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    Transcript for Racial Health Disparities: How COVID-19 Magnified a Public Health Emergency

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    David Skorton: I'm David Skorton, president and CEO of the Association of American Medical Colleges. Over the past three months, the coronavirus has laid bare the existing health inequities that cause such disproportionate harm to our nation's racial and ethnic minority communities. Simultaneously, our country has been shaken to our core because of the increasing and tragic examples of the everyday danger of being Black in America. This finale episode of season one of "Beyond the White Coat" will launch us into our second season, where we will focus more deeply on issues of racism and public health in America. 

    I'm here today with my colleague Dr. Malika Fair to talk about these persistent challenges and the need for academic medicine's ongoing work with communities to eliminate health disparities. Dr. Fair is the senior director of health equity partnerships and programs at the AAMC and she is also an associate clinical professor and a practicing physician in the department of emergency medicine at the George Washington University School of Medicine and Health Sciences. Dr. Fair, thank you so much for joining us on "Beyond the White Coat." 

    Malika Fair: Thank you for having me, Dr. Skorton. 

    David Skorton: So, Dr. Fair, I'd love to start by hearing just a bit more about you. Anything our listeners should know, that you would like them to know, anything about the work you do or maybe some examples of your direct personal involvement in our local D.C. community? 

    Malika Fair: So I have, like a lot of emergency physicians nationwide, a few different jobs. I think I like to be busy. But my favorite job is being a new mother to a seven-month- old daughter. She keeps me really busy but she brings me a lot of joy. I also have the pleasure of working at George Washington University in the emergency department where I not only get a chance to take care of patients, but I also am able to teach medical students. I have a small group of eight students that I've watched from the beginning of their M1 year, their first year of medical school, all the way to now-fourth-years, and we talk about professional development once a month. And before my husband passed away, we lived in Ward 7 in the District of Columbia, which is — Ward 7 and Ward 8 are two wards that have a greater number of African Americans and a lot of poor health outcomes. And I was asked to serve as a vice-chair of the board of directors of the nearby local hospital which is called United Medical Center, and that experience has also brought me great joy because we are making a difference in improving health on the east end of the city. 

    David Skorton: Thank you. That's so, so interesting and so admirable. Well, one of the striking things we are all learning about COVID-19 over the last few months is how it has affected people of color much differently than many others. What are some of the disparities that we all ought to be paying attention to as this pandemic continues? 

    Malika Fair: The disparities that you mention are really concerning. As a Black woman, I'm particularly concerned about how it's affecting my community. We represent 13% of the nation's population but 24% of the COVID-19-related deaths. Here in the District, we represent about 47% of the District population but over 80% of the deaths related to COVID-19. So we have a lot of work to do, but it's not just the Black community that has these challenges. The Latinx population has the highest infection rate in the city, and in other parts of the country, the Native American population is also being hit really hard. 

    David Skorton: Yes, we learned a lot about many of those things, including the suffering of the Navajo Nation during this pandemic. You know, as I hear you remind us of these very troubling numbers, I can't help but ponder the underlying causes for the disparities. And you've had a recent opinion piece in AAMCNews in which you said the prevalence of chronic disease and social factors both play a role. Can you explain a bit more of that to our listeners?

    Malika Fair: Sure. We oftentimes want to get to the bottom of what's happening with health disparities, and the first thing that we talk about are chronic conditions. And yes, this is part of the problem, that African Americans are disproportionately affected by chronic conditions such as obesity, diabetes, and hypertension. But then you might hear people say, "Well, it's not just the chronic conditions. It's the social factors such as where you live, where you work, and where you play." And these absolutely make a difference, too, such as if you live near an airport or near a plant that has high air pollution, that can impact how you deal with COVID-19 as well. 

    But that's not the end of the story. We have to look a little bit deeper. And even when all of these can be controlled — so if you control for obesity, diabetes, or income, or insurance, we still see that there's differences in the death rates, which is really concerning. And we think that one of the reasons is because of structural racism in our society.  

    David Skorton: Well, thanks so much for sharing those very, very troubling statistics, and I'm glad you talked about social factors because some of those are things that many of us wouldn't necessarily think of even if we've been trying to pay attention to general social determinants of health. For example, social distancing has been one of the core strategies for limiting the spread of COVID-19, but you said in that piece that even social distancing can be a privilege that's available unevenly by race. Can you tell us more about that? 

    Malika Fair: Sure. According to the  U.S. Bureau of Labor Statistics, we know that African Americans and Latinx populations are disproportionately represented in service-related jobs, so home health care workers, transportation, grocery stores, et cetera. And if you remember, at the beginning of the pandemic there was a huge push to make sure that health care workers had the appropriate personal protective equipment. But who was left out of that discussion were the people who were also at the front lines with helping you with your groceries and making sure you got from point A to point B, and a lot of those people were infected and died. And so that's one area in which we can say that social distancing did not help because they weren't able to. They weren't able to telework like a lot of us in the country. 

    David Skorton: Some people believe that such biases are really relics of the past, but in fact, the COVID-19 pandemic has shown us otherwise, hasn't it? 

    Malika Fair: It has. So we look at differences of care between Blacks and Whites as a problem. And when we find it, I hope that we as a community can address it. With the COVID-19 pandemic, unfortunately we've seen some of those examples recently. There was a study done in the Northeast that looked at seven states, and for Black people who were presenting with fever and cough, they were less likely to receive a COVID-19 referral test than their White counterparts. We also see some cities across the nation, such as Memphis and Philadelphia, that the testing sites either didn't have enough supplies or there weren't enough testing sites in communities of color. So, you know, we as a community have work to do, and unfortunately some of these disparities are still present in today's pandemic, and you can see it in a host of other conditions as well.  

    David Skorton: Well, despite that, I appreciate that you believe we can use the pandemic to actually address health inequities in ways we just haven't gotten the job done before. I'd like to focus just a little bit on the pandemic first. What do you think is the role of medical schools and teaching hospitals and health systems and even the whole university to recognize and combat inequities as this pandemic continues? 

    Malika Fair: Well, first we have the nation's attention. For the first time, everyone — the lay public, the medical students, the residents, our staff — everyone is thinking about the pandemic, but also the inequities that we are speaking about today. And because we have this opportunity, we have to act now. One thing that we need to do as a community is to make sure that we are having testing sites equitably across the city to make sure that those that have high incidence of the virus are making sure that they have adequate testing. But we also have to make sure that we are not giving care disparately. The example that I mentioned, that we weren't giving referrals to COVID-19 tests, we need to collect those data and make sure that that's not happening in our institution. And we also have to work with our communities to develop anti-racism training. Now that we are interested in this and you see examples across the country of physicians kneeling in their white coats and standing with White Coats for Black Lives Matter, that's great to demonstrate. But we also have to change the way we practice and change our systems in our hospitals. 

    David Skorton: You know, it's obviously impossible to have this conversation in June of 2020 without talking about racism and police brutality. Is that part of our lane as holistic physicians and caregivers and community members? Should we be speaking out in academic medicine on issues that at first blush may feel out of our ambit? 

    Malika Fair: Health is our lane. Anything that impacts health is something that we should act on. And unfortunately these violent acts of racism is impacting not only the lives of the people that we are seeing murdered in front of us, but also the stress that that's impacting on a community, the fear of my colleagues who are driving to work and wondering if they're gonna get picked up by the police and killed. So we have to speak out against this racism, the structural racism that manifests both in law enforcement, but also take a hard look at ourselves and see how we are contributing to this overall societal problem.  

    I'd like to tell you a story about my husband, Yante Newfeld. He died in 2017 and he was 38 years old, an African American man. When he died, I had to go through all of his things and one of the things that he had an abundant supply of were eyeglasses. Now you may think that's odd. Why would someone have so many eyeglasses? Well, he told me once that he was not interested in getting the corrective eye surgery, because wearing glasses as a Black man made him appear less threatening. This is concerning that an individual would feel that he has to wear glasses because he is a threat when he goes to work, when he goes to the grocery store, or when he's walking around our neighborhood.  

    We as physicians have to recognize that what's happening in the media, what's happening in our neighborhoods, and what we are hearing impacts the patient in front of it. It impacts their health, their blood pressure. If we don't speak out, who will? This is our lane, and this is something that we must speak out against. 

    David Skorton: So, Dr. Fair, if you want our listeners to take away one single message, one single thought from today's conversation, what would that be? 

    Malika Fair: There is no easy solution to solve racism in health care. We oftentimes want to blame the population that we're talking about and say, "It's due to your chronic conditions; it's due to your social position," but that's not the end of the story. We have to address the structural racism in our society, but even when we do that, there is still sexism, ageism, xenophobia, homophobia that all impact health. And we as a community have to address these discriminatory beliefs and practices if we are going to get to a society that can — all of us can achieve our optimal state of health. 

    David Skorton: You know, I'm gonna ask you as a last question to put your hat on as a leader in the Association of American Medical Colleges. There are many, many interesting things going on and many people with good ideas trying to put them into action, not only at the headquarters of the AAMC but throughout our member institutions, at schools of medicine and hospitals and health systems. If someone at one of those settings really wanted to find out, you know, what are other people doing, what are other institutions doing, is there a way that — are there resources available through the AAMC to learn about some things that may be successful elsewhere? Are there resources available? Are there stories or even what you might call best practices that people who have good intentions but don't really know exactly how to get it done — are there things available for our listeners who are at academic health centers?  

    Malika Fair: Absolutely. So if you are interested in racism and health in general, then we urge you to come to the website at AAMC.org, and a new collection has just been launched that has several resources on there. For those who are in medical education, there is a collection being developed on anti-racism education. We are gonna keep putting other resources up, but if you have an interest in research, we have a whole collection on community-engaged research for another example. But we want our members, our faculty, and our students to know that we are listening to their concerns and we are continuing to develop real-time resources and opportunities to engage with us as we collectively fight structural racism, both in academic medicine as well as in our society. 

    David Skorton: Well, I want to thank you very, very much, Dr. Fair, for joining us today. We know this is only the beginning of a very important discussion that is really long, long overdue, and I invite all of you who are listening to join us in the next season of "Beyond the White Coat" as we continue to explore these difficult but extremely important topics. Thank you, Dr. Fair, and thank you all for joining us today on "Beyond the White Coat." 

    Malika Fair: Thank you, and I am so hopeful that the medical students, the residents, the faculty, and even those of us at AAMC can work together to fight the racism that we see in our society.  

    [End of Audio]