The COVID-19 pandemic has had devastating health and economic impacts in the United States. However, as shown beginning with data from the first refereed paper by Dr. Cato Laurencin on Connecticut and subsequently throughout the country, these impacts have disproportionately affected communities of color in the United States, especially Black communities.1 According to data presented at the workshop summarized in this proceedings, the mortality rate for Black Americans is more than twice as high as for any other racial or ethnic group. Testing in major cities with high Black populations shows similarly disproportionate rates of infection. As the virus has persisted, with no universal treatment or vaccine in place as of the writing of this report, efforts to understand and minimize this disparity have become critical.
On June 23, 2020, the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop to discuss the landscape of COVID-19, including how systemic racism contributes to the disproportionate effects related to infection rates and mortality of this virus and other health conditions. Presenters highlighted relevant research and creative responses from many perspectives, including how Black scientists, engineers, and doctors are contributing to solutions and are ready
1 SARS-CoV-2 is the new virus identified in 2019 that causes Coronavirus Disease 2019 (COVID-19). The workshop and this summary ultimately focused more on COVID-19 than on the virus.
to do more. National Academies leaders and members also discussed the role of the National Academies in addressing the pandemic and underlying issues of systemic racism that have led to health disparities in the United States.
Victor Dzau, M.D., president of the National Academy of Medicine (NAM), thanked the Roundtable members and workshop participants for addressing a critical issue for the nation. The past 3 to 4 months have been trying and painful in terms of human lives, suffering, and the economy, he commented, with 2.3 million cases and 120,000 deaths to date. Predominantly Black counties have been experiencing 3-fold the infection rate and 4-fold the death rate as predominantly white counties.
In suggesting some of the reasons why, he noted many people of color live in areas with high housing density, limited access to health care, and higher rates of unemployment or employment in jobs with a higher risk of infection. Many African Americans have comorbidities that further put them at risk of infection or death. These health disparities, Dr. Dzau pointed out, are created by inequity, bias, and structural racism.
As the nation copes with COVID-19, the killings of George Floyd and Rayshard Brooks, and the protests that followed, a period of reflection has taken place to confront the inequities that persist in the criminal justice system, health care, and broader social systems and institutions, he observed. Dr. Dzau acknowledged that NAM staff and members have experienced pain, fear, and distress. In his role as NAM president, Dr. Dzau issued a statement on racial equity and the adverse effects of racism that says in part:2
I commit to ensuring that all people and especially people of color feel safe and supported while working at the NAM, as well as to pursuing racial equity in our organizational policies and procedures. I commit to using our platform to improve the lives of people who experience disproportionate health disparities as a result of socioeconomic inequity, bias, and structural racism. I commit to listening, learning, and working with all of you.
2 For the full statement, see https://nam.edu/statement-on-racial-equity-and-the-adverse-effects-of-racism-by-nam-president-victor-j-dzau.
NAM staff requested a way to express their sentiments and feelings in a safe space with no senior leadership involved. A committee formed following Dr. Dzau’s statement and defined a three-part commitment to advance racial equity within the institution: (1) creating an internal environment and culture of diversity and equality; (2) putting a lens of racial diversity and inclusivity in all that NAM does; and (3) addressing the root cause of racism in NAM programs. Dr. Dzau highlighted action steps under each area, including in recruitment and retention to achieve a racially and ethnically diverse staff, and in transparency and accountability through development of measurable goals. Beyond its own operations, he said, “the NAM has a great platform to make a difference,” in terms of convening groups to study societal issues that can influence policy, and structural racism and inequity will be addressed across the range of NAM programs and topics. One of the most significant outputs of NAM’s Culture of Health Program,3 funded by the Robert Wood Johnson Foundation, was publication of Communities in Action: Pathways to Health Equity (NASEM, 2017), which called out structural racism as a barrier to the attainment of health equity. The recent renewal of the program will allow for a focus on structural racism, informed in part by two workshops that looked at root causes and strategies.
Dr. Dzau closed by stressing the need for action, and not just words. “Looking at COVID-19 and the Black community is important, but it is a symptom of a bigger problem that we all need to address and work together on,” he concluded.
Cato Laurencin, M.D., Ph.D., professor at the University of Connecticut and chair of the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine, provided context on the origins and work of the Roundtable. It emerged after an examination of the growing absence of Black men in medicine, which he noted was at a critically low point from 2015 to 2018. A workshop was held, with the proceedings published in 2018 as An American Crisis: The Growing Absence of Black Men in Medicine and Science (NASEM, 2018). The effort helped lay out a blueprint for action to create change. When members of the Congressional Black Caucus were briefed, they asked about next steps. One such step was to
create the Roundtable as a permanent presence at the National Academies. (See front matter for the roster of members.)
The Roundtable has two primary goals: (1) understand issues impacting Black men and Black women in science, engineering, and medicine, and (2) create ideas for solutions, especially solutions utilizing the strengths in having Black men and Black women in science, engineering, and medicine. Underscoring the theme “Black lives matter in science, engineering, and medicine,” Dr. Laurencin said, “We believe it is crucial for success in America.”
At its December 2019 inaugural meeting, the Roundtable set forth how it would operate at each meeting to encompass data gathering, ideas generation, a business meeting, and a workshop planned by one of six action groups. The action groups cover public advocacy, mentorship and advising, psychological factors, racism and bias, pre-kindergarten to graduate education, and financing. These groups aim to foster information sharing and development of an evidence-based approach; engagement with key stakeholders and a broader community of scientists, clinicians, engineers, and administrators; and activities to include design and conduct of workshops, papers and other publications, and other activities for meaningful change. The Racism and Bias Action Group held the Roundtable’s first formal workshop virtually on March 22, 2020 (NASEM, 2020).
In April 2020, the Roundtable formed a new action group to examine COVID-19 and the Black community. The current workshop, COVID-19 and the Black Community, results from this effort. (See Box 1-1 for the Workshop Statement of Task.)
The co-chairs of the COVID-19 action group made brief remarks about the expectations for the workshop. Mark Alexander, Ph.D., noted the group looked forward to a lively discussion to provide information needed to make essential changes in the country. He suggested that this time of disruption may be an opportunity to reset national priorities. Dr. Camara Jones, M.D., M.P.H., Ph.D., emphasized the Roundtable members welcomed comments, insights, and questions from all attendees. Cora Marrett, Ph.D., added that the group is interested in how to foster the human capital necessary not only to address national issues related to COVID-19 but also to forge partnerships moving forward.
The remainder of this publication is organized to follow the agenda of the workshop. Chapter 2 summarizes the keynote session, which laid out the landscape of COVID-19. Chapter 3 looks more closely at the disproportionate impact of COVID-19 on Black communities. Chapter 4 presents perspectives from the National Academies beyond those expressed by Dr. Dzau in the opening session, with a look at current work performed regarding COVID-19 and how synergies with those efforts and the Roundtable might develop. Chapter 5 presents views on community responses and resilience from grassroots, nursing, engineering, and medical school perspectives. A final chapter provides concluding thoughts from the workshop and Roundtable co-chairs. The agenda and biographical sketches of the workshop Steering Committee and presenters can be found in the Appendixes.
In accordance with the policies of the National Academies, workshop participants did not attempt to establish any conclusions or recommendations about needs and future directions. In addition, the Planning Committee’s role was limited to planning the workshop. This proceedings was prepared by the rapporteurs as a factual summary of what occurred at the workshop.
NASEM (National Academies of Sciences, Engineering, and Medicine). 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press.
NASEM. 2018. An American Crisis: The Growing Absence of Black Men in Medicine and Science. Washington, DC: The National Academies Press.
NASEM. 2020. The Impacts of Racism and Bias on Black People Pursuing Careers in Science, Engineering, and Medicine: Proceedings of a Workshop. Washington, DC: The National Academies Press.