The COVID-19 pandemic laid bare inequities in the US health system — but they have existed for more than a century.
The disproportionate toll that the pandemic exacted on African-Americans and Hispanics, in particular, blighted an already difficult period in modern American history. Research paper upon research paper documented that more ethnic minorities died, lost their jobs, or suffered in other ways, as a result of COVID-19.
Addressing health inequity is a moral imperative that has gone 150 years unfulfilled.
In 1865, as the Civil War ended and Congress initiated its efforts to integrate newly freed slaves into the wider population, Congress approved a request by Abraham Lincoln to create a Bureau for the Relief of Freedmen and Refugees — the Freedmen’s Bureau — that promised to, among other tasks, provide emergency and temporary healthcare to freed slaves.
The victims of slavery suffered horrendously from health issues. High rates of infectious diseases, such as tuberculosis and smallpox, high infant mortality, severe malnutrition, and unaddressed injury were
Underfunded and openly racist, the Freedmen’s Bureau failed to fully address the health issues facing the victims of slavery and was closed in 1872 — the beginning of 150 years of the systemic health inequity.
In 1985, 103 years after the Freedmen’s Bureau was closed, US Secretary of Health and Human Services, Margaret Heckler, released a report authored by the agency’s Task Force on Black and Minority Health — the “Heckler report.” A landmark moment in the fight against healthcare inequity, the report acknowledged and documented the differences in health and healthcare access between white Americans and minorities. Perhaps most importantly, those findings led to the creation of the Office of Minority Health, an office that sat within the wider Department of Health and Human Services.
Eighteen years later, the Institute of Medicine of the National Academies released a new report: “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” Critically, the study documented healthcare inequities experienced by minorities after accounting for socioeconomic status. The role that unconscious bias and lack of cultural competency play in healthcare was finally exposed.
But knowing what happens to black and Hispanic people in the healthcare system did not automatically solve the problem — and as society has changed in other ways, new issues have emerged.
In the early days of the pandemic, misinformation flourished in communities of color. Unfounded rumors circulated that certain groups were less likely to get sick from the virus, and misinformation campaigns actively tried to spread deadly falsehoods in minority communities, for example aiming to undermine trust in vaccines.
Health inequity did not start with COVID-19, and it likely will not end with it. The pandemic did, however, lay it bare for all to see. Never have we had more evidence of the human cost of health inequity.
Easy to ignore but bubbling under the surface for 150 years, we must live up to the promise made by Lincoln in 1865 and eliminate health inequity.