Health equity is imperative for the future of the health of the nation

In May 2020, during the COVID-19 pandemic, I read the National Public Radio report, “African-American deaths from COVID-19 are nearly two times greater than whites.” I was reminded why my uncle, Dr. Eric Yancy, became one of the early Black pediatricians in Indianapolis. He experienced first-hand the inequity in the treatment of Black people in the 1950s. Seeing a woman and her sick child turned away from the pediatrician’s waiting room due to long wait times for Black patients moved him deeply. It was a moment that stirred him to action. In response to his grandfather’s challenge, he resolved to become a doctor, determined to address such disparities.

Due to gross injustices in the healthcare system toward Black people during my childhood, my mother, one of the first students to integrate the Baton Rouge high schools in the 1960s, always checked with my pediatrician uncle to ensure information given by other doctors was correct. This constant vigilance shaped my interactions in healthcare settings and is a persistent behavior among my family members. Health professionals do not frequently consider this burden.

The COVID-19 headline felt like a gut punch to my personal mission as a Black female allergist/immunologist to ensure I give optimal healthcare for all patients, including my own community. Therefore, I embarked on describing healthcare disparities in patients with allergic and immunodeficiencies with my other allergist/immunologist colleagues nationally.  The focus was to provide practical information for clinical encounters and point readers to resources that can support the evaluation of social determinants of health to ultimately reduce disparities.

Although I should not have been surprised, Black people had universally disproportionate, poor outcomes in almost all allergy/immunology disorders, including food allergy, my specific area of research. Progress has been made for food allergic patients in Texas through the provision of life-saving medication (injectable epinephrine) for school students at risk for anaphylaxis, albuterol for students with asthma, and a bipartisan bill to educate all restaurant workers about food allergens. But barriers still exist to implementation and Black and other minoritized populations are disproportionately impacted.

Food insecurity has a huge impact on the quality of life of food-allergic patients due to the inaccessibility of more expensive, allergen-free products. Twenty percent of all food-allergic patients are food insecure, and this disproportionately impacts lower-income and minoritized communities. Although eating food free of proteins that could cause life-threatening reactions is the treatment for food allergy-related disorders, these foods are not covered by insurance the same way medications are covered as treatments for other diseases. School meal distribution, supplemental nutrition assistance program protections and connection of families with resources like allergen free food banks will be instrumental in mitigating food insecurity.

The reasons for healthcare disparities are myriad and most solutions are inadequate to address all the multi-layered determinants of disparities. Health equity for all is still a worthy goal. Increasing the number of healthcare providers with experiences fostering sympathy for their patients will be important in the future, and support for medical insurance coverage for otherwise inaccessible treatments would be transformative.

I walk in the steps of my uncle when I quote Martin Luther King Jr.: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” We must work to be a more humane society to protect the future health of our nation, including Black and other minoritized people.

By Dr. Carla M. Davis, professor of pediatrics, chief, Division of Immunology, Allergy, and Retrovirology, director, Texas Children’s Hospital Food Allergy Program, Janie and Sandra Queen Endowed Chair in Immunology and HIV/AIDS, Baylor College of Medicine, Texas Children’s Hospital