that that’s not the case, then we need to ask, well why?” 

She says that we need to dig deeper and deeper for some level of understanding as to why and how these ethnic and racial groups were treated the way they are. These questions will fundamentally lead you to avoid planting the blame on an individual and instead discovering and acknowledging the root cause explanations. But once these rooted issues are found, we can not work alone to combat racism, but we must work collectively. Racism can be dismantled, but viewing this from an individualistic standpoint, it seems extremely overwhelming and this way of thinking probably will not get you anywhere. Instead, collectivizing and organizing with those in your community or even in larger organizations can propel and also protect you from burnout, physical protection, etc. 

To summarize, our generation must do three things: name racism, ask how racism operates, and strategize, collectivize and organize to combat it. 

At the end of the day, wear a mask, social distance and wash your hands.

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America still has a long way to go. The instinctive individualism that is counterproductive and undermines any progressive policies and systems that have been embedded in our society today, has driven up the rate of contagion among the non-essential working population. People fight for the “right to get a haircut” before they would even begin to start thinking about protecting the lives of others around them. The disparities in the treatment of different racial, ethnic and other marginalized groups in so many fields have wedged a gap between many communities. The list of concerns happening in this country goes on. 

Yet, no one wants their death to become showcased as a statistic during a pandemic. Even if it isn’t displayed anymore, health care and essential workers are still risking their lives and working hard to provide for or save our community. No matter your age, wear a mask and social distance if you can. We must work together to save our lives and those around us. Stay safe, everyone.

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