‘We know our pain is questioned’: Creating equitable health care in a pandemic and beyond

Benyam Alemayehu gets the Pfizer vaccine at a pop-up clinic at St. Mary Ethiopian Orthodox Church, Feb. 13, 2021. The focus was primarily aimed to get vaccines in the arms of immigrant communities in the metro area.
Photo by PHILIP B. POSTON/Sentinel Colorado

One year later, experts say that the pandemic has illuminated structural racism in healthcare systems that goes well beyond COVID-19. 

Hispanic and Black residents in Colorado have suffered disproportionately from COVID-19 cases and continue to receive vaccinations at a lower rate than white residents in the Tri-County region, data shows. 

In fact, a study by the Centers for Disease Control and Prevention found that, during the first seven months of the pandemic, Hispanic adults in Denver accounted for the majority of COVID-19 cases, hospitalizations and deaths — even though they only made up about a quarter of the city’s population. 

Statewide, Hispanic Coloradans have continued to bear an outsized burden of COVID-19 cases, according to data from the Colorado Department of Public Health and Environment.

Researchers found that’s because Hispanic residents tended to live in larger households and work in front-line jobs where it was harder to avoid the virus. 

According to the state, Black residents also saw disproportionate case counts, although to a lesser extent than Hispanics, while white Coloradans have contracted the virus far less than their share of the state population.

Glen Mays, chair of the Department of Health Systems, Management and Policy at the Colorado School of Public Health, said the obvious disparities illuminated a bigger issue: racial minorities tend to have worse health outcomes because of less access to healthcare in general. Or, they receive inferior care when they do. 

“The nature of this pandemic, its immediacy, it’s made these racial and ethnic inequities in our health system much more visible,” he told the Sentinel. “We usually just don’t have this real-time data on new cases and hospitalizations and deaths to just be able to see these inequities. They’re just less visible in our health system.” 

Mays said racial disparities permeate just about every facet of healthcare — and they have long before the pandemic. 

The Associated Press reported in the fall that nearly 20% of Hispanic people under 65 were uninsured in the U.S., compared with 11% of Black people and 8% of white people, citing the Kaiser Family Foundation. 

Mays, echoing providers and experts in Aurora, said language barriers, affordability, transportation and flexibility are all factors. Food deserts and pollution contribute to less healthy residents in lower-income neighborhoods, who also tend to avoid expensive hospital visits. 

Mays also said there’s a deep well of evidence that many clinicians are guided by subtle biases against racial minorities. There’s decades of solid evidence in this arena, he said. 

Using a virtual reality platform, researchers will have physicians interact with a virtual reality patient and then change the patient’s race or accent and watch how treatment changes. The clinicians sometimes offer weaker treatment plans because they think the patient couldn’t understand a more complex one or follow it, according to Mays. 

These factors have led to higher mortality rates for certain ailments, especially cardiovascular diseases in Black Americans. 

But this also played out during the pandemic in treatment strategies. In Chicago, The Associated Press reported that a Black COVID-19 patient felt doctors had ignored her pain and offered her less treatment during the pandemic. 

Christy DeGallerie said she noticed white patients got medications she’d never heard of, were offered X-rays and their doctors listened to their concerns.

“We know our pain is questioned and our pain is not real to them,” said DeGallerie, who later started a group for Black COVID-19 survivors. “Getting medical help shouldn’t be discouraging for anyone. It is a discouraging place for Black people.”

The silver lining: Mays said that the plain disparities in COVID-19 case counts and vaccination efforts have spurred renewed urgency to address racism in healthcare.

Public health authorities at the state and local levels re-tooled their vaccination distribution plans this winter to specifically reach Black and Hispanic residents, as well as lower-income residents and immigrant communities in Aurora who have proved hard to reach. 

Polly Anderson, the vice president of strategy and finance at the Colorado Community Health Network, is optimistic that the vaccine disparities will smooth out with the efforts. 

“We’ll do better on the equity picture on this challenge, and then we’ll move forward to the work that we’re always engaged in, which is to reduce health disparities and provide access for communities in need,” she told the Sentinel. 

CCHN represents the network of 20 community health providers in the state, including STRIDE clinics in Aurora. Those have proved crucial to COVID-19 testing and vaccine roll-outs, and they’re a vital hub for residents who can receive subsidized primary care in their language if they fall under an income cap. 

So far, CCHN hasn’t taken a position on Colorado Democrats’ plan to create a subsidized “public option” health plan they say would be cheaper for residents. But Anderson said the group typically approves of measures to reform the “terrible system” that leaves out lower-income residents and people of color. 

And Anderson said she would welcome more research about racist bias among healthcare providers. 

On the Anschutz Medical Campus, officials announced last year they’re standing up a brand new center for health equity. Mays said researchers will dig deeper into how doctors and staff can recognize and avoid biases that subtly downgrade the quality of their care for minority patients. 

He said healthcare systems aiming to address this pervasive issue will have to “scale up and invest more.”