By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities
The year 2020 will be remembered in history as one that changed the way we live as a result of a new global pandemic and the unequal effects on specific communities. The novel SARS-Cov-2 virus that has caused the COVID-19 global pandemic, has caused a societal awakening to the issues of existing health disparities and inequities in health care. The data we have for race and ethnicity present a stark reality: African American, Latino, American Indian and Pacific Islander populations are bearing a disproportionate burden of the disease.
As the NIMHD Director, I have had multiple opportunities to discuss the impact of COVID-19 on disparity and other vulnerable populations and share my thoughts on what the biomedical community can do and is doing in response to the COVID-19 pandemic. In this blog post, I will highlight two recent examples of these opportunities to place a spotlight on mitigating the COVID-19 burden on minority health and health disparities.
On May 4, 2020, I taped a Zoom interview with the NIH Director Francis S. Collins, M.D., Ph.D., for his newest blog endeavor called Francis Collins at Home. In Episode 9, you get to see our candid discussion about the challenges and opportunities we hope to see for improving health, especially for minorities and underserved populations, during this pandemic. Reports from multiple cities and states show that African Americans are disproportionately dying from COVID-19. In Washington, D.C., the highest rate of COVID-19 infections are in the wards east of the Anacostia river, that have more than 90% Blacks in the population. New York City, which has been the epicenter for this pandemic in the U.S., has had an increased rate of mortality among Latino populations as well.
It could have been predictable that we were going to face this dilemma with disparities. If you go back in history, similar things happened in the 80s, with the HIV/AIDS pandemic. With the COVID-19 pandemic, the outcomes have been observed on an accelerated timeline. The initial and most likely explanation for higher mortality in minority populations relates to two factors.
First, racial and ethnic minorities have a disproportionate burden of known comorbidities, such as cardiovascular disease, diabetes, obesity, asthma and many immune system disorders. These underlying comorbidities, along with advanced age, and being male, are the known demographic and medical vulnerabilities for a severe COVID-19 outcome.
The second factor relates to the risk of getting exposed to the virus, of which we have fewer clear data points. By neighborhood and household assessments, racial and ethnic minorities and the urban poor communities live in more crowded conditions that don’t offer effective physical distancing. A significant number of disparity populations work in service jobs where they are in the frontlines facing the public. They are the restaurant servers and people in the kitchen. They’re still the bus and Uber drivers, and those who are working in the pharmacies and supermarkets. These people are also the breadwinners of their household and need to work to feed their families and pay their bills.
I am also pleased to share a recent JAMA Network article that was written by NIMHD Deputy Director Monica Webb Hooper, Ph.D., NIMHD Scientific Director Anna Maria Nápoles, Ph.D., M.P.H., and myself. This Viewpoint was released on May 11, 2020. We share data about the most pervasive disparities from COVID-19, hypothesize why some pandemic prevention efforts may be hard to implement in racial and ethnic populations, and report on the current limited data on disease rates by race and ethnicity that is expanding. I encourage you to read the article and offer your comments here in the comment section of the blog.
At NIMHD, we are acutely aware of the many challenges that COVID-19 presents to our stakeholder communities. The pandemic has placed a spotlight on a health system that generates inequities. As states begin to relax risk-mitigation policies, an unfortunate opportunity to observe the etiology of health disparities presented by COVID-19 will be on display. Rigorous research is needed to identify the root causes of inequities, beyond individual behavior and biology. They must include the physical and social environment, policy, healthcare systems and social determinants. The pandemic presents a window of opportunity for achieving greater equity in healthcare of all vulnerable populations.
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