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Unpacking COVID-19 Inequities and Exploring Strategies to Minimize Healthcare Disparities Among BIPOC Communities

Stephaun Elite Wallace, PhD, MS

Clinical Assistant Professor
Global Health
University of Washington
Principal Staff Scientist
Vaccine and Infectious Disease Division
Fred Hutchinson Cancer Center
Seattle, Washington

Stephaun Elite Wallace, PhD, MS, has no relevant financial relationships to disclose.

View ClinicalThoughts from this Author

Released: January 17, 2023

Key Takeaways

  • BIPOC communities are disproportionately represented in COVID-19 cases, hospitalizations, and deaths, and this is not related to race or ethnic identity, but rather to systems and norms that are grounded in racism, xenophobia, homophobia, transphobia, and other forms of discrimination and bias.
  • The likelihood of illness in BIPOC communities is related to overrepresentation in essential and low-wage jobs, housing or living arrangements, and high levels of chronic stress.
  • Healthcare professionals should partner with BIPOC communities in healthcare delivery and planning to create trustworthy relationships.

The Problem
Although attention has shifted away from COVID-19 for much of the United States, we continue to observe more than 400,000 cases, more than 5800 hospitalizations, and nearly 2500 deaths weekly. Black, indigenous, and people of color (BIPOC) communities are disproportionately represented in these numbers. This is not related to race or ethnic identity, but instead is due to longstanding and pervasive social and structural systems and norms that are grounded in racism, xenophobia, homophobia, transphobia, and other forms of discrimination and bias that can be conscious and/or unconscious, and explicit and/or implicit. BIPOC community members who carry multiple identities that are devalued socially are even more vulnerable to the interactive effects of these social and structural systems of discrimination and oppression, which result in extreme disease burden and general health inequities, including COVID-19 inequities.

The experiences BIPOC community members carry from navigating these often negative, violent, and racist social and structural systems include those within healthcare systems. The historical examples of abuse and mistreatment of BIPOC communities by the medical and scientific community are well documented, and it should be apparent and appreciated that these examples still inform how (or not) BIPOC communities engage in healthcare today.

Possible Solutions
To inform how we can support BIPOC communities to reduce COVID-19 inequities and healthcare disparities, we should consider BIPOC community and patient engagement strategies that are informed by a foregrounding of medical racism from both a historical and contemporary perspective. These strategies should support efforts that seek to detach race from biology and overcome attitudes and beliefs that racial differences equate to material indicators of substantive biological and physiological differences. In short, BIPOC communities and members are not inferior to their White counterparts, and every attempt should be made to ensure that any vestige of this belief, which is interwoven into the fabric of medicine and science, is identified and addressed. Policies and perspectives in our healthcare system, and attitudes and beliefs of healthcare professionals (HCPs), contribute greatly to the harm and abuse that BIPOC communities experience.

We also should consider that, due to social and structural systems of oppression, the likelihood of illness (in general and due to COVID-19) is increased because:

  • BIPOC communities are overrepresented in jobs and careers considered essential, placing them at higher risk for exposure to SARS-CoV-2.
  • BIPOC communities are overrepresented in low-wage jobs that do not provide (or do not provide sufficient levels of) health insurance, paid sick leave, childcare, options to work remotely, or other benefits such as retirement savings, which can be leveraged in times of economic hardship. These experiences further affect one’s ability take time off when sick or to be supported by systems to ensure optimal wellness.
  • BIPOC communities are more likely to live in residentially segregated settings with high housing density, live in more multigenerational households with limited space for physical distancing, and have poor access to healthy food options. These experiences further affect the immune systems of members of these communities and the ability to reduce SARS-CoV-2 exposure.
  • BIPOC communities experience increased levels of chronic stress, resulting from structural racism, increased incidence of violence, and everyday aggressions and trauma. These experiences further affect the immune systems of members of these communities.

As HCPs, the onus is on us to establish trustworthy relationships with BIPOC patients and communities. This is an important factor in identifying and reducing COVID-19 inequities and healthcare disparities. BIPOC communities who do not trust HCPs or institutions likely will not engage except in emergencies—if at all—which ensures that health inequities remain constant or worsen. An HCP seeking to establish themselves as trustworthy to BIPOC patients should endeavor to demonstrate accessibility, approachability, attentiveness, empathy, honesty, humility, and respect. When a conflict arises, immediately seek to resolve and involve the patient in the solution process.

We also should partner with BIPOC patients in healthcare delivery and planning. HCPs should pay close attention when BIPOC patients report pain or discomfort and ask clear and probing questions to uncover the root causes. HCPs should maximize opportunities to educate patients on COVID-19 and related inequities, including COVID-19 vaccination, through respectful and patient-centered communications that include listening with the intent to understand a patient’s perspective and asking permission to inform. Focus on answering patients’ questions directly, rather than seeking to anticipate or making assumptions about what they know, and speaking accurately without unnecessary scientific jargon.

BIPOC communities are at increased vulnerability to experiencing severe COVID-19, hospitalizations, and death, and they should be prioritized for healthcare outreach and engagement. These high-risk BIPOC groups include:

  • Unvaccinated or undervaccinated persons
  • Persons with preexisting health conditions associated with severe COVID-19 (eg, chronic kidney disease, chronic obstructive pulmonary disease, heart disease, diabetes, obesity)
  • Pregnant persons
  • Persons with disabilities
  • Persons in correctional facilities
  • Persons who are unhoused
  • Older adults and children

Among BIPOC, indigenous and native communities may require special support around healthcare and COVID-19 vaccination, especially those living on reservations. All of these efforts must not be presented in ways that contribute further to social stigma.

Your Thoughts?
How do you and your staff actively engage with your BIPOC community members to reduce or prevent inequities related to COVID-19? Join the discussion by posting a comment below.

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