Navigating Health Equity: A Look into Cultural Awareness, Corporate Strategy, and Community Engagement with Tamara Smith

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Hi everyone, welcome to Exploring Health Macro to Micro.

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I'm your host, Parker Condit.

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In the show, I interview health and wellness experts around topics like sleep, exercise, nutrition, mental health, stress management and much more.

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So by the end of each episode you'll have concrete, tangible advice that you can start implementing today to start living a healthier life, either for yourself or for your loved ones.

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And that's the micro side of the show.

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The macro side of the show is discussing larger, systemic issues that contribute to health outcomes, and today's episode is almost entirely on the macro side of that spectrum, and it's a topic that's actually been on the fringes of a few previous conversations.

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So maybe you'll notice this word or this concept that's come up before, and this will be more of a deep dive into that particular topic.

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And that topic is health equity, and I can't imagine a better guest to discuss this than who we have with us today.

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My guest today is Tamara Smith.

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She's a healthcare executive and health equity leader.

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Professionally, tamara is the Associate Vice President of Strategy Advancement for Humana and she's pursuing a doctorate in public health at UNC Gillings, which is the top public health school in the country.

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I had the pleasure of seeing Tamara speak at a conference this past fall and she's by far the best communicator I've come across on this particular topic, so I'm really grateful for her coming.

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On the show we go over the differences between health equality, health equity and justice some clear examples of how this shows up in the real world, how awareness is such an important step to driving change and how people can make changes at the individual and community level.

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This episode can serve as a good primer or introduction to people who are unfamiliar with this topic, I think for anyone who wants to dive deeper into health equity.

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Tamara is also a podcast host and her show is called Our Journey to Equity.

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It's excellent, she's a great host and the production quality is top notch, so it's gonna be linked in the description of this show.

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So if you enjoyed this conversation and want to learn more and dive a little bit deeper, I highly suggest you check out her podcast as well.

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So, without further delay, I hope you enjoyed my conversation with Tamara Smith.

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Tamara, thanks so much for being here.

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I just want to start off by giving a little bit of context.

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So we actually got connected through a conference that we're at.

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You were the opening speaker at the conference and you kind of talk through a visual kind of outlining the differences and definitions of health, equality, health equity and justice.

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I think it would be a great place to start kind of walking through that image and I'll pop this up on the screen for people to reference it as well.

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But I think that'll be a great way to frame the conversation.

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Yeah.

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So thank you so much for inviting me on, and I'm so excited to be able to share more about the topic that I'm the most passionate about, which is health equity, and I do think that's a great way to start a conversation with that visual.

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So if you imagine three individuals at a baseball game just enjoying America's favorite pastime, and there is a fence in front of them, and obviously that fence presents a barrier and they need to be able to see over the fence to be able to actually see the game, and so these three individuals one is taller than all of the other individuals, and there's a set of boxes, right?

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So I would say that in one instance, we know that there's inequalities when one person has an advantage that the others don't, and the initial inequality or disadvantage is that one person is taller than the others, and obviously that by no fault of anyone's, it's just how they were presented and born into the world.

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And so in order to sort of write and create equality which is what I think a lot of people assume is what equity is then that means that everybody needs the same thing in order to achieve the same goal, and the goal in this example is watching the baseball game, and so when we think about it from an equality lens, that means great.

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Everybody needs a box.

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So everybody in this instance gets a box.

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The tallest individual now is seeing, like I don't know, a foot over, a foot over the fence, and I mean you could already see over the fence, really didn't need an extra box.

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But now they're like way above.

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Now the individual that's in the middle, which now is right at that point where they can see the fence because they were shorter than the first individual, but not too much.

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But then there's an individual at the very end and this individual, one box is still not enough.

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One box is really only getting them still maybe a few inches.

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The fence is still a few inches above them.

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Even if they were to stand on their tipi toes they still wouldn't see the game.

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And so equality is saying everybody gets the same thing and we should all have the same result.

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And that is the very reason why, from this depiction, equality doesn't really work, because even if everybody has the same thing, not everybody has the same needs, and so needs meeting needs has to be something that's more custom fit, that actually goes and says well, what does this person actually need in order for them to be able to achieve the goal, and what the other individual actually needed was a little bit more height assistance.

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And then what we realized is that the person the first person that we began with was already tall enough to begin with and didn't need a box at all, right, and so that person had resources that could have been redistributed towards the individuals that needed it most.

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And so it's not about taking from one person, it's about making sure that resources are equally distributed in a way that actually helps fill gaps that present themselves for certain individuals.

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So now equity is this concept that we're meeting the needs that everybody has individually, uniquely, and we're not just applying a one size fits all sort of solution across the board for everybody.

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But here's the kicker, and this is where I'm challenged, and this is where the field of health, equity, social justice, any justice and healthcare related work, is really challenged, which is, if equity and justice are synonymous terms, which many of us believe that they are, then the question that we really have to push ourselves to answer is why is there a fence to begin with?

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Why is there a barrier in between certain individuals and the goals that they're looking to achieve to begin with, and what sorts of things can we do to eliminate the fence, the barrier and totality, so that we don't even need to have to play white-haemal with all these resources and try to solution for all.

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We really can just eliminate the fence with just the ultimate root cause of the problem whatsoever.

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So that's just a broad way to describe and create a picture in people's minds.

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But what the difference is when we're talking about these terms equity, equality and justice?

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Yeah, thanks for explaining that, and when I saw you kind of give that presentation, it was the first time I had a really clear framework to kind of have in my mind for those particular terms.

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So hopefully that was helpful to other people as well.

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And then, as you were going through that explanation, you ended up saying it at the end.

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I was like, oh, it's like getting to a defense.

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In this case it's like a root cause analysis and hopefully we're gonna try to touch on some of these things throughout today's conversation.

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But could you share a little bit about sort of your upbringing and how that sort of led you?

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I'll probably end up asking follows, but how that ended up leading you towards sort of the field you're in today.

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Yeah, so it's funny.

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I grew up in Florida and I was just telling a friend of mine this morning.

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Right now I'm in Charlotte, north Carolina, still the South.

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So for those of you in the Midwest or up North, I apologize in advance for what I'm about to say, but it cold y'all and it's dry.

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It's my version of cold.

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Okay, I was telling a friend of mine this morning the air here is so dry, my skin and my hair is not meant for these conditions and I need to be in the tropic.

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You need humidity.

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Yeah, so I truly a Florida girl.

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Just the core of my being and my do they speaks to that.

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And the part of Florida that I grew up in was incredibly diverse.

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My little friend group, I mean, we just had probably a girl every race in that group and we it was.

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I consider myself a geriatric millennial, so you know I'm up the millennial type that.

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You know you go outside and you just play and then you know at night you come home before the street like come on.

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So we sort of you know summers were just full of memories of us just playing with our imagination outside on our bike all day long.

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I'm sun up, that hot Florida sun.

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I mean it inevitably rained every single afternoon of Florida and so you come back out after the rain and there's like steam coming up off of the ground and you know we really had the liberty to create in our minds whatever it was that we wanted to do, to be in those moments right In our childhood.

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And I think for me now it's actually very sheltering and I did not realize it at the time.

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I was kind of like this, you know, anti-status quo a little little, being running around with my little group of girlfriends, because we had the permission space to dream and to be and not have to worry about the outside conflict, racial, you know, injustices and just all the things that you're not really aware of as a child.

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More should you have to be.

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But when I was 10, we moved to the suburb of this area in Northeast Atlanta called Marietta's Marietta-Roswell area at East Cobb, and for those of you that might be Googling right now, east Cobb is a pretty affluent neighborhood and at my first day of school and fifth grade there I was sort of shell-shocked to be, I think, the only or one of the only black children in my classroom.

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It was just a completely different experience and that would be the rest of my formative experience until really just all the way through, you know.

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And so I learned very quickly that there was a difference between me and everyone else and that I was othered in a lot of different ways that I had not previously been in my upbringing, and so what that did for me is that it just created an initial awareness, right, and I remember when I started to, you know, develop friendships, one of my first experiences that really made that comes alive for me.

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We were in the South, okay.

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So everybody goes to church on Sunday.

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That's just the given and my experience with church I learned very quickly it's very different from any of my classmate experience.

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So you know, black church in the South is long.

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I mean you really need to bring snacks but you can't get caught eating snacks, I mean, and you cannot fall asleep.

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Like there was no sleeping in the pews, like just not an option.

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And I went to spend the night with one of my friends and the next morning we, you know, had to wake up and go to church.

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But this was a Caucasian family and they went to a Presbyterian church and I think we were out in like 45 minutes.

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I was like what in the- Totally new experience for you.

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That's like.

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What kind of church is this?

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You know, please take me back.

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Why is our church not like this?

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And when we came back to our house, you know, for me, my family, just culturally, we would have Sunday dinners.

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You know, mac and cheese, rice and gravy, fried chicken, I mean just all the things right.

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And when we came back to our house, we had bowls of tomato soup and I was like how, where and when is the chicken coming?

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You know what's so?

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Where's the rest?

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Exactly, Exactly.

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And you know, while there are so many parts of that experience that I love, I think what I took the most away from that experience was years ago, and I still remember it so vividly is how different our cultures were.

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So, going back to your original question about my upbringing, I grew up sort of living in between two worlds, with a hyper-awareness of where I was from and then moving into a space where I was all of a sudden needing to be acutely aware of my differences and me being different and my family's experiences being different, and that, you know, going along with that was, you know, differences from healthcare experiences, seeing how my friends' families you know were aging and you know their families and their health, and seeing how my family was aging and our experiences and our health, despite being educated, despite living in the same neighborhoods, and things like that.

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And so I think that I still back then, had no idea what it was called and what I would want to do with it one day.

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I just knew I wanted to work in healthcare and I knew that there was a there, there, and so I think that probably the best sort of you know way to describe how I grew up and how I got into an interest, at least how that seed got planted in me to do health equity work.

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Yeah, that's really helpful and I appreciate you sharing all that.

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And you mentioned awareness twice and one of the things that I had down here for later is kind of the idea of like where do we go, where do we begin, because your first introduction to the awareness of this was very early.

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So, my experience growing up.

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I grew up in a very white area of New Jersey, so I'm coming to this much later, but it did start with awareness and people around me like making me aware of the situation, so hopefully people listening if they're also in a similar situation where they're not aware that this is a thing that needs to be addressed.

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Is it fair to say that like that's sort of the first step to this, because I always end up getting in these conversations.

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I'm like I don't know what the first action needs to be.

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But, maybe it's not action, maybe it is awareness.

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first, oh, absolutely so.

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My husband is a therapist, he's a like medical mental health clinician and he basically like preaches cognitive and behavioral theory.

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And years ago in my career, when I was doing a lot of one-on-one coaching and, you know, really working on the behavior change side of health care and working with communities and doing a lot of education, I thought for the longest that if I can just educate people, give them all the knowledge that they need, then that is the first step to improving their health behaviors and outcomes.

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And let me tell you, education is important.

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I'm a certified health education specialist.

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I believe in the importance of health education.

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However, there has to be a level of awareness that occurs in order for you to be able to put the pieces together.

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So the trade theoretical model, or stages of change, is a model that's discussed a lot when comes to how do you actually influence and change behavior.

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And in that model there's actually a step called pre-consumption and that occurs before you're ever even really thinking about changing anything you know.

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And so pre-consumption, if I'm not even thinking about it, I'm not even you know it's.

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You may have heard it on your radar, but it's not something that you're interested in addressing at the moment.

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So, again, from pre-consumption to contemplation, that's really the step where you begin to become aware and you know, maybe something has happened, or you've heard a podcast, or you know something has, you know, sort of planted a seed that has started to, you know, create a series of thoughts around, you know a topic that you believe or that you would not have thought previously about how you contribute, to work and play a role.

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So, yes, awareness, in my opinion, is really, like you know, level one for us to be able to enter into any kind of productive conversations about how to transform health equity.

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Okay, that's helpful and I'll try to keep kind of pulling out what I think are steps and kind of asking you, like, what are sort of the steps and sort of the?

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I know it's not going to be a linear path but hopefully at least a general roadmap for people and, more important, or myself but other people to follow as well.

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So can you explain what you're doing with your work at Humana right now?

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Just kind of parlaying from you know, your childhood, and that early awareness to what you're doing now.

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Yeah, yeah.

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So my full-time job, I would say, is, out of many being, you know, a wife and a mom, and you know, for work at Humana, I'm the associate vice president for strategy advancement, and there's a whole bunch that's within that vertical.

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But just to try to summarize it, I'm responsible for thinking about number one what is a national health equity strategy for a payer like Humana to really wrap its arms?

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What does it need for a payer to be involved in health equity work?

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So, through, those big, more conceptual, theoretical questions are part of what I need to be able to answer and think about how the industry is changing and shifting and transforming and where health equity plays a role in a lot of those shifts.

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And then also, how do you actually measure where you are today and close the gap from where you want to be tomorrow?

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And so that is a lot of really looking at.

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How do you translate strategy from something that's a concept at a corporate level and at a national level down to the market and into the community where our members which is who we call our customers live, work, play and frame.

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So there's an implementation side of my work that goes from high level corporate strategy all the way down to implementation where it's felt, in the communities.

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And one of the things that we know about health equity is that, because it's health inequity, they're so complex, right, it's not.

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You know, you woke up one day and, because you are black, then you're just.

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You know, that's just.

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You're just going to be, you know, predisposed to all kinds of inequities, but it's not really how it works.

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I mean, of course, there's a little bit of individuals maybe born with and things like that.

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That's somewhat different, but there are a lot of different reasons for health inequity.

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So it's your environment.

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You know where you live, the type of housing that you live inside, do you have access to green space around your community?

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Your income, you know, because those individuals with lower income often don't have the resources needed, the time resources, as well as physical resources necessary to help support better health outcomes.

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Transportation, food insecurity, right.

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So all of these things play a role.

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So you know there's not one sewer bullet solution that we at Humana that I'm leading, that is going to be the one solution, right, that covers it all, because it's integrated.

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It's very complex, but what we do know is that you can't do health equity because of those reasons.

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You can't do health equity without also having a really strong community engagement strategy, and so that's the other part of my role, which is leading community engagement work and really defining what that looks like for us as a national health insurer.

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And so, yeah, there's a lot of strategy, very, very heavy on strategy and strategic implementation, but also thinking about what goes on in our market.

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How can we best support those needs in the market and how do we really pull the thread all the way through to communities and making sure that we are investing in communities and taking a look at, you know, how we can improve the environment in some of those social needs that are impacting individuals' ability to have the same equitable health outcomes.

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So, on the idea of community, it seems like, with all the benefits and upsides of technology, it seems like over the past I don't know, maybe it's happened for a longer period of time, but the I feel like communities are becoming less and less connected because a lot of it has sort of shifted online.

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Do you have any advice on how to build stronger community engagement, because I've been having a lot of conversations around social determinants and it seems like yet there needs to be policy change, for sure, and institutional change, but so much of it needs to happen at the community level and with the community leaders, and I have so little experience with community leadership and engagement, so you seem to be a great leader.

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So, kirit, like, are there any tips or do you have any advice on how to sort of become a leader, or are there organizations that would be good to get involved in to start building that sort of community leadership piece?

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That's a great question and actually you're right on target with a growing body of research coming out right now related to community engagement and healthcare justice and, just you know, a lot of justice and type of fields of work in general, which is thinking about how you redistribute power back into the community Power.

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There's a few health equity framework out there, but there's one in particular that I'll have to get the name of it for you because I can't think of it off the top of my head, but there's an element of the framework that describes power as a critical element in creating and sustaining health equity.

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And within that power it's both how people are, you know, distributed and as far as positions of power, political power, city councils, things like that but then also how resources are distributed.

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I've heard it said so many times, and I'll say it again here, that we don't have.

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When we think about all the different food deserts in the United States and certain communities, we really don't have a food problem.

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There's plenty food in our country.

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We have a food distribution power problem and that is as a result of how power is distributed, policies that basically make the decision for where grocery stores are and why there are some communities that have too many grocery stores, to be honest, I mean in others where you have to go two miles just to get to any kind of fresh produce, and so within that framework, there's a lot of work happening right now.

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That's really taking a look at how do you redistribute power of communities because, conceptually, if communities had the power that they need in order to make decisions and change policies to ensure that they can have a grocery store in their community or sidewalks built, you know that also requires would enable the redistribution of funds into those communities to invest in those communities and make them healthier and safer and more livable, and so that is a huge issue.

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That, I think, is a huge part of the solution in order to create health equity.

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So, community organizing and an effort to redistribute power, networks of power Now the how behind that is really where the research is trying to articulate solutions right now and frameworks right now.

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So that's a little bit more.

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I think there are some case studies out there that are really compelling for how it's worked in certain communities, but I would say, at the most basic level, it is listening to the community.

00:25:58,789 --> 00:26:12,424
I cannot underscore how important it is as business leaders, really no matter what your spheres of influence are, is to go to some of these spaces, and what I used to do.

00:26:12,424 --> 00:26:18,601
Priority joining Humana, I worked for a large provider down here in the southeast.

00:26:18,601 --> 00:26:51,622
It's a hospital and primary care network and we used to set up these community listening sessions, and afterwards I found out that there's ongoing sort of community sessions that happen in Charlotte, but in these spaces it's the opportunity to ask one or two questions to the community and let them talk back and really understand what are the challenges that you're facing here and what is the role that the corporate community and that others can play in addressing those challenges.

00:26:51,622 --> 00:27:17,717
There are coalition, neighborhood coalition lots of different community leaders that may not have the title from a corporate standpoint, but have a lot of power and a lot of trust in the community that a corporate giant coming in will never have right, and so working with those individuals is really the key to making sure that you can actually create sustainable on-sale solutions.

00:27:17,829 --> 00:27:37,352
Now, the other thing I will say, though on that note is on the issue of trust is I think a lot of times Maybe not a lot of times, but in some cases I've seen different organizations try to come in and work with the community just so that they can achieve their own business goal.

00:27:38,299 --> 00:27:50,027
And that's not what this is, because one thing about the community is that they're used to groups coming in, making promises and then leaving after two to three years, and that is a significant challenge.

00:27:50,027 --> 00:27:58,171
That has played and contributed to your lack of trust in the healthcare system and a lack of trust with many of these communities.

00:27:58,171 --> 00:28:17,173
And I think that if we're going to be serious about this, then there's in any business exchange there's a little bit of give and take, but you have to be willing to understand, going into it, that you might not be able to get all of your business goals achieved if they don't align with what the community actually needs.

00:28:17,173 --> 00:28:20,838
And then that's the question that goes back to the question of well, what are you really here for?

00:28:20,838 --> 00:28:29,400
And are we really here for health equity and healthcare justice and for community engagement, or is it just a business object?

00:28:30,924 --> 00:28:45,316
Yeah, the two notes I had jotted down were corporate slash government, and I feel like there can be concerns or misaligned incentives where maybe the people making decisions aren't directly connected to that community.

00:28:45,316 --> 00:29:05,491
Definitely from a government standpoint, I can see that being the case where, within a city, the people making decisions about what resources are going to be allocated to a particular district for roads, green spaces, sidewalks, things like that they may not live there and they may not be adequate representation.

00:29:05,491 --> 00:29:12,445
And then on the corporate side, I'm always concerned within the healthcare space, of for-profit motives.

00:29:12,445 --> 00:29:22,790
Where are these like community outreach programs, just kind of designed to increase a RAF score or anything like that?

00:29:22,790 --> 00:29:33,696
So it's like you said, it's a multifactorial problem and it's layered on so many different layers so it's tricky.

00:29:33,696 --> 00:29:38,508
Is this some of what you're exploring with your you're getting your doctorate from?

00:29:38,667 --> 00:29:45,577
UNC which is one of the best, like one of the best, or if not the best, public health school in the country.

00:29:45,577 --> 00:29:46,760
Is that what you're exploring there?

00:29:47,521 --> 00:29:48,923
It is actually.

00:29:48,923 --> 00:29:49,986
It's funny.

00:29:49,986 --> 00:30:17,503
I went into the program not really knowing specifically what I would want to study, but my journey in my career has just sort of left me feeling like the work is so unfinished and there's something more that I think I study, learn, do right To really make an impact.

00:30:17,503 --> 00:30:28,519
And so, yes, I am pursuing my doctorate in public health at UNC, Gilling Skull Public Health, which is actually the number one public health school.

00:30:29,221 --> 00:30:29,762
I wasn't sure.

00:30:29,762 --> 00:30:31,488
I knew it was always like top three.

00:30:31,488 --> 00:30:32,290
I knew it was up there.

00:30:34,021 --> 00:30:38,929
And I'm looking, I think, broadly, at both.

00:30:38,929 --> 00:30:48,771
What does it really mean to organize well, organize in a way that can advance health equity?

00:30:48,771 --> 00:31:04,085
I think to be able to answer the question through a dissertation does this achieve health equity is really tough, right, Because health equity is so layered and I would never finish my dissertation and I'd be, like you know, 100 years old still trying to finish.

00:31:04,085 --> 00:31:18,371
But, however, I think there are there's a lot, I believe, from what I was studying, that we can begin to put in place from the research that has been done.

00:31:18,371 --> 00:31:24,007
I mean, we stand on the shoulders of giants, right Alks, that have been in this and doing this work for years.

00:31:24,848 --> 00:31:42,088
And how do we really take from what we've learned over the past you know, several decades and what we're learning now, and develop the right sort of frameworks to help us organize, whether it's in the community or even in the corporate space, in the payer space?

00:31:42,088 --> 00:31:50,472
You know, what do we know from best practices that can help us organize and understand how to set ourselves up to advance health equity work?

00:31:50,472 --> 00:32:11,613
So it may not be that, again, no silver bullet or this is the single most effective solution, but we know that these things have contributed to successful outcomes related to, you know, closing guests in care or you know all of those leading indicators of achieving health equity.

00:32:11,613 --> 00:32:23,231
So I'm sort of in that space right now where I think I am in full position to really look at the corporate community and especially the payer community.

00:32:23,231 --> 00:32:32,039
But my first love and passion is community engagement, like the actual, you know, sort of grassroots boots on the ground work.

00:32:32,039 --> 00:32:39,015
So I'm figuring it out, but I definitely think that that is where my research is going to lead me.

00:32:40,826 --> 00:32:41,569
Yeah, that's great.

00:32:41,569 --> 00:32:56,452
I think it's really important to have sort of a foot in both worlds, as you mentioned, where you know being able to operate in that corporate space where you're going to have that influence, but also having the expertise and experience and the original like love and passion for the community engagement side of it as well.

00:32:56,452 --> 00:33:00,263
I'm sure it's going to be a very interesting dissertation.

00:33:01,086 --> 00:33:02,328
Challenging, Challenging.

00:33:02,328 --> 00:33:04,212
For sure, let's have my finish so.

00:33:05,861 --> 00:33:06,583
I'm sure you will.

00:33:06,583 --> 00:33:15,366
Can we kind of get into some of the specifics around this, Like, can you just kind of rattle off some of the current barriers?

00:33:15,366 --> 00:33:21,737
And then I'd love to be able to circle back to trying to kind of root cause analyze, like where do these all come from?

00:33:21,737 --> 00:33:25,207
Because I think to move forward is really important to understand how we got here.

00:33:25,929 --> 00:33:33,906
Yeah, so I'll actually take that from maybe a slightly different lens.

00:33:33,906 --> 00:33:47,413
So we know that you know, social determinants, appell, are sort of what we know are the midstream sort of barriers to affecting health equity.

00:33:47,413 --> 00:34:07,595
So what we see sort of downstream are things like mortality rate, differences in mortality among racial groups or higher prevalence of certain types of cancer and LGBTQ communities.

00:34:07,595 --> 00:34:13,416
We may see, you know, differences based off of zip code, from chronic disease rate.

00:34:13,416 --> 00:34:16,181
Those are the things that we see downstream, on the surface.

00:34:16,181 --> 00:34:23,367
I think you know, a lot of times it's used this iceberg picture is used to describe what we can see on the surface.

00:34:23,367 --> 00:34:28,244
But we know, underneath the surface of this there's like this massive structure, right.

00:34:28,244 --> 00:34:36,490
So to ask ourselves why we see what we see on the surface, it's just, you know, asking why you know, why does that exist?

00:34:36,490 --> 00:34:38,117
So why does it exist?

00:34:38,117 --> 00:35:07,552
Because, well, you know, perhaps there's we already talked about a lack of healthy food, which you know if you are in a community where you know it's not very walkable, you're working a sedentary job, there's not healthy foods around you, you know you are sedentary and you know you're got diabetes and the foods that you're eating are not helping right to manage that well.

00:35:07,552 --> 00:35:09,025
So I mean it's all those things.

00:35:09,025 --> 00:35:12,481
So it could be food, it could be housing, kind of things we talked about earlier.

00:35:12,481 --> 00:35:20,742
It could be just health discrimination, just in general, our own implicit biases.

00:35:20,742 --> 00:35:45,168
So when you're going to a healthcare provider to seek care, there are multiple unfortunate documented instances of healthcare providers Just either not taking seriously the concerns that the patient has when they present them, thinking that individuals are just being problem patients.

00:35:45,168 --> 00:35:55,005
So there's a lot of function, our implicit biases, that are brought to the table because we're human and it's just the way that our brains are designed.

00:35:55,005 --> 00:36:42,039
And if you're not trained appropriately to check those biases and to understand that you may be practicing and making decisions when biasing and you need to just sort of practice what they questioning attitude as a value, then what we see in the iceberg is just a lot of inequities with the rates in which certain individuals might be diagnosed late for certain conditions or diseases or just go completely misdiagnosed right Because the providers may have thought that they were just making things up, or just drug seeking, which is something that we see a lot in literature.

00:36:42,039 --> 00:37:04,449
There's a lot out there about using AI to detect bias in electronic medical work and that a real thing that we're seeing today is that there is bias in the way that certain patients, either by race or sexual orientation, their notes are written differently in comparison to white patients being concerned.

00:37:04,599 --> 00:37:07,268
So racial discrimination, right?

00:37:07,268 --> 00:37:49,911
So when you started thinking about, well, why do these individuals live in areas or are subjected to lives where resources are limited, the answer to why goes back really to racist policies and really truly discriminatory practices that have occurred just historically in the United States, where we've got communities that were historically redlined during Jim Crow, the Jim Crow era, and where minority communities were intentionally disinvested in during that period of time.

00:37:49,911 --> 00:38:00,521
Well, that was years ago and I think a lot of times people say, well, I mean, come on, we've gone so thin, why haven't it?

00:38:00,521 --> 00:38:02,829
These groups of people moved on since then?

00:38:02,829 --> 00:38:06,648
I think anybody out there is sitting there to station.

00:38:07,059 --> 00:38:41,693
Another thing that is really key for us to understand is really the true impact of years of systemic oppression, because that happens in the mind and so when you think about really the root to why some families and are just separated from generations of poverty, cycle of poverty and it's just so hard to get out of that cycle, it's not like, oh well, we're just going to brush it over to a school in a different district and you'll be fine.

00:38:42,242 --> 00:38:42,945
You know, good luck.

00:38:42,945 --> 00:39:09,023
It's not quite that simple, because they and their families have been subjected to truly years of oppression that have changed the way that individuals think, move and feel and move about the world around them, and so what we're talking about is really, really complex, but I do think that it begins like we started off.

00:39:09,023 --> 00:39:10,427
It begins with awareness.

00:39:10,427 --> 00:39:27,375
Having that initial awareness about really what the root to many of these problems are, which is largely rooted in policy and largely rooted in just culture of racism and discrimination.

00:39:27,375 --> 00:39:51,543
We can address those issues, we will do ourselves a lot of justice and we will go much further in actually impacting health equity in the long term than trying to create like quick fix solutions here and there in the middle, which is concerning because it seems like in the US, in particular in the healthcare system, so much of it is.

00:39:51,824 --> 00:39:54,050
let's treat the symptom and not the root cause.

00:39:54,639 --> 00:39:57,431
So I do worry when it comes to things like this.

00:39:57,431 --> 00:40:01,389
It's like there's going to be a lot of band-aid solutions where it's.

00:40:01,389 --> 00:40:17,789
I mean, I think it's good to address things from sort of the top of the iceberg perspective, as you were describing it, where, if you're talking about maternity care so just to give a concrete example, I think black women are three times more likely to die after giving birth than a white woman.

00:40:17,789 --> 00:40:28,911
So obviously you can do training in maternity wards around that, and that's sort of the top of the spectrum sort of trying to address that.

00:40:28,911 --> 00:40:34,632
But it goes down to why are maternity wards generally money losers in hospitals?

00:40:34,632 --> 00:40:39,291
Why are OBGYNs generally the lowest paid procedural specialists?

00:40:39,291 --> 00:40:41,125
That's a gender issue.

00:40:41,125 --> 00:40:46,246
So there's so many more layers you can go down to and I think this is what you're getting at where it's.

00:40:46,246 --> 00:40:47,469
How do we address those?

00:40:47,469 --> 00:40:50,371
And this is where I come to the question.

00:40:50,371 --> 00:40:51,519
I don't know what to do, right.

00:40:51,820 --> 00:40:55,550
So we can have these conversations and I'm like what's the next step?

00:40:55,550 --> 00:40:58,489
I think awareness is good and I'm still learning.

00:40:58,489 --> 00:41:00,005
I think a lot of people are still learning.

00:41:00,005 --> 00:41:02,704
What do we do next?

00:41:02,704 --> 00:41:07,771
Like I understand, this is like the premise of your dissertation and so much research.

00:41:07,771 --> 00:41:09,583
It's like where do we go?

00:41:09,583 --> 00:41:12,070
It's such a challenge.

00:41:12,842 --> 00:41:13,824
Where do we begin?

00:41:13,824 --> 00:41:14,668
Where do we start?

00:41:14,668 --> 00:41:43,471
I think I get asked that question daily, honestly, and it's not just individuals like you, individuals that I work with, you know individuals in the community, folks from other sectors that are trying to figure this out as well, and so I would say that because it does feel really overwhelming when we start really thinking about what's underneath the surface and where all this began.

00:41:43,471 --> 00:41:50,465
And, like, these are people that made decisions before I was even alive and you know like now we're here to clean up the mess.

00:41:50,465 --> 00:42:03,996
So, first and foremost, let me just say that I completely honor and I think we just need to like respect the fact that this is really really complex and hard.

00:42:03,996 --> 00:42:15,092
But just because something is really really complex and hard, I would challenge us to not think like, oh, it's just too much to deal with, like I can't even begin.

00:42:15,092 --> 00:42:27,576
I think that what I tell people is that the place where you begin is where you have, and don't try to go somewhere else where you have very little influence or expertise.

00:42:27,576 --> 00:42:29,608
You know and try to do something there.

00:42:29,608 --> 00:42:31,733
Begin where, exactly where you are.

00:42:31,733 --> 00:42:44,047
So you know, invite someone on your podcast, for example, to talk about these issues and help that witty, because you never know what level of awareness that might contribute to someone else that's listening.

00:42:44,047 --> 00:42:48,836
Another place that you can start is right in your community, as you are.

00:42:48,836 --> 00:42:54,699
You know hearing about policies, you know everybody sees those little zone thing.

00:42:54,699 --> 00:42:59,889
You know, as you're driving around in your community, why is being zone and why.

00:42:59,889 --> 00:43:15,193
You know and it's not necessarily to say like, don't walk around you with a tablet, you know, write down all the zoning codes, but have a level of awareness about the decisions that your city council is making, your local politicians are making about your community.

00:43:15,193 --> 00:43:18,472
And join groups in the community.

00:43:18,472 --> 00:43:29,387
And in this day and age you can Google, okay, you can Facebook, whatever community you are, and I am telling you, if there's an organized group that's talking about it, you will be able to find them.

00:43:29,387 --> 00:43:37,601
And if that's a little bit outside of your wheelhouse, start where you are in your profession, begin the conversation.

00:43:37,601 --> 00:43:38,664
What are we doing?

00:43:38,804 --> 00:43:46,800
When I first joined Humana, I was listening to these weekly calls.

00:43:46,800 --> 00:43:53,851
We have all of the different pilots that get tested in the organization and I love that semi-ideals person.

00:43:53,851 --> 00:43:56,277
I just love to hear about all the different patients that are being tested.

00:43:56,277 --> 00:44:03,981
But one of the things that I realized very quickly is that there was not a race ethnicity view on really any of the pilots.

00:44:03,981 --> 00:44:08,730
Is that every time I would have to come up with you and say, hey, have you guys considered they're really looking at race?

00:44:08,730 --> 00:44:12,394
Hey, you know, hey, there's something about health like what do you see?

00:44:12,394 --> 00:44:13,626
You know?

00:44:13,807 --> 00:44:31,092
So it's such a small question to ask, even fate, but in the grand scheme of fate, it's kind of like one of those you know pictures where there's like a million dots up close and then they could step back and see them out and you'd be like, oh my gosh, this is a masterpiece, you know.

00:44:32,445 --> 00:44:46,072
So it's one of those situations that you got to think about what you're able to do, where you're able to do it, because now there's an entire cultural shift that we're experiencing inside the organization, where we're looking at things differently from the health activity.

00:44:46,072 --> 00:44:51,731
I'm not saying that, you know, my little question was the thing that shifted it, but it got everyone thinking about it.

00:44:51,731 --> 00:44:58,431
Right, that was all those calls, and they go back to their fears of influence and they're thinking about it and they're talking about it.

00:44:58,431 --> 00:44:58,945
That's all.

00:44:58,945 --> 00:45:15,317
This is really sort of being comfortable and courageous enough to ask the question right, and then from there, what can we do here in order to make a small change?

00:45:15,317 --> 00:45:17,693
Don't try to attack the whole iceberg.

00:45:17,693 --> 00:45:19,851
Come on like a small change.

00:45:19,851 --> 00:45:29,394
We're taking one step at a time around this sort of behavior and you know stages of change in order to get to that masterpiece that we can all zoom out on.

00:45:30,476 --> 00:45:31,137
I think that's great.

00:45:31,137 --> 00:45:37,179
Yeah, because I think anytime you're taking on something new or challenging, you're going to need some small wins in order to keep going.

00:45:37,284 --> 00:45:40,173
If you don't see any progress for eight years, nobody's going to do it.

00:45:40,173 --> 00:45:44,521
So I think it's great advice to kind of work within your sphere of influence.

00:45:44,521 --> 00:45:53,815
Talk with your friends, have these conversations, and then you know, you'll be able to slowly but surely change minds, and then they're going to be able to do the same thing.

00:45:53,815 --> 00:45:55,550
You can sort of get this cascading effect.

00:45:55,550 --> 00:45:58,684
Tamara, I could talk to you for three hours.

00:45:58,684 --> 00:46:00,190
I want to be respectful of your time, though.

00:46:00,190 --> 00:46:04,175
Do you have any closing thoughts for the listeners before I let you go?

00:46:04,985 --> 00:46:07,653
Oh man, this has been a dream Really enjoy.

00:46:07,653 --> 00:46:09,931
I mean, I actually can talk about this for hours.

00:46:09,931 --> 00:46:14,615
Clearly, I'm not sure that everybody would want to listen to me talk about it for hours.

00:46:15,447 --> 00:46:16,050
I think they would.

00:46:16,704 --> 00:46:20,976
Yeah, well, if you are interested, it's helpful to me about it for hours.

00:46:20,976 --> 00:46:24,114
I do have a podcast called Our Journey to Equity.

00:46:24,114 --> 00:46:29,664
You can find us on YouTube really anywhere where you get your podcast.

00:46:29,664 --> 00:46:35,657
I'm on Instagram at our journey to equity, where I just do very similar things.

00:46:35,657 --> 00:46:45,875
You know where I'm looking at, who's doing this, where, what their experience has been and how can we chip away at the iceberg, one chip at a time.

00:46:45,875 --> 00:46:51,394
If you're interested in learning more, listening more to me, go on and on about this.

00:46:51,394 --> 00:46:53,347
That's where I can be found.

00:46:54,751 --> 00:46:55,253
It's excellent.

00:46:55,253 --> 00:46:57,452
I watched a few episodes this past weekend with my partner.

00:46:57,452 --> 00:46:59,068
It's very well shot.

00:46:59,068 --> 00:47:02,373
You're a great host, a great communicator on this topic.

00:47:02,373 --> 00:47:05,074
I'll certainly link to that in the show notes as well.

00:47:05,074 --> 00:47:07,050
I just want to genuinely thank you.

00:47:07,050 --> 00:47:08,949
This was really helpful for me.

00:47:08,949 --> 00:47:12,010
I hope it was helpful for the listeners and I really appreciate you coming on.

00:47:12,391 --> 00:47:12,811
Thank you.

00:47:12,811 --> 00:47:13,974
Thank you so much for having me.

00:47:14,235 --> 00:47:14,795
Hey everyone.

00:47:14,795 --> 00:47:15,898
That's all for today's show.

00:47:15,898 --> 00:47:20,510
I want to thank you so much for stopping by and watching, especially if you've made it all the way to this point.

00:47:20,510 --> 00:47:26,891
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00:47:26,891 --> 00:47:30,474
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00:47:30,474 --> 00:47:34,856
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00:47:34,856 --> 00:47:37,853
That website will also be linked in the description.

00:47:37,853 --> 00:47:43,235
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00:47:43,235 --> 00:47:45,490
So any of that you can do I would really appreciate.

00:47:45,490 --> 00:47:48,672
And again, thank you so much for watching and I'll see you next time.