THIS IS PERSONAL

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This is Dr. Ron Wyatt as a pre-med student at the University of Alabama Tuscaloosa in 1974. He was denied admission to UAB’s medical school partly due to his protest of a racist test question in biology. After three attempts applying to medical school, he was accepted at Morehouse School of Medicine.
A note to our readers: This edition of our newsletter was in production prior to the senseless and shocking murder of George Floyd at the hands of a former Minnesota Police Officer. At More Inclusive Healthcare we stand with George Floyd’s family and we stand for his brother Terrance’s calling for “Peace on the left, justice on the right.” As it is reflected in Dr. Wyatt’s story that follows, we believe that systematic oppression and racial trauma are the foundation of health disparities. Racism is a public health crisis and all of us at More Inclusive Healthcare will continue to disrupt the system and work towards long-term culture change through coaching, education, and training because #ThisIsPersonal.

COVID-19: Structural Racism and Health Inequity

Dr. Ron Wyatt, Vice President and Patient Safety Officer at MCIC Vermont, LLC and Physician Champion for Quality and Health Equity at More Inclusive Healthcare

Health disparities are personal to me because I have witnessed and experienced their injustices. Early on in life I had some encounters with racism in healthcare that lit a fire inside me before I even knew what health equity was. As a young African American man growing up in Perry County, Alabama, I remember being segregated from white patients in the waiting rooms of doctor offices. I remember one local physician who put sutures in a Black child, but when he found out the mother couldn’t pay, he removed them and she had to take her child to a veterinarian instead.

I had seen enough to motivate me to go into medicine to push for better, more equitable healthcare, and so I became a doctor, despite the odds. As an undergraduate biology major at The University of Alabama Tuscaloosa I protested a test question that was posed in the following way: “What reproduces the fastest? A. rabbits, B. rodents, C. negroes, D. plankton.” My objection resulted in federal mediation and a Washington Post article that was not well received by the University. When I subsequently applied for medical school at The University of Alabama at Birmingham (UAB), one interviewer told me that because of my actions at Tuscaloosa, he would not let me into medical school even if I attended the University for another four-year degree and made all A’s.

Some might point out that experiences like mine are relegated to the history books. But COVID-19 has arrived and painfully and tragically exposed to the world that a long history of racial disparity has taught us very little. Racism lives on and African Americans are dying from it. Regrettably, it comes as no surprise that Black people are infected with the novel coronavirus at a higher rate and dying from COVID-19 in disproportionate numbers. A report through June 10, shows that if all Americans had died at the same rate as White Americans, White Americans, at least 14,400 Black Americans, 1,200 Latino Americans and 200 Indigenous Americans would still be alive.

The reasons for the enormous death gap for Blacks are simple yet complex. Because typical social and working conditions in Black, urban communities make it difficult to be physically distant, Black people may be more prone to catching the coronavirus. Additionally, some Black people did not believe that social distancing was a necessity early on, partly due to false, racialized, disease narratives of Black immunity. To complicate matters more, early testing was in short supply and reserved for people who had recently traveled or were in contact with those who had traveled or already tested positive—which presented a structural barrier to testing our most vulnerable populations. Black communities across the country are now in the crosshairs of inequity, bias, racism, and increased rationing of care. Comorbid conditions, nonmedical determinants of health, and high allostatic load all further contribute to the high risk of infection and death for Black people from COVID-19.

While the mainstream media conversation about Black people and COVID-19 would have us focus on the impact of chronic diseases as the most significant contributor to the enormous inequity being experienced by Black people, we cannot and must not be distracted from the other stuff that is killing us and being exacerbated by the pandemic. We see increased unemployment, more police brutality, worsening hunger, housing evictions, and heightened minority stress. It is true that coronavirus patients who have a chronic condition like high blood pressure, obesity, or diabetes are more likely to develop COVID-19 and have a harder time recovering from it. But chronic diseases are the downstream expressions of upstream causes—primarily institutional and structural racism. This is the true conversation we need to have about COVID-19.

Historical injustices are not new. Over one hundred and twenty years ago W.E.B. DuBois wrote a scientific report that looked at the quality of care for Black people in Philadelphia called Philadelphia Negro. DuBois describes “a peculiar indifference” to the health, healthcare, and health outcomes of African Americans in Philadelphia. We see this indifference to the suffering of African Americans being played out in the pandemic and the streets today as a stark reminder that the peculiar indifference has persisted. Some providers are dismissing Black patients’ symptoms, while some Black people are reporting being turned away from healthcare facilities altogether. Some Black people may even delay seeking medical treatment for COVID-19 because of historically rooted mistrust of the healthcare system, including care that is laced with implicit bias. By the time some Black people are admitted to the hospital, if they make it there, they may be worse off than other patients.

It is the rule, rather than the exception, that African Americans bear the brunt of health and healthcare disparities. In the midst of this pandemic it is more urgent than ever that we act collectively, mutually, and intentionally to declare that if health inequity is to be eliminated, structural and institutional racism must be called out, addressed, and eliminated at long last. We must begin to build a system that is responsive to non-white and other marginalized patient populations. Leaders who care need to root out biased decision-making and communicate to care teams and policymakers about the need to serve the most vulnerable. We have to begin to hardwire this inside healthcare organizations.

For many years I have called for one major action step. We need a national patient safety goal that states that disparity and inequity must be eliminated. This must include collecting accurate race, ethnicity, and language (REAL) data and sexual orientation and gender identity (SOGI) data. This data must be analyzed and acted upon to ensure that resources are provided where they are most needed. In addition, we must go beyond cultural competency training and implement education and training for reducing implicit bias and fostering cultural humility in healthcare. We must lead with love and value all people. This is personal. This is heart work.

Below you will find articles about the topics discussed that we hope you will share to help raise awareness and spark discussions about these issues. We have also included links to a COVID-19 racial data report and a racial data tool on the pandemic, where you can see how your state is faring daily.

Best,
Ron Wyatt, MD, MHA

Ronald Wyatt Bio

Health Equity Champion Ron Wyatt, MD, MHA, is an executive leader with over twenty years of clinical experience. He is recognized in the U.S. and abroad as a patient safety and quality improvement expert. With passion and humility, Dr. Wyatt has dedicated his career to overcoming the historically rooted indifferences that continue to disproportionately affect minority patient populations. He hopes his work will motivate individuals, organizations, and the broader healthcare system to look inside and figure out how they can become better.

ARTICLES

March 23, 2020, Dorianne Mason, Rewire.News

Truly investing in the health and well-being of Black women would reform our healthcare system and obviate the inevitable scramble to address public health crises like COVID-19.

April 14, 2020, Colleen Walsh, The Harvard Gazette

Harvard experts discuss how the coronavirus pandemic is providing new figures showing that the pandemic is exacerbating longstanding racial inequities in American society.

May 5, 2020, Frieda Wiley, yes! Solutions Journalism

As the coronavirus exacerbates longstanding racial health disparities, researchers, local governments, and philanthropists are looking to data to understand and mitigate its impact.

RESOURCES

June 8, 2020, Duane Reynolds, MHA, Founder & CEO, Just Health Collective

With the recent murder of George Floyd and the subsequent protests and riots across our nation, there is no denying these are some of the most profound moments of racial unease we have experienced in our lifetimes. But, Duane Reynolds believes we have an opportunity in time like no other to honestly confront the festering wound that has hampered us for generations: systemic racism.

June 10, 2020, APM Research Lab Staff

This report from APM Research Lab deeply analyzes data about the race and ethnicity of deaths from COVID-19 through May 11, 2020, compiled from Washington D.C. and the 39 states releasing these statistics.

June 2020, The COVID Tracking Project

A collaboration of the COVID Tracking Project at The Atlantic and the Antiracist Research & Policy Center, the COVID Racial Data Tracker collects, publishes, and analyzes racial data on the pandemic from across the U.S. to track inequity. The tool includes a dashboard where you can see the racial breakdown of positive cases and deaths by state daily.

More Inclusive Healthcare (MIH) is a minority woman owned social enterprise and small business. We coach healthcare executives in establishing vision and strategic priorities for health equity, healthcare disparities resolution and racial justice. We also offer related training and education programs for your healthcare staff. Our most popular eLearning module focuses on the foundation of all health disparities work – race, ethnicity, and language data collection training for registration staff. Training modules for more advanced health systems includes implicit bias education and using data to discover and resolve healthcare disparities. All training can be combined with on-line, live education with a trainer. Please consider More Inclusive Healthcare as you strategize on historically important work of making healthcare more inclusive and equitable so that all people have the opportunity to achieve their full health potential. Contact us, we will help.

#ThisIsPersonal

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