The following is a Flintside opinion piece by Dr. Aisha Harris, a family medicine physician at Hamilton Community Health Network and a Flint native. Have an idea for an essay or opinion piece you'd like to write for Flintside about life in Flint? Email [email protected].
As a primary care doctor, the last year has been challenging to say the least. I experienced the unforgiving and continuous reality of health access barriers in a country with high ideals and low resources. Words like 'disproportionate' and 'unprecedented' send cringes down my spine now as I look at what healthcare has settled into or more importantly what it has missed.
It may surprise some but most of my day as a doctor is not spent talking about or managing COVID-19-related issues. COVID-19 is a very small fraction of health problems that exist. This is not to say that COVID-19 is not important in this moment. There is no way to ignore an entire pandemic. But the long list of medical problems that have been discovered, treated, and – unfortunately for some – ignored continues to impact the lives of many people, with and without the presence of the pandemic.
The pandemic provided a new perspective on what it means to be high risk, for better or for worse. Generally, telling patients that this or that would increase their risk of heart attacks, strokes, or cancer sometimes seemed to be missing a sense of urgency. All the disabilities, amputations, blindness, and even death that I’ve experienced in my medical career doesn’t roll off my tongue as a strong “please help yourself or help me help you” plea because the injury or destruction can’t always be seen or felt. And that is the tough part of primary care and medicine in general. There are a lot of silent killers and not everyone is able to find them before it is too late.
Prior to COVID, the health disparities that existed showed an association between zip codes and life expectancy. People living in Flint’s 48504 zip code had a life expectancy of 65 years old while those in Grand Blanc’s 48439 zip code had a life expectancy of 84 years old according to the CDC. Health disparities also showed how income inequality was associated with health outcomes and access. The 2019 Community Health Needs Assessment reported that 40% of Flint’s residents lived below the federal poverty line and were five times more likely to have poorer health compared to residents living 400% above the federal poverty level. Additionally, being black has been associated with increased risk of kidney disease, postpartum deaths, infant mortality, fatal heart attacks, cancer deaths, high blood pressure, diabetes, and I could go on and on. These health disparities still exist! For the people in the back, these health disparities still exist and have worsened in many aspects over the past year.
Early in the pandemic, patients who had not seen a primary care doctor in months or years for various reasons wanted a checkup as the country was shutting down. Patients concerned about being at risk for COVID-19 complications wanted to improve their health overall. However, deferring medical care, whether before or during a pandemic, can cause longterm and sometimes irreversible consequences. Barriers to healthcare access continue to challenge the health status of our communities even as people strive for better health.
In medicine, time matters and long delays can drastically impact treatment options and health outcomes. We can’t ignore the unique barriers present during the pandemic but we also have to recognize the difficulties and health inequities that were already present. Over the last 20 years, the rate of drug-induced deaths have quadrupled in Genesee County and the mental health barriers during the pandemic worsened these outcomes. Even diabetes-related mortality increased by 21% from 2015 to 2017 and likely did not improve in 2020.
The healthcare system is flawed and is linked to every aspect of American life. The pandemic promptly uncovered and highlighted many of these areas and the social determinants of health. As we celebrate the recent success of the vaccine distribution we have to remind ourselves that, for many, COVID-19 was only one problem on someone’s list and for others it never made the list. We can focus on COVID-19 but caution must be taken in order to not fixate on it being the most dominant healthcare issue. COVID-19 has a place in history but in your personal medical history there were, are, and will be more medical problems to manage and prevent.
Put simply, health disparities have persisted with and without the pandemic and will continue to do so if not properly addressed. We can’t think the vaccine is our saving grace in regards to ALL of healthcare. As the vaccine distribution efforts are strengthened we have the chance to look at our own health status again and often. The fragility of human life requires more work to be done on all of our parts. Health is an inconvenient truth for some, a sobering reality for others, and an opportunity to grow for all. We, the Flint community, have to challenge ourselves to improve our health in all areas for every generation. Are you ready to help close the health disparity gaps? Please say yes, your health depends on it.