December 22, 2020 • 39 mins
Who’s affected most by COVID and why? Who deserves to receive care? And how can we treat everyone equally – both in society and in the hospital? This week’s episode of Contakt World dives into the hot-button issues of race, equal access to healthcare, and the political determinants of health – specifically, how historic inequities in our health system have never been more apparent. As COVID disproportionately affects communities of color, we talk with national health equity leader Daniel E. Dawes, executive director of Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta. A co-founder of the Health Equity Leadership and Exchange Network (HELEN) and Author of The Political Determinants of Health, Daniel shares unique insights from the frontlines of the healthcare reform movement, and provides a thorough overview of how we, as a country, even got here. To learn more visit https://contakt.world/podcast/
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Episode Transcript
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Speaker 1 (00:02):
You know, COVID nineteen is a dangerous, all encompassing, downright
awful virus that is wreaking havoc on our country. But
one thing COVID nineteen is not is sentient. What I
mean by that is, while it's true that COVID nineteen
is disproportionately affecting communities of color, it is not doing
(00:23):
so because the virus itself is targeting black and brown folks. Instead,
the system in which COVID nineteen operates targets black and
brown folks. That's Daniel E. Dawes, one of the leading
experts on health equity in the US. As executive director
of Stature Health Leadership Institute at Morehouse School of Medicine,
Daniels among the most knowledgeable about the history of our
(00:46):
health system and how we really got here. So get
ready to go on a journey back to the beginning
with our founding fathers to truly understand the political determinants
of health, why we're in this position today, and how
long are marginalized in underserved communities have suffered at the
hand of a broken system. During the early days of
(01:06):
this pandemic, we thought that this virus was the great
equalizer because it was infecting people without regard to how
athletic or healthy they were, or how rich they were.
But we know now that COVID nineteen has proven to
be the great revealer, the great exacerbator, right, because the
virus is simply amplifying the disparities in the system that
(01:29):
have existed and persisted for so many years. So to
scistically answer your question of why it is disproportionately affecting
Native Americans, Latin X, and Black people, it's because our
system disproportionately affects Native American, Latin X, and black people.
COVID nineteen is simply reading the room. I'm Justin Beck,
(01:57):
founder and CEO of Contact World. I'm here with my
co host Katherine Nelson and deep Deepava and over the
coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
may not have all the answers, but you deserve to
understand what goes on in your neighborhood and the decisions
(02:20):
that will affect you and your family's health. Hi, everybody,
I'd like to welcome our listeners back to Contact World.
Now that the vaccines are being rolled out and the
first patients are receiving them, it's critical for people to
understand the importance of this progress and the misinformation they
may be hearing or reading. So I urge our listeners
(02:42):
to check out episode one and the conversation we had
with Dr Peter Hotez, world renowned vaccine expert. Today and
for the next two episodes, Catherine deep D and I
are going to talk about something that's really important. We're
gonna focus on healthcare and the inequities of our health
care system. We hear so much about the social determinants
(03:02):
of health, but one of the things that escapes most
of the media are the political determinants of health and
how our system is broken, and it's been that way
for a long time. We spend more money on healthcare
in the United States than really any other developed nation,
but we have the worst health care ratings of anyone.
So it's really interesting to see the underlying causes of
(03:23):
those which often tracks back to politics. You know, justin
one of the memos from Vice President elect Kamla Harris,
written in April when she was still a Senator where
she says that you know, they need to prioritize addressing
the racial health iniquities during COVID nineteen. But what you
wrote was these numbers are straggering, sobering, but unsurprising, which
(03:47):
means that they reflect longstanding iniquities in our health care system.
Good nineteen has just amplified old problems which require a
new radical approach to solving these issues for you know,
for health iniquities as well as it's just exposed the
fragility of these systems. I think one of the key
things is the hope and the potential that there is
(04:09):
for us to make changes to the systems. Yes there
are inequities, Yes there are disparities, but with the new
administration and everything else that is happening, with people being
more aware of what's going on out there, that level
of awareness is positioning us to make the changes, the
radical changes that are needed to better position our public
health systems and help people and make sure that they
(04:32):
are okay. I really like what you said about hope,
because we take all of the strides we've made in healthcare,
for granted, it is scary to think that Obamacare has
actually been in front of the Supreme Court, and at
least we've had some early wins there. But we're living
right now in a movement where things are getting better.
And to your point, the new administration has clearly made
(04:55):
a dedication to changing and building upon the political determinants
of health. So, DT, you had the opportunity to speak
with the daughter of a healthcare worker who lost her
life to COVID nineteen. We're actually going to dedicate an
entire episode to the conversation that you had because it's
just so important. What did you learn from that conversation
(05:18):
with Fianna Tulip, Yeah, Justin, I spoke with Fianna Tulip.
She's a hero in my opinion, she's actually turning her
grief into action. During my conversation with her, all I
heard her say was and urge a plea to people
to take this disease more seriously, to save themselves and
(05:38):
them and their family and their and their loved ones.
You know, those are the stories that put us on
a better path to really help to equalize the system
to the extent that we can. Guys, it's always great
discussing the issues with you, and we're about to hear
from Daniel Dawes, Justin, can you tell us a little
bit about that. I gotta tell you, I don't think
I've ever learned so much about our health care system.
(06:00):
We learned how politics has a direct impact on healthcare,
health workers, health equity in this country, and also some
of the strides that we made under Obamacare, and what
we really need to do is meet this moment and
keep the momentum that we have. So I'm really excited
to share that with our listeners. I can count on
(06:28):
one hand, Daniel, the people in the world that really
truly inspire me. Who inspired you to dedicate your life
or what inspired you to health equity? Well, you know,
my journey to improve the health of all communities, to
eliminate health disparities, and to advance health equity and reform
our health system really began with a series of personal
(06:51):
experiences that I had with our health system. It was
in witnessing my father struggle to attain healthcare owing to
his existing conditions. Right. It was, you know, witnessing and
observing disparities in the length of life and in the
health status between my black and white family members, as
well as a number of other things. And I think
(07:13):
my interest in health reform was piqued when I discovered
the hardships many people in my own community we're facing.
Nowhere is that hardship more evident, I think, in shocking
than in healthcare and in public health, where a lack
of resources or insurance and disparities and care can deprive,
desperately ill people of the quality care, the treatments, and
(07:36):
the medicines that they need to survive and thrive. So
I wanted to do something about it. During high school,
I volunteered at a hospital where I got a up
close look at the massive problems faced by underserved communities.
On my first day, I was assigned to the emergency
department and witnessed an episode that convinced me that I
(07:57):
wanted to spend the rest of my life increasing awareness
of and meaningfully addressing health disparities. This involved a woman
who had immigrated from Haiti. She was in a great
deal of pain, but each time she tried to tell
the staff about her problems, they responded with nothing more
than blank stares. Very unfortunate, and this patient could speak
(08:21):
only Haitian creole. As I watched her trying to make
herself understood, I could not help but think, Oh, my gosh,
what if her condition is life threatening? Every second was critical.
That afternoon was a revelation for me about how vulnerable
many patients really are and how complicated health care delivery
(08:44):
could be in the United States. It was from that
path forward that I knew I wanted to dedicate my
life to understanding what was determining and driving these health
outcomes and how could we realize a healthy, equitable, and
inclusive society where every individual in our society is afforded
(09:05):
a fair opportunity to not only be healthy, but to
also reach their full potential. So, for our listeners who
may not be familiar with the term, what does the
word or term health equity mean? Yeah, the most distinct
way to define health equity is to understand that it
is all about providing every person with the care that
(09:25):
they need in the amount that they need, in order
to help them achieve their optimal level of health. So
health equity at its core is a tailored approach so
that each individual is able to overcome the systemic and
the systematic barriers that stand in the way. One of
the things that shocks me is the United States is
(09:48):
the largest economy in the world, and it accounts for
about of the global economy. But somehow we spend more
on healthcare amongst all the high income countries, but we
consistently rank last in performance. How did we get here?
So I can tell you that we didn't get here
(10:08):
starting four years ago or even forty years ago. You know,
for too long, many racial and ethnic minorities, people with disabilities,
and lower socce economic status individuals have found themselves in
a precarious situation. Their health, their lives have literally been
hanging into balance right over centuries, and many of them
have been falling through the cracks of our health system,
(10:29):
our education system, human services system, behavior health system, you
name it, right. They struggled to live in a society
that has erected barrier after barrier to weaken their bodies
and hasten their debts. We've seen this for over four
hundred years in America. These groups have experienced health inequities
throughout the life course from womb to tomb, but they've
(10:52):
struggled also to gain access to quality health services. So
to get to your question, you know, to understand why
the US health care system specifically is the way it is,
you really have to go back over a hundred and
fifty years ago and look at the early days of
healthcare in the US up and to the present times. So,
(11:13):
if you would permit me, I'd like to take maybe
a couple of minutes to walk us through that history.
Is that okay? Absolutely? Please do so. We know that
you know, for almost two hundred and thirty years, there
were a group of abolitionists, mental health reformers, advocates for
homeless populations, and others who had labored assiduously to get
our policy makers to implement policies that would drive health equity.
(11:36):
They pleaded with our newly formed government, begging them to
really advance and implement right policies that would drive that
needle of health equity forward. Well, the abolitionists decided at
that point to approach Benjamin Franklin. They said, Benjamin, would
you please use your influence and your power, your privilege
(11:59):
to help us advanced this cause, this agenda. And although
Benjamin Franklin had been a lifelong slave owner, he decided
that you know what slavery, that these inequities in our
society were horrible, they were awful, and so he says, yes,
I will help you craft this petition, and I'll sign it,
and let's send it to Congress. And in this petition
(12:21):
they argued for not only abolishing slavery, but to provide
medical care to these individuals, to stop the separation of
children from their mothers, from the breakup of these enslaved families.
They begged them to provide educational opportunities and meaningful and
true employment opportunities. What that letter did was to unleash
(12:42):
one of the greatest debates in the U S. Congress.
People were upset with Benjamin Franklin. Well, the Senate decided
they weren't going to even entertain Benjamin Franklin's letter, right,
But the House said they could not ignore it, and so,
bullet by bullet, they made an argue meant for why
they couldn't stop the separation of these children from their
(13:03):
mothers and the breakup of these enslaved families, why they
couldn't provide medical care and education and employment opportunities, etcetera.
Basically making an argument that the people are in the states,
and the states are closest to the people, so the
states therefore should be the ones basically providing this medical
care and providing the educational opportunities. It's not the role
(13:24):
of the federal government. We are not authorized by the
Constitution to provide for the general welfare of our citizens,
which we know is not true. We see how quickly
that arguments pushed aside right in moments of crises. And
that was the first time in US history that the
light of health equity had dimmed in the United States. Well,
it would take a seventy five years after that before
(13:45):
these groups, these advocates got together, and they again, during
a major crisis, the Civil War, pleaded with President Abraham
Lincoln and his supporters to create a bill that would
address what we now know as the social determinants of health. Right.
They wanted not only to abolish slavery, but they also
wanted to provide food and clothing and education, employment opportunities,
(14:10):
as well as medical care. And fortunately, you had a
majority of proponents in the Congress who said, you know what,
we are going to advance this health reform agenda. We
are going to advance civil rights for these formerly enslave people,
right and poor whites who will be displaced as a
(14:31):
result of the Civil War. And finally, after two years
of negotiating from eighteen sixty three to eighteen sixty five,
they finally succeeded in getting this bill passed right that
was intended to address all of these determinants that drive
health and equities. But there was one provision that was
the most contentious. It was the idea of providing medical
(14:53):
care health services. There was no appetite in that Congress,
even though they had a majority to provide medical care.
So President Abraham Lincoln decided that, you know what, in
the spirit of compromise, will strike that provision and leave
the rest intact. And that's what they did. Well. That
became the most comprehensive health reform in America. But as
(15:15):
you and I know, justin you know, racism doesn't sleep
in America, and the forces the opponents of health equity
were working over time. After seven years, they finally overturned
the Freeman's Bureau Act. It would then take us a
hundred and fifty years after that to create similar legislation
(15:36):
in the form of the Affordable Care Act or Obamacare.
So our country's unique approach to health care really hinges
on the prioritization of many other factors and concerns. Rather
than prioritizing the health and well being of individuals. While
it's true that we as a country spend far more
than many other high income countries on healthcare, it's also
(16:00):
through that a lot of that spending allows us to
be on the absolute cutting edge of medical technology and research.
So that's a plus, right, But at the same time,
we do rank near the bottom of performance, and that
can consistently be tied to how frequently we simply do
not look out for those among us that need the
most health, which again gets back to health equity. Yes,
(16:24):
we have some of the best and the brightest in
the world working to improve healthcare here, but we have
not yet turned that brain trust towards meaningfully alleviating health disparities,
and that is why our performance continues to lag. Thank
you for that history, I think I don't think a
lot of people are aware of it. You've referenced how
politics have really played a major role then, dating back
(16:47):
hundreds of years. So your latest book, published by JOHNS
Hopkins University Press, is entitled The Political Determinants of Health.
Can you describe the political determinants of health a little
bit more absolutely? So, you know, the political determinants of
health are the upstream factors that impact every component of
our health and our health care system, the political determinants.
(17:09):
They create the social drivers, including the poor environmental conditions,
the inadequate transportation, unsafe neighborhoods, and lack of healthy food
options just to name a few, that affect all dynamics
of health. So many people have an understanding of what
the social determinants of health are. You heard me mention
(17:30):
that earlier. These are the structural conditions in which people
are born, they live, they learn, they work, they play,
they worship that affect a wide range of health. Well,
the political determinants go one step further. The political determinants
of health are what actually creates, sustains, or exacerbates those
(17:53):
social determinants. Right, for every social determinant of health, there
was a preceding legislative policy or legal decision that results
in that outcome. So for instance, it might be a
law passed, or a city council ordinance, or a ruling
handed down by a judge. But there is always some
(18:14):
force of law or politics that create the disparities, and
that is what needs to be addressed the political determinants.
So politics clearly affects everyone's health. Are there any other
ways that people might be surprised to learn that politics
influences health? Absolutely, So let's talk about structural racism for
(18:34):
a moment, right, because these political determinants of health really
are the instigators as you've you've heard me mentioned when
it comes to looking at all of the drivers that
impact our health, whether environmental or social or behavioral. But
undergirding these political determinants is what we term structural racism.
And structural racism and the health of America are inextricable
(18:57):
and they affect all of us at all levels. So
think about it this way, right, Inequality gets under our
skin and it leads to accelerated aging or biological weathering.
If you think about a block of concrete and a
constant drip of water hitting that concrete. At first, you
(19:18):
may not notice that water having an impact on that
cement block, right, but then after a while you can
see it chipping away at the concrete. That's essentially what
is happening in many vulnerable populations bodies today right owing
to the stressors in our society of systemic racism throughout
(19:38):
our society, and it leads, again, like I said, to
increase chronic diseases that we see in terms of racial
mythic minorities and other groups. So, by its very definition,
one of the structures that racism operates in is a
health care system in America. So I want to focus
on that a bit. Right. Our history is littered with
(19:59):
known examples. You can go as far back as the
health care that was not afforded to slaves or indigenous populations,
to the contentious creation of the Freedman's Bureau that I
just talked about two separate but inherently on equal medical facilities,
to the maternal mortality crisis black women are facing today,
(20:19):
to even the disparate impact that COVID nineteen is having
on communities of color. Absolutely, that's right, and it compounds
one after the other, right, So there is no ignoring
the fact that structural racism is just as pernicious in
healthcare as it is in any other corner of our society. However,
(20:39):
the key thing to remember is that structural racism in
our health care system is a net negative for everybody.
So from infection rates and hospitalizations to death. Why does
COVID nineteen disproportionately affect Native Americans, Latin X and black people.
You know, COVID nineteen is a dangerous, all encompassing, downright
(21:03):
awful virus that is wreaking havoc on our country. But
one thing COVID nineteen is not is sentient. What I
mean by that is, while it's true that COVID nineteen
is disproportionately affecting communities of color, it is not doing
so because the virus itself is targeting black and brown folks. Instead,
(21:24):
the system in which COVID nineteen operates targets black and
brown folks. During the early days of this pandemic, we
thought that this virus was the great equalizer because it
was infecting people without regard to how athletic or healthy
they were, or how rich they were. But we know
now that COVID nineteen has proven to be the great
(21:45):
revealer because the virus is simply amplifying the disparities in
the system that have existed and persisted for so many
years to the detriment of so many minority populations. So
to seistically answer your question of why, uh it is
disproportionately affecting Native Americans, Latin X, and black people, It's
(22:08):
because our system disproportionately affects Native American, Latin X, and
Black people. COVID nineteen is simply reading the room. So
let's talk a little bit more about Affordable Care Act.
(22:29):
In your book A hundred and Fifty Years of Obamacare,
which you artfully describe the history of our country around healthcare,
you explain how the Affordable Care Act is much more
comprehensive than most people realize. What are the most overlooked
benefits of the Affordable Care Act? The a c A
is the most comprehensive and inclusive health law employing an
(22:52):
equity lens, which took us a hundred and fifty years
to realize in America. So this is an incredible as
lative feed it as a landmark law. To your point
about what are some of those benefits right that are
often overlooked. There were so many health insurance reforms and
protections that were included in this bill, many antidiscrimination protections,
(23:16):
essential benefits of course that were included for women, for
people with disabilities, for veterans, people of color, and lgbt
Q plus individuals. And some of these include the first
ever protection that allows individuals the ability to go to
a court of law and sue to protect their rights.
First ever health law that allows that right. Medicaid doesn't
(23:39):
include that Medicare, Social Security, none of those other health
laws in the past include that private right of action.
There are other provisions to that I think are really critical.
For the first time ever in US history, the law
includes a mandate that employers that health insurance companies, if
they are offering a health insurance planning qualified health and
(24:00):
they have to include mental and behavioral health coverage. That
again is a huge feat, especially for people who have
struggled with mental illnesses or substance used disorders in America.
Then there was another provision for people with disabilities where
we included habilitative and rehabilitative coverage as part of tennessential
(24:21):
health benefits that you must get if you purchase health
insurance plan from the marketplace. And then for women, we
know that women were treated as a pre existing condition
if they were of reproductive age. So the law, you know,
forbids of course discrimination based on their sex, they can't
be charged twice as much as a man like they
(24:43):
could pre Obamacare, that is no longer allowed. And also
if they have been the victims of domestic abuse, let's
say they were raped. Insurance companies at that time would
resend coverage to many women because now they believe that
the provision of health services was going to increase astronomically, right,
They're gonna need more psychological um therapy sessions, are going
(25:04):
to need more physical services, and so forth. So they
would discriminate and find any pretextual reason to drop their
coverage that is not allowed. And then another thing that
is a really major win for us in the health
equity movement was providing maternity coverage. That's nine zero percent
of women who thought that they had maternity coverage realized
(25:27):
that they didn't have that coverage once they had gotten
pregnant and they needed to use those benefits, and they
were discriminated. So now maternity coverage is an essential benefit
in the affordable care That's another major deal. You know,
after we've gone so long with these health care disparities
in our country, how do we protect the strides that
(25:48):
we've made under Obamacare and the health equity movement With
a conservative majority in the Supreme Court. If the Supreme
Court overturned you know, part or all the A c A,
the Biden administration would have a number of options, so
you know it would be a complicated process. But with
the leadership of a president and vice president that have
(26:11):
spent so many years in the Senate, coupled with the
fact that the President elect played a pivotal role in
shepherding the a c A through Congress the first time,
I'm fairly confident that he would and he could make
certain that in the event of such a disastrous ruling,
the country would remain protected. Now, the Biden administration will
(26:33):
be hitting the rewind button on many of the health
policies from the Trump administration. Especially, They'll also be working
assiduously to unwind many of the Trump policies around reproductive health,
drug pricing, health disparities, and health equity right. Whereas the
Trump administration primarily leveraged regulatory actions and executive orders to
(26:57):
undermine key health policies and programs, you can expect the
Biden administration to employ a very similar strategy. And this
actually would be the first presidential administration in US history
that has committed to a very robust health equity agenda
in all of its policy priorities. You lead something called
(27:21):
the Health Equity Tracker Project through a grant from Google,
c DC Foundation in gileyad Sciences. Why don't we have
a better grasp on tying demographic data in this country? Realistically?
The the answer to your question is twofold. I think,
first and foremost opponents of the health equity movement understand
the intrinsic value in having data that highlights demographic disparities.
(27:47):
No data, no problem. If there is no data to
illuminate an issue, right or in equity, then there is
no problem that requires change. The second reason is that
it is truly difficult to obtain demographic data for a
whole host of reasons. Chief among these reasons being that
(28:08):
we as a country have never prioritized collecting such data,
so the system is not designed to easily tabulate it.
The same systemic issues that exacerbate the political and social
determinants of health are the same issues that make collecting
data difficult. And this is not by happenstance. Right that said,
(28:30):
the creation of the Health Equity Tracker tool that we've
been working on is all the more important precisely because
there is no comparison. So do you think that maybe
like more effective sharing of data will improve trust and
transparency and vaccines? Absolutely? There is no doubt. And I
think that gets to the heart of the issue of transparency.
(28:51):
You know, if you are giving people access to the data, right,
and you're giving them access to all the data, then
of course it does allow them to see for their
own selves, right, what you have been saying is true.
But if you are hiding the data, or you're hiding
even a part of it, then it does allow for
you know, opponents of these vaccines to push that agenda
(29:13):
that you know they're hiding something that could be hurting you.
So you know, you're just gonna be lab rats, You're
gonna be guinea pigs. Don't do it. So I do
think data is a critical element. Are you concerned, you know,
with the health equity lens about equitable distribution of vaccines
in the United States? I am, And it's because if
we do not learn from history, we are what we're
(29:34):
doomed to repeat it. A review of studies in this
country have shown us that in many instances, you know,
racial and nothing minorities, people with disabilities, and other marginalized
groups have been the most disproportionately impacted by pandemics. It's
always the same group who are on the downside of
advantage and opportunity, that fear the worst. But during this pandemic,
(29:58):
I've been heartened by the increase attention that we've seen
and the efforts to ensure a more equitable distribution of
COVID nineteen vaccines. And I think the incoming Biden administration
will take the necessary steps to have a thoughtful approach
to this issue. With that said, again referencing those pest
key political determinants of health, it will be incumbent upon
(30:21):
all of us to continue to push for an equitable
distribution of vaccines. Yeah, because one thing is having finally
a federally coordinated response, and it's another to have that
localized somehow in a way that is not convoluted by politics. So,
going forward, not just with COVID nineteen, how do we
encourage or you know, increase minority participation in clinical trials? Generally,
(30:46):
increasing minority participation in clinical trials starts at the top.
You know, you have to increase the diversity of the
researchers performing and setting up the trials. I think you
have to increase the diversity of the companies that are
facilitating the trials, right, and then you have to increase
the diversity of the medical and health professionals who are
advocating for such So going into and recruiting from communities
(31:11):
that have traditionally been underrepresented in clinical trials is a
good first step. But it's just that a first step, right.
You need to have diversity for every step of the process,
so that there is an echo chamber of individuals with
actual power who can continually push for the diversity throughout
(31:31):
the entirety of the process. Yeah, so having researchers that
are more reflective of our population that we're asking for participation,
that makes sense. So if you had the power and funding,
what else would you focus on, you know, broadly for
vaccine development, trust and transparency, what would be like your
first step? I would say that we certainly need to
(31:53):
increase spending in our public health infrastructure. I do think
that is absolutely critical at all levels. Again, whether you
are at the municipal level, the local level, or the
state level, right and even the federal level. Because three
cents of every dollar that has been invested in this
country has been invested in public health. Why aren't we
(32:15):
investing in more? You know? One of the issues that
we've had to deal with over time is the fact
that historically policymakers have usually been reactive rather than proactive. Right.
So once the crisis is adverted, so too is the
funding until the next crisis comes along and reeks even
greater havoc. Right. So for me, in terms of what
(32:37):
I would start first, it would be, you know, investments
in equitable distribution of vaccines and equitably distributing them. Contact
tracing absolutely critical, right, Testing is absolutely critical. We've seen
early on how with contact tracing and even with testing,
how many communities of color were there raising their hands saying, hey,
(32:58):
you know, we want to be counted to, We'd like
to be able to access these resources, but they were ignored.
If you have inequitable distribution of testing, then you cannot
perform contact tracing. And it's again just part of a
vicious cycle. Absolutely. So any other words of wisdom for
our listeners, Daniel, we really appreciate all the time you
(33:21):
spent with us today. My final words would be just
to remind folks about how long and challenging it has
been to advance health equity in America and around the world.
This is a movement that is not for the faint
of heart and it does take the resolve that is
needed right. It takes persistence, and it takes courage, it
(33:43):
takes knowledge, and so I want to urge our listeners
today to really think about that and to continue to
press this agenda. Even when the tough gets going right,
we've got to keep pushing and stop that pendulum from
swinging too far that it unravels the gains that have
been made previously by health equity leaders and champions throughout
the course of our history. Well, you've given us great context,
(34:06):
because I don't think anybody fully understood the hundreds of
years it's taken us to get here. So we have
to put our foot on the gas. You're an inspiration, Daniel.
I can't thank you enough for your time today. It's
been great. Thank you so much. Essin for the opportunity
to learn more about the work that Daniels doing to
improve health equity and reduce disparities in our system, visit
(34:29):
Daniel E. Dawes dot com or read one hundred and
fifty Years of Obamacare and the Political Determinants of Health
from Johns Hopkins University Press. On the next episode, Deeply
had the opportunity to speak with Fianna tulip a grieving
(34:50):
daughter who bravely and heroically shares the story of how
her mother, Isabel Papa Demitru, a healthcare worker from Texas,
lost her life unnecessarily to COVID name team. It feels
like the leadership is letting my people die, Hispanics, the
Latin X community, people of color. It feels like they're
(35:12):
just throwing them to the wayside and saying good luck.
I mean, there's been a real failure among people of color,
and it's it's speaking to deeper divisions that we have
and to structural inequalities in this country. And unfortunately, you know,
the Hispanic community, they are on the front line. They
(35:33):
work in jobs that increase their risk of contracting the virus.
They are the ones who are caring for their elderly
and living with them. They're fulfilling online orders, they're they're
working in the hospital. They live in institutions such as
prisons and homeless shelters, and these are all places where
it's easy to spread this virus and there's no support.
(35:56):
There's no support. Fianna's heartbreaking story is one we all
need to hear, but she is truly an inspiration turning
grief into action. When I really started out on this crusade,
I guess you can call it, I started realizing that
people would say, no, look at the death rate, it's
(36:17):
not that bad, or but I need to see my family.
It's more important that I see my family than stay home. Um,
masks don't work. In fact, I can't breathe with the mask.
And it was so frustrating to me because I just
come back with but I lost my mom. But I
didn't have to lose my mom if we had just
followed these simple public health measures. So I want people
(36:43):
to know that this crisis the one where my family
must stay apart to do our part, even when we
most want to be together. It's more than just death
rates and a death count. It's a human life. It's
a person who has passions, it's a person who has
children or grandchildren, and it's a person who didn't want
(37:05):
to die this way. And it's a person who didn't
want to die alone in a hospital. I want people
to know that and and to think about that. Okay,
I want you, dear listener, to take the following very
seriously to avoid a lifetime of potential regret. Think about
(37:27):
the family and friends you love and care for for
just a moment. Now consider the actions you take and
the company you keep this holiday season. Is it worth
maintaining your family traditions and gathering this year when it
could mean some of you may not be around next
year to enjoy another holiday that any one of your
(37:50):
family or friends could literally suffer in complete isolation on
a ventilator to start, that is, if they are even
lucky enough to be offered one in our over extended
health care system. If you had a choice between getting
together for the holidays at the expense of losing one
of your loved ones or electing not to gather this
(38:10):
year even though it hurts, which would you choose? Well,
guess what, you do have a choice? Do you truly
think for a virus that transmits asymptomatically that you can
control all the variables, Whether it's three, four, or even
five or more of your family and friends from different households,
(38:31):
The entire country should have access to quality vaccines before
next holiday season. Let's make sacrifices together. I know it's hard.
We owe it to each other, and we owe it
to our public health agencies and our frontline health workers.
I don't care what your political persuasion might be, and
neither it is this virus. Let's just get through this
(38:52):
holiday season together. Please, without gathering from other households. Make
sure are you join us for the next episode of
Contact World. I'm justin back and I'll see you next time.
Listen to Contact World of podcast on the I Heart
Radio app or wherever you get your podcasts. M
You know, COVID nineteen is a dangerous, all encompassing, downright
awful virus that is wreaking havoc on our country. But
one thing COVID nineteen is not is sentient. What I
mean by that is, while it's true that COVID nineteen
is disproportionately affecting communities of color, it is not doing
(00:23):
so because the virus itself is targeting black and brown folks. Instead,
the system in which COVID nineteen operates targets black and
brown folks. That's Daniel E. Dawes, one of the leading
experts on health equity in the US. As executive director
of Stature Health Leadership Institute at Morehouse School of Medicine,
Daniels among the most knowledgeable about the history of our
(00:46):
health system and how we really got here. So get
ready to go on a journey back to the beginning
with our founding fathers to truly understand the political determinants
of health, why we're in this position today, and how
long are marginalized in underserved communities have suffered at the
hand of a broken system. During the early days of
(01:06):
this pandemic, we thought that this virus was the great
equalizer because it was infecting people without regard to how
athletic or healthy they were, or how rich they were.
But we know now that COVID nineteen has proven to
be the great revealer, the great exacerbator, right, because the
virus is simply amplifying the disparities in the system that
(01:29):
have existed and persisted for so many years. So to
scistically answer your question of why it is disproportionately affecting
Native Americans, Latin X, and Black people, it's because our
system disproportionately affects Native American, Latin X, and black people.
COVID nineteen is simply reading the room. I'm Justin Beck,
(01:57):
founder and CEO of Contact World. I'm here with my
co host Katherine Nelson and deep Deepava and over the
coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
may not have all the answers, but you deserve to
understand what goes on in your neighborhood and the decisions
(02:20):
that will affect you and your family's health. Hi, everybody,
I'd like to welcome our listeners back to Contact World.
Now that the vaccines are being rolled out and the
first patients are receiving them, it's critical for people to
understand the importance of this progress and the misinformation they
may be hearing or reading. So I urge our listeners
(02:42):
to check out episode one and the conversation we had
with Dr Peter Hotez, world renowned vaccine expert. Today and
for the next two episodes, Catherine deep D and I
are going to talk about something that's really important. We're
gonna focus on healthcare and the inequities of our health
care system. We hear so much about the social determinants
(03:02):
of health, but one of the things that escapes most
of the media are the political determinants of health and
how our system is broken, and it's been that way
for a long time. We spend more money on healthcare
in the United States than really any other developed nation,
but we have the worst health care ratings of anyone.
So it's really interesting to see the underlying causes of
(03:23):
those which often tracks back to politics. You know, justin
one of the memos from Vice President elect Kamla Harris,
written in April when she was still a Senator where
she says that you know, they need to prioritize addressing
the racial health iniquities during COVID nineteen. But what you
wrote was these numbers are straggering, sobering, but unsurprising, which
(03:47):
means that they reflect longstanding iniquities in our health care system.
Good nineteen has just amplified old problems which require a
new radical approach to solving these issues for you know,
for health iniquities as well as it's just exposed the
fragility of these systems. I think one of the key
things is the hope and the potential that there is
(04:09):
for us to make changes to the systems. Yes there
are inequities, Yes there are disparities, but with the new
administration and everything else that is happening, with people being
more aware of what's going on out there, that level
of awareness is positioning us to make the changes, the
radical changes that are needed to better position our public
health systems and help people and make sure that they
(04:32):
are okay. I really like what you said about hope,
because we take all of the strides we've made in healthcare,
for granted, it is scary to think that Obamacare has
actually been in front of the Supreme Court, and at
least we've had some early wins there. But we're living
right now in a movement where things are getting better.
And to your point, the new administration has clearly made
(04:55):
a dedication to changing and building upon the political determinants
of health. So, DT, you had the opportunity to speak
with the daughter of a healthcare worker who lost her
life to COVID nineteen. We're actually going to dedicate an
entire episode to the conversation that you had because it's
just so important. What did you learn from that conversation
(05:18):
with Fianna Tulip, Yeah, Justin, I spoke with Fianna Tulip.
She's a hero in my opinion, she's actually turning her
grief into action. During my conversation with her, all I
heard her say was and urge a plea to people
to take this disease more seriously, to save themselves and
(05:38):
them and their family and their and their loved ones.
You know, those are the stories that put us on
a better path to really help to equalize the system
to the extent that we can. Guys, it's always great
discussing the issues with you, and we're about to hear
from Daniel Dawes, Justin, can you tell us a little
bit about that. I gotta tell you, I don't think
I've ever learned so much about our health care system.
(06:00):
We learned how politics has a direct impact on healthcare,
health workers, health equity in this country, and also some
of the strides that we made under Obamacare, and what
we really need to do is meet this moment and
keep the momentum that we have. So I'm really excited
to share that with our listeners. I can count on
(06:28):
one hand, Daniel, the people in the world that really
truly inspire me. Who inspired you to dedicate your life
or what inspired you to health equity? Well, you know,
my journey to improve the health of all communities, to
eliminate health disparities, and to advance health equity and reform
our health system really began with a series of personal
(06:51):
experiences that I had with our health system. It was
in witnessing my father struggle to attain healthcare owing to
his existing conditions. Right. It was, you know, witnessing and
observing disparities in the length of life and in the
health status between my black and white family members, as
well as a number of other things. And I think
(07:13):
my interest in health reform was piqued when I discovered
the hardships many people in my own community we're facing.
Nowhere is that hardship more evident, I think, in shocking
than in healthcare and in public health, where a lack
of resources or insurance and disparities and care can deprive,
desperately ill people of the quality care, the treatments, and
(07:36):
the medicines that they need to survive and thrive. So
I wanted to do something about it. During high school,
I volunteered at a hospital where I got a up
close look at the massive problems faced by underserved communities.
On my first day, I was assigned to the emergency
department and witnessed an episode that convinced me that I
(07:57):
wanted to spend the rest of my life increasing awareness
of and meaningfully addressing health disparities. This involved a woman
who had immigrated from Haiti. She was in a great
deal of pain, but each time she tried to tell
the staff about her problems, they responded with nothing more
than blank stares. Very unfortunate, and this patient could speak
(08:21):
only Haitian creole. As I watched her trying to make
herself understood, I could not help but think, Oh, my gosh,
what if her condition is life threatening? Every second was critical.
That afternoon was a revelation for me about how vulnerable
many patients really are and how complicated health care delivery
(08:44):
could be in the United States. It was from that
path forward that I knew I wanted to dedicate my
life to understanding what was determining and driving these health
outcomes and how could we realize a healthy, equitable, and
inclusive society where every individual in our society is afforded
(09:05):
a fair opportunity to not only be healthy, but to
also reach their full potential. So, for our listeners who
may not be familiar with the term, what does the
word or term health equity mean? Yeah, the most distinct
way to define health equity is to understand that it
is all about providing every person with the care that
(09:25):
they need in the amount that they need, in order
to help them achieve their optimal level of health. So
health equity at its core is a tailored approach so
that each individual is able to overcome the systemic and
the systematic barriers that stand in the way. One of
the things that shocks me is the United States is
(09:48):
the largest economy in the world, and it accounts for
about of the global economy. But somehow we spend more
on healthcare amongst all the high income countries, but we
consistently rank last in performance. How did we get here?
So I can tell you that we didn't get here
(10:08):
starting four years ago or even forty years ago. You know,
for too long, many racial and ethnic minorities, people with disabilities,
and lower socce economic status individuals have found themselves in
a precarious situation. Their health, their lives have literally been
hanging into balance right over centuries, and many of them
have been falling through the cracks of our health system,
(10:29):
our education system, human services system, behavior health system, you
name it, right. They struggled to live in a society
that has erected barrier after barrier to weaken their bodies
and hasten their debts. We've seen this for over four
hundred years in America. These groups have experienced health inequities
throughout the life course from womb to tomb, but they've
(10:52):
struggled also to gain access to quality health services. So
to get to your question, you know, to understand why
the US health care system specifically is the way it is,
you really have to go back over a hundred and
fifty years ago and look at the early days of
healthcare in the US up and to the present times. So,
(11:13):
if you would permit me, I'd like to take maybe
a couple of minutes to walk us through that history.
Is that okay? Absolutely? Please do so. We know that
you know, for almost two hundred and thirty years, there
were a group of abolitionists, mental health reformers, advocates for
homeless populations, and others who had labored assiduously to get
our policy makers to implement policies that would drive health equity.
(11:36):
They pleaded with our newly formed government, begging them to
really advance and implement right policies that would drive that
needle of health equity forward. Well, the abolitionists decided at
that point to approach Benjamin Franklin. They said, Benjamin, would
you please use your influence and your power, your privilege
(11:59):
to help us advanced this cause, this agenda. And although
Benjamin Franklin had been a lifelong slave owner, he decided
that you know what slavery, that these inequities in our
society were horrible, they were awful, and so he says, yes,
I will help you craft this petition, and I'll sign it,
and let's send it to Congress. And in this petition
(12:21):
they argued for not only abolishing slavery, but to provide
medical care to these individuals, to stop the separation of
children from their mothers, from the breakup of these enslaved families.
They begged them to provide educational opportunities and meaningful and
true employment opportunities. What that letter did was to unleash
(12:42):
one of the greatest debates in the U S. Congress.
People were upset with Benjamin Franklin. Well, the Senate decided
they weren't going to even entertain Benjamin Franklin's letter, right,
But the House said they could not ignore it, and so,
bullet by bullet, they made an argue meant for why
they couldn't stop the separation of these children from their
(13:03):
mothers and the breakup of these enslaved families, why they
couldn't provide medical care and education and employment opportunities, etcetera.
Basically making an argument that the people are in the states,
and the states are closest to the people, so the
states therefore should be the ones basically providing this medical
care and providing the educational opportunities. It's not the role
(13:24):
of the federal government. We are not authorized by the
Constitution to provide for the general welfare of our citizens,
which we know is not true. We see how quickly
that arguments pushed aside right in moments of crises. And
that was the first time in US history that the
light of health equity had dimmed in the United States. Well,
it would take a seventy five years after that before
(13:45):
these groups, these advocates got together, and they again, during
a major crisis, the Civil War, pleaded with President Abraham
Lincoln and his supporters to create a bill that would
address what we now know as the social determinants of health. Right.
They wanted not only to abolish slavery, but they also
wanted to provide food and clothing and education, employment opportunities,
(14:10):
as well as medical care. And fortunately, you had a
majority of proponents in the Congress who said, you know what,
we are going to advance this health reform agenda. We
are going to advance civil rights for these formerly enslave people,
right and poor whites who will be displaced as a
(14:31):
result of the Civil War. And finally, after two years
of negotiating from eighteen sixty three to eighteen sixty five,
they finally succeeded in getting this bill passed right that
was intended to address all of these determinants that drive
health and equities. But there was one provision that was
the most contentious. It was the idea of providing medical
(14:53):
care health services. There was no appetite in that Congress,
even though they had a majority to provide medical care.
So President Abraham Lincoln decided that, you know what, in
the spirit of compromise, will strike that provision and leave
the rest intact. And that's what they did. Well. That
became the most comprehensive health reform in America. But as
(15:15):
you and I know, justin you know, racism doesn't sleep
in America, and the forces the opponents of health equity
were working over time. After seven years, they finally overturned
the Freeman's Bureau Act. It would then take us a
hundred and fifty years after that to create similar legislation
(15:36):
in the form of the Affordable Care Act or Obamacare.
So our country's unique approach to health care really hinges
on the prioritization of many other factors and concerns. Rather
than prioritizing the health and well being of individuals. While
it's true that we as a country spend far more
than many other high income countries on healthcare, it's also
(16:00):
through that a lot of that spending allows us to
be on the absolute cutting edge of medical technology and research.
So that's a plus, right, But at the same time,
we do rank near the bottom of performance, and that
can consistently be tied to how frequently we simply do
not look out for those among us that need the
most health, which again gets back to health equity. Yes,
(16:24):
we have some of the best and the brightest in
the world working to improve healthcare here, but we have
not yet turned that brain trust towards meaningfully alleviating health disparities,
and that is why our performance continues to lag. Thank
you for that history, I think I don't think a
lot of people are aware of it. You've referenced how
politics have really played a major role then, dating back
(16:47):
hundreds of years. So your latest book, published by JOHNS
Hopkins University Press, is entitled The Political Determinants of Health.
Can you describe the political determinants of health a little
bit more absolutely? So, you know, the political determinants of
health are the upstream factors that impact every component of
our health and our health care system, the political determinants.
(17:09):
They create the social drivers, including the poor environmental conditions,
the inadequate transportation, unsafe neighborhoods, and lack of healthy food
options just to name a few, that affect all dynamics
of health. So many people have an understanding of what
the social determinants of health are. You heard me mention
(17:30):
that earlier. These are the structural conditions in which people
are born, they live, they learn, they work, they play,
they worship that affect a wide range of health. Well,
the political determinants go one step further. The political determinants
of health are what actually creates, sustains, or exacerbates those
(17:53):
social determinants. Right, for every social determinant of health, there
was a preceding legislative policy or legal decision that results
in that outcome. So for instance, it might be a
law passed, or a city council ordinance, or a ruling
handed down by a judge. But there is always some
(18:14):
force of law or politics that create the disparities, and
that is what needs to be addressed the political determinants.
So politics clearly affects everyone's health. Are there any other
ways that people might be surprised to learn that politics
influences health? Absolutely, So let's talk about structural racism for
(18:34):
a moment, right, because these political determinants of health really
are the instigators as you've you've heard me mentioned when
it comes to looking at all of the drivers that
impact our health, whether environmental or social or behavioral. But
undergirding these political determinants is what we term structural racism.
And structural racism and the health of America are inextricable
(18:57):
and they affect all of us at all levels. So
think about it this way, right, Inequality gets under our
skin and it leads to accelerated aging or biological weathering.
If you think about a block of concrete and a
constant drip of water hitting that concrete. At first, you
(19:18):
may not notice that water having an impact on that
cement block, right, but then after a while you can
see it chipping away at the concrete. That's essentially what
is happening in many vulnerable populations bodies today right owing
to the stressors in our society of systemic racism throughout
(19:38):
our society, and it leads, again, like I said, to
increase chronic diseases that we see in terms of racial
mythic minorities and other groups. So, by its very definition,
one of the structures that racism operates in is a
health care system in America. So I want to focus
on that a bit. Right. Our history is littered with
(19:59):
known examples. You can go as far back as the
health care that was not afforded to slaves or indigenous populations,
to the contentious creation of the Freedman's Bureau that I
just talked about two separate but inherently on equal medical facilities,
to the maternal mortality crisis black women are facing today,
(20:19):
to even the disparate impact that COVID nineteen is having
on communities of color. Absolutely, that's right, and it compounds
one after the other, right, So there is no ignoring
the fact that structural racism is just as pernicious in
healthcare as it is in any other corner of our society. However,
(20:39):
the key thing to remember is that structural racism in
our health care system is a net negative for everybody.
So from infection rates and hospitalizations to death. Why does
COVID nineteen disproportionately affect Native Americans, Latin X and black people.
You know, COVID nineteen is a dangerous, all encompassing, downright
(21:03):
awful virus that is wreaking havoc on our country. But
one thing COVID nineteen is not is sentient. What I
mean by that is, while it's true that COVID nineteen
is disproportionately affecting communities of color, it is not doing
so because the virus itself is targeting black and brown folks. Instead,
(21:24):
the system in which COVID nineteen operates targets black and
brown folks. During the early days of this pandemic, we
thought that this virus was the great equalizer because it
was infecting people without regard to how athletic or healthy
they were, or how rich they were. But we know
now that COVID nineteen has proven to be the great
(21:45):
revealer because the virus is simply amplifying the disparities in
the system that have existed and persisted for so many
years to the detriment of so many minority populations. So
to seistically answer your question of why, uh it is
disproportionately affecting Native Americans, Latin X, and black people, It's
(22:08):
because our system disproportionately affects Native American, Latin X, and
Black people. COVID nineteen is simply reading the room. So
let's talk a little bit more about Affordable Care Act.
(22:29):
In your book A hundred and Fifty Years of Obamacare,
which you artfully describe the history of our country around healthcare,
you explain how the Affordable Care Act is much more
comprehensive than most people realize. What are the most overlooked
benefits of the Affordable Care Act? The a c A
is the most comprehensive and inclusive health law employing an
(22:52):
equity lens, which took us a hundred and fifty years
to realize in America. So this is an incredible as
lative feed it as a landmark law. To your point
about what are some of those benefits right that are
often overlooked. There were so many health insurance reforms and
protections that were included in this bill, many antidiscrimination protections,
(23:16):
essential benefits of course that were included for women, for
people with disabilities, for veterans, people of color, and lgbt
Q plus individuals. And some of these include the first
ever protection that allows individuals the ability to go to
a court of law and sue to protect their rights.
First ever health law that allows that right. Medicaid doesn't
(23:39):
include that Medicare, Social Security, none of those other health
laws in the past include that private right of action.
There are other provisions to that I think are really critical.
For the first time ever in US history, the law
includes a mandate that employers that health insurance companies, if
they are offering a health insurance planning qualified health and
(24:00):
they have to include mental and behavioral health coverage. That
again is a huge feat, especially for people who have
struggled with mental illnesses or substance used disorders in America.
Then there was another provision for people with disabilities where
we included habilitative and rehabilitative coverage as part of tennessential
(24:21):
health benefits that you must get if you purchase health
insurance plan from the marketplace. And then for women, we
know that women were treated as a pre existing condition
if they were of reproductive age. So the law, you know,
forbids of course discrimination based on their sex, they can't
be charged twice as much as a man like they
(24:43):
could pre Obamacare, that is no longer allowed. And also
if they have been the victims of domestic abuse, let's
say they were raped. Insurance companies at that time would
resend coverage to many women because now they believe that
the provision of health services was going to increase astronomically, right,
They're gonna need more psychological um therapy sessions, are going
(25:04):
to need more physical services, and so forth. So they
would discriminate and find any pretextual reason to drop their
coverage that is not allowed. And then another thing that
is a really major win for us in the health
equity movement was providing maternity coverage. That's nine zero percent
of women who thought that they had maternity coverage realized
(25:27):
that they didn't have that coverage once they had gotten
pregnant and they needed to use those benefits, and they
were discriminated. So now maternity coverage is an essential benefit
in the affordable care That's another major deal. You know,
after we've gone so long with these health care disparities
in our country, how do we protect the strides that
(25:48):
we've made under Obamacare and the health equity movement With
a conservative majority in the Supreme Court. If the Supreme
Court overturned you know, part or all the A c A,
the Biden administration would have a number of options, so
you know it would be a complicated process. But with
the leadership of a president and vice president that have
(26:11):
spent so many years in the Senate, coupled with the
fact that the President elect played a pivotal role in
shepherding the a c A through Congress the first time,
I'm fairly confident that he would and he could make
certain that in the event of such a disastrous ruling,
the country would remain protected. Now, the Biden administration will
(26:33):
be hitting the rewind button on many of the health
policies from the Trump administration. Especially, They'll also be working
assiduously to unwind many of the Trump policies around reproductive health,
drug pricing, health disparities, and health equity right. Whereas the
Trump administration primarily leveraged regulatory actions and executive orders to
(26:57):
undermine key health policies and programs, you can expect the
Biden administration to employ a very similar strategy. And this
actually would be the first presidential administration in US history
that has committed to a very robust health equity agenda
in all of its policy priorities. You lead something called
(27:21):
the Health Equity Tracker Project through a grant from Google,
c DC Foundation in gileyad Sciences. Why don't we have
a better grasp on tying demographic data in this country? Realistically?
The the answer to your question is twofold. I think,
first and foremost opponents of the health equity movement understand
the intrinsic value in having data that highlights demographic disparities.
(27:47):
No data, no problem. If there is no data to
illuminate an issue, right or in equity, then there is
no problem that requires change. The second reason is that
it is truly difficult to obtain demographic data for a
whole host of reasons. Chief among these reasons being that
(28:08):
we as a country have never prioritized collecting such data,
so the system is not designed to easily tabulate it.
The same systemic issues that exacerbate the political and social
determinants of health are the same issues that make collecting
data difficult. And this is not by happenstance. Right that said,
(28:30):
the creation of the Health Equity Tracker tool that we've
been working on is all the more important precisely because
there is no comparison. So do you think that maybe
like more effective sharing of data will improve trust and
transparency and vaccines? Absolutely? There is no doubt. And I
think that gets to the heart of the issue of transparency.
(28:51):
You know, if you are giving people access to the data, right,
and you're giving them access to all the data, then
of course it does allow them to see for their
own selves, right, what you have been saying is true.
But if you are hiding the data, or you're hiding
even a part of it, then it does allow for
you know, opponents of these vaccines to push that agenda
(29:13):
that you know they're hiding something that could be hurting you.
So you know, you're just gonna be lab rats, You're
gonna be guinea pigs. Don't do it. So I do
think data is a critical element. Are you concerned, you know,
with the health equity lens about equitable distribution of vaccines
in the United States? I am, And it's because if
we do not learn from history, we are what we're
(29:34):
doomed to repeat it. A review of studies in this
country have shown us that in many instances, you know,
racial and nothing minorities, people with disabilities, and other marginalized
groups have been the most disproportionately impacted by pandemics. It's
always the same group who are on the downside of
advantage and opportunity, that fear the worst. But during this pandemic,
(29:58):
I've been heartened by the increase attention that we've seen
and the efforts to ensure a more equitable distribution of
COVID nineteen vaccines. And I think the incoming Biden administration
will take the necessary steps to have a thoughtful approach
to this issue. With that said, again referencing those pest
key political determinants of health, it will be incumbent upon
(30:21):
all of us to continue to push for an equitable
distribution of vaccines. Yeah, because one thing is having finally
a federally coordinated response, and it's another to have that
localized somehow in a way that is not convoluted by politics. So,
going forward, not just with COVID nineteen, how do we
encourage or you know, increase minority participation in clinical trials? Generally,
(30:46):
increasing minority participation in clinical trials starts at the top.
You know, you have to increase the diversity of the
researchers performing and setting up the trials. I think you
have to increase the diversity of the companies that are
facilitating the trials, right, and then you have to increase
the diversity of the medical and health professionals who are
advocating for such So going into and recruiting from communities
(31:11):
that have traditionally been underrepresented in clinical trials is a
good first step. But it's just that a first step, right.
You need to have diversity for every step of the process,
so that there is an echo chamber of individuals with
actual power who can continually push for the diversity throughout
(31:31):
the entirety of the process. Yeah, so having researchers that
are more reflective of our population that we're asking for participation,
that makes sense. So if you had the power and funding,
what else would you focus on, you know, broadly for
vaccine development, trust and transparency, what would be like your
first step? I would say that we certainly need to
(31:53):
increase spending in our public health infrastructure. I do think
that is absolutely critical at all levels. Again, whether you
are at the municipal level, the local level, or the
state level, right and even the federal level. Because three
cents of every dollar that has been invested in this
country has been invested in public health. Why aren't we
(32:15):
investing in more? You know? One of the issues that
we've had to deal with over time is the fact
that historically policymakers have usually been reactive rather than proactive. Right.
So once the crisis is adverted, so too is the
funding until the next crisis comes along and reeks even
greater havoc. Right. So for me, in terms of what
(32:37):
I would start first, it would be, you know, investments
in equitable distribution of vaccines and equitably distributing them. Contact
tracing absolutely critical, right, Testing is absolutely critical. We've seen
early on how with contact tracing and even with testing,
how many communities of color were there raising their hands saying, hey,
(32:58):
you know, we want to be counted to, We'd like
to be able to access these resources, but they were ignored.
If you have inequitable distribution of testing, then you cannot
perform contact tracing. And it's again just part of a
vicious cycle. Absolutely. So any other words of wisdom for
our listeners, Daniel, we really appreciate all the time you
(33:21):
spent with us today. My final words would be just
to remind folks about how long and challenging it has
been to advance health equity in America and around the world.
This is a movement that is not for the faint
of heart and it does take the resolve that is
needed right. It takes persistence, and it takes courage, it
(33:43):
takes knowledge, and so I want to urge our listeners
today to really think about that and to continue to
press this agenda. Even when the tough gets going right,
we've got to keep pushing and stop that pendulum from
swinging too far that it unravels the gains that have
been made previously by health equity leaders and champions throughout
the course of our history. Well, you've given us great context,
(34:06):
because I don't think anybody fully understood the hundreds of
years it's taken us to get here. So we have
to put our foot on the gas. You're an inspiration, Daniel.
I can't thank you enough for your time today. It's
been great. Thank you so much. Essin for the opportunity
to learn more about the work that Daniels doing to
improve health equity and reduce disparities in our system, visit
(34:29):
Daniel E. Dawes dot com or read one hundred and
fifty Years of Obamacare and the Political Determinants of Health
from Johns Hopkins University Press. On the next episode, Deeply
had the opportunity to speak with Fianna tulip a grieving
(34:50):
daughter who bravely and heroically shares the story of how
her mother, Isabel Papa Demitru, a healthcare worker from Texas,
lost her life unnecessarily to COVID name team. It feels
like the leadership is letting my people die, Hispanics, the
Latin X community, people of color. It feels like they're
(35:12):
just throwing them to the wayside and saying good luck.
I mean, there's been a real failure among people of color,
and it's it's speaking to deeper divisions that we have
and to structural inequalities in this country. And unfortunately, you know,
the Hispanic community, they are on the front line. They
(35:33):
work in jobs that increase their risk of contracting the virus.
They are the ones who are caring for their elderly
and living with them. They're fulfilling online orders, they're they're
working in the hospital. They live in institutions such as
prisons and homeless shelters, and these are all places where
it's easy to spread this virus and there's no support.
(35:56):
There's no support. Fianna's heartbreaking story is one we all
need to hear, but she is truly an inspiration turning
grief into action. When I really started out on this crusade,
I guess you can call it, I started realizing that
people would say, no, look at the death rate, it's
(36:17):
not that bad, or but I need to see my family.
It's more important that I see my family than stay home. Um,
masks don't work. In fact, I can't breathe with the mask.
And it was so frustrating to me because I just
come back with but I lost my mom. But I
didn't have to lose my mom if we had just
followed these simple public health measures. So I want people
(36:43):
to know that this crisis the one where my family
must stay apart to do our part, even when we
most want to be together. It's more than just death
rates and a death count. It's a human life. It's
a person who has passions, it's a person who has
children or grandchildren, and it's a person who didn't want
(37:05):
to die this way. And it's a person who didn't
want to die alone in a hospital. I want people
to know that and and to think about that. Okay,
I want you, dear listener, to take the following very
seriously to avoid a lifetime of potential regret. Think about
(37:27):
the family and friends you love and care for for
just a moment. Now consider the actions you take and
the company you keep this holiday season. Is it worth
maintaining your family traditions and gathering this year when it
could mean some of you may not be around next
year to enjoy another holiday that any one of your
(37:50):
family or friends could literally suffer in complete isolation on
a ventilator to start, that is, if they are even
lucky enough to be offered one in our over extended
health care system. If you had a choice between getting
together for the holidays at the expense of losing one
of your loved ones or electing not to gather this
(38:10):
year even though it hurts, which would you choose? Well,
guess what, you do have a choice? Do you truly
think for a virus that transmits asymptomatically that you can
control all the variables, Whether it's three, four, or even
five or more of your family and friends from different households,
(38:31):
The entire country should have access to quality vaccines before
next holiday season. Let's make sacrifices together. I know it's hard.
We owe it to each other, and we owe it
to our public health agencies and our frontline health workers.
I don't care what your political persuasion might be, and
neither it is this virus. Let's just get through this
(38:52):
holiday season together. Please, without gathering from other households. Make
sure are you join us for the next episode of
Contact World. I'm justin back and I'll see you next time.
Listen to Contact World of podcast on the I Heart
Radio app or wherever you get your podcasts. M
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