Increasing access to Covid vaccines in the U.S.: The legacy of the Atlanta Medical Center closure and a shared solution to the “covid crisis”

It was part of a pattern and it may have been an extreme case. Around the U.S., many Black and Latino communities had limited early access to the Covid vaccines. That lack of access, combined with a more vaccine hesitancy among some people of color, contributed to the large racial gaps in vaccination and Covid death rates.

The Trump administration seemed unwilling to address those inequalities, leaving it to the states. President Biden prioritized closing the gaps. “We built our Covid response with equity at the heart of it,” Ron Klain, the White House chief of staff, told me.

Alford, 65, said that she suffers from asthma, diabetes and high blood pressure, and that there were times when the Atlanta Medical Center’s (AMC) downtown hospital, formerly known as Georgia Baptist Hospital, would keep her overnight for monitoring.

“If you get shot or have an accident or a heart attack at the wrong time of day, it’s a real problem to get from southwest Atlanta to Grady Memorial Hospital in downtown Atlanta,” Rose said. “It’s an unnecessary struggle.”

The decision to close the hospital was a shock for staff and residents, according to the Atlanta Journal-Constitution. The newspaper reported the pending closure on August 31.

Wellstar has invested over $350 million in capital improvements and incurred sustained operating losses since they became the operators of AMC. In the last 12 months there was a decrease in revenue and an increase in costs due to soaring inflation. The pandemic and the intense financial headwinds straining healthcare organizations right now have only made matters worse at AMC,” the nonprofit said in a statement.

Community advocates and health policy experts feel that the AMC closure will disproportionately burden Black communities and low-income communities.

He said that they may further hurt the health outcomes of Black residents because they relied on their primary and specialty care doctors.

There has been an increase in patients in the emergency department. However, we have taken several steps to help absorb the increased volume. We have hired former Atlanta Medical Center trauma surgeons and primary care physicians to help meet the growing need at our trauma center and in our neighborhood health centers. Additional practitioners have been added to Grady’s Walk-In Center and our ER waiting room. We have added 41 new inpatient beds, and more are forthcoming,” Grady Health said in a statement.

In an October open letter to community members, he said that Grady Health would receive more than $130 million in American Rescue Plan funds to add 185 beds to the hospital by the end of 2023.

Nancy Kane, an adjunct professor of management at the Harvard University TH Chan School of Public Health, summarized the precarious state of access to care in Atlanta and beyond the following way.

She told CNN that when a hospital leaves, the whole network collapses. There are also trauma and maternity services. The whole care continuum starts to be affected.”

More than 50% of emergency room patients seen by the two AMC locations were Medicaid and Medicare recipients, according to Wellstar figures cited by the Atlanta Journal-Constitution.

Similarly, the closure of AMC South’s hospital and emergency center has left a number of families in south Fulton County – a cluster of suburbs with a mix of poor, middle-class and upper-middle-class residents – without a full-service hospital less than 7 miles away.

And while Google Maps estimates a 15-minute drive from AMC South to Grady, that commute could be many leagues worse during peak traffic hours in the bustling metropolis.

The Annihilation of Hahnemann University Hospital in Philadelphia is a Double Whammy: Why Do We Need Hospitals?

Rose referred to Kemp’s pledge to fund more beds at Grady as a “Band-Aid fix on an open wound,” and explained that the closures jeopardize the health of residents who live near shuttered facilities.

“The most obvious consequence is that if you’re in a low-income neighborhood, the distance to care is going to be greater. She said the distance can be a big issue for people without a car.

Kane said that many diseases are caused by poor health care access and low income and stress. Hospitals in communities of color and low-income areas have higher demand than hospitals in other areas. So, it’s a double whammy: You’re sicker, and you have worse access.”

She also highlighted that, in the US, race and poverty are associated with health disparities, including uneven access to high-quality doctors and care.

Just two months prior, in June, Philadelphia’s Hahnemann University Hospital, which was the chief teaching hospital affiliated with the Drexel University College of Medicine, announced that it’d be shutting its doors for good.

Alan Sager, a professor of health policy and management at the Boston University School of Public Health who over the course of the past 12 years has documented hospital closures in nearly every major US city, characterized the country’s health-care system as “anarchic.”

You are hurting people. You’re really hurting people. You’re messing with people’s lives, and you can’t do that. You really can’t do that,” as Phillip Lee, a lifelong DC resident, told the CNN affiliate WUSA in 2019.

Why do black people go to hospitals? The role of cosmetic diversity in identifying the problems facing Black people, women, and young black people in higher education

“Declining revenue isn’t an event that comes from Mars. It comes from under-investment in the facility,” she explained. “That’s part of the problem. There is not a word that people say to not go there anymore. It’s because they can’t get in or they don’t need the services they do anymore, and so they go somewhere else.

“If you look broadly across the country, there are big chains acquiring hospitals. They may have more than 100 hospitals. The headquarters is in St. Louis. Hospitals are in nine or 10 states for the chains. And the chains no longer have a sense of commitment or loyalty to the local community,” Kane said. “And so, if you’re a hospital that has lots of Medicaid patients or lots of uninsured patients, or if you’re a hospital that doesn’t get much government support, you end up looking like a poor performer in a portfolio where no one knows what’s underneath.”

In short, because chains aren’t necessarily familiar with the community, they might not have a commitment to it, and state governments aren’t demanding that they pay attention.

Because metro Atlanta does not have an adequate transit system that can get people to other countries, many residents will struggle to get appointments.

“They’re putting profits over people,” he told CNN. Black people suffer from chronic illnesses at a higher rate, and have a lower life expectancy. It’s going to be very difficult for those people to access basic services.”

Even though our institutions tell about progress on diversity, stories like Noble’s are very rare. For example, universities with lower student diversity are more likely to put students of color on their websites and brochures. But you can’t fake it till you make it; cosmetic diversity turns out to influence white college hopefuls but not Black applicants. In the 10 years since Noble obtained a degree, the percentage of PhDs given to Black candidates by Information Science programs has not changed. People of color are more likely to be discriminated against even if the illusion of inclusiveness is present. To spot cosmetic diversity, ask whether institutions are choosing the same handful of people to be speakers, award-winners, and board members. Is the institution elevating a few people instead of investing more in change?

In this next in a short series of articles about decolonizing the biosciences, obstetrician and gynaecologist Kecia Gaither advocates a multi-pronged approach to address structural racism in the health care of Black pregnant people. Improved screening and antibias training for physicians could help turn the tide of maternal death rates, according to the director of maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx.

I did my residency and fellowship training in Brooklyn, New York, and Newark, New Jersey. I observed that people from the African diaspora who did not have health insurance and had poor access to health care had higher rates of certain conditions than other people.

In West Palm Beach, an affluent city in Florida, I saw that wealthy white women were treated differently from the poor and uneducated women. Rich white people seemed to be listened to and offered help, labour pain relief and treatment as soon as they needed it, and this seems to have increased their respect for rich white people. People of colour were referred to harshly because of their social situation. They were stereotyped as lazy, substance-using people and so on, and not listened to.

Black people also have a higher incidence of underlying conditions, such as heart disease, diabetes, HIV and high blood pressure, which puts them at risk of complications during and after pregnancy. There is a rare type of heart failure called peripartum cardiomyopathy, which can begin after the last month of pregnancy and five months after delivery. Black people are also more likely to experience bleeding during pregnancy and premature delivery.

Because cardiac disease plays a significant part in adverse outcomes, I think there should be a more concerted and stringent screening process as part of prenatal and postpartum care. We really need to do the research to see whether rigorous screening would improve outcomes.

Since the programme started, there has been a marked reduction in the incidence of cardiovascular deaths in people at Lincoln compared with what I saw in 2017. For example, there have been no cases of postpartum cardiomyopathy or undiagnosed cardiovascular decompensation, symptoms that indicate that the heart can’t support proper circulation.

We should also direct more research towards how using medical support staff — such as those who help people navigate the medical system, doulas and midwives — could improve Black maternal-health outcomes.

It is worth looking at parts of the world that have better maternal-health outcomes. Many people in other countries have access to low-cost health care during the postpartum period whereas a lot of people in the US do not. Nearly half of US births are covered by Medicaid, which offers free or low-cost health care for low-income people, which only covers mothers’ care for the first 60 days after birth. Researchers say that, to catch more medical problems earlier, Medicaid should provide financial cover through at least the ‘fourth trimester’, or the first three months of the baby’s life, and ideally up to a full year after birth. 27 states have already adopted Medicaid plans for 12 months after birth after congress approved a Medicaid extension in 2021. Each state has different policies on health-insurance coverage for fourth-trimester care, which leaves many people vulnerable.

Bringing out the best in medical research: How African Americans get involved in their research and what they don’t: a case study of Dr. James McCune Smith

When patients engage with Black physicians, they are more likely to get preventative care. Garrick is working to raise awareness of how more diverse populations are needed to participate in clinical research.

Only about 5.7% of physicians in the United States identify as Black or African American, according to the the latest data from the Association of American Medical Colleges. This statistic does not reflect the communities they serve, as an estimated 12% of the US population is Black or African American.

And from the research perspective, if you are familiar with a particular set of issues because you are from the same background as the participants, then you can address nuances in your research more readily and build rapport and trust.

Adebagbo, who was born in Nigeria and grew up in Boston, said that as a child, she often saw tensions between certain aspects of Western medicine and beliefs within Nigerian culture. She yearned to have the expertise to bridge those worlds and help translate medical information while combating misinformation – for her loved ones and for herself.

“I wanted to go into medicine because I felt like, ‘Who better to mediate that tension than someone like me, who knows what it’s like to exist in both?’ ” said Adebagbo, 26, who graduated from Stanford University and is now a third-year medical school student in Massachusetts.

“When you’re going through a really difficult training program, it makes a big difference if there are people like you in the leadership positions,” he said, adding that this contributes to the disproportionate number of Black medical school students and residents who decide to leave the profession or are “not treated equally” when they may make a mistake.

This has enabled Adebagbo to connect with patients of color in her rotations. She recognizes that their encounters with her are brief, she said, and so she tries to empower them to advocate for themselves in the health system.

“We can improve our admissions to medical school, make them more holistic, try to remove bias from that, but that’s still not going to solve the problem,” Dill said.

Non-Whites are not accepted by a lot of US medical schools. The first black American to hold a med degree was Dr. James McCune Smith.

Smith owned a pharmacy in New York City, became the first black person to be published in US medical journals, and received his MD in the 18th century.

The study found that black men were less likely to get treated for colon cancer than white men.

A study published in Annals of Internal Medicine last year claimed that diversity in medical schools was affected by bans on affirmative action programs in some states. That study included data on 21 public medical schools across eight states with affirmative action bans from 1985 to 2019: California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington are all located there.

The study found that the percentage of students fromunderrepresented racial and ethnic groups fell by more than a third after the bans were implemented.

Among White students, 2.3% left medical school in the academic years of 2014-15 and 2015-16, compared with 5.2% of Hispanic students, 5.7% of Black students and 11% of American Indian, Alaska Native, Native Hawaiian and Pacific Islander students, the study found.

“Despite the discomfort that may arise on the giver of feedback’s side, it’s necessary for the growth and development of students. You’re hurting that student from becoming a better student on that rotation, not giving them that situational awareness that they need,” she said. That is what ends up happening with students of color. At the end of the rotation, it becomes obvious that they have made so many mistakes, that we should either dismiss you or give you no honors or high marks. “It’s “

Adebagbo says she had one site director, a White male physician, during her surgery rotation who genuinely cared, listened and wanted to see her grow as a person and physician.

Where do I fit? A physician’s perspective on a broken trust between black doctors and black patients: a case study of syphilis in black men

At times, he wondered where he fit in when all-night study sessions and exams were the norm.

On the day in 2009, Howard graduated with a PhD and an MD from the University of Medicine and Dentistry of New Jersey.

“Only slightly different semantically, the second question shifts focus away from the ‘where’ that implies an existing location. Instead, ‘how’ requires me to illustrate my relationship with existing labels and systems, rather than within them, allowing a multitude of answers to my question of ‘how do I fit?’ ” Howard wrote.

“Despite the challenges and realities of the medical field today, I fit wherever and however I can, actively shaping my space and resisting the assumptions that first prompted me to ask where I fit,” he said. “To finally answer my question: I don’t fit, but I am here anyway.”

The US has made some progress with regards to diversity in medicine, but it is still not there, said Dan Barouch, a professor at Harvard Medical School.

One example of broken trust between physicians and Black patients happened in the 1930s, when the US Public Health Service and the Tuskegee Institute launched an unethical study in which researchers let syphilis progress in Black men without treating them for the disease. In 1972 the study ended.

Black men and Black women are also about six to 14.5 times as likely to die of HIV than White men and White women, partly due to having less access to effective antiretroviral therapies. But Black people with HIV got such therapies significantly later when they saw White providers, compared with Black patients who saw Black providers and White patients who saw White providers in a study published in 2004 in the Journal of General Internal Medicine.

Source: https://www.cnn.com/2023/02/21/health/black-doctors-shortage-us/index.html

The Next 150 Years of Digital Health: A Reflection on the Challenges and Opportunities for Health Care Workers in the U.S. and Other Public Sectors

Studies show that more open the patient population is for recommendations and instructions from their doctor, if the workforce in the health care setting reflects the community it serves.

In the emergency departments she has worked in across the nation, the diversity of the health care workforce did not match that of the patient populations.

The research shows that it makes a difference in how well patients do, as well as how long they live. “Especially at this juncture in history in the United States, where social justice is in the forefront, this is one of the most actionable places where we can make a difference.”

Tech is similar to public health in that it puts inequality into its systems and institutions. In the past decade, pathbreaking investigations and advocacy in technology policy led by women and people of color have made the world aware of these failures, resulting in a growing movement for technology governance. Industry has responded to the possibility of regulation by putting billions of dollars into tech ethics, hiring vocal critics, and underwriting new fields of study. Scientific funders and private philanthropy have also responded, investing hundreds of millions to support new industry-independent innovators and watchdogs. I am very excited about the growth of these public-interest institutions.

Public health has transformed human life through 150 years of public institutions that serve the common good. In just a few generations, some of the world’s most complex challenges have become manageable. Millions of people can now expect safe childbirth, trust their water supply, enjoy healthy food, and expect collective responses to epidemics. In the United States, people born in 2010 or later will live over 30 years longer than people born in 1900.

A public health model of digital governance is being proposed by the leaders in technology and policy, which includes detection of past harms of technology on society, as well as supporting societal well-being and preventing future crises. Public health also offers a plan for building the systems needed for a healthy digital environment.

The problem affected many Americans, how long did it take for the field to notice it? Noble was one of seven Black scholars who received Information Science PhDs in her year, and was able to ask important questions that mostly white computing fields were unable to imagine.