番茄社区

WASHINGTON -- Recruiting more minority physicians would help reduce the healthcare disparities that have become evident during the COVID-19 pandemic, several experts said at a House hearing.

Increasing funding to programs such as the Health Careers Opportunity Program, which helps people from economically and educationally disadvantaged backgrounds enter the health professions, "would help diversify the pipeline -- a more diverse physician workforce would be very helpful," said Alicia Fernandez, MD, professor of medicine at the University of California San Francisco and an internist at Zuckerberg San Francisco General Hospital.

For the immediate crisis, "we need to insist that communities, public health departments, and the CDC put out information in the target language in affected communities" as well as better integrate language access into telehealth, she said. "That's a place where the federal government can make clear what the rules are."

James Hildreth, PhD, MD, president and CEO of Meharry Medical College in Nashville, agreed that "the first thing we need to do is diversify the workforce so the existing workforce gets comfortable with the idea of having colleagues who don't look like them, and helps them interact with people who don't look like them."

One way to help with diversity would be to lower the financial barriers faced by minority students trying to get into medical school, he added. "The average American medical student graduates owing $108,000 to $110,000. but the minority student owes twice that much," because they often have debts from their undergraduate education as well. "So scholarship and increasing graduate medical education slots would be a great way to help us solve this problem."

Fernandez and Hildreth were testifying Wednesday at a on the disproportionate way the COVID-19 pandemic has affected racial and ethnic minorities. Committee member Mike Thompson (D-Calif.) noted that in Sonoma County, which he represents, Hispanics accounted for 60% of the COVID-19 cases even though they comprise only 27% of the population.

"In the same county, 95% of the young people with COVID-19 are Hispanic," he said. "Unfortunately, these heartbreaking numbers are nothing new -- racial and ethnic disparities have persisted for decades across the healthcare system and these disparities have been laid bare with COVID-19."

Ibram X. Kendi, PhD, founding director of the Antiracist Research & Policy Center at American University here, noted that a found that the hospitalization rate for African Americans in northern California who contracted COVID-19 was nearly three times that of non-Hispanic white patients. "One reason people are suggesting is lack of access to health insurance," he said.

Similar disparities have been found in other places; in Kansas, for example, African Americans account for 6% of the population but 31% of the deaths from COVID-19, Kendi added.

How can COVID-19 care for minorities be improved? Hildreth said that his institution has been working with three other historically black colleges and universities -- Howard University, Morehouse University, and Drew University -- to develop a solution to the problem.

"We propose to establish a consortium of black medical schools to provide critical services -- expanded testing, contact tracing, training of frontline workers, and drug development, to address the needs of those disproportionately impacted by the pandemic," he said. "We understand the subtle, yet critical cultural differences long overlooked by mainstream providers, creating deep fear and mistrust."

Hildreth noted that earlier this month, when the state of Tennessee sent members of the National Guard to public housing to test residents, "not surprisingly, people were apprehensive and stayed behind closed doors. I also saw reports just this morning that in Texas, testing centers are being placed disproportionately in whiter neighborhoods," he said. "That may have been an oversight, but it could lead to dangerous new outbreaks because key areas are not being tested. We can deploy quickly, we know where to go, and we will be welcome."

Hildreth asked committee members to fund the consortium at an estimated cost of $5 billion over 5 years. "That's less than a tenth of 1% of the total stimulus package," he said. "I urge you to act now; too many people have already died ... All we need is a small fraction of the nation's resources to make a profound difference."

A lack of healthcare workers overall is a particular problem for the Native American community, said Thomas Dean Sequist, MD, MPH, professor of medicine and health care policy at Harvard Medical School in Boston. "One of the most pressing things we need to address ... is availability of healthcare workers," said Sequist, who is a member of the Navajo Nation.

For instance, although many Indian Health Service [IHS] facilities may have ventilators, but "may not the people experienced with using that equipment," he said. "We have to take drastic steps to increase the supply of healthcare workers. IHS regularly reports a 30% vacancy rate for physician, nursing, pharmacy, and dentist roles."

Sequist recommended a two-pronged approach: In the shorter term, "we need to get funding to these communities as soon as possible, so they can enact not only programs to improve access to personal protective equipment and testing, but also improve access to food and water," he said. "These are basic life necessities that these populations are really lacking. Longer term, we in these communities need to create long-term economic sustainability," to reduce the current poverty rate of 42%.

Committee member Jackie Walorski (R-Ind.) said affordable housing was important for improving health outcomes for all low-income Americans, including those in minority communities. She asked witness Douglas Holtz-Eakin, president of the American Action Forum, about the role played by social determinants of health. Holtz-Eakin replied that, for example, "in Medicare, often the best thing you can reimburse for is the ride to and from the doctor's office."

Social determinants, he added, "are an important part of the health phenomenon and require cutting across payment 'silos' and thinking about how to pay cohesively for better outcomes. That's what I would focus on."

Comment