The Health Disparities Podcast

Health policy at the American Academy of Orthopedic Surgeons. Featuring Shreyasi Deb.

Researcher Shreyasi Deb, PhD, MBA, became interested in health disparities when studying economics, and has since applied this perspective to understanding public health. At the American Academy of Orthopedic Surgeons, Shreyasi is looking at the positives and negatives of bundled payment models and the unintended policy consequences around value-based care. Are some patients already experiencing inequity and exclusion? Can we address the unique socioeconomic and multiple comorbidity aspects of each patient in a post fee-for-service world by spending more on social services? With Bill Finerfrock.

What if your father struggles with arthritis - and you are a physician? Featuring Michael Parks.

When an accomplished surgeon sees his own father struggle with arthritis, he knows there are some structural problems in play. HSS surgeon Dr. Michael Parks shares some insights into the processes behind health disparities (or health differences as he prefers to say). Why do some people steadily progress through the steps of intervention, but others languish? What role does race and gender play? Dr. Parks also discusses why the WHO sees health disparities as a social injustice, and why a new bill sponsored by Congressman John Lewis is so important to health equality. With Bill Finerfrock.

How risk adjustment payments could help complex conditions in rural areas. Featuring Tammy Huff.

Tammy Huff, MD discusses how rural health disparities are driven by many logistical challenges in remote and underserved areas, where limited public transport and hospital closures make access to care increasingly difficult. Bundled payments may be adding to these challenges by asking providers to carry more risk. Low health literacy, high medical co-morbidities and risk factors such as tobacco use are more prevalent in these rural areas, making many patients care management more complex. Are these factors increasing disparities by making surgeons more cautious about proceeding with procedures? Can different payment models mitigate these problems? With Bill Finerfrock.

Nurses have always understood the social determinants of health. Now the world is catching up. Featuring Deborah Coplin-Hall.

Deborah Coplin-Hall, MS, RN and Carla Harwell, MD discuss how nurses have been at the forefront of screening patients for social determinants for decades, only now are social determinants and cultural competency being taught, structured and systematized. Deborah describes some important progress being made with health disparities, such as increasing the minimum wage in her city of Buffalo, NY, and she explores the impact of gentrification on communities of color. Deborah has successfully married her work as a nurse with an active role in the church, where strong emphasis on engagement in personal health has been integrated with faith-based activities. She also discusses countering “the brush off” by asking physicians the right questions and making sure care providers fully listen and respond to patient concerns.

Access deserts, Magnet designation, and comorbidity management centers in Boston. Featuring Sasha Dubois.

Brigham and Women’s nurse Sasha Dubois, MSN, RN discusses how racial segregation, gentrification, and displacement in her native Boston can create “healthcare access deserts” that fuel health disparities, even in an area where there are a number of high-quality hospitals. Establishing medical homes in the communities where patients are is one approach that Brigham and Women’s is implementing, together with centers that focus on understanding and managing multiple co-morbidities by integrating factors such as social determinants into care plans and health records. Sasha is an expert in Magnet designation, a driver for excellence which raises standards of care and encourages a more patient centered approach. Magnet also emphasizes the importance of cultural competency, unconscious bias, and understanding disparities. With Dr Carla Harwell.

Collaborative approaches and hospice care in the Sunshine State. Featuring Lyn Peugeot.

Lyn Peugeot MSN, RN, is a nurse focused on hospice care, and has recently completed her doctoral research project looking at dementia diagnosis in African Americans. She discusses her concerns about the relatively low percentage of African Americans who choose hospice care, which may be less about access and more due to misperceptions about the role of hospice and its implications. Because of this, Lyn believes it is very important to educate all nurses about hospice care as a positive philosophy built around providing comfort and care at the end of life while maintaining dignity and autonomy. In terms of disparities, she sees access to care and medication as the areas where minorities experience the greatest barriers, and she discusses how the closure of safety net hospitals can exacerbate these access issues by reducing the availability of care navigation support, as well as care itself. Lyn helped found the Broward County, Florida chapter of NBNA, they will host the national conference in summer 2020. With Dr Carla Harwell.

Making sure healthcare isn’t a lottery in rural Nevada. Featuring Debra Toney.

Dr. Debra A. Toney PHD, RN, FAAN, is Vice President of Quality Management at Nevada Health Centers, President of NCEMNA and a past president of NBNA. She discusses her groups approach to population health management in Nevada, a primarily rural population where remoteness is a major factor in health disparities. Dr Toney talks about the importance of social determinants, particularly in the context of FQHC care provision, and how telehealth and mobile units are making a difference to disparities in conjunction with the consistent implementation of evidence-based guidelines and care personalization. Dr Carla Harwell and Dr Toney also discuss the decline of paternalistic medicine and the rise of patients as partners in their own health, and how better engagement can be facilitated by meeting patients where they are.

Carter Todd: Nursing inspirations and aspirations in Sacramento, California

Pediatric ICU nurse Carter Todd RN, MS, CCRN, switched from athletics to nursing and this changed his life completely. On graduation he realized he could help both his community and the nursing profession by advocating for greater workforce diversity. Carter went on to start his local NBNA chapter and create a barbershop outreach program. In California, health access is the number 1 issue, like most other states. But uniquely, California has the highest number of undocumented or uninsured agricultural workers, all deserving and needing care. Carter discusses the importance of health literacy and integrating an understanding of social determinants into day to day care decision making and talks about a collaboration with the African American Health Legacy initiative to bring preventive health to the community. With Carla Harwell, MD.

NBNA’s 50th Anniversary vision: Getting patients engaged in their own health by moving away from the illness model.

Incoming NBNA President Martha Dawson, DNP, RN, FACHE, shares her priorities for the organization as she becomes its 13th President. As the NBNA approaches its 50th anniversary in 2021, Martha is planning to highlight its founders and past leaders, and to focus on emphasizing the importance of meeting patients where they are, before they get sick. Martha describes how the 122 chapters are at the heart of NBNA, and ways their community programs have been effective in mitigating health disparities. Local programs include working with politicians on environmental aspects such as lead levels, addressing violence, recognizing the importance of social determinants, and facilitating better access to care. The NBNA is one of very few professional development organizations that bring together RNs, LPNs, and students under the same umbrella, and then supports them along varied career paths, which include business and management positions as well as the clinical track. Martha believes that legislation is perhaps the most important conduit to change, and she talks about why she supports mentoring future leaders to ensure there are strong voices from the black nurse community able to influence future health policy. With Carla Harwell, MD.

Going beyond disparities and competency: why we need to focus on achieving health equity and cultural proficiency.

Eric J. Williams, DNP, RN, CNE, FAAN, is a Professor of Nursing and the outgoing President of the National Black Nurses Association (NBNA). Eric talks about some of the priority initiatives at NBNA during his leadership, and how NBNA has built on its mission to improve health equity in America since its founding in 1971. As well as discussing the importance of treating violence as a public health crisis and building a culture of health, Eric discusses ways that we can move beyond cultural competency to attain the higher skill level of cultural proficiency – skills that are good for healthcare and the wider world. Eric also discusses an important new initiative to increase diversity in the nursing workforce, working in collaboration with AARP and the Robert Wood Johnson Foundation. With Carla Harwell, MD.