A panel discussion Thursday afternoon featuring U.S. Rep. Lauren Underwood (D-14th) drew attention to the continuing issue of racial inequality in the country's healthcare system, and focused on the ways that the COVID-19 pandemic has exacerbated this longer-lasting problem.
COVID-19 has disproportionately impacted Black and Brown people, in part because many of them are essential workers who have had more exposure to the virus. In August, the death rate among Black Americans rose from 80 to 88 per 100,000 people, according to the Guardian.
During Thursday’s conversation, hosted by the University of Chicago Urban Network, Brenda Battle, one of the panelists, pointed to the ways that the healthcare system discriminates against Black people, and Black women in particular. In Chicago, she said, healthcare systems on the North Side receive 72% more in funding than systems on the South Side overall.
“When you’ve got a public and a private system, the systems get set up separately,” said Battle, vice president of school's Urban Health Initiative and the U. of C. Medical Center’s (UCMC) chief diversity and inclusion officer. “There is a system for the care for the poor and a system of care for the privileged, and often where care was delivered to the poor they were Black and brown people.”
But this structural difference also makes itself felt at the individual level. “In cardiac care, we know that if a person of color comes into an emergency room and they say they have chest pain — they might need a balloon blown up in their coronary artery — the timing is often slower than if it is a White person,” said Melissa Gilliam, a doctor, professor and researcher at UCMC, as well as a vice provost at the U. of C..
“Because we have these blinders, we have these ways in which our reaction to the thing can affect our behavior.”
One area where the disparity has been particularly dire is maternal mortality: from 2011 to 2016, Black women were more than three times as likely to die of a pregnancy-related mortality during live birth than a white woman. And that difference persists even as education levels rise — a 2019 study found that pregnancy-related mortality rates for Black and Native American women with at least some college education were higher than those for all other racial and ethnic groups with less than a high school diploma.
Underwood, a registered nurse who was elected to represent part of the western suburbs in Congress in 2018, co-founded the Black Maternal Health Caucus last year. The group put out a “momnibus” bill this year that calls for more research into and funding for groups working on maternal healthcare.
Underwood also introduced the Maternal Health Pandemic Response Act together with U.S. Sen. Elizabeth Warren. The bill would call for federal data with more information on race, income and gender to be released, and ensure vaccines are developed for people who are pregnant or lactating.
“I know that people hear the headlines about the COVID relief package, the way that the conversation has kind of shifted beyond COVID disparities and the healthcare needs of the virus,” said Underwood. “And I want you to know, there is a group of us who are very focused on these disparities and the impact of maternal health in particular.”
But part of bringing maternal mortality down more generally, Gilliam said, is to ensure that there’s more diversity within healthcare systems. “When you have systems that are in place where you can hire a diverse workforce, those are systems that are thinking about equity,” she said. “At the interpersonal level, if you are a person of color and have that experience, you're less likely to introduce those same levels of potential areas of bias or potential prejudices into care.”
For Underwood’s part, she said, more diversity should go hand-in-hand with an expansion of Medicaid. “When we look at states that haven’t expanded Medicaid, we’re seeing that (mothers’) coverage cuts off 60 days postpartum,” she said. “We’re setting up a scenario where it’s not a surprise that we receive these negative birth outcomes.”
This problem is present more locally, too. “On the South Side, we had seven hospitals at one point that were doing deliveries. And now, with the closures of maternity wards and potential closure of Mercy Hospital, we’re going to get down to two hospitals that are delivering,” said Battle. “There needs to be a better investment in healthcare in communities that already are healthcare deserts, particularly on the South Side of Chicago.”
Gilliam concluded by pointing out that doctors and researchers need to do a better job of engaging with communities they treat or study. “We'll come back with something that is really profound but actually quite obvious to anyone who's dealing day to day with the situation …. For people who live directly in this in these communities, they can tell you and they know what it is that is affecting them,” she said.
“That leadership coming from members of the community about their own sense of well-being is, I think, a really important part of how we will address and fix this.”