Healthcare In The U.S. Is Still Segregated, So Community Organizations Are Taking COVID-19 Testing Into Their Own Hands
Predominantly Black neighborhoods have less access to primary care physicians and healthcare services, at a time when COVID-19 is killing Black Americans at a rate 2.3 times higher than white Americans. Now grassroots organizations are trying to compensate for failures of public health.
South Atlanta is considered the city’s Black cultural core, known for its strong community cohesion and rich history. The area’s population is over 90 percent Black, a product of racist policies that produced stark segregation. During the COVID-19 pandemic, Black Georgians have been hit hardest—a Centers for Disease Control and Prevention study found that in March, nearly 80 percent of hospitalized COVID-19 patients in metropolitan Atlanta were Black.
But at a time of great need, there’s a dire lack of quality healthcare facilities to serve the area. South Atlanta’s neighborhoods have a shortage of primary care health providers, according to the federal Health Resources and Services Administration (HRSA). Most areas in Georgia are medically underserved—but on top of that, hospitals in South Atlanta’s neighborhoods also receive lower marks for healthcare quality compared to hospitals in northern areas, according to federal assessments. Unlike the metro area’s wealthier, whiter northern parts and suburbs, South Atlanta neighborhoods contend with conditions that fuel racial disparities in health and healthcare access, including a lack of adequate transportation, affordable housing, and access to fresh, healthy food options—all of which make a community more vulnerable to the novel coronavirus.
Decades of discriminatory housing policy have left American cities racially segregated. Since Black and Latinx Americans comprise a disproportionate share of essential workers, this residential segregation has concentrated people who are more likely to be exposed to COVID-19 together in the same neighborhoods. And those neighborhoods also have less access to quality care—predominantly Black neighborhoods have little to no access to primary care physicians, healthcare services, and pharmacies.
“I don’t think we quite understand just how segregated healthcare provision is,” said Arrianna Planey, an incoming assistant professor at the University of North Carolina at Chapel Hill who studies health and medical geography.
Even as the pandemic hit Black communities hard, few testing sites were available in South Atlanta. There are about five federally qualified health centers in the area, according to HRSA data, all of which made novel coronavirus testing available between March and April. In addition to those, there were only four Georgia Department of Public Health testing sites in metro Atlanta by early May. County public health sites began offering testing to all residents, regardless of symptoms, on May 7, yet there are only three Fulton County Board of Health public health sites within a five-mile radius of South Atlanta.
So community-based organizations mobilized to fill in the gaps.
Project South, a 34-year-old grassroots social movement organization, launched its own COVID-19 Testing and Education Site in South Atlanta, offering free drive-thru and walk-up testing five days a week to community members regardless of symptoms. It tested 436 people in its first three weeks.
“We just want to make sure we can protect ourselves, and our families, and our communities because … the powers that are responsible for public health won’t do it, so we have to rely on ourselves” said Angela Oliver, Project South’s communications coordinator.
The group started the testing initiative at the Mutual Aid Liberation Center in partnership with the Hunger Coalition of Atlanta and the national Community Organized Relief Effort (CORE). Later in the month, these groups also launched mobile testing sites.
Oliver says the effort began with a community survey in March to identify residents’ most pressing needs.
For several weeks, Project South delivered care packages containing food, hand sanitizer, masks, and bleach-and-water solutions to 100 or more households in South Atlanta neighborhoods weekly. Oliver said people who tested positive for coronavirus were able to request food so that they are able to stay home and isolate. “We try to add that extra resource so that’s one less thing they have to worry about.”
“There’s a very strong need for the food distribution and the testing, just because there’s no kind of medical facility that’s anywhere close to us,” Oliver said.
Black Americans have the highest overall mortality rate from COVID-19, which is about 2.3 times as high as the rate for white and Asian people and twice that of Latinxs and Pacific Islanders, according to data from the APM research Lab. Approximately 1 in 1,500 Black Americans has died from the disease, followed by Natives at 1 in 2,300, 1 in 3,200 Latinxs, and 1 in 3,600 white Americans. Native people are dying above their population share most starkly in New Mexico, but also in Arizona and Mississippi.
Recognizing the effect of COVID-19 on “socially vulnerable populations,” the U.S. Department of Health and Human Services recently put forth new guidance on reporting testing, requiring that “demographic data like race, ethnicity, age, and sex” must be reported with test results.
Residential segregation contributes to this inequity in myriad ways, including exposing residents to chronic stressors and toxins that wear down the body’s vital systems. Black and white patients are also largely treated by different doctors and hospitals, with disparities in quality of care. A 2004 study that analyzed over 150,000 visits by both Black and white Medicare beneficiaries found that physicians who treated mostly Black patients are less likely to be board certified and have less access to crucial clinical resources compared to those who treated mostly white patients. Another study found that mortality after a heart attack is significantly higher in U.S. hospitals that disproportionately serve Black patients. Yet another study found the Black patients were less likely to survive cardiovascular and cancer procedures largely because of the quality of hospitals that treated them.
In addition to segregation, discrimination at the individual level contributes to poorer healthcare, and mistrust of medical institutions, for Black patients. For patients trying to survive COVID-19, access to well-trained healthcare professionals who can use important equipment and medication can mean life or death.
Research shows that implicit and explicit racial biases among physicians increase in stressful situations. One 2016 study found that cognitive stressors such as overcrowding and a high patient load were associated with pro-white/anti-Black implicit bias.
But even in non-stressful situations, healthcare workers may exhibit bias, including false beliefs about biological differences between Black and white people. A 2017 review found that physicians have the same level of implicit bias as the general population and this bias most likely influences decisions around treatment.
Reports of Black COVID-19 patients being denied testing have been emerging since April. Gary Fowler, who died from the disease, went to three metro Detroit hospitals asking for a coronavirus test because he presented symptoms, but he was denied each time. His stepson, Keith Gambrell, told CBS News, “I honestly believe it was because my father was black. They didn’t honestly take his symptoms seriously enough to give him a test.”
Yeshimabeit Milner, founder and executive director of Data for Black Lives, says COVID-19 testing is critical to getting people needed care and being denied it is an injustice. “Without testing we don’t get care, we don’t know the real impact.”
Even more, community-based efforts around COVID-19 can inform long-standing demands for improved health and medical resources in communities that need them, said Milner. “Especially for groups and individuals [that’ve been] fighting to save their hospitals … against the privatization of hospitals, how do we actually fund hospitals in our communities? How do we make them community hospitals? What are the resources that need to be put in?”
Milner’s Data for Black Lives is a nonprofit dedicated to using data for social justice change and activism. She urges communities to “use this moment to really just further some of these demands that we’ve been asking for” by conducting community-needs assessments to identify gaps in the medical and healthcare environment that have led to disparate effects of COVID-19.
Community-based efforts to test people have emerged in communities like Little Village, a predominantly Latinx neighborhood in Chicago, as well as in Miami.
In Miami, the SPARK-C initiative, a joint effort by the University of Miami Miller School of Medicine and Miami-Dade County, finished its second round of COVID-19 community testing in April “to ascertain the prevalence of infection within the County’s 2.75 million residents,” according to a press release from the county.
Unlike other testing programs in the U.S., SPARK-C employs randomized sampling to generate an estimate of the county’s COVID-19 prevalence. SPARK-C tested nearly 1,800 individuals, finding a 6 percent positive rate for antibodies that equates to approximately 165,000 Miami-Dade County residents being infected, a jarring contrast to the estimate of 10,000 cases generated by testing sites and local hospital data, according to the press release. They also found higher rates among the county’s Black American and Caribbean populations.
With the actual number of infections being potentially 16.5 times the number captured by testing, the SPARK-C effort highlights the critical importance of community-based testing filling in the gaps of a faulty public health system.
The pandemic has made longstanding, persistent inequities more stark—and data collected now can help address these inequities in the future. Milner says that mapping COVID-19 testing sites can give a clearer picture of inequalities and gaps in government investments so that residents can make demands for resource allocation and long-term structural changes in their community, including in local healthcare systems.
She criticized Governor Andrew Cuomo of New York for the hospital shortages that occurred during the peak of the COVID-19 hospitalizations, referencing the defunding of the state’s Medicaid system by $400 million. “Resource allocation is really key in terms of testing, but also hospital funding,” she said. “A lot of people are, for example, here praising Governor Cuomo, but honestly part of the reason that there’s a hospital shortage in a city of eight million people is because of the defunding of hospitals over his tenure as governor. And that’s a big deal.”