At first it looked like an anomaly. COVID-19 was disproportionately killing more African Americans than any other race in this country. But then an all too familiar pattern began to emerge, and it wasn鈥檛 pretty. Health disparities exist in this country, not just with coronavirus, but nearly all illnesses. And, regrettably, this has been the case for a very long time.

鈥淪adly, this is nothing new; it鈥檚 just now in our face,鈥� said professor in MUSC鈥檚 Department of Psychiatry and Behavioral Sciences.听

According to the Department of Health and Environmental Control, among the more than 4,000 South Carolinians diagnosed with COVID-19, 54% are white and 41% are black 鈥� even though African Americans make up only 27% of the state鈥檚 population.

鈥淭hose numbers should get your attention,鈥� said psychologist and associate dean for Assessment and Evaluation in MUSC鈥檚 College of Medicine. 鈥淚 think certainly there鈥檚 an ongoing history of racial disparities in health care. I think this is just really shining a light on it and that they鈥檝e been pervasive in our society for decades.鈥澨�

According to Hughes-Halbert, who has studied health disparities for the better part of her career, there are many different reasons why these gaps in treatment exist. Some are purely physical, meaning that some people have different immunities and just handle infection and sickness differently. At the same time, she said, there are other factors 鈥� such as social conditions, behavior, geography and culture 鈥� that influence risk factors not only for health but also a person鈥檚 or community鈥檚 well-being. More specifically, things like access to good education, affordable housing, jobs with health care coverage; living in a neighborhood where it鈥檚 safe to walk; having access to high-quality food and a support structure 鈥� all of these 鈥渟ocial determinants of health鈥� affect a person鈥檚 physical, mental and emotional condition.听

鈥淚 think certainly there鈥檚 an ongoing history of racial disparities in health care. I think this is just really shining a light on it and that they鈥檝e been pervasive in our society for decades.鈥�

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鈥� Chanita Hughes-Halbert, Ph.D.

Take this real-life example of how disparities might inform a doctor鈥檚 visit. A patient has high blood pressure. His doctor prescribes him an ACE inhibitor to lower it. Problem solved? Not if the patient doesn鈥檛 share with his doctor that he can鈥檛 afford to buy it. So, he doesn鈥檛 get the medicine, problems continue 鈥� or possibly get worse 鈥� and a year later, he goes back to the doctor for the same issue. It鈥檚 back to square one.

鈥淭hat鈥檚 a missed opportunity. Critical time lost,鈥� Hughes-Halbert said. 鈥淚t鈥檚 a vicious cycle that we can find ourselves in.鈥� Plus, she explained, it鈥檚 people with chronic conditions, like high blood pressure and diabetes, who often face the most increased risks for severe complications if they get the virus.

听associate director of cancer disparities at MUSC鈥檚 Hollings Cancer Center, agrees. She explained that when you have a virus like this, it鈥檚 going to go to the most vulnerable groups, where it can take hold.听

鈥淧eople with service jobs. Delivery drivers, kitchen workers, essential workers with low-pay and high-risk jobs that put them in positions where they鈥檙e more likely to contract the virus and then don鈥檛 have the financial resources to combat it.鈥澨�

Ford would know a thing or two about health disparities. She got into this line of work because of how directly they affected her own life 鈥� she never got to meet any of her grandparents, and both of her parents died before she turned 41.听

Still, these personal hardships served to spark a passion in her life and career. 鈥淚t鈥檚 exciting to talk about something that鈥檚 been such a major part of my life, and now that it鈥檚 at the forefront of people鈥檚 minds on a national and international level, I really believe these things are solvable.鈥�

But it starts at the top, Ford said, adding that groups of people can鈥檛 simply separate themselves from others 鈥� especially during times like this.听

鈥淲hat happens to one group affects all of us,鈥� she said. "This is an opportune moment to come up with solutions to keep our entire population healthy. That鈥檚 the key with successful interventions. It鈥檚 not enough to tell people not to do things; we need to give them the tools. That鈥檚 where we don鈥檛 want to fall short.鈥�

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Hughes-Halbert agreed, explaining that MUSC recognized this issue years ago and her precision medicine center is responding by developing continuing education courses to help providers better understand these types of social determinants. And over the past 15 years, both Hughes-Halbert and Ford have worked tirelessly, with complete buy-in from leadership, not only to gain a better understanding of patients who have these types of hardships but also to give providers better tools to mitigate them.听

Ford and Hughes-Halbert have led studies funded by the National Institute of Minority Health and Health Disparities as well as the National Cancer Center. Hughes-Halbert has not only evaluated how providers deal with their patients but has also developed tools to track, measure and improve those interactions more effectively. Currently, she is working with MUSC endocrinologist to gain a better understanding of how food and security are discussed in clinical visits. Meanwhile, Ford has spent the majority of her professional life identifying and addressing the disparities in cancer outcomes due to race, geography and other socioeconomic factors. She is currently focused on providing lesser-served communities with improved access to mobile health care, including telehealth services. She also leads the National Cancer Institute-funded South Carolina Cancer Disparities Research Center, along with Judith Salley-Guydon, Ph.D., of South Carolina State.

Though potentially uncomfortable at times, these types of frank but delicate discussions are critical, said both Hughes-Halbert and Ford. This type of paradigm shift requires a strong commitment at both the institutional as well as patient level.

As for this coronavirus outbreak, MUSC President David Cole, M.D., FACS, said the university is actively planning next steps for how it can implement better and more effective screening for COVID-19 with testing and follow-up in rural and African American communities. Beginning this week, in fact, pop-up testing sites will commence in certain zip codes.听

鈥淲e鈥檙e trying to leverage technology, but sometimes, it鈥檚 just a matter of getting out and meeting people where they are,鈥� he said. 鈥淭o accomplish this, we must get mobile vans and mobile hotspots into places, such as rural areas, where we can help create access to the internet. We鈥檙e doing everything we can to come up with a plan that will be supported and implemented.鈥�

Hughes-Halbert and Ford know it鈥檚 a long battle, but they genuinely believe it is one that can be won.听

鈥淭he good news is we have to remember we are one nation. What happens to one group affects all of us,鈥� Ford reiterated. 鈥淭hese disparities have been happening for decades, but now that they鈥檙e in the forefront of everyone鈥檚 conversations, we can come up with real solutions.鈥澨�