The COVID-19 Pandemic: An American Health Divide

Editor’s Note: We are grateful Dr. Ray Breaux is contributing his medical expertise to PACE NEWS to help educate in times like these. This article here and in our print edition is one of a series of articles Dr. Breaux will be contributing to enlighten PACE  NEWS readers. Please feel free to comment.  

 

 

 

By Dr. Ray Breaux   

“Where you live often determines how well and how long you live”.  In a recent study of Harris County Health System. in Houston Texas Dr.  Shah, Director of Harris County Public Health, Houston, Texas, stated  that the COVID-19 Pandemic has led to tracking by targeted zip codes that are showing a higher incidence of this COVID -19 in underserved  than  non-underserved communities.  Perhaps what should more appropriately called “under-resourced” as opposed to “underserved” communities,  African- Americans and other ethnic minorities living in under-resourced/ underserved communities are at greater risk of infections from the COVID-19.  Besides being under-resourced/ or underserved there are some long term social factors that significantly contribute to and serve as determinants of the quality of health  and social wellbeing of the residents.  These include; overcrowded housing for family size, poor nutrition, limited education and low incomes.

The Civil Right Bill of 1965 (CRB’65) removed some of the Jim Crow laws that proved to be structural and cultural barriers to blacks entering mainstream society.  However, the effects of social isolation caused by segregation has had long term adverse effects on the biological, physiological and behavioral health of Blacks and other  ethnic minorities.  To a large extent, research is still lacking to better understand and improve the quality of health for future generations of African Americans.  According to the Center for Disease Control (CDC) and the World Health Organization (WHO), health is defined as the physiological, mental, and social well-being of a person or group.  It is well documented that, historically, as United States slave descendants of African origin Black people in America have been inhabitants of socially impoverished conditions.  Fast forwarding to the present, African Americans remain the most socially vulnerable and   the ethnic group suffering from the highest rate of chronic diseases.  This include: Diabetes, Hypertension, Obesity, Chronic Obstructive Pulmonary Disease (COPD), and Mental Illness. According  to the OMH these chronic diseases  have contributed to African Americans having  the highest rate that have contributed to African American  high mortality rate associated with  covid-19 death..

Moreover, African Americans and other ethnic minorities have been exposed to many generations of long term exposure in workplace environments and other non-workplace toxic  environments that have been associated with mental and/or chronic diseases, Veldsman, T.(2016).  There are a number of other social factors in society that contribute to the disproportionate burden of public health crises on certain populations.  These include socioeconomic status, age, ethnicity, Limited English Proficiency (LEP), housing type, vehicle access, and other cultural and structural barriers. For example, African Americans are more likely than whites to lack health insurance coverage.  African Americans are more likely to go without needed care due to cost. African Americans are more likely to distrust the healthcare system. African Americans also, very frequently, encounter a language barrier and discrimination because they speak English less than very well.. US Census (2020).

Approximately eight percent of U.S. residents report speaking English less than very well and one in five U.S. residents speak a foreign language at home, at the age of 10.   This equates to more than 61 million people,US Census (2020). One in five adults in the U.S. have limited English literacy levels, of which 34% are Hispanic and 23% are Blacks..  African Americans and other ethnic minority groups  live in areas that are further from medical facilities or where medical facilities are under-resourced . A recent study by the Office of Minority Health (OMH), showed African Americans  and other ethnic minorities are generally more vulnerable to the negative impact of public health emergencies and disasters.  Another study  also showed that Black who were exposed to  Hurricane Katrina  developed higher risks  of  Chronic Obstructive Pulmonary Diseases( COPD)  from the  exposure  to  mildew and mold .(Doheny,K. 2017) This study is consistent with the Office  of Minority Health( OMH)  study that  found  African-Americans  and other  ethnic minorities experienced higher rates of injury, diseases, traumatic stress, death , and loss due to public health emergencies than non-minority populations.,

Thus , a number of health and social challenges place African Americans and ethnic minority populations at higher risk for poor health in a pandemic.  This includes higher mortality, more medical complications, limited access to health care, lower annual influenza vaccination rates, greater socioeconomic, cultural, educational, and linguistic obstacles to the adoption of pandemic interventions. The, OMH data collection from the COVID -19 Pandemic suggests that African Americans and ethnic minority populations bear a disproportionate burden of illness and death from COVID-19.  The decline and  paucity  of black professional schools has also contributed to the lower socioeconomic status and health inequity   in African-Americans and other ethnic minority population..  As the United States population continues to grow in number, age and diverse cultures, the need  for medical  facilities in the underserved/under-resourced  communities will also grow.  Currently there are 100 plus Historically Black Colleges and Universities (HBCU’s) that are adjacent to underserved/ under resourced communities. However, in the entire United States, as compared to their white counterparts, there are  only  (4) black medical schools, seven (7) black pharmacy schools and 40 nursing schools to serve the underserved/under-resourced  communities.  Hence, the disproportionate number of Black physicians as compared to white physicians also contributes to  the socioeconomic and  health/healthcare  inequities or needs  in  underserved/resourced communities.

Moreover, the shortage of physicians is being offset by the rapid advancement in tele-medicine is making it necessary for HBCU’s to expand their health curricula into  non-traditional roles in healthcare delivery.  That is, HBCU’s must now integrate tele-medicine into their curricula  as an outreach to the underserved//under-resourced communities .  While this expanded curricula not only promotes closer communications between HBCU’s and the adjacent communities, this  non-traditional HBCU role has also become important in the removal of cultural and structural barriers. Consequently, this reverses the inequities that exists in the health and healthcare of underserved/under-resourced communities.

The formation of Community University Task Force Committees can also be used to better coordinate different community groups to expand the the role of HBCUs as institutions of higher learning in the prevention and treatment of the aforementioned chronic diseases in African American and ethnic minority sub populations, i.e.; Obesity, Diabetes, Hypertension, Chronic Obstructive Pulmonary Diseases (COPD) and other respiratory diseases e.g. COVID-19 and mental illness.