Episode 145: Antiracism in Medicine Series Episode 3 – Structural Inequities and the Pandemic’s Winter Surge

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we sit down with Ed Yong, an award-winning journalist and science writer with The Atlantic, to discuss the structural inequities amplified by COVID-19 as well as the social concerns associated with the impending/present second wave of the pandemic.

Learning Objectives

After listening to this episode listeners will be able to…

1. Understand the trajectory of the COVID-19 pandemic’s unique impact on communities of color in the United States and its tie to historical discrimination and structural inequities
2. Describe the racialized and politicized national response to COVID-19
3. Recognize the crucial role that social interventions can and could have played in decreasing the burden of COVID-19

Credits

• Written and produced by: Dereck Paul, MS, Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Michelle Ogunwole, MD, Naomi Fields, Chioma Onuoha, and Jazzmin Williams
• Hosts: Dereck Paul, MS, Utibe R. Essien, MD, MPH
• Infographic: Creative Edge Design
• Guests: Ed Yong staff writer at The Atlantic (@edyong209)

Clinical Problem Solvers: Anti-Racism in Medicine

Show Notes – Episode 3: Structural Inequities and the Pandemic’s Winter Surge

December 3rd, 2020

By: Chioma Onuoha

Timestamps

00:00 Music/Intro

00:20 Mission and Vision

00:32 Introduction of Ed Yong

02:00 Disproportionate impact of COVID-19 on minority communities

04:00 Racism in the national/policy response to COVID-19

07:00 Health Care Worker Fatigue

09:30 Grief and the Unique Frustrations of Health Care Workers of Color

11:30 The “Chinese” Virus and the history of the pandemic

14:00 Administrative Blame Shifting

17:00 How Could This Have Been Prevented?

20:00 COVID-19 and indigenous populations

Takeaways

1. Social Interventions are Valuable

Currently in the COVID-19 pandemic, social interventions are the only interventions available to us. When it comes to pandemics more broadly, the role of non-pharmaceutical interventions, like mask wearing, social distancing, and stay at home orders, must be recognized for their robust potential to reduce disease spread and burden. (Reflection Question: How can I best communicate the importance of social interventions to my extended family, community, and patients?)

1. The Racial Disparities Exposed by COVID-19 are Not a Result of Biological Difference

It is dangerous to look at the racial and ethnic health disparities highlighted by COVID-19 and attribute them to biological differences*. Many of the populations who suffer from these disparities also suffer from structural inequity and historical discrimination which impact their quality of life and health outcomes. Marginalized communities have historically received the brunt of the blame when it comes to widespread pandemics without recognition of the role that structural factors play in creating and maintaining health inequity.

*To learn more about the danger of biological explanations for health disparities see the CPS Anti-Racism in Medicine three-part episode series Dismantling Race-Based Medicine. Part 1: Historical & Ethical Perspectives featuring Professor Edwin Lindo is available now.

1. Health Policy Must Target Structural Inequities

Inequities worsen if they are not specifically addressed in policy. Without intentional effort put into addressing the root cause of structural inequities, it is possible that interventions will cause more harm than good. (Reflection Question: How should the concept of equity vs. equity be applied in creation of health policy?)

Pearls

The disparities amplified by COVID-19 are not new or unsurprising

The narrative of COVID-19 being a “ great equalizer” is largely untrue. If anything, COVID-19 has removed “the veil” and made the extent of the inequities in this country very clear. Marginalized communities are especially vulnerable to COVID-19 due to structural factors like segregation, lack of access to clean water, poor air quality, and limited availability of health care.  These structural inequities are longstanding and will require long-lasting and intentional rectification.

Frontline Workers Pushed to their Limits

Touching accounts from frontline workers, in particular, nurses, who are uniquely positioned to face the devastating impacts of the disease, have clarified the toll that COVID-19 has placed on care workers. The emotional and physical fatigue associated with such immense loss of human life is leading to burnout among the very group that is required to address this disease. For many health care workers of color, their struggles are compounded by personal grief and increased expectations to lead anti-racism efforts within institutional walls.

Blame shifting

During COVID-19, we have seen marginalized communities be positioned as scapegoats to explain the prevalence and persistence of the disease. This is not a new phenomenon. Ed Yong cites anti-Blackness during the Ebola outbreak; homophobia, transphobia, and condemnation of sex workers and people who use drugs during the HIV epidemic; and current anti-asian rhetoric during COVID-19 and the original SARS as examples. Blame is deflected to populations on the outskirts of society and used as justification to delay or fail to provide aid. Throughout the duration of the pandemic, we have seen the nature of this blame evolve. While it started with accusations that Black people and POC do not take the virus seriously and/or have chronic diseases and unhealthy habits, most presently it manifests through discourse around black people’s weariness of taking the forthcoming COVID-19 vaccine. Rather than placing blame on marginalized populations, it is crucial that we first analyze history and external influences that may explain the behaviors and outcomes being observed.

Overreliance on Biomedical Measures

“[Rudolf Virchow] specifically writes ‘Medicine is a social science’ and we have lost that understanding” – Ed Yong

For much of the COVID-19 pandemic, rhetoric in the United States has centered around waiting for biochemical and pharmaceutical interventions to be developed rather than fully taking advantage of the social interventions currently available. Social interventions are powerful, and as we can see from the COVID-19 responses of countries like South Korea and Taiwan, they are effective at managing this disease. This reality highlights the importance of sociological and anthropological expertise in medicine and the need to expand interdisciplinary exchange in health care more broadly.

References Discussed in Episode

Additional References

1. Essien, U. R., & Venkataramani, A. (2020, April 28). Data and Policy Solutions to Address Racial and Ethnic Disparities in the COVID-19 Pandemic. JAMA Health Forum. https://jamanetwork.com/channels/health-forum/fullarticle/2765498
2. Gold, J. (2020, June 12). ‘I Am Tired’: What Black Doctors Need You To Know Right Now. Forbes. https://www.forbes.com/sites/jessicagold/2020/06/12/i-am-tired-what-black-doctors-need-you-to-know-right-now/?sh=29a644254ad7
3. Gross, C. P., Essien, U. R., Pasha, S., Gross, J. R., Wang, S., & Nunez-Smith, M. (2020). Racial and Ethnic Disparities in Population-Level Covid-19 Mortality. Journal of General Internal Medicine, 35(10), 3097–3099. https://doi.org/10.1007/s11606-020-06081-w
4. Jones, CP (2020, April 7). Coronavirus Disease Discriminates. Our Health Care Doesn’t Have To | Opinion. Newsweek. https://www.newsweek.com/2020/04/24/coronavirus-disease-discriminates-our-health-care-doesnt-have-opinion-1496405.html
5. Kendi, I. X. (2020, June 16). Black People Are Not to Blame for Dying of COVID-19. The Atlantic. https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/
6. Krishnan, L., Ogunwole, S. M., & Cooper, L. A. (2020). Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward. Annals of Internal Medicine, 173(6), 474–481. https://www.acpjournals.org/doi/full/10.7326/M20-2223
7. Tavernise, S., & Oppel, R. A. (2020, June 2). Spit On, Yelled At, Attacked: Chinese-Americans Fear for Their Safety. The New York Times. https://www.nytimes.com/2020/03/23/us/chinese-coronavirus-racist-attacks.html
8. Williams DR, Cooper LA. (2020). COVID-19 and Health Equity-A New Kind of “Herd Immunity”. JAMA.323(24):2478-2480. doi:10.1001/jama.2020.8051
9. Williams, V. (2020, March 27). A poll finds African Americans and Latinos are more worried about the coronavirus; a public health expert explains why. The Washington Post. https://www.washingtonpost.com/nation/2020/03/27/poll-finds-african-americans-latinos-more-worried-about-covid-19-doctor-explains-why/?arc404=true
10. Yong, E. (2020, August 19). We Live in a Patchwork Pandemic Now. The Atlantic.https://www.theatlantic.com/health/archive/2020/05/patchwork-pandemic-states-reopening-inequalities/611866/
11. Yong, E. (2020, September 14). America Is Trapped in a Pandemic Spiral. The Atlantic. https://www.theatlantic.com/health/archive/2020/09/pandemic-intuition-nightmare-spiral-winter/616204/

Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Yong E,  Essien UR, Nolen L, Khazanchi, R, Ogunwole M, Fields N, Onuoha C, Williams J, , Paul D. “Episode 4: Structural Inequalities and a Second Wave.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. December 3, 2020.

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