Health disparities, laid bare by the virus, lead to loss of both lives and limbs.

amputate-300x157Although the Covid-19 pandemic may be opening more and more Americans’ eyes to the harsh effects of the country’s economic and racial inequities, the stark damage from the nation’s health disparities can be plain to see — in truly disheartening ways.

Lizzie Presser, a reporter for the Pulitzer Prize-winning investigative site ProPublica, deserves high praise for her distressing article on “The Black Amputation Epidemic.” As she wrote recently from deep in the poverty, neglect, and racial discrimination of the Mississippi Delta:

“[W]ithin months, the new coronavirus would sweep the United States, killing tens of thousands of people, a disproportionately high number of them black and diabetic. They were at a disadvantage, put at risk by an array of factors, from unequal health care access to racist biases to cuts in public health funding. These elements have long driven disparities, particularly across the South. One of the clearest ways to see them is by tracking who suffers diabetic amputations, which are, by one measure, the most preventable surgery in the country.

“Look closely enough, and those seemingly intractable barriers are made up of crucial decisions, which layer onto one another: A panel of experts decides not to endorse screening for vascular disease in the legs; so the law allows insurance providers not to cover the tests. The federal government forgives the student loans of some doctors in underserved areas, but not certain specialists; so, the physicians most critical to treating diabetic complications are in short supply. Policies written by hospitals, insurers and the government don’t require surgeons to consider limb-saving options before applying a blade; amputations increase, particularly among the poor. Despite the great scientific strides in diabetes care, the rate of amputations across the country grew by 50% between 2009 and 2015. Diabetics undergo 130,000 amputations each year, often in low-income and underinsured neighborhoods. Black patients lose limbs at a rate triple that of others. It is the cardinal sin of the American health system in a single surgery: save on preventive care, pay big on the backend, and let the chronically sick and underprivileged feel the extreme consequences.”

Presser focused her report on Foluso Fakorede, a native of Nigeria and the only cardiologist in Bolivar County, Miss. He is a feisty, obsessive, and even dislikable character, Presser reported. But the doctor has gotten results in his crusade against the ravages of diabetes and how it costs poor people their lives, a toe or an entire limb at a time.

Fakorede underscored for Presser the historic shame that his work seeks to combat. ProPublica has presented one of his most damning arguments: two maps that show where slavery existed before the Civil War and where the tragic prevalence persists today of amputations due to peripheral artery disease. It is tied to diabetes’ terrible toll, Presser reported:

“About 30 million people in America had diabetes, and Mississippi had some of the highest rates. The vast majority had Type 2; their bodies resisted insulin or their pancreas didn’t produce enough, making their blood sugar levels rise. Genetics played a role in the condition, but so did obesity and nutrition access: high-fat meals, sugary foods and not enough fiber, along with little exercise. Poverty can double the odds of developing diabetes, and it also dictates the chances of an amputation. One major study mapped diabetic amputations across California, and it found that the lowest-income neighborhoods had amputation rates 10 times higher than the richest.

“The Delta was Mississippi’s poorest region, with the worst health outcomes. Fakorede had spent years studying health disparities: African Americans develop chronic diseases a decade earlier than their white counterparts; they are twice as likely to die from diabetes; they live, on average, three years fewer. In the Delta, Fakorede could treat patients who looked like him; he could find only one other black interventional cardiologist in the entire state. A growing body of evidence had shown how racial biases throughout the medical system meant worse results for African Americans. And he knew the research — black patients were more responsive to, and more trustful of, black doctors. He decided after his trip that he’d start a … practice in Mississippi …”

Without giving away more, Presser’s excellent article might be worth printing out and packing in to peruse as folks head, safely, to the great outdoors as the Covid-19 public health restrictions begin to ease.

In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of therapies and prescription drugs, too many of which turn out to be dangerous drugs.

The global response to the novel coronavirus has prompted lots of sloganeering, including the catchy and popular phrase, “We’re all in this together.” It also is true, however, that we individually bear the burdens of our lives and health and inequities and injustices exist and, sadly, flourish in this great country. As we fret about sickness, we can think about how we can be well, too — eating better, exercising, avoiding excess sugar and salt, staying away from too much consumption of alcohol and other intoxicants, refusing to smoke or vape and stopping if we do. We all can learn more about avoiding chronic, debilitating conditions like obesity and diabetes.

We all can think about and determine, too, how we can make the post-virus world a fairer place without discrimination, poverty, and other giant social harms. We’ve got work to do.

 

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