AAEM/RSA EDITOR
Like many other epidemics, COVID-19 has both magnified and exposed the societal effects of structural racism and other paradigms of structural violence.” redlining and pre-existing conditions for heightened risk of morbidity in COVID-19 patients like asthma, COPD, diabetes, hypertension, high cholesterol, kidney disease, obesity, and stroke.4 All too often we individualize population-wide disease processes, placing the blame on individuals for their “poor decisions” rather than recognizing that people often make the most reasonable decisions from a limited set of options. 100,000 people making the same dangerous decision ought not be seen as 100,000 individual dangerous decisions. There are
systemic forces that impel dangerous choices and systemic problems require systemic solutions. If we bear that in mind during our patient encounter and afterwards, we may be able to more effectively address the unique problems that poverty and racism create for our patients. As the lowest barrier to health care settings across the United States, how will we make our emergency departments sites for remedying these effects?
References: * Louisiana State University Internal Medicine/Emergency Medicine Program 1. Miami Life Expectancy Methodology and Data Table. Center of Society and Health. Virginia Commonwealth University. Published 2014. https:// societyhealth.vcu.edu/media/society-health/pdf/LE-Map-Maimi-Methods.pdf. 2. Rojas D, Melo A, Moise IK et al. The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017. J. Racial and Ethnic Health Disparities 8, 763–772 (2021). https://doi.org/10.1007/s40615-020-00838-z 3. On Being. https://onbeing.org/programs/vivek-murthy-and-richarddavidson-the-future-of-well-being/ 12/2/2021 4. Nelson RK, Ayers EL. “Not Even Past: Social Vulnerability and the Legacy of Redlining,” The Digital Scholarship Lab and the National Community Reinvestment Coalition. American Panorama. https://dsl. richmond.edu/socialvulnerability.
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