COVID widens racial gap in Minnesota's health care system

Black Americans have about twice the risk as whites of developing a medical problem called peripheral artery disease, in which blood vessels in the legs become narrowed or blocked off. Severe untreated PAD can lead to amputation.

Yet white people are more likely than Black people to get a medical procedure for a severe form of PAD called critical limb ischemia. In Hennepin County, white men get procedures to clear the leg-vessel blockages or place stents there five times more often than Black men. And Black women are 20 times less likely to get a revascularization, or unblocking of the vessels, according to public and proprietary data.

Such health care disparities have become more pronounced during the COVID-19 pandemic, which has had a disproportionately negative impact on the health and financial well-being of people of color compared with white Americans.

As hospitals and clinics now try to rebuild from the financial wreckage wrought by the ongoing pandemic, some doctors and health care officials say there's never been a better time for the health care system to reach out to historically underserved communities and offer them the same levels of care as white people:

"Save More Lives. End Systemic Racism," blares one electronic billboard along the Interstate 94 corridor, just south of downtown Minneapolis.

The billboard ad is sponsored by Boston Scientific — a major medical device company in Minnesota with a long-running health disparities program, and which also happens to sell millions of dollars' worth of devices to treat PAD and other vascular problems every year.

The company's disparities ads — running in Dallas, New Orleans, Detroit, Minneapolis and online — feature the faces of Black Americans staring directly at the viewer, plus a web address, fightforhealthequity.com, with more information about disparities in disease in states where Boston Scientific sells devices.

The company's "Close the Gap" program uses data from public sources like Medicare and private sources like Truven MarketScan to produce statistics, including the ones about PAD prevalence and treatment in Hennepin County.

"At the end of the day, if we sell a Boston Scientific product, that's great. We are in business to sell products. But that is not the motive — the motive is educating the community," said Camille Chang Gilmore, global chief diversity officer at Boston Scientific. "We've been doing this for 16 years, and we've now evolved it to try and figure out how do we bring these resources to people."

University of Minnesota associate Prof. Sarah Gollust, who studies how media messages affect population health, said it's noteworthy to see a bold message calling out structural racism in health care just months after elected officials in Minneapolis and Hennepin County formally declared race disparities a major public health problem.

"You have cities and government officials ... being upfront and making these statements that racism is a public health crisis. And then to see that message echoed in this billboard by a private company, I thought was really striking," Gollust said.

COVID-19 is exacerbating the long-standing differences in the health of racial groups.

At the People's Center community health clinic in Minneapolis' Cedar-Riverside neighborhood, 6% of the 1,980 COVID-19 tests given to white residents have come back positive since April. But among the 2,530 tests offered to African Americans, including those in the sizable East African communities near the clinic, 40% of the COVID-19 tests have come back positive.

Ann Rogers, CEO of the 50-year-old People's Center, said COVID-19 has worsened what had been a sense of concern around health care for people of color. "What's happened with COVID has put it into crisis," she said.

On Sunday, Minnesota added 741 new cases of COVID-19 to its tally of 84,311 lab-confirmed diagnoses of the viral respiratory illness. The state also added 13 new deaths, bringing the confirmed death toll to 1,919 in Minnesota.

Residents of long-term care and assisted-living facilities accounted for nine of the newly announced deaths.

To date, nearly 16,000 of the confirmed cases of COVID-19 have been in Black residents. That means African Americans account for 6% of the state population and 19% of the confirmed cases. Hispanic residents account for 5% of the state population but 17% of confirmed cases.

Having underlying health conditions makes people more likely to develop COVID-19 and need hospitalization if they get it, according to the Centers for Disease Control and Prevention. High rates of conditions like obesity, diabetes and high blood pressure in racial minority communities contribute to the higher risks.

"Data has shown that racial and ethnic minority groups with the referenced conditions are at even higher risk for severe COVID-19 illness," the CDC says.

The roots of disparities reach back many generations in America, involving factors such as diet, lifestyle, health literacy, as well as genetics, place of birth, income level, family support and social biases. Many key drivers are socially determined, such as whether the person has access to stable housing, good grocery stores and health insurance with an adequate local network of doctors and clinics.

Telemedicine is often touted as a tool to break down barriers to care. Hennepin Healthcare, which is a few blocks north of the Boston Scientific sign, embraced telemedicine early in the pandemic, but people there quickly realized that they had to modify their strategy to reach diverse populations.

Dr. Deepti Pandita, a physician at Hennepin Healthcare who has worked to address health disparities, said a community-needs survey and anecdotal evidence quickly showed problems: People in some cultures can't use a camera; others were concerned about having their faces recorded.

Hennepin took all the feedback and changed its system so that telemedicine calls didn't always have to begin inside the system's English-only MyChart app. Instead, the calls could start via text messages that could be in several languages, and be conducted on a smartphone instead of a home computer.

Pandita acknowledged a more complex issue: Patients need to trust their doctors and hospitals. That can be hard to maintain in the wake of revelations like Hennepin Healthcare's participation in a controversial study that administered the sedative ketamine to African Americans more often than white people during police encounters.

"Trust is something that needs to be earned and maintained, and there have been these issues ... that have set us back a little bit," she said. "We have a community advisory board that is very diverse and guides us, and we also have a public research advisory board that meets at a regular frequency and is sort of the eyes and ears of the community telling us what we need to improve on."

Acknowledgment of inherent bias is often emphasized. Dr. Penny Wheeler, CEO of the 12-hospital Allina Health system in the Twin Cities, recalled a recent example with hospice care. Although referring patients to hospice care is a priority for the system, internal data showed that such referrals were "overwhelmingly" being offered to white patients, she said.

After seeing the evidence of bias, "one physician even said they didn't offer it as much because they just made an assumption that in the African American community, more families were involved in their care and they'd be less interested," Wheeler said. "The intentionality of recognizing that bias has started to overcome and close that gap."

She added: "If there is any time, any time, to try to turn this ship in a more positive direction, it is now."

Joe Carlson • 612-673-4779