The U.S. joined nations around the world last week in instituting sweeping emergency measures to combat the coronavirus pandemic. In an attempt to slow the spread of COVID-19, the disease caused by the virus, schools and universities shut down, and concerts and conventions have been canceled. The NBA suspended the remainder of its season, along with most other professional sports leagues. For the first time in its 81-year history, the NCAA canceled its annual March Madness basketball tournament. Friday, President Donald J. Trump declared a national emergency.
For a whole host of economic, political and historical reasons, Georges C. Benjamin, executive director of the American Public Health Association, says it’s a threat that African Americans need to take particularly seriously.
“We get a lot of misinformation circulating through our communities,” Benjamin said. “We fundamentally don’t trust some of the [non-black] institutions because they do not serve us well. We need to make sure our trusted institutions, clinicians of color, churches, community organizations, are better educated.”
Benjamin spoke with The Undefeated about the history of health care in the community and the obstacles to treatment that exist.
This interview has been edited for length and clarity.
Why are African American communities at added risk for the coronavirus?
I think the biggest challenge is the fact that people of color, African Americans, start out with health outcomes that are disproportionately poor when compared to white Americans. The highest risk, if you get this disease, is to someone 60 or older with chronic disease. With African Americans, you start with a population that is disproportionately sicker, and if it gets exposed, it will have a higher death rate.
Why is our at-risk population for the virus starting out more sick?
The reasons for the health inequities include access to health care, and differences in the quality of care African Americans receive. A lot of what makes you healthy happens outside the doctor’s office, so all the social determinants – including racism and discrimination, housing, access to transportation and education – are a factor. And I’ll say differences in individual behaviors that we all have based on our life experiences.
Let’s talk about the uninsured. Obviously, we still have too many people of color who are uninsured, particularly in those states that chose not to expand the Medicaid program. They certainly don’t cover the non-African Americans either, but African Americans have had real challenges in those communities, which tend to be in the South and the Midwest.
We have lots of folks who work in the gig economy, so they don’t necessarily have coverage. Looking at this coronavirus, the whole issue of not having paid sick leave is an issue where we have people of color who are disproportionately working in the service industries, in the restaurant industries, working for hotels, or places where they are not in unions that have bargained for benefits that give them sick leave. They are hourly workers who don’t have certain kinds of benefits, so that if they don’t work, they don’t eat. And that’s a challenge. Obviously, if you get sick and we tell you to stay home, you should stay home. But you’re less likely to do so because you’ve got to work. You’ll probably come to work during the early part of your illness and the challenge with that, of course, is you’ll infect others.
Why is there so much distrust between African Americans and the medical community?
Everyone obviously goes back to the Tuskegee experiment. The syphilis study where African American men were not treated for syphilis and they continued not to be treated even after we had treatment available. Ultimately the Public Health Service apologized, as well as President Clinton apologized on behalf of America.
We also have experiences where people go into academic health centers and the word on the street is you go in, but you don’t come out. That’s a reality, but the reason they don’t come out is because people go into those places in a much later state of disease. Quite often we have far too many women who are found to have breast cancer. They have a lump in their breast, but they still show up far too late to get the best cancer care.
Also, when you go in and you have someone who doesn’t look like you or doesn’t communicate with you in a culturally competent way, that’s a problem. We still have lots of clinicians out there that talk down to patients. They don’t give us the full range of options.
What do you think needs to happen with coronavirus testing in the African American community?
People go to see practitioners that they trust. Most of our [local] governmental public health agencies are in the community all the time. They have outreach workers, they have programs so they are not just showing up today and deciding that we now want to test you so that your first question is who are these folks, where are they from and what’s their motive for being here. If you have a long-standing relationship with those communities, you’re much more likely to accept who they are and trust what they say, so you have compliance with getting the test and believing the test results.
At some point when treatment becomes available, compliance with taking medication or getting the vaccine – it’s not available now, but at some point when it becomes available – is absolutely essential. Otherwise, if people don’t trust it, they won’t get the prescription filled, they won’t take the shot, they won’t even do the quarantine process because they don’t trust the information they are getting. If you have a strong federal, state, local and community partnership, then you’re going to have a much more effective engagement.
What do you think of the decision by sports leagues to cancel their tournaments and seasons?
Because of the trajectory that we’re projecting for the number of people who are going to get sick if we don’t do what we call social distancing, I applaud the sports industry for reducing our exposure and canceling or delaying those events until the peak of this epidemic is over. People of color go to a lot of those games, so we can see that as a way of putting us less at risk.
We’re social people and in addition to sports, we’re going to be loath to give up our church services and our reunions and those places that are incredibly meaningful to us. So what would you tell us about weighing those gatherings against the risk of the coronavirus?
This is serious business and they need to pay attention to trusted voices on this. I actually happen to trust the Centers for Disease Control and Prevention – I know they screwed up part of the testing piece – but that information on their website is solid.
Go to organizations like mine, the American Public Health Association, our information is solid.
I’m hoping we will get ministers and trusted advisers in the community up to speed. The places we also get health information – Uncle John and Aunty Sue, our barbers, our beauticians – right now they don’t all have the right information, but I’m hoping they’ll get that right information so that we can have all our trusted advisers give us the right scoop.