The COVID-19 pandemic has revealed structural inequalities in health care and has brought many issues of health equality to the forefront of public consciousness.
Health disparities in racial, ethnic, and socioeconomic populations are well documented and have a negative impact on many communities. Pharmacists and pharmacy educators are in a position to help mitigate those differences.1
These messages were firmly established in a presentation by Dayna Bowen Matthew, JD, PhD, during the virtual 2020 meeting of the American Association of Colleges of Pharmacy, July 13-31.1 Matthew, an accomplished lawyer who specialized in constitutional equality, has worked as a Robert Wood Johnson Health Policy Fellow and holds an appointment in the University of Virginia School of Medicine’s Department of Public Health Sciences.2
The main speaker in the AACP meeting’s opening session, Matthew addressed the issue of health equality by sharing data, historical references, and personal experiences. She explained that health equality means everyone has a fair and just opportunity to be as healthy as possible, and that they are free to pursue it by the removal of social determinants.1
The coronavirus disease 2019 (COVID-19) pandemic has revealed structural inequalities in health care and has brought many issues of health equality to the forefront of public consciousness, Matthew said.
Overall, data presented by Matthew from a 4-month period ending June 13, 2020, showed 221.1 per 100,000 individuals in the Native American or Alaska Native population hospitalized with COVID-19; with 178.1 of 100,000 in the Non-Hispanic black population, and 160.87 of 100,000 in the Hispanic or Latino population also affected. The non-Hispanic white population had 40.1 individuals per 100,000 hospitalized with COVID-19 during the same period, and there were 48.4 per 100,000 in the Non-Hispanic Asian or Pacific Islander population affected as well.1
Matthew also shared data showing a disproportionate number of COVID-19 deaths affecting black and Hispanic populations compared with white people in cities such as Chicago, in which 71% of COVID-19 deaths were black individuals, although black people make up only 29% of the population. Other cities with disproportionate statistics include New York City, Milwaukee, and Los Angeles, and in Louisiana, which includes New Orleans.1
Differences in COVID-19 death rates by race are not due to biological differences, Matthew said, but rather income inequalities that are directly associated with health inequality, such as poor health and social outcomes.1
One example of structural inequality’s impact on health is the prevalence of COVID-19 in more densely populated areas, such as large cities and multi-generational households. Dense housing is more disproportionally occupied by black people and other minorities, Matthew said.1
In addition to physically being in closer proximity to other people—making it more difficult for social distancing to occur—living in dense, urban areas can impact health by lack of access to clean air and water, lack of health care, lack of green spaces, and lack of healthy foods. Reliance on public transportation, jobs without paid sick leave, and the criminal justice system are other social disparities that can impact health.1
The connection between these disparities and the impact of COVID-19 reveals structural racism, Matthew said.
“Why is this racism and not inequality? Because history has created these injustices,” she added.1
Pharmacists can play a unique role in the mitigation of structural racism, according to Matthew.1
Health care was historically among the most segregated areas of society, she said; however, a “quiet revolution” occurred from within, with desegregation led by providers. She said pharmacists can lead a “second quiet revolution,” using the COVID-19 pandemic as an opportunity to lead a healing of this country’s racial divide.1
“Pharmacists are on the frontlines because of their relationships. People see their pharmacists more than their primary (physicians),” Matthew said.1
Matthew urged AACP meeting attendees to advocate for patients through research, training, and outreach initiatives. Everyone is vulnerable to racial biases, she said, and those biases should be identified and mitigated.1
“You can train your pharmacists different. You can change the culture,” Matthew said.1
With more than 60,000 pharmacies in communities across the United States, Matthew said 90% of people live within 5 miles of a pharmacy and many of them offer health services at a lower cost than other providers. Additionally, data show that patients see their pharmacists 8 times more often than primary care providers, making pharmacists uniquely influential in health care.1
Pharmacists can further mitigate structural inequality through health care services, such as administering vaccines and addressing substance dependence. Patient education, individual counsel, and community outreach programs are other avenues through which pharmacists can serve people.1
Matthew noted that pharmacy educators also have a role in the “quiet revolution.”1
Pharmacy institutions can wield influence by enrolling more students from minority groups, for example. According to data presented by Matthew, only 6.1% of the 65,540 students enrolled in 143 US pharmacy colleges and schools in 2018 were black or African-American, 4.1% were LatinX, and 0.6% were Native American or Alaska Native.1
Institutions also need to identify biases and work to mitigate them, and should be making changes that promote structural equality. One suggested way to promote structural equality is to improve research that addresses these deficits, as well as inequalities to medication access.1
Overall, pharmacists have many opportunities to help reduce or eliminate structural inequality in health care, Matthew said. “We’re all connected in this battle.”1