At first it looked like an anomaly. COVID-19 was disproportionately killing more African Americans than any other race in this country. But then an all too familiar pattern began to emerge, and it wasn't pretty. Health disparities exist in this country, not just with coronavirus, but nearly all illnesses. And, regrettably, this has been the case for a very long time.
"Sadly, this is nothing new; it's just now in our face," said Virginia Fonner, Ph.D., professor in MUSC's Department of Psychiatry and Behavioral Sciences.
According to the Department of Health and Environmental Control, among the more than 4,000 South Carolinians diagnosed with COVID-19, 54% are white and 41% are black - even though they make up only 27% of the state's population.
"Those numbers should get your attention," said Chanita Hughes-Halbert, Ph.D., psychologist and associate dean for Assessment and Evaluation in MUSC's College of Medicine. "I think certainly there's an ongoing history of racial disparities in health care. I think this is just really shining a light on it and that they've been pervasive in our society for decades."
According to Hughes-Halbert, who has studied health disparities for the better part of her career, there are many different reasons why these gaps in treatment exist. Some are purely physical, meaning that some people are biologically more prone to disease or just handle infection and sickness differently. These issues are largely unavoidable. However, she said, there are other factors - such as social conditions, behavior, geography and culture - which influence risk factors not only for health but also a person's or community's well-being. More specifically, things like access to good education, affordable housing, jobs with health care coverage; living in a neighborhood where it's safe to walk; having access to high-quality food and a support structure - all of these "social determinants of health" affect a person's physical, mental and emotional condition.
"All these things matter," said Marvella Ford, Ph.D., associate director of cancer disparities at MUSC's Hollings Cancer Center. "So when you get a pandemic like this, a society that was already having a tough time will have it even worse."
"I think certainly there's an ongoing history of racial disparities in health care. I think this is just really shining a light on it and that they've been pervasive in our society for decades."- Chanita Hughes-Halbert
Take this real-life example of how disparities might inform a doctor's visit. A patient has high blood pressure. His doctor prescribes him an ACE inhibitor to lower it. Problem solved? Not if the patient doesn't share with his doctor that he can't afford to buy it. So, he doesn't get the medicine, problems continue - or possibly get worse - and a year later, he goes back to the doctor for the same issue. It's back to square one.
"That's a missed opportunity. Critical time lost," Hughes-Halbert said. "It's a vicious cycle that we can find ourselves in." Plus, she explained, it's people with chronic conditions, like high blood pressure and diabetes, who often face the most increased risks for severe complications if they get the virus.
Ford explained that when you have a virus like this, it's going to go to the weakest group, where it can take hold.
"People with service jobs. Delivery drivers, kitchen workers, essential workers with low-pay and high-risk jobs that put them in positions where they're more likely to contract the virus and then don't have the financial resources to combat it."
Ford would know a thing or two about health disparities. She got into this line of work because of how directly they affected her own life - She never got to meet any of her grandparents, and both of her parents died before she turned 41.
Still, these personal hardships served to spark a passion in her life and career. "It's exciting to talk about something that's been such a major part of my life, and now that it's at the forefront of people's minds on a national and international level, I really believe these things are solvable."
But it starts at the top, Ford said, adding that groups of people can't simply separate themselves from others - especially during times like this.
"What happens to one group affects all of us," she said. "This is an opportune moment to come up with solutions to keep our entire population healthy. That's the key with successful interventions. It's not enough to tell people not to do things; we need to give them the tools. That's where we don't want to fall short."
Hughes-Halbert agreed, explaining that MUSC recognized this issue years ago and quickly responded by providing continuing education courses to help providers better understand these types of social determinants. And over the past 15 years, both Hughes-Halbert and Ford have worked tirelessly, with complete buy-in from leadership, not only to gain a better understanding of patients who have these types of hardships but also to give providers better tools to mitigate them.
Hughes-Halbert has led studies funded by the National Institutes of Health as well as the National Cancer Center. Ford has not only evaluated how providers deal with their patients but has also developed tools to track, measure and improve those interactions more effectively. Currently, she is working with MUSC endocrinologist Anita Ramsetty, M.D., to gain a better understanding of how
food and security are discussed in clinical visits. These types of frank but delicate discussions are critical, said both Ford and Hughes-Halbert, in addition to willing providers and a supportive process. This type of paradigm shift requires a strong commitment at both the institutional as well as patient level.
As for this coronavirus outbreak, MUSC President David Cole, M.D., FACS, said the university is actively planning next steps for how it can implement better and more effective screening for COVID-19 with testing and follow-up in rural and African American communities. Beginning this week, in fact, pop-up testing sites will commence in certain zip codes.
"We're trying to leverage technology, but sometimes, it's just a matter of getting out and meeting people where they are," he said. "To accomplish this, we must get mobile vans and mobile hotspots into places, such as rural areas, where we can help create access to the internet. We're doing everything we can to come up with a plan that will be supported and implemented."
Ford and Hughes-Halbert know it's a long battle, but they genuinely believe it is one that can be won.
"The good news is we have to remember we are one nation. What happens to one group affects all of us," Ford reiterated. "These disparities have been happening for decades, but now that they're in the forefront of everyone's conversations, we can come up with real solutions."
