Pandemics of COVID-19 and Systemic Racism: Lessons and strategies for future

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This article was exclusively written for The European Sting by Ms. Sadia Khalid, early-stage researcher (ESRs) and specialist at Tallinn University of Technology (TalTech), Estonia. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

People have put COVID-19 and COVID vaccine behind them. We have forgotten about masks. When COVID-19 is still among us. General inattentiveness to flu and other respiratory viruses is alarming and 400 to 500 people are still dying from Covid every day in the USA alone. The data on the actual death rate is unavailable. According to infectious disease and public health experts, we will experience a surge of respiratory infections in January even more following holiday gatherings and New Year’s Eve celebrations.

COVID-19 made us all realize that we are experiencing two pandemics simultaneously COVID-19 and systemic racism. Social media enabled Healthcare staff, activists, and NGOs to emphasize the deleterious impact of systemic racism and health inequality on the daily life experiences and health of populations of colour. These experiences are compounded for immigrant/refugee communities that may have other barriers such as language literacy or trauma. We were reminded again during COVID-19 that racism is still a battle we have to fight and the cumulative stress of healthcare inequalities due to everyday racism is a poison for health.

Despite the numerous reviews of health and disability systems demonstrating the ways in which BIPOC (Blacks, indigenous, and people of colour) including immigrant/refugee communities are often mistreated, healthcare administrators and frontline staff often don’t admit that the systemic racism in healthcare is a determinant in BIPOC peoples’ health and often racism in healthcare is tends to be conceptualized at the individual level. Racist discourses permeate society like a disease it exists in the consciousness of our healthcare staff social workers, unit clerks, and receptionists. 

The myth that still lingers around is that ill health, disease, injury, and death are often one’s own fault. The little understanding among the public of the social determinants of health and the role that the history of colonization, cultural oppression, socioeconomic disparities, discrimination, racism, and Western organizational culture on BIPOC ‘s health is alarming. 

Despite efforts to increase cultural sensitivity and cultural safety in healthcare, research continues to demonstrate the extent to which a high proportion of the BIPOC population experience individual and systemic racism when seeking health services. Experiences of racism and negative attitude by healthcare professionals are amplified by existing issues of poverty, substance use, disadvantaged women entering pregnancy, mental illnesses, or stigmatizing chronic which can intersect with people’s sense of being treated differentially based on race. The societal /stereotypes for the BIPOC population also form the assumptions of those charged with managing healthcare i.e., frontline workers and policymakers and it impacts the attitudes of staff who make valuable decisions about which patients are credible or ‘deserving’ of care.

Inequities in healthcare have become an enduring, detrimental problem as a challenge too big to solve which we can no longer be ignored.

To detect racism in real time needs strategies for combating racism in healthcare. Numerous teaching medical centres are developing tools such as equity scorecards and real-time reporting systems to identify racism in their policies and practices and to assess their effectiveness at addressing it. 

We have also seen academic medical centres introducing AI in healthcare which would also be a promising tool to mitigate healthcare inequities. AI can provide us with health screening tools and predictive that would help inform doctors on the frontlines to make life-saving decisions. But we need to be aware that AI models can inadvertently exhibit substantial bias against people of colour as health care systems have consistently spent less money caring for BIPOC patients than whites, which can flaw the AI algorithm which can result in under-allocation of resources for the care of BIPOC patients, who are likely to be sicker than cost indicators alone would suggest. 

it’s important to keep in mind that AI is not a replacement for good clinical care. Though it is a good knowledge, prevention, and screening tool. In an age of technology, we must not forget that flawed AI models can under-represent diverse populations, deepening bias rather than reducing it. Unlocking artificial intelligence (AI) potential for healthcare can help close the equity gap in health care thus it must be understood by healthcare in times when during the COVID-19 pandemic health disparities grew worse and we saw that age-adjusted, Covid-19 fatality rate in BIPOC (Blacks, indigenous and people of colour) population in the USA was twice as high as the white population. Across the USA racism was declared a public health crisis or emergency. Certainly, these declarations must be followed by the allocation of resources and strategic action. if we don’t move more quickly to identify and correct them these health disparities will grow to become worse than ever. 

Some of the strategies for combatting racism in healthcare are discussed below.

1: Reassessment of the institutional policies with an equity lens. This strategy also calls for revision of the hiring and promotion policy and finding ways to better support BIPOC staff.

2: Introduction of accountability frameworks such as equity scorecards in health care.

3: Auditing medical school curricula for erroneous references to race.

5: Reviewing clinical algorithms that erroneously rely on race.

6: Investing in scholarships and research grants for students of colour, and minorities interested in health professions. Income distribution or wealth is related to health where it represents a measure of the differences in social class in society. It’s important to create more equitable workplaces, including efforts to build wealth and opportunities for advancement. Reviewing vendor and suppliers’ relationships to support Black and other minority-owned businesses. 

7: Mandatory workshops covering topics of race, gender & workplace equity. Training leadership and staff in diversity, equity, inclusion, and antiracism principles is crucial. While individual assessment of healthcare professionals can be recommended if fellow colleagues or patient feedback suggests unconscious bias, stereotypes, and discrimination.

8: Creating real-time reporting initiatives to track and respond to racist or discriminatory behaviour. Which should be dealt with by the authorities as a Hate crime. Similarly, racism and violence faced by healthcare staff should also be prosecuted as a hate crime or a criminal offense.

9: Listening to and learning from the experiences of patients and health care professionals of colour.

10: Special resources should be allocated to remote communities where indigenous people face lower health outcomes than non-Indigenous peoples, which is exacerbated by the lack of access to quality health care and lower socio-economic situation (as confirmed by the social determinants of health).

We have heard words such as “time for action” and promises to “double down” on efforts to reduce racial and ethnic disparities in healthcare but We medical community calls on leaders of healthcare organizations across the spectrum to commit themselves and their resources to #Ajusthealth mission to create more equitable workplaces for their employees and invest in communities of colour where many of their patients and staff live. We urge them to focus on the actions suggested by scientific literature that will drive real, lasting change. we encourage medical centres to challenge clinicians to pursue new research on health inequities. And to leverage creative collaborations across multiple domains such as science, technology, clinical care, and venture capital.

Everyone is entitled to high-quality healthcare regardless of their ability to pay. Health care system vision should be a society free of social inequities, with a healthy population accessing high-quality health care, delivered in comprehensive health systems by culturally competent providers. Our mission under #Ajusthealth should be to promote social justice and challenge inequities in health and health care. 

Healthcare is a human right and health & public health systems should be effective, efficient, patient-centred, culturally competent, coordinated, community-based, and not profit-driven to ensure a healthy society.

About the author

Sadia Khalid, early-stage researcher (ESRs), medical writer and specialist at Tallinn University of Technology (TalTech), Estonia. She has been working on her PhD research project  “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Her current research interests include Molecular Medicine, cell biology, infectious diseases, bacteriology, hepatology, and gastroenterology.

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