Racism, Health Equity, and Crisis Standards of Care in the COVID-19 Pandemic

Abstract

Long-standing and deeply embedded institutional racism, notably anti-Black racism in US health care, has provided a solid footing for the health inequities by race evident in the COVID-19 pandemic. Inequities in susceptibility, exposure, infection, hospitalization, and treatment reflect and reinforce this racism and cause incalculable and preventable suffering in and loss of Black lives. This paper identifies multiple expressions of racism evident in the crisis standards of care (CSC) created by states and health care institutions to guide the ethical allocation of scarce critical care resources including ventilators. Contextualized within the broad landscape of health inequities pre-COVID-19 as well as during the pandemic, the paper analyzes two manifestations of racism in CSC: 1) the scarce participation of Black health care and public health professionals as well as of Black communities in CSC creation, and 2) the ostensible “objectivity” and “race irrelevancy” of features of CSC. This ethical analysis leads to a proposal for dismantling racism in CSC by embracing antiracism as health equity at the outset of CSC policy-making. An initial exploration of the nature of health equity and related policies and practices in this COVID-19 era support a concluding outline of distinctive “first steps” toward antiracist pro-health equity CSC.