The Health Disparities Podcast

Definitions of systemic & structural racism in healthcare. Round Table. (Systemic Bias & Systemic Racism in Healthcare 2/4)

For the second episode in our mini-series exploring systemic racism in healthcare, our panel explores different definitions of bias, stereotyping, systemic racism, and structural racism, and how these behaviors intersect with social determinants of health. Perspectives from both patient and professional viewpoints are addressed. The panel also discuss solutions such as bias training, cultural competency, language competency, self-reflection and mentoring.
Dr. Melvyn Harrington is an orthopedic surgeon and Vice Chair for Community Engagement & Health Equity at Baylor College of Medicine in Houston. Dr. Elena Rios serves as President & CEO of the National Hispanic Medical Association, (NHMA), representing 50,000 Hispanic physicians in the United States.  Episode host Dr. Charla Johnson is the Director of Clinical Information Systems & Nursing Informatics, Franciscan Missionaries of Our Lady Health System, in Baton Rouge.
0:20 Introductions | 1:55 How patients experience & express bias | 4:45 Harmful stereotyping | 6:40 Bias in medical record | 8:20 Bias as gatekeeper to college admissions & healthcare careers | 10:05 Systemic factors for healthcare workforce | 11:30 Bias steering students away from premed | 12:30 Importance of bias training | 14:40 Resistance towards bias training | 17:10 Differences between structural racism & systemic racism | 21:10 Role of social determinants of health (SDOH) | 24:05 Bias towards people with obesity | 26:10 Bias leading to inconsistencies and inequities | 27:50 Importance of self-reflection | 28:50 Bias causing patients to disengage | 29:30 Importance of cultural and language competency | 30:15 Role of age bias | 30:45 Bias toward minority healthcare professionals | 34:25 Do professionals & patients understand structural and systemic racism? | 37:10 How NHMA works to educate professionals & patients about bias | 41:00 Closing remarks.
© Movement is Life 2023

Unconscious Bias: Yes, it is Real. Audio Booklet. (Systemic Bias & Systemic Racism in Healthcare 1/4)

This is the first of a 4 episode mini-series of The Health Disparities Podcast exploring bias & systemic racism in medicine. The series aims to bring to the surface discussions, definitions, & perspectives about the problem of bias, examples of bias, structural & systemic racism, & examples of programs and policies that are tackling bias & racism.
"Unconscious Bias, Yes it is Real" is a useful short guide to understanding unconscious bias, its consequences in healthcare, & some ways to mitigate unconscious bias. It discusses most types of bias impacting the quality of healthcare, including race, ethnicity, gender, gender identity, sexuality, religion, mental health, & weight bias. The "Unconscious Bias, Yes it is Real" booklet is available as a digital download on our website. Movement is Life invites listeners to use the booklet in association with this audio resource as the basis for workshops and discussion groups aimed at improving cultural sensitivity & understanding.
1:35 Introduction – We are all biased | 3:25 What is bias? | 5:30 Types of bias | 8:02 Unconscious or implicit biases | 9:55 Unconscious bias in healthcare | 13:40 Unconscious bias involving weight | 16:12 Unconscious bias involving mental health | 18:20 Unconscious bias involving race & ethnicity | 23:10 Unconscious bias involving gender & gender identity | 28:35 Unconscious bias involving sexual orientation | 30:35 Limitations in research | 32:18 How patients respond to bias | 36:30 Measuring unconscious bias using IAT | 41:50 Counteracting bias in healthcare | 44:30 The LEARN model | 46:00 Glossary | 50:30 Closing comments
Unconscious Bias, Yes it Real - Digital Booklet: http://startmovingstartliving.com/wp-content/uploads/2019/07/Unconscious_Bias_Content_03_print.pdf
About Movement is Life https://www.movementislifesummit.org/website/56162/about-movement-is-life/
Narration by Dr. Michelle Leak & Rolf Taylor.
Adapted for audio from the booklet & produced by Rolf Taylor. 
(c) Movement is Life 2023
 
 
 
 

Preview: Health Equity Summit Nov 30 - Dec 01, 2023 ”Bridging the Health Equity Gap in Vulnerable Communities” in Washington, DC

The Movement is Life Annual Summit is fast approaching, and thanks to philanthropic support from the Zimmer Biomet Foundation, there is no cost to register. Over two days (Nov 30 - Dec 01) a mix of plenary sessions and workshops will feature a stellar lineup of health equity thought leaders at the Renaissance Hotel Downtown, Washington, DC. Online registration: https://www.movementislifesummit.org/website/56162/program/ or Google Movement is Life Summit. 
In our 150th episode of the Health Disparities Podcast, Dr. Michelle Leak hosts a discussion about Summit highlights, exploring the theme of  "Bridging the Health Equity Gap in Vulnerable Communities." Joining Dr. Leak are Movement is Life Chair, Dr. Mary O'Connor, and Vice-Chair Dr. Carla Harwell. Attendees can hear a sneak preview of the program and also consider which two of the four workshops they will want to attend. 
We hope to see you at the Summit, but if you can't make it there is a plan B, as many of the Summit speakers will be joining us on the The Health Disparities Podcast after the event. 
(c) Movement is Life 2023. 
*please note this schedule is not final and is subject to change*
 

Mentoring healthcare leaders: Howard University President Dr. Wayne Frederick moved to DC at 16, mentorship has provided both professional & spiritual guidance. With fellow alum, Dr. Randall Morgan.

Very few physicians can name Dr. LaSalle Leffall and Dr. Clive Callender as pivotal mentors in their career, and also cite their experiences growing up with sickle cell as another important teacher. In a wide ranging discussion with fellow surgeon and Howard University alum Dr. Randall Morgan, Dr. Frederick explores some of the most important aspects of mentorship. He also discusses developing young leaders in science, the ongoing evolution of Howard University, and the challenges of building a diverse healthcare workforce that is better able to meet the needs of a diverse population. Dr. Frederick also talks about why his frequent visits to Trinidad to teach science are so important to him, and how he will enjoy his upcoming sabbatical. Recorded at the recent National Medical Association annual meeting in New Orleans. 
Dr. Wayne Alix Ian Frederick is a Trinidadian-American scholar, surgeon, and university administrator. He is currently serving as president of Howard University in Washington D.C. since July 21, 2014. He also serves as the distinguished Charles R. Drew Professor of Surgery.
Dr. Randall Morgan is an orthopedic surgeon based in Sarasota Florida, and the Executive Director of the W. Montague Cobb Institute. He also serves on the steering group of Movement is Life. 

Affirmative Reaction: Mission-centered advancement is now central to education & workforce diversity as ruling reshapes DEI. With Michaele Turnage Young, Senior Counsel, LDF, & Dr. Tamara Huff. E148

Michaele Turnage Young, Senior Counsel at Legal Defense and Educational Fund (LDF), joins orthopedic surgeon Tamara Huff, MD, MBA, to discuss the recent SCOTUS ruling on the Fourteenth  Amendment which has impacted affirmative action.
According to the Legal Defense Fund, "the Supreme Court has bowed to pressure from anti-civil rights activists, finding that Harvard and the University of North Carolina’s affirmative action programs violate the Equal Protection Clause of the Fourteenth Amendment. This radical decision comes at a time when efforts to advance opportunity in education have been under attack across the country, and the need for such programs remains acute."
Although the ruling is widely considered as a barrier to DEI efforts, Michaele Turnage Young shares an optimistic analysis of the ruling with Dr Huff. She outlines the many areas of DEI activity that the ruling does not affect, and discusses strategies which admissions officers can adopt. Central to this approach is supporting the mission of the many institutions aiming to address health disparities in underserved communities, where lived experience is a key qualification. 
For further information on LDF please visit: www.naacpldf.org & www.defenddiversity.org
© Movement is Life Inc., 2023
Excerpts: 
“It’s really important to understand what this ruling does and does not cover.”
“It seems to be a coordinated effort to cause a chilling effect, to lead people to retreat from efforts to further equal opportunity. These efforts have not been successful thus far.”
“Black students were 13% of US high school graduates, but only 6 % of students enrolled in large selective public colleges, while white students were 50% of US high school graduates and 56% of students enrolled in large selective public colleges.” (2020-2021 academic year).
“If you are charged with looking for talent, you want to do so in an objective way that serves your mission, and it might be that the mission of your school has something to do with serving communities that have long gone underserved.”  
Producer: Rolf Taylor
 

Framing a new post-affirmative action world. Insights from Dr. Ruth Simmons, Harvard University & Rice University, and Dr. Tamara Huff, orthopedic surgeon. E147

When the supreme court struck down race-conscious admissions this year, they ended policies of affirmative action that have helped to diversify college campuses since 1978. The ruling is considered detrimental to efforts to cultivate a representative healthcare workforce. At this year’s annual National Medical Association scientific assembly in New Orleans, Dr. Ruth Simmons was the keynote speaker at a symposium organized by the Cobb Institute, in association with Movement is Life (1). In this episode she explores the implications of the SCOTUS ruling with Dr. Tammy Huff, a board director for Movement is Life and an orthopedic surgeon.
In 1995, Dr. Simmons became the first African American woman to head a major college or university upon being named president of Smith College. Here, she established the first engineering program at a woman’s college. In 2001 she was selected president of Brown University, making her the first African American woman to head an Ivy League institution. She was later appointed President of Prairie View A&M University, the second-oldest public institution of higher education in the state of Texas. Most recently she joined Rice University, in her home state of Texas, as a President’s Distinguished Fellow, and is an advisor on HBCU engagement to Harvard University.
(1) “From Hopwood to Harvard: Anti-Affirmative Action in Higher Education Admissions Amidst Systemic Racism and Historical Racial Inequities in Health.”
© 2023 Movement is Life, Inc.
Host:           Dr. Tamara Huff, Vigeo Orthopedics 
Production:          Rolf Taylor, Project Advocacy
Executive Producer:     Dr. Randall Morgan, Cobb Institute 
Excerpts:
“Merit has often been defined in the past in a political context. We cannot give so much credit to assertions of merit that are fundamentally rooted in something that is corrupt.”
“I want us to begin to talk about human worth in different terms, and not these, I would say, lazy ways of classifying people.”
“Seeing yourself as worthy of healthcare, seeing yourself as worthy of education, seeing your family and your children as worthy of something better – is powerful.”

Healthcare Ready is a disaster preparedness organization working to make communities more resilient to emergency situations, with a health equity focus. With Executive Director Tom Cotter, MPH. E146

From COVID to Katrina to soaring temperatures, when disasters strike it is our most vulnerable communities that are on the emergency frontline, and it’s our underserved populations who experience the most disproportionate impact – and widening health disparities.
The mission of Healthcare Ready  is to help build resilient community health infrastructure that is prepared for, can respond to, and able to recover from disasters and disease outbreaks. One of their specific goals is to ensure historically underserved communities and medically fragile populations can access medications and medical care during a pandemic or natural disaster.
In this episode, Healthcare Ready’s Executive Director Tom Cotter shares some of the ways that the organization goes about helping to prepare communities for disasters, and how these approaches target the drivers for better health equity. With host Rolf Taylor.
© Movement is Life 2023

Why do religious people achieve better nutrition & physical activity goals, & have better cardiovascular outcomes? Clarence Jones, Dr. LaPrincess Brewer & Dr. Mary O’Connor unravel a new study. E145

Research findings from Mayo Clinic & published in the Journal of the American Heart Association at the end of 2022 found that “participating in religious activities, from church services to private prayer, as well as holding deep spiritual beliefs, are linked to better cardiovascular health among Black Americans.” According to Dr Brewer of the Mayo Clinic, multiple socially determined challenges which were magnified by COVID-19 are preventing African Americans from living their best lives by following a healthy lifestyle to prevent heart disease.
The recent study focused on better understanding some of the psychosocial influences on health behavior change among African Americans, and in particular following those activities as defined by The American Heart Association’s “Life’s Essential 8TM.” These include eating well, being active, quitting tobacco, healthy sleep, weight management, controlling cholesterol, managing blood sugar, & managing blood pressure. 
The study found that increased church attendance and spirituality was associated with higher levels of physical activity and less smoking, suggesting that having social support and an optimistic outlook may also encourage individuals to practice healthy behaviors.
Today’s discussion features Robert “Clarence” Jones, M. Ed., CPH, CHW, CPE, Executive Director at the Hue-MAN Partnership and a Community Engagement Strategist, along with Mayo Clinic cardiologist and study lead author Dr. LaPrincess Brewer, MD, MPH, whose primary research focus is in developing strategies to reduce and ultimately eliminate cardiovascular disease health disparities in racial and ethnic minority populations and in underserved communities. Dr. Brewer is also an Assistant Professor of Medicine at Mayo Clinic.
This episode is hosted by Dr. Mary O’Connor, Chair of Movement is Life and Co-Founder of Vori Health.
Copyright Movement is Life 2023

Five barriers & pathways to DEI, discussed in the context of healthcare delivery. With Professor Laura Morgan Roberts, Dr. Randall Morgan & Dr. Mary O’Connor. Episode 144.

In a recent white paper, “Normalize DEI in Your Organization,” professors at the University of Virginia Darden School of Business discuss common barriers to real progress in DEI, and offer evidence-based steps that can help transform DEI efforts from siloed side-projects to core systems embraced throughout an organization’s culture and practices.
For this episode of the podcast, one of the authors, a UVA Professor, explores the findings of the white paper with two surgeons, one of whom is her father. Together they discuss the importance of inter-generational change, "positive weirdness" and some unique aspects of DEI in healthcare.
The white paper references the following framework:
Five barriers and pathways to DEI    1) The Identity Regulation Barrier, 2) The Authority Barrier, 3) The Things Are Working Well for Me Barrier, 4) The Inertia Barrier, 5) The Motivation Barrier.
Five pathways to DEI    1) Build a More Inclusive Hiring Process, 2) Design for Intelligent Inclusion, 3) Enable Mindful Conversations, 4) Empower Mentorship and Sponsorship, 5) Leverage Identity. 
Featuring Professor Laura Morgan Roberts, Associate Professor of Business Administration, Darden Business School, & CEO and Founder, The Alignment Quest Enterprise, LLC; Randall C. Morgan, Jr., M.D., M.B.A., Clinical Associate Professor of Orthopedic Surgery at Florida State School of Medicine, President & CEO, Cobb Institute; and episode host Mary O'Connor, MD, Co-Founder and Chief Medical Officer, Vori Health, & Chair, Movement is Life. 
“Normalize DEI in Your Organization” (link to article & White Paper): https://news.darden.virginia.edu/2022/09/02/new-white-paper-normalize-dei/ "Positive Organizing in a Global Society" https://www.amazon.com/Positive-Organizing-Global-Society-Roberts/dp/1848725760   Excerpts 
“Practice expressing your positive weirdness. It gives others permission to bring out their weird. Differences are assets and resources for organizations, not problems to be solved.”
“Diversity, equity and inclusion (DEI) efforts in the corporate world remain a vortex of passion, malaise, hope and cynicism, despite overwhelming evidence that diverse and inclusive workplaces simply perform better.”  
“DEI does not often generate the short-term benefits that people would like to see. It requires a long-term, sustained, and often inter-generational investment for us to see those returns.”  
“A perpetual learning environment should be a goal of any organization that really wants to make an advance with regard to diversity, equity and inclusion.”
“We need diversity in thought, and diversity in culture and background, because people bring their life experiences into that filtering process. That all matters if we are going to make good decisions, especially in healthcare, with how we take care of people.”
© Copyright 2023 Movement is Life Inc.
Host: Mary O'Connor, MD
Research & Production: Rolf Taylor 

As the number of patients getting value-based healthcare doubles, many more high-risk patients are excluded. EMMT is a potential bipartisan solution. Episode 143.

Value-based care has emerged as an alternative and potential replacement for traditional fee-for-service reimbursement, centering quality and outcomes rather than quantity. That is the theory.
In practice, value-based care has been shown to exacerbate some disparities in the healthcare system by making it harder for those patients with complex conditions, or being impacted by social determinants of health, to access care. Put simply, if some categories of patient are more financially risky than others to treat, providers may find ways to exclude them – unless checks and balances are put in place to help manage risks associated with SDOH and comorbid conditions.
Health policy expert Matt Reiter hosts a discussion featuring Bill Finerfrock from Capitol Associates, and Tom Dorney from The Root Cause Coaltion. Together they discuss the very real danger of widening health disparities resulting from the expansion of value-based care, and the legislative solution proposed by the John Lewis EMMT Act (Equality in Medicare and Medicaid Treatment) which has been reintroduced in 2023 by Rep. Teri Sewell and Sen. Cory Booker.
All organizations advocating for health equity are encouraged to help advance the legislation by writing letters of support (template below) to Matt Reiter reiterm@capitolassociates.com who will coordinate their forwarding to Representative Sewell and Senator Booker.  
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LETTER OF SUPPORT TEMPLATE 
Dear Representative Sewell & Senator Booker, 
I am writing in support of S.1296/H.R.3069, the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act of 2023.
The EMMT Act would require the Center for Medicare and Medicaid Innovation (CMMI) to include experts in health disparities and social determinants of health as part of the evaluation and review process for new payment models. If enacted, this bill would also require fairness of these new payment methods for women, high-risk patients, patients from racial or ethnic minorities, or patients from rural communities. Lastly, it directs CMMI to develop and test a payment model that is tailored to addressing social determinants of health.
While quality and cost are important considerations, equal consideration should be given to the impact a proposed model may have on access to care for women, minorities and beneficiaries residing in rural areas. CMMI is under no statutory obligation to account for social determinants of health when considering new payment models. Indeed, the only factors CMMI must consider when determining whether to approve a new payment model are quality and cost.
Because Medicare is the single largest health care payer in the country, and many commercial insurance plans will adopt policies based on Medicare, Congress must ensure that the models approved by CMMI incentivize reductions in minority and rural health disparities and not create barriers to care. We appreciate all that this CMS Administration has done to advance health equity. Passing the EMMT Act will ensure that all new models account for social determinants of health and how the models impact minority and rural populations.
Your leadership on eliminating health disparities for women, minorities and beneficiaries residing in rural areas is deeply appreciated.
I applaud your leadership on this important bill. The EMMT Act will go a long way towards improving access to quality healthcare for Medicare and Medicaid beneficiaries.
On behalf or our organization: 
Sincerely,
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Health Disparities Podcast Episode 143 (c) Movement is Life 2023