Racial Disparities During the COVID-19 Pandemic Continue – Featuring Larry Selkow

Earlier during the COVID-19 pandemic, we reported on the racial differences affecting our communities and the potential solutions pharmacists can provide. As the pandemic continues on, we see how these disparities remain magnified during public health emergencies. An analysis published last week describes continued higher mortality rates of communities of color as compared to Whites, despite these differences having been identified early during the COVID-19 pandemic. As the rate of infections and deaths continue to rise, and with 12 million Americans at risk for losing unemployment benefits come December 26th, we are likely to see worsening rates of food insecurity, homelessness, and of course, inability to pay for health care over the coming months.  

In our last post, we noted several inequities in social determinants of health that put racial and ethnic minority groups at an increased risk of morbidity and mortality associated with COVID-19. These factors include, but are not limited to, healthcare access and utilization, such as access to COVID-19 testing; occupations, as many people of color are essential workers; and housing. Another factor that has amplified these disparities and must be addressed in order for solutions to be made, is the delay in translating critical health alerts and recommendations into other languages. Pharmacists practicing in different areas are faced with this problem all too frequently. 

We have shared the stats and have seen the widespread impact that without policy solutions these racial differences, amplified by the pandemic, will continue to expand. Recognizing the power of stories and that each of us need to hold ourselves accountable for addressing racism, inequities, and disparities in our society, we bring you a narrative reflection on how language barriers can impact patient care from a pharmacist in the field. 

Where Do We Go From Here? A Reflection by Larry Selkow, A Pharmacist in the Field

I have been a community pharmacist for almost 40 years. Currently, I live in a well-to-do golf course community in the Palm Springs area of Southern California. President Barack Obama played a round of golf on the course where I live a few years ago. My current position also puts me in a very affluent area. However, a few years ago I was employed by a large retail pharmacy chain in a not so well-to-do neighborhood, not too far from my current home. Actually, if I drive around 5-10 minutes from my home, the area is very poor with a large Latino population. When I worked in that neighborhood, there was a huge language barrier that I faced on a daily basis. 

I do not speak Spanish, but my pharmacy technicians did and they would often have to translate for me back and forth. If my technician was not there, which occurred at night and on weekends, I would often have to page another Spanish speaking employee to the pharmacy to translate for me. When I think about my work in the Latino neighborhood, I often wonder… what kind of care was I really providing? In the current state of affairs in this country, what I have experienced happens on a daily basis. Actually, when you think about it, a language barrier is a huge public health issue in this country. If patients are not able to communicate properly with their pharmacist or any other health professional, this creates a public health issue,: like any other public health issue such as smoking, HIV, or obesity. It is perfectly fine to have someone translate back and forth. But, does it provide equitable care to these patients? Do these patients fully understand their current health situation? 

Many pharmacists may not have the ability to speak Spanish fluently when working in a Latino neighborhood. This creates a problem for all. These patients often do not get the proper consultation or health information that they need. During the pandemic, we are facing a time when timely dissemination of accurate information is crucial, there has been a lot of press coverage about the huge disparities between different ethnic groups. The Latino population has been hit especially hard from COVID-19. Imperial County in California, which is about an hour drive from my home, has been devastated by COVID-19. This area has an even larger Latino population than where I worked. I know a few pharmacists that have worked in Imperial County, and from talking to them, the language barrier is even worse than I experienced. Again, what level of health care is actually being provided? Sometimes I myself, get frustrated that I am letting my patients down. I know other pharmacists that get frustrated as well. But, we as health professionals must do the best we can with the current situation, while also advocating for future equitable solutions. 

We became pharmacists to provide care to all patients regardless of the language that they speak. We must realize that a language barrier is a huge public health issue, like any other public health issue. So, the question is: where do we go from here? There is no perfect answer, but if we can look at the current situation in this country, one word comes to mind: Empathy. Yes, we heard that word often during the 2020 Presidential campaign. Now that the campaign is over, we must apply that word to our daily practice. I feel a little more understanding of our patients needs can go a long way towards providing the necessary care that they deserve. In the long run, their health and well-being will be much better off.

Solutions Needed: Empathy and Policy Change

Empathy is crucial not only to understand our patient’s needs, but to build trusting relationships that allow for patients to express their thoughts and concerns. Although there is hope for a COVID-19 vaccine becoming available soon, historically communities of color have been underrepresented in clinical trials and have a deeper mistrust for the healthcare system, which may cause significant barriers to administering vaccines to this vulnerable population. In a recent New England Journal of Medicine perspective the authors note “When Covid-19 vaccines are eventually approved by the FDA, their success in Black and other communities will depend on whether members of these communities not only trust that they are safe and effective, but also believe that the organizations offering them are trustworthy.”  Although there are steps that must be taken, such as ensuring these communities have access to necessary healthcare if they are injured as a result of receiving the vaccine, they also note that efforts must be grounded in grassroots involvement of individuals and organizations with reputations of trustworthiness among these populations. We believe pharmacists are key players in building and maintaining these relationships, and serving as a voice for the underrepresented.  

Additionally, advocating for our patient’s needs, ensuring access to care, and providing educational resources that are easily understood by all patients will also help build these trusting relationships. As we described in August, policy changes including development and implementation of payment models are needed in order to ensure access to pharmacist’s services, such as COVID-19 testing and vaccines, for all people. Furthermore, funding to support agencies to provide public health infrastructure are crucial to combating the inequities of social determinants of health that impact many of our patients. We challenge pharmacists and national pharmacy organizations to also consider these factors when developing resources for your communities and ensuring minority voices are properly represented.