AMA past president Dr. Patrice Harris advocates for equity in the COVID-19 era

Even as the medical association itself works toward more diversity, it's helping lead the charge on social determinants, ZIP code disparities and other challenges brought to the fore by a pandemic that's disproportionally affected communities of color.
By Mike Miliard
02:18 PM

"The organization in 2021 is not the same as the organization it was years ago," said Dr. Patrice A. Harris, 174th president of the American Medical Association and the first African-American woman to hold that title.

Speaking Tuesday as part of the virtual "CHeT Talks" series hosted by the University of Rochester's Center for Health + Technology, Harris noted that there are many more women and people of color among AMA's House of Delegates than even five years ago.

"I've always been about changing from within and getting involved and engaged. And if you see a problem, take a solution with you and join and fight to change the organization."

As the AMA has grown more diverse, the association has been focusing more of its efforts at tackling the root causes of health inequities in underserved populations and among people of color. And it's doing so at a moment where those communities are suffering disproportionately from the pandemic.

COVID-19 "has elevated so many issues that many of us already knew," said Harris. "Many of us already knew about the health inequities. But what this pandemic has forced us to do is have a conversation about structural racism – and more conversations about the interconnection between the social determinants of health."

One in 800 Black Americans has died from COVID-19, one attendee pointed out – which, as Harris noted, that isn't because of their particular genetics.

"And that is not a genetic issue ... as to the reason that Black and brown people, indigenous people are dying more, hospitalized more," she said. "It's the racism, it's not the race."

The U.S. healthcare system "has to be more focused on the determinants of why more black and brown folks are dying," she said.

"Originally, we didn't even have the data – race data, gender. We also needed ZIP code data. That was one of the early recommendations. I particularly cared about the ZIP code data and overlaying that, because if we found that there was a higher illness incidence or hospitalization ... we need to take resources to that community."

'Own health equity in your organization'

Whereas once upon a time, "African-American physicians couldn't join the AMA," said Harris, in 2019 the association established a Center for Health Equity – and hired its chief health equity officer, Dr. Aletha Maybank.

"We are on a journey – and it's a journey, not a destination – to embed health equity into the DNA of AMA," said Harris.

That said, "we're not looking to Aletha to fix the problem," she explained. "That happens a lot in institutions: They hire a DEI person [diversity, equity and inclusion] and that person owns it and is accountable."

Striving for a more just healthcare system is a job for everyone – right up to the top, said Harris. "When leaders talk to me, when I've talked to CEOs, I say, 'Own health equity in your organization.'"

"We are on a journey to embed health equity into the DNA of AMA."

Dr. Patrice Harris, American Medical Association

She's cautiously optimistic, so far, that national leadership recognizes the stakes.

"The Biden team is already, of course, on COVID-19. They appointed for the first time Dr. Marcella Nunez-Smith as their lead around equity. I remember getting chills the first time I heard her speak, and how that conversation has been elevated: Equity related to COVID-19, related to equitable vaccine distribution, social determinants of health, structural racism.

"The Biden Administration has certainly hit the ground running," she added. "And as they have the top-line priority of COVID-19, all of those other issues that must be addressed, and they are committed thus far, from what I've seen, to addressing those other issues."

Someone asked Harris how she suggested encouraging more people of color to enter the health professions and help combat healthcare inequity from the front lines.

"We provide the pipeline, I believe, by starting early with our children and making sure that they have what they need," she said. "We start in preschool and make sure [of] their resources, social-emotional resources and there's adequate education and there's parity in education.

"I wasn't prepared as well as some of my peers when I went to college," she added. "We have school systems that are based on property taxes. And years ago we had redlining, so you have certain communities of color who live in an area that may be next to an environmental hazard because of redlining. If you live next door to that, your property values are going to be lower, and that's not as good of a tax base to the educational system."

These problems "are not ours alone to solve, but we do have to be a part of the conversation around good paying jobs and transportation and whether or not you live in a food desert." said Harris of those SDOH essentials. "We've got to start young, but we've got to make sure that the systems are in place that allow everyone the equitable opportunity to achieve."

In the meantime, the pandemic and its many aftereffects, from shuttered schools to mental health challenges, continue.

"Resources, resources, resources," said Harris. "Schools need to open, but they need to have resources. We need a broad, comprehensive testing strategy. We need to make sure this data is mapped out by ZIP code. And we need to go to communities, ask them what they need, and then be committed and accountable to providing them the resources they need."

Twitter: @MikeMiliardHITN
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