I am a board-certified African American orthopedic surgeon. I continue to see patients and care for trauma cases, but I am not on the front line of this fight. My practice encompasses patients from some of the wealthiest Zip codes in Manhattan and from some of the poorest in rural and inner-city Connecticut. My wife, also a physician, works at a care facility for underserved areas, known as a federally qualified health center. It is from these perspectives I observe the inequities deeply rooted in the nation’s health-care system.
Many factors have fueled the racial disparities in covid-19 outcomes: lower access to health care and higher rates of asthma, diabetes and heart disease. There are social, economic and political reasons for these lopsided outcomes. We call them the “social determinants of health” — a group of nonmedical variables that impact up to 80 percent of health outcomes. These social determinants include access to healthy food, transportation, Zip code, health insurance and even mold levels. Most of these are not immediately correctable. New supermarkets to place fresh vegetables in communities that are food deserts will not be built tomorrow. The next day we will not narrow education achievement gaps.
To that long list of traditional social determinants affecting my community, I would like to add one more, with a 400-year context: the African American “essential worker” designation.
In the medical world, as elsewhere, these workers often go unnoticed and too often unnamed. They are the hospital cleaning personnel, the delivery, food service and warehouse workers, and municipal employees who truly are on the front line. They stand between us and pure social chaos. These workers are black or brown, low-wage and with limited formal education. They come in contact with the coronavirus in its most pernicious forms: on cardboard, stainless steel, on clothing and in the air. Pandemic 1, African Americans 0.
As if fighting this silent enemy were not enough, the communities of these essential workers often have low rates of testing and few testing facilities. Everyone I know who desired a test has managed to get one. My neighbors line their vehicles up for tests at one of Connecticut’s many drive-through sites, just as they lined up at Starbucks in January. Instead of using an app to order a latte, they grasp the winning ticket of a prescription for testing from their primary-care physician. I know of only a few walk-up testing facilities in the neighborhoods where the disease is most prevalent. For essential workers who don’t have a car or primary-care physician, and can’t find a local walk-up site, that means one thing: no covid-19 tests. Pandemic 2, African Americans 0.
In cities where essential workers rely on public transportation, they now find reduced train and bus schedules — placing more people onto fewer transports and making social distancing unlikely. With many doctors and nurses scrambling to find personal protective equipment, what are the chances that these workers — also laboring in proximity to the disease — are going to be adequately supplied? After work, they nonetheless must head home on that same overcrowded public transportation. Pandemic 3, African Americans 0.
I rely on telemedicine to help many of my patients, communicating with them through what is essentially a one-on-one video conference. Though minorities have high levels of smartphone ownership, telemedicine has largely failed to catch on in African American and Latino communities. That’s unfortunate, because it removes an important tool for screening, reassurance, education and care. Pandemic 4, African Americans 0.
In trying to inform the public about the pandemic, have we done our best to reach young people where they interact? I worry particularly about the young black men and women. Their media diet may not include CNN or The Post or other major news outlets. Why can’t the same systems used for flash-flood warnings and Amber Alerts be deployed to reach a population with high rates of cellphone use? Until that happens, Pandemic 5, African Americans 0.
Addressing any or all of these social determinants is not just the moral thing to do — it is vital for flattening the curve of covid-19 infections nationwide. African American outcomes are America’s outcomes.