Commemorating National African American Hepatitis C Action Day in the time of COVID-19 and Black Lives Matter

Alex Eanes

July 25, 2020 marked the eighth annual National African American Hepatitis C Action Day (NAAHCAD). NAAHCAD is a community mobilization initiative started by the National Black Leadership Commission on Health (NBLCH) that aims to draw attention to the significant burden of hepatitis C virus (HCV) infection in the African American community as well as to promote hepatitis C education, testing, and curative treatment. African Americans have higher HCV-related morbidity and mortality compared to other racial/ethnic groups. African Americans make up 11% of the U.S. population, yet account for 25% of people living with HCV. Furthermore, in 2018, the HCV death rate for African Americans was twice as high compared to whites. These same inequities manifest themselves in our current COVID-19 pandemic. Black people are disproportionately testing positive for and dying from COVID-19 compared to other racial and ethnic groups.1

NASTAD’s Commitment to Black Lives states “We recognize that we will not end the HIV and hepatitis epidemics and related syndemics without dismantling the systems of oppression that fuel racial disparities in access and outcomes. We prioritize fighting injustices where we see them, and we value diversity and inclusivity in all forms.” Often, we hear that Black and Brown people are at highest risk for chronic illnesses, including HCV, without examining the systems of oppression and structural racism responsible for creating these inequities. In honor of NAACHAD and our commitment to Black lives, we must acknowledge racism as a barrier to health equity, hold ourselves accountable for our roles in health equity, and address gaps in the public health response.

In order to do so, first, we must acknowledge racism as a public health crisis. Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks, that unfairly disadvantages some individuals and communities.2 It is racism that is the issue, not an individual’s race. The COVID-19 pandemic has highlighted the many structural issues that continue to exacerbate negative health outcomes for Black people in the U.S., including outcomes related to viral hepatitis.

Second, we must hold ourselves and our leaders accountable for the roles we play in perpetuating racism and discrimination in public health and systems of care. Accountability in public health prioritizes the voices and expertise of communities and of public health professionals of color. Accountability in the response to both COVID-19 and viral hepatitis means shifting our focus from individual behavior to long-standing systemic issues.1 This includes addressing the enduring problem of incomplete collection of race and ethnicity data related to COVID-19 and hepatitis C, respectively. Akin to hepatitis, COVID-19 surveillance data are often incomplete. About 52% of reported COVID-19 cases are missing race or ethnicity data.3 Similarly, as noted in the 2018 CDC Viral Hepatitis Surveillance Report, a number of hepatitis race and ethnicity data were missing. Without complete race and ethnicity data, it is impossible to know the full impact of COVID-19 or viral hepatitis on communities of color. In the words of Aletha Maybank, MD, MPH, Chief Health Equity Officer and Vice President at the American Medical Association, “You can’t address what you don’t measure.” Without gathering demographic data, organizations working to address COVID-19 and eliminate viral hepatitis cannot fully understand nor adequately address the intersecting barriers impacting disproportionately impacted individuals and communities.

Health inequities are not someone else’s problem to fix. They are everyone’s responsibility. The COVID-19 pandemic has challenged us as a country to think about how systemic racism impacts health. The systemic racism that underlies outcomes related to COVID-19 and hepatitis cannot be dismantled without collective action. As a community of people impacted by and responding to hepatitis, we all need to fight against systemic racism. Learning about the uneven burden of diseases, such as hepatitis, on communities of color is only the beginning. It is not enough to simply acknowledge the reality of health inequities and move on. As public health professionals, we are responsible for creating a new system that holds our leaders accountable, amplifies the voices of impacted communities, and ultimately is free of health inequities. We can and should use the opportunities afforded by NAAHCAD and the COVID-19 pandemic to address pressing health equity needs, including hepatitis-related health inequities.