An Open Letter: Can Telehealth be Saved from Systemic Racism?

Gil Addo headshot 2016 (3) (2)

All,

My name is Gil Addo. In 2013, I co-founded RubiconMD, a telehealth company that connects primary care clinicians and specialists through a virtual platform. Over the past 6 months, we have been on the frontlines of the healthcare industry’s massive virtual shift. Telehealth has received both bipartisan praise and a flood of Wall Street attention for its role in triaging COVID-19 patients, and in keeping other patients out of overburdened care settings. Physicians on our platform have reported up to 4,000% increases in patient virtual visits through the early months of the pandemic. Despite this boom, telehealth’s full potential is being significantly curtailed by the same forces of systemic racism that compromise our current healthcare system. I write today in hopes that together we can change that.

Alongside COVID-19, America has been slowly acknowledging the public health crisis of racial injustice. Prior to COVID, structural racism has had a devastating impact on healthcare, education, employment, housing, and infrastructure in Black and Brown communities. Health outcomes have lagged commensurately and dramatically. This is the house that COVID-19 entered. A house poorly equipped, staffed and supported for routine healthcare. Telehealth doesn’t fix the larger problem. Layered on top of our existing inadequate system, telehealth exacerbates the problem. Only investment to combat the underlying system will allow telehealth to reach its true potential of enhanced access to care. 

COVID-19 has and will continue to disproportionately sicken and kill Black and Brown communities. Black people are 2.4x more likely to die of COVID-19 than white people, and Hispanic and Latinx people are 1.5x more likely to die of COVID-19 than white people1. Our healthcare system guarantees this. Moreover, the lack of a coordinated national response has only further condemned these vulnerable populations. The virus and its complications will continue to drain the resources of these underserved communities long into the future. Telehealth, now a cornerstone of our nation’s response arsenal, again leaves these communities behind.

Communities of color and low-income households are frequently confronted by a digital divide with inadequate access to computers, high-bandwidth internet, and remote monitoring devices. While 64% of households with an annual income of $100,000 or greater have access to a smartphone, desktop or laptop computer, broadband internet, and a tablet, only 18% of households making less than $30,000 have the same access2. Individuals in these communities are also less likely to have secure patient-provider relationships, again weakening the fundamentals of the existing healthcare system and the potential for telemedicine. Finally, we continue to see fewer resources allocated to the community health centers and safety net hospitals which support our Medicaid populations, particularly in rural communities. This includes a continued underinvestment in technology.

And this is all just what we think we know. Given the omission of these communities in much of scientific research, and the understandable reluctance of minorities in America to contribute health data, it is without a doubt that the challenges are even greater than we fully understand.

The solution must then be multipronged. First, there must be an awareness, understanding and acceptance that systemic racism has massively contributed to the chronic underinvestment in the healthcare system of our communities of color. Building on that common understanding, national and local plans must be developed, tested and scaled to comprehensively address deficiencies and gaps. Notably, investment should address fundamental gaps in the digital divide and infrastructure to support our community and safety net health system. But telehealth leaders cannot sit idly by waiting for broad infrastructure changes to come to fruition. As an industry, we must develop programs and services which affirmatively combat structural racism and ensure equitable access. 

As the old saying goes, the best way to get out of a hole is to stop digging. We are in a hole. It will take courage and leadership to get out of it. Leadership will need to address difficult issues of race and injustice. Only then can we get to understanding, agreement, acceptance and broadly supported corrective actions. We know this change will take time. As we kick the movement off today, all I ask is that you take the first step. Join us by clicking below to express your personal commitment to being part of the solution. 

Telehealth has tremendous potential. Together, we can realize that potential. We have so much to gain! Thank you.

In hope, 

Gil Addo

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1. The COVID Tracking Project: https://covidtracking.com/race

2. Digital divide persists even as lower-income Americans make gains in tech adoption: https://www.pewresearch.org/fact-tank/2019/05/07/digital-divide-persists-even-as-lower-income-americans-make-gains-in-tech-adoption/