COVID-19 Exposes Deep-Rooted Inequities, Provides Opportunity for Change

Healthcare experts have acknowledged — and Black, Latinx and Native American patients have long experienced — deep racial disparities within the U.S. healthcare system. The pandemic has tragically underscored this state of affairs, striking down communities of color at disproportionate rates to the overall population. Recently, a group of experts from all corners of the globe and the healthcare system gathered virtually to take on this entrenched issue during The Atlantic Festival. They say the current crisis may offer an opportunity for reform.

As a third-wave of COVID-19 spreads across the country, communities of color continue to be hit the hardest by the pandemic. Black, Latinx and Native American patients are dying at higher rates than White individuals, exposing and magnifying deep disparities in the U.S. healthcare system.

“It’s shocking, but I’m not surprised,” U.S. Representative Robin Kelly (D-IL) said during a recent virtual roundtable of healthcare policymakers, healthcare professionals and academics gathered to discuss racial disparities in the healthcare system. “We’ve been dealing with this forever.”

Kelly represents a majority Black district that stretches south from Chicago, where many of her constituents lack health insurance. Kelly listed access to healthcare as one of the biggest obstacles her community faces. Poorer neighborhoods have far fewer healthcare options than more affluent ones. Transportation costs make traveling for healthcare prohibitively expensive, among many other barriers to access.

The System is ‘Rigged’

The 16 other experts at The Atlantic Festival’s virtual panel also ticked off a number of other reasons for the wide disparity in healthcare.

Genentech’s representatives on the panel unveiled a new study on health equity, showing that a large portion of “medically disenfranchised” patients from Black, Latinx, LGBTQ+ and low socioeconomic status communities forgo treatment because they distrust the U.S. healthcare system and believe it is “rigged” against them.

The survey found that one-third of respondents don’t participate in clinical trials, skip vaccinations and don’t get tested for medical conditions.

This crisis has created a window of opportunity to have real impact and change like I have never seen.

- Eliseo Pérez-Stable, Director of the National Institute on Minority Health and Health Disparities

“COVID-19 is amplifying health disparities in communities of color,” said Genentech’s Chief Diversity Officer Quita Highsmith. “It is now time for us to stop tiptoeing around it and start thinking about what we are going to do.”

Much of the mistrust comes down to a lack of diversity in the healthcare workforce, several of the panelists said.

“We have to look at our workforce,” said Gaurdia Banister, executive director of the Institute of Patient Care at Massachusetts General. “We need to figure out how to advance the diversity so that we have clinicians who look and sound like the patients we take care of.”

Panelists also called on reforms in K-12 education to inspire opportunities for more students of color to embrace future careers in science, technology, engineering and mathematics.

“We need to change the mindset of all doctors,” said Dr. Bon Ku, an emergency room doctor who is also a medical school professor. “That starts in K-12, because becoming a doctor starts there.”

Stacey Stewart, chief executive of the March of Dimes, said eliminating implicit bias among healthcare providers would help close the disparity gap. As an example, Stewart said that pregnant women of color often aren’t listened to when they report pain and other symptoms, and are treated only when in obvious need.

“We reward people when they are more sick than well,” Stewart said. She shared that, “Healthy outcomes require earlier care. We should help women with proper healthcare before they are pregnant.”

Panelists concluded that several complex and interrelated factors contribute to the problem, ranging from implicit bias among healthcare providers to lack of insurance coverage, poverty, poor dietary habits and many other factors.

Opportunity Found in Crisis?

There was hope among the panelists that this once-in-a-lifetime crisis may offer the best chance for change for the better.

“This crisis has created a window of opportunity to have real impact and change like I have never seen,” said Eliseo Pérez-Stable, director of the National Institute on Minority Health and Health Disparities.

Dr. Ku, the emergency room physician from Philadelphia, was more blunt.

“There is an opportunity to blow up the system,” Ku said. “We can’t go back to pre-pandemic ways.”

Clinical research is one area where healthcare disparities are starting to be addressed. Clinical trials are the key to tackling some of the world’s most deadly diseases, including cancer.

Because responses to medicine can vary based on factors like ethnicity, genomic ancestry and gender, it’s important for clinical research to reflect the entire population of patients who experience disease. Historically, patients representing diverse backgrounds have not been included in clinical trials in proportionate numbers. That’s starting to change.

Inclusive Research

Jamie Freedman, head of U.S. Medical Affairs at Genentech, discussed how. Freedman said Genentech sprang into action earlier this year when it became clear that the virus was killing Black and Hispanic people at twice the rate of White people.

In only 16 days, Genentech designed and launched a clinical trial to test one of its medicines on patients with COVID-19 pneumonia. The trial focused on enrolling minority patients who are often underrepresented in clinical trials by coming up with new ways to engage patients from diverse backgrounds.

We have to make this more than a moment. This has to be a movement. When the pandemic is over and we are back to everyday life, are we still going to be talking about this?

- Quita Highsmith, Vice President and Chief Diversity Officer, Genentech

“As the pandemic moved across the United States, our main focus was going to community-based hospitals in underserved patient populations so we could enroll as many minority patients as possible,” Freedman said.

It was successful: about 85% of patients came from racial and ethnic groups typically underrepresented in clinical studies.

Freedman affirmed how the trial reinforced Genentech’s commitment to inclusive research in clinical trials and its importance to the patients, company and industry.

“This is really a call to action,” Freedman said. “We want the entire industry to do more of these types of trials.” Genentech will share its learnings so this success can be replicated.

Genentech’s Highsmith said the key to lasting, systemic change, is to act now with real reforms.

“We have to make this more than a moment. This has to be a movement,” Highsmith said. “When the pandemic is over and we are back to everyday life, are we still going to be talking about this?”