On April 8, the Stern Healthcare Association had the good fortune of hosting Dr. Joseph Ravenell, the Associate Dean of Diversity Affairs and Inclusion at NYU Langone Health. Dr. Ravenell led a discussion on how this pandemic has hit lower socioeconomic neighborhoods with a higher disease burden and mortality rate than more privileged neighborhoods.
Racism has been with us for centuries, and long-standing social disparities go back throughout the history of the U.S. Any group seen as different from the dominant group in this country has often been seen as a threat and discriminated against. This was made more evident during the pandemic, which can be seen both from health outcomes and the social unrest arising from blatant systemic racism.
The hardest hit areas by COVID in the U.S. have the biggest socioeconomic gap. This is consistent with many of the other disparities we see in minority populations, such as hypertension in black communities that leads to higher mortality rates. There is no physiologic reason why people of color (POC) should experience higher rates of chronic morbidities, such as obesity, hypertension, hypercholesterolemia, or diabetes. Poor health outcomes in minority communities are related to social determinants of health and a very flawed healthcare system.
There has been a consistent trend in some of the social determinants we saw in the last year that led to disproportionately high morbidity and mortality rates of COVID. Low-income neighborhoods tend to have more essential workers. The stores that were still opened in Spring 2020 – grocery stores and food delivery services – were staffed by employees receiving hourly wages. These neighborhoods therefore faced higher food and housing insecurity and a lack of childcare and transportation. POC are often the last hired and first fired due to structural and interpersonal racism. In addition, men of color (MOC) are more likely to have jobs without health insurance and not be given time off to go get the healthcare and preventative care they need.
With the previous presidential administration, we saw almost a license to express racism. It appeared by political leaders to be not only condoned but encouraged. Dr. Ravenell said this time, now, is an opportunity to reckon with and elevate our consciousness, so that we can address racism. Dr. Ravenell further stated that when we talk about racism, we have to clarify the group being targeted, because each group is affected differently. We continue to see anti-black racism and more awareness has been raised about anti-asian racism and acts of violence. But to be clear, these are not new phenomena. They now have media coverage, which is leading to active discussions and public advocating for social justice and change.
How does racism play out in healthcare? A number of studies have shown marginalized communities with a higher prevalence of COVID transmission have received fewer vaccines per capita than more privileged neighborhoods. This comes down to institutional racism and resource allocation with a limited supply. It turns out zipcodes are quite relevant when it relates to access to vaccines. Even when lower-socioeconomic neighborhoods receive needed vaccines designated for vulnerable populations, people from wealthier neighborhoods travel to these areas to get access to them. Disparities in healthcare are also seen in COVID testing and treatment for the homeless and incarcerated populations. These groups are highly susceptible to the disease but have far less access to high-quality care. Additionally, it is tough to get accurate data for the rates of morbidity and mortality in these populations. What we hear is probably underreporting of what is actually occurring.
Dr. Ravenell is a strong believer that healthcare providers can help by living out the Hippocratic oath of caring for anyone who needs care, regardless of immigration and socioeconomic status. According to Dr. Ravenell, innovative strategies should be utilized to give everyone access to primary care providers. Providers can utilize safe spaces outside of healthcare institutions to care for MOC, which can be done by partnering with community leaders, such as barbers and pastors, two of the reported safest and trusted places for black men. Dr. Ravenell stated that by putting patient navigators in these places, we are far more effective in outreach for people who are distrusting of the medical system. The hardest part is sustaining and scaling this practice. However, he believes MBA students know how to build financial models to maintain and expand these solutions.
I had the opportunity to ask Dr. Ravenell about the poorer quality of medical care given in low-income neighborhoods that is adding to the disparity problem. The COVID mortality rate was far higher in community hospitals in the outer boroughs than medical centers in Manhattan. Dr. Ravenell pointed to interesting statistics published by NYU Langone Medical Center indicating there was very little correlation between races and mortality outcomes. In fact, black patients had slightly better outcomes when it came to mortality and being admitted to the ICU at NYU Langone. This further demonstrates that POC didn’t have access to medical centers and that quality of equitable care during the pandemic. He stated that NYU School of Medicine, in response to COVID and racial equity reckoning, has developed a strategic roadmap to reflect on and hold each other accountable to change. The four point strategy includes optimizing institutional culture, making it safe and encouraging to talk about racism and antiracism changes; promoting inclusive communities from the top down to develop leaders from early stages who have a diverse background; increasing equity inclusion capacity, with training on implicit bias; and developing and implementing equity-related knowledge with guides to to support listening and processing sessions for students, trainees, faculty, and staff to disseminate to institutional leaders.
This widely shared roadmap at Grossman School of Medicine is changing the way students learn, healthcare is allocated, and leaders are developed. I wonder what we could be doing at Stern to successfully align actions with our words of intention for social change. We have the intellect and education to make valuable contributions towards equity and inclusion. If we learned anything from Solidarity Week, it is that now is the time to come together and strategize how we, as future business leaders, are going to make a difference.