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  • The Power of Trust and Truth

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    Getting and sharing the facts about COVID-19, trusting science can help turn tide for pandemic-strapped communities of color

    NOTE: This post originally appeared as an Op-Ed on and in La Vision Newspaper
    Co-authored by
    Gary H. Gibbons, M.D., Director National Heart, Lung, Blood Institute
    Eliseo J. Pérez-Stable, M.D., Director National Institute on Minority Health and Health Disparities

    COVID-19 has killed more than 230,000 people in the U.S., and the death toll continues to rise at a rate of about 1,000 per day [see recent data at CDC]. We know, however, that families and communities don’t count their losses in thousands or hundreds; they count them one-by-one – a father, a teacher, a sister, a friend, a nurse, a son, a Tribal elder, a church member. And these losses hurt.

    But some communities feel the impact of COVID-19 more than others. Latinos, along with African Americans and American Indians, account for more than half of all COVID-related cases, even though they represent just a third of the population. According to the Centers for Disease Control and Prevention (CDC), these groups require hospitalization at a rate about five times higher than whites, due to the severity of their illnesses or lack of early access to health care. And the mortality outcomes reflect this as well: Latinos and American Indians die at 1.5 times the rate of whites, and African Americans, at 2.4 times the rate.

    As scientists and NIH colleagues with more than 60 years of combined research experience in health disparities, we are not surprised by these discouraging statistics. But these awful numbers also feel deeply personal: they represent our friends, our family, our loved ones, too, as our roots are in these very communities—Philadelphia’s African American neighborhoods, Miami’s Cuban immigrant diaspora.

    COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has simply shone a spotlight on health disparities that have long affected underrepresented communities like ours. We know, for example, that obesity, diabetes, and heart disease are more prevalent among people of color. If you have any of these conditions and contract COVID-19 you run a much higher risk for severe complications and death.

    But biology and behavior are just part of the picture. Where we work, whether we have access to quality health care, what we eat, and other socio-economic conditions also drive health disparities.

    As we grapple with the effects of these health inequities on our daily lives, we can take simple public health measures to help prevent the immediate spread of this disease, starting with wearing a mask, washing our hands, and maintaining six feet of distance from others. But that won’t be enough to end the pandemic in communities of color.

    As the leaders of two public health research agencies, we know we can’t just devise solutions from Washington, D.C. We must also work with those who are most trusted, respected, and closest to these hard-hit communities. Through joint local efforts, we believe we can ensure that the best, most accurate information reaches these communities, and that they are informed about, and included in, diverse research studies essential for developing safe, effective treatments, and vaccines for all. That is why the National Institutes of Health (NIH) has issued a $12 million award to support teams in 11 states to establish the Community Engagement Alliance (CEAL) Against COVID-19 Disparities.

    This Alliance has already brought together community- and faith-based organizations, doctors, patients, researchers, community advocates and minority-serving educational institutions. For weeks, from Sacramento, California to Jackson, Mississippi, we have been listening carefully—to concerns, fears, very practical questions, and ideas. Our sincere hope is that, working together, we will find ways to overcome COVID-19 in a manner that takes into account the history, cultural differences, and unique input and needs of the people it affects most.

    How do we do this? We start by offering reliable and easily understood information based on science, by dispelling myths, and by explaining the importance of research. CEAL is working with trusted members in communities like yours to ensure access to information that can be shared through virtual town halls, infographics, animated videos, and in many other ways – like social media posts.

    Importantly, we also will be encouraging participation in research studies designed to stamp out COVID-19 in high-risk communities. That’s because clinical trials, the fundamental part of the scientific process, show whether new medicines and vaccines are effective at protecting you against disease. When a drug gets approved and your doctor prescribes it for you, you are not wrong to wonder whether it has been tested and shown to work — and especially shown to work for people like you.

    This is why it is so important for research studies to include people from all races, genders, ages, socio-economic classes and more. We simply need to learn who is likely to benefit the most from any given treatment. In other words, we can’t develop effective drugs and vaccines to conquer COVID-19 in communities of color without the active participation of the people who live there.

    We strongly believe that when done right, inclusive research leads to solutions that get us where we need to be. We already have safeguards in place to ensure historic wrongs are not repeated, and that safe and ethical standards are practiced consistently. The Food and Drug Administration, review boards, and expert panels at the NIH—indeed, each institution and company conducting medical research—rigorously review every phase of a clinical trial, from before it begins until after it ends. These review boards include not just scientists, doctors, and experts, but also community advocates who keep a watchful eye on the process.

    While these factors are critical to ending this public health emergency, we must keep our eyes on an even bigger prize—a nation without the disturbing health inequities that compromise the health of our whole society. As clinicians who have cared for countless patients of color, as mentors who have supported underrepresented groups, and as members of communities where each one teaches one, we fully understand the power of community to make a difference in the long fight against this conquerable problem.

    We firmly believe that by traveling this journey together—by sharing sound information, by squashing misinformation, by being responsible citizens and building trust in science—we can push this deadly pandemic into retreat. Hopefully when that happens, we can embark on a path of inclusion that gives everyone in America a fighting chance for a long and healthy life.

  • Racism and the Health of Every American

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    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    The past few weeks have been an extremely difficult time in the United States. George Floyd’s death was so painful to witness. Even more painful is the knowledge that he was only one in a long, long line of African American men and women who have been killed by police in America. It is a relentless, terrible history, and his death was yet another reminder of injustice in our lives. It is the same injustice that American Indians suffered in colonial times and the 19th century, losing their lands and being victimized by war. It is the same injustice that led to mass deportation of Mexican Americans—people born in the United States—in the 1930s. It is the same injustice that led to the internment of Japanese Americans during World War II. This is our history.

    I have watched the protests—at times coupled with violence but mostly peaceful—and been heartened by the Americans of all races who have continued to show up, day after day, to say that Black lives matter and structural racism must end. This is a society that is proud to say that all are created equal, with liberty and justice for all, but the history of injustice is clear. People are not standing for it anymore.

    Here at the National Institute on Minority Health and Health Disparities, we spend a lot of time thinking about inequality. In our 10 years as an institute and our 10 years as a center before that, we have funded countless studies on minority health and on the health disparities that exist in our country.

    Race and ethnicity are social constructs defined by self-identity and encompass culture, tradition, history, and biology all at once. But the effects of these social constructs are real and influenced by appearance, skin color, and social class. Racial and ethnic minorities in the United States face a disproportionate burden of many conditions, including heart disease, diabetes, obesity, and asthma.

    We have funded many studies on the reasons for these problems and how to help. Social conditions are responsible for many of the health disparities affecting African Americans. African Americans are more likely to live in places with no full-service grocery stores—and with very easy access to cheap foods that raise the risk of diabetes, obesity, and other metabolic disorders. Low-quality housing and exposure to air pollution in their neighborhoods make asthma worse. A lack of educational opportunity and employment discrimination mean African Americans are more likely to work low-wage jobs without health insurance.

    Over the last few months, my colleagues and I have watched, heartbroken, as health disparities have been made clear yet again through the coronavirus pandemic. African Americans, Latinos, American Indians, and Pacific Islanders are more likely to get seriously ill with COVID-19 and more likely to die from the disease. One reason for the disparity is the higher rates of underlying diseases such as diabetes that make COVID-19 worse. The other reason is the risk of getting infected in the first place. These groups are disproportionately the bus drivers, the supermarket cashiers, the frontline workers in pharmacies, the delivery drivers. They are less likely to have paid sick leave than White people are and less likely to be able to wait out the pandemic while working from home. People from these groups are more likely to live in dense housing with many family members, possibly several generations in a small space. Physical distancing, teleworking, and the option to self-isolate at home are novel markers of social privilege.

    The underlying reason for these disadvantages is racism. Racism keeps minorities from being hired in many white-collar jobs and from feeling comfortable if they are hired. For decades, racism has kept African Americans and Latinos out of neighborhoods with strong schools—and poverty still does that today. Minority families have not had the chance to accumulate the generational wealth and security that many White families enjoy; racial discrimination in housing was banned only a little more than 50 years ago. And an African American man going for a run—getting the exercise that he knows he needs for his health—also has to wonder whether someone will murder him like someone murdered Ahmaud Arbery.

    Racism degrades the health of African Americans and other minorities not only by limiting opportunity and sustaining poverty but also by increasing stress. We know from years of rigorous biological research that having high levels of stress hormones in the long term contributes to the development of chronic disease. We also know that getting suspicious looks, being followed in stores, and hearing racist remarks increase stress, as does poverty. Racism and the overpolicing of poor neighborhoods also increase the risk of dying from police brutality—yet another epidemic that has disproportionately affected African Americans for far too long.

    We are all feeling roiled by a profound sense of unfairness, especially after months of watching the unequal consequences of the pandemic.

    But I am an optimist, and I hope that these protests indicate the beginning of a change in our nation. As a teenager in Miami, I watched the news of the 1968 riots on our black-and-white television. Real change for the better has taken place since then. Now, in 2020, there is more for us to do. Real action to address systemic racism will not only reduce deaths from overpolicing, it will also improve the health of all Americans and move us toward a future in which all populations will have an equal opportunity to live long, healthy, and productive lives.

  • Spotlight on COVID-19 and Health Disparities: Opportunities to Achieve Better Understanding and Equality for Vulnerable Populations

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    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.