05/08/2020

The Many Ways COVID-19 Exacerbates Pre-existing Inequality

34:08 minutes

people of color wearing face masks line up outside of a building along a wire fence
People line up at a COVID-19 walk-in testing site at Gotham Health, Belvis in Bronx, New York. Taken on April 28, 2020. Credit: Shutterstock

This story is part of Science Friday’s coverage on the novel coronavirus, the agent of the disease COVID-19. Listen to experts discuss the spread, outbreak response, and treatment.


Coronavirus is still hitting the U.S. hard. And breaking down infections by race shows a striking pattern: Black, Latino, and Native American people are hit much harder than other communities. 

National data shows black Americans account for nearly 30% of COVID-19 deaths, despite only being 13% of the population. In New York City, the epicenter of America’s epidemic, the death rate among black and Latino residents is more than double that of white and Asian residents. 

Coronavirus is spreading on tribal lands, too. If Navajo Nation were a state, it would be behind only New York and New Jersey in infection rates. Native communities are also often categorized in the racial category of “other” in statewide infection data —making it hard to know just how bad COVID-19 is for Native people.

Joining guest host John Dankosky to talk about COVID-19 inequities are Uché Blackstock, physician and founder of Advancing Health Equity in Brooklyn, New York, Rebecca Nagle, journalist and citizen of the Cherokee Nation in Tahlequah, Oklahoma, and David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA’s medical school in Los Angeles.


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Segment Guests

Uché Blackstock

Uché Blackstock is a physician and founder of Advancing Health Equity in Brooklyn, New York.

David Hayes-Bautista

David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at the David Geffen School of Medicine at UCLA in Los Angeles, California.

Rebecca Nagle

Rebecca Nagle is a journalist and a citizen of Cherokee Nation, based in Tahlequah, Oklahoma.

Segment Transcript

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky in for Ira Flatow. Coronavirus is still hitting the US very hard. And while some say the virus doesn’t discriminate, breaking down infections and deaths by race shows that black and Latino people are hit a lot harder than other communities.

National data shows black Americans account for nearly 30% of COVID-19 deaths, and only 13% of the US is black. In New York City, the epicenter of America’s epidemic, the death rate among black and Latino residents is more than double that of white and Asian residents.

Coronavirus is spreading on tribal lands, too. Native communities are grappling with fewer resources and a lack of data to even show how bad the problem is.

Joining me today to talk about these inequities in COVID-19 are Dr. Uché Blackstock, a physician and founder of Advancing Health Equity based in Brooklyn, New York. Dr. Blackstock, welcome to our show.

UCHÉ BLACKSTOCK: Thank you for having me.

JOHN DANKOSKY: Also with us is Rebecca Nagle, a journalist and citizen of the Cherokee Nation in Tahlequah, Oklahoma. Rebecca, welcome.

REBECCA NAGLE: Thank you so much.

JOHN DANKOSKY: And Dr. David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at the medical school at UCLA in Los Angeles, California. Dr. Hayes-Bautista, welcome to our show.

DAVID HAYES-BAUTISTA: It’s a pleasure.

JOHN DANKOSKY: Dr. Blackstock, I want to start with you. And you work part time in emergency care in Brooklyn. Maybe you can tell us as best you can the racial breakdown of your patients coming in with COVID-19 symptoms.

UCHÉ BLACKSTOCK: Sure, absolutely. So I work in central Brooklyn at various locations. And typically, we have a very racially and socioeconomically diverse patient population. But starting in about mid-March, we noticed a shift in the demographics. We noticed mostly black and brown patients coming in with COVID-19 symptoms. And it was very apparent.

It was even to the point where my organization actually had to close down certain urgent care sites that were in predominantly white and affluent neighborhoods because the patient volume, the number of patients coming in was so low, and had to shift some of our staffing to black and Latino neighborhoods because we had a surge in patients we needed to care for.

JOHN DANKOSKY: My goodness. So how does this compare to patients that you see coming into the clinic normally? I mean on a regular day, pre-COVID.

UCHÉ BLACKSTOCK: So on a regular day, the volume is pretty low. We don’t really see that many very sick people. But it shifted a few weeks ago. We started seeing people coming in– fever, cough, shortness of breath, chest tightness. Their oxygen levels are very low. And it was quite scary. And as someone who’s been practicing for about 10 years, I’ve never seen such sick people. And even when I speak with my colleagues who’ve been practicing for about 35 years, they also agree they’ve never seen anything like this.

JOHN DANKOSKY: You said you saw some of this relatively recently. When did you realize the coronavirus was going to be really bad for the patients that you see?

UCHÉ BLACKSTOCK: I think it was probably about the second week in March that we started seeing coronavirus patients and really appreciating how sick they were. But what’s interesting was that although in the very beginning, we were given these CDC criteria to test, because we had such limited testing supplies, we were only allowed to test people who had visited one of the areas where coronavirus is endemic, like Italy or China. Or you had to know someone who had been tested.

So the patients I was caring for, the black and Latino patients I was caring for in central Brooklyn, they hadn’t traveled outside the country recently. And they didn’t know anyone who had been tested because at that point, it was really only politicians, celebrities, and athletes, like the entire Utah jazz team who got tested.

JOHN DANKOSKY: Yeah, so essentially, the guidelines at the time early on when you were seeing this just mitigated against any of the patients you were seeing from getting any of the testing they could have needed.

UCHÉ BLACKSTOCK: Exactly. And so while the criteria has evolved over the last four to six weeks, initially, I know I’m certain that we missed a good number of COVID-19 patients because that criteria essentially was embedded with bias.

JOHN DANKOSKY: So tell us more about that. I mean, why do you think that so many of your black and brown patients are disproportionately impacted by this disease?

UCHÉ BLACKSTOCK: Oh, so many, many different factors. We talk a lot about the social determinants of health, so access to health care, not even just health care, but access to quality health care, access to adequate housing, access to employment where you have sick leave and paid benefits.

And so we know that all of those social determinants of health, which is what influence a community’s health status, the driving force of those are structural racism. And so my patients already had high burden of chronic diseases like diabetes, high blood pressure, and asthma, which we now know are underlying factors that lead to very serious complications of COVID-19.

Also, my patients, many of them are essential workers and service workers. So many of them here in New York City, they work for transit or they’re bus drivers. And so they still have to go to work. And a few of them have even told me they were scared to go to work, especially in the beginning, because they were explicitly told not to wear masks in order to scare passengers. And so, essentially, my patients were exposed in many, many different ways and put at higher risk of contracting the virus.

JOHN DANKOSKY: They were told they can’t wear masks. They were told they can’t get the tests, all the things that could have helped them at the time early on they weren’t able to get.

UCHÉ BLACKSTOCK: Exactly.

JOHN DANKOSKY: Let’s move out to Los Angeles and see how it’s going there. Dr. Hayes-Bautista, I mean, what are you seeing amongst the folks who you’re looking at, especially in Los Angeles, the racial breakdowns there?

DAVID HAYES-BAUTISTA: OK, well, actually, the very first week of March, the LA County Health Department released its first map of COVID cases. And they were all located in West LA, which is the high income area, Beverly Hills, Bel Air, Brentwood. And some people said, well, see, it’s going to bypass minority communities completely.

And I said, wait a minute. Who has the discretionary time and the income to travel to Europe, to Asia? So they come back. They’ve been exposed. But what about the nannies, the gardeners, the cooks, the construction workers, the farm workers? Those are largely minority, particularly in Southern California, almost all Latino. So they’re getting exposed.

And it goes all the way back to farm workers, for Pete’s sake, who plant the very food, harvest it that we all need, so that the population can shelter in place and just go to the store one hour a week. The farm workers, first of all, are out there exposing themselves. And they are 100% Latino, 100% immigrant, between 50% and 80% undocumented.

They are probably the most essential workers you can think of. And yet, by the way, they can also be deported at any minute– so much for essential workers– not supplied personal protective equipment, have to work in gangs, et cetera. You have the truck drivers who bring the produce into the cities, the grocery store checkout clerks. On an average shift, that clerk is within half of an arm’s length of about 200 to 300 people. And there was no personal protective equipment even offered, until just a couple of weeks ago.

Then you have the automobile mechanics. That’s essential. You have the public transportation engineers. That’s essential. You have the attendants in the nursing homes, which, again, in California, are largely Latino. So you have a population that was exposed as they went to support the population in West LA. And as the West LA population hunkered in homes, that other population, largely Latino minority, had to continue their jobs.

Now within that, the second week of the crisis, the second week of March, both the Los Angeles County and California Health Department said– and even said it in Spanish– you have a fever, you have a cough. [SPANISH] Well, wait a minute. We have a huge provider shortage here in California, particularly that speaks Spanish.

In fact, the shortage is so great that it will take the medical schools in California 500 years to graduate enough Latino medical students, so that Latinos have the same access as non-Hispanic whites– 500 years. So Senora Gomez has a fever, a cough. She wants to see the doctor so she can get a test. And you say, well, yes, Senora Gomez. Please have a seat, and the doctor will see you in 500 years.

And you needed, up until recently, that doctor’s recommendation to get testing. Testing used to cost quite a bit. And it still can, depending on how you’re getting it. And Latinos are still twice as likely not going to have health insurance, even after Obamacare.

So you add the increased multiple exposure by the way of how they are working to support those who can stay in house, and then the lack of access to both medical care and the public health infrastructure, the weakness of the public health infrastructure, the shortcoming of the private medical care system.

And let’s just go one step further. Latino households, because of high cost of housing and because of very low wage work– farmers, workers don’t earn very much– tend to live very densely, more people per household. That’s an historic pattern. And also because of low wages, tend to have more wage earners going out every day. So you have more adults leaving the house every day. So even with the children are not going to school– they’re sheltering at home– more adults can possibly bring this in.

So what we’re seeing here in California is that while the curve has pretty much flattened in the rest of the state, it is still growing in Los Angeles, largely increasingly Latino and African-American because those folks are just now entering the data systems. But they’ve been exposed. They just– they didn’t know it.

JOHN DANKOSKY: I want to ask you quickly, if you would, how much difference between the numbers that we’ve seen and reality do you think there is? I mean, the numbers that have been reported of the Latino population in LA County in California versus the number of people who you believe are actually infected, what’s the disparity there, do you think?

DAVID HAYES-BAUTISTA: Well, I couldn’t put a number to it, but it will be far greater, and rolling in a little bit later. People have talked about a second wave of COVID maybe this fall. So we’re looking at wave 1.0 here, 2.0. But I think for minorities, we’re seeing, like, wave 1.5– not that they got it much later, but rather, they’re entering the data systems and the care systems much later because of these problems in access to care.

JOHN DANKOSKY: Mm-hmm. And I don’t know. Uché, do you see the sort of the same thing, this big gap between what the numbers really say and what the reality is?

UCHÉ BLACKSTOCK: Yeah. Actually, yeah. I wanted to comment on that because, actually, what we’re seeing here in New York City is that as testing is expanding, we’re seeing higher rates of positive cases, especially in black and Latino neighborhoods. Because those people were not being tested before. And so those testing rates are catching up with the cases and the hospitalization and mortality rates. And so it’s making more sense now.

DAVID HAYES-BAUTISTA: And if I might add, John, one additional thing here is up until the second week of March, ICE, Immigration Customs Enforcement, was going into hospitals here in Southern California and extracting folks to deport, which, of course, tends also then to depress someone’s willingness to go into a medical facility for whatever reason.

So we have all these structural things and then wonder why are Latino and African-Americans having higher rates. Well, it’s not that we’re weaker. It’s just that this shows the structure of the system. We’re more exposed. We have less access to care.

UCHÉ BLACKSTOCK: And just to piggyback on that, I would like to say the structural racism has essentially made these communities sick. So when you have a pandemic and a crisis like this, it’s essentially a crisis within a crisis. And so it’s these most vulnerable communities that end up suffering the most, which is why we’re seeing these incredibly high mortality rates in black and Latino communities.

JOHN DANKOSKY: Mm. I’m John Dankosky, and this is Science Friday from WNYC Studios. We’re talking about inequities in COVID-19 and coronavirus cases. We’re talking with Dr. Uché Blackstock from Brooklyn, New York and Dr. David Hayes-Bautista, who’s from Los Angeles, California.

I want to bring into our conversation Rebecca Nagel. She’s a journalist, and she’s also a citizen of the Cherokee Nation in Oklahoma. So let’s talk about the part of America that you’re looking at, Rebecca. Some tribal nations have been hit very hard by coronavirus. Tell us about what’s happening in Navajo and Pueblo lands.

REBECCA NAGLE: Yeah, so there are some tribal communities in the United States that have been hit really, really hard by this outbreak. So if Navajo Nation were a state, it would have the third highest rate of infection in the United States, only behind New York and New Jersey. It’s important to note in that that they’re also testing at a really high rate per capita.

But right now, in New Mexico, which is one of the states where their reservation is located, Native Americans are less than 10% of the state’s population, but over 55% of the state’s coronavirus cases.

There’s also been a really, really disproportionate impact on Native Americans in Arizona. So a couple weeks ago, the Arizona Health Department released some data that even though Native Americans were less than 6% of the population in this state, they accounted for 16% of the state’s COVID-19 related deaths.

JOHN DANKOSKY: And are they being tested at a higher rate, not just testing at a higher rate, but are the tests being administered at a higher rate on the tribal nations?

REBECCA NAGLE: Within Navajo Nation, the testing rate is higher than across the United States. And so their testing rate per capita, I think– I believe that they’re also third in the number of people that they’re testing. But they’ve also had a really high death rate, so I think as of today, there are 79 confirmed deaths on Navajo Nation for an area that has a population of about 180,000 people.

And so what we see in these pockets is an extremely disproportionate impact of coronavirus. And one of the reasons that the disproportionate impact in Indian country is not being talked about on a national level is because across the country, that data is not being collected. And it’s not being collected consistently. So we don’t even have the numbers to have a conversation about what’s happening across the country in terms of the impact on Native Americans.

JOHN DANKOSKY: So we’ve been talking a well some of the reasons why these disparities are happening across the United States in various communities. What do you think are some of the issues that are specifically affecting the Native American community here?

REBECCA NAGLE: Yeah, so when you look at the underlying health conditions that the CDC lists, things like asthma and diabetes, Native Americans rate the highest. And that comes from years of racial inequity in access to health care.

And so access to health care is actually a treaty right for Native Americans. It’s not a handout. We gave up billions of acres of land so that the United States could expand. And in exchange for that, our tribes were promised health care for our citizens, among other things. And so in the 1950s, the United States created the Indian Health Services to answer that promise. And it has been woefully underfunded basically since the day it came into existence.

And today, most health programs, like when we think about Medicare or Medicaid, they’re what are called entitlement programs. And so they’re funded based on need. So if you qualify to get Medicare or Medicaid, you get it. Indian Health Services doesn’t work that way. Congress sets aside how much money they want to give to it. And then if the place where you access health care as a Native American is out of money, you don’t get that service.

And so right now, it’s funded at about 16% of what tribal leaders and native health experts say its needed. And so that’s created this gulf of health disparities that leaves Native Americans more vulnerable to coronavirus.

JOHN DANKOSKY: And you see this in the African-American community and the Latino community, where the resources needed in various communities aren’t getting there from governmental agencies. But in this case, very specifically, the government just is saying, we’re not going to fund the needed medical care.

REBECCA NAGLE: And funding since the epidemic has started has been woefully inadequate. Tribes don’t have direct access to the national strategic stockpile. There have been some really glaring mistakes that have been made. In the first few weeks of the epidemic, IHS sent out a bunch of N95 masks to different service providers and centers that were expired, telling people that they were probably still safe to use, but examine them before using them.

And even the relief that was passed that was supposed to specifically go to tribes, that $8 billion that Congress passed, it’s been held up for a month by the Trump administration. And now it looks that a little over half of it will actually get distributed now a month later.

JOHN DANKOSKY: We’re looking at some of the inequities in who is getting and who is dying of COVID-19 across America. Stay with us right after this break. We’re going to continue our conversation.

This is Science Friday. I’m John Dankosky. We’re continuing our conversation about why some communities have been hit the hardest by coronavirus in the US. Our guests are Dr. Uché Blackstock, a physician and founder of Advancing Health Equity in Brooklyn, New York, Rebecca Nagle, a journalist and citizen of the Cherokee Nation in Oklahoma, and Dr. David Hayes-Bautista, who’s director of the Center for the Study of Latino Health and Culture at UCLA’s medical school in Los Angeles, California.

Dr. Blackstock, I want to go back to you. A recent poll of New York City voters found 75% of white residents don’t know someone who has died of COVID, but half of black and Latino voters say that they do know someone who has died. Does this discrepancy sound right to you?

UCHÉ BLACKSTOCK: Yeah, and absolutely, it sounds right. And I think in terms of the disparities in hospitalizations and mortality rates that you mentioned earlier in the other segment, I think that sort of confirms that one thing that I did notice, not only were we seeing more black and brown patients starting in mid-March, but less white and affluent patients. And many of those patients had the luxury of working remotely from home.

Another phenomenon that I’ve noticed– and this is anecdotally– is that a number of white new Yorkers actually had second homes outside of the city, whether it’s upstate New York or out on Long Island, and actually went to their second homes or were able to leave the densely populated city to less dense areas.

And so right now in New York City, we don’t even have all of the data. We only basically have a small percentage of the data that’s showing these trends. I think that as we go further along, we’re going to see these disparities widen even further.

One other thing that I wanted to mention is that on an average day, about 20 new Yorkers die at home. Now we’re seeing about over 200 New Yorkers a day dying at home. And I think that when you look at that demographic data racially and ethnically, it’s probably going to be black and Latino. And I think it’s for several different reasons that we’ve already discussed, but I also wanted to bring up this issue of distrust between especially the black community and the health care system.

JOHN DANKOSKY: Mm. That distrust, as you talked about before, doctor, obviously, is happening in the Latino community as well. I’m wondering if you could follow up on this. The numbers that we talked about of people feeling like they know somebody in their community who’s died of COVID or has gotten sick from it, do you feel like those numbers kind of hold up in the community you’re looking at in LA, too?

DAVID HAYES-BAUTISTA: Well, in fact, I would like to take it one step further. Even though people in West LA, again, the affluent where UCLA is, Beverly Hills, might know very few people personally that have died of COVID. They depend upon those who are dying. Let’s talk about the farm workers just for a second. They plant the food. They tend the crops. And if it weren’t for the farm workers, we wouldn’t have the food that people need to shelter at home.

Now in the early days when the markets first started to close down, you remember there were fights in the aisles over toilet paper? Just imagine when there are fights over food, over meats. That is going to be very, very serious, and because of largely immigrants, largely undocumented farm workers, slaughterhouse workers, et cetera, they keep us all fed.

So while maybe somebody in West LA doesn’t know somebody personally with COVID, the people in West LA are very much dependent upon that person out there they don’t know personally. Because of their willingness to expose themselves to COVID, everyone else can eat.

I’m just very, very glad that Rebecca really alluded to the history of these things. This situation didn’t just pop up overnight. We have the history of what happened with Native Americans, the lands. Here in California, medical services have been provided in Spanish for 251 years. California came into the union as not only a free state, but also a bilingual state.

And Spanish is not a foreign language in this state. Yet it is treated as if it were such, and there are very, very few providers that can speak Spanish. These are historic things. They just didn’t pop up since the first of the year. And there’s an African-American story as well that I’m sure Uché can fill us in on.

JOHN DANKOSKY: Well, David, I want to go to something else that you’ve been studying for a long time that I think really links into this, a type of a health paradox in the Latino community. Maybe you can explain exactly what this is.

DAVID HAYES-BAUTISTA: We’ve been studying the Latino epidemiological paradox for about 35 years. And the paradox is this. Latinos have very low income, very low education, horrible access to care. So normally, we expect Latinos to have really super elevated mortality in heart cancer and stroke when, in fact, we see just the opposite. Paradoxically, Latinos have 30% lower mortality for heart compared to white, 32% lower cancer.

In fact, as you look at all causes of death, Latinos have overall a 30% lower mortality rate, which leads to a 3 and 1/2 year longer life expectancy, very good infant mortality, and actually far less likely to drink, smoke, or do drugs than non-Hispanic whites. Now this with lower income.

So I’ve had some people say, well, then COVID is not going to affect them. But we don’t see that same curve for communicable diseases. Latinos consistently have had much higher rates for communicable, hepatitis, you name it, which, for me, is an indication of the weakness of the public health infrastructure.

With COVID, we’re getting the worst of all possible worlds because it will affect Latino populations the way other communicable diseases do very high. But while you don’t die of TB anymore, you will die of COVID. That’s going to be really different, the worst of both possible worlds.

JOHN DANKOSKY: Dr. Blackstock, do you have a thought on that? It’s such an interesting idea.

UCHÉ BLACKSTOCK: Yeah, I know. That’s so interesting. Actually, what I was thinking in terms of black communities is that we know that there is a mortality crisis among black mothers. We know that black babies have the highest infant mortality rate. Actually, the rate is almost higher than that during 15 years before slavery. And we know that black men have the shortest life expectancy.

And I think what that speaks to is this legacy of essentially legal discrimination against black people in this country, where our communities have been disinvested in and disenfranchised. And even this notion of epigenetics where the chronic stress of living with racism actually influences gene expression to the point where that’s why we’re seeing higher rates of diabetes in black communities or higher rates of autoimmune diseases.

JOHN DANKOSKY: Rebecca, I want to bring you back into the conversation. You wrote an article for The Guardian about Native Americans being left out of coronavirus data. Tell us about some of what you learned in reporting this story.

REBECCA NAGLE: Yeah, so we looked at how states were reporting racial demographic data, and we found, at the time, about 80% of states had published at least some demographic breakdowns. And over half of those didn’t even list Native Americans, didn’t have a category for Native Americans. And most of them put us into what’s called an other category, which statistically doesn’t mean anything.

We found that this was also happening in places with high native population. So over half of all Native Americans in the United States live in only 10 states, according to the US Census Bureau. And four of those states had put native people in the other category. Also, while there’s the stereotype that a lot of us live on reservations, actually about 70% of us live in urban areas with the highest numbers– not surprisingly, because they’re big cities– in LA and New York City.

And in the racial demographic data that is being published by both of those places, Native Americans aren’t included. We’re put into the other category. And that’s a huge problem because, one, it’s something that happens in public health data all the time, that we’re not included. And then what happens often is that when we’re actually pulled out of the data, it shows really, really stark disparities.

So I’ll just give one example. Just this past January, the CDC released a very detailed study on the rate of maternal mortality by race in the United States. It didn’t include native women. And a separate study done by the Urban Indian Health Institute found that native women living in cities were 4 and 1/2 times more likely than white women to die during pregnancy and childbirth.

And so, basically, what happens to our communities over and over and over again is we are experiencing these public health crises, but because the data isn’t being collected, they’re not being named.

The other big problem that’s happening right now with the data collection is– I mentioned Indian Health Services before as the federal health system set up to service Native Americans. IHS serves 2 and 1/2 million tribal citizens and some family members in 37 states. And the data reporting system that they have, which you would think could at least provide a snapshot, is woefully inadequate.

So one thing about IHS is that it’s a health system that is mostly primary care, and so critically ill patients are transferred out to non-IHS facilities. And the data does not follow that patient. So if a patient is tested at an IHS facility, but goes on to be hospitalized and even if that person goes on to pass away from COVID-19, that data doesn’t come back to IHS.

So IHS can really, at this point, only publish testing data, which we know, when we’re talking about racial disparities, rates of hospitalization and death are one of the really important ways that people are talking about the disproportionate impact of coronavirus.

JOHN DANKOSKY: I just want to ask each of our panelists before we run out of time here about something that’s been really important to following and understanding this pandemic– how much worse COVID seems to be on elderly populations. And the elderly play such an important, very specific role in each of the communities that you follow and that you’re parts of. Dr. Blackstock, maybe you could start here. I mean, how do you see the elderly African-American population being this personally affected by COVID?

UCHÉ BLACKSTOCK: Right. No, this is such a great question. I will say that I have been emotionally affected by this, as many of my patients who have come in and been very sick from COVID have been elderly black patients. And some of them are even close to retirement. And they are essentially the stalwarts of our communities.

And so it’s especially painful that in the twilight of their lives, when they’re supposed to be retiring and really enjoying life after many years of working very hard, that they have to really suffer from this very dangerous virus.

JOHN DANKOSKY: Dr. Hayes Bautista, how about you? What are you seeing in your community?

DAVID HAYES-BAUTISTA: Well, we see a couple of things. One is that there has been a tendency for generations for Latinos, elderly, to stay in place with the rest of their family, rather than being put out to a nursing facility. So on the one hand, they missed that exposure within nursing facilities, although their adult children will wind up being the assistance in that nursing facility, then can bring it back into the house.

Also because of the restrictions placed on Medicare and Social Security, a lot of Latino elderly today, because of when they were active workers back in the ’60s, ’70s, and ’80s, certain industries were excluded from Social Security and Medicare, such as farm work where you get people that have been nannies or gardeners off the record all this time, so they never had accounts.

So that they’re now aging– 30% of Latinos in a survey we did 15 years ago, Latino elderly did not have Medicare. And you normally assume when you got 65, you got coverage. About 20% did not have Social Security. They do need to live with their adult children, but their adult children are the ones who are going out and being exposed and then bringing it back in. And that’s been a concern in the Spanish language press, how do we protect our elderly, given the structure of the situation.

JOHN DANKOSKY: And Rebecca, how about you?

REBECCA NAGLE: Yeah, I think that’s the aspect of the disease that is really, really scary for Indian Country. I think that our elders, they hold a really, really important role in our communities. A lot of times, they’re in leadership roles. They do a lot of caretaking for their family members. And they also often hold a lot of cultural and language knowledge.

Just to talk about my own tribe, basically the last generation of fluent speakers are mostly over the age of 60. We have less than 10 people who speak our language fluently under the age of 40. We’re already in a place where we’re losing speakers at a rate that we don’t know what we’re going to do with this crisis. And when I get really emotional about coronavirus is I think about that increasing. It’s a really, really scary thought.

And so I think that that’s one of the ways that the impact on coronavirus in Indian Country is going to be disproportionate because some of what is important to us about our elders and some of the knowledge that they hold is irreplaceable. We cannot afford to lose elders, like what we saw happen in Italy.

JOHN DANKOSKY: I’m John Dankosky. This is Science Friday from WNYC Studios. All three of you, I think, have referred to this earlier in our conversation. But I’m wondering quickly, if you would– and Rebecca, I’ll start with you– this idea of just having more black, Latino, native people in medicine, whether or not this would change in some way the outcomes that you’ve been reporting on. I mean, Rebecca, do you have a strong feeling on that?

REBECCA NAGLE: Yeah, absolutely. I mean, I think that we need to be represented across the board. I mean, I think that even though the funding that we’ve gotten from coronavirus has been inadequate, it wouldn’t have been possible without our greater representation in Congress. And so even just seeing our numbers in Congress double in the last election and having more leaders on both sides of the aisle made a huge impact.

But yeah, absolutely. I mean, I think that even just having health care providers for those speakers that can speak their language so that they can talk to somebody that they can understand. I know a lot of elders that maybe do speak English when they’re seriously ill struggle more with their second language and are more comfortable in their first language. And so we absolutely need people from our communities in those roles, both on the ground and at the national level.

JOHN DANKOSKY: David, how about you?

DAVID HAYES-BAUTISTA: Not only is it important for patients, it’s important for everybody. It’s important for science. I’m a researcher. And I’ve been studying the Latino epidemiological paradox. Yet when I present my data to even the National Institutes of Health, people shake their heads because we don’t fit what we’re supposed to do. They say, where do you get your data? And I say, well, they’re your data. They’re NIH data.

Now here’s the situation. If non-Hispanic whites have the same epidemiological profile as Latinos for heart cancer, stroke, et cetera, we would say 250,000 lives a year. And they would be quite baby boomer lives. But because we have not invested, the research that are there have their, if you will, narrative about what Latinos and minorities are like.

So we haven’t done the research, so we don’t know how Latinos manage to reduce the risk for heart disease. And baby boomers are the ones who are going to pay the price for our negligence of medical education of Latinos and minorities in medicine.

JOHN DANKOSKY: Mm-hmm. And Dr. Blackstock, I’ll give you the last word. I know this is something you’ve written about and thought about substantially in your career.

UCHÉ BLACKSTOCK: Yeah, absolutely. Especially being a black woman physician, we know from the data that one of the solutions to addressing racialized health disparities is having a diverse healthcare workforce.

And so, as Dr. Bautista mentioned, we’re doing the research to address these health disparities. We’re more likely to work in underserved communities. And we also know that our interactions with patients have more positive outcomes and affects after the interaction. So it’s really important that we be here.

And I also want to say that the reason why our numbers are so small are due to structural issues. So it’s pipeline issues. It’s due to practices and policies of structural racism. So this is definitely not a mistake that we’re not there. And so we need intentional and explicit efforts to address diversity in the healthcare workforce.

JOHN DANKOSKY: Dr. Uché Blackstock is a physician and founder of Advancing Health Equity in Brooklyn, New York. Dr. David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at UCLA medical school in Los Angeles, California. And Rebecca Nagle is a journalist and a citizen of the Cherokee nation in Oklahoma. I want to thank you all for the work that you do. I want to thank you all for spending some time with us here on Science Friday.

UCHÉ BLACKSTOCK: Thank you.

DAVID HAYES-BAUTISTA: Our pleasure.

REBECCA NAGLE: Thank you so much.

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