Columbia University, Irving Medical Center, January 12, 2021
The COVID-19 pandemic has exacerbated the deep fissures in our nation’s health care system, accentuating tragic disparities largely along racial and ethnic lines and highlighting the need for an immediate exploration of the underlying structural racism so that health care can become more inclusive and equitable, according to Maya Sabatello, LLB, PhD, associate professor of medical sciences in the Division of Ethics in the Department of Medical Humanities and Ethics and in the Department of Medicine at Columbia University Vagelos College of Physicians and Surgeons.
Sabatello, an expert on human rights and the ethical, legal, and social implications of genetics, proposes a COVID-19 Truth and Reconciliation Commission. “These commissions began as a way to help authoritarian governments recover from their abusive pasts and transition toward democracy without being punitive,” Sabatello says. “The United States may not be a fragile democracy, but our health care system—who controls it, who benefits from it—resembles an autocratic regime.”
In a paper published in the American Journal of Bioethics, Sabatello and colleagues outline a forward-looking path to break the cycle of disparity and create a nationally equitable health care system.
Why do you think a Truth and Reconciliation Commission could help address the inequities exposed by the pandemic?
Truth and Reconciliation Commissions are an attempt to establish and publicly record the experiences and scale of the physical and emotional harm caused by past injustices. They help us think about the experiences of victims and perpetrators so we can develop ways to address and overcome systemic issues. A Truth and Reconciliation Commission is aimed at acknowledging wrongdoing and learning from injustices in order to move forward.
A Truth and Reconciliation Commission would allow racial and ethnic communities that have been targets of structural racism and have been disproportionately impacted by the COVID-19 pandemic to speak up and share their experiences in a forum that aims to lead to real change. This would include Black/African American, Latinx, and Indigenous communities but should also be inclusive of other groups experiencing structural discrimination. It would also give clinicians a forum to have conversations around the systemic issues they face in providing equal care so that they can help reconstruct the system. Additionally, it’s a constructive way for administrators of health care systems and politicians to hear the perspectives and the pain that’s caused by their decisions in order to promote systemic and structural changes.
Structural Racism in the COVID-19 Pandemic: Moving Forward
By Maya Sabatello, Mary Jackson Scroggins, Greta Goto, Alicia Santiago, Alma McCormick, Kimberly Jacoby Morris, Christina R. Daulton, Carla L. Easter & Gwen Darien
The American Journal of Bioethics, Published online: December 19, 2020
The COVID-19 pandemic has taken a substantial human, social and economic toll globally, but its impact on Black/African Americans, Latinx, and American Indian/Alaska Native communities in the U.S. is unconscionable. As the U.S. continues to combat the current COVID-19 cycle and prepares for future pandemics, it will be critical to learn from and rectify past and contemporary wrongs. Drawing on experiences in genomic research and intersecting areas in medical ethics, health disparities, and human rights, this article considers three key COVID-19-related issues: research to identify remedies; testing, contact tracing and surveillance; and lingering health needs and disability. It provides a pathway for the future: community engagement to develop culturally-sensitive responses to the myriad genomic/bioethical dilemmas that arise, and the establishment of a Truth and Reconciliation Commission to transition the country from its contemporary state of segregation in healthcare and health outcomes into an equitable and prosperous society for all.
The COVID-19 pandemic gives a face to decades of segregation, racism and structural discrimination. It forces us to look to the generations of especially Blacks/AAs, Latinxs and AI/ANs that have often endured mistreatment in all aspects of life—from limited educational and employment opportunities to high levels of poverty and environmental neglect, insufficient, often absent, access to basic healthcare services, police brutality, and overrepresentation in the criminal justice system.
The opportunities for moving forward are plenty. Although the COVID-19 pandemic raises numerous questions, it intersects with other areas in which there is an abundance of knowledge that can inform the discussion. In this article, we drew on scholarship in genomics to highlight challenges that are likely to arise. These include collection, use and storage of data for research, fair and equitable access to the benefits of research, testing and surveillance concerns, and lingering healthcare needs and long-term disability among individuals, families, and communities at large. Community engagement and multi-leveled commitment will be vital for ensuring tailored and culturally sensitive approaches to assure that historical wrongs are addressed and remedied. The COVID-19 pandemic calls for self-reflection, broad public engagement and cultural humility to transform our troubled health, socioeconomic and political infrastructures into a sustainable, equitable and prosperous society for all.
Free access to the full article:
By Don McCanne, M.D.
This is yet another article that shows how the COVID-19 pandemic has given a face to decades of segregation, racism and structural discrimination. This one is somewhat unique in that it recommends a Truth and Reconciliation Commission. This, of course, would not obviate the need to enact and implement a single payer, improved Medicare for All, but it would be a great step forward.
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