Health inequity for African Americans is not a new phenomenon. COVID-19, however, shined a light on the problem.
The COVID-19 virus hit African Americans disproportionately hard. African Americans are still contracting the illness—and dying from it—at rates twice as high as would be expected based on their share of the population. In Michigan, African Americans are only 14% of the population, but account for one-third of the state’s COVID-19 cases and 40% of its deaths. In some states, the disparities are even more stark. Wisconsin and Missouri have infection and mortality rates three or more times greater than expected based on their share of the population.
Some have suggested these disproportions are because of several factors: African Americans are more likely to live in poor neighborhoods, work at riskier occupations, and have more underlying health conditions and limited access to health care. But similar inequities exist in African American communities with above-average wealth and health care access. Staggering rates of COVID-19 occurred in Prince George’s County, Maryland—the nation’s wealthiest African American enclave. Comparable White communities were relatively unaffected.
African American women are more than twice as likely to die from childbirth than White women. Even if the African American women were educated and wealthy, they were more likely to die from childbirth than uneducated and poor White women.
An analysis by the National Academy of Sciences found African Americans receive poorer quality care than White patients across all medical interventions and routine health services—even when insurance status, income, age, co-morbid conditions, and symptom expression were equal. Experts point to racism as a root cause for these disparities. Indeed, the American Academy of Pediatrics has outlined how racism affects health outcomes for African American children.
When health providers withhold critical information about a health condition; when they don’t include the patient’s voice during decision making about care; and when they don’t refer the patient for further tests or specialty care, this can result in patients being less likely to understand their health conditions, which is necessary for patients to manage an illness effectively. Patients who are well-informed about their health and confident in managing their care have better outcomes virtually across the board: in HIV-AIDS, cancer, diabetes, cardiovascular disease, and mental health conditions such as schizophrenia.
The location of hospitals, clinics, and other health care facilities are often a barrier to care. Transportation—or the lack of it—affects the patient’s ability to receive services. African American patients have noted the frustration when health care facilities are not close to their homes. To get there, many of them rely on public transportation. The result: missed or canceled appointments, sometimes because of policies regarding late arrival times by patients.
Differences also exist between African American and White patients in the length of wait time for appointments and the ability to schedule follow-up appointments. This can result in delayed health care—which leads to poorer health outcomes for illnesses, including COVID-19.