COVID-19 exposed health inequities. These doctors let people know.

A community of people link arms in a show of unity and support
Communities of color have suffered disproportionally from COVID-19. (Image: Adobe Stock; Illustrations: David Chrisom, Boston Children's)

What’s a doctor to do when social issues make their patients sick? Traditional medicine can treat disease, but most people don’t realize that problems like racism, poverty, poor housing, and food insecurity can put children and families at risk for a wide range of health problems.

Driven by concern that communities of color would experience higher rates of COVID-19 illness and possibly even death, a group of doctors in the Boston Combined Residency Program (BCRP) tried a new approach. They used a combination of data and social media to shine a light on how COVID-19 was particularly harmful to patients of color.

COVID-19: ‘The great UNequalizer’

Early in the pandemic, many health and government officials referred to COVID-19 as “the great equalizer,” asserting that the virus didn’t discriminate on the basis of race or socioeconomic status. “That struck me as so frustrating and incorrect,” says Dr. Colleen Kelly, a resident in the BCRP Urban Health and Advocacy Track. “Everything we were hearing indicated that Black and Latinx people were bearing the brunt of the outbreak.”

The fact that communities of color would suffer disproportionately from COVID-19 came as no surprise to Dr. Kelly and her colleagues, Drs. Rohini Jain and Sagar Mehta. In caring for the children of Boston, they’d already seen how structural racism and economic disparities undermined children’s health well before the start of the pandemic. From housing that put children at risk of lead poisoning and asthma, to limited food options that foster malnutrition and obesity, poverty and racism are known — but often overlooked — causes of childhood illness.

Before COVID-19, 1 out of 10 children in Massachusetts lived with food insecurity. During the pandemic, that number rose to 1 in 5 children.
The team used Twitter to raise awareness of rising food insecurity due to COVID-19.

“As pediatricians, we directly witnessed the impact of COVID-19 in ways that are not always as apparent to lawmakers or the public,” says Dr. Jain. Not only did they witness it, they decided to do something about it. The team started compiling and analyzing public health data on COVID-19 in communities of color, starting with Black communities. The data confirmed their suspicions: Rates of COVID-19 infection, serious illness, and death were far higher in Black populations throughout the country.

COVID-19’s many impacts on children’s health

Though COVID-19 directly affects many more adults than children, children’s health has suffered in many indirect ways. For instance, food insecurity, a lack of consistent access to enough food for an active, healthy life, doubled in Massachusetts. Before COVID-19, 1 out of 10 children had food insecurity. During the pandemic, as parents lost jobs or fell ill, and as school closures cut off access to vital meal programs, that number rose to 1 in 5 children.

The data was shocking and clear, but few people knew about it. It was time to get the word out.

Stethoscopes and social media

Doctors typically share their research through medical journals and conferences. However, these doctors felt the situation called for a more rapid response and a broader audience. “Social media, especially Twitter, gave us a good way to share this information quickly,” says Dr. Mehta.

The group first tweeted about their concerns on April 16 with the hashtag, #greatUNequalizer — and more tweets followed. Another post illustrated trends in states reporting COVID-19 data by race. In nearly every state, the percent of Black people who died from COVID-19 far exceeded the proportion of Black people in the state’s overall population. Another showcased the rising rate of childhood food insecurity in Massachusetts.

Percent of Black population and Black COVID-19 deaths by state. In 23 of 28 states reporting COVID-19 death rates by race, the percent of Black people who died was greater than percent of Black people in the state's population.
A graphic developed for Twitter illustrating COVID-19 death rates by race. Click to enlarge.

Overall, the posts reached more than 100,000 people, with retweets by hospitals and several state legislators. The message was getting out, but they also recognized Twitter’s limitations. “Social media can be an echo chamber of like-minded people,” says Dr. Mehta. “We wanted to inspire action, not just likes.”

About the Boston Combined Residency Program and Health Advocacy Track

The Boston Combined Residency Program (BCRP) is a training program offered jointly through Boston Children’s and Boston Medical Center to engage young doctors in meeting the evolving needs of children, families, and communities.

As part of the BCRP, the Urban Health and Advocacy Track develops pediatric leaders who will dedicate their careers to advocacy and health equity while also providing children exceptional care.

Using data to expose structural racism

“This pandemic’s devastating effect on people of color comes down to structural racism,” says Dr. Amanda Stewart, a physician in the Division of Emergency Medicine who provided mentorship for the social media campaign. “But data can play an important role in driving more equitable decisions and policies.” Dr. Joanna Perdomo, director of the Urban Health and Advocacy Track, and Dr. Destiny Tolliver, a former chief resident and current fellow at Yale, also provided support and guidance for the project.

To continue their work, the team has been awarded a grant to cover the cost of delivering meals to families struggling with food insecurity. Meanwhile, observations of the first phase of their social media campaign will be published in the medical journal Pediatrics.

“We wanted to start a conversation,” says Dr. Jain. “We hope this pandemic can become a driving force to raise awareness and influence more equitable policies in the future.”

Read more about health equity at Boston Children’s and get answers about COVID-19.

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