Editor’s note: The opinions expressed by the author do not necessarily reflect the views of the AAMC or its members.
One of the most alarming consequences of the coronavirus pandemic in the United States is that disproportionately high rates of chronic diseases like hypertension, asthma, and diabetes among people of color are dramatically affecting outcomes and mortality from COVID-19.
In my state of Alabama, over 45% of the state’s 197 COVID-19 deaths are among African Americans, while the state’s population is just 26% African American.
Similar trends are emerging across the country. In Michigan, African Americans account for 40% of COVID-19 deaths, despite representing only 14% of the state’s population. In Louisiana, African Americans represent 70% of deaths while accounting for just 33% of the state’s population. And in Illinois, African Americans make up over 40% of COVID-19 deaths but just 14% of the population.
Other minority populations have likewise been heavily impacted. In Washington state, 28% of those infected are Hispanic, even though they make up just 13% of the state’s total population. In Utah, Hispanic or Latino people make up 14% of the state’s population but are 35% of COVID-19 cases. And as of April 20, the Navajo Nation had a per capita infection rate 10 times higher than that of neighboring Arizona and the third-highest infection rate in the country, according to NBC News.
Racial and socioeconomic health disparities among communities of color are driven in large part by unequal access to primary care, housing, education, transportation, and healthy foods. In fact, research has shown that socioeconomic and environmental factors account for approximately 50% of a person’s overall health.
Even under normal circumstances, our failure to address health disparities comes at a steep price. According to the Kaiser Family Foundation, disparities amount to approximately $93 billion in excess medical care costs and $42 billion per year in lost productivity and premature deaths.
The coronavirus pandemic has illustrated, perhaps more vividly and starkly than any event in our lifetimes, the critical importance of addressing these health disparities. Certainly no one can reasonably expect physicians to solve societal problems like poverty and racism. However, continuing to equip medical students with an understanding of cultural competence, help them recognize and address racial bias in medicine, and teach them about the costs of health disparities — both as they affect patient outcomes and the health care system at large — is vital to improving care and reducing costs in the long run.
In light of the coronavirus pandemic, disaster preparedness and public health are likely to become a greater focus of many medical schools’ curriculum. However, health disparities will remain one of the most critical issues affecting patient outcomes and health care costs, not just in an emergency but persistently. Moreover, minorities and socioeconomically disadvantaged populations are likely to suffer the most in any future epidemic or pandemic, just as they are now.
This is not an “either/or” scenario — in a post-coronavirus pandemic world, medical schools should strive to better integrate both social determinants of health/health disparities and public health/disaster preparedness in the training of health care providers. Addressing health disparities and social determinants of health, in part through providing culturally competent care, will not only make us a healthier country but will also make all our communities better prepared to confront — and survive — the next pandemic.
Selwyn Vickers, MD, is senior vice president of medicine and dean of the University of Alabama School of Medicine. Other contributors include: L.D. Britt, MD, MPH, chair of the Department of Surgery at Eastern Virginia Medical School and past president of the American College of Surgeons; Deborah Deas, MD, MPH, vice chancellor for health sciences and the Pam and Mark Rubin dean at the University of California, Riverside, School of Medicine; Henri Ford, MD, dean of the University of Miami Leonard M. Miller School of Medicine; James Hildreth, MD, PhD, president and CEO of Meharry Medical College; Danny Jacobs, MD, MPH, president of Oregon Health & Science University; Robert Johnson, MD, dean of Rutgers New Jersey Medical School and interim dean of Rutgers Robert Wood Johnson Medical School; Talmadge King Jr., MD, dean of the University of California, San Francisco, School of Medicine; Ted Love, MD, president and CEO of Global Blood Therapeutics; Charles Mouton, MD, executive vice president, provost, and dean of the University of Texas Medical Branch School of Medicine; E. Albert Reece, MD, PhD, MBA, executive vice president for medical affairs at the University of Maryland, Baltimore, and dean of the University of Maryland School of Medicine; Valerie Montgomery Rice, MD, president and dean of the Morehouse School of Medicine; Joseph Tyndall, MD, MPH, professor and interim dean of the University of Florida College of Medicine; and David Wilkes, MD, dean of the University of Virginia School of Medicine.