Failure to Respect Needs of Vulnerable Groups Will Undermine Response

March 22, 2020

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Berman Institute faculty member Zackary Berger, MD, PhD, has published a new paper in The BMJ, “Covid-19: Control Measures Must Be Equitable and Inclusive,” stating that failure to respect the needs of vulnerable groups will seriously undermine response efforts. His paper says:

“Containment, mitigation, and suppression plans must be as inclusive as possible or risk undermining response efforts. A commitment to inclusion means responding to covid-19 in a way that is sensitive to our most vulnerable communities, including homeless people, those without adequate insurance or employment, communities of colour, indigenous communities, immigrant communities, people with disabilities, and certain frontline healthcare workers and emergency responders.

“Trust begins with communication, and communicating information during outbreaks is challenging, especially as our knowledge of a disease evolves. Inclusive messaging should be tailored and available in a variety of languages, including sign languages. Honest, transparent communication is vital; confusing or contradictory health messaging engenders mistrust and leads people to seek information from unreliable alternative sources. Underserved communities are rightly distrustful of public health institutions: communities of colour and people with disabilities have historically been undertreated or abused through the medical system, and undocumented immigrants fear punitive measures should they present at a clinic or hospital.”

The paper calls for free testing of all patients. Berger also states that during influenza outbreaks, paid sick leave policies could lower influenza infection rates by up to 40% and calls for healthcare institutions to set “the standard by guaranteeing paid sick leave for all employees. Governments should reimburse sick leave expenses for the healthcare enterprises counted on to respond to covid-19 and implement similar programmes to support casual, small business, and gig economy workforces.”

The BMJ (mostly referred to as the British Medical Journal) is one of the world’s top four most cited general medical journals.  Dr. Berger is an internist, clinical epidemiologist, and bioethicist whose clinical, educational, and research work is located at the intersection of shared decision making, patient-centered care and evidence-based medicine. How to make sense of a sharing patient-physician relationship in the context of social and political inequities is a central question underlying much of our health system’s imperfections. Dr. Berger is using interdisciplinary techniques to explore possible answers, especially among vulnerable and victimized populations.