Syringe and vials of vaccine.

Racial Inclusivity in COVID-19 Vaccine Trials

By Colleen Campbell

Recent calls for racial inclusivity in vaccine trials, which often rely on genetic rationales while emphasizing medical distrust among African Americans, unfortunately lack an equally robust critique of medical racism and the ongoing reasons for this distrust.

Even though race lacks genetic meaning, the COVID-19 discourse is rife with biological notions of race. Because of [g]enetics related to racial differences” African Americans must be involved in clinical trials, said Dr. Larry Graham in an NBC News article. He continued: “We must be sure it works in Black folks.” For this reason, companies like biotech firm Moderna are enlisting Black religious leaders to heavily recruit African American participants. They are also exploiting networks previously used for HIV clinical trials.

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Civil rights march on Washington, D.C. Film negative by photographer Warren K. Leffler, 1963. From the U.S. News & World Report Collection. Library of Congress Prints & Photographs Division. Photograph shows a procession of African Americans carrying signs for equal rights, integrated schools, decent housing, and an end to bias. https://www.loc.gov/item/2003654393/

Structural Racism: The Root Cause of the Social Determinants of Health

By Ruqaiijah Yearby, J.D., M.P.H.

In 1906, W.E.B. DuBois noted that social conditions, not genetics, impacted the health of Blacks, causing racial disparities in mortality rates. In 2010, the federal government formally recognized that social conditions, specifically the social determinants of health (SDOH), were responsible for racial health disparities.

Racial health disparities, estimated to cost the United States $175 billion in lost life years and $135 billion per year in excess health care costs and untapped productivity, persist because of the failure to address their root cause: structural racism.

Structural racism describes the way our systems are structured to produce racial inequalities between whites and racial and ethnic minorities in the SDOH, leading to racial health disparities.

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New York City, New York / USA - June 13 2020 New York City healthcare workers during coronavirus outbreak in America.

COVID-19 and the ‘Essential’ Yet Underappreciated Front-Line Health Care Worker 

By Kimani Paul-Emile

When considering those on the front lines of the coronavirus pandemic response, most people likely envision doctors and nurses. However, there is an often forgotten, front-line workforce comprised of orderlies, nursing facility workers, and nursing assistants (“NAs”) that earns very little money, has few protections, and is largely Black and Brown and female. Many individuals in this group are also subject to a unique form of discrimination: rejection on the basis of their race or ethnicity by some of the very patients they are assigned to aid.

The millions of people who make up this group of essential workers constitute a substantial portion of the health care workforce and earn an average of $13.48 per hour despite the risks they take. Their work, which involves bathing, dressing, and feeding patients; brushing their teeth, and assisting with their use of the toilet, puts these workers at high risk of contracting COVID-19. Nevertheless, early in the pandemic, many of these workers lacked or had inadequate personal protective gear due to the tiered system used for distributing this equipment. Doctors and nurses were first in line for smocks, masks, and other essential gear; last were members of this underappreciated group of front-line health care workers.

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Woman holding sign that reads "I can't breathe."

Black Women Can’t Breathe

By Michele Goodwin

Years before George Floyd begged to be released from under the knee of Officer Derek Chauvin, Barbara Dawson, a fifty-seven year old Black woman, died begging a police officer, John Tadlock, not to remove her oxygen mask. Her death occurred right outside the Calhoun Liberty Hospital in Blountstown, Florida, shortly before Christmas in 2015.

Just before Officer Tadlock’s arrival, Ms. Dawson arrived at the hospital seeking oxygen. The hospital’s response to Ms. Dawson’s request was to call law enforcement. Photographs show Ms. Dawson slumped next to the police car. A police recording captures the tragic end of Ms. Dawson’s life. Officer Tadlock reprimands Ms. Dawson: “Falling down like this and laying down, that’s not going to stop you from going to jail.”

Ms. Dawson’s life ended on the pavement, feet away from the entrance of the hospital that phoned the police on their patient — because she refused to leave. She lay there nearly twenty minutes before being pronounced dead. It turns out she had a blood clot in her lungs.

In some sense, there is nothing extraordinary about the image of Ms. Dawson, or the interactions of the hospital and officer, which further complicates the deadly exchange. Indeed, the interaction was far too normal: Black women fear for their health and safety when they do not seek care and, troublingly, even when they do.

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Close-up Of Doctor's Hand Measuring Blood Pressure Of Male Patient.

Understanding the Role of Race in Health: A New Digital Symposium

By Craig Konnoth

In the 1980s, a vanguard of critical race theorists debated their contemporaries as to whether law could or should play a role in achieving equity — in particular, racial equity. Scholars such as Kimberlé Crenshaw and Patricia Williams argued that while legal discourse historically had been used to oppress Black, Indigenous, and people of color (BIPOC), history had shown that in the law also lay the seeds of empowerment. Conceptualizing BIPOC as persons endowed with legal rights, and as a community subject to heightened legal solicitude because of the historical injustices they have faced, has helped undergird their selfhood, dignity, identity and activism. Law could thus be a discourse of despair — but also one of hope.

Whether or not the years have proved those claims correct as to the law, today, a similar debate unfolds in the context of race, medicine, and health care. Today, medicine and the health care system embody discourses of power that rival the law. Will these discourses inevitably serve to oppress BIPOC — and if not, how can we harness their power to achieve justice? Those are the questions that this symposium seeks to answer.

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Photograph of a doctor holding a headset sitting in front of a laptop

How Telehealth Can Reduce Disparities

By Jenna Becker

Telehealth can and should be used in an intentional effort to reduce health disparities.

Increased COVID-19 mortality rates in communities of color have been a constant, tragic reminder of the ways in which systemic racism causes poor health outcomes in the United States. Immigrants are facing an increased risk of illness and limited access to care. Rural Americans may face an increased risk of serious illness.

Telehealth can reduce barriers to care that these groups face, such as lack of access to transportation, culturally-competent providers, and childcare.

The last six months have seen rapid growth in the use of telemedicine in response to the COVID-19 pandemic. In response to urgent need, regulatory agencies and private insurance companies have loosened requirements that previously inhibited the use of telehealth.

The expansion of telehealth and removal of traditional barriers to care may lead to more equitable health outcomes.

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The Week in Health Law podcast logo twihl.com

New TWIHL: Equity in All Policies with Sarah de Guia

This week, my special guest is Sarah de Guia, Chief Executive Officer of ChangeLab Solutions. Along with Scott Burris, Wendy Parmet, Lance Gable, and Donna Levin, Sarah and I worked together on our report, Assessing Legal Responses to COVID-19, which was just published. Our broad discussion looks at the report’s terminology, general approach to equity, and local strategies for change, along with some specific examples drawn from the assessment.

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a crowd of people shuffling through a sidewalk

The SSTAR Initiative: A Policy Proposal for a Full, Equitable Recovery from COVID-19

By Sara E. Abiola and Zohn Rosen

Full recovery from the COVID-19 pandemic in the U.S. will require new policy that promotes equity and streamlines access to social services while supporting small businesses

Unprecedented job loss due to COVID-19 has led to an economic crisis for families of all backgrounds and income levels.

Current health and social services programs are ill-equipped to handle this need. Moreover, long-standing racial health inequities and the stigma associated with using social services will persist in the absence of significant systems-level change.

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Task force on coronavirus and equity report card.

The Health Equity Failures of Massachusetts’ COVID-19 Reopening Plan

By Charlene Galarneau

Massachusetts began Phase III of its reopening plan this week. Reopening unquestionably involves disproportionate risks to the health of some residents relative to others, and the State’s push forward fails to adequately address these risks.

Phase III of Governor Baker’s Reopening Massachusetts Plan began on July 6, with the exception of Boston, which will begin Phase III on July 13. The first step of Phase III focuses on the reopening of recreational activities: gyms, movie theaters, museums, casinos, and professional sports teams, with specific rules for each type of operation.

In its May 2020 report, “Reopening Massachusetts,” the State’s Reopening Advisory Board asserts that “key public health metrics will determine if and when it is appropriate to proceed through reopening phases.” It references six indicators, including the COVID-19 positive test rate, deaths, hospitalizations, health care system readiness, testing capacity, and contact tracing capabilities.

But these state-wide metrics are inadequate, in both public health and ethics terms. Missing from these metrics in particular, and this Reopening Plan in general, is recognition of, not to mention accountability for, the predictably disproportionate negative impacts that reopening has on the lives of Black and Latinx residents, low-wage workers, and other groups already disparately harmed by COVID-19.

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Image of Normal blood cells next to a sickle blood cell, colored scanning electron microscope image.

Recharting the Course of Sickle Cell Disease – Who will Benefit?

By Vence L. Bonham and Anitra Persaud

Scientific advancements in gene therapy and the implications of leveraging this technology to develop new curative therapies are at the forefront of medical research. Sickle cell disease (SCD), the most common genetic blood disorder, stands center stage. Last month, 60 Minutes aired a segment showcasing the story of a patient at the NIH Clinical Center who is on her journey to a cure of sickle cell disease (SCD) with the help of an experimental gene therapy.

Preliminary clinical trial findings suggest that gene therapy has an acceptable level of safety and can help individuals with the disease produce normal red blood cells instead of the sickle-shaped ones that underlie the physiological basis of the disease and its complications. Given these promising results, there is hope that gene therapy may catalyze a turning point for the SCD population, a community that has long suffered the debilitating effects of not only their disease, but of longstanding neglect within the medical system and research enterprise. Read More