Montefiore CEO: COVID-19 Has Exposed Dire Health Care Inequities

As the war against COVID-19 rages on, it is clear the virus has unmasked another problem. According to the Centers for Disease Control and Prevention, hospitalization rates for Blacks and Latinos are five and four times greater, respectively, than that of non-Hispanic whites. For patients with underlying conditions, hospitalizations are six times higher and deaths 12 times higher than for patients without those complications. In the Montefiore Health System, fully half of the 2,250 patients killed by the coronavirus had diabetes.

Disease is a cruel teacher — the coronavirus is one of the cruelest I have encountered — but the lesson here is beyond valuable, and it applies to more than the current acute catastrophe. The pandemic has exposed an underlying public health crisis, a chronic disaster, if you will, that has been afflicting and killing minorities and the poor for decades. Poverty, unemployment, hunger, crowded and substandard public housing, violence, threats to public safety, limited access to healthy food choices — such social determinants of health can combine to leave entire communities at increased risk for the chronic diseases and disorders that have left them particularly vulnerable to COVID -19.

[See: A Look at Hospitals, Health Care Workers Fighting the Coronavirus Pandemic.]

From my vantage point in the Bronx, home to Montefiore Health System and Albert Einstein College of Medicine, I can readily see the impact these forces have on individuals of all ages. They reduce quality of life, promote disease and have the power to reduce life expectancy itself.

All of this endures in the shadow of our flagship hospital, a state-of-the-art facility with a world-class staff and some of the best complex-care outcomes in the country. We treat every person who shows up, regardless of their circumstances, and we treat them all with the same respect and standard of care. I am unashamedly proud of our performance during the pandemic, during which we treated tens of thousands of patients. But all too often, for reasons beyond the control of the health care system — lack of (or insufficient) health insurance, fears about missing work, fears about immigration status — people stay away until they are seriously ill.

[Read: How the Pandemic Is Changing the Way Hospitals Care for Patients]

I find it maddening that individuals who live within blocks of my hospital are made more vulnerable by their physical and social environments. I’m a doctor, I can handle COVID-19 and other diseases when they appear. But I need partners to address the issues that over time create the health disparities that so impact the survival of minorities and the poor, things like inadequate schools, food deserts and the lack of safe outdoor space.

This is why we have created a roster of community-based programs at Montefiore that directly impact our neighbors. These include our own soup kitchen, and working with local bodegas in areas with high rates of diabetes to improve the availability of healthy food choices in a culturally relevant way. In coordination with the New York City Housing Authority, we promote asthma education and improved cleaning and pest control in city housing projects. And we teamed up with BronxWorks, the Bronx’s largest social service provider, to hold a Poverty Simulation, to help our staff better understand the lives of the people they serve and alert them to any unconscious biases in their interactions.

[Read: Mayo Clinic CEO: We Mustn’t Go Back to Business as Usual After the Pandemic]

I believe that health care leaders like me, and the institutions we are part of, have a special responsibility — and are uniquely positioned — to be advocates for public health. It’s up to us to draw attention to the social determinants of health and to work with public officials, community leaders and local residents to come up with strategies to address the inequities that plague our poor and minority populations.

We have now seen firsthand what a novel virus can do to people whose health has been compromised for years by the oldest virus of all — racism. We must do everything we can to make sure we never have to see it again.

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