Q&A: The biggest equity issues in the state amid the pandemic

By: - November 4, 2021 5:53 am
A doctor with a patient

Within various cultures, “there is a distrust of the benevolence of medical systems and structures, either historical or cultural.” (Getty Images)

People of color have been disproportionately impacted by the pandemic in New Hampshire and throughout the country. But the collection of data related to race has lagged, obscuring our understanding of COVID’s impact on minority populations in the state. 

On Friday, the state’s equity dashboard showed that race data was unknown in 30 percent of cases. The data collection for deaths resulting from COVID was better but still unknown in 4 percent of cases.

We asked Dr. Marie Ramas, a family medicine doctor who works with underserved populations in Nashua, about the biggest equity issues facing the state today, vaccine hesitancy, and what the state can do to close these gaps. Ramas is also the regional medical director for Aledade, a national accountable care organization, and co-founder of The Lighthouse NH Facebook page that aims to increase public health confidence for communities of color in New Hampshire.

This interview has been edited for length and clarity.

At this stage in the pandemic, what are the most pressing equity issues the state is facing right now?

Dr. Marie Ramas
Dr. Marie Ramas

There’s still a large degree of skepticism as it relates to the COVID-19 vaccine. In New Hampshire, there’s a large Latino population but also Caribbean and New American populations as well. Within those cultures, there is a distrust of the benevolence of medical systems and structures.

In many households either the matriarch or elders are revered. The decisions and the viewpoints of the older population are respected. I have many patients that are millennials, Gen Xers, or Gen Z’s who support the vaccine or would seriously consider getting vaccinated but are hesitant because of the pressures from elders within their community. 

We still have a tremendous issue with access to care. That’s coupled with the financial and economic impact from the pandemic, particularly on our groups of color within the state, or New Americans. 

On the clinic side, we’re also seeing the attrition of primary care clinicians. Within the greater Nashua area, there’s been a significant loss of primary care workforce. There have been hospital closures up in the North Country. 

On the systemic side, we are still having difficulty in penetrating these communities of color to start creating relationships with them.

More recently, the state has refused federal funding for ongoing efforts regarding COVID-19 vaccination. So we’re at a crisis here.

What initiatives would you like to see the state take to address some of these inequities?

We’re going to be dealing with permutations of the COVID-19 pandemic for the next several years. That’s just our new reality, and so having the ability for agencies to openly discuss racial and socioeconomic disparities is imperative in how we develop our approach and strategies.

It would be of utmost importance as we are training new clinicians and health care workers that they have the ability to discuss concepts related to diversity, equity, and inclusion. And as you know, our state recently passed the budget legislation that could potentially threaten institutions that have state funding for discussing these matters. Our state government has an opportunity to repent from that faulty decision.

We also have to remember that outside of COVID-19 we still have chronic disease management. People are still getting appendicitis, and people are still suffering from addiction. People are still dealing with heart attacks and consequences of uncontrolled hypertension, diabetes within our state. And so, maintaining the funding and resources to support and bolster access to those services is absolutely paramount to the backbone of the health of our communities.

Unfortunately, again, our state government has cut funding for mental health services and particularly for drug treatment and addiction treatment, which I think is terribly myopic as we’re trying to emerge from this pandemic.

What can be done to address vaccine hesitancy?

I’m a family doctor at heart, and so my go-to answer for that is relationships. Those who want to be vaccinated have already been vaccinated. So the question now really is: How do we create a safe space for those who aren’t? You can’t always do that in a public setting.

We need to assess the why behind a person’s decisions. For many people, their reasons for not getting vaccinated – whatever they are – are legitimate for them. Listening takes time, though. We have clinicians that are absolutely weathered from the mental, physical, and emotional demands of COVID, and on top of that we have many practices that are struggling to stay open.

We have opportunities to create alliances with community leaders who are trusted. 

Do you think that improving how data around race is collected should be a priority for the state?

If it’s not written, it’s not real. If it’s not collected and if it’s not identified, then there will be problems that will emerge that we can’t address. I am grateful that we have the State Health Improvement Plan Advisory Council that is still in effect, which is bipartisan. That will help to identify areas of opportunity for that matter. How do we address and create a unified structure in how we evaluate and how we document the health and wellness needs of Granite Staters across the state?

What else is important for people to know?

We don’t have all the answers, but what we do know is that the No. 1 thing protecting us against infection and death is getting vaccinated and wearing masks. I would rather take my chances on something that has proven over the millions of doses given to be safe and effective than the unknown, long-term consequences of a COVID-19 infection.

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Amanda Gokee
Amanda Gokee

Amanda Gokee is the New Hampshire Bulletin’s energy and environment reporter. She previously reported on these issues at VTDigger. Amanda grew up in Vermont and is a graduate of Harvard University. She received her master’s degree in liberal studies, with a concentration in creative writing, from Dartmouth College. Her work has also appeared in the LA Review of Books and the Valley News.