This pandemic has amplified both health disparities and education inequities. Together, we can fix this.
By Danette Howard and Derek Robinson
COVID-19 is forcing two essential industries to change quickly—and no doubt, permanently. One affects our lives; the other, our livelihoods. They are health care and higher education.
Both are innovating rapidly to meet customers’ urgent needs in the pandemic. Both quickly implemented remote services – telehealth for patients and virtual classes for students. Both employed new technology to heal, teach, and support. Both stepped up to help their communities. They even shared resources: As hospitals filled up, colleges offered empty dorms to exhausted health care workers.
In these and other ways, our fields are on parallel paths through this time of crisis. That’s why we’ve teamed up on this article—an educator with Lumina Foundation and a doctor with Blue Cross Blue Shield of Illinois. We can learn from each other as we serve those who count on us every day.
Working together is essential as our industries face hard truths. This pandemic has amplified both health disparities and education inequities. The quality of health care and the quality of education are major determinants of health. People of color experience significant challenges in both areas. African Americans and Hispanics face a much higher risk of COVID-19 and struggle with inequities in education that hurt their chances at good jobs. The COVID-19 pandemic may present new barriers to increasing their representation in the physician workforce. Together, we can fix this.
Almost overnight as the pandemic spread, colleges and universities closed campuses, emptied dormitories, and shifted classes to remote learning. These changes were jarring for students, some of whom lost the only homes they had – along with daily hot meals, Wi-Fi, and health centers.
This sudden, forced shift to online instruction is redefining college. Ironically, amid the pandemic and its terrible toll, we are seeing some welcome, innovative changes that meet students’ urgent needs and those they’ll face well into the future.
For the first time, many schools are relaxing entrance requirements, freezing or even offering free tuition, adjusting calendars, allowing more transfers and loans, and providing emergency resources such as laptops. Such changes are essential as we build a better system of learning—one that is more affordable, accessible, equitable, flexible, and relevant to today’s marketplace.
Across campuses and communities, educators are leading the way in responding to the crisis. But we must do more.
With our focus sharpened by this crisis, we must work to ensure that all Americans – especially low-income students and people of color who face persistent inequities in their pursuit of high-quality education beyond high school – have multiple, flexible paths to degrees and credentials. We must ensure that they get the knowledge and skills they’ll need to keep learning and earning during the pandemic and beyond.
A similar commitment—aided by that same, crisis-sharpened focus—now drives health care.
Widespread cancellation of elective services and a near-total shutdown of in-person clinical visits were necessary to open up ICU beds and limit shortages of protective masks and shields. But COVID-19 has also delayed and disrupted access to important preventive services and immunizations.
Suddenly, patients and providers became largely disconnected as relationships established for the noble purpose of healing could now spread contagion and put lives at risk. Communities of color, where trust of the health care system is already fragile, suffered a disproportionate burden of infection, hospitalization, and death from COVID-19. Many societal factors contribute to this inequitable burden, from occupational exposure and poor housing to endemic chronic medical conditions to wealth inequality.
Nothing in recent memory has challenged health care to adapt so quickly in its efforts to confront the racial and ethnic disparities in the industry. Physicians have responded – working relentlessly to improve the treatment of COVID-19, ramping up telehealth services, and serving as credible voices to inform the public about how to slow the spread of the virus.
Unfortunately, the pandemic is far from over. We must intensify our efforts to keep all communities well and safe, starting with a public commitment to wearing masks and social distancing. We must remain adaptable in our efforts to deliver high-quality care and ensure that a telehealth digital divide does not emerge and increase health disparities.
Historic mistrust of the health care system among communities of color persists—at a time when trust is absolutely vital. Physicians of color are underrepresented in medicine and research suggests that more physicians of color can have a durable effect in building trust and addressing long-standing health disparities. We must encourage local action to change this reality—and medical education must help lead that change. Now is the time to commit to producing a physician workforce that reflects the racial/ethnic diversity of our communities.
For example, implementing a holistic application review process could make a difference—as would ongoing training about implicit bias for faculty and staff participating in the admission and match processes. This is especially important now, as interviews for medical school and residency programs are largely virtual, and prospective residents of color do not have the added benefit of visiting clerkships. Some medical schools allocate points in the application review process for hospital volunteer hours; perhaps this review element should be waived in the 20-21 cycle since applicants from communities hardest hit by COVID-19 are less likely to have hospital access for safety reasons and more likely to be minority.
These are actions that the medical education system can take today. By doing so, we commit to a healthier America supported by a more diverse workforce and equitable care for all.
One thing is certain: there is no going back to the old ways—in health care or education.
We’ve long known that education and health care have important intersections and that both can produce better results. And now, we must do better—during the pandemic recovery and for generations to come.
Danette Howard, Ph.D., is senior vice president and chief policy officer for Lumina Foundation. Derek Robinson, M.D., is vice president and chief medical officer of Blue Cross Blue Shield of Illinois.