Prescribing Change: Tackling Black Health Disparities

This episode will discuss black health and the different ways community members, health care professionals, and politicians can make strides to end health disparities. It is known that black people in the United States are more likely to suffer from chronic conditions such as diabetes, hypertension, asthma, making their life expectancies much shorter than their white counterparts. According to the Centers for Disease Control and Prevention (CDC) in 2017, the average life expectancy of a black American is 75.3 years compared to 78.8 years for their white counterparts. The cause for these visible inequities isn't limited to systemic racism and bias in the healthcare and medical treatment, but also to the lack of access to care, information, and socio-economic differences. So, join Hemen Mekonnen, an incoming fourth year public policy major with a track in health and population and an intern at UCR School of Medicine Center for Healthy Communities, as she explores this critical issue. We will hear from Michelle Burroughs, Director of UC Riverside Center for Healthy Communities and public health experts, and Dr. Sims, a professor in the UCR medical school Department of Social Medicine, Population, and Public Health

Transcript

[Intro]

Hello, welcome to Healthy disruptions, a podcast about health and health inequities across our diverse communities in southern California. In this podcast, we speak with community members, students, researchers, and leadership to bring you real experts on health disparities. Join us each month as we discuss local issues as they are happening and highlight members of our communities who are seeking better health for themselves and their communities.

Hemen Mekonnen:

I'm Heman Mekonnen, an incoming fourth year public policy major with a track in health and population at UCR. I'm also an intern at UCR School of Medicine Center for Healthy Communities and I am thrilled to be your host for today. Joining me is Michelle Burroughs, Director of UC Riverside Center for Healthy Communities and public health experts, and Dr. Sims, a professor in the UCR medical school Department of Social medicine, population and public health. In today's episode, we'll discuss black health and the different ways we can make strides to end health disparities. It is known that black people in the US are more likely to suffer from chronic conditions such as diabetes, hypertension, asthma, making their life expectancies much shorter than their white counterparts. According to the CDC, in 2017, the average life expectancy of a black American is 75.3 years compared to 78.8 years for their white counterparts. The cause for these visible inequities isn't limited to systemic racism and bias in the healthcare and medical treatment, but also to the lack of access to care, information and socio economic differences.Thank you for being here with us say I'd like to give you the floor to say a few words before we delve deeper into our discussion.

Michelle Burroughs:

Oh, I just appreciate you having me Hemen. I am very passionate about public health. And I'm excited to be a part of this podcast. 

Dr. Mario Sims:

Yeah, so thank you for having me, Hemen. And I'm glad to talk about some of my work as far as social determinants of cardiovascular disease. And also get into some of the discussion points about specific groups, their health inequities, disparities here in the Inland Empire as well as the nation as a whole, particularly marginalized and minoritized groups. 

Hemen:

Perfect. Thank you both so much. So Michelle, you have a remarkable mission to educate marginalized community members to not only take action when it comes to their health, but to also advocate for themselves in the health care world. Could you please tell us what health disparities mean to you, especially as it relates to black health?

Michelle:

Absolutely, I'd be honored to share my perspective on this critical topic. So health disparities represents a deeply entrenched and unjust inequity in access to health care resources and opportunities that disproportionately affect marginalized communities, specifically the black community. So when, when discussing health disparities within the realm of black health, we're addressing multifaceted issues. It's about acknowledging undeniable reality that black individuals often face disproportionately higher rates of chronic illnesses, shorter life expectancies, and limited access to quality health care services, is also it also further exasperates by social determinants of health such as systemic racism, economic inequality, educational disparities, and unequal distribution of resources. For me, health disparities in black health represents a systemic failure, a failure of our healthcare system to provide equitable care, a failure of policymakers to address the root cause of these disparities, and also a failure of society to recognize and dismantle the barriers that prevent black individuals from achieving optimal health outcomes. So I believe it's important to emphasize also that health disparities are not solely due to individual choices or behaviors, a lot of individuals pinpoint people right, they say it's because you are not conducting yourself in a way that would manifest optimal health. But that's just not the case. There are other things that are rooted in historical and justices, discriminatory practices and ongoing prejudices that create a complex web of obstacles that disproportionately affect the black community, and also other marginalized communities, which impacts or which causes health disparities.

Hemen:

Yeah, no, thank you. Definitely the idea of it being a multifaceted approach is something to take into consideration as one single approach is not something that could be taken in this regard. So thank you for that answer. Michelle,

Michelle:

You definitely have to think about, like I said, like you said, multifaceted, you have to think about all the things that contribute to health disparities. It's just not one soul. You know?

Hemen:

Most definitely. Yeah. Thank you. So I understand that you were one of the lead organizers and the fourth annual health disparities research symposium back in February. Would you be able to explain the importance of this event? Like what were the key issues that were discussed and what were key initiatives presented to address equity and access in the inland region? 

Michelle:

Absolutely. So the symposium I was so pleased and so happy to be a part of that. And it serves as a platform to bring awareness to pressing health disparities that exist in Southern California, particularly within our inland region. This event aimed to foster a collaborative environment where researchers, health professionals, community leaders and policymakers could come together and share insights, particularly about our research findings and innovative initiatives that are aimed at addressing health disparities in the Inland Empire. One of the key focal points of the symposium was to address the health disparities that affect our community members, specifically, our Latin X and other marginalized populations. We discussed issues about health care access, quality, and outcomes or health outcomes, which are often again rooted in social determinants of health, such as income inequality, education, and housing and environmental factors. And we talked about environmental justice.

That's emerged as another critical issue that's affecting the Inland Empire, specifically around air quality, and how it's impacting our health like out in the Salton Sea with a lot of our indigenous communities being impacted by asthma, as it relates from again, harmful particulates that are being emitted out into the air. So we delved into what that looks like, as far as the pollution, environmental hazards, and different things that our community members have to encounter or are encountering in the inland living in the Inland Empire, and how we want to turn things around, we want to create more green spaces. We want to, you know, of course, find interventions and different things that we can do to improve our health outcomes. So I was very excited that we were able to bring all those individuals, different people from different perspectives together to address these concerns. And one of the central symposium goals was to pursue health equity. And what does that look like? So we had two amazing speakers, Dr. Briggs-Malonson, and Dr. Marshare Penny shaping, who helped us understand how to move towards equity and justice. And this involves rectifying the unequal distribution of resources and opportunities that lead to disparate health outcomes. Most of the attendees explore strategies to create a more just and equitable health care system that provides everyone with fair access to healthcare quality, regardless of their background or circumstances. So we talked a lot about enlightening speakers, what health equity really looks like, and actionable steps that we can take to you know, move towards a more what they call equitable and just society. So one of the noteworthy projects there are actually many noteworthy projects that were presented at the symposium, but one in particular was addressing the health disparities through virtual care to prevent postpartum depression. And this project brought to the forefront that women have lower socioeconomic statuses. And those with lower social support levels are at higher risk of postpartum depression. So these women often go undiagnosed or untreated due to barriers to their access to health care. The group interventions were telephone based. So they had a peer support group that was telephone based. And it showed to reduce the risk of postpartum depression by having that social context and that, you know, not them not having to leave their home or trying to provide childcare or find childcare, right, while they go to seek some type of individual therapy. They were able to do put together a collective group of women over the phone or over zoom, where they could be there to support one another. So I thought that that was very innovative and a good way to address an issue you know, as far as postpartum that may not you know, again, they go untreated and don't really often have the support because of their the limitations that you know, are there as it relates to access to, you know, behavioral health or mental health services. So I really appreciated one of our presenters being able to share her research study and what she's doing to address an access issue, and to also eliminate some barriers to care for women out in the East Coachella Valley.

Hemen:

Wow, that's very interesting. I didn't know about this. And it's that idea that there was a focus group or some sort of like telephone line that was presented for just women and dealing with postpartum depression. And you said that those phone calls or those zoom calls, were they kind of like a therapy session? Or is it kind of like focused around just hearing women out and what they were going through, during that period of their lives? How was that really centered? 

Michelle: 

It was both. It was both just hearing from them, right? Giving them a safe space to be able to share their concerns or their thoughts about what they were going through, you know, post having a baby and what the support look like for them. So it was it was, you know, multifaceted again, it allowed them a safe space to be able to talk about their concerns and be able to relate to other women and what you know, they may be going through.

Hemen:

Wow, thank you so much for that. Michelle, the What a beautiful project. So turning to you now, Dr. Sims. So black people in the US are more likely to suffer from chronic conditions such as diabetes, hypertension, asthma, making their life expectancy much shorter than their white counterparts. What do you believe are the key factors contributing to the higher prevalence of chronic conditions among black individuals in Southern California, when we compare them to their white counterparts?

Dr. Sims:

Well, that's a $2 million question there. Its multi layer, multi prong sort of approach to the answer.  I think it's known that not only are behaviors different across ethnic and racial groups that contribute towards the disparities and chronic conditions such as diabetes or hypertension. So behaviors such as you know, diet, physical inactivity, things like that are associated with higher prevalence of these types of chronic conditions, behaviors such as smoking, alcohol abuse, or consumption. Those all have factors that are associated with higher risk of these types of chronic conditions. But they're also not only these biological risk factors that might impact one's behaviors. You also have social determinants that impact these risk differences across various groups in the Southern California area, as well as the nation as a whole things like residential segregation, where you live, it shapes your environment, your ability to exercise to be exposed to safe environments, where you can get out and exercise you can choose to tour, healthier profile cardiovascular health. So you have the segregation effect, you have just a number of things that one can trace towards health inequities, things like stress exposures, we see that a higher prevalence in minority populations, higher personal stressors, such as various forms of discrimination, those are associated with higher risk of chronic diseases among minority populations, which impacts not only one's physical health, they impact one's mental health. So you have a higher incidence and prevalence of mental or we call negative pathologic conditions such as anxiety, depressive symptomatology, and then things like that follow down towards the lower cascade things like anger, which are then associated with things like one's behaviors and being feel a certain way then you're not going to be as likely to engage in certain behaviors, which then contributes toward you know, higher blood pressure in things like diabetes and then even obesity and even the inflammatory pathway, you have higher levels of C reactive protein, which are then associated with downstream factors such as heart attacks and angina chest pain and then thereby mortality. So you have lower life expectancy. So you see how this cascade occurs on the social determinants exposure to downstream cardiovascular events and different prevalence levels across various groups. So other groups do not experience these types of stressors, negative affect states as readily as other groups do. And even when they do they have different ways to cope with them. You know, they may have social supports that are in place, access to health care, treatment facilities and things like that. So you see that there's this difference, even if they do experience some of the same conditions, which are under the rubric of what we call social and psychosocial determinants of health. So that's just a little bit about to provide a little bit of that answer. 

Hemen:

Yeah, no, thank you so much for that answer. Definitely. It is something to think about. It's not only just a single faceted approach to this question. There's a lot of things that come into it. So it's definitely something that we must keep in mind when we, you know, tackle these type of problems in our community. So thank you for that answer. Dr. Sims. Moving on to our next question. In your opinion, what are the primary barriers that black individuals in Southern California face when it comes to accessing health care services? How do these barriers contribute to the disparities in health outcomes? 

Dr. Sims:

Well, again, involves a multi prong approach. It's not a single silver bullet that one prescribes and problems go away. You have to look at structures that have where the systems are embedded in that produce discriminations and prejudices, and things like discrimination and segregation, lower access, lower levels of education was produced lower levels of incomes produce lower access, which then produces and creates a culture of prejudice and the healthcare treatment arena would you have, do you have discord in Concord in pairs of black faces versus an a black doctor do you have a different type of treatment regimen versus a minority patient and a white doctor, particularly male doctors, they may feel and treat you differently, not give you access to proper therapeutics, medications, treatments. So you have that in the healthcare system that perpetuates inequities, but it's built based on an upstream system of discriminations and inequalities that are built into the systems like the healthcare system, the insurance industry, and just what even not only the the more of the macro level factors, but the individual interpersonal types of factors impact health inequities, like I explained the treatment between patient and provider. And also, even in these settings, minority patients tend to participate less in their treatment. They're not as engaged with their health care providers as our other populations, particularly white populations. They don't know what questions to ask, they don't feel as involved nor do the provider invites them to be participants in this health care, exchange, as they do other groups. That's the research has shown. So as not much of my opinion, is based. It's based in what's been demonstrated in the literature and healthcare, healthcare services research, which shows those types of things. Those are just a few examples of not only my opinion, but based on what does the research bear out as to why these inequities exist in the health care services? 

Hemen: (18:40)

Yeah, to follow up on that, have the research provided any type of solutions as to how we can as a community, or an institution or just like community members in general? How can we build that trust between marginalized people and their health care providers so that they're more engaged in their health and take action? 

Dr. Sims:

Yeah, I think that programs such as CHC, being engaged with the community, build relationships, and that takes time to gain the trust of a community as one who represents what we call the ivory tower, or the Academy because, you know, in the past, relationships have not been good. And even in present day, when many universities and surrounding communities you know, the citizens or or the citizens of those immediate communities, you see the academic researchers, as doing drive by research, you know, you collect our data, you collect our blood, you collect our sample, we don't know where you go after that. What do you do so when you need to publish these papers, what does that mean for me and my family? What are the actionable steps that can take place beyond, you collected my data beyond where US inviting you into our homes, to our communities, what are the things that we can take to improve our health and how are you contributing toward it, a participant may say, towards a researcher. So it's just it's those types of things. It's, it's rooted in the historical experiences of the Tuskegee syphilis study, you know, as to particularly black populations and other minority populations as well. You know, we've experienced hardships and blatant inequities in the past. So we're not as, let me see quick to, I guess, get on board with certain medical research or certain, you know, CBPR initiatives coming from local university. So it takes time, takes time to forge those relationships, particularly in his heart as among men too, because men are rarely involved in studies versus women. In most studies that I've seen, I've seen it here in Southern California, studies that I've been a part of around the nation, as well as Mississippi, personally placed in LA. So we have to do a better job of creating that trust. And having not only men, but just minority minoritized populations earn their trust. But not only that, we have to include them at the table, where the community are partnering, we're not working, they're not working for us, we're working together to create solutions. And they have to be equal partners at the table.

At the front end of things not downstream, where you create your hypotheses, you create a program, and you try to stick it on a community and say, Ah, we have the solution, that's not going to work, I don't care how good your program is, they have to have some way they have to have decision making, they have to have buy in. And they have to have leadership as well. So that's very, very important. So if you work in from that type of model, which I know, Michelle Burroughs, and you all and at CHC, are working toward that end, and even other researchers around UCR, then you'll have that participation. And then these types of engagements with the community building a trust building to the efficacy within your community, you're more likely to get them on board with the program. And then you'll more likely see reduce disparities, you're more likely to see favorable health outcomes, not only in participants, but in their children, because what happens, they spread the word about this program, they spread the word today, children and have different practices over time, and better blood pressure, more optimal blood sugar values, which leads to better cardiovascular health, not even cardiovascular risk anymore, right? Because, I mean, so So you said it just it amounts in making some easy decisions upfront. But for a lot of people is really radical because it hasn't been done. So when you when you do that downstream, you have better outcomes. You have more harmonized community members who are waiting, are willing to, to develop and partner with the University or CHC type centers and you know, forge ahead to produce better health outcomes. 

Hemen:

Yeah, I totally agree. When you're coming up with a program that's going to be beneficial for a community, it is definitely important to have that community have a say in what that program should look like. Because at the end of the day, they're the ones that are going to be benefiting out of it. And also, it's a part of like, the ethical considerations to, you know, having a say and having them kind of like lead also the program in a sense where they can feel comfortable to participate in spread the word just as you said. Thank you.

Dr. Sims (23:37)

Absolutely.

Hemen:

Alright, so moving on to our next questions. Would you both be able to tell me if there are any specific cultural or historical factors that contribute to health disparities within the black community in SoCal? And how should these factors be taken into account when developing interventions or policies to reduce these disparities?

Michelle:

Hmm. So I say one of the key historical factors is the legacy unfortunately of systemic racism. That includes discriminatory practices like redlining. So I'm not sure if you're aware of that. But you know, when communities are segregated and redline, oftentimes, specifically black and brown communities, they are redlined. In areas where there is not adequate housing, the housing is not really, you know, a place where people want to live. There are no green spaces. There, the educational opportunities are limited or below standard, and there's just not a lot of economic opportunities within their community, right, they have to oftentimes commute far distances to be able to earn a living wage. And these disparities have perpetuated you know, socio economic challenges for communities which oftentimes it has to there's no way around it, it affects your health outcomes. So All this has been turned into distrust of a health care system due to historical and medical mistreatment. You know, we have an example of the Tuskegee syphilis study, which led to hesitancy in seeking care. I think for a lot of, you know, members of the black community, they felt like that wasn't a trusted space. And a lot, oftentimes people will say, Well, that was so many years ago, right. But there have been several examples recently, where people have tried to access services and health care. And they found that they were oftentimes discriminated against. So developing effective interventions, and my my belief is, it requires policies, you know, really, it's a multi again, and multifaceted approach, we have to change the policies, community engagement is vital, I think it's very important to go out and talk to the community, and learn from the community, what their perspective is, on whatever the health issue that you're you're trying to address, we must involve local leaders and organizations that, you know, can ensure that the interventions that are out there, they're culturally sensitive and tailored to the community's needs, again, asking the community what their needs are, instead of, you know, feeling like we have all of the answers right, and going out there and putting on to community, what we think they need, but asking them what their needs are, and effective educational campaigns that address the historical and justices, you know, we have to acknowledge, before we can build trust, you have to go into communities and acknowledge the pain that has happened, whether you agree with it or not, you have to acknowledge that all communities of color who have experienced some level of injustice as a relates to you know, accessing care. So we have to acknowledge that to be able to build start building trust. And again, you know, just asking them, What can we do different? What can we do better? What things you know, are currently being done that may be offensive to your cultural practices. And once we do that, then getting to the policymakers, you know, effecting change where we can as it relates to some of these harmful policies that continue to impact people being able to access and receive competent and quality health care.

Dr. Sims:

Yeah, that's a very good question. So there are structural barriers that are embedded within, there's communities and cultural practices and attitudes and ideologies that work to create contemporary inequities and to eliminate, and I think the main one is just structural racism, discrimination. You can't run from that. You can't hide from it. But when you learn to address those and how to address them and coming up with viable programs to address them, then you can attract or attack the root causes getting to the root. You're not hitting at the branch, you're getting to the root to change how people operate, how they think, and then what types of results come about in people's lives. So to eliminate structural discrimination, adverse communities must be transformed. Basically, it has to be a holistic approach. Communities must promote health for historically marginalized groups, and reducing disparities will require restructuring of systems to improve conditions that affect health, the health of people in workplaces, neighborhoods, schools.

So education interventions has been shown that improve education quality to increase things like graduation rates, improve cardiovascular health of children in different stages of a life cycle. So that's been shown to have complete great efficacy. And then other programs that expand income and employment opportunities that reduce discrimination in the workplace have been shown to result in more favorable health outcomes, and movement toward health equity when you have these types of programs and second policies to improve. Also, the quality of housing and neighborhood environments have been shown to improve the mental and physical health of individuals. And the third thing, future policies must eliminate inequities and access to quality of health healthcare. So for example, the Affordable Healthcare Act increase the access to insurance and healthcare for historically marginalized groups and underserved groups who lack insurance. But it must be done. But I think more should be done when you can make these interventions more scalable to broader segments of the population than you see broader changes. You'll see more impactful changes. Also dismantling structured discrimination.

I think that discrimination is predicated on race, and you have to transform people's ideologies and their attitudes, right? So we need to foster allyship between racial and ethnic groups. So Malcolm X said that when the “I” in “illness” is replaced with “we”, then you end up with “wellness”. And so I think that when you create a sensibility and a sensitivity of people about equities and inequalities and disparities, then people begin to see the role that they play in either benefiting from the system or somehow either contributing toward the demise of another group in the system. Awareness of inequity should foster change and individual cultural attitudes, political support for change, public empathy for change that needs to occur. All of this contributes to what we call allyship because it creates a sensitivity in groups who have benefited from the system and say, you know what? If they're not benefiting from this type of system, then we need to call in into question the system. We need to change some things. So it not only it puts the responsibility  on minoritized groups to become engaged with help promoting activities, but it encourages those who have been beneficiaries of the community to also make changes. So that's just part of my 2 cents on some things that they need to change. And it all stems from what I said originally. I think there needs to be broad community changes on multiple sectors in order to have and realize health equity.

Hemen: (31:43)

Yeah, I think when you think about it, like you said, like redlining is a big historical factor, if you look at it holistically, you could say that redlining is just about like dividing neighborhoods between like rich and poor. But like you said, it goes deeper than that. It says when it comes to for marginalized communities are mainly low income. So they will fall into the place where there's like, inadequate housing, therefore, like could also affect their health. So it's kind of like interrelated. Nothing is just one. Just one one thing. 

Michelle:

Absolutely. So even with, you know, as far as access to health care, you know, in poor communities, there aren't community clinics, there aren't even hospitals that are within a walking distance, or even within, I'd say, a 10-20 mile radius, right. And oftentimes, if there are you no public transportation, it's not I can say, in Southern California, which is what we're talking about, you know, if you're going to take your kids to an appointment, for example, and you live in one of our, you know, our lower economic communities, it's gonna take you a couple of hours, just to get, you know, you may only be going 10 miles, but if you're waiting on public transportation, right, it's gonna take you over an hour to be able to get to that destination, and then you have your appointment, and then you're gonna have another hour right to get back and say, you've been prescribed medication, you have to go to a pharmacy, the pharmacy may be another 10 miles out the way, going in the other direction opposite from your house. So you know, there's so many different factors that go into, you know, somebody receiving quality and competent health care, and being able to access it. And we need to start addressing those social ills that have been barriers that have created, you know, this widespread health disparities among communities of color.

Hemen:

Yeah, it's very interesting. And even like, in those low income communities, even if there were to be a clinic that was accessible, there is no guarantee that that clinic has the proper infrastructure to adequately tend to their needs. So it's very much an exercise.

Michelle:

Yeah. And a lot of people don't want to come. Because if that's if it's going to be a community clinic, let's be honest, it's going to be primarily medical, the reimbursement rate for Medical is not great. So it's going to be hard to get really good providers that want to come and work in that clinic. And then to there going to be, you know, receiving the second hand or, or generic version of supplies. So there's a there's, yeah, there's so many factors that go into it. And it requires all of us it requires healthcare professionals, our local policymakers, our legislators, our community leaders to stand up, you know, and really say, this is something that's important to our community. And we all need to work in partnership to be able to affect change, and increase everyone's health health outcomes, because it's not just about one community, right? If, if all of us are healthy, if one community is healthy, and we're looking at each other as brothers and sisters, then all of us will be healthy.

Hemen: 

100% Yeah. Thank you for that insight Michelle. And moving on to our next question. Could you discuss any initiatives or strategies that have been implemented, or any that you can think should be implemented to address the lack of access to care and information for the black community? Like, in your opinion, how effective do you think that these interventions have been in reducing health disparities in the past?

Dr. Sims: 

Well, just going back to the previous point that I made, some of the sweeping interventions as far as things like education interventions, those are comprehensive interventions because not only improve one's education quality, it also increase things like graduation rates. So you're producing more productive citizens that will contribute towards society. Then that downstream creates better health outcomes, mental as well as physical. And that then bridges the gap between the health of minority and majority groups. So you have things like that, and those have been shown to be very, very impactful. Also, from a housing standpoint, when we are looking at addressing the unhoused population, housing insecurity, housing segregation, when you open up housing and you combat things like residential segregation, racial redlining, and then you're contributing toward a whole society where health outcomes are going to be better. Our research has shown that a lot of projects that I've been a part of shown that residential segregation increase the risk of heart attacks,incident stroke and heart failure greater than twofold risk. So when people live apart in unequal neighborhoods, in unequal segments of society, then they're not going to be as likely to experience favorable health outcomes, optimal mental health outcomes and things like that. So housing intervention, things like, lemme see, what do they call 'em? Stipend, I think they call 'em like stipend type programs where they're opening up housing to even lower income minority groups. Over time, we're realizing that children of these parents who are able to take advantage of these housing voucher programs, have better education outcomes, better mental health outcomes, they concentrate in school more. They have higher grades, they're more likely to go to college, they're more likely to contribute higher income towards society downstream. So you have just this nice cascade of these increasing elements that flow from opening up housing as an intervention. So those are the type of what I call more macrolevel interventions that need to take place. I like the intervention, I mean the individual interventions as well. Those are helpful as well. But you're not tackling a broader segment of society like you could with more macro level kind of governance or social policy types of interventions. Those are going to be the ones that become more impactful for a broader and a larger group of people, as well as have some sustainability over the life course. They're more likely going to be able to occur and having not only in the parents' lives, but then to be translated or transferred or transmitted into the lives of their children. So you have this intergenerational cascade that likely impact future mental and physical health outcomes, particularly chronic diseases of folks, children, particularly minoritized populations.

Michelle:

I think there's been a lot of great interventions, honestly, that have, that are actively working in the community and that haven't been implemented, I can tell you about one that we're actively doing. So we're working in partnership with the California Health Care Foundation, and we have launched a black health equity initiative. And one of the things that we're doing at that health equity initiative, we're trying to give the community back their power, right. So we're trying to educate them, and teaching them ways into how they can access health care, how they can take action and doing so how they can navigate the healthcare system, how they can advocate for themselves and their loved ones. So I think that really effective initiatives, they have to involve the community, they have to have a community's voice. And we have to create an environment where they can come and learn things that you know, we think maybe are obvious, but you know, not so obvious. And then there's things that we can do. So I'd say four, on our side, we need to learn how to be more culturally competent as providers. And that's all of us, right? What does that look like? It's, it's not, I like to say more culturally humble, or have cultural humility, instead of being competent, because I really don't think you can ever really be competent in someone and understanding someone's culture, but you can be humble and willing to open yourself up and learn about someone else's culture and how that impacts their health or how they receive healthcare information. So I think that interventions that, you know, on the healthcare side, they're being culturally competent. And then also on the community side, we need to do a lot of work around health literacy. So I think that that needs to be embedded in any type of intervention in the community, really making sure that the education and the materials that you are giving out to the community, that they are receptive that the community, you know, understands the information that you're trying to communicate, and can you go and then use it, you know, it's one thing to be able to understand, but then to be able to apply it. So I think it's really important. And that's the work that we do. And our series, we call it, how do I but how do I campaign. And it's about teaching and helping folks feel empowered to be able to take action and to be able to advocate for themselves, but they have to be literate they have to understand what does that look like? So when I say how do you navigate the healthcare system? Well, first of all, do you understand how to go about making an appointment? And once you do that, okay, how do I engage my healthcare provider? Shouldn't How can I be prepared right to go into the healthcare setting and access health care. And also changing people's mindset, helping them realize it, that health care providers are there to serve them. It's a partnership, right? In their journey they're supposed to work to in partnership with you to create, or to make sure that you're able to obtain optimal health, or whatever that looks like for you, you know, but not to tell you what you should do, you know, for your health to be better, but to ask you and to learn from you, you know, what are you doing? What is your ultimate goal, you know, if you don't already have a chronic, if you don't have a chronic illness, let, these are the things that we can do to create a plan so that you can prevent, right? Getting a chronic illness, but we have to these, these interventions really have to be actionable. And they have to be done, deliver it in a way that, like I said, our community can receive it, and then can actually apply it. Because it's one thing to educate somebody to give people all this information, and then they go home, and they don't remember half of the things that you said, and they don't know what to do with all of the information that you gave them. So I think it's very critical. You know, now when we're going out doing interventions, to make sure that the community understands the information that's being received, and they know how to go out and actually apply it.

Hemen: 

Ya no, definitely community interventions, I feel like is definitely one of the ways you can put a plan forward. When you said that, you know, you launched this black health equity initiative, and you're trying to deliver information in a way that is, you know, more receivable by these community members. But what has been like the most difficult part and like, you know, organizing or planning a an education system that is receivable.

Michelle: 

Wow, really. I don't, I wouldn't consider it difficult. The whole my whole desire is to create safe spaces. Because I feel like if you create a space where it's safe for people to come and ask questions, no matter how big or small, you know, oftentimes people will say, Well, I was afraid to ask that to my provider, because I did not want to look like I wasn't intelligent, right? Or, I didn't, I didn't really talk about what was alienate me at my medical appointment, because I didn't want it to come off as I wasn't really concerned about my health. So we need to create safe spaces, I think that's the biggest thing to build, again, Community Trust, to create a space where they can come and they can feel free to ask whatever, you know, it no question is an unintelligent question, especially when it relates to your health. So just having the space and I think that we've been successful in doing that, and creating those spaces where people come, because we often have folks say stuff, you know, in the sessions, where it's even shocking to me, I was like, Oh, wow, that's, that's pretty personal information that you share. But I felt happy that they felt like this was a space for them to be able to ask that question that they have, you know, may have wanted to ask their health care provider for quite some time. But we're just afraid to do so. So I, like I said, I don't really see any hard challenges in putting these, these programs or these workshops together. I really enjoy and I'm, I'm always excited, even if, you know, say 50 people register, but only a handful of people show up. I really believe that people that showed up, were meant to be there because they needed to hear the information that was provided.

Hemen:

And 100%. Yeah, thank you for the answer. Michelle. Going on to our next question. What role can healthcare providers and institutions play in addressing or mitigating health disparities experienced by black individuals? Are there any examples of like successful efforts or best practices in this regard?

Dr. Sims

I think that healthcare providers, the role that they play is critical, and we're talking about not only physicians as healthcare providers, we're talking about nurses, phlebotomists, front desk persons or admin type. So it's a whole field that needs to become more sensitive to inequities among groups, maybe aware of some of their implicit biases that they have toward groups which can impact their healthcare experience, be it good or bad, the extent to which they participate in their healthcare. That's important as questions of groups to understand that factors beyond biological risk factors are important in diagnosing physical and mental conditions. So there needs to be more of a holistic approach toward diagnosing health inequities. There needs to be more integration of social determinants of health factors and EHRs, because if you have dashboarding with certain social conditions, then you may get this alert about social risk based on where a person lives stressors that they answered on a particular questionnaire in the provider's office.

So then they can take more of a holistic approach to treating their patients versus just this myopic individualistic standpoint of prescribing one therapeutic or one potential solution. Well, it's a multiplicity of things. So if we integrate a lot of what we do from a socioeconomic psychosocial standpoint into the healthcare model, then we'll be able to pick up more and take more of a universal and holistic approach toward treatment of health inequities, and then lowering health disparities or narrowing the gaps between various groups. We can do that. And lemme see. Are there examples of successful efforts or best? I think some of these have been shown to be some of the best practices because it's becoming more universal to include some social determinants of health, neighborhood environment, degree of stress, degree of anxiety, degree of depressive symptomatology. I think these are becoming more incorporated into the healthcare EHR system to help make diagnosing of conditions, and then it helps to avoid misdiagnosing conditions or even ignoring things that might contribute towards certain behaviors.

For example, if you knew a person lived in a food desert, for example, you may be able to speak to them differently versus saying just, well, you got to eat such and such, then you'll have better health. You'll have more favorable health blood pressure, you'll have more favorable blood sugar. You won't have diabetes. Well, if you can say, well, I can see that you're not, if you saw in the dashboard or even the neighborhood, it may be a neighborhood that does not have access to a gym or a workout facility or educational system, or schools are lacking in certain ways, that holistic approach, you'll be able to speak to their full lives rather than one place where the pain is. It may be acute or not. So I think that's just one example, and I think it's shown to be effective, but it needs to be done more widely. We're going to start doing some work on this in the Southern California region to see how efficacious to see this in the lives of people. How much does it change as far as the EHR social determinants, health merging and yeah. 

Michelle:

I, again, I think it's understanding black patient's unique needs in the historical context and, you know, their cultural perspectives, and taking the time to improve communication and trust, you know, I know that providers only have 15 minutes or 10 minutes, right, and those appointments, and but you know, and then initial appointment, work to understand, you know, here ask your, your patient, what is your concern? What did you come in here for today, you know, not what you think you heard, but ask them, what, what are you here for, what is your main concern, and have a dialogue around that, and work to continuously improve communication, and investing in diversity within the healthcare workforce, is can be very impactful. I do believe representation matters and having black healthcare professionals can enhance patient provider rapport understanding. I think it's important to make sure that you collaborate with community based organizations, you know, if you are a healthcare provider, you should know about some of the community resources that are available. Because say, somebody comes in and they're lacking, you know, they're not eating healthy, and they're diabetic. You know, it's one thing to have them schedule an appointment with a registered dietician, but if they live in a food desert, and they don't have access to healthy, nutritious, nutritious food, then that's an issue right there. Right. So kind of, like I said, building that report, getting to know your patient in understanding what some of the social determinants of health are, that are impacting their ability to be able to either be compliant with their, their medication regime, or or whatever it is, make sure that you kind of, like I said, create that space where you understand where your patient is coming from and really be intentional about having open dialogue and communication with them. I think it's also important for us as healthcare providers to understand it, or come from the the, the lens of everybody wants to be healthy, right? Everybody, no one, I don't think wakes up in the morning says, You know what? I don't need my own, I don't care about my health, I don't believe that anyone feels that way. So coming from the perspective that, you know, when I engage my patient, you know, they want to be healthy. So what can I do to help facilitate that right? What information can I provide you with? How can I help you manage? If like I said, you already have a chronic illness? How can I help you manage that effectively, within the context of whatever you, you know, you have available to you, but we have to start broadening the scope and asking those questions. Do you have access to nutritious food? Right? Do you have access to funds to be able to get your prescriptions if I prescribe you this medication, and yeah, you're not going to have all the answers of the provider, you're not going to be able to address you know, their economic needs, or whatever. But that gives you at least more context that maybe I'll do the generic brands who will be cheaper for them, right. Or maybe I can have my somewhere in the office, we can have a list of community resources where they can go and get, you know, a food basket or something like that. So I just think as as providers, we need to work on being you know, more intentional and really come in come from a community focus space and treat people like you would want someone to treat your family member if they were going to access healthcare.

Hemen: 

Yeah, no, definitely. And to touch upon that first point that you made about establishing communication, and trust, the pivotal, when that person or action happens, you know, you know that first interaction, even with the front desk is very important, it's negative, you can kind of set the tone throughout the whole, like, checkup session, and the next time, they might not even be compelled to come back. So.

Michelle: 

Absolutely

So it's definitely an important thing to establish within the healthcare system. So thank you for that answer, Michelle, and closing up with our last question. So looking ahead, what are your recommendations for policymakers, health care professionals and community leaders to effectively address and reduce health disparities among the black population in SoCal?

Michelle: 

Well, let's start with policy. policymakers should really be engaged in developing policies that are anti discriminatory and really, looking like I said, from a social determinants of health lens, you know, what is going to be the best thing for my community that I'm representing as a whole, right? Do the greatest good with the platform that I have. So I would implore policymakers to really, like I said, look at the health and well being of their community, they, they are given data and stats all the time. So what does that look like and then try to put into place or change, like I said, practices, that you have the platform to be able to do so to improve the health of your your constituents. As far as healthcare professionals, again, really be intentional about, you know, participating in cultural humility trainings, if they're made available to you. And if they're not seek them out on your own, you know, you would want to be, I would hope that everyone wants to be the best health care professional that they could possibly be. Right, and that they would want to engage their patients in a way that they would be happy and fulfilled, and you know, that you're doing everything that you possibly can to help people along their health journey, in a positive way. So I would encourage all health professionals to really, you know, take an implicit bias test, check your biases, all of us have it, no matter you know, all of us have some type of bias and we need to acknowledge that right versus acknowledgement. We need to acknowledge that so that we can move forward and be intentional when maybe that bias is creeping up, say no, you know, I am here to serve all people in everyone in the best way that I possibly can. Our community leaders, you know, they are the voice of the community. That's why they're called community leaders. Community will go to them and share their challenges as it relates to health. And I would like them to work in partnership with academic institutions like ours, with other health care professionals, you know, work with us, tell us be the voice of the community, tell us what's going on and how we can partner with you in a meaningful way to bring information to the community to educate the community to learn from the community. So those are the things that I would ask that moving forward, that our policymakers, healthcare professionals and our community leaders would do to start to address right and reduce the health disparities among the black population in Southern California

Dr. Sims: 

To realize that not a single sort of, I guess a silver bullet type approach to getting the answer to the solutions of health disparities and to realize there's a multiplicity of factors, particularly over time. We've ignored social determinants of health. Now that's become more of a sort of buzzword that people are understanding, but we have to measure things correctly. We can't just throw anything in the pot with social determinants, say, oh, that's it. We are representing the environment by looking at this measure. We can't do that. Also realize that there are mechanisms that need to be better explored when you're exposed to stress, how to elucidate the pathway between exposure and end-stage sickness. What are some of the pathway kind of factors that we need to unpack? Things like the whole genome sequencing, genetic factors. How are genes altered by the exposure of stressors in the lives of people that downstream impact their prevalence or risk for heart disease, diabetes, incident, hypertension, heart failure, coronary artery, calcification, just the list goes on and on and on.

So just explore more so that pathway, but also I think policymakers and healthcare professionals need to understand, as well as community leaders need to understand that there's an interaction between structural discrimination and levels of stress. So we need to be aware that there are interactive effects of these social determinants of help within and among themselves. So for example, a person who reports high levels of discrimination may also report high levels of stress. What does that mean as far as their health outcomes? If there's stressed at a high level and you're discriminated at a high level, then you may likely be angry at a high level, anxious at a high level. To what extent does that accumulation of social risk have on your health? We can't study things in isolation. We have to bring things together and understand the cumulative nature because real life occurs simultaneously. We don't experience discrimination, and then later on, we're depressed. No, that depression may come as a result of discrimination. So how do they pair together or jointly impact your health? That's very important. That's been ignored. So we need to really look at that as well. I think because policymakers can look at exploring the need to address anxiety as well as structural improvements and systems simultaneously to then ward off or mitigate the negative impacts of these factors downstream with things like chronic disease disparities and things like that.

Hemen:

Yeah, I definitely agree. The fact that there's an interaction between the social determinants of health and just all of these different external stressors that also apply in to our health, it's definitely important to understand. And also keep in mind, as you know, we go forward and to try and implementing it better health outcomes for the black community. So definitely, it is something that I as well will keep in mind because I work and my journey in public health. So thank you so much for that insight.

All right. Well, that concludes our episode on the topic of black health disparities in Southern California. Michelle and Dr. Sims, I just want to express my gratitude for your invaluable insights and expertise on this topic. Your deep understanding of the complex factors contributing to these inequities and your commitment to addressing them is truly commendable. So I know that all your words today has inspired me as a young public health scholar to make some sort of change within my community. And I hope it does the same to our listeners. And I hope also that your insights will undoubtably inspire policymakers, healthcare professionals and community leaders to take meaningful action towards reducing health disparities, promoting health equity. So any last words before we close off?

Michelle:

Yeah, I just like to thank you for the opportunity to be able to speak on this topic. It's near and dear to my Heart, I am a black woman. And I know that we were definitely disproportionately affected during COVID. And that's what kind of, you know, really made me want to be more intentional specifically as it relates to the black community to start having these conversations right with our community members and with other healthcare professionals, as well to say, how can we change this narrative around, I don't want another pandemic or any other major thing to happen, where, you know, we see the headlines disproportionately affected, and it always has black community after it. I want to change that narrative. And I believe that if we all work together, we can, we can and we will, you know, improve our health outcomes for not only black community, but for all communities. So thank you. Thank you for this opportunity to speak.

Hemen: 

Yeah of course, thank you so much Michelle.

Dr Sims:

Yeah thank you very much and thanks for having me.

Closing
Thank you for listening to Healthy Disruptions. Thanks to Vince Parra from BelzarMusic for the intro and outro music. 

This podcast was produced by the Community Engagement and Dissemination Core of the Center for Health Disparities Research at the University of California, Riverside in collaboration with the Center for Healthy Communities at the University of California, Riverside School of Medicine.

Content was developed by our team in collaboration with community members.

For more information and the show notes for this episode, you can also visit our website at healthydisruption.buzzsprout.com 

We’ll see you next time for some more Healthy Disruptions.”