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"I would ask each of us to consider the forces that make some of us far more vulnerable."

Dirty Street with graffiti on walls
By Bram Wispelwey

Boston, MA
United States

As a physician who works on the front lines in Boston and in the occupied West Bank, one common thread I see in this pandemic is the inequity in degree of vulnerability across race and class. While efforts are being proposed and even implemented in the US to mitigate the effects of racial and economic inequities — including cash payouts to middle- and low-income Americans, universal paid sick leave, expanded unemployment insurance, special enrollment periods for Medicaid, relief from bills and student debt, and release of incarcerated people — this is likely to be too little, too late to staunch the health legacy of structural racism and pro-rich policies.

In Boston, my impression is that the vast majority of the people being tested are white, an inequity that early figures suggest is true in New York City. While limited data on COVID-19 case breakdown by race are available at this point, the numbers coming out of Michigan, for example, are horrifying: Black Americans, who make up just 13.7% of the state’s population, comprise 35% of cases and 40% of deaths. In Illinois, the story is similar, with Black Americans making up 14.6% of the population but 28% of cases. While undertesting may lead to later and sicker presentation, these harrowing numbers are also formed by the structural racism that manifests as the political, social, and commercial determinants of health that drive stark inequities in healthcare access and chronic disease prevalence, many of which increase the severity of COVID-19 and thus disease mortality.

But there is hope.

I see a growing number of people determined to make change, willing to take on enormous collective effort to alter these dynamics. From the work of the Social Medicine Consortium’s Campaign Against Racism, to the Social Justice and Health Equity Committees at my hospital, to our community health workers providing emergency care in Palestinian refugee camps, health professionals are uniting to confront the injustices that produce poor health. While this virus threatens everyone, I would ask each of us to consider the forces that make some of us far more vulnerable to its worst outcome and join a local movement to address the fight for equity in the COVID-19 response and beyond.

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