In New York City, Black people are nearly twice as likely to die from COVID-19 as white people. In cities like New Orleans, Detroit, and Los Angeles, and rural counties across the deep south Black people and other diverse groups make up a disproportionate share of COVID-19 cases and deaths; in some places they are affected at rates up to six times higher than white Americans. Across the country, 17.9% of COVID-19 cases are in Black people, who make up just 13% of the population. Another 28.8% of cases are in Hispanic people, who make up 18.3% of the population. Native Americans and Alaska Natives are also disproportionately affected; in New Mexico, they make up 54.2% of COVID-19 deaths but only 8.8% of the state population.
When the Centers for Disease Control and Prevention started reporting data on the racial distribution of COVID-19 cases in early April, the numbers were startling. Numbers on the disproportionate impact of the disease on other underserved populations, from the elderly to the less educated, have been similarly shocking to many. But to those of us who have studied health inequities, these observations were not surprising. They were a stark reminder of how far our country is from equality when it comes to healthcare. Now—facing a pandemic, with a renewed sense of unity and humanity—is the time to change that.
When it comes to COVID-19, there are many reasons for racial disparities—Black, Hispanic and Native American people tend to have higher rates of underlying conditions like diabetes and hypertension; they are more likely to live in crowded multigenerational households; they are more likely to work essential jobs that require close contact with others, often without proper PPE; and they are less likely to have health insurance. People of color are also more likely than white people to live in urban settings and rely solely on public transportation—this can make it challenging to seek testing or treatment for COVID-19. But COVID-19 isn’t creating these racial inequities for the first time; it’s revealing and amplifying them.
Over the past year, Stand Up To Cancer’s Committee for Health Equity has been grappling with these very issues when it comes to racial inequity in cancer care. According to the National Cancer Institute, Black patients have the highest cancer mortality rate of any racial or ethnic group. And while the Hispanic population has a lower overall rate of cancer than most other groups, Hispanic people are more likely to die of certain cancers than non-Hispanic white people. SU2C has come up with actionable ways to change this. In January, we announced the SU2C Health Equity Initiative, aimed at reducing racial and ethnic disparities in cancer research and improving outcomes for underserved populations. While our work to finetune this initiative revolved around cancer, many of our messages are just as applicable to the SARS-CoV2 virus.
First and foremost, we believe that there must be a concerted, global effort to include diverse people in screening efforts, studies and trials—those exploring the demographics of COVID-19 and the basic biology of SARS-CoV2 as well as those aimed at gauging the safety and effectiveness of treatments and vaccines. As part of the Health Equity Initiative, SU2C now requires all funding applications to include a description of how patient recruitment plans will include underrepresented racial and ethnic populations. We hope that funding agencies, researchers, and companies involved in COVID-19 research will consider similar efforts.
Today, we don’t know whether there are genetic factors making some minorities more likely to get sick or die from COVID-19. There is no question that testing sites must be expanded to include significant numbers of diverse patients. Clinical trials must take place not only at top-tier research hospitals, but at community hospitals and clinics where Black people, Hispanic people, Native Americans and other people of color are most likely to seek care. Even at the level of biochemistry and basic immunology, researchers must make an effort to use cell lines from diverse populations to study the molecular details of SARS-CoV2. Continued research is also needed to understand the underlying causes of racial inequities with COVID-19; it has taken decades of work to start to understand some of the driving factors in cancer disparities and there will be unique factors at play with COVID-19 that we don’t yet know about.
Closely entwined with the challenges of including Black, Hispanic and other diverse populations in trials is the goal of educating these communities about the benefits of testing, the proper use of personal protective equipment (PPE), and how to become empowered to take their healthcare into their own hands. Cancer researchers have found that Black women often don’t get mammograms because they’re worried about the downstream effects of the results; how will they afford care if they have cancer? How will they support their family if they can’t work? Today, we’re seeing similar barriers and questions when it comes to COVID-19 testing.
Our most successful programs to reach diverse populations have been community-based approaches. Community health workers and those who are already trusted by the public—from church leaders and business owners to local nurses—can become valuable liaisons between healthcare providers and the people they serve. A community-based approach to cancer education helped boost cancer screening rates among Black women in Harlem, for instance. There are currently mixed messages and rampant rumors related to COVID-19, its spread, and the use of PPE and it can be difficult for people to get a grasp on the real science. We believe that community-based education on COVID-19 is critical to engage people of color and help tackle the pandemic. In some cases, this can be initiated immediately using existing community infrastructures, and can be used to help target other underserved populations using similar approaches.
Finally, eliminating COVID-19 and preventing future pandemics requires a commitment to health equity that is broader than this single virus. Our country must re-examine the fundamental principles by which we provide access to healthcare for all subpopulations of the country. We need better treatment of underlying, chronic health conditions in underserved communities, equal access to adequate nutrition and education, and a healthcare structure that ensures no one is avoiding medical tests or care because of the cost. We have been writing white papers on these subjects for decades; now is the time to act. When COVID-19 is over, our healthcare inequities will not be gone unless clinicians, researchers, policymakers, funders and the public come together to act.
If there’s a silver lining to COVID-19, perhaps it is that this pandemic can act as a wakeup call, bringing to light just how vulnerable underserved populations are, and spurring action towards equity.
These opinions are those of the individual authors and not the organizations for which they work.
Sung Poblete, PhD, RN: CEO, Stand Up To Cancer
SU2C Health Equity Committee Members
Edith A. Perez, MD: Professor of Medicine, Mayo Clinic
The late Cheryl A. Boyce, MS: Former Executive Director, Ohio Commission on Minority Health
John D. Carpten, PhD: Director, Institute of Translational Genomics, Keck School of Medicine of USC
Elizabeth Jaffee, MD: Deputy Director, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Guillermina (Gigi) Lozano, PhD: Chair, Department of Genetics, Division of Basic Science, University of Texas MD Anderson Cancer Center
John Whyte, MD, MPH: Chief Medical Officer, WebMD
Raymond M. Williams, JD: National Diversity and Inclusion Partner, DLA Piper
Karen Winkfield, MD, PhD: Director, Office of Cancer Health Equity, Wake Forest Baptist Health