Coming Together: A Public Health Reflection on Global Health Inequities

The day the world started to shut down, March 15, 2020, I remember being stuck at home engrossed by the reporting of a new disease, COVID-19. The entire world went through an unprecedented lockdown. Although it was an uncertain time, one statement that brought me comfort was “we’re all in this together.”

As the pandemic raged on, I questioned this sentiment. At the beginning, it seemed as if this were true: we stayed home, socially distanced, and wore masks. My perception of unity faded as I watched divisiveness emerge over simple prevention methods. Some pretended the pandemic was not happening, acting in their own best interest, and some even went as far as to declare that the pandemic was over.

I began to see who the COVID-19 statistics were disproportionately affecting, and they were all people who looked like me. How can we say “we’re all in this together” when we abandoned our most vulnerable populations?

My time during the pandemic was spent between two countries: the United States and Nigeria.

In both countries, I witnessed how the COVID-19 pandemic exposed drastic social and health inequities. During my time in the United States, people of color faced higher mortality and morbidity from COVID-19 than their White counterparts. The difference in mortality stemmed from a multitude of factors. For example, people of color had increased rates of comorbidities such as heart disease, obesity, and asthma.¹ In addition to increased comorbidities, Black workers were overrepresented in frontline jobs.² A study assessing racial and ethnic differences in COVID-19–related job exposures in the United States showed that Black and Latino frontline workers were overrepresented in lower-income occupations as well, increasing their exposure to COVID-19.³

Furthermore, there is an underlying distrust between people of color and medical institutions stemming from historical injustices. This has given rise to vaccine hesitancy among minority communities. In November 2020, “the National Association for the Advancement of Colored People (NAACP) and partners reported that only 14% of Black survey respondents trusted the vaccines’ safety and only 18% said they would definitely get vaccinated.”^4(p.e12) Engaging minority communities in decision-making can help improve these outcomes.

In contrast, Nigeria was severely impacted by the indirect effects of the COVID-19 pandemic. As I spent my summer working with the local cancer center, I saw firsthand how the pandemic exacerbated preexisting health challenges for Nigerians. This inadvertently resulted in worse patient outcomes, including reduced access to care caused by lockdowns and social distancing restrictions. What may have seemed to be an easy solution revealed itself to be a web of social problems.

Furthermore, I was troubled to see a great proportion of cancer patients dying weekly at the clinic as a result of COVID-19–related restrictions that prevented free community cancer screening efforts. These community outreach programs are essential in detecting early-stage cancer because the average Nigerian cannot afford annual screenings. In addition, lockdown restrictions between states and nightly curfews prevented people from traveling to receive cancer care. This led to a greater proportion of patients presenting with late-stage cancer, thus worsening patient outcomes.

To understand why Nigeria is impacted by the indirect effects of COVID-19, one must recognize the existing social, economic, and political challenges Nigerians face regarding the health care system. To understand why COVID-19 is disproportionately affecting people of color in the United States, one must recognize the sociodynamic elements that contributed to this issue. These structural and economic impacts are social determinants (defined as economic and social conditions that influence individual and group differences in health outcomes⁵). In each country, I witnessed how these economic and social inequities have intersected to influence health outcomes. Since March 15, 2020, close to 1 million people have died of COVID-19 across Nigeria and the United States.⁶ Although it is easy to become desensitized to this figure, it is important to remember that there is a story of human life behind every number.

Lessons from my experiences in both the United States and Nigeria demonstrated that although identifying problems may be easy, solving them is not. The pandemic exposed that we are not in this together; however, we can be if we address social determinants and work alongside communities. To move forward from this pandemic, public health officials need to focus on healing communities and correcting inequities. To be a public health leader is to be an activist. Public health officials should not only show people that inequities exist but also implement corrective actions. This will ensure that we are all truly in this together.