COVID-19: Race, Class & Collaboration

In Chicago, residents of Englewood — most of them black and brown — live an average 60 years, while 10 miles north in Streeterville, 90 is the median lifespan. After decades of health disparities between them, coronavirus has widened the divide.

According to the Illinois Department of Public Health, Englewood reports 890 COVID-19 infections and Streeterville 108.(1) Chronic conditions like diabetes, heart disease and hypertension which disproportionately affect the South Side, now cause greater complications from COVID-19.

Variations on the same theme occur in communities of color across the United States.

“Persons who are African American or black are contracting coronavirus at higher rates and are more likely to die,” said Dr. Clyde Yancy, past president of the American Heart Association. Yancy is also vice dean of diversity and inclusion and chief of cardiology at Northwestern University’s Feinberg School of Medicine, and associate director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital.

COVID-19 has claimed more than 97,000 American lives, but the death toll by race is incomplete because only 39 states and the District of Columbia report these statistics.(2) What we know is, the mortality rate among black Americans is 2.2 times higher than Latinos, 2.3 times higher than Asians and 2.6 times higher than whites. 

Population density plays a big part and — even as rural hot spots emerge — more populous communities report higher rates of infection. The most effective tool for controlling disease spread is social distancing, which presents a challenge for low-income families, many of whom live in crowded neighborhoods and have multiple generations under one roof.

“Being able to maintain social distancing while working from home, telecommuting, and accepting a furlough from work but indulging in the plethora of virtual social events are issues of privilege,” Yancy said. “In certain communities, these privileges are simply not accessible.”

Addressing social determinants of health

The American Heart Association has long fought against heath disparities, establishing the AHA Office of Health Equity to champion and oversee initiatives.

A year ago, the Association set up the Social Impact Fund to address social determinants of health — the conditions where people live, work and play that impact well-being and longevity.

“Social determinants really matter,” said Dr. Regina Benjamin, former U.S. Surgeon General and a member of the American Heart Association Board of Directors. “Financial health is related to physical health, and access to clean water, healthy foods and quality care count. We must address these issues based on what we know.” 

To date, the Association has invested $3 million in 19 organizations breaking down barriers to healthy living. In turn, that funding inspired an additional $13.8 million from other investors. Soon, $1 million more will go to organizations across Flint, Boston and Chicago that are meeting needs during the pandemic and beyond.

Among the investees is Forty Acres Fresh Market, founded in response to the scarcity of fresh and healthy foods on Chicago’s West Side. Every day, the nonprofit delivers about three dozen boxes of fruits and vegetables to underserved communities, as well as areas with high concentrations of people who are vulnerable to COVID-19.

HomeStart in Boston is increasing support for families living in public housing who are struggling to pay rent due to missed paychecks or layoffs.

Smart from the Start — also in Boston — is delivering food and learning materials to families with children, conducting weekly telephone check-ins and providing virtual crisis intervention.

Many more Social Impact Fund investees are stepping in to support fragile communities and fill voids left by redirected government resources.

Blacks and Hispanics, “come to the hospital sicker, deteriorate faster and die sooner,” said Benjamin during a May 15 guest appearance on “Color of COVID” a CNN Tonight special. “We have to survive until there is a vaccine or treatment.”

Engaging communities of color in clinical trials

Research is the key to improving prevention, detection and treatment of coronavirus. CenterWatch, the leading global clinical trials repository, lists 575 COVID-19 studies currently recruiting patient participants. The Association has awarded $2.5 million to 12 scientific teams fast-tracking studies on the heart and brain impact of COVID-19.(3)

“It’s especially important that all of these projects be focused with an equity-first lens to ensure our most vulnerable populations are being served,” said Association volunteer, James A. Weyhenmeyer, Ph.D., vice president for research and economic development at Auburn University, who also chairs the peer review team that selected the grant recipients. Grantees are working on the health technology aspects of the COVID-19 rapid response program.

Active recruitment of communities of color is vital to developing targeted therapies for COVID-19, and other conditions, and fulfilling the promise of personalized medicine. Though humans are 99.9 percent similar at the molecular level, there are subtle genetic differences that affect how medication is metabolized. The results of race as a research proxy are seen in different dosing regimens and levels of effectiveness for blacks, Asians and whites taking the same class of drugs.

At issue is historically low black and Latino participation in clinical research. There are many theories to explain why, including lack of awareness, cultural beliefs and distrust of medical establishment. For some, suspicion is based on historical injustices like the infamous Tuskegee Study of Untreated Syphilis in the Negro Male — conducted by the U.S. government without informed patient consent from 1932 to 1972.

Today, patient protections are in place, including institutional review boards and ethics review committees that oversee the trial process. Informed consent ensures patients understand and agree to the potential risks and benefits of study participation.

“The real problems are inadequate culturally appropriate information and ineffective effort — both of which perpetuate health disparities along racial lines in this country,” said Dr. James H. Powell, principal investigator of Project IMPACT, a National Medical Association initiative to increase minority participation and awareness of clinical trials.

EmPOWERED beyond the pandemic

With oversight by the Office of Health Equity, the Association’s suite of EmPOWERED programs will be addressing social determinants of health long after the pandemic has passed.

Through EmPOWERED to Serve Business Accelerators, entrepreneurs may apply for grants to activate their ideas for improving health and well-being in under-resourced communities. Candidates receive MBA-style business training, present their ideas to judging panel, and may receive up to $15,000 in funding. With the program’s foray into Puerto Rico, the first bilingual Accelerator will take place virtually this year.

Recently, the Association announced the 2020 class of EmPOWERED to Serve Scholars, 10 enterprising college students working to address health disparity in their communities through advocacy, education and outreach. Each receives a $10,000 scholarship to bring their visionary ideas to life. And with the disproportionate impact of COVID-19 on communities of color, the time for innovation is now. 

Recognizing the pivotal role of the church in promoting good health, the Association provides faith communities free, weekly virtual health lessons through its EmPOWERED and Well Virtual Faith Community to support mental, physical and spiritual health and well-being.

We are continuing our policy advocacy to ensure equitable access to testing, care, financial support, healthy foods and physical activity.

In tandem, Community Impact teams in Puget Sound, Denver, Chicago, Nashville, Jackson, Baltimore and beyond are partnering with local stakeholders to reduce the burden of chronic disease.

As Dr. Yancy sees it, “the scourge of COVID-19 will end, but health care disparities will persist” until civil societies no longer accept disproportionate suffering.

“It is less an action plan and more of a commitment.”

Nancy Brown has been CEO of the American Heart Association since 2008.

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(1) COVID-19 Statistics. Illinois Department of Public Health, May 14, 2020

(2) American Public Media (APM) Research Lab

(3) 12 scientific teams redefining fast-tracked heart and brain health research related to COVID-19