The COVID-19 pandemic has shed light on issues of racial inequality, said Nicole Lurie, MD, MSPH, former Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services. “The excess mortality in Black, Latinx, and Native American populations has been absolutely staggering compared to white populations,” she said. “This has coincided with a very challenging and emotional national dialogue about race and racial injustice, structural inequality, and racism.”
Lurie gave the Christopher R. Blagg, MD, Endowed Lectureship in Kidney Diseases and Public Policy as part of the “Policy in a Post-COVID World” session.
Race-based patient disparities have been described frequently, with Blacks, Hispanics, and indigenous people having poorer outcomes than other groups in most chronic diseases. About 200 studies in the PubMed database report on race-based disparities and COVID-19, said Kiesha Gibson, MD, FASN, chief of pediatric nephrology at the University of North Carolina School of Medicine. Yet many of these studies fail to address the extent to which outcomes may be explained or driven by structural racism leading to poverty, poor access to care, and other factors.
Structural inequalities in society have put many people of color in the path of COVID-19 exposure, including frontline workers, those who need to take public transportation to work or cannot work from home, and those who may not have good access to testing or live in crowded, multigenerational households. This has pointed to “some real underinvestment in the science of how structural racism and inequality make you sick,” Lurie said. Institutional biases, or assumptions that race differences are just differences people cannot change, are now causing people to question whether that’s true, Lurie said.
“The kidney community is at the leading edge of this dialogue in medicine, and it has the opportunity to continue to lead and think [about] how to prevent conditions that cause renal failure, and how to get to equity in transportation, home dialysis, and access to new technologies,” she said.