In the midst of the COVID-19 pandemic, residents depend on hospitals for community health and wellness. However, many West Harlem residents have experienced feelings of discontent and distrust toward local hospitals. The strain in community relations has put the most vulnerable populations—in particular, working-class Black, senior, and undocumented residents—at risk.
One key reason for local discomfort is that Mount Sinai Morningside, the only hospital within Community Board 9, is currently at 94 percent Intensive Care Unit capacity. Low-income Black New Yorkers have long suffered from a shortage of local hospitals; 24 hospitals in New York have closed since 2000, most of them in low-income Black neighborhoods.
Shawn Hill, vice president of the Harlem Neighborhood Block Association, discussed the different barriers, both physical and social, that hinder low-income communities of color from accessing safe health care.
While the block association is composed mostly of what Hill describes as “retired, Black, middle-class, townhouse-owning” residents without the same economic barriers as many others in the community, he notes that residents are still wary of hospitals as a result of the capacity levels of the ICU, as well as the high risk of exposure to COVID-19.
“Nobody wants to put themselves at greater risk by going into an environment where people are being treated for COVID,” Hill said.
Besides the decrease in ICU capacity, residents also say that long-standing systemic issues have deepened distrust in local hospitals. West Harlem is largely composed of working-class Black and Latinx communities who have been disproportionately impacted by the pandemic as a result of barriers to affordable health care and high rates of preexisting conditions among residents, often as a result of environmental issues that plague low-income communities of color.
“It’s a history of inequity that makes our community and communities of color more vulnerable,” Miriam Aristy-Farer, co-chair of the health and environment committee for Community Board 9, said. “It’s not one specific thing.”
For Black residents in West Harlem, a long history of medical racism has instilled discontent toward health care providers. This has especially come into play as the COVID-19 vaccine distribution has begun in surrounding communities.
“Within the African-American community there’s the history of the Tuskegee experiments with vaccines,” Farer said. “So you hear a lot of skepticism.”
In the Tuskegee Syphilis Study, an experiment that started in 1932 and lasted for 40 years, medical professionals told 600 Black men that they were being treated for “bad blood” while subsequently infecting hundreds with syphilis, unbeknownst to the patients. Compounded with the historical pattern of anti-Blackness within health care, Black residents and local hospitals have a tenuous relationship.
Hill recently wrote a blog post comparing the smallpox pandemic to COVID-19 and the disparities in the ways in which COVID-19 is impacting different communities.
“It was one of those things where it vastly, vastly affected the Black population of New York City at the time,” Hill said. “Far more profoundly than it did the white population for all of the same reasons. It is the same kind of phenomena that happens now.”
Hill noted that the mistreatment of Black people in the medical field dates back to the Middle Passage and the introduction of chattel slavery in the west.
For seniors, the historical relationship between people of color and the medical field often prevents them from seeking health care, but the lack of accessibility hinders seniors from reaching medical facilities. The hospitals and medical facilities within West Harlem are often in inaccessible geographical locations and many have veered toward online appointment services, which many seniors, especially those who do not speak English, have trouble navigating.
The Health and Environment Co-Chair of Community Board 9, Edwin Torres, has noticed the ways in which the senior population has a strained relationship with the health care system, rooted in a lack of access. Exacerbated by health literacy concerns for residents who don’t speak English, a schism is created between health care providers and the most vulnerable populations.
“They either have to go through an online portal, or call a number,” Torres said. “And these are barriers that one, assumes that you know how to use the technology, and two, that you speak the language.”
Torres believes that these barriers are not just seen on a local level, but also an institutional one, and thus must be addressed nationwide. “The whole system has done a very poor job making it more accessible for those who are the highest risk,” he said.
For the immigrant community in West Harlem, feelings of distrust go beyond the COVID-19 pandemic. For many undocumented residents, there is a looming fear when interacting with governmental or health care systems in the country. The anxiety of deportation can increase any time a resident has to engage with a place that puts their name on record, which often keeps undocumented West Harlem residents from seeking care before it is absolutely necessary.
“With the immigrant community you do have a fear of institutions,” Farer said. “And a hospital is an institution.”
To combat misinformation and to encourage community members to seek health care during the pandemic, Farer and Torres are hoping to conduct public service announcements in both English and Spanish, and to partner with faith-based organizations in the city to help spread information regarding local resources.
“We need to be cognizant that this is a community that is very vulnerable,” Torres said. “Very vulnerable to misinformation and also vulnerable to not understanding the materials, the advertisement, that’s going around.”
Torres also noted the ways in which the inaccessibility of health care for low-income residents can deepen the distrust and discomfort toward local hospitals.
“The number one reason for bankruptcy in the United States is health care bills,” Torres said. “That’s not by the draw of luck. That is because people don’t have the money to pay for health care.”
Farer and the rest of Community Board 9 are seeking to build bridges between the community and health care systems by working with different city organizations to spread information and reinstill public trust.
“Coming from a community of color, there’s a lot of trust that needs to be rebuilt in general, by all public institutions right now,” Farer said.