June 17, 2020

By now we have all seen the headlines from across the United States about the disproportionate impacts of COVID-19 on communities of color. The CDC has reported an overrepresentation of Black/African American patients among those hospitalized, as well as higher mortality rates for both Black/African Americans and Hispanic/Latinos.[1] New Hampshire is not immune from this reality; where Hispanic/Latinos comprise only 3.9% of the population, they comprised 9.8% of the COVID infections, a disproportionality rate of 2.5, and Black/African Americans comprise 1.4% of the population, but they comprised 6.3% of the COVID infections, a disproportionality rate of 4.5.[2] Meaning these groups are affected 2.5 and 4.5 times their frequency in the population.

As we know from our exploration of the social determinants of health this year, where people live, work, learn and play has an outsized impact on their overall health. African Americans and Hispanics, in this country, all too often live, work, learn, and play in communities that, due to the chronic effects of institutional and systemic racism, have limited access to safe housing, nutritious food, robust education, and opportunities for economic advancement. And there is growing evidence that the chronic stress of racism and discrimination experienced by people of color in the U.S. is internalized in their biology and is hurting their health, manifest as disparities in birth outcomes, hypertension, cardiovascular disease and more.[3],[4], [5]  

Thus, clearly racism is a public health problem, and in the midst of a public health crisis like the COVID pandemic, we should not be surprised that people in these racial/ethnic groups are getting sicker and dying more.

And now we are confronted with the killing by police of George Floyd, and we see the confluence of the current COVID pandemic with the ongoing epidemic of violence against people with black and brown skin in this country. A study in the Proceedings for the National Academy of Sciences[6] estimates that black men have a 1 in 1000 risk for being killed by police. This makes it one of the leading causes of death in young black men. Postmortem evidence indicated that George Floyd tested positive for COVID[7]  so in his last words, “Please, I can’t breathe”, we hear the tragic expression of racial inequities in both COVID and police brutality.

Where do we go from here? We know that we, in health care, cannot alone solve the inequities in housing, food security, education, economic opportunity, and institutional racism. But there is much we can do.  We can acknowledge that Black Lives Matter is not a political cause, it is a human rights cause, and that racism is an ongoing public health crisis. How do we in health care approach other scientific crises?  We gather data, we use it to understand the root causes of a problem, and we then study various interventions to see what works. Those should be our next steps - and much is already known about what works to address the underlying structural factors that limit opportunity and lead to premature illness and death for so many.

We can also work in partnership with communities to help improve equity in the social determinants of health for everyone – which will contribute to improvements in the health and well-being of racial-ethnic minority populations. Individually, we can educate ourselves as much as possible about racial inequities and how to promote equity – and, if we are motivated, learn about racism and how to be anti-racist. And we must begin to examine our own implicit biases that may be affecting our interactions with any of our patients, recognizing that we all have biases as it is a normal part of the human condition. Our task is to become aware of our biases and work to mitigate them so they do not impact our interpersonal interactions and clinical encounters. And we can speak out against injustice, as physicians and also just as Americans, as so many other Americans have through the protests we have seen nightly across the country since George Floyd’s death. These are difficult topics and challenging conversations, and the work ahead will not be easy, but we must acknowledge and address these issues if we are to improve the health of all Granite Staters.

Special thanks to Dr. Trindad Tellez, Director, Office of Health Equity, NH-DHHS, for additional references and data, as well as editorial input.

In health,

John Klunk, MD
NHMS President

Please send comments or questions to john.klunk@nhms.org


[2] According to the NH DHHS COVID-19 summary dashboard, accessed 6/14/20, https://www.nh.gov/covid19/dashboard/summary.htm

[6] Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex. Frank Edwards, Hedwig Lee, Michael Esposito. Proceedings of the National Academy of Sciences.  Aug 2019, 116 (34) 16793-16798; DOI: 10.1073/pnas.1821204116; https://www.pnas.org/content/116/34/16793

[7] Stolen Breaths. Hardeman, Rachel R., Medina, Eduardo M., Boyd, Rhea. 2020/06/10; New England Journal of Medicine. DOI: 10.1056/NEJMp2021072. https://www.nejm.org/doi/full/10.1056/NEJMp2021072