COVID-19 has ‘magnified’ the structural racism that leads to disparities in kidney disease
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Arguing that “racism is a root cause of disparities in kidney disease,” a speaker here outlined the ways in which these disparities have been magnified by the COVID-19 pandemic.
“The United States is one of the countries that has been hardest hit by COVID-19,” Tanjala S. Purnell, PhD, MPH, of Johns Hopkins Bloomberg School of Public Health, said during her virtual presentation at the National Kidney Foundation Spring Clinical Meetings. “We know that COVID-19 has disproportionately impacted many of the same groups that were already at highest risk for kidney disease and kidney failure. What this means is yet another form of health disparity that patients now must endure.”
According to Purnell, structural racism — effects of which play out in housing, education, employment, earnings, benefits and health care — has been on full display throughout the pandemic, as Black, Hispanic, American Indian and Alaskan Native individuals are more likely to not only contract COVID-19, but to experience hospitalization and mortality as a result.
“We know that there have been many challenges that have been magnified for vulnerable populations since the COVID-19 outbreak,” she said, pointing to lack of access to basic resources (such as food, water, shelter and transportation), employment in “essential” jobs with limited protections (potentially leading to job loss or unemployment), high levels of grief and social isolation, and lack of insurance or medication coverage causing disrupted access to health care services.
All of these coalescing factors, she said, must be considered when thinking about existing racial disparities and how these adversely impact health outcomes. Here, she referenced an editorial she co-authored with Deidra C. Crews, MD, ScM, in which they suggest these factors — as well as “high profile acts of racism” — join together to form “the weathering hypothesis.”
“The Weathering Hypothesis highlights for us how many of the same groups often have to endure, or weather, the worst of the worst every time something bad happens,” she said. “What’s happening is that now all these bad influences are really coming together to have detrimental consequences for our patients. As a field, we need to think of ways to respond to mitigate these disparities and the extra burden for patients.”
Ensuring health equity requires “targeted, multi-level efforts,” according to Purnell. To begin to reduce the burden of kidney disease, she proposed the following solutions:
- patient and provider education;
- improved community awareness;
- population-based screening programs;
- improved partnerships among policy makers, behavioral interventionists, patient/advocacy groups, religious leaders, community organizations and health care providers;
- social media outreach; and
- increased access to fresh foods and to safe public spaces for exercise.
“COVID-19 magnified existing disparities,” Purnell concluded. “It helped to highlight the things that were already longstanding problems. I hope it has also brought about a sense of urgency and will bring about a new allocation of resources so we can tackle these disparities.”
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Purnell TS. Health disparities and COVID-19. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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