As protests rage in cities throughout the United States, the world sees our country’s pain and desire for justice. Like everyone else, I worry about whether there will be meaningful criminal-justice reform and what we will do to finally address institutional racism. But I also worry about something else: the direct health effects of the uprisings.

My worry is greatly magnified by the ongoing crisis of covid-19 — a crisis with which the ongoing protests are deeply intertwined.

In 2015, my city of Baltimore erupted after the death of an African American man, Freddie Gray, while in police custody. The news coverage focused on the burning cars, looted stores and standoffs between protesters and law enforcement.

As the city’s health commissioner at the time, I saw a different picture unfold. In the initial days of the protests, clinics were closed because of safety concerns. Patients didn’t know whether they could get care. Many were too scared to venture out. We had to figure out which health centers were still open and how to direct people to them. People still needed lifesaving treatments such as chemotherapy and dialysis, and we worked with state and local officials to coordinate safe passage of staff and to arrange transportation for patients.

We received hundreds of calls for other health concerns. There was an elderly woman who’d had a heart attack a year earlier and who had run out of her blood-pressure pills. Her pharmacy was one of more than a dozen that burned down and closed, and she and her neighbors didn’t know where to get their prescriptions filled.

Nearly 6 in 10 Americans who are working outside their homes are concerned that they could be exposed to the virus at work and infect their families. (The Washington Post)

I remember a call from another woman, who was being treated for a blood clot in her lungs and was out of her blood thinner. Her doctor’s office transferred her prescription from her regular pharmacy to one that was two miles away. She had no way of getting there and no relatives who could help her; “It might as well be a hundred miles,” she said at the time.

I talked to a man with diabetes who had run out of food. Like 1 in 3 African Americans in Baltimore, he and his elderly mother lived in a food desert. Already faced with limited options, they lost their access to groceries when their local corner store was vandalized and had to close.

While we worked to set up prescription-delivery services and transportation to access food and other necessities, we also became aware of the acute mental health impacts that our residents were facing. People described how a lifetime of trauma that they’d suppressed came out in that moment. The anger at police brutality was compounded by fear of personal safety and grief over the destruction of their community. Calls to mental health hotlines skyrocketed. In the weeks that followed, our community also experienced an increase in the number of drug overdoses.

What we experienced in Baltimore is going to be seen in cities all around the United States. When access to health care and other essential services is disrupted, those who are already the most vulnerable suffer the most. Existing disparities will be amplified in communities that already bear the brunt of structural racism and health inequities.

And, of course, there’s a new dimension now, too: the coronavirus pandemic. By now, all of us know that covid-19 has struck vulnerable communities the hardest. Black Americans are dying at nearly three times the rate of white Americans. The reasons underlying the disparate outcomes are part of the trigger for the protests, and now there is also the concern that the mass gatherings will increase transmission of covid-19 among the same communities.

Addressing the health aspects of protests must go far beyond guidance for reducing covid-19 risk, such as wearing a mask and practicing hand hygiene — important as these are. We need to support local health departments and community-based organizations that are providing food, transportation and medication access. We need to ramp up testing and treatment so covid-19 related services can be provided free and are specifically targeted to underserved and minority communities. We need urgent attention to the mental health impacts of the converging crises in health, the economy and social stability.

And we must keep in mind that institutional racism and injustice are at the root of disparate outcomes in health. Uprisings affect people’s health in the short term, but the reason they are occurring is because of the long-standing reality that people’s lives are valued differently in our society. This is a reality that none of us should tolerate.

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