Structural Racism Tag

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Structural Racism Keynote Speakers

25 Jun

Posted at 17:36h in Uncategorized

The protests occurring across the US beginning the day after Memorial Day were sparked by a shocking video that captured how black persons are often grossly abused and even killed by a broken criminal justice system. In front of our eyes, George Floyd died on May 25, 2020, as a police officer pressed his knee on Floyd’s neck as Floyd gasped, “I can’t breathe.”

In addition to attributing the cause of death to “cardiopulmonary arrest while being restrained by law enforcement officer(s),” Hennepin County prosecutors and an early account from the medical examiner in the case list other “significant conditions,” including “arteriosclerotic and hypertensive heart disease.”

At a time when many people in the US are awakening to the systemic racism in the criminal justice system, it is equally important to acknowledge its existence in the US health care system.

Research shows that because of systemic racism, black persons have higher levels of chronic illnesses compared with white persons. It is hard to fathom the gall it took to imply blame for Floyd’s death on the very disparities in which racism plays so large a role.

Evidence has shown for decades that black persons are treated differently (worse) than white persons by the US health care system. In the notorious Tuskegee experiments, members of the US Public Health Service followed up black men infected with syphilis without treating them to observe how the disease took its course; the experiments ended in 1972, but their effects are still being felt. The US Agency for Healthcare Research and Quality has been tracking racial disparities since 2000. They still remain.

Every single time I hear a presentation or read a manuscript pointing out differences in how black persons are treated with respect to health care, I despair. It seems to me that anyone who does not know this yet is actively remaining ignorant and will not be convinced by 1 more study.

Black women’s maternal mortality is 3 times that of white women. Black patients in the US are less likely to receive proper care for diabetes, kidney disease, and various cancers even though they have higher rates of almost every disease.

Sickle cell disease affects 3 times as many people in the US as cystic fibrosis. Yet cystic fibrosis receives 11 times as much funding per patient from the federal government, and 440 times more funding from foundations.

Black persons in the US face roadblocks in every aspect of health care and even in academic medicine. They are less likely to be able to access health care. If they are able to do so, they are less likely to get the care they need to remain healthy. They are less likely to succeed in the profession. They are less likely to be awarded grants. They are less likely to be promoted, and less likely to be in positions of leadership. There is evidence demonstrating all of this.

The coronavirus disease 2019 (COVID-19) pandemic has underscored the many levels of systemic racism. Black persons are more likely to have chronic conditions that lead to severe cases of COVID-19. They are more likely to hold lower-paying yet “essential” jobs that place them in harm’s way, more likely to be reliant on public transportation where social distancing is hard, and more likely to live in housing that compounds all that risk.

Even before any protests began, black persons were dying of COVID-19 at rates twice the rate that one would expect based on their share of the US population. In Wisconsin, COVID-19 deaths among black persons comprise more than one-quarter of such deaths, even though they are only 6% of the population. In a study in Louisiana, more than 70% of deaths occurred in black persons despite their comprising only 30% of the studied population. Disproportionately black counties account for more than half of COVID-19 deaths nationwide, and wealth and access to health care do not seem to equalize things.

Should the protests following George Floyd’s death cause transmission of infection, many will blame those who showed up. Those at higher risk—again, black persons—will be more likely to develop severe illness and die. This and all the other disparities are easily predicted, yet it seems, like so many US politicians, the health care community too often offers only “thoughts and prayers” rather than effecting change.

Part of public health is making sure the public is healthy. The US health care system has failed to do that with too many in this country. The US society in general and the health care community in particular need to acknowledge that so much of what is wrong with the health of black persons is the fault of the health care system and not of patients. “Personal responsibility” plays well, but it is often a way to blame the patient when the system fails to support their ability to care for themselves.

It is time to stop wasting time and money proving that disparities exist. It is clear that they do, and pointing out the problem is easy. It is time to do something about it, which is infinitely harder.

It is time to invest in public health to improve the ability of everyone to eat right and exercise regularly, and to quit smoking and drinking unsafely. Just telling them to do so is not enough. Massive investment into making it easier to do so is necessary.

It is time to make sure that everyone has access to the health care system and preventive care. The Affordable Care Act was necessary, but not sufficient. Too many still do not have access to Medicaid, and too many cannot afford care even when insured.

It is time to train physicians to avoid implicit and explicit racial bias when seeing patients. It is time to rebuild trust with black persons and for the health care community to own past mistakes and prevent them from happening again. And it is time to recognize that the reasons black persons fare so poorly with respect to health is because of disparities, not because they chose not to care for themselves, and to fix those disparities.

As efforts to contain the COVID-19 pandemic continue after protests subside, it is essential to recognize that systemic racism kills black persons through poor health as much as or even more than police brutality. It does so because society tolerates a system that sees them as expendable, even as it labels them essential.

(Reprinted from JAMA Network – JAMA Health Forum https://jamanetwork.com/channels/health-forum/fullarticle/2767595)

Aaron E. Carroll, MD, MSa healthcare speaker, professor of pediatrics at Indiana University School of Medicine who speaks/blogs on topics such as COVID-19, health research and policy at The Incidental Economist and speaks LIVE on Healthcare Triage. 

23 Jun

Posted at 18:39h in Aaron Carroll MD

 

(Reprinted from The Incidental Economist)

Sometimes I write pieces and can’t place them. I usually save them for later. In this case, I feel strongly enough about it that I’m posting it here. It won’t get the eyeballs it might at a major media site, but it’s more important to me that I publish it now.

Public health has a messaging problem. It’s made the management of COVID hard in the past, and it’s potentially damaging our ability to manage future issues. Some are arguing that declaring the protests more important than infection is damaging the credibility of experts to recommend actions related to preventing outbreaks.

Both the issues being protested and the pandemic are crises. But comparing them, or weighing their relative worth, is a mistake. Black Americans are at real risk from state violence and structural racism. They are risking their lives if they don’t protest, and they’re risking them if they do. Many of us cannot understand the risk calculus, and we likely shouldn’t try. Instead, we should focus our messages consistently on improving health, admitting what we don’t know as well as what we do.

This isn’t the first time we’ve failed to be transparent and clear.

When the pandemic initially reached our shores, we told people that masks were not necessary, because – at that time – most people were wearing masks to protect themselves from infection. Now, however, the prevailing wisdom is that masks might prevent people from infecting others. There’s some evidence for this, although we wish there was more. Given that many more are infected in the United States now, encouraging the wearing of masks seems like a low-cost, potentially beneficial thing to do to protect others.

We have failed to explain these nuances well.

When the pandemic first raged, we did not know how many people were infected, where they were, or how catastrophic this might be. In addition, we feared that many were spreading the disease without knowing they were sick. Studies showed that people without symptoms were infecting others, and because of this, we needed to separate everyone, even when it meant economic or personal sacrifice.

Recently, though, the WHO muddied the issue by first appearing to assert, and then walking back, the claim that asymptomatic transmission is ‘very rare’. Communication could clearly be better.

When I saw protests by people demanding the country open, I noted a lack of masking and social distancing. I was concerned.

When I see protests by people demanding an end to structural racism, my concern remains. I support the call for social justice and radical reform, and I support recommendations that reduce the risk of infection.

That message has been articulated differently by many in public health. Some have taken to making judgments about the value of protest activities, and whether they are, therefore, “worth” the risk. Such judgments from public health experts may make infection control efforts more difficult because others will deem different activities “worth” risk themselves.

More consistent messaging would be desirable.

Public health might be better served continuing to push for the things that will make everyone safest in the coming months and years. These include both the need to eliminate structural racism and the need for better infection control.

As we move into the next phases of this pandemic, we must shift from extreme social distancing to risk minimization. I discussed this weeks ago when focusing on camp. We can do the same with protests.

While outside activities are less likely to lead to an outbreak, the potential still exists. The time and intensity of exposure also matters, and as we seek to minimize risk, we should try and limit both as much as possible. Therefore, we should, as much as we can, limit discretionary activities that take place with other people. When such activities occur, we should make them as safe as possible.

Protests are almost all outside, which is a good thing. In an ideal world, protestors will also respect social distancing and stay physically apart from each other, as they are able. They should wear masks if they’re shouting/chanting/singing. They should wash their hands, or at least carry hand sanitizer.

If they’re sick, protestors should absolutely stay home.

If they are worried about having been exposed, or have any reason to think they might be infected, they should get tested. They should self-isolate while awaiting results. They should be concerned about infecting others, and make every effort to keep their fellow protestors safe.

Police and public officials have other things to consider. They can avoid crowding people. They can avoid using tear gas and other agents that might increase transmission. They can avoid physical contact and wear masks themselves.

Most importantly, they can avoid arrests.

A recent study published in Health Affairs looked at the relationship between jailing practices and the pandemic in Illinois. They found that “jail cycling” is significantly related to COVID-19 infection. In fact, it accounted for 55% of the variance in case rates in Chicago and 37% in all of Illinois.

Jail cycling was more of a predictor of variance than race, poverty, public transportation, and population density. Unbelievably, cycling through Cook County Jail alone was associated with 15.7% of all documented COVID-19 cases in Illinois and 15.9% in Chicago as of mid-April.

Locking protestors up will increase infections.

Infection control efforts might be better served focusing on these facts and continuing to argue for the things that will make everyone safest from COVID transmission in the coming months and years. That includes continuing to call for much better and more ubiquitous testing so that we can really understand who can participate in riskier activities and when. That also includes the elimination of disparities in every aspect of society, including both the health care and criminal justice system.

We should also publicly recognize that sacrifices matter, financial and personal; it is difficult to make them. COVID-19 is deadly. Economic ruin is horrific. Missing out on important life events is soul-crushing.

Structural racism is all of these things.

Aaron E. Carroll, MD, MS  a healthcare speaker, professor of pediatrics at Indiana University School of Medicine who speaks/blogs on topics such as COVID-19, health research and policy at The Incidental Economist and speaks LIVE on Healthcare Triage. 

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