There is growing evidence that some racial and ethnic minority groups have been disproportionately affected by the novel coronavirus pandemic. Inequities in the social determinants of health, including access to healthcare, have resulted in higher levels of COVID-19 related hospitalizations among African American, Latinx and Native American individuals. These disparities are visible on a national level and also all across South Carolina.
“Coronavirus clearly brought forth the inequities in our healthcare system,” said Dr. Michael Seemuller, a family medicine specialist at AnMed Health. “We saw early on that our African American population was being much more affected by coronavirus, both in regards to the number of people in the hospital, the number of people who got sick and number of people who died.”
The impact of social determinants
As a clinician, Seemuller said his work only accounts for 10 to 20 percent of a patient’s outcome. More than 40 percent of a patient's outcome is due to the impact of social determinants, including their physical environment, the type of job they have and their income level.
Many of Seemuller’s African American patients were more likely to work in lower income jobs or jobs that do not offer an option to work remotely. Therefore, more African Americans were exposed to COVID-19. Additionally, many families in minority communities live in multigenerational households with more people together under one roof.
According to the Centers for Disease Control and Prevention, COVID-19 related hospitalizations among racial and ethnic minority groups have been more than three times higher than for white populations.
“When you have a lower income population living in a more dense area of housing, then you're going to have a higher likelihood that the virus will be transmitted,” Seemuller said. “I think those social determinants definitely contributed to people in our African American and Latino populations getting sicker at higher numbers.”
What drives racial inequities?
Anton Gunn, executive director of community health innovation at the Medical University of South Carolina, and a former advisor to President Barack Obama, said inequities are driven by many factors including transportation, education, housing and insurance status.
“There are four counties in the state of South Carolina that don't have an OBGYN in the county and all four of those counties have a majority population that is African American,” Gunn said.
Oftentimes, women in these areas cannot afford to travel outside of their community to receive healthcare. Another barrier to healthcare for minority communities relates to the issue of Medicaid expansion under the Affordable Care Act.
“We have some 300,000 South Carolinians who can't afford to buy health insurance coverage,” Gunn said.
Some people fall into a healthcare coverage gap, he said, because they work but have a type of job that doesn't provide health insurance and also do not earn enough income to be able to afford private insurance. Additionally, many of the same people who lack the ability to purchase health insurance also live in areas where hospitals and healthcare professionals are disappearing at an alarming rate.
Gunn noted that other factors that drive inequities include limited or nonexistent access to broadband Internet and the implicit biases held by individuals in the healthcare industry. Add all these factors together and easily treatable health problems can go undiagnosed for years, sometimes turning into life-threatening conditions.
How Telehealth Can Help
Congressman Jim Clyburn (D-SC) said the expansion of telehealth could be a solution to many of the issues surrounding accessibility for minority communities.
“We've had four rural hospitals close in South Carolina in recent years,” Clyburn said. “Those people are very upset about not having a hospital in their communities. I think if we had telehealth in these communities, many, if not all of these hospitals would still be open.”
In areas of the state where telehealth has already been adopted, it has proven to be a valuable way for people to receive medical care in rural or under-resourced communities. One example is found at Charleston Promise Neighborhood, an organization that works to improve access to healthcare and education for students attending Title I, under-resourced public elementary schools in Charleston, South Carolina.
The organization piloted a Medical University of South Carolina school-based clinic program that provides access to high-quality healthcare in the school setting. The clinics work by pairing a nurse practitioner or a pediatrician from MUSC with a school nurse using telehealth technology. A telemedicine exam can take place at school using secure video conferencing equipment and high-definition cameras.
Sherrie Snipes-Williams, chief executive officer of Charleston Promise Neighborhood, said telehealth has been “vitally important” because it allows the organization to increase the quality of care that it provides to students. In addition, she said it helps to make specialist referrals more easily and more efficiently for parents who are not able to leave work for their child’s appointment.
“Our partnership with MUSC and our kids-well school-based health clinics have saved countless lives over the years and we need to do more of those,” Snipes-Williams said.
Moving forward with progress
Increasing awareness is the first step toward solving racial inequities and disparities, according to Gunn.
“When it comes to racial inequities and disparities, every one of us has a responsibility and every one of us has the power to do something,” said Gunn. “There are tremendous opportunities for people to get involved, but you first have to raise your awareness and then you have to figure out what you want to have an impact on.”
Racial disparities exist in education, housing, employment, and healthcare. One way to take a closer look is by studying local community health needs assessments. These documents are created by major healthcare systems and they identify the major needs in each community.
“Once you understand what the disparities are, you can be a part of the process for change,” Gunn said. “Talk to your lawmaker, your city councilmember, your mayor, your community members or even your local hospital leaders about what they are doing to close the gaps on disparities.”