What once was touted as the great equalizer—the coronavirus—quickly brought to light the deep-rooted disparities in our society and renewed a push toward change. Based on the discrepant consequences of COVID-19 across demographics, there exists an underlying inequality within our healthcare system. Long after COVID-19 becomes a headline of the past, certain groups of people will continue to suffer from the social determinants of health. The hope is that this time, “amid an acute public health crisis that is transforming medicine, perhaps we have an opportunity to reset our priorities to face this deeper, more chronic crisis as well” (1). Many hospitals and organizations have released eloquent statements stating their commitment to justice and healing. So, what work is being done?
In St. Louis, African Americans represent a disproportionate percentage of COVID-19 cases, nearly 75%. This statistic is no surprise when contextualized in the “systematic exploitation, exclusion, subordination, and predation” of African American communities (2). Dr. Fredrick Echols, the acting health director for the City of St. Louis, shared with the St. Louis American that “[w]hen we talk about disparities, it’s more than numbers. It’s knowing the resources that are available and being able to connect people with resources. This involves building relationships, not only with individuals in need but also with organizations that provide essential services” (3). When the COVID-19 pandemic first sent ripples of alarm throughout the country, St. Louis was quick to respond. Canvassers organized by the Regional Health Commission, the City of St. Louis Department of Health and the Saint Louis County Department of Public Health came together in a campaign called PrepareSTL. It began with canvassers going out to the poorest communities to inform grocery shoppers and neighbors about personal protection. Their goal is to stop the spread and spread the word, particularly with black Americans, immigrants/New Americans, low-to-moderate income people, and seniors. Share the word on PrepareSTL at https://www.preparestl.com/.
In St. Louis, the Delmar divide is an inescapable physical reality of the racial divide that puts African Americans at a higher risk for exposure to “poor air or water quality, industrial toxins, and the failure of sanitary infrastructure” (2). Perhaps these social determinants of health explain the “higher rates of infant death, asthma and heart disease, among other conditions” seen in communities of color (4). In communities around the country, the safety net of care is tirelessly working to catch those who are often ignored by the healthcare system. One such example is the Roots Community Health Center in Oakland, California. The founder, Noha Aboelata, and her team began testing in mid-March at their clinics as well as through their street medicine team. In a Nature interview, Aboelata explains the importance of their own testing system that is adapted to serving uninsured people, who are often people of color. By providing local centers where familiar faces are the virus testers, community members will have more access to testing without the burden of needing to bring an ID or enter an email address.
The COVID-19 pandemic is not the cause of the racial and socioeconomic health inequalities. Rather, the racial and socioeconomic disparities of the healthcare system are once again rearing their preferential, life-taking heads through this global crisis. From the very beginning of life, health disparities can have as much influence over human life as the genes the baby carries. Today in America, black infants are more than twice as likely to die than white infants. Black women are three to four times as likely to die from pregnancy as compared to their white counterparts (5). St. Louis’s only non-profit midwifery and doula organization, Jamaa Birth Village, is dedicated to lowering infant and maternal mortality and disease rates by providing affordable access to perinatal care delivered by midwives and doulas of color. While ensuring the safety of their staff, volunteers, and over 400 families that the non-profit has served, the Village’s work has not stopped. On Juneteenth of 2020, Brittany “Tru” Kellman and her team livestreamed the grand opening of the Equal Access Midwifery Clinic.
After birth, the social determinants of economic stability, career success and health further exacerbate the divides between individuals of different communities. “In St. Louis, African Americans are more than twice as likely as whites to be uninsured,” which further causes inequalities in health outcomes (2). Although the 2010 Affordable Care Act did provide Americans with greater access to insurance, it also left a significant population of individuals stuck in the middle between not being able to afford private insurance and not being eligible for government-aided support. In November, Chancellor Martin and Dr. Perlmutter of Washington University in St. Louis sent out a statement in support of expanding Medicaid coverage in Missouri. Amidst the COVID-19 lockdown, the campaign has not stopped. As a result, the Medicaid expansion initiative will appear on the August 4th ballot as Amendment 2. Medicaid is a public assistance program that people can qualify for based on demonstrated financial need if they fall below an income level. In Missouri, coverage is mostly limited to pregnant women who often lose coverage after birthing, children, people with disabilities, some seniors, and parents who earn less than $3,626 annually. This means that many minimum wage workers and individuals making just enough to get by are barred from any health insurance. Medicaid expansion is one tangible policy change that has made a difference in the 36 states that have already adopted it. Read more about the research done on this amendment at https://www.publichealth.wustl.edu/other-policy-publications/. And definitely vote!
The problem of racial injustice that is looming in the headlines, clouding the future of America, and causing us discomfort, is massive and intimidating. At times, it may feel too overwhelming and even paralyzing. To dispel this paralysis, we can take small and manageable steps. Together, these steps can form a current of positive change. Just as thousands of students, faculty, and staff of the Washington University School of Medicine in St. Louis marched in solidarity against racism at the White Coats for Black Lives event (6), we can commit to being the change in every field and space. We can uplift the work of organizations that have been fighting systemic discrimination since before the pandemic and will continue to until there are no more steps needed.
Edited by: Isaac Mordukhovich
Illustrated by: Lucy Chen