Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities.

Black people living in the United States suffer disproportionate morbidity and mortality across a wide range of neurologic conditions. Despite common conceptions to the contrary, "race" is a socially defined construct with little genetic validity. Therefore, racial health inequities in neurology ("neurodisparities") are not a consequence of biologic differences between races. Instead, racism and associated social determinants of health are the root of neurodisparities. To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem. Structural racism, largely ignored in current neurologic practice and policy, drives neurodisparities through mediators such as excessive poverty, inferior health insurance, and poorer access to neurologic and preventative care. Interpersonal racism (implicit or explicit) and associated discriminatory practices in neurologic research, workforce advancement, and medical education also exacerbate neurodisparities. Neurologists cannot fulfill their professional and ethical responsibility to care for Black patients without understanding how racism, not biologic race, drives neurodisparities. In our review of race, racism, and race-based disparities in neurology, we highlight the current literature on neurodisparities across a wide range of neurologic conditions and focus on racism as the root cause. We discuss why all neurologists are ethically and professionally obligated to actively promote measures to counteract racism. We conclude with a call for actions that should be implemented by individual neurologists and professional neurologic organizations to mitigate racism and work towards health equity in neurology.

Clinicians' Perspectives on the Impacts of Post-2016 Immigration Enforcement on Immigrant Health and Health Care Use

Objective. To examine clinicians' perspectives on changes in health and health care utilization of immigrant patients, the presence of immigration enforcement in health facilities, and institutional responses to these changes in the post-2016 period in the United States. Methods. From a survey of clinician members of the Physicians for Human Rights Asylum Network (March–June 2020), we described responses and identified key themes. Results. Post-2016 anti-immigrant policies and rhetoric negatively affected mental health, physical health, and health care-seeking behaviors among immigrant patients. Although most clinicians reported rarely witnessing immigration enforcement activities, nearly half reported persistent fear among their immigrant patients. A higher percentage of clinicians in U.S. border states reported increased fears associated with adverse physical and mental health effects among immigrant patients than those in non-border states. Conclusion. Clinicians' perspectives on the impact of immigration enforcement on patient health is critical to informing multi-level interventions to improve immigrant health.

Public policy and health in the Trump era

This report by the Lancet Commission on Public Policy and Health in the Trump Era assesses the repercussions of President Donald Trump's health-related policies and examines the failures and social schisms that enabled his election. Trump exploited low and middle-income white people's anger over their deteriorating life prospects to mobilise racial animus and xenophobia and enlist their support for policies that benefit high-income people and corporations and threaten health. Although Trump's actions were singularly damaging, many of them represent an aggressive acceleration of neoliberal policies that date back 40 years. The suffering and dislocation inflicted by COVID-19 has exposed the frailty of the US social and medical order, and the interconnectedness of society. A new politics is needed, whose appeal rests on a vision of shared prosperity and a kind society. Health-care workers have much to contribute in formulating and advancing that vision, and our patients, communities, and planet have much to gain from it. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Risk of Poor Outcomes with COVID-19 Among U.S. Detained Immigrants: A Cross-Sectional Study.

Conditions in immigrant detention centers facilitate the spread of infectious diseases like COVID-19. However, there is no publicly-available data on detainees' health characteristics, making it difficult to estimate the prevalence of risk among detained people. We use cross-sectional survey data from the only survey of detained immigrants, conducted in California in 2013-2014, to assess the prevalence and health-related correlates of health conditions among detained immigrants. We calculated the proportion of detained immigrants with chronic conditions, their interruptions in care, and stratified by sociodemographic characteristics, evaluating differences using two-tailed tests. Among 529 detained immigrants, 42.5% had at least one chronic health condition; 15.5% had multiple chronic conditions. 20.9% experienced disruption in care upon entering detention. 95.6% had access to stable housing in the U.S. Many detained people face health conditions that confer greater risk for poor outcomes with COVID-19. Stable residence can facilitate release of detainees via Alternatives to Detention programs.

Disparities In Telehealth Use Among California Patients With Limited English Proficiency.

Telehealth services that allow remote communication between the patient and the clinical team are an emerging part of care delivery. Given language barriers, patients with limited English proficiency present a unique set of challenges in integrating telehealth and ensuring equity. Using data from 84,419 respondents in the 2015-18 California Health Interview Survey, we assessed the association between limited English proficiency and telehealth use (telephone and video visits) and evaluated the impact of telehealth use on health care access and use. We found that patients with limited English proficiency had lower rates of telehealth use (4.8 percent versus 12.3 percent) compared with proficient English speakers. In weighted multivariable logistic regression, patients with limited English proficiency still had about half the odds of using telehealth. Telehealth use was associated with increased emergency department use for all patients. This study suggests that policy makers and clinicians must focus on limited English proficiency as an important dimension to promote telehealth equity and decrease digital divides.