The Health Disparities Podcast

Building healthy communities against a backdrop of declining healthcare infrastructure. With Dr. Alisahah Jackson & Dr. Tamara Huff. Episode 139

Dr. Tamara Huff, MD, MBA sits down with Dr. Alisahah Jackson for a discussion about enhancing the health of every community, and they explore the challenges of building healthier communities against a backdrop of declining health infrastructure, particularly in rural communities. They also discuss the reality of the elephant in the room, that racism exists both in terms of attitudes and bias, and in various structural forms, and how building trust is vital to the displacement of bias. 
Dr. Jackson is a proven leader in empowering women to improve their health and the health of their families and communities. She was named the first Chief Community Impact Officer at Atrium Health, where she established strategies for Health Equity and Social Determinants of Health. More recently, she became the System Vice President, Population Health Innovation and Policy, at CommonSpirit Health, and is also CEO of Why Health Matters. Dr. Tamara Huff is a member of Movement is Life Steering Committee & Founder & CEO, Vigeo Orthopedics, LLC.
Excerpts: 
“There are decisions that are being made for us that actually drive health outcomes. Economic, policy and investment decisions. People may live in a food dessert. Or a maternity dessert. We have to start acknowledging that these decisions are happening outside of our own decisions about our health behaviors.” 
“Providers will often label patients as “non-compliant,” and that is a term I encourage everyone to take out of their vocabularies. I simply don’t believe that people wake up in the morning and decide that they want to be unhealthy. Our responsibility as care providers is to identify what the barriers are that people have to achieving great health, and help patients mitigate or eliminate them.”  
“I was a young African American female physician coming into a community that had only seen one other Black female physician, and I really had to build trust. I’m not going to sugar coat it, there were definitely patients who did not want to see me.”
“One of the things I love about Movement is Life is that you are providing resources to help with behavior change. And thank you, Movement is Life, for being an accelerator of these much needed conversations.” 
“What the data tells us, what the research tells us, is that people who have providers who look like them, who can connect with them, tend to have better health outcomes. Movement is Life has been culturally humble enough to say that things like food are very cultural, it’s one of the things that makes a group uniquely different, so their needs are different. Changes in Hispanic culture are going to look different to changes in African American culture, and different from the dominant culture.” 
 

Diversity is where it starts, belonging completes the cycle. How inclusion when setting the agenda combines with diverse voices at the decision-making table to advance health equity.

Dr. Garfield Clunie (NYU Langone) works on the frontline of maternal child health in New York City, where recent policies to standardize treatments are part of efforts to replace outdated race-based decision-making with more equitable care. This insightful conversation, hosted by Dr. Michelle Leak (Mayo Clinic, Florida), covers several discussion areas. Firstly, the importance of the concept of belonging, which Dr. Clunie believes is at least equal to the more commonly referenced trio of DEI. Secondly, addressing the need for patients to receive care from people who look like them, and the challenges in increasing diversity in the healthcare workforce. This includes proactive policies such as resourcing mentorship appropriately so that it is not an additional unrewarded burden to health equity leaders. Dr. Clunie and Dr. Leak also discuss aspects of the Movement is Life annual Caucus experience, and some suggested health equity reads. With host Michelle Leak, DEd, MBA, FACHE, Mayo Clinic, Member, Board of Directors, Movement is Life; and Dr. Garfield Clunie, Associate Professor of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Vice-Chair, Diversity, Equity and Inclusion, NYU Grossman School of Medicine/NYU Langone Health, & the 123rd President of the National Medical Association. © Movement is Life 2022-2023.
“Diversity is like being asked to attend the party. Inclusion is being asked to dance at the party, equity is having the same space as everyone else in which to dance. But belonging is being involved in the planning of the party and which kind of music is there. So, you are completely immersed with the other participants, and your input is equal to everyone else’s input.”  ~ Dr. Garfield Clunie
“The take home message is that diversity is important in all realms of our life. In business, medicine, in healthcare. And it’s very important to have different lived experiences come to the table, to create solutions that will be beneficial to tall.” ~ Dr. Garfield Clunie
“When it comes to diversity, equity, inclusion, and also belonging, I personally believe that out of all of those belonging is the most important.” ~ Dr. Garfield Clunie
“Many medical students comment on the positive value that diversity brings to their experience in education. When you bring all the dimensions of diversity together, all the benefits that these dimensions bring to an organization, and to patients, is seen in better quality of care, better decision making, and better leadership.” ~ Dr. Michelle Leak
“Not everyone has the same background or pathway, but they have the same perseverance. A holistic review application (to medical school) takes into account and places value on unique experiences and attributes beyond the standardized tests. But once you have a place, you are still going to have to pass the same exams.” ~ Dr. Garfield Clunie
“In maternal and child health, to try and remove bias, we have moved as much as possible towards standardized care. Every patient is an individual, but it’s unfortunate that in medicine we have adopted different thoughts for different races and ethnicities. In New York City we have made a big effort to remove instances where race is used as part of treatment algorithms. I think that using race or ethnicity to determine treatment pathways is absolutely the wrong way to go.” ~ Dr. Garfield Clunie

From Anti-racism to Z-codes, following the JEDI path to health equity. Episode 137.

Episode 137. Following on from a workshop titled “JEDI Journey: This is the Way,” our diverse panel discusses the importance of processes such as integrating the social determinants of health (SDOH) into information systems via Z codes to advance Justice, Equity, Diversity & Inclusion (JEDI) & anti-racism. With episode host Charla Johnson, DNP, and guests Tonya Jagneaux, MD, Holly Pilson, MD, and Daytheon Sturges, PhD.
The group also explores achieving workforce diversity in general and orthopedic surgery specifically, which is the least diverse specialty of all. With current trends it will take 217 years to reach parity in terms of race and gender representation, and the group shares strategies for accelerating the pace. We hear how part of the challenge is getting diverse students into schools, but once this is achieved the environment must be set up for success. Otherwise, tokenism can lead to isolation and burnout. With pointers towards actionable steps and resources, this episode takes DEI up a notch.
© Copyright Movement is Life 2022-2023
Host: Charla Johnson, DNP, RN-BC, ONC
Secretary, Board of Directors, Movement is Life
System Director, Nursing Informatics
Franciscan Missionaries of Our Lady Health System Baton Rouge, LA
Featuring:
Tonya Jagneaux, MD, MSHI, FCCP
Chief Medical Information Officer – OLOL
Associate Professor of Clinical Medicine, Pulmonary/Critical Care, Louisiana State University Health Sciences Center, Baton Rouge Campus
Holly Pilson, MD, FAAOS, FAOA
Associate Professor of Orthopaedic Trauma, Vice Chair of Social Impact, Co-Director of Diversity and Inclusion, Co-Director of Clinical Research, Department of Orthopaedic Surgery and Rehabilitation, Affiliate Faculty of Maya Angelou Center for Health Equity, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine
Daytheon Sturges, PhD, MPAS, PA-C, DFAAPA, CHES®
Assistant Professor of Family Medicine, Vice Chair for JEDI, Associate Program Director for Regional Affairs and Academic Affairs, JEDI, MEDEX Northwest Physician Assistant Program, University of Washington School of MedicinePhysician, University of Washington Primary Care – Northgate
Producer/Editor/Writer: Rolf Taylor 
Resources: 
USING Z CODES: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes: https://www.cms.gov/files/document/zcodes-infographic.pdf
Advancing excellence in PA education through leadership, scholarship, equity, and inclusion. DEI Toolkit & Best Practices Guide: https://paeaonline.org/diversity-equity-inclusion
Fewer Words, More Action: Cultivating an Anti-Racist Environment Strategies/Solutions (CARES) Framework for Physician Assistant Education. Carl Frizell et al: https://pubmed.ncbi.nlm.nih.gov/34817435/
Excerpts: 
We need to do a rebranding and a paradigm shift, so that we don’t view diversity as a risk, but we view it as a strength, and we view it as beautiful. I use that term because this is not only hard work it is heart work, and there is some emotional exhaustion that comes with that.” ~ Daytheon Sturges PA-C
“It’s voluntary in 2023 then mandatory in 2024 to be screening for social determinants of health for Medicare and Medicaid for reimbursement. So, people really need to understand the importance of this, and it can’t be just another check the box. At Our Lady of the Lake we have a marketing slogan, “we listen, we heal,” – which is perfect alignment with integrating social determinants of health.” ~ Charla Johnson, DNP
“Just like we look at things like A1C, I’d like to see Z codes be reviewed routinely so we ask the questions, have we resolved food insecurity, have we resolved homelessness, and we can report on that and close that loop. And I really appreciate a provider wanting to use Z codes.” ~ Tonya Jagneaux, MD
“From the vantage point of the good, the bad, and the ugly, the good is that the trend for gender and race diversity is that orthopedic surgery has got better. But the bad is that we remain, year after the year, the least gender, race and ethnically diverse specialty in all of medicine, recruitment efforts alone have not reversed that. To get to parity at the present rate would take 217 years.” ~ Holly Pilson, MD
“I liked how you laid it bear that your zip code is more of a social determinant than your genetic code, and speaking of codes, I really like that you introduced the Z codes as well because that introduces a level of accountability. When you document it, you then have to have a plan about it.” ~ Daytheon Sturges PA-C
“We had two great talks from Cara McLellan and Frank McLellan, and I am going to start using that term: The power of the purse. Until you incentivize it, it does not become a priority. When people see a target then they see this is the journey we are taking.” Tonya Jagneaux, MD
“My part of the session was about workforce diversity, particularly in orthopedic surgery, and what better specialty to talk about in terms of workforce diversity than the one that struggles the most with it.” ~ Holly Pilson, MD
“When you fix policy at the system level then you are able to see more results. We need to look at policy with a JEDI lens, so Justice, Equity, Diversity, and Inclusion, but I also add in anti-racism, to become anti-racist we have to center and discuss race. We are looking at our policies using an equity impact tool, and we are looking as possible harm as well as alternative approaches.” ~ Daytheon Sturges PA-C
“One of the quotes I heard recently is “Nothing about us without us,” it takes bringing those stakeholders to the table, working alongside them and with them, to figure out how we get to more equity in this space.”  ~ Holly Pilson, MD
“It’s important that the minority people who are leading these efforts are doing it alongside and with the majority members of our departments and institutions, because it takes both together. “It’s important to equip the champions and provide education. I have my lived experience as a gender and racial ethnic minority, but I’m not a (DEI) expert.” ~ Holly Pilson, MD
“Medical students have consistently said that orthopedics as a specialty is less welcoming. I don’t know if it’s the surgical culture, some the other specialties mentioned as being less welcoming were also surgical.” ~ Holly Pilson, MD
“I like to offer a DEI toolkit that the Physician Assistant Education Association (Diversity and Inclusion Advancement Commission) has developed.  It’s 6 steps of a quality improvement loop.” ~ Daytheon Sturges PA-C
“Target the leadership structure: what is the racial composition? What voices are there? Do you have buy-in? These are the people who are yielding and wielding power. We need to look at admissions and ask how can we kick the door open and look at our applicants holistically, because this is where the gatekeeping is. We will never have a diverse medical workforce if the schools are not admitting these students.” ~ Daytheon Sturges PA-C
 
 
 

Hispanic panel: The social influences of health, translating “medicalish,” and understanding intersectionality.

People live and work in social communities, where a huge amount of information that drives decision making around health is disseminated person to person by community voices. Our panel of Hispanic health leaders discuss how achieving health equity requires healthcare providers to utilize social influence as a way to improve population health.  
Dr. Adela Valdez describes the concept of community intersectionality, a framework that allows us to better understand the intersecting social and demographic drivers for our communities in order to better meet their needs. Dr. Ramon Jimenez discusses how learning about the intersectionality concept has enabled him to unpack some of his personal experiences and history to better understand his own journey as a Hispanic orthopedic surgeon. Dr. Ilan Shapiro explores the limitations of speaking “medicalish” and the importance of creating culturally appropriate conversations about health within our communities, using tools and language that make health information accessible to everyone, using social and other media. Dr. De Alba Rosales discusses how achieving health equity will require broader approaches that address social, economic, and environmental factors that influence health. This episode is co-hosted by Claudia Zamora, National Hispanic Medical Association, and Dr. Ramon Jimenez, American Association of Latino Orthopedic Surgeons.
All viewpoints are the participants own.
Co-hosts
Claudia H Zamora, MPA
Founder and CEO, Zamora Consulting Group, LLC
Board Member, National Hispanic Medical Association
Washington, DC
 
Ramon Jimenez, MD, FAAOS
Executive Board, Movement is Life
Treasurer, Board of Directors, Movement is Life
Co-Founder and President, American Association of Latino Orthopaedic Surgeons
Salinas, CA
 
Guests
 
Armando De Alba Rosales MD, MPH
Assistant Dean of Diversity, Equity, and Inclusion (DEI) Student Programs
College of Medicine, Faculty Member of Family Medicine at UNMC
University of Nebraska Medical Center
Omaha, Nebraska
 
Adela Valdez, MD, MBA, FAAFP
Associate Dean, Diversity, Inclusion and Health Equity
Associate Dean of CME at The University of Texas Rio Grande Valley
Professor, Family Medicine
University of Texas Rio Grande Valley School of Medicine
Harlingen, Texas
 
Ilan Shapiro MD, MBA, FAAP, FACHE
Chief Health Correspondent and Medical Affairs Officer
AltaMed Health Services
Los Angeles, California
 
© Copyright Movement is Life 2023.

Integrating clinical excellence with health equity at Walgreens & driving urban innovation at the Lindy Institute. Featuring Dr. Priya Mammen, MD, MPH

Integrating clinical excellence with health equity at Walgreens, & driving urban innovation at the Lindy Institute. Featuring Dr. Priya Mammen, MD, MPH 
Emergency room physician and public health leader Dr. Priya Mammen, MD, MPH, still misses her acute care patients, but building on her clinical experiences has enabled her to find ways to advance both urban innovation and health equity.
In this interview, recorded at the annual Movement is Life caucus, episode host Dr. Charla Johnson invites Dr. Mammen to talk about her work with the Lindy Institute for Urban Innovation, her role as Senior Medical Director, Office of Clinical Integrity at Walgreens, and as adjunct faculty at the University of Pennsylvania. Dr. Mammen also discusses some of the themes from her presentation at the caucus, Walgreens: Advancing Health Equity with Community Engagement. 
Featuring:  
Dr. Priya Mammen, MD, MPHSenior Medical Director, Office of Clinical Integrity, Walgreens,Emergency Physician, Public Health Specialist,Adjunct Faculty, University of Pennsylvania, Fellow at Lindy Institute for Urban Innovation
Hosted by:  
Dr. Charla Johnson, DNP, RN-BC, ONCMovement is Life Steering Committee, Immediate Past President, National Association of Orthopedic Nurses, System Director, Nursing InformaticsFranciscan Missionaries of Our Lady Health System
Production:  Rolf Taylor, Project Advocacy
All opinions expressed are the participants own.
Copyright © Movement is Life 2023. 
Selected Excerpts
“It is not only my profound responsibility, but it is a deep, deep honor to take forward the stories and the voices of patients that have taught me for my entire career.” 
“I miss my patients and I miss touching people. There is that tactile component that I did not realize I would miss. Apparently, I am always checking my husband’s pulse!”
“The populations who are marginalized and disenfranchised often get missed if you look at the health system as a whole.” 
“Cities are engines of innovation, a group of people who have chosen or remain in a finite community. We learn how to coexist. Everything we do is intertwined with the rest of the city. Cities can answer their problems if you bring their leaders, their champions, and the voices of all the cities communities together.” 
“Emergency medicine is the only part of the US health system that is user-triggered, and as Prof. McClellan pointed out, the only truly equitable part of the US health system is EMTALA (The Emergency Medical Treatment and Labor Act). What becomes grueling is to try and help in situations where you need to move people beyond the emergency room.”

Playing “The Race Cards” from 904WARD can create safe spaces for building understanding and advancing equity. Featuring Dr. Kimberly Allen.

“The Race Cards” is an interactive resource kit and activity designed for small groups. Working to end racism so that everyone thrives requires some uncomfortable conversations to be facilitated, because too often discussions about race either stay at the surface level or happen only among audiences steeped in knowledge about sociology, history, systemic racism, and privilege. The Race Cards create a safe space for an honest, authentic discussion in a way that is accessible to everyone.
Dr. Kimberly Allen is the inaugural CEO of 904WARD. Her organization evolved the Jacksonville 904 dialing code into a new nonprofit whose mission is to create racial healing and equity through deep conversations and learning, trusting relationships, and collective action. Episode host Sarah Hohman invites Dr. Kimberly Allen and 904 resident Sharon LaSure-Roy to reflect on the practical application of The Race Cards and report on their use in a workshop at the Movement is Life annual caucus.
Link to 904WARD resource page: https://904ward.org/racecards/ 
Copyright © Movement is Life 2023. All opinions expressed are the participants own. 

COVID connections: How resiliency training and social contact in the era of COVID-19 support mental health, behavioral change and addiction recovery.

COVID-19 impacted mental health in fundamental ways, forcing isolation and insecurity on individuals, families, and communities. Dr. Reginald Richardson explores ways we can rebuild resilience as we transition from pandemic to endemic, with particular emphasis on social support. Dr. Richardson also discusses how isolation has had a particularly damaging influence on alcohol and drug addiction rates and overdoses, with limited access to emergency mental health services contributing to poor outcomes. Episode host Dr. Yashika Watkins and Dr. Richardson also unpack some of the features of the stages of behavioral change, noting commonalities between the processes of increasing physical activity and reducing alcohol and food consumption, and how these changes can be facilitated through social contact in a group setting, as demonstrated by the Movement is Life program Operation Change.
Copyright © Movement is Life 2023. All opinions expressed are the participants own. 

Round Table: Personal experiences of how affirmative action has increased Hispanic & African American healthcare workforce diversity.

Diversity as a goal has been considered a compelling reason (and legal precedent) for higher education institutions to apply policies which attempt to correct the effects of intentional and structural discrimination impacting gender, race, and ethnicity.
Our esteemed panel of healthcare stakeholders and health equity advocates share personal experiences of how affirmative action has benefitted them, and the Hispanic and African American healthcare workforces in general. The discussion also explores affirmative action policy milestones, the positive impact these policies have had on overall workforce diversity and STEM education programs, and other knock-on effects such as increasing diverse participation in clinical trials.
Featuring Mary O’Connor, MD, Oly, Chair of Movement is Life, Co-Founder & Chief Medical Officer, Vori Health (host); Prof. Frank McLellan, Esq., Professor Emeritus, Beasley School of Law, Temple University; Elena V. Rios, MD, MSPH, MACP, President & CEO, National Hispanic Medical Association; Bonnie Mason Simpson, MD, FAAOS, Medical Director of Diversity, Equity, and Inclusion, American College of Surgeons; Ramon L. Jimenez, MD, Board-Certified Orthopedic Surgeon, Treasurer of Movement is Life. Copyright © Movement is Life 2022.

Affirmative Action: As severe under-representation of minorities in the healthcare workforce persists, affirmative action now faces a legal challenge in the Supreme Court.

Featuring Cara McClellan, JD, MEd, and Mary I. O’Connor, MD.
Addressing the under-representation of racial minorities in the health professions is considered central to reducing overall health disparities and inequalities. Multiple “race-conscious” laws and policies have been introduced that seek to help marginalized communities, ranging from affirmative action to voting rights, reproductive rights, and environmental protections. Legal action now brought before the Supreme Court by conservative activist Edward Blum calling for all higher education admission applications to be effectively “color-blind” could end affirmative action as we know it, with wider ramifications for race-conscious legislation.
In this episode of the Health Disparities Podcast, Cara McClellan, JD from the Advocacy for Racial and Civil (ARC) Justice Clinic at the University of Pennsylvania Carey School of Law in Philadelphia unpacks the origins of affirmative action with Dr. Mary O’Connor, Chair of Movement is Life. Together they discuss the foundational impact of the 14th Amendment to the United States Constitution, the role of the Freedmen’s Bureau, the Civil Rights Act of 1964 and the Higher Education Act of 1965, and current judicial deliberations. Depending on how SCOTUS rules on overturning affirmative action, the long battle to desegregate higher education in the United States could take a backwards step. But are there alternative approaches?
Copyright: Movement is Life 2022 

Health Zones & Healthy 2030 Goals: CVS & Aetna commitment to community health equity with Jennifer Truscott

Jennifer Truscott is Senior Vice President, Cross-Enterprise Strategic Innovation, with Aetna, whose parent company is CVS. Jennifer shares some of the ways in which CVS is centering and investing in health equity, particularly at the local level, by leveraging the strong engagement that CVS has with many underserved communities. Initiatives discussed include investments in specific “Health Zones,” and also in affordable housing. Jennifer also shares her thoughts on the importance of acting locally, and a great health equity read called Take us to a Better Place, RWJFs first book of fiction. With host Dr. Jonathan Silver, Chief Orthopedic Physician Associate, Department of Orthopedics, Kings County Hospital Center, New York, and President, Academy of Doctoral Physician Associates.
Resources and initiatives mentioned in this episode:
CVS Healthy 2030 Goals: https://www.cvshealth.com/social-responsibility/corporate-social-responsibility/healthy-2030-goals
About CVS Health Zones: https://www.cvshealth.com/social-responsibility/health-zones  
Take us to a Better Place, RWJFs first book of fiction:  https://www.rwjf.org/en/library/research/2019/11/take-us-to-a-better-place-stories-coming-january-2020.html
Excerpt:
“At CVS we are concerned about the health disparities in our communities. There are disproportionate rates of illness and death and limited cultural competency among providers and resources. We see ongoing and deep-rooted discrimination and racism…it’s those -isms that we just have to uncover and address. And until we have those honest conversations, we are never going to be able to solve them.”  ~ Jennifer Truscott, CVS & Aetna
Copyright © Movement is Life 2022