Latest / CareTalk: Healthcare. Unfiltered. / Confronting Healthcare Disparities in Black Communities w/ Caretha Coleman

Transcript

Confronting Healthcare Disparities in Black Communities w/ Caretha Coleman · CareTalk: Healthcare. Unfiltered.

• 0:00
  Despite sustained attention and investment, tremendous disparities remain in US healthcare.
• 0:05
  The black community is affected most of all, reflecting a legacy of racial discrimination.
• 0:11
  What would it take to make a dramatic difference?
• 0:14
  How would a comprehensive national approach be developed and could it succeed?
• 0:24
  As kids, we're always learning and growing, but as adults, we can sometimes lose that sense of curiosity that makes life exciting.
• 0:32
  It's easy to fall into a routine.
• 0:35
  Therapy can help you break out of it.
• 0:37
  If you've been considering starting therapy, now is the perfect time to give it a try.
• 0:43
  BetterHelp offers entirely online therapy that's designed to be convenient, flexible, and tailored to fit your schedule.
• 0:51
  Whether you're dealing with stress, anxiety, or seeking personal growth, BetterHelp connects you with licensed therapists who can support you on your journey to rediscovering your curiosity and becoming your best self.
• 1:03
  Don't miss out on therapy.
• 1:05
  Visit betterhelp .com slash care talk to get 10 % off your first month and take the first step toward enhancing your mental wellbeing.
• 1:14
  That's betterhelp, H -E -L -P dot com slash care talk.
• 1:20
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 1:24
  I'm David Williams, president of Health Business Group.
• 1:27
  Today's guest, Karetha Coleman, is a leader in healthcare and in diversity, equity, and inclusion.
• 1:33
  She's board chair of the Black Director's Health Equity Agenda, BDHEA, where she's driving progress on Black maternal health, food insecurity, and health equity.
• 1:44
  Come join the vibrant Care Talk community on LinkedIn.
• 1:47
  where you can dig deep into healthcare business and policy topics, access Care Talk content, and interact with the hosts and our guests.
• 1:55
  And please be sure to leave us a rating on Apple or Spotify while you're at it.
• 2:00
  Karetha Coleman, welcome to Care Talk.
• 2:02
  Thank you, good morning.
• 2:03
  Karetha, what are the key health issues facing black people in the United States today?
• 2:08
  Well, I think really if I have to go to the key areas, everything sort of is...
• 2:16
  underlined by the economics.
• 2:19
  I think that all roads of inequity for me actually ultimately lead to economics because it's about your zip code, know, where you live, it's what you eat and how you eat.
• 2:31
  It's your ability to access quality and affordable health care when you need it.
• 2:38
  It's being able to do things on a preventative basis.
• 2:42
  mean, those are a few, I think, of the key components for me.
• 2:45
  But it really does, unfortunately, come back down to economics.
• 2:51
  And of course, these economics didn't come out of just out of nowhere.
• 2:54
  It's not a today kind of an issue.
• 2:56
  And so if you can share just generally sort of the historical background and how and the legacy in this country of racial and social injustice has put us to this point as far as economics go or broader health issues.
• 3:09
  Well, from an economics standpoint, and I actually an advisor to the Black Economic Alliance organization that actually focuses on work, wealth and wages in the Black community specifically.
• 3:22
  And a lot of what we're finding is certainly has to do with policies that were created years ago, way before you and I existed, that have to do with a systematic approach to ensuring that the Black community as a population was not rising up, certainly not at an equal pace with our white counterparts, et cetera.
• 3:49
  And so it starts there.
• 3:51
  It started with not being able to have a mortgage loan and buying homes.
• 3:56
  And for most Americans, your real equity stake really comes from being able to have ownership.
• 4:06
  And so when you start with that and not being able to access that, You create this legacy, if you want to call it that, that actually has almost a zero base.
• 4:19
  And you just can't increase from there.
• 4:22
  There's nowhere to go from there.
• 4:23
  And unfortunately, that's continued to persist.
• 4:27
  And so it has to do with debt and education debt.
• 4:32
  So even though we try to move forward, we're plagued by different things that keep bringing us back down.
• 4:41
  And we don't have the ability or haven't had the ability to, with a, with a good base to create generational wealth.
• 4:48
  And so that's really from an economic standpoint where it is, think from a healthcare standpoint, the inability to access affordable healthcare, just something that we all find as we're doing this work in healthcare, but also for the people who need to access it with their findings is just totally inadequate.
• 5:10
  And.
• 5:10
  know, preventative healthcare is so important.
• 5:13
  And yet what happens for people who don't, who are really in underrepresented categories and underserved is that they end up in the emergency centers of the different hospitals across the country, which carry a higher cost for everyone, including the healthcare system as a whole.
• 5:32
  But more importantly, it's a one -off treatment, right?
• 5:36
  So.
• 5:37
  You go in on emergency basis, you get treated for one thing that is plaguing you at that moment, but it has nothing to do with what happens before you go to the hospital or after you leave the hospital in terms of care.
• 5:50
  The BDHEA site does a good job of drilling into some of the specific issues after discussing this overall economic context that you described.
• 5:59
  Some that I noticed there were infant mortality, deaths from COVID -19.
• 6:05
  and hypertension and heart disease.
• 6:08
  Can you help us understand a little bit more about each one of those issues and how it maybe uniquely or disproportionately affects a black community?
• 6:16
  If you just take the infant mortality rate as one example, our infants actually, through birth, die at twice the rate of any other population, certainly the white population.
• 6:28
  And part of that is caused from, again, what happens before you get to that point.
• 6:35
  So for Black mothers, they typically will not have access to prenatal care for whatever sets of reasons.
• 6:44
  And so that starts the birthing process, right, very early.
• 6:49
  And then Black babies have an instance of low birth weight, which exacerbates the problem.
• 6:58
  And there is still a lot of research being done on why we have these issues.
• 7:04
  But the fact is that we do have them.
• 7:06
  And so we have higher death rates.
• 7:08
  Diabetes, we have two times the rate of diabetes within the black community than in other races.
• 7:15
  And that alone, actually, if you look at diabetes and you take what we just talked about, the infant mortality rate, you just take those two.
• 7:23
  You know, not even talking about colorectal cancer, which is also something that plagues the black community.
• 7:29
  And I can't remember the percentage higher, but.
• 7:33
  So I don't want to quote it, but it's actually very high.
• 7:37
  But when you take all of those into consideration, the cost of that in terms of those instances happening, the cost of death, know, the cost of, and it's not just dollars and cents.
• 7:49
  It also has to do with not being able to have a population that is a part of America, that actually is part of creation of where we want to go.
• 8:02
  I want to come back to a related topic to infant mortality, which is maternal mortality.
• 8:08
  And I know we didn't discuss this before.
• 8:10
  It's maybe not directly addressed on the site.
• 8:13
  And I know we've been talking about the economic factors a lot, but one of the shocking things to me has been that even after you adjust for some of these economic factors, you find that black women moms dying at a terrible rate.
• 8:28
  And it doesn't seem to be explained just by the economic side of things.
• 8:32
  That's one of the things that struck me in recent times when I've read about that.
• 8:36
  That's really true.
• 8:37
  And we have found that to persist.
• 8:41
  And that's why the research needs to continue.
• 8:44
  That's also why I think from a practical standpoint, we at the BDHEA also have a keen interest in ensuring that we do our part to affect being able to have more Black practitioners.
• 8:58
  Right?
• 8:58
  Because that also can have an impact.
• 9:02
  We are different, you know, I think in so many ways we are the same, but we do have different makeup.
• 9:11
  Right?
• 9:11
  And so, and I, a lot of what we're seeing and what we saw with COVID, same kind of thing.
• 9:18
  Where we have to be able to address the issues that disproportionately affect us as Blacks in this country in a different way.
• 9:28
  sometimes by different people.
• 9:30
  And different people just means that they've been able to see it and experience it as well.
• 9:36
  And so they're able to inform what happens to us when we're in those situations.
• 9:41
  But you're absolutely right.
• 9:42
  When I think about Black maternal health, it's very difficult to understand all of the different parameters.
• 9:49
  But when you sort of strip everything away, you say, okay, there are people who came to this country.
• 9:57
  from other places who actually had, and I'm talking about black women, who actually gave birth in other countries.
• 10:04
  And that seemed to go well, but somehow when they're here, by and large, it doesn't work as well.
• 10:11
  And why is that?
• 10:12
  And these are women, sometimes they have great jobs, great access to healthcare.
• 10:17
  So different from what I started out with.
• 10:21
  they are, you know, they have great living situations.
• 10:24
  They have...
• 10:24
  access to the best of everything.
• 10:26
  And yet they still have a persistence of unfortunately being very ill during the birthing process or they ultimately pass away.
• 10:36
  And that shouldn't be happening.
• 10:37
  And so we need to really try to understand that.
• 10:40
  So you and I obviously have heard about these things.
• 10:42
  We're discussing them, the various nuances.
• 10:45
  If we look broadly within society or even the medical profession and healthcare policy, to what extent are these disparities?
• 10:53
  recognized?
• 10:53
  Is it sort of front and center or is it just buried among all the other kind of health care issues we have of cost and quality and access and all the different things that are going on?
• 11:02
  I would have to say that prior to COVID, a lot of them were sort of buried or not recognized at a higher level.
• 11:10
  But I do believe that one of, at least for the Black community, I would have to say that one of the silver linings, if you will, of COVID is that it brought a lot of attention to the disparities.
• 11:24
  And it wasn't certainly just with the black population, but certainly highlighted the black population.
• 11:32
  And so that's been a good thing to me because we actually can talk about this very openly and across the board.
• 11:41
  And there has been, I think, increased interest in trying to understand the issues and to come together.
• 11:48
  I think one of the things that we find with the conversations that we have with people certainly within our even membership at BDHEA across different health systems and people representing those health systems is that, you know, there's a coalescence and an understanding that we need to partner on ways that we can solve this problem together.
• 12:10
  And it's not just one problem, right?
• 12:13
  As you articulated, it's several across the board.
• 12:16
  But, and we know that not any one entity is going to have all the answers.
• 12:20
  nor should we because we need to focus on certain things and then come together on others.
• 12:25
  And so I do believe that because of that, we can do a better job.
• 12:31
  And more importantly, and this is why we exist, more importantly, we will all affect better outcomes for this population.
• 12:39
  And what that means to me is while it starts with the black population, because that is our focus.
• 12:45
  that I do believe in the saying about, you know, all boats rise in high tide.
• 12:50
  And I believe that we can have that same effect.
• 12:53
  If you if we can fix it for the black population and understand it better, everyone will be better off, you know, including looking at, again, the economic factors of the health care system, because, as you know, we spend a lot of money in health care.
• 13:11
  We should be getting better results.
• 13:12
  We had worked some time ago in my job with Robert Wood Johnson Foundation on a program called Aligning Forces for Quality.
• 13:19
  And they were actually focusing on disparities as one of the topics.
• 13:22
  And one of the things that I used to put out there was, don't worry about it sort of due gooding standpoint, just take the math side.
• 13:29
  And if all of your patients, if all your white patients are at 90, 95, and you want to improve overall and the black patients are at 70, get them to 80.
• 13:37
  That's how you're actually going to bring your overall score up.
• 13:40
  So this sort of rising tide, lifting everything.
• 13:43
  It's just mathematically, there's more of an opportunity if there's a disparity to make improvements in the area where there's a lower score rating outcome, what have you.
• 13:52
  That's how you can actually bring up your overall score.
• 13:55
  I absolutely love that.
• 13:57
  And that is a great perspective.
• 13:59
  And when we were talking about different diseases that disproportionately affect the black community, so when you take some of them, if you look at...
• 14:09
  diabetes and colorectal cancer and obesity is a big one within our community as well.
• 14:15
  And lupus, infant mortality, as we just talked about.
• 14:18
  But if you just take those, you know, there's a number around $30 billion that could be saved, just those, right?
• 14:30
  And so I can only imagine how the healthcare system could look and the impact that it could have on these disease states in our community.
• 14:42
  And we talk about the economics of it when we actually have conversations with some of our counterparts who sit on boards of different health organizations, which is actually a big part of the reason that we exist is to really work with directors on boards in health systems and other organizations so that they can have these conversations within their entities as well.
• 15:05
  I want to ask you about a topic that I'm just sort of becoming aware of myself, which is this concept about race -based algorithms in medicine.
• 15:13
  So you talked about, for example, people are mostly the same, but there's some differences and need to recognize population.
• 15:19
  So it makes sense in a way to say, well, let's treat some people like somewhat differently.
• 15:23
  But then I'm also understanding that some of these algorithms, as this is a quote from a researcher, lead back to slavery era race science.
• 15:33
  And so.
• 15:34
  How do you sort out like the good from the bad, maybe good intentions from not what's buried in there and what do we actually do?
• 15:41
  Yeah, well, I guess I want to start with good intentions because I want to believe that these things are developed with the best of intentions for everyone.
• 15:51
  But people just get left out.
• 15:53
  I think that's in some ways, I will say it's human nature.
• 15:56
  But if you start from a human nature standpoint that has bias built in, because of conditioning, because of the way you were brought up, just because of the way you think, just the way that you're educated.
• 16:11
  So, you know, those differences come out, but they're not always intentional.
• 16:16
  And I get that.
• 16:17
  When you're talking about historically, certainly, you know, it always brings me back to Tuskegee experiment, right?
• 16:23
  The one that gets talked about all the time.
• 16:25
  I do think it's something that we can never forget in history, but we also want to move on and do better again.
• 16:34
  And so when I think about that, the thing that plagues us in terms of that history is, and you know it, I'm sure, but you know, there were a number of blacks who were used as human experiments, if you will, to see how we reacted to different things.
• 16:50
  And so, and then there was this notion that blacks didn't feel pain as much as our white counterparts, et cetera.
• 16:57
  It's all these things that of course we know are not true.
• 17:02
  But it is there.
• 17:03
  And because it's there, it hangs over the heads of some people still.
• 17:07
  When you are looking at clinical trials, which would be so important to some of the things that we just talked about, right?
• 17:14
  But in order to do that, you have to be a black person who's raising your hand that you're gonna go in and become a part of a clinical trial.
• 17:21
  Now I do believe that that is changing as I talk to some of my doctor associates, that we're doing more and more of that and people are raising their hand more because We understand, number one, that we need to be a part of making it better.
• 17:36
  But the other is that for us, we won't have that impact unless we do.
• 17:41
  And so I do believe that that's changing.
• 17:44
  I hope that answers your question.
• 17:46
  does.
• 17:46
  It does.
• 17:47
  I guess it's a tricky question, I give a good answer.
• 17:50
  It is.
• 17:50
  is.
• 17:50
  Yeah.
• 17:52
  I think it's a good ongoing discussion.
• 17:54
  as well as people start to have this awareness and they sort of delve into a little bit more deeply, you know, what's behind it?
• 18:00
  How do we go from good intentions to good processes and good outcomes as well?
• 18:07
  I live in Silicon Valley.
• 18:08
  So when you start talking about algorithms and things like that, really, really close to me.
• 18:13
  And I think about that a lot because that's built in, it can be built into almost anything, right?
• 18:19
  And so again, I am just hoping that most people have good intentions, knowing that sometimes having a computer hacked people, people will wake up in the morning wanting to do things like that.
• 18:31
  But in general, I think people have a good heart.
• 18:34
  Let's talk about the BDHEA Black Director's Health Equity Agenda, which is a fascinating name.
• 18:40
  And I'm wondering, you've been sharing the organization for little while, what is the vision and the mission of this organization?
• 18:46
  So the mission really is to, I would say, close the gap, but I wouldn't be totally truthful about that because I remember having an early conversation with one of our members and when we were actually starting the BDHEA in 2020.
• 19:04
  I had used that term about, I really think that we want to get together and try to close the gap of health disparities in the black community.
• 19:13
  And she said to me, my gosh, we've been trying to do that for a really long time, Carisa.
• 19:18
  And really, can we just...
• 19:20
  focus on eliminating it, can we just go all the way there?
• 19:24
  And if we do, I'm in, and as we talk to more and more people, certainly we said, you know what, that really does need to be our goal.
• 19:32
  And so it's really our North Star that we want to eliminate these disparities that disproportionately affect blacks when it comes to our health.
• 19:43
  And so we'll pick a few to start with and we'll just keep adding on as we go.
• 19:50
  and as is necessary.
• 19:52
  I meant about the name was that is sort of the last word, agenda.
• 19:56
  Usually I would have guessed it's like alliance or something, but it's like agenda means we're here to do something.
• 20:01
  Like we have an agenda, you know, we're going to lay it out and try to accomplish it.
• 20:04
  So it's very consistent with the way you just described the mission.
• 20:07
  Yeah.
• 20:07
  And an agenda changes, right?
• 20:10
  So that's the other thing.
• 20:11
  We wanted it to be fluid as well.
• 20:14
  So I saw you had a 2024 summit.
• 20:16
  saw some of the highlights and I actually recognized somebody there from US News who was speaking.
• 20:21
  I I recognize Marianne.
• 20:23
  What was the goal of that summit?
• 20:25
  What was the outcome of it?
• 20:27
  Well, first of all, I just have to say Marianne has been a wonderful partner.
• 20:31
  So I'm glad you know him and you probably know that about him.
• 20:35
  I think for 2024, what we came away with, it was a resounding theme and that was the importance of partnership.
• 20:44
  because of all of the disparities, but also the social determinants, right?
• 20:48
  Which we haven't talked about much, but we did refer to it relative to before the hospital and after the hospital.
• 20:54
  So all of the social determinants of health, they're not held in one place.
• 20:59
  It doesn't happen by one entity.
• 21:02
  It has to be a public -private partnership in a lot of ways.
• 21:06
  It does take a village to ensure that...
• 21:10
  all the oars are pulling in the same direction.
• 21:13
  And in order for any one part of the community to actually be achieving their health equity goals, it takes that.
• 21:21
  It's going to take looking at housing, if you will, and how do you have those conversations?
• 21:27
  If we had people approach us who actually are spending their time in on the dental side of health, we haven't even started to talk about that, but we all know that that can have an impact on our overall good health as well.
• 21:41
  We actually are just starting to look at what we can impact in terms of mental health, just because we know that it plagues all of us, regardless of our race.
• 21:53
  But certainly there's again, because of the economic and socioeconomic differences, it disproportionately affects the black community.
• 22:03
  So partnership was loud and clear at the conference and one of the things that we do well and this is how we started with the BDHEA is I think we convene the right kinds of people in the room who are action oriented, who have the fervor and determination to ensure that we can solve this problem.
• 22:28
  We are smart people.
• 22:29
  We just need to figure it out and do something as you just mentioned.
• 22:34
  I read your bio and it's pretty clear about why you'd be the right choice as the chair, but I'd love to hear kind of in your own words how your career and maybe life experience have prepared you for this role.
• 22:44
  Well, you know, I think it was somewhat linear without necessarily an objective of being linear.
• 22:50
  I'd never thought about health care.
• 22:52
  I was before 2005 when I joined Dignity Health as a board member because my career had been spent in technology.
• 23:01
  And then I find myself going on this board, falling in love with our objective of, again, providing, if the tagline was providing quality health for the underserved community.
• 23:12
  And that just spoke volumes to me, but I had no idea the importance of, and the beauty of, and the gift of being able to bring together technology and health.
• 23:23
  So, you know, I sort of find myself working at that, those intersections, and then layering onto that, the work that I have.
• 23:31
  been doing and have done for a long time, just relative to the black community and ensuring that, you know, that I am doing everything I can to help lift us up as we move forward.
• 23:41
  So everything, it's a common thread.
• 23:43
  I work on four different initiatives that actually focus on increasing the number of black Americans on boards.
• 23:50
  And so again, they just sort of weave together.
• 23:53
  And then another board that actually focuses on, which is Accion Opportunity Fund.
• 23:57
  which actually focuses on providing loans to people who are starting small businesses, which again, is the population of people of color.
• 24:06
  So you mentioned a silver lining, if we want to say that about COVID -19 was I think an awareness that, there's some disparities here and that it's not just cheering for, you know, essential workers and all that, but there's like dramatic differences.
• 24:20
  And some of that, think was starting to be addressed.
• 24:23
  Now, I'd say what we've seen in the last 12 months or so is a growing pushback against anything labeled or closely coming to DEI, including in health care.
• 24:32
  And I'm wondering about how you interpret that and if it influences the approach at BDHEA and if so, how?
• 24:41
  I think that's something that we all have to continue to think through.
• 24:45
  The most important thing is that we continue to forge ahead on our objectives.
• 24:51
  And it might take, you The current thinking in general when I talk to my counterparts and other parts of the country, know, is that, yeah, it probably requires us to ensure that we sort of move our language in a way that is more acceptable for people to support.
• 25:12
  And I think for us, what doesn't change at all is the fact that we are creating inclusivity in everything that we do.
• 25:19
  And that's really what we're asking for when we...
• 25:22
  talk about and working for when we're talking about disparities in the black community is just inclusion, inclusion to good health.
• 25:30
  And I'm sure that there will always be one or two people who would disagree that maybe we should have that.
• 25:38
  But we're not gonna move off of that.
• 25:41
  I think that we, as a population, as a black population, we've had a lot of experience at having to sort of do workarounds, if you will.
• 25:51
  to make the right thing happen.
• 25:53
  And so I don't think that's anything new.
• 25:55
  And so I'm speaking for myself.
• 25:58
  I'm forging ahead and nothing's gonna stop us from doing this work, but we'll find the language perhaps that makes people a little more comfortable.
• 26:08
  But you know what?
• 26:08
  Sometimes it's not about being comfortable.
• 26:11
  Sometimes doing the right thing is making sure that you're claiming what is really happening.
• 26:18
  And I think if we're willing to do the work, we can always find people who are willing to help us do that.
• 26:23
  Well, that's it for another episode of Care Talk.
• 26:26
  My guest today has been Karetha Coleman.
• 26:28
  She's chair of the Black Directors Health Equity Agenda.
• 26:31
  We've been talking about disparities in US health care and what can be done to address them.
• 26:36
  Karetha, thank you for your insights today.
• 26:38
  thank you for having me.
• 26:40
  I'm David Williams, president of Health Business Group.
• 26:43
  If you like what you heard, or even if you didn't, please subscribe on your favorite service.