July 5, 2020
AliExpress WW

The Panel believes that several approaches are needed to overcome health inequalities in the United States.

AliExpress WW
  1. Janice Hopkins Thane
  1. New York, USA

Mortality from covid-19 among black Americans is almost double that among whites, and blacks, browns and natives are facing structural racism and health inequalities, experts say.

AliExpress WW

Not only do minority Americans die at a higher rate from Covid-19, they also die at a higher rate than whites from chronic diseases. The maternal mortality rate for black women is three to four times higher than for whites.

Although black Americans make up about 13% of the population, they account for 24% of covid-19 deaths when the race is known. About half of deaths at the age of 19 do not have racial data, says Lori Zefirin, an obstetrician-gynecologist who is vice president of the Commonwealth Fund. According to her, similar differences exist for Hispanics and Native Americans.

Racial mortality data are incomplete for most states, and North Dakota does not report racial data, she said. Mortality among Hispanics and indigenous people is reported to be higher than among whites.

Among the reasons for this discrepancy is that these minorities are more likely to live in contaminated communities that predispose them to health problems, less often than whites with health insurance, less often than whites to be able to work from home, and face bias in medical treatment, she said. They are more likely to remain unemployed due to a pandemic and thus lose employment-based health insurance.

The panel was organized by the Health Policy Alliance, a non-partisan, nonprofit organization dedicated to improving understanding of health policies, health issues, and change proposals; The Commonwealth Fund, which promotes a high-performance healthcare system with improved access, quality and effectiveness, especially for the most vulnerable sectors of society; and the National Institute for Health Management, a non-profit, non-partisan organization whose goal is to improve healthcare.1

Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota, said the pandemic showed it wasn’t working. He said: “We have the opportunity to build a new system.”

Wizd Powell, director of the University of Connecticut Institute for Health Inequality, said there is a link between people with discrimination and poor physical and mental health. The differences, both before the pandemic and now, “have significant implications for healthcare costs and labor productivity, and thus affect our ability to compete in the global market,” she said.

Adaez Enekčevi, an expert on health policy at George Washington University, said that the number of cases of infection with Covid-19 continues to grow, and 200,000 people are likely to die by October. According to her, the United States was unique in the world in its gloomy results. “We are the richest country in the world, but we see results that look like you can see in a poorer developing country.” The current situation shows what needs to be done to deal with the next pandemic, natural disaster or public health crisis, she said.

Among the changes recommended by the commission are improved data quality, universal health care and the termination of labor medical insurance, as well as increased participation of minorities in the health workforce.

Data on race, ethnicity and knowledge of English is needed to show where the problems are.

Powell said: “We are not sufficiently educating blacks and minorities. “We must open new paths to the human resources for health for people unemployed as a result of the pandemic.”

“We need more people of color in the healthcare sector,” said Enekwehi. “They are more likely to return to their communities after training – often in rural areas where there are few trained workers and hospitals close.”

According to her, they will help put an end to antagonism on the part of medical workers, because they trust the community and understand it. Minorities “were experimented, received no treatment, disrespectfully and were not treated for pain,” she said. Continued distrust will worsen their reaction to contact tracing and even to the vaccine when it becomes available.

Universal health could be achieved if the United States replaced employment-based health insurance with the expansion of Medicare (state health insurance for the elderly) and Medicaid (health insurance co-paid by the federal government and some states). Affordable Care Act encouraged states to expand Medicaid, but 14 states, mostly in the south, did not.

This article is made freely available for use in accordance with the terms and conditions of the BMJ website for the duration of the covid-19 pandemic or until the BMJ determines otherwise. You can use, download and print the article for any legal, non-commercial purposes (including extracting text and data), provided that all copyright and trademark notices are preserved.



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