National Medical Association Annual Convention
National Medical Association Annual Convention
Source/Disclosures
Source:

Sullivan LW, et al. COVID-19 and the Black Community. Presented at: NMA Annual Convention; July 31 to Aug. 4, 2020 (virtual meeting).

Disclosures: Adams is U.S. Surgeon General. Healio Primary Care was unable to confirm relevant financial disclosures at the time of publication.
August 07, 2020
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Experts discuss ways to combat disproportionate COVID-19 burden in Black community

Source/Disclosures
Source:

Sullivan LW, et al. COVID-19 and the Black Community. Presented at: NMA Annual Convention; July 31 to Aug. 4, 2020 (virtual meeting).

Disclosures: Adams is U.S. Surgeon General. Healio Primary Care was unable to confirm relevant financial disclosures at the time of publication.
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Leaders in public health held a discussion during the National Medical Association’s virtual convention about how the COVID-19 is disproportionately impacting the Black community and other communities of color in the United States.

Data from the CDC show that COVID-19 hospitalization rates are four to five times higher among patients who are Black, Latino, Native American and Native Alaskan compared with white patients, according to former HHS Secretary Louis W. Sullivan, MD. He said this is due to “long-standing inequities in access to health services, social inequities, including poor housing, poverty and other problems, as well as a higher incidence of preexisting conditions.

Jerome Adams, MD

“This pandemic has shown in stark detail the dramatic inequities in the nation’s health system and how the system does not adequately reach and effectively serve many African Americans as well as other minorities,” he said.

There are four major deficiencies in the U.S. health care system that contribute to health inequities, according to Sullivan. These include a lack of funding in public health at the federal, state, local and tribal levels, an inadequate public-private health insurance system that fails to reach about 30 million Americans and provides “marginalized support” to an additional 80 million Americans, insufficient health literacy among the public, and a lack of racial and ethnic representation in medicine.

“The confluence of COVID-19 and the Black Lives Matter movement has brought us to a unique moment when our entire society is focusing on the issues of race, ethnic and gender inequity and health inequities,” Sullivan said. “We should utilize this opportunity to find ways to eliminate these inequities and to improve our society.”

Investments in public health

Increasing investments in “chronically underfunded” public health services will help address social determinants of health that are contributing to poor COVID-19 outcomes among minority populations, Sullivan said. U.S. Surgeon General Jerome Adams, MD, noted that these social determinants of health — which are “impacted by structural and institutional concerns related to race and bias” — are just as important to address as medical vulnerabilities to COVID-19, including diabetes and lung conditions.

“Public health research tells us your ZIP code is often more important than your genetic code when it comes to health,” Adams said.

But in order to convince policymakers to increase funding for public health services, Sullivan said that researchers need to “find compelling ways” to demonstrate the benefits of a healthy society. One strategy is to demonstrate how healthy communities strengthen the economy.

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“Good health is a prerequisite for a productive community,” Sullivan said.

He cited data that showed Medicaid expansion not only improved child and maternal health in participating states, but it was also associated with “a positive economic return.” These benefits were not observed in states that did not expand Medicaid, Sullivan said.

“So, we should continue to support investments for a more robust public health system at all levels,” he added.

Improving health literacy

While more funding is needed for public health, Adams said that physicians can help combat COVID-19 in their communities by educating patients about healthy behaviors and reinforcing “the three W’s: Wash your hands. Watch your distance. Wear a mask.”

The United States is on “record pace” towards a vaccine, and health officials are pushing for more COVID-19 testing, according to Adams. But he noted that other hard-hit countries such as Italy, Spain and China have already begun reopening schools, inviting tourists back to visit and resuming professional sporting events with “far less” testing capacities and “a less robust health care system.”

“We have the tools right now to choke out spread. What we actually lack is a collective will to take preventive measures which will help our communities to get the disease under control,” Adams said.

Sullivan agreed that there is little personal responsibility among Americans to take steps to protect themselves.

“We need to do a better job for our citizens to help build the trust and understand the power of what medicine can do,” Sullivan said. “Too many people don’t understand the power of biomedical research.”

This point is highlighted by a recent survey on COVID-19 vaccine acceptance in the U.S., according to former U.S. Surgeon General Vivek H. Murthy, MD. He said the results showed that less than 50% of those who were surveyed reported being either unlikely to receive a vaccine for COVID-19 or they would be uncertain to receive a vaccine if one was currently available.

“We don’t think about how to teach people how to interpret scientific data,” Murthy said. “We should be proud that vaccine development is accelerating but given all the suspicion and misinformation during this time, we’re going to need to do more than what we’ve done before. People need to hear from different voices that a vaccine is safe and effective.”

Diversity in medicine

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Collaborating with trusted community partners such as churches is one way to spread positive messages about preventive COVID-19 measures, Adams said. But more equal racial and ethnic representation in the health care workforce also has an important role.

“A more diverse workforce would lead to better communications, improved understanding and more trust between our health system and citizens, including people of color,” Sullivan said. “More trust leads to more understanding and results in better adherence to health recommendations such as utilization of vaccines, prescription medicines and other health behaviors.”

However, there are fewer Black men entering medical school today than there were 40 years ago, Adams said. Part of the issue, according to Sullivan, is that many Black people are educated in underfunded inner-city school systems, “so they have not been adequately exposed to a rigorous curriculum.”

Another major challenge is financial support for medical school. The average medical student graduates with an average debt of $250,000, Sullivan said.

“That discourages many from even considering a medical career,” he added.

Excessive medical school debt is “the result of an error in national policy” that occurred in the mid-1970s when federal loan programs and scholarships were greatly reduced based on the theory that students in health professions would be “high earners,” Sullivan said.

“That’s a theory that works well for someone from a middle- or upper-income family, but for a student coming from a family earning $30,000 or $45,000 per year, that really doesn’t seem practical,” he said.

Medical debt is also pushing young physicians into high-paying specialties such as anesthesiology, radiology and orthopedic surgery, and driving them away from primary care, “where they are most needed,” Sullivan said. To address the issue, federal policymakers need to increase the number of scholarships available to medical students, he said.

In addition to promoting diversity in medical practice, Adams said it is important to increase racial and ethnic representation in public health. This will help ensure that Black patients and other vulnerable populations are prioritized during public health responses.

“As a fellow physician of African descent, I want you to know that I’m doing my part ... by being a member of the Coronavirus Task Force,” Adams said. “I want you to know that I’m following and prioritizing the science, and that I’m fighting to be that voice for the vulnerable. As some of my mentors have said to me in the past, ‘If you’re not at the table, you may find yourself on the menu.’ It is important to make sure that you’re at the table.”

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