April 20, 2021, 1:45 p.m. Melanie VanDeMark, M.D, A.B.O.M. — We are now over a year into fighting the COVID-19 pandemic, and while I want to breathe a sigh of relief and have hope for the future, I instead find myself feeling angry, frustrated and powerless. Time and again, I have watched as the pandemic has brought to light the health care and health disparities facing our communities, especially among those patients who historically have been marginalized in this country: the elderly, people of color, people with substance use disorders and patients impacted by significant social determinants of health.
In Volusia County, Fla., where I practice, once the initial doses of COVID-19 vaccines were available the county set up a vaccine distribution site at the county fairgrounds. Unbelievably, however, the only way to get an appointment for months was through the internet. This meant that elderly people — a group at highest risk of disease and death from COVID-19, but with traditionally lower internet access rates and lower overall knowledge of the internet and technology than other age groups — would have to use the internet just to get an appointment for a vaccine. In addition, the fairgrounds were not accessible via public transportation. This became less of an issue once more hospitals and pharmacies started receiving the vaccines, but for the first few weeks, for some people living in the county’s most impoverished areas, this meant over a 40-minute drive to get the vaccine.
I can’t say for certain, but I’ll bet the governor of my state did not pause to ask a family physician about the best way to get our most vulnerable populations vaccinated.
This situation underscores what has happened to other marginalized groups, as well. We have watched as more people of color have died and had severe disease from COVID-19. The Kaiser Family Foundation in 2020 noted that people of color are more likely to have chronic underlying disease that puts them at higher risk, to not have health insurance, to not have a primary care physician, and to be more likely to live in low-income and public housing with many generations of family living in the same household, which makes it difficult to socially distance or quarantine. People of color also are more likely to be employed in industries like hospitality and retail. People in these positions were laid off at a very rapid pace at the start of the pandemic, which has caused loss of income and food, and an increase in housing insecurity.
We know that people of color also have less access to behavioral health care and substance use disorder treatment. With the pandemic, we have seen a rise in substance use disorder across the board. So now we have individuals who can’t get additional access to treatment, but who are experiencing job loss, food insecurity, housing concerns and all the other added stressors that come from the pandemic. It’s understandable, in that light, that there has been such an increase in substance use disorder and other conditions.
In my mind, there is one word that gives me hope as we move forward: advocacy.
I see the pandemic as a defining moment for health care professionals and for the health care system in this country. We are at a crossroads. We can continue on this same non-equitable path for health care, with devastating outcomes for so many people. Or we can choose to accept that inequities have been systemically put in place and have shaped our health care system for a long time, and use this opportunity as a springboard for change.
Never before has it been so important for family physicians to advocate for our patients, to push to get vaccines distributed to our most vulnerable communities, and to form community and health system partnerships to increase health equity in this country. We have the vaccines. We have the resources to organize, like the AAFP’s Family Medicine Action Network and the upcoming Family Medicine Advocacy Summit. And we have the knowledge that we have attained and retained over the past year.
The COVID-19 pandemic has shined a glaring light on the health care system in this country, and what we’ve seen is, to be quite frank, pretty ugly. Talk is one thing. It is time to move forward with action.
Family medicine has always been on the edge of social change. It is our responsibility now to use our resources and leverage our expertise to effectively advocate for our patients and communities at the local, state and federal level. The door has been blown wide open. Our country and the rest of the world are ready to listen, but advocacy has to start with me and you.
I want to leave you with a quote from Harriet Tubman: “Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience and the passion to reach for the stars and change the world.”
Melanie VanDemark, M.D., A.B.O.M., is the associate program director for the Halifax Family Medicine Residency program, medical director for the Center for Family and Sports Medicine at Halifax Health, and an associate clinical professor of medicine for Florida State University College of Medicine in Daytona Beach. She is also a fellow of the AAFP Health Equity Fellowship.