Boston’s top doctors spoke about longstanding racial disparities in the health care system as part of NBC10 Boston’s Discover Black Heritage initiative.
Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center; Dr. Sharlay Butler, obstetrician-gynecologist at Brigham and Women’s Hospital; and Dr. Sharma Joseph, an anesthesiologist and critical care physician at Tufts Medical Center, explained the disparities related to COVID-19, emergency care reliance and black maternal mortality.
The covid-19 pandemic
The coronavirus pandemic has brought to light many long-standing racial disparities in the health care system both in Massachusetts and nationwide.
The three doctors said they are concerned about equal access to care in Massachusetts now that The US decided to stop giving out free vaccines for COVID as early as this fall. Shifting the distribution of vaccines to the private market is part of President Joe Biden’s decision to end national emergency and public health emergency declarations related to the pandemic in May.
The US will stop offering free COVID vaccines and shift distribution to the private market as soon as this fall. Top Boston doctors explain what this means for Massachusetts.
“Now that this emergency declaration is ending, patients may not understand exactly what it means, and what they have access to and what they don’t have access to,” Joseph said. “And that means we really need to continue to collaborate and involve community organizations that patients trust and trusted resources where they can get the information they need.”
Experts are concerned about shifting the cost to US insurers and uninsured Americans losing access to vaccines, particularly people of color.
“One of my main concerns is that by cutting federal funding, we stop investing in those multidisciplinary, community-centered strategies to deliver care and that we kind of chalk it up to that, which is exactly what we did with COVID,” Butler said. “Instead of reframing the way we think about the delivery of care for black and brown communities and other minority communities, and instead thinking that maybe this is the way we need to start thinking about delivery here.”
Assoumou noted one The last STUDY from the US Centers for Disease Control and Prevention that found racial disparities among patients age 20 and older when it comes to treatment. Black and Hispanic patients were 36% and 30% less likely than white and non-Hispanic patients to be treated with Paxlovid between April and July 2022.
“I’m actually very concerned that after certain measures that were put in place, such as access to testing, access to vaccines, access to health insurance — this is a big thing,” Assoumou said, “when some of these things to be phased out. That means numbers that weren’t great before can get worse.”
Emergency room care support
Compared to white patients, black and Hispanic patients are 60-110% more likely to rely on emergency room care, according to research from the Center for Health Information and Analysis.
“Part of what that tells me is that there’s a gap in access to reliable, consistent health care,” Joseph said. “There’s a lot to think about so that we don’t have the ED — the Emergency Department — as a primary resource for health care, but we really shape a society and our patients to be able to be consistently healthy.”
Joseph noted that support can occur because of a gap in health insurance and that enrollment periods can cause a revolving door of uninsured people.
“It will be really essential and important to make sure that we increase access to primary health care and also make sure that insurance is sustainable,” Assoumou said. “But we also need to make sure that health care professionals look like the population that we serve, so that there’s a relationship there, so that when patients have questions, they can talk to them.”
Maternal mortality and morbidity
Doctors said they are frustrated they keep hearing it CDC statistics that black women are three times more likely to die from a pregnancy-related complication than white women.
“The statistic is much more than a statistic to me. It’s the actualization of someone’s worst fear that they won’t live to see the child born,” Butler said. “And so this is very, very near and dear to my heart.”
The factors driving the disparate death rates are complex, experts said, but they pointed to poverty, food insecurity, education levels and access to prenatal care as major contributors, as well as systemic racism within the health care system.
“It’s rooted in systemic racism, but it’s the environment where people are born, where they live, where they worship, where they work, where they go to school — that really has a long history,” Assoumou said. “I’m actually tired of hearing statistics and people repeating studies that show there are gaps. I really want to see solutions.”
“So much of the system that has taken care of black women and black women giving birth has been rooted in racism and discrimination,” Butler said. “And that bias — that disrespect that’s built into our system — affects how we listen to black women. It affects how we recognize the need for care.”
Both Assoumou and Butler pointed to programs at their respective hospitals, including Boston Medical Center The Health Equity Accelerator as well as Brigham and Women’s Education courses for parents and childbirth.
In addition to educational initiatives and programs, Joseph stressed the need for workforce diversity, “so that providers — not just doctors, but doulas, midwives, nurses, etc. — really understand where patients are, people of color that are born, what their stories are and the stories are. That’s incredibly, incredibly important. That level of education is really, really paramount.”
Thea James, MD, Associate Chief Medical Officer of Boston Medical Center, joins us to discuss what it means now that Boston Mayor Marty Walsh says race is a public health crisis.
