COVID-19 pandemic highlights racial health inequities

In 1966, Dr Martin Luther King Jr stated, “of all the forms of inequality, injustice in health care is the most shocking and inhumane”. These words remain ever true and relevant in our current climate of health care.
The COVID-19 pandemic has substantially affected health care on a global scale, and has magnified the inequities in access to health care that existed before. This pandemic has highlighted the equity gap in outcomes for marginalised communities, specifically the Black community, as starkly shown by the disparate morbidity and mortality from COVID-19 in individuals from these communities compared with the majority white population.
 Furthermore, obesity and its associated comorbidities, which disproportionately affect racial or ethnic minorities, have played a central role in the severity of COVID-19 in marginalised communities.
While the obesity epidemic in the USA has continued an upward trend over the last few decades, the number of Black women with obesity also continues to rise and is approximately 40% higher than the number of white women with obesity, and 25% higher than the number of Hispanic women with obesity.
 Surprisingly, only 1% of patients eligible for bariatric surgery (ie, those with a BMI of ≥35 kg/m2 with obesity-related comorbid conditions, or those with a BMI of >40 kg/m2) actually receive surgical management for obesity.
 Racial or ethnic factors, socioeconomic factors, referral bias, and insurance barriers have been well established as contributing factors to inequity in access to this life-saving treatment for obesity.
As bariatric surgeons, our patients seek us out, reporting their weariness in struggling with obesity and its associated diseases, decreased quality of life, weight stigma, discrimination, and shortened life expectancy. As physicians, we took an oath to prevent harm to patients entrusted to our care, yet we have witnessed the inequity of the American health-care system first hand, in which equal access to care is not ubiquitous among all communities, races, and ethnicities. Finally, as Black women, we know all too well that our community is one in which these disparities in access to care are widespread or the quality of care received might be substandard (or both).
Therefore, our oath remains yet unfulfilled. One pandemic has unearthed a second; one of inequity in health care that continues to have a devastating impact on the Black community. With equitable access to health care and by adequately treating the disease of obesity, we can improve the health, and consequently reduce the severity of COVID-19, in these individuals. We are duly bound as a community to address these health disparities immediately, and to eliminate bias as a barrier to care. After all, these are the very inequities about which Dr King warned. Our bariatric patients need us, and the Black community needs us. We cannot continue to deny these individuals access to a proven procedure that we know can reduce the prevalence of obesity, improve health, and, most importantly, save lives. We must stand in the face of injustice, and work towards equitable health care for all.
We declare no competing interests. We acknowledge the support of Tuesday Cook (Merit Ptah Associates, Rockville, MD, USA), January Hill (Live Healthy MD, Macon, GA, USA), Michael Doonan (Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA), and Daniel Dawes (Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA).


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Published: July 10, 2020


DOI: https://doi.org/10.1016/S2213-8587(20)30225-4


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