Black men are the least likely group to have access to or receive adequate healthcare in the United States for a variety of reasons. As a result, black men still have some of the worst healthcare outcomes. How can we approach some of these issues to help black men be healthy or become healthcare professionals? UrbanFaith contributor Maina Mwaura interviewed Dr. Jerome Adams, former US Surgeon General and Dr. William Humphries, Neurosurgeon and healthcare expert about Black Men’s health.
In the past week, the Biden administration launched two programs that aim to get rapid covid tests into the hands of every American. But the design of both efforts disadvantages people who already face the greatest barriers to testing.
From the limit placed on test orders to the languages available on websites, the programs stand to leave out many people who don’t speak English or don’t have internet access, as well as those who live in multifamily households. All these barriers are more common for non-white Americans, who have also been hit hardest by covid. The White House told KHN it will address these problems but did not give specifics.
It launched a federally run website on Jan. 18 where people can order free tests sent directly to their homes. But there is a four-test limit per household. Many homes could quickly exceed their allotments — more than a third of Hispanic Americans plus about a quarter of Asian and Black Americans live in households with at least five residents, according to an analysis of Census Bureau data by KFF. Only 17% of white Americans live in these larger groups.
“There are challenges that they have to work on for sure,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
Also, as of Jan. 15, the federal government requires private insurers to reimburse consumers who purchase rapid tests.
When the federal website — with orders fulfilled and shipped through the United States Postal Service — went live this week, the first wave of sign-ups exposed serious issues.
Some people who live in multifamily residences, such as condos, dorms, and houses sectioned off into apartments, reported on social media that if one resident had already ordered tests to their address, the website didn’t allow for a second person to place an order.
“They’re going to have to figure out how to resolve it when you have multiple families living in the same dwelling and each member of the family needs at least one test. I don’t know the answer to that yet,” Benjamin said.
USPS spokesperson David Partenheimer said that while this seems to be a problem for only a small share of orders, people who encounter the issue should file a service request or contact the help desk at 1-800-ASK-USPS.
A White House official said 20% of shipments will be directed every day to people who live in vulnerable ZIP codes, as determined by the Centers for Disease Control and Prevention’s social vulnerability index, which identifies communities most in need of resources.
Another potential obstacle: Currently, only those with access to the internet can order the free rapid tests directly to their homes. Although some people can access the website on smartphones, the online-only access could still exclude millions of Americans: 27% of Native American households and 20% of Black households don’t have an internet subscription, according to a KHN analysis of Census Bureau data.
The federal website is currently available only in English, Spanish, and Chinese.
According to the White House, a phone line is also being launched to ease these types of issues. An aide said it is expected to be up and running by Jan. 21. But details are pending about the hours it will operate and whether translators will be available for people who don’t speak English.
However, the website is reaching one group left behind in the initial vaccine rollout: blind and low-vision Americans who use screen-reading technology. Jared Smith, associate director of WebAIM, a nonprofit web accessibility organization, said the federal site “is very accessible. I see only a very few minor nitpicky things I might tweak.”
The Biden administration emphasized that people have options beyond the rapid-testing website. There are free federal testing locations, for instance, as well as testing capacity at homeless shelters and other congregate settings.
Many Americans with private health plans could get help with the cost of tests from the Biden administration reimbursement directive. In the days since its unveiling, insurers said they have moved quickly to implement the federal requirements. But the new systems have proved difficult to navigate.
Consumers can obtain rapid tests — up to eight a month are covered — at retail stores and pharmacies. If the store is part of their health plan’s rapid-test network, the test is free. If not, they can buy it and seek reimbursement.
The program does not cover the 61 million beneficiaries who get health care through Medicare, or the estimated 31 million people who are uninsured. Medicaid and the Children’s Health Insurance Program are required to cover at-home rapid tests, but rules for those programs vary by state.
And the steps involved are complicated.
First, consumers must figure out which retailers are partnering with their health plans and then pick up the tests at the pharmacy counter. As of Jan. 19, however, only a few insurance companies had set up that direct-purchase option — and nearly all the major participating pharmacies were sold out of eligible rapid tests.
Instead, Americans are left to track down and buy rapid tests on their own and then send receipts to their insurance providers.
Many of the country’s largest insurance companies provide paper forms that customers must print, fill out, and mail along with a receipt and copy of the box’s product code. Only a few, including UnitedHealthcare and Anthem, have online submission options. Highmark, one of the largest Blue Cross and Blue Shield affiliates, for instance, has 16-step instructions for its online submission process that involves printing out a PDF form, signing it, and scanning and uploading it to its portal.
Nearly 1 in 4 households don’t own a desktop or laptop computer, according to the Census Bureau. Half of U.S. households where no adults speak English don’t have computers.
A KHN reporter checked the websites of several top private insurers and didn’t find information from any of them on alternatives for customers who don’t have computers, don’t speak English, or are unable to access the forms due to disabilities.
UnitedHealthcare and CareFirst spokespeople said that members can call their customer service lines for help with translation or submitting receipts. Several other major insurance companies did not respond to questions.
Once people make it through the submission process, the waiting begins. A month or more after a claim is processed, most insurers send a check in the mail covering the costs.
And that leads to another wrinkle. Not everyone can easily deposit a check. About 1 in 7 Black and 1 in 8 Hispanic households don’t have checking or savings accounts, compared with 1 in 40 white households, according to a federal report. Disabled Americans are also especially likely to be “unbanked.” They would have to pay high fees at check-cashing shops to claim their money.
“It’s critically important that we are getting testing out, but there are limitations with this program,” said Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh School of Medicine. “These challenges around getting tests to individuals with language barriers or who are homeless are sadly the same drivers of disparities that we see with other health conditions.”
KHN Midwest correspondent Lauren Weber contributed to this report.
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NASHVILLE, Tenn. — Just before students at Meharry Medical College went home for Thanksgiving, Dr. James Hildreth, the school’s president, emailed them a video message that he acknowledged seemed hard to believe. Or at least they had to give it a second listen.
“We’ll gift each of you $10,000 in cash,” he said, looking at the camera. “You heard me right.”
They were told to expect a direct deposit the next day or pick up a check in person. Hildreth, an expert in infectious diseases who helped lead Nashville’s pandemic response, explained that this gift with no strings attached was money from the CARES Act, a major covid-19 relief law passed by Congress in 2020. He asked only that they be “good stewards” of the windfall.
After deep consideration, Meharry’s administration decided to give roughly a third of its CARES Act funding — $10 million — directly to its future doctors, dentists and public health researchers. All told, 956 students received payments.
Meharry’s students had already been heavily involved in the pandemic response, staffing Nashville’s mass covid testing and vaccination sites. But the money isn’t so much surprise compensation for volunteer efforts as it is an investment in a future career — and an assist in overcoming financial hurdles Black students especially face to become medical professionals.
While Black Americans make up roughly 13% of the population, the Association of American Medical Colleges finds Black doctors account for just 5% of the nation’s working physicians — a figure that has grown slowly over more than a century. And studies have found that Black patients often want to be cared for by someone whom they consider culturally competent in acknowledging their heritage, beliefs and values during treatment.
“We felt that there was no better way to begin distributing these funds than by giving to our students who will soon give so much to our world,” Hildreth said.
Cheers erupted in the library as students clicked the video link.
Andreas Nelson fell silent, he recalled later. He went to his banking app and stared in disbelief. “$10,000 was sitting just in my bank account. It was astonishing,” he said. “I was literally lost for words.”
The Chicago native is finishing a master’s degree in health and science at Meharry with hopes of entering its dental school. The average student loan debt in the program totals more than $280,000. So, undoubtedly, 10 grand won’t make much of a dent in the debt.
But the money in his pocket eases his top concern of making rent each month. Nelson said it feels as though he’s being treated like an adult, allowing him to decide what his greatest needs are in getting through school.
“It’s motivating,” Nelson said. “Because that means they have trust in us to do with this money whatever the cause may be — whether it be student debt, investing or just personal enjoyment.”
Across the board, students at HBCUs rely more on student loans than students at historically white institutions. Roughly 80% take out student loans, according to an analysis by UNCF, formerly known as the United Negro College Fund, and they borrow considerably more.
Meharry was founded a decade after the Civil War to help those who had been enslaved. But the 145-year-old institution has always struggled financially, and so have its students.
The reasons are rooted in the country’s racist past, which has left the institutions with less money potentially available for scholarships than other universities. And students’ families generally have less wealth to tap into since Black households across the country have averaged around $17,000 in net worth — about a tenth of the average for white families.
Meharry’s average student debt is far higher than other area schools of medicine at Vanderbilt University and the University of Tennessee, representing both private and public institutions.
Virtually all colleges and universities received allotments under the CARES Act, but HBCUs have been much more aggressive about funneling substantial amounts directly to students, who tend to have greater need. More than 20 HBCUs have erased outstanding tuition balances. Some have canceled student fees.
But Meharry, one of the few stand-alone HBCU graduate schools, is a rare case in cutting checks for students.
“These young people are rising to medical school against all odds,” said Lodriguez Murray, who leads public policy and government affairs at UNCF. “Of course, they have to borrow more because people who look like them have less.”
During the pandemic, major philanthropists have taken new interest in supporting the few HBCU medical schools. Michael Bloomberg committed $100 million to four institutions, including Meharry, to help educate more Black doctors.
Students at Meharry can now apply for $100,000 scholarships. The $34 million from Bloomberg Philanthropies is also going toward other kinds of financial support.
The school is now offering, for no additional fee, expensive test-prep services through a Boston-based company, MedSchoolCoach. The service, which entails paying a doctor by the hour to help with studying, can cost thousands of dollars.
While the price is often out of reach for students tight on cash, acing the benchmark exams toward board licensure is key to landing coveted fellowships, qualifying for lucrative specialties or just finishing on time. And Meharry’s four-year completion rate of roughly 70% is below most schools. The most up-to-date national average is around 82%.
For some, Murray said, a $10,000 windfall may make all the difference in whether they cross the finish line and become a doctor who can afford all their medical school debt.
“Many of those students are borrowing a lot of money to complete their dream, and to become relatively high earners in the future,” Murray said. “The fact that these students are largely coming from lower socioeconomic backgrounds means that the funds that Meharry turned around and gave to the students are particularly impactful.”
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When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 users — most of them Black — visited the platform in the first two weeks.
“It wasn’t the most fully functioning platform,” recalled Wisdom, 31. “It was not sexy.”
But the launch was successful. Now, more than a year later, Wisdom’s company, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.
As more patients seek culturally competent care — the acknowledgment of a patient’s heritage, beliefs and values during treatment — a new wave of Black tech founders like Wisdom want to help. In the same way Uber Eats and Grubhub revolutionized food delivery, Black tech health startups across the United States want to change how people exercise, how they eat and how they communicate with doctors.
Inspired by their own experiences, plus those of their parents and grandparents, Black entrepreneurs are launching startups that aim to close the cultural gap in health care with technology — and create profitable businesses at the same time.
“One of the most exciting growth opportunities across health innovation is to back underrepresented founders building health companies focusing on underserved markets,” said Unity Stoakes, president and co-founder of StartUp Health, a company headquartered in San Francisco that has invested in a number of health companies led by people of color. He said those leaders have “an essential and powerful understanding of how to solve some of the biggest challenges in health care.”
Platforms created by Black founders for Black people and communities of color continue to blossom because those entrepreneurs often see problems and solutions others might miss. Without diverse voices, entire categories and products simply would not exist in critical areas like health care, business experts say.
“We’re really speaking to a need,” said Kevin Dedner, 45, founder of the mental health startup Hurdle. “Mission alone is not enough. You have to solve a problem.”
Dedner’s company, headquartered in Washington, D.C., pairs patients with therapists who “honor culture instead of ignoring it,” he said. He started the company three years ago, but more people turned to Hurdle after the killing of George Floyd.
In Memphis, Tennessee, Erica Plybeah, 33, is focused on providing transportation. Her company, MedHaul, works with providers and patients to secure low-cost rides to get people to and from their medical appointments. Caregivers, patients or providers fill out a form on MedHaul’s website, then Plybeah’s team helps them schedule a ride.
While MedHaul is for everyone, Plybeah knows people of color, anyone with a low income and residents of rural areas are more likely to face transportation hurdles. She founded the company in 2017 after years of watching her mother take care of her grandmother, who had lost two limbs to Type 2 diabetes. They lived in the Mississippi Delta, where transportation options were scarce.
“For years, my family struggled with our transportation because my mom was her primary transporter,” Plybeah said. “Trying to schedule all of her doctor’s appointments around her work schedule was just a nightmare.”
Plybeah’s company recently received funding from Citi, the banking giant.
“I’m more than proud of her,” said Plybeah’s mother, Annie Steele. “Every step amazes me. What she is doing is going to help people for many years to come.”
Health in Her Hue launched in 2018 with just six doctors on the roster. Two years later, users can download the app at no cost and then scroll through roughly 1,000 providers.
“People are constantly talking about Black women’s poor health outcomes, and that’s where the conversation stops,” said Wisdom, who lives in New York City. “I didn’t see anyone building anything to empower us.”
As her business continues to grow, Wisdom draws inspiration from friends such as Nathan Pelzer, 37, another Black tech founder, who has launched a company in Chicago. Clinify Health works with community health centers and independent clinics in underserved communities. The company analyzes medical and social data to help doctors identify their most at-risk patients and those they haven’t seen in awhile. By focusing on getting those patients preventive care, the medical providers can help them improve their health and avoid trips to the emergency room.
“You can think of Clinify Health as a company that supports triage outside of the emergency room,” Pelzer said.
Pelzer said he started the company by printing out online slideshows he’d made and throwing them in the trunk of his car. “I was driving around the South Side of Chicago, knocking on doors, saying, ‘Hey, this is my idea,’” he said.
Wisdom got her app idea from being so stressed while working a job during grad school that she broke out in hives.
“It was really bad,” Wisdom recalled. “My hand would just swell up, and I couldn’t figure out what it was.”
The breakouts also baffled her allergist, a white woman, who told Wisdom to take two Allegra every day to manage the discomfort. “I remember thinking if she was a Black woman, I might have shared a bit more about what was going on in my life,” Wisdom said.
The moment inspired her to build an online community. Her idea started off small. She found health content in academic journals, searched for eye-catching photos that would complement the text and then posted the information on Instagram.
Things took off from there. This fall, Health in Her Hue launched “care squads” for users who want to discuss their health with doctors or with other women interested in the same topics.
“The last thing you want to do when you go into the doctor’s office is feel like you have to put on an armor and feel like you have to fight the person or, like, you know, be at odds with the person who’s supposed to be helping you on your health journey,” Wisdom said. “And that’s oftentimes the position that Black people, and largely also Black women, are having to deal with as they’re navigating health care. And it just should not be the case.”
As Black tech founders, Wisdom, Dedner, Pelzer and Plybeah look for ways to support one another by trading advice, chatting about funding and looking for ways to come together. Pelzer and Wisdom met a few years ago as participants in a competition sponsored by Johnson & Johnson. They reconnected at a different event for Black founders of technology companies and decided to help each other.
“We’re each other’s therapists,” Pelzer said. “It can get lonely out here as a Black founder.”
In the future, Plybeah wants to offer transportation services and additional assistance to people caring for aging family members. She also hopes to expand the service to include dropping off customers for grocery and pharmacy runs, workouts at gyms and other basic errands.
Pelzer wants Clinify Health to make tracking health care more fun — possibly with incentives to keep users engaged. He is developing plans and wants to tap into the same competitive energy that fitness companies do.
Wisdom wants to support physicians who seek to improve their relationships with patients of color. The company plans to build a library of resources that professionals could use as a guide.
“We’re not the first people to try to solve these problems,” Dedner said. Yet he and the other three feel the pressure to succeed for more than just themselves and those who came before them.
“I feel like, if I fail, that’s potentially going to shut the door for other Black women who are trying to build in this space,” Wisdom said. “But I try not to think about that too much.”
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In the 1960s, health care across the Mississippi Delta was sparse and much of it was segregated. Some hospitals were dedicated to Black patients, but they often struggled to stay afloat. At the height of the civil rights movement, young Black doctors launched a movement of their own to address the care disparity.
“Mississippi was third-world and was so bad and so separated,” said Dr. Robert Smith. “The community health center movement was the conduit for physicians all over this country who believed that all people have a right to health care.”
In 1967, Smith helped start Delta Health Center, the country’s first rural community health center. They put the clinic in Mound Bayou, a small town in the heart of the Delta, in northwestern Mississippi. The center became a national model and is now one of nearly 1,400 such clinics across the country. These clinics, called federally qualified health centers, are a key resource in Mississippi, Louisiana and Alabama, where about 2 in 5 people live in rural areas. Throughout the U.S., about 1 in 5 people live in rural areas.
The covid-19 pandemic has only exacerbated the challenges facing rural health care, such as lack of broadband internet access and limited public transportation. For much of the vaccine rollout, those barriers have made it difficult for providers, like community health centers, to get shots into the arms of their patients.
“I just assumed that [the vaccine] would flow like water, but we really had to pry open the door to get access to it,” said Smith, who still practices family medicine in Mississippi.
Mound Bayou was founded by formerly enslaved people, many of whom became farmers.
The once-thriving downtown was home to some of the first Black-owned businesses in the state. Today the town is dotted with shuttered or rundown banks, hotels and gas stations.
Mitch Williams grew up on a Mound Bayou farm in the 1930s and ’40s and spent long days working the soil.
“If you would cut yourself, they wouldn’t put no sutures in, no stitches in it. You wrapped it up and kept going,” Williams said.
When Delta Health Center started operations in 1967, it was explicitly for all residents of all races — and free to those who needed financial help.
Williams, 85, was one of its first patients.
“They were seeing patients in the local churches. They had mobile units. I had never seen that kind of comprehensive care,” he said.
Residents really needed it. In the 1960s, many people in Mound Bayou and the surrounding area didn’t have clean drinking water or indoor plumbing.
At the time, the 12,000 Black residents of northern Bolivar County, which includes Mound Bayou, faced unemployment rates as high as 75% and lived on a median annual income of just $900 (around $7,500 in today’s dollars), according to a congressional report. The infant mortality rate was close to 60 for every 1,000 live births — four times the rate for affluent Americans.
Delta Health Center employees helped people insulate their homes. They built outhouses and provided food and sometimes even traveled to patients’ homes to offer care, if someone didn’t have transportation. Staffers believed these factors affected health outcomes, too.
Williams, who later worked for Delta Health, said he’s not sure where the community would be today if the center didn’t exist.
“It’s frightening to think of it,” he said.
Half a century later, the Delta Health Center continues to provide accessible and affordable care in and around Mound Bayou.
Public health data from last month shows that Black residents of those states have consistently been more likely to die of covid than residents of other races.
“We have a lot of chronic health conditions here, particularly concentrated in the Mississippi Delta, that lead to higher rates of complications and death with covid,” said Nadia Bethley, a clinical psychologist at the center. “It’s been tough.”
Delta Health Center has grown over the decades, from a few trailers in Mound Bayou to a chain of 18 clinics across five counties. It’s managed to vaccinate over 5,500 people against covid. The majority have been Black.
“We don’t have the National Guard, you know, lining up out here, running our site. It’s the people who work here,” Bethley said.
The Mississippi State Department of Health said it has prioritized health centers since the beginning of the rollout. But Delta Health CEO John Fairman said the center was receiving only a couple of hundred doses a week in January and February. The supply became more consistent around early March, center officials said.
“Many states would be much further ahead had they utilized community health centers from the very beginning,” Fairman said. Fairman said his center saw success with vaccinations because of its long-standing relationships with the local communities.
“Use the infrastructure that’s already in place, that has community trust,” said Fairman.
That was the entire point of the health center movement in the first place, said Smith. He said states that were slow to use health centers in the vaccine rollout made a mistake that has made it difficult to get a handle on covid in the most vulnerable communities.
Smith called the slow dispersal of vaccines to rural health centers “an example of systemic racism that continues.”
A spokesperson for Mississippi’s health department said it is “committed to providing vaccines to rural areas but, given the rurality of Mississippi, it is a real challenge.”
Alan Morgan, CEO of the National Rural Health Association, said the low dose allocation to rural health clinics and community health centers early on is “going to cost lives.”
“With hospitalizations and mortality much higher in rural communities, these states need to focus on the hot spots, which in many cases are these small towns,” Morgan said of the vaccine efforts in Mississippi, Louisiana and Alabama.
A report from KFF found that people of color made up the majority of people vaccinated at community health centers and that the centers seem to be vaccinating people at rates similar to or higher than their share of the population. (The KHN newsroom, which collaborated to produce this story, is an editorially independent program of KFF.)
The report added that “ramping up health centers’ involvement in vaccination efforts at the federal, state and local levels” could be a meaningful step in “advancing equity on a larger scale.”
Equal access to care in rural communities is necessary to reach the most vulnerable populations and is just as critical during this global health crisis as it was in the 1960s, according to Smith.
“When health care improves for Blacks, it will improve for all Americans,” Smith said.
This story is from a partnership that includes NPR, KHN and the three stations that make up the Gulf States Newsroom: Mississippi Public Broadcasting; WBHM in Birmingham, Alabama; and WWNO in New Orleans.
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