Why Racial Disparities Made the Pandemic That Much Worse for People of Color
by Shelley Zalewski
Similarities in racial disparities in cancer and COVID-19, and how the pandemic has affected efforts to close the inequality gap.
For many types of cancer, people of color are more likely to have poorer outcomes than those who are white. This disparity exists for COVID-19, too — and for many of the same reasons. We asked Michigan Medicine’s John Carethers, M.D., to explain the similar factors behind racial disparities in both diseases and to discuss how the pandemic has aff ected eff orts to close the inequality gap.
Q: What do doctors mean when they talk about health disparities?
When a certain health outcome is more likely to occur in one group of people than another, and the difference can be explained, at least in part, by social or economic disadvantage — in income, education, employment, or access to housing, transportation, health insurance or medical care — that’s a health disparity.
Q: Can you give an example?
Becoming infected with COVID-19 is a health outcome. About 13% of Americans are Black, and about 17% are Latino — together, that’s about a third of our population. All things being equal, you would expect they’d account for about a third of COVID-19 cases. But all things aren’t equal. And together, these groups make up more than 50% of COVID-19 cases.
Receiving a COVID-19 vaccination is another health outcome. Th is spring, about 1 of every 3 adults in the state of Michigan had been vaccinated. But in the largely African-American city of Detroit, fewer than 1 in 5 had received the vaccine.
Q: And similar disparities are seen in cancer?
When it comes to health disparities, the parallels between cancer and COVID are uncanny. Th e same societal barriers are putt ing the same groups at greater risk. Why, for instance, are five-year cancer survival rates for Black people lower than for those who are white? Those same social and economic disadvantages I mentioned make it more difficult for communities of color to access preventive tools like screening, and resources to manage risk factors like diet, weight, tobacco and alcohol use. As a result, they have poorer outcomes.
Q: Can you share specifics from your own clinical experience?
My main focus is the genetics of colorectal cancer, but I also study how health disparities impact cancer outcomes in African Americans. I see patients with strong family histories of colorectal cancer. Regular screening is the key to managing their inherited cancer risk. Screening appointments definitely fell off during the pandemic, and some people are still reluctant to make medical appointments.
There are real consequences — and not just for people with genetic risk — in delaying regular cancer screening. Researchers project that delaying regular cancer screenings for just six months will result in an additional 10,000 breast and colon cancers down the road. Percentages are likely to be higher in people of color, as they already did not achieve the same screening rates as whites before the pandemic.
Q: You co-authored a recent study on the health disparities shared by cancer and COVID-19. What are the key takeaways?
In both diseases, the biggest challenges are insurance coverage and medical access to preventive health services to combat conditions like obesity, diabetes and cancer. Our recommendations include increasing diversity in clinical trial participants; supporting the safety net hospitals that serve the medically underserved; and improving access to technology so all populations can access telehealth services.
Q: Can you tell me more about the telehealth recommendation?
The pandemic has challenged — and changed — how doctors and patients interact. At the Rogel Cancer Center, we’re embracing the change. We hope that our investments in telehealth technology will not only help us better serve our existing patients but will also connect us to patients in underserved areas.
Q: How do you feel about the future?
I’m optimistic. While we have a long way to go to overcome racial inequality in health care, I have seen firsthand that the right interventions, even modest ones, can move mountains. Like a recent program that matched 10,000 patients with patient navigators — people trained to educate and motivate them to get colorectal cancer screening, as well as provide guidance on whom to communicate with and where to go to get the screening. Big results came from that added support. Screenings of both white and Black participants increased, mortality dropped for both groups, and both had the same incidence of colorectal cancer.
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