How to Fight Institutional Racism in Our Health Care System

CHRISTIANE AMANPOUR: Now, there is a new campaign out today on YouTube trying to remedy the fact that the black community is the hardest hit by COVID-19 and, also, the least likely to get vaccinated. “The Conversation: Between Us, About Us” is a video series featuring black doctors, nurses, scientists to provide credible information about COVID-19 vaccines, also cultural figures as you can see. Here is a clip from the trailer.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: OK. First question. The vaccine happened fast, like super-fast, like you say bolt headed to the bathroom fast. Is that something we should be concerned about?

JOIA CREAR PERRY, OB-GYN AND PUBLIC HEALTH ADVOCATE: Having an emergency authorization for these medications was critical but that doesn’t mean any steps were cut.

DAMON FRANCIS, MD, INTERNAL MEDICINE: Anything where money could be traded off for time, that was happening. Like money was no object.

(END VIDEO CLIP)

AMANPOUR: Now, Dr. Rhea Boyd codeveloped the series. She’s a pediatrician and a public health advocate. Dr. Joia Crear Perry is one of the doctors featured, and she’s OB-GYN and founder of the National Birth Equity Collaborative. Here they are talking to our Hari Sreenivasan about all of this.

(BEGIN VIDEOTAPE)

HARI SREENIVASAN: Christiane, thanks. Thank you, Dr. Boyd and Dr. Crear Perry, for joining me. First, Dr. Boyd, what is the campaign you’re rolling out and why is it necessary right now?

RHEA BOYD, PEDIATRICIAN AND PUBLIC HEALTH ADVOCATE: So, it’s called “The Conversation: Between Us, About Us,” and it is so critical because what we’re seeing is that despite black folks making up the second highest COVID mortality rates in the country, they are now second to last in access to the COVID vaccines. And so, this campaign is specifically to speak directly to their concerns, to ensure we are respecting those concerns and treating them as legitimate and to answer them so that folks can have their questions answered as they make this critical choice.

SREENIVASAN: Dr. Crear Perry, one of the first sort of questions that we get from anybody who is a little hesitant is this idea of warp speed. OK. They did this really fast. We, from what little I remember and high school biology class, it takes years and years to get a vaccine. But here we are, in just under a year. Why should I trust this?

JOIA CREAR PERRY, OB-GYN AND PUBLIC HEALTH ADVOCATE: Well, you know, a lot of times we take a long time to do things because we want to be extra careful and then sure, but we also have years of research that leads up to this moment. We’ve known that there was going to be some type of virus or some type of pandemic for many — for a long time. And so, it’s not — although, warp speed happened rapidly recently, it was built upon years of research. And so, this idea of having a vaccine quickly, we didn’t skip over anything we needed to do. The federal government, I trust the FDA, I trust that the people who are putting together these medications, the drug companies, really followed all of the safety protocols because they had years of research to build it upon. So, although it was fast, it was not new. We’ve known things were coming and we knew that this is important.

SREENIVASAN: OK. Dr. Boyd, early on, one of the, I guess, almost rationales that was offered of why black Americans were not getting vaccinated was, well, you know, there is deep distrust in the community ever since the Tuskegee experiments. They had reason not to be, you know, first in line. Are we conflating that kind of hesitancy with just plain old access to health care?

BOYD: Absolutely. I think we in health care have completely misdiagnosed the real barrier that’s keeping black folks from accessing the COVID vaccine. And as you said, it is not their own hesitancy, it’s that black folks don’t have equal access to information about the vaccine and they don’t have equal access to actually receive the vaccine in their neighborhoods if they are interested in getting it. Recent data from Kaiser Family Foundation told us that although the rates of folks who are interested in the vaccines among black populations is increasing, there is still about more than a third of people, about 37 percent who are still waiting to see. And among those groups, the vast majority have common concerns. The number one concern is, is this vaccine safe? That’s not a concern that’s unique to black folks. It is the number one concern of our medical establishment when we created the clinical trials to actually determine if we would give the vaccine to anybody. Another high concern that 50 percent of folks had who are still waiting to see is if they have to pay for it. People are still concerned about cost. And so, it’s critical that people understand that not only are these vaccines safe but they are also absolutely free. And folks are working to make sure that they can receive it in their own backyards.

SREENIVASAN: Dr. Perry, that leads us to one of the questions that people also have is, how safe is this? I hear kind of a technological skepticism. This mRNA stuff, is this messing with my DNA? Is this actually putting the virus into my body?

CREAR PERRY: You know, we understand — our understanding of viruses has evolved so much even since I was in medical school in the late 1990s and we recognize that having pieces of the virus are just as effective as trying to take the whole virus and then put it inside of your body. So, we know that the effectiveness is above 90 percent for most of these vaccines and we have vaccines that we’ve given to the general public that don’t have the same actual effectiveness. And we know it is effective in keeping us from dying and from becoming really ill. And that’s what we want to stop. No, there’s no vaccine makes us impenetrable. I think the best what people are looking for that there’s this medical one shot that makes you never get sick or never to have anything. But we do know that this is highly effective, more than many of the other vaccines we have from you actually dying. And that’s what we want to stop people from doing, from becoming really ill and from dying.

SREENIVASAN: Dr. Boyd, you mentioned cost, but access also in ways has to do with proximity. I mean, you know, there was a story recently about how dodger stadium, one of the mass vaccinations sites, is right next to China Town but it was drive through only. So, here were people in China Town who didn’t have cars who couldn’t go to the thing that was technically right next to them.

BOYD: Absolutely. Access for people isn’t just that we make it affordable, it’s that we bring it to people. And honestly, if you look historically about how the federal government has done vaccination campaigns in the past, sometimes we actually had to go door to door, particularly in rural areas where people don’t live proximate to a pharmacy or proximate a regular provider, and I think that same — that may also be true right now. That for people to really have open access to the COVID vaccine, that we actually have to bring it to them. We saw a great example from a black health care worker led initiative in Philadelphia where after they just brought the COVID vaccines into people’s neighborhoods, people weren’t hesitant. They lined up around the block to get it. We have to decrease people’s barriers to getting it by making sure it is available at hours when they’re not at work and in places that are near where they live so that they can easily receive it if they’re interested.

SREENIVASAN: Dr. Crear Perry, one of the things that we hear from women and perhaps their partners is, are there concerns with infertility or should people take this if they are pregnant or trying to get pregnant? What should the rule be?

CREAR PERRY: We are not actually sure if COVID — actually the virus was not going to impact people’s fertility, right? And so, we have to be really clear that we know it impacts blood vessels. And so, there is a long-term conversation we haven’t even gotten to yet around actually contracting the virus can cause harm. But what we do know is that the vaccination is safe. That we’re trying to keep you from contracting a virus that could possibly impact fertility. We also know, I was part of the study out of UCFF looking at all of the pregnancies and births across the United States during COVID and we know that the vaccine is safe in pregnancy. They are not going to articulate that. We know that they’re not going to — we haven’t tested in pregnant people but many birthing people and pregnant people are currently taking the vaccine and they are fine and they are healthy. So, if your provider says that it’s OK for you to take it, then you should take it.

SREENIVASAN: Dr. Boyd, some of the questions that I am asking are things that you hear kind of through the grape vine but then there’s also this really enormous news source which is the internet. What kinds of challenges does the internet pose when it comes to misinformation and then disinformation that you’re having to dispel in the black community?

BOYD: That’s a major concern of ours and it is part of why we started this project before a single vaccine even had emergency use authorization. We already saw black folks being targeted online for misinformation, in social media comments, on message boards that are centered around social justice issues that attracted large black audiences. Folks were going there peppering in messages that were complete lies and myths about the COVID vaccines. And so, we created a campaign that in one respect will live always on the internet. To make sure that right where misinformation lives, we now paper over it with the truth that comes from black health care workers. But we’re also making sure that it doesn’t just live on the internet. The other part of this campaign that is absolutely critical is that we actually bring it to people so that they can have their questions answered live, in person, with a health care provider. Because we know 1 in 5 black folks across the country don’t have access to a regular health care provider. And so, we are making sure that our network, our providers who helped us create these resources are also available to everybody across the country at different periods. And for folks who are interested in that, they can visit our website betweenusaboutus.org to learn more about joining one of those live conversations.

SREENIVASAN: Now, Dr. Crear Perry, when you watch some of the videos as part of the campaign, you realize how just shocking it might be to see 15 or 20 black scientists and doctors in the same place on a video because this just — it doesn’t — it kind of hits you. I think the image in itself is powerful, but some of this comes down to trust. People walking in and seeing a doctor who they can connect with and say, I trust her in a way that I might not trust someone else.

CREAR PERRY: Yes. And we know segregation was a really effective tool, right? This idea that we have lived for generations not near each other, not able to go to school together, like that government sanctioned tool caused harm, that we still live the replications from today. So, people feel trusting when they see someone who looks like them because we created structure and that is what we saw in each other. So, I’m more — a black patient is more likely to feel trusting in me because most of their life they’re spent in black places, in black neighborhoods, in black churches, in jobs, in sororities, in fraternities. And so, there’s a level of community that was orchestrated and created that creates this space that we are in now. So, it doesn’t mean that a white provider can’t be trustworthy but we created a structure where people see others who look like them most of the time. And so, they are more willing and more likely to trust in information that they share. We also have data that shows out of Oakland that there are providers who when they — there were black men who were more likely to get the vaccine when they had a black provider tell them about the vaccine. So, that — we cannot let go of that history and legacy that comes with why we have segregation, the history of white supremacy, the history of racism, like that is real. So, it’s important for us to say, OK. How do we then move forward and ensure people feel trusted, feel valued, feel heard? And so, that ensures that we have providers who look like their patients (INAUDIBLE).

SREENIVASAN: Yes. Dr. Boyd, it seems like this is an opportunity to address or begin addressing some far more structural and deep-rooted issues about health care access and equity.

BOYD: Absolutely. I think the major thing that drives racial health and equities as Joia just shared, Dr. Crear Perry just shared, is lack of access and that lack of access is a reflection of racism and particularly antiblack racism that we have not built a health care system that is equally accessible to everyone regardless of your racial and ethnic background. That instead, we have a health care system that tends to tier the quality of care you receive by your insurance status, which is an incredibly effective way of tiering the quality of care you receive by your racial and ethnic group. And so, we as a health care system are also having challenging conversations to confront the ways we have profited from and benefited from racism and the ways that white supremacy is still manifest and how we distribute resources from the COVID-19 vaccine to COVID testing to COVID care to all of the preventative services that our health care system should be providing.

SREENIVASAN: Dr. Crear Perry, I know this is part of why you are in the campaign and why you’re involved in this, but pivoting a little bit, how do we change that on a doctor to patient basis or a member inside a community basis? What do we do to start having this kind of transformative or this necessarily transformative conversation?

CREAR PERRY: Well, for me, it started with myself. Many people who are my age or older or people who look like me who were taught by their professors that the reasons that we have racial inequities is because there is some biological basis of race. And even when we stop teaching that, that belief is still undergirding how we treat patients, how we think about things like the C-section calculator or the way we talk about people’s kidneys being differently capable of maintaining kidney function or your lung capacity. All the racist ideology that’s embedded in our health care system and the ways we teach medicine in public health is really showing up today. So, what we have to do is unlearn all of that. We have to work really hard to say, well, why would we ever say that? What would be magical about melanin production that has anything to do with my kidneys and how they operate? Why would we say that it is something that — there’s a connection between our ability to have a C-section and the amount of melanin we produce? So, really undoing that belief as a biological construct and replacing it with understanding racism, the impact of a belief of a hierarchy of human value based upon skin color, based upon ethnicity, and that is where you see differences in outcomes. So, when I say racism, I’m not calling you a bad name, I’m not saying you are a mean person. Even when we talk about this public health response and the racist — in ways that it’s happening, it’s not because we are saying people are sitting down saying, oh, you’re worthless valuable. So, therefore, I harm you. Because the belief is so innate, we automatically do it. So, we have to be truthful about that. So, you’ll see places give vaccines like in the District of Columbia — I mean, D.C., trying to give vaccines to the neighborhood and the communities that have the highest risk, but people coming from other parts of the city to take those vaccines, right? And so, we’ll say, well, that’s just how that goes. It’s not how it goes, right? We create a system where we could say, you should not come — you cannot get this vaccine unless you actually live in this community. You can make policy that proactively stops harm to the people who are the most harmed, who are the least centered. And that’s how you undo the racism that we’ve been (ph). So, we can’t have survival of the fittest. We can’t continue with this narrative that those who work really hard are the ones who are deserving of actually having access. It’s never been a truth. People who work really hard are now the essential workers who are still working, who are still dying, who are still taking care of us. And so, they are fit. They just have never been invested in and they’ve never been valued. So, how do we ensure that they get first access to the vaccine?

SREENIVASAN: Dr. Boyd, sort of same question to you. Where do we start that conversation on a personal level and then kind of on a national scale?

BOYD: I think we have to start within our own homes and our own relationships about the choices that we’re making. That as Dr. Crear Perry said, one of the ways that white supremacy can show up is in the choices that we make to also try to take resources that are attempting to prioritize communities who are disproportionately affected and say that we still, as a white person or as a white community, want to have that just for ourselves. We have to ask ourselves what drives that and then people then have to try to surrender that advantage, to instead of trying to have more access than other groups attempt to have equal access. Because the truth is, even as these efforts are trying to place vaccine access, for example, into people of color’s community, it is never at the expense of white communities, right? Like people don’t need to go to that extent. I think even just the recent announcement where the Biden administration said that, you know, they are committing that by May we will have vaccine doses for every single Americans. We do not have to continue to believe that there is this scarcity around the resource that our federal government has put enormous resources in such that then people don’t have to try to continue to reassert a hierarchy about who should receive that based on people’s racial or ethnic background. So, I think that starts with conversations just between people and themselves and introspection with their own families and communities. And then, hopefully, it will filter into how our systems work, which is where the work of Dr. Joia Crear Perry and I lives, which is shifting how our systems respond to communities such that we have responses that give communities resources commiserate with their need and not simply commiserate with the power that they have.

SREENIVASAN: Dr. Crear Perry, how do you make sure that black Americans have physical access to it? I mean, if you look across the country right now you can say that there are food deserts, you can say that there are news deserts and there are certainly health care access deserts. So, how do we make sure that we are taking something not just like this particular shot door to door but using this as a pathway to say, hey, this is an opportunity to increase access to all kinds of medical information and medicines?

CREAR PERRY: Both Dr. Boyd and I are not surprised that this is what’s happening because we have all this other evidence that this is what always happens. But what we hope — but I’m hopeful and I’m optimistic. So, this might not happen. But I’m an optimist that we recognize when we don’t invest in the communities, that all of us die, right? You can’t — that the virus doesn’t care about our biases. The viruses do not have a hierarchy of human value based upon (INAUDIBLE). The viruses say, OK, if you are going to decimate black and brown communities, I’m coming for the rich person next, right? I’m coming for your rich. Because the virus can go that quickly. So, hopefully, this is a moment of empathy, of combined humanity for us as a country to come together and say, we will no longer allow health care resources to only go to certain communities because they have more power and they have access to it. We’re going to say, let’s center the most impacted, let’s ensure that they get it first. Because when they do, man, we’re going to all thrive. I know from my work around black maternal health, if we could get hospitals to treat black mamas well, man, it would be amazing for everybody else, right? So, when you (INAUDIBLE) people who are the most impacted, if you actually ensured that Wards 7 and 8 got all the vaccines, trust me, the rest of us are going to thrive.

SREENIVASAN: All right. Dr. Rhea Boyd, Dr. Joia Crear Perry, thank you both.

CREAR PERRY: Thank you. That was fun.

BOYD: Thank you so much for having us.

CREAR PERRY: Appreciate you.