Metrics Highlight Health Care Disparities During COVID-19 Pandemic

BOTTOM LINE: Historically marginalized populations experience a disproportional rate of COVID-19 cases and deaths.

As in many states, North Carolina officials have been collecting numerous metrics during the COVID-19 pandemic to track the virus’ spread. They also have informed the guidance and recommendations to health care providers, other officials, and all citizens on controlling the spread of COVID-19 and managing the care of affected patients. 

North Carolina’s State Health Director and Chief Medical Officer for the Department of Health and Human Services (NCDHHS) is Elizabeth Cuervo “Betsey” Tilson, MD, MPH. She is also a board-certified pediatrician.

When speaking with us recently, Dr. Tilson described how analyzing the state's COVID-19 metrics shed light on health disparities in North Carolina, where the ABP is headquartered. 

“When we look at how this pandemic has played out, it’s put a spotlight on disparities that have existed historically in our state,” Dr. Tilson says. 

Black people or African-Americans comprise approximately 22% of North Carolina’s population, yet, as of June 9, 27% of laboratory-confirmed COVID-19 cases and 33% of deaths in NC are among black or African-American residents. Hispanics make up about 9.6% of the state’s population, but 42% of COVID-19 cases. Other states report even higher disparities.  

The Centers for Disease Control and Prevention (CDC) reports that, nationwide, 33% of all hospitalizations for COVID-19 were among blacks or African Americans, who comprise 18% of the U.S. population. 

“I think trust in the health care system is even more important than it’s ever been,” Dr. Tilson says. “Some of our historically marginalized populations haven’t had much trust in the health care system, for some very valid reasons. Maybe pediatricians can think about who they can partner with to build trust with those communities.”  

The NCDHHS is reaching out to historically marginalized populations with COVID-19 information about precautions, testing and contact tracing. They have engaged prominent leaders from communities of color to deliver messages via radio and video. 

On top of COVID-19 disparities, the death of George Floyd has led to widespread protests against systemic racism. The ABP Board of Directors released a statement last week denouncing racism and committing to address health care disparities for children. All major pediatric organizations have made similar commitments. 

While public commitments represent the first step, a concerted effort to understand the causes must follow in short order. Dr. Tilson, her team, and many other health officials throughout the country are doing that. Factors contributing to the increased burden of COVID-19 on minority populations mirror factors that contribute to all health disparities, including lower income, denser living arrangements, more multi-generational households, mass incarceration, underlying health conditions, poor access to health care, and lack of health insurance. In addition to these issues affecting the entire family, the COVID-19 associated school closures have aggravated food insecurity and reduced instructional time for children of color.

“Health disparities are driven by social disparities,” Dr. Tilson says. 

In addition, social distancing is difficult for many low-income families. “Social distancing is a privilege,” she says. “Many people on the front lines, working in grocery stores or meat packing plants, can’t work from home. Many people with lower incomes don’t have computers and internet access at home.”

What Can Be Done?

NCDHHS and other groups offer COVID-19 guidance to health care providers (PDF), including best practices for community testing of historically marginalized populations (PDF), special Medicaid bulletins specific to COVID-19, and COVID-19 guidance and resources for Medicaid beneficiaries

At the ABP, besides working to diversify the membership of our exam-writing committees and other groups of volunteers, we are analyzing exam questions for unintended bias. The quality improvement and learning networks, for which Maintenance of Certification (MOC) credit is offered, have been highly effective in reducing morbidity and mortality for many pediatric conditions. Quality improvement methodologies should now urgently focus on eliminating health care disparities.

As Dr. Tilson’s work demonstrates, we can work to eliminate health disparities. I challenge us, as the ABP, and you, as pediatricians, parents, public health officials, elected leaders, and members of your communities, to end these disparities. In the words of our Board of Directors: “Surely better days are ahead when all children can grow up with the same expectation of safety, health, and opportunity, regardless of skin color.”

About the Author

David G. Nichols, MD, MBA

David G. Nichols, MD, MBA, is the President and CEO of the American Board of Pediatrics (ABP). As leader of the American Board of Pediatrics (ABP) staff and a member of the nonprofit organization's Board of Directors, Dr. Nichols actively promotes high-quality health care for children by upholding the standards of certification in pediatrics and by encouraging and facilitating initiatives in quality improvement. Although he assumed his new leadership role in late 2012, he has been associated with the ABP for more than 20 years. He is board certified in General Pediatrics and is board certified and maintaining certification in Pediatric Critical Care Medicine.