Q: I hear that communities of color are experiencing more severe illness and death from COVID-19. What role does the healthcare system play in contributing to worse outcomes?
A. One way to think about the healthcare system is to imagine links in a chain. Researchers have used a framework like this (“cascades of care”) to improve clinical outcomes for other diseases.
The following are a few of the links in the chain of care for COVID-19, which can help identify some of the weaknesses that have left communities of color disproportionately impacted by the epidemic:
HEALTH INSURANCE: Even before the pandemic, Blacks and Latinos were more likely to have inadequate health insurance (or none at all). Then the pandemic came along, resulting in millions more losing their jobs—and, along with that, their health insurance. (https://www.pewsocialtrends.org/…/about-half-of-lower…/). Without insurance, families often put off seeking care, so that when they do show up, their disease is so far advanced that treatment is less effective.
TESTING: In many cities, predominantly Black and Latino neighborhoods have fewer testing sites (https://www.npr.org/…/across-texas-black-and-hispanic…. Moreover, in most states people have needed a referral from a doctor to get tested which further limits access for individuals that don’t have a regular care provider. If people don’t know they’re infected, they are more likely to infect others.
ACCESS TO CARE FACILITIES: Access to ambulatory care facilities and pharmacies is more limited Black and Latino neighborhoods (https://jamanetwork.com/…/jamanetwo…/fullarticle/2766043). People of color are also less likely to report having a usual place of care or a regular provider. This has had impacts on testing (noted above), and leads to more delays in seeking care once infected.
TREATMENT: Once in care, communities of color face a myriad of other issues that affect the quality of care and treatment. For example, implicit racial and ethnic stereotypes held by healthcare professionals has been shown to impact patient-provider interactions and treatment decisions (https://pubmed.ncbi.nlm.nih.gov/26469668/). In emergencies when seconds count, language issues have also led to delays in administration of care: https://www.propublica.org/…/hospitals-have-left-many…
A “cascades of care” approach can be a useful tool to visualize the gaps along the healthcare chain that contribute to more severe illness and death from COVID-19 in communities of color.
But it’s also important to stay mindful that healthcare is just ONE component of a broader array of social factors that place Blacks and Latinos at higher risk of death from COVID-19, as well as other diseases.