A Case Study in Separate and Unequal Healthcare

The Separation of Light from DarknessSeparate but (un)equal education was a concept the U.S. Supreme Court repudiated in 1954. However, separate and unequal healthcare is something that persists in the U.S. to this day. If you want a stark reminder, just take a look at the disparities in care that people get for obesity. Even more dire are the disparities in care for COVID-19.

And of course, these two conditions are intertwined. Systematic racism in healthcare makes it all worse.

Too Many Patients,
Too Few Resources

Martin Luther King Jr. Community Hospital in Los Angeles offers a vivid case study. Sitting at the epicenter of California’s surge in COVID-19 in the new year, the surge overwhelmed it. MLK had more patients than nearby hospitals that are three to four times larger. Yet it has fewer resources.

MLK could not give monoclonal antibodies to the patients who needed it – even though the antibodies could prevent more serious illness. Giving this treatment takes two hours – an hour to infuse them and another hour to observe the patients. That takes up space and staff time in a hospital that has neither to spare. So the hospital tried to keep a lid on community awareness of this treatment. “If we publicize it, we wouldn’t be able to handle it,” said the VP of medical affairs for MLK.

Lives Lost to Separate and Unequal Healthcare

With too many patients and too few resources, MLK is a hospital where 86 percent of COVID patients requiring intubation have died. Other hospitals see much lower mortality, for example, 43 percent mortality in this study. MLK’s chief executive, Elaine Batchlor, gave a blunt assessment to the New York Times:

“We’ve created a separate and unequal hospital system and a separate and unequal funding system for low-income communities. And now with Covid, we’re seeing the disproportionate impact.”

U.S. Healthcare:
Separate and Unequal by Design

None of this is new. As Jamy Ard explained in a powerful plenary presentation at ObesityWeek, separate and unequal healthcare in America has been a fact from the very beginnings of this country. In 1946, the Hill-Burton Act funded a boom in hospital construction. It also provided for separate and “equal” facilities. This legislation is unique in the 20th century. It is the only federal legislation to fund racially segregated services. This federally-sanctioned segregation of healthcare survived for a full decade after the Supreme Court struck down segregated schools. A 1964 ruling finally killed the separate-but-equal healthcare provisions of the Hill-Burton Act.

Yet still, we have separate and unequal healthcare based on race and ethnicity. Black and Latino communities suffer from higher rates of conditions – diabetes, heart disease, and obesity – that make people vulnerable to COVID-19. Disparate social and economic factors lead to disparate infection rates. Thus mortality is nearly three times higher for these communities in this pandemic.

Rebuilding Trust

In a recent NEJM commentary, Simar Singh Bajaj and Fatima Cody Stanford explain how everyday racism has created a healthcare system that is not trustworthy for Black communities:

“When trust is in short supply everywhere, we need all hands on deck to begin rebuilding trust in healthcare. We believe the best way to learn from the atrocities of the past is to change our present.”

We cannot continue to accept separate and unequal healthcare based on race and ethnicity.

Click here for more on the case study of Martin Luther King Jr. Community Hospital. For the commentary by Bajaj and Stanford, click here. Finally, Sara Bleich and Jamy Ard describe the challenges here that obesity, COVID-19, and structural racism present for future progress in healthcare.

The Separation of Light from Darkness, woodcut by Paul Nash / WikiArt

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February 9, 2021