The country seems to be crumbling before us… We are still in the throes of a global pandemic which has sadly claimed the lives of over 100,000 Americans and almost 400,000 worldwide. This was already a polarizing event in our country’s history with a federal administration dismissing science and health research for political and financial interests. Something as simple and innocent as wearing a mask to protect your fellow Americans has become a fight-inducing, divisive, political debate. Now with the tragic murder of George Floyd in Minneapolis, tensions and divisiveness have exploded exponentially. Centuries of inequality and racism have bubbled over to a breaking point and the country has erupted into protests in all 50 states and across the globe (rightfully so). Black lives DO matter despite whatever your beliefs may be. This isn’t a black vs. white vs. police vs. republican vs. democratic issue. This is about racism, oppression, and inequality. It’s not us vs. them, its everyone vs. oppressive ideologies and bias against human beings. I am in full support of these protests and will never understand the fear of living everyday life just because of the color of my skin. I can go for a run at night (which I have many, many times) without worrying about being questioned, suspected of wrong-doing, or potentially killed (as in the sad case of Ahmaud Arbery). I can drive at 2am without being stopped for no reason at all and if I am stopped for any reason, while I might be nervous, I’m not fearing a disproportionate risk of being killed or falsely arrested. Sadly, various ethnic groups such as the hispanic and black community face an even larger threat that is not as obvious…health disparity…a slow, suffering death.

I’ve had the fortunate opportunity to serve various populations of all socioeconomic statuses, ages, and ethnicities as well as various locations around Massachusetts. Despite treating all my patients with the same amount of compassion, respect, and clinical comprehensiveness, I have indirectly done harm by them. No not because of negligence, incompetence, or bias, but because our society is falsely slanted against people of color. Social determinants of health play a direct role in the well-being of every patient. These include housing, neighborhood environment, education, employment, social engagement, incarceration, health literacy, food access, crime/violence exposure, and quality of life. Food deserts, health access issues, transportation inadequacies, and socioeconomic inequalities which are out of my control have put these patients at risk causing vast health disparities. Patients of color are almost twice as likely to die from COVID-19 than white patients. That’s appalling and it has shed a brighter light on extensive changes needed within our healthcare system, as well as our overall society.

I have seen the effects of these racial disparities in our society which have a direct impact on health. In various roles, I have gone into the homes of patients in the community both as a nursing student and as a seasoned provider. Also, I have surveyed my patients’ local neighborhoods and communities to better understand what their living environment consists of and how to help offset any inadequacies. It’s clear why many of these patients are more likely to suffer from diabetes, kidney disease, high blood pressure, heart disease, and stroke. They live in food deserts where the only restaurants serve fried, trans-fat laden, refined carbohydrate-rich, processed foods. The only accessible, local markets offer discounted prices on the unhealthiest options including soda, dessert snacks, and chips meanwhile, fruit, lean proteins, and healthy options are expensive or very limited in availability. Many elderly patients live alone with limited to no support and lack transportation living on a small, fixed income. There is no or very little access to public parks or fitness centers which are reasonably priced to help promote exercise. Senior centers are hard to get to and public libraries are often limited in their funding and resources. Let’s talk about why this impacts someone’s health directly.

If your only sources of affordable food include fast food restaurants and small markets filled with processed foods, your nutrition automatically suffers. You gain weight, blood pressure increases, cholesterol goes up, and blood sugar rises. This then puts strain on the heart, hardens the arteries, and puts undo stress on the pancreas, liver, and kidneys. This can then quickly lead to diabetes, heart failure, stroke, liver disease, heart attack, and kidney disease. Add in the fact that there isn’t access to an affordable gym/fitness center, clean/safe park, or senior center to exercise and those negative physiological effects worsen. Also, because nutrition is poor and exercise is lacking, mental health becomes an issue. Adding in racial profiling and bias, mental health worsens dramatically. This places individuals at risk for self harm, harming others, substance use disorder, and further health disparity. Unemployment rates are significantly higher in various ethnic groups when compared to their white counterparts. There is a direct correlation to unemployment and mental health which then affects physical health. Systemic racism persists deeply in our culture here in the United States and it has penetrated through generations. The country was segregated until 1954 and even still, inequalities were blatantly obvious in every day culture since then. Among these resulting inequalities, health literacy has remained shockingly low in patients of color. Health literacy is the ability to understand, process, and employ basic health education to make appropriate health decisions. This then further widens the gap and creates deeper health disparities. If you have poor access to food and exercise modalities and you don’t understand why it’s important or how to be healthy, it’s obvious you’ll have poor health outcomes. Now I don’t know about you, but it seems pretty unfair for people of color when they are born into a society that already stacks the chips against their own health and well-being in addition to every other aspect of their life.

So what can be done to set the bar higher and provide equal health opportunities and equitable care amongst all people? First, get out and vote. We need to elect officials into office who are passionate about these causes and will make it a priority to increase funding for people of color and disadvantaged communities. It is important to provide safe and affordable housing with better developed neighborhoods within communities that provide healthy, accessible food options including fully stocked supermarkets that provide inexpensive, healthy choices as well as restaurants offering economical, nutritious meals. Local parks should offer clean, well-managed areas for exercise including tracks for running, tennis/street hockey/basketball courts, soccer pitches, pull up bars, as well as budget-conscious fitness centers or gyms. We must increase funding for education and schooling within the communities which also focus on health to improve health literacy and bridge the gap in our educational system. It is imperative, now more than ever due to the lockdown to support local black-owned business such as restaurants, bookshops, auto repair garages, and other retailers. Educate yourself on racism and the current disparities in our society and how it affects your fellow Americans. Medical schools should include a strong focus on health disparities and ensure appropriate education of its trainees regarding some of the physiological differences vs. actual health disparities. Sadly, a survey of over 200 medical students found that they have misconceptions and racial biases regarding physiologic differences between white and black patients. While black patients do have a higher physiologic propensity for stroke or heart attack, some medical students surveyed actually believed that black patients have thicker skin, smaller brains, are more fertile, and possess less sensitive nerves than white patients. This is frightening to think that these misconceptions are believed to be true and some black patients don’t receive appropriate care or pain relief as a result of this. As healthcare providers and educators, we MUST do better for our fellow humans.

The most important thing we can do, in my opinion, is to be kind, call out racism when present, and simply respect and care about your fellow humans, regardless of their color, beliefs, country of origin, sexual orientation, and so on. We are all humans and in order for us to live happy, successful lives, we must do better for those who are disparaged and oppressed. I will continue to uphold the core of nursing which is to care for all patients to the best of my ability and holistically account for all aspects of their life, most importantly their social determinants of health and educate them regarding how to live a healthy lifestyle. We can do better; we MUST do better. Let’s all work together so that our friends, family, colleagues, and community members who have felt these effects of racism can finally live a life without judgement and fear. This only scratches the surface of health disparity and how it affects people of color and various ethnic groups. Be kind to one another, stand up for those who cannot, and just listen to those voices who have fallen on deaf ears for so long. Let’s all try to be better people.

Oh and remember, we’re still deep in a pandemic despite our shift in media focus…wear your mask, wash your hands, stay 6 ft (2 meters apart), and stay home if you don’t feel well. COVID-19 is still among us and continues to claim lives every day.

Be safe and stay well…