Top Boston doctors talked about long-standing racial inequities 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, an 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, reliance on emergency care and Black maternal mortality.
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COVID-19 Pandemic
The coronavirus pandemic brought to light many longstanding racial inequities in the health care system both in Massachusetts and across the nation.
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The three doctors said they are worried about equal access to care in Massachusetts now that the U.S. decided to stop giving out free COVID vaccines as early as this fall. Shifting vaccine distribution to the private market is part of President Joe Biden's decision to end the national emergency and public health emergency declarations related to the pandemic in May.
"Now that this the emergency declaration is ending, patients may not understand what exactly that means, and what they have access to and what they don't have access to," Joseph said. "And so that means that we really need to continue to partner and involve community organizations that patients trust and trusted resources where they can get the information that they need."
The experts are concerned about shifting the cost to U.S. insurers and uninsured Americans who stand to lose access to vaccines, particularly people of color.
"One of my main concerns is that by decreasing the federal funding, we stop investing in those multidisciplinary, community-centered strategies to deliver care and that we sort of chalk that up to, that's just what we did in COVID," Butler said. "Instead of reframing how we think about delivering care to Black and brown communities and other minority communities, and instead, thinking about maybe this is the way that we should even just start thinking about delivering here."
More From Boston Doctors on COVID-19
Assoumou pointed to a recent study from the U.S. Centers for Disease Control and Prevention that found racial disparities among patients ages 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 am actually very concerned that once certain measures that were in place, such as access to testing, access to vaccines, access to health insurance -- that's a big one," Assoumou said, "when some of these things get phased out, that means that the numbers that were not great before may actually get worse."
Emergency Room Care Reliance
Compared to white patients, Black and Hispanic patients are 60-110% more likely to rely on the emergency room for care, according to research from the Center for Health Information and Analysis.
"Part of what that tells me is that there is a gap in access to reliable and stable health care," Joseph said. "There's a lot to think about so that we do not have the ED -- the Emergency Department -- as a primary resource for health care, but we really shape a society and our patients to being able to be consistently healthy."
Joseph noted that the reliance can happen due to a gap in health insurance and that enrollment periods can cause a revolving door of uninsured people.
"It's going to be really key and important to make sure that we increase access to primary health care and also making sure that insurance is stable," 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 actually talk to them."
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Maternal Mortality and Morbidity
The doctors said they are frustrated that they keep hearing the CDC statistic that Black women are three times more likely to die from a pregnancy-related complication than white women.
"The statistic is so much more than a statistic to me. It is the actualization of someone's worst fear that they're not going to survive childbirth to see the child that they delivered," Butler said. "And so this is very, very near and dear to my heart."
The factors that drive disparate mortality rates are complex, the 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 learn in schools -- that really has a long history," Assoumou said. "I'm actually tired of hearing the statistics and people repeating studies showing that there are gaps. I really want to see solutions."
"So much of the system that has cared for Black women and Black birthing people has been rooted in racism and discrimination," Butler said. "And that bias -- that disrespect that's built into our system -- it impacts the way that we listen to Black women. It impacts the way that we recognize need for care."
Both Assoumou and Butler pointed to programs at their respective hospitals, including Boston Medical Center's Health Equity Accelerator as well as Brigham and Women's Parent and Childbirth Education Classes.
In addition to educational initiatives and programs, Joseph emphasized the need for workforce diversity, "so that providers -- not only physicians, but doulas, midwives, nurses, etc. -- really understand where patients, Black birthing people, what their stories and histories are. That is incredibly, incredibly important. That level of education is really, really paramount."
