Abstract
IMPORTANCE: Tensions around COVID-19 and systemic racism have raised the question: are hospitals advocating for equity for their Black patients? It is imperative for hospitals to be supportive of the Black community and acknowledge themselves as safe spaces, run by clinicians and staff who care about social justice issues that impact the health of the Black community; without the expression of support, Black patients may perceive hospitals as uncaring and unsafe, potentially delaying or avoiding treatment, which can result in serious complications and death for those with COVID-19. OBJECTIVE: To explore how hospitals showed public-facing support for the Black community as measured through tweets about social equity or the Black Lives Matter (BLM) movement. DESIGN, SETTING, AND PARTICIPANTS: Using a retrospective longitudinal cohort study design, tweets from the top 100 ranked hospitals were collected, starting with the most recent over a 10-year span, from May 3, 2009, to June 26, 2020. The date of the George Floyd killing, May 25, 2020, was investigated as a point of interest. Data were analyzed from June 11 to December 4, 2020. MAIN OUTCOMES AND MEASURES: Tweets were manually identified based on 4 categories: BLM, associated with the BLM movement; Black support, expressed support for Black population within the hospital's community; Black health, pertained to health concerns specific to and the creation of health care for the Black community; or social justice, associated with general social justice terms that were too general to label as Black. If a tweet did not contain any hashtags from these categories, it remained unlabeled. RESULTS: A total of 281 850 tweets from 90 unique social media accounts were collected. Each handle returned at least 1279 tweets, with 85 handles (94.4%) returning at least 3000 tweets. Tweet publication dates ranged from 2009 to 2020. A total of 274 tweets (0.097%) from 67 handles (74.4%) used a hashtag to support the BLM movement. Among the tweets labeled BLM, the first tweet was published in 2018 and only 4 tweets (1.5%) predated the killing of George Floyd. A similar trend of low signal observed was detected for the other categories (Black support: 244 tweets [0.086%] from 42 handles [46.7%] starting in 2013; Black health: 28 tweets [0.0099%] from 15 handles [16.7%] starting in 2018; social justice: 40 tweets [0.014%] from 21 handles [23.3%] starting in 2015). CONCLUSIONS AND RELEVANCE: These findings reflect the low signal of tweets regarding the Black community and social justice in a generalized way across approximately 10 years of tweets for all the hospital handles within the data set. From 2009 to 2020, hospitals rarely engaged in issues pertaining to the Black community and if so, only within the last half of this time period. These later entrances into these discussions indicate that these discussions are relatively recent.