COVID-19 has not only uncovered significant health inequalities, but it has also shed light on how racism has impacted the health of minority populations even before the pandemic. In this episode of Better Edge Aderonke Pederson, MD, psychiatrist and instructor in the Department of Psychiatry & Behavioral Sciences at Northwestern Medicine, discusses how COVID-19 and civil unrest have had a disproportional impact on Black Americans. She shares how mental health can be reformed to better serve patients in underserved communities and provides recommendations for physicians when treating Black patients.
Related: Pederson and her colleague wrote an opinion piece for The Washington Post, addressing how Black women are facing a heavy burden because of COVID-19 and racism.
Selected Podcast
COVID-19, Racism and the Impact on Black Americans
Featured Speaker:
Aderonke Pederson, MD
Dr. Pederson's work focuses on mental health stigma specifically in ethnic minority populations, exploring the content of stigma to inform building interventions that reduce mental health stigma particularly among black ethnic minorities. She has particular interest in the intersection of race, religion, stigma and migration. Transcription:
COVID-19, Racism and the Impact on Black Americans
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I’m Melanie Cole and today, we’re discussing COVID-19, racism and the unique burdens on the Black community. Joining me is Dr. Aderonke Pederson. She’s an Instructor in the Department of Psychiatry and Behavioral Sciences at Northwestern Medicine. Dr. Pederson, thank you so much for joining us. Across the board, we’ve seen mental health rise due to the unprecedented challenges the world and really the country is facing right now. Black Americans have faced a disproportionate mental health burden in light of the impact of COVID and racial injustice, the civil unrest. Can you talk to us a little bit about the unique challenges the Black community is facing?
Dr. Pederson: Yes, that is an excellent question and one that we as a society really have to focus in on and do our best to answer because of the disproportionate ways and rates in which Black people are dying from COVID-19and have been affected by COVID-19. Really, we have two pandemics going on right now. And I think we’ve talked about this as a society, the pandemic of COVID-19. But that has also uncovered in new ways the pandemic of racism that is historic and current. And in terms of how Black people are being affected right now, Black people if we’re focusing in on mental healthcare for example, before COVID-19 happened, Black people are less likely to be offered mental healthcare. Black people are less likely to seek mental healthcare because of stigma. And many times, we find that within the literature, we see that Black people are sometimes undertreated or overtreated, over-pathologized for mental healthcare. And so, Black people experience discrimination within our healthcare system due to systemic and institutional racism as well as individual racism. And all of these things are issues that I think are at the forefront of us right now as a public health crisis that we really need to engage with as a health system as a health community.
Host: Well it really is so important and Doctor, Black women in particular are facing this increased social psychological economic burden during the pandemic. Tell us about some of those challenges and how are they taking this toll on their mental health and what can we do to help them?
Dr. Pederson: I think a great starting point for some of these questions are just looking at the raw statistics because I think that really helps us frame the scope and nature of the problem. If we look at for example, the rates that which Black people in particular, Black women are being affected in terms of job loss, furlough, reduced hours, as it pertains to the impact of COVID-19; we find that Black women are at the edge of that in a negative way and white men are at the other end of that statistic. So, for example, Black women are 58% more likely to say that they have lost their job, they have been furloughed, they have had reduced hours whereas 31% of white men say the same thing. They’ve lost their job, they’ve been furloughed, or they have had reduced hours.
And one might ask, should we compare Black women to white women? The same thing if you compare Black women to white women, you find that Black women 58% of them say that they are more likely to have lost their jobs, been furloughed or have reduced hours. And 32% of white women would say the same. So, essentially, you find that Black women are at the edge of COVID-19 in a way that places significant burdens on them just in terms of basic things like how they are more likely to be essential workers, how they are more likely to care for elderly relatives or family members compared to other people in terms of race in the community.
Host: Well then how can healthcare workers break down some of these barriers Dr. Pederson and help make mental healthcare more accessible for the Black community? Really, it’s outreach, right, it’s communication. Tell us how they can help to break down some of these barriers.
Dr. Pederson: I think the first step is always understanding the problem itself. I think many times, as healthcare providers, we think about our role as healers, as addressing those who are sick, not just those who are sick, but preventing illness or sickness. But I think as a healthcare system, we don’t do enough thinking about the social factors, the psychosocial factors that contribute to illness in our – within our healthcare system and within our society at large. And so I think the first step for physicians really is to take that extra time and energy to really learn about these social factors that affect your patient so that your patient if they are coming in to see you for high blood pressure or heart disease or mental healthcare issues that you understand the likelihood of your patient not being offered, for example, mental healthcare because of several different factors. And knowing that, I think puts us a step ahead in terms of addressing racism and addressing discrimination as healthcare providers.
Host: Thank you for telling us why it’s important for healthcare providers to weigh in on these issues especially given the current landscape and as we’re talking about that and this is a difficult question. Physicians play a critical role obviously in addressing these public health concerns. Do you have some top recommendations for providers to consider when they are treating Black patients and especially Dr. Pederson, for those physicians that may not have felt the strain of racism, if they cannot really know exactly what it feels like; what would you like them to know about trying to help their patients with mental health issues at this time when it’s really so critical?
Dr. Pederson: I think the first thing I would say is listen. I think for physicians, part of our job is hearing someone’s story, hearing about their symptoms, in particular, but I think listening to their larger story is important. We think about things like food insecurity, we think about things like healthcare access beyond just the hospital but if you tell a patient for example, I want you to exercise. Are you thinking about their access to spaces in which they can exercise? Are you thinking about the larger context in which some of the recommendations you’re giving them, the larger context they might find themselves in?
So, I think the first thing is that as physicians, we really need to take that extra step to really listen. Not just to the physical symptoms that our patients have, but we need to listen to the larger social psychosocial context that they find themselves in and we need to learn. And I think part of becoming a physician is this idea that you are a lifelong learner. That is part of the calling. We’re constantly learning and we’re – we think about that a lot when it comes to changes that happen in terms of innovation and science, but we also have to think about that in terms of the social context that our patients find themselves in.
So, listening and learning and what does learning look like? Learning looks like a variety of things. I think there’s a personal layer to learning which is what are you reading about personally? What are you educating yourself about personally? But also engaging in the diversity, the diversity talks, the diversity programs, signing up for things. I think it’s really important to put ourselves in a position of seeking out that honest truth about the conditions in which your patients might find themselves in and doing your best to engage with empathy, not just sympathy but to really engage with empathy where you can start to see yourself in your own patient.
I think one additional layer that I would recommend is that collaborating. Part of this work includes having diversity amongst physicians. So, every physician has a task to diversify our community as a whole so when we have residency applicants and we have medical students really looking out for making sure that from the healthcare worker who is that first year medical student all the way up to the chair of the department, we’re thinking about how do we reflect and represent the community that we serve and why is that important. Because representation really has been shown to impact the quality of healthcare when it comes to race, ethnicity, gender. So, these are all things that I think we have a personal responsibility and then we have this larger community level responsibility.
I think there is a lot of work being done and it’s about really getting in there and getting engaged and doing your part.
Host: Well I couldn’t agree with you more and thank you for telling providers how to engage in that dialogue around these sensitive events and without triggering really uncomfortable discussions but having empathy exactly as you say and really trying to bring in other providers. So, as we wrap up and thinking about long term solutions, how do you think mental health can be reformed to better serve patients and what else would you like physicians to know and to consider and this is the important part really, as they are caring for Black patients, especially at this time?
Dr. Pederson: So, part of the DSM which is our psychiatry handbook for mental illness; talks about really understanding the underlying conditions, the underlying factors that are contributing to any kind of mental health symptom or mental illness symptom. And I think as providers, I would say it’s really important for us to dig into what are the underlying factors. So, if your patient comes in and says I haven’t been sleeping, I’m exhausted, I’m tired; while you want to be thinking about depression, you want to be thinking about anxiety, you should also be thinking about what other factors might be contributing to this and I think on the granular cellular level, just between you and your patient, empathy factors in and providing resources and learning about what resources are available not just in your own community as a physician but in your patient’s community as well. And making sure they have access to it.
But I think at a more global level, I hope that some of these encounters that we have because we’re choosing to see them more clearly as what they are; really challenges us to grow so that we can advocate for our patients not just individually but at a communal level.
Host: Absolutely great information for providers. Dr. Pederson, thank you for coming on and sharing your incredible expertise on this topic. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information, please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.
COVID-19, Racism and the Impact on Black Americans
Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I’m Melanie Cole and today, we’re discussing COVID-19, racism and the unique burdens on the Black community. Joining me is Dr. Aderonke Pederson. She’s an Instructor in the Department of Psychiatry and Behavioral Sciences at Northwestern Medicine. Dr. Pederson, thank you so much for joining us. Across the board, we’ve seen mental health rise due to the unprecedented challenges the world and really the country is facing right now. Black Americans have faced a disproportionate mental health burden in light of the impact of COVID and racial injustice, the civil unrest. Can you talk to us a little bit about the unique challenges the Black community is facing?
Dr. Pederson: Yes, that is an excellent question and one that we as a society really have to focus in on and do our best to answer because of the disproportionate ways and rates in which Black people are dying from COVID-19and have been affected by COVID-19. Really, we have two pandemics going on right now. And I think we’ve talked about this as a society, the pandemic of COVID-19. But that has also uncovered in new ways the pandemic of racism that is historic and current. And in terms of how Black people are being affected right now, Black people if we’re focusing in on mental healthcare for example, before COVID-19 happened, Black people are less likely to be offered mental healthcare. Black people are less likely to seek mental healthcare because of stigma. And many times, we find that within the literature, we see that Black people are sometimes undertreated or overtreated, over-pathologized for mental healthcare. And so, Black people experience discrimination within our healthcare system due to systemic and institutional racism as well as individual racism. And all of these things are issues that I think are at the forefront of us right now as a public health crisis that we really need to engage with as a health system as a health community.
Host: Well it really is so important and Doctor, Black women in particular are facing this increased social psychological economic burden during the pandemic. Tell us about some of those challenges and how are they taking this toll on their mental health and what can we do to help them?
Dr. Pederson: I think a great starting point for some of these questions are just looking at the raw statistics because I think that really helps us frame the scope and nature of the problem. If we look at for example, the rates that which Black people in particular, Black women are being affected in terms of job loss, furlough, reduced hours, as it pertains to the impact of COVID-19; we find that Black women are at the edge of that in a negative way and white men are at the other end of that statistic. So, for example, Black women are 58% more likely to say that they have lost their job, they have been furloughed, they have had reduced hours whereas 31% of white men say the same thing. They’ve lost their job, they’ve been furloughed, or they have had reduced hours.
And one might ask, should we compare Black women to white women? The same thing if you compare Black women to white women, you find that Black women 58% of them say that they are more likely to have lost their jobs, been furloughed or have reduced hours. And 32% of white women would say the same. So, essentially, you find that Black women are at the edge of COVID-19 in a way that places significant burdens on them just in terms of basic things like how they are more likely to be essential workers, how they are more likely to care for elderly relatives or family members compared to other people in terms of race in the community.
Host: Well then how can healthcare workers break down some of these barriers Dr. Pederson and help make mental healthcare more accessible for the Black community? Really, it’s outreach, right, it’s communication. Tell us how they can help to break down some of these barriers.
Dr. Pederson: I think the first step is always understanding the problem itself. I think many times, as healthcare providers, we think about our role as healers, as addressing those who are sick, not just those who are sick, but preventing illness or sickness. But I think as a healthcare system, we don’t do enough thinking about the social factors, the psychosocial factors that contribute to illness in our – within our healthcare system and within our society at large. And so I think the first step for physicians really is to take that extra time and energy to really learn about these social factors that affect your patient so that your patient if they are coming in to see you for high blood pressure or heart disease or mental healthcare issues that you understand the likelihood of your patient not being offered, for example, mental healthcare because of several different factors. And knowing that, I think puts us a step ahead in terms of addressing racism and addressing discrimination as healthcare providers.
Host: Thank you for telling us why it’s important for healthcare providers to weigh in on these issues especially given the current landscape and as we’re talking about that and this is a difficult question. Physicians play a critical role obviously in addressing these public health concerns. Do you have some top recommendations for providers to consider when they are treating Black patients and especially Dr. Pederson, for those physicians that may not have felt the strain of racism, if they cannot really know exactly what it feels like; what would you like them to know about trying to help their patients with mental health issues at this time when it’s really so critical?
Dr. Pederson: I think the first thing I would say is listen. I think for physicians, part of our job is hearing someone’s story, hearing about their symptoms, in particular, but I think listening to their larger story is important. We think about things like food insecurity, we think about things like healthcare access beyond just the hospital but if you tell a patient for example, I want you to exercise. Are you thinking about their access to spaces in which they can exercise? Are you thinking about the larger context in which some of the recommendations you’re giving them, the larger context they might find themselves in?
So, I think the first thing is that as physicians, we really need to take that extra step to really listen. Not just to the physical symptoms that our patients have, but we need to listen to the larger social psychosocial context that they find themselves in and we need to learn. And I think part of becoming a physician is this idea that you are a lifelong learner. That is part of the calling. We’re constantly learning and we’re – we think about that a lot when it comes to changes that happen in terms of innovation and science, but we also have to think about that in terms of the social context that our patients find themselves in.
So, listening and learning and what does learning look like? Learning looks like a variety of things. I think there’s a personal layer to learning which is what are you reading about personally? What are you educating yourself about personally? But also engaging in the diversity, the diversity talks, the diversity programs, signing up for things. I think it’s really important to put ourselves in a position of seeking out that honest truth about the conditions in which your patients might find themselves in and doing your best to engage with empathy, not just sympathy but to really engage with empathy where you can start to see yourself in your own patient.
I think one additional layer that I would recommend is that collaborating. Part of this work includes having diversity amongst physicians. So, every physician has a task to diversify our community as a whole so when we have residency applicants and we have medical students really looking out for making sure that from the healthcare worker who is that first year medical student all the way up to the chair of the department, we’re thinking about how do we reflect and represent the community that we serve and why is that important. Because representation really has been shown to impact the quality of healthcare when it comes to race, ethnicity, gender. So, these are all things that I think we have a personal responsibility and then we have this larger community level responsibility.
I think there is a lot of work being done and it’s about really getting in there and getting engaged and doing your part.
Host: Well I couldn’t agree with you more and thank you for telling providers how to engage in that dialogue around these sensitive events and without triggering really uncomfortable discussions but having empathy exactly as you say and really trying to bring in other providers. So, as we wrap up and thinking about long term solutions, how do you think mental health can be reformed to better serve patients and what else would you like physicians to know and to consider and this is the important part really, as they are caring for Black patients, especially at this time?
Dr. Pederson: So, part of the DSM which is our psychiatry handbook for mental illness; talks about really understanding the underlying conditions, the underlying factors that are contributing to any kind of mental health symptom or mental illness symptom. And I think as providers, I would say it’s really important for us to dig into what are the underlying factors. So, if your patient comes in and says I haven’t been sleeping, I’m exhausted, I’m tired; while you want to be thinking about depression, you want to be thinking about anxiety, you should also be thinking about what other factors might be contributing to this and I think on the granular cellular level, just between you and your patient, empathy factors in and providing resources and learning about what resources are available not just in your own community as a physician but in your patient’s community as well. And making sure they have access to it.
But I think at a more global level, I hope that some of these encounters that we have because we’re choosing to see them more clearly as what they are; really challenges us to grow so that we can advocate for our patients not just individually but at a communal level.
Host: Absolutely great information for providers. Dr. Pederson, thank you for coming on and sharing your incredible expertise on this topic. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information, please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.