I was in the middle of my morning jog when I realized that the health system was going to collapse. It was the first week of March, and at the time, I had no idea that my state would be shut down by the end of the week. As I listened to the news reporter describe the sharp uptick in Coronavirus cases over the last few days, I knew that this was not a false alarm. The pandemic was coming for us.
As that realization sunk in, so did an equally dire one: not everyone was at equal risk of dying. Mind you, the news outlets and official missives reported that coronavirus does not discriminate. But as a black woman, and community psychiatrist, I knew that statement subverted the truth. It belied the fact that health disparities based on race and socioeconomic status are baked into the fabric of our healthcare system. These systemized disparities are codified by thick hospital policy books and maintained by healthcare administrators who have never even heard of critical race theory, let alone applied it to their work.
None of this is news- not to those of us who have devoted our lives to the work of dismantling racism in medicine. I was gutted to learn that 70% of COVID deaths in Chicago were black people, even though blacks make up 29% of the city’s population. But I was far from surprised. I work at a community clinic called Heartland Alliance Health. HAH is a federally qualified health center where anyone can receive healthcare regardless of their ability to pay. The vast majority of our participants are experiencing homelessness, living in poverty and/or seeking safety. The majority of our patients come from the black and latinx communities. They are the exact people that Coronavirus is disproportionally killing.
Healthcare’s only chance at survival now, is to listen to and learn from organizations and people that serve those that medicine traditionally overlooks. While academic hospitals build multi-million dollar atriums to serve those with insurance, community health centers constantly ask themselves how they can serve more people with ever-decreasing funds. If academic hospitals are cruise ships, then community health centers are rowboats with oars, riding our tumultuous torrents with grit and endless perseverance.
Although I grew up in a small Ohio town full of well-meaning upholders of racism, I came of age in the Ivory Tower of academic medicine. I work at an academic hospital now, and so am a part of the machine that helps some while ignoring others. Despite their missteps, I truly believe that most hospital administrators strive to improve the health of all people. However, they are entering the health equity battle unarmed.
Healthcare administrators must listen now, to the lived experience of the people on the ground. Hospital administrators must set a table that does not just include people in white coats and overpriced suits. It must reflect the communities that are in most need of fair treatment.
Top-down administrations devoid of people with lived experience, will never be nimble enough to meet the ever-changing needs of the underserved. The good news is, the wheel must not be reinvented. Patients themselves, shelter workers, and community health workers know what needs to be done to provide safe, equitable care.
The question now is whether medicine at large, is ready to listen.