Q&A: Why minority patients are suffering more during COVID-19; how physicians can help

The COVID-19 pandemic is shining a glaring spotlight on the social determinants of healthcare, and how minority and marginalized patients are receiving inferior care — or no care at all. The American Medical Associaton has long been an advocate for better representation of minority and marginalized populations in healthcare and has been particularly active with the issue during the pandemic.

AMA Immediate Past President Patrice Harris, MD, is sharing the problems and the solutions to these glaring disparities with Physicians Practice.

Physicians Practice®: What is the problem that AMA and member physicians are seeing in terms of black and other minority populations not receiving adequate medical care during COVID-19?

Harris: We continue to see that marginalized and minoritized patients have and will suffer disproportionately during the COVID-19 crisis. This pandemic has amplified the long-standing and systemic health inequities that underserved communities face.

Recent research published in the Journal of the American Medical Association (JAMA) found that in major U.S. cities, counties with a substantially non-white population had a COVID-19 death rate of up to nine times higher when compared to counties that were substantially white—even with the same median income.

We know that marginalized and minoritized patients are at a greater risk of contracting COVID-19 due to:

• Preexisting conditions, such as diabetes, hypertension, and obesity that disproportionately impact the Black community.
• Essential jobs that are not in the health profession—including bus drivers, train operators and custodians—are overrepresented by communities of color.
• Structural inequities and social determinants of health that are influenced by implicit bias and racial discrimination, which present barriers to health care access. 

Physicians Practice®: What can be done to better serve these populations during the pandemic?

Harris: Science and data can be used to address inequities that continue to plague the U.S. health system. Because insufficient data could widen existing health gaps, we need to pay particular attention to race and ethnicity data, which are crucial to understanding health inequities.

At the start of the pandemic, the American Medical Association (AMA) successfully called on HHS to collect and release demographic data to help understand any potential race, sex, age disparities during the pandemic to prioritize equity and effectively manage the response. 

Over the summer, the AMA submitted a statement to Congress in connection with a hearing on the disproportionate impact of COVID-19 on communities of color, recommending that lawmakers invest in professional diversity and adopt policies addressing such issues as implicit and unconscious bias; data collection challenges; and social determinants of health.

Physicians Practice®: How can physicians/practices better reach these underserved communities? What programs/resources are available to assist physicians with this issue?

Harris: Ensuring that underserved and under-resourced communities have ample access to physicians is a challenge in normal times, and the COVID-19 pandemic has exacerbated this issue. While there is no one-size-fits all approach, there are some considerations and resources for physicians to help reach underserved communities and deliver the best patient care.

To start, at the core of high-quality medical care is establishing a trusting relationship between patient and physician, which may be primarily virtual under the current circumstances. It’s essential to recognize that minoritized communities face significant challenges with accessible, reliable, and quality telehealth — and to be proactive in enabling these patients to have their health needs met.

The AMA has urged lawmakers to expand broadband infrastructure and access to telehealth services.

Also important is the dissemination of culturally appropriate health information for those who may not be connected to mainstream health communications. Grassroots community outreach organizations can help provide fact-based information to these communities, reducing fear and uncertainty about COVID-19 and other health issues.

The AMA continues to compile critical COVID-19 health equity resources for physicians, including a COVID-19 FAQ page about health equity during a pandemic, to shine a light on the structural issues that contribute to and could exacerbate already existing inequities.

The AMA also recently launched the COVID-19 health equity initiatives across the United States webpage, aimed at showcasing national efforts using equity lens to curb the COVID-19 epidemic. By highlighting the issues along with the solutions, the AMA hopes that healthcare leaders and public health officials can apply these learnings in their efforts towards advancing health equity.

Other available resources include:

AMA’s EdHub module and physician resource guide on accurately collecting race and ethnicity data within their practice, specifically when it comes to the disproportionate impact of hypertension on Black, Latinx, Asian, and Native American adults who are less likely than white adults to have their blood pressure controlled.

AMA’s Doctors Back to School pipeline program that uses practicing physicians, usually of color, to visit elementary and high schools to outreach to underserved populations as a way to introduce young people to professional role models of all racial and ethnic groups and increase the number of minority physicians.

AMA also encourages physicians to utilize the PRAPARE screening tool, which helps physicians and care teams to screen for and act on patients’ social needs.