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Project Definition:

            The pandemic, COVID-19, has risen in tested positive cases and death tolls globally. The United States Center for Disease Control (CDC) and the administration of the President have instilled widespread social distancing and stay at home orders in an attempt to, “slow the spread.” Previous reports released data of these death tolls limiting the information strictly to gender, age, and location. No information is released on the victim’s race. CNN released a report on April 13, 2020 featuring Dr. Jerome Adams, United States Surgeon General, titled, “Coronavirus Highlights Wealth, Racial Divides in U.S.” Adams spoke on behalf of Derrick Johnson -- President of the National Association for the Advancement of Colored People arguing for “targeted outreach to the African American community” (Adams 1:37). A journal written by Ruqaiijah Yearby, “The continuation of inequality in the US due to structural racism” argues that African American patients do not seek healthcare because of wealth, racial segregation, reduced healthcare services, racism, and location of residency. The distribution of wealth among black and white Americans influences racial discrimination. However, these studies have been sparsely explored during the COVID-19 outbreak.

            Other studies have shown that African American men and women are more susceptible health conditions like asthma and lung cancer – making these individuals vulnerable candidates for a coronavirus infection (Cooper). Kenneth Cooper in his journal The Crisis, that African Americans in Maryland are 20% more likely to have asthma than their white counterparts. 53.8% of asthmatic related hospitalizations could have been avoided if medical resources were distributed among hospitals equally. Scientific studies conducted by multiple sources have confirmed these statistics due to enabling factors and external stressors like living conditions, income, and access to health insurance (Fiscella,2002). In these areas, African American’s living conditions have limited access to grocery stores and outdoor recreational facilities. Jamila Taylor, director of health care reform, reports 58% of African American’s living in the south are now the nations sickest people. Restricted income combined with lack of health insurance impacts the economy as a whole when African Americans require adequate medical care. A series of outstanding emergency room debts increases from of out-of-pocket payments because there is a lack of health insurance policy holders (Taylor). However, without government intervention these statistics are likely to plateau or even increase.

In this proposed study, the outbreaks within 150 miles of Lancaster County, Pennsylvania across central Pennsylvania and northern Maryland regions will be used as samples to explore the  disparities in the United States health care system. As Taylor recorded, African American’s in the south have the most pronounced inequitable treatment amongst all races. This proposal will explore the northern The death rates in low-income, minority neighborhoods is hypothesized to have the highest death tolls due to COVID-19. Additionally, the results of this study will indicate the possible economic infractions African American citizens without health insurance will influence our failing economy. In a similar manner, and understanding of the demographic of these deaths would determine what hospitals should be prioritized in the distribution of ventilators and medical supplies. Five different hospitals laying within 150 miles – Maryland, Pennsylvania, and the District of Columbia -- of Millersville University with similar demographics and the highest infection rates will be analyzed.  If proven, this will confirm the practice of structural racism in low-income, urban Pennsylvania and Maryland areas where the majority of the demographic is the minority.

 

Methodology

 

Subjects:

As the global pandemic of COVID-19 continues to rise, the argument is made that our healthcare systems cannot withstand the anticipated number of infected cases. Following the maps and outbreaks, one can deduce that the highest infection rates lie within the densest populations in concentrated cities. In Pennsylvania the highest rate of infection is Philadelphia and the surrounding counties. Pennsylvania Governor Tom Wolfe ordered lockdowns and stay-at-home orders for these highly infected areas. Other counties like Lancaster, have an increasing number of cases with a death toll surpassing its surrounding counties. Within a 150 mile radius of Lancaster, Maryland Governor Larry Hogan and other health officials deduced the rates are much higher across the state than proven. Prior to this prediction, the highest rate of infection is in Baltimore City and Baltimore County and the surrounding counties of Washington D.C like Montgomery and Prince George counties ranging from 41 to 107 as of March 24th, 2020.  As a country, we are notified almost hourly, each day, of the rising death toll in each state and each county. The only additional information given is gender and age. Designer hospitals like Johns Hopkins located in Baltimore, Maryland – an area were minorities make up the majority of the demographic (but lower rate of infection) and Howard University’s school of medicine in D.C (an HBCU) the infection rates higher. These five hospitals are selected due to their locations, similar demographics, and amount of COVID-19 patients.

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Procedure:

            The execution of these trials is conducted by an individual. In a two week time span (the amount of time it takes for COVID-19 symptoms to surface) the selected research will visit each of the five hospitals once. During their time at each location they will be responsible for working closely with a health care professional gathering data of gender, race, and age of incoming emergency room patients. One will be assigned to a specific health care professional for the entirety of their 12 hour shift. First shift, 0600-1800 hours, are assigned. Meticulous, daily reports will be submitted assessing the days statistics of patients with health insurance, positive-testing patients, emergency room visits, intensive care unit individuals, discharges, and deaths.

 

 

 

Materials:

 

Facilities

Lancaster General Health Hospital, Lancaster, Pennsylvania

Temple University Hospital, Philadelphia, Pennsylvania

The Johns Hopkins Hospital, Baltimore, Maryland

Howard University Hospital, Northwest, District of Columbia

Anne Arundel Medical Center, Parole, Maryland

Millersville University, Millersville, Pennsylvania

 

 

 

References:

 

Burrows, Vanessa, and Barbara Berney. “Creating Equal Health Opportunity: How the Medical Civil Rights Movement and the Johnson Administration Desegregated U.S. Hospitals.” Journal of American History, vol. 105, no. 4, Jan. 2019, pp. 885–911., doi:10.1093/jahist/jaz004.

Cooper, Kenneth. “The Crisis.” The Crisis, vol. 115, 1 Jan. 2018.

Fiscella, Kevin, et al. “Disparities in Health Care by Race, Ethnicity, and Language Among the Insured.” Medical Care, vol. 40, no. 1, 2002, pp. 52–59., doi:10.1097/00005650-200201000-00007.

Taylor Director, Jamila, and Jen Mishory. “Racism, Inequality, and Health Care for African Americans.” The Century Foundation, 12 Feb. 2020, tcf.org/content/report/racism-inequality-health-care-african-americans/?agreed=1.

President Johnson Discusses COVID-19's Disproportionate Impact on Black Communities. (2020, April 13). Retrieved from https://www.naacp.org/latest/president-johnson-discusses-covid-19-disproportionate-impact-black-communities/

Yearby, Ruqaiijah. “Racial Disparities in Health Status and Access to Healthcare: The Continuation of Inequality in the United States Due to Structural Racism.” American Journal of Economics and Sociology, vol. 77, no. 3-4, 2018, pp. 1113–1152., doi:10.1111/ajes.12230.

 

Schedule of Work:

 

April 13     Schedule hospital visits

April 17     Visit Lancaster General Health

April 20     Visit Temple University Hospital

April 24     Visit Johns Hopkins University Hospital

April 27     Visit Howard University Hospital

April 30      Visit Anne Arundel Medical Center

May 1         Expected end of quarantine

May 4         Analyze and organize collected data

May 15       Asses curve rates two weeks after quarantine is lifted

 

Budget

Item

Description

Cost

Lancaster, Pennsylvania

Travel costs for research at Lancaster General Hospital.

Mileage Reimbursement from Millersville University: .53 @ 5 miles, twice a day

$5.30

Philadelphia,

Pennsylvania

Travel costs for research at Temple University Hospital.

Mileage Reimbursement from Millersville University: .53 @ 71 miles, twice a day

$75.26

Baltimore,

Maryland

Travel costs for research at Johns Hopkins University Hospital

Mileage Reimbursement from Millersville University: .53 @ 76 miles,

One night hotel stay: $187.00

$267.56

District of Columbia

Travel costs for research at Howard University Hospital

Mileage Reimbursement from Millersville University: .53 @ 116 miles, twice

One night hotel stay: $287.00

$409.96

Parole,

Maryland

Travel costs for research at Anne Arundel Medical Center

Mileage Reimbursement from Millersville University: .53 @ 105 miles, twice

One night hotel stay: $157.00

$268.30

Salary for Labor

105 hours @ $28/hour

$2,940

Total Costs

 

$3,996.38

 

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Conclusion

            This research is expected to find a racial gap in the United States health care system. Recognizing and proving racial disparities in the medical field will allow for further funded research that explores this theory once the pandemic has passed. If these disparities persist our nation’s economy will feel the impacts. This research will benefit students and researchers beyond the medical field. The findings can be translated across a variety of studies such as sociology, history, anthropology, social work, and psychology. The funding of this proposal would raise awareness across many fields on a wildly understudied topic.