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

Episode Transcript
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Parker Condit (00:00):
Hi everyone, welcome to Exploring Health
Macro to Micro.
I'm your host, Parker Condit.
In the show, I interview healthand wellness experts around
topics like sleep, exercise,nutrition, mental health, stress
management and much more.
So by the end of each episodeyou'll have concrete, tangible
advice that you can startimplementing today to start
living a healthier life, eitherfor yourself or for your loved

(00:21):
ones.
And that's the micro side ofthe show.
The macro side of the show isdiscussing larger, systemic
issues that contribute to healthoutcomes, and today's episode
is almost entirely on the macroside of that spectrum, and it's
a topic that's actually been onthe fringes of a few previous
conversations.
So maybe you'll notice thisword or this concept that's come
up before, and this will bemore of a deep dive into that

(00:42):
particular topic.
And that topic is health equity, and I can't imagine a better
guest to discuss this than whowe have with us today.
My guest today is Tamara Smith.
She's a healthcare executiveand health equity leader.
Professionally, tamara is theAssociate Vice President of
Strategy Advancement for Humanaand she's pursuing a doctorate
in public health at UNC Gillings, which is the top public health

(01:05):
school in the country.
I had the pleasure of seeingTamara speak at a conference
this past fall and she's by farthe best communicator I've come
across on this particular topic,so I'm really grateful for her
coming.
On the show we go over thedifferences between health
equality, health equity andjustice some clear examples of
how this shows up in the realworld, how awareness is such an

(01:25):
important step to driving changeand how people can make changes
at the individual and communitylevel.
This episode can serve as a goodprimer or introduction to
people who are unfamiliar withthis topic, I think for anyone
who wants to dive deeper intohealth equity.
Tamara is also a podcast hostand her show is called Our
Journey to Equity.
It's excellent, she's a greathost and the production quality

(01:48):
is top notch, so it's gonna belinked in the description of
this show.
So if you enjoyed thisconversation and want to learn
more and dive a little bitdeeper, I highly suggest you
check out her podcast as well.
So, without further delay, Ihope you enjoyed my conversation
with Tamara Smith.
Tamara, thanks so much forbeing here.

(02:09):
I just want to start off bygiving a little bit of context.
So we actually got connectedthrough a conference that we're
at.
You were the opening speaker atthe conference and you kind of
talk through a visual kind ofoutlining the differences and
definitions of health, equality,health equity and justice.
I think it would be a greatplace to start kind of walking

(02:30):
through that image and I'll popthis up on the screen for people
to reference it as well.
But I think that'll be a greatway to frame the conversation.

Tamara Smith (02:39):
Yeah.
So thank you so much forinviting me on, and I'm so
excited to be able to share moreabout the topic that I'm the
most passionate about, which ishealth equity, and I do think
that's a great way to start aconversation with that visual.
So if you imagine threeindividuals at a baseball game

(03:01):
just enjoying America's favoritepastime, and there is a fence
in front of them, and obviouslythat fence presents a barrier
and they need to be able to seeover the fence to be able to
actually see the game, and sothese three individuals one is
taller than all of the otherindividuals, and there's a set

(03:25):
of boxes, right?
So I would say that in oneinstance, we know that there's
inequalities when one person hasan advantage that the others
don't, and the initialinequality or disadvantage is
that one person is taller thanthe others, and obviously that

(03:46):
by no fault of anyone's, it'sjust how they were presented and
born into the world.
And so in order to sort ofwrite and create equality which
is what I think a lot of peopleassume is what equity is then
that means that everybody needsthe same thing in order to

(04:07):
achieve the same goal, and thegoal in this example is watching
the baseball game, and so whenwe think about it from an
equality lens, that means great.
Everybody needs a box.
So everybody in this instancegets a box.
The tallest individual now isseeing, like I don't know, a
foot over, a foot over the fence, and I mean you could already

(04:30):
see over the fence, reallydidn't need an extra box.
But now they're like way above.
Now the individual that's inthe middle, which now is right
at that point where they can seethe fence because they were
shorter than the firstindividual, but not too much.
But then there's an individualat the very end and this

(04:50):
individual, one box is still notenough.
One box is really only gettingthem still maybe a few inches.
The fence is still a few inchesabove them.
Even if they were to stand ontheir tipi toes they still
wouldn't see the game.
And so equality is sayingeverybody gets the same thing
and we should all have the sameresult.

(05:11):
And that is the very reason why, from this depiction, equality
doesn't really work, becauseeven if everybody has the same
thing, not everybody has thesame needs, and so needs meeting
needs has to be somethingthat's more custom fit, that
actually goes and says well,what does this person actually
need in order for them to beable to achieve the goal, and

(05:33):
what the other individualactually needed was a little bit
more height assistance.
And then what we realized isthat the person the first person
that we began with was alreadytall enough to begin with and
didn't need a box at all, right,and so that person had
resources that could have beenredistributed towards the
individuals that needed it most.
And so it's not about takingfrom one person, it's about

(05:55):
making sure that resources areequally distributed in a way
that actually helps fill gapsthat present themselves for
certain individuals.
So now equity is this conceptthat we're meeting the needs
that everybody has individually,uniquely, and we're not just
applying a one size fits allsort of solution across the

(06:19):
board for everybody.
But here's the kicker, and thisis where I'm challenged, and
this is where the field ofhealth, equity, social justice,
any justice and healthcarerelated work, is really
challenged, which is, if equityand justice are synonymous terms
, which many of us believe thatthey are, then the question that
we really have to pushourselves to answer is why is

(06:43):
there a fence to begin with?
Why is there a barrier inbetween certain individuals and
the goals that they're lookingto achieve to begin with, and
what sorts of things can we doto eliminate the fence, the
barrier and totality, so that wedon't even need to have to play
white-haemal with all theseresources and try to solution

(07:06):
for all.
We really can just eliminatethe fence with just the ultimate
root cause of the problemwhatsoever.
So that's just a broad way todescribe and create a picture in
people's minds.
But what the difference is whenwe're talking about these terms
equity, equality and justice?

Yeah, thanks for explaining that, and when I saw
you kind of give thatpresentation, it was the first
time I had a really clearframework to kind of have in my
mind for those particular terms.
So hopefully that was helpfulto other people as well.
And then, as you were goingthrough that explanation, you
ended up saying it at the end.
I was like, oh, it's likegetting to a defense.
In this case it's like a rootcause analysis and hopefully

(07:47):
we're gonna try to touch on someof these things throughout
today's conversation.
But could you share a littlebit about sort of your
upbringing and how that sort ofled you?
I'll probably end up askingfollows, but how that ended up
leading you towards sort of thefield you're in today.

Yeah, so it's funny.
I grew up in Florida and I wasjust telling a friend of mine
this morning.
Right now I'm in Charlotte,north Carolina, still the South.
So for those of you in theMidwest or up North, I apologize
in advance for what I'm aboutto say, but it cold y'all and
it's dry.
It's my version of cold.
Okay, I was telling a friend ofmine this morning the air here

(08:27):
is so dry, my skin and my hairis not meant for these
conditions and I need to be inthe tropic.

You need humidity .

Yeah, so I truly a Florida girl.
Just the core of my being andmy do they speaks to that.
And the part of Florida that Igrew up in was incredibly
diverse.
My little friend group, I mean,we just had probably a girl
every race in that group and weit was.

(08:59):
I consider myself a geriatricmillennial, so you know I'm up
the millennial type that.
You know you go outside and youjust play and then you know at
night you come home before thestreet like come on.
So we sort of you know summerswere just full of memories of us

(09:21):
just playing with ourimagination outside on our bike
all day long.
I'm sun up, that hot Floridasun.
I mean it inevitably rainedevery single afternoon of
Florida and so you come back outafter the rain and there's like
steam coming up off of theground and you know we really
had the liberty to create in ourminds whatever it was that we

(09:44):
wanted to do, to be in thosemoments right In our childhood.
And I think for me now it'sactually very sheltering and I
did not realize it at the time.
I was kind of like this, youknow, anti-status quo a little
little, being running aroundwith my little group of

(10:05):
girlfriends, because we had thepermission space to dream and to
be and not have to worry aboutthe outside conflict, racial,
you know, injustices and justall the things that you're not
really aware of as a child.
More should you have to be.
But when I was 10, we moved tothe suburb of this area in

(10:30):
Northeast Atlanta calledMarietta's Marietta-Roswell area
at East Cobb, and for those ofyou that might be Googling right
now, east Cobb is a prettyaffluent neighborhood and at my
first day of school and fifthgrade there I was sort of

(10:51):
shell-shocked to be, I think,the only or one of the only
black children in my classroom.
It was just a completelydifferent experience and that
would be the rest of myformative experience until
really just all the way through,you know.
And so I learned very quicklythat there was a difference

(11:13):
between me and everyone else andthat I was othered in a lot of
different ways that I had notpreviously been in my upbringing
, and so what that did for me isthat it just created an initial
awareness, right, and Iremember when I started to, you
know, develop friendships, oneof my first experiences that

(11:33):
really made that comes alive forme.
We were in the South, okay.
So everybody goes to church onSunday.
That's just the given and myexperience with church I learned
very quickly it's verydifferent from any of my
classmate experience.
So you know, black church inthe South is long.
I mean you really need to bringsnacks but you can't get caught

(11:57):
eating snacks, I mean, and youcannot fall asleep.
Like there was no sleeping inthe pews, like just not an
option.
And I went to spend the nightwith one of my friends and the
next morning we, you know, hadto wake up and go to church.
But this was a Caucasian familyand they went to a Presbyterian

(12:17):
church and I think we were outin like 45 minutes.
I was like what in the- Totallynew experience for you.
That's like.
What kind of church is this?
You know, please take me back.
Why is our church not like this?
And when we came back to ourhouse, you know, for me, my

(12:38):
family, just culturally, wewould have Sunday dinners.
You know, mac and cheese, riceand gravy, fried chicken, I mean
just all the things right.
And when we came back to ourhouse, we had bowls of tomato
soup and I was like how, whereand when is the chicken coming?

(13:01):
You know what's so?

Where's the rest?

Exactly, Exactly.
And you know, while there are somany parts of that experience
that I love, I think what I tookthe most away from that
experience was years ago, and Istill remember it so vividly is
how different our cultures were.
So, going back to your originalquestion about my upbringing, I

(13:25):
grew up sort of living inbetween two worlds, with a
hyper-awareness of where I wasfrom and then moving into a
space where I was all of asudden needing to be acutely
aware of my differences and mebeing different and my family's

(13:47):
experiences being different, andthat, you know, going along
with that was, you know,differences from healthcare
experiences, seeing how myfriends' families you know were
aging and you know theirfamilies and their health, and
seeing how my family was agingand our experiences and our
health, despite being educated,despite living in the same

(14:09):
neighborhoods, and things likethat.
And so I think that I still backthen, had no idea what it was
called and what I would want todo with it one day.
I just knew I wanted to work inhealthcare and I knew that
there was a there, there, and soI think that probably the best
sort of you know way to describehow I grew up and how I got

(14:32):
into an interest, at least howthat seed got planted in me to
do health equity work.

Yeah, that's really helpful and I appreciate
you sharing all that.
And you mentioned awarenesstwice and one of the things that
I had down here for later iskind of the idea of like where
do we go, where do we begin,because your first introduction
to the awareness of this wasvery early.
So, my experience growing up.
I grew up in a very white areaof New Jersey, so I'm coming to

(15:02):
this much later, but it didstart with awareness and people
around me like making me awareof the situation, so hopefully
people listening if they're alsoin a similar situation where
they're not aware that this is athing that needs to be
addressed.
Is it fair to say that likethat's sort of the first step to
this, because I always end upgetting in these conversations.
I'm like I don't know what thefirst action needs to be.

(15:24):
But, maybe it's not action,maybe it is awareness.

first, oh, absolutely so.
My husband is a therapist, he'sa like medical mental health
clinician and he basically likepreaches cognitive and
behavioral theory.
And years ago in my career,when I was doing a lot of

(15:47):
one-on-one coaching and, youknow, really working on the
behavior change side of healthcare and working with
communities and doing a lot ofeducation, I thought for the
longest that if I can justeducate people, give them all
the knowledge that they need,then that is the first step to

(16:09):
improving their health behaviorsand outcomes.
And let me tell you, educationis important.
I'm a certified healtheducation specialist.
I believe in the importance ofhealth education.
However, there has to be a levelof awareness that occurs in
order for you to be able to putthe pieces together.
So the trade theoretical model,or stages of change, is a model

(16:32):
that's discussed a lot whencomes to how do you actually
influence and change behavior.
And in that model there'sactually a step called
pre-consumption and that occursbefore you're ever even really
thinking about changing anythingyou know.
And so pre-consumption, if I'mnot even thinking about it, I'm
not even you know it's.

(16:53):
You may have heard it on yourradar, but it's not something
that you're interested inaddressing at the moment.
So, again, from pre-consumptionto contemplation, that's really
the step where you begin tobecome aware and you know, maybe
something has happened, oryou've heard a podcast, or you
know something has, you know,sort of planted a seed that has

(17:14):
started to, you know, create aseries of thoughts around, you
know a topic that you believe orthat you would not have thought
previously about how youcontribute, to work and play a
role.
So, yes, awareness, in myopinion, is really, like you
know, level one for us to beable to enter into any kind of

(17:41):
productive conversations abouthow to transform health equity.

Okay, that's helpful and I'll try to keep
kind of pulling out what I thinkare steps and kind of asking
you, like, what are sort of thesteps and sort of the?
I know it's not going to be alinear path but hopefully at
least a general roadmap forpeople and, more important, or
myself but other people tofollow as well.
So can you explain what you'redoing with your work at Humana

(18:07):
right now?
Just kind of parlaying from youknow, your childhood, and that
early awareness to what you'redoing now.

Yeah, yeah.
So my full-time job, I wouldsay, is, out of many being, you
know, a wife and a mom, and youknow, for work at Humana, I'm
the associate vice president forstrategy advancement, and

(18:33):
there's a whole bunch that'swithin that vertical.
But just to try to summarize it, I'm responsible for thinking
about number one what is anational health equity strategy
for a payer like Humana toreally wrap its arms?
What does it need for a payerto be involved in health equity
work?
So, through, those big, moreconceptual, theoretical

(18:56):
questions are part of what Ineed to be able to answer and
think about how the industry ischanging and shifting and
transforming and where healthequity plays a role in a lot of
those shifts.
And then also, how do youactually measure where you are
today and close the gap fromwhere you want to be tomorrow?

(19:17):
And so that is a lot of reallylooking at.
How do you translate strategyfrom something that's a concept
at a corporate level and at anational level down to the
market and into the communitywhere our members which is who
we call our customers live, work, play and frame.
So there's an implementationside of my work that goes from

(19:40):
high level corporate strategyall the way down to
implementation where it's felt,in the communities.
And one of the things that weknow about health equity is that
, because it's health inequity,they're so complex, right, it's
not.
You know, you woke up one dayand, because you are black, then
you're just.
You know, that's just.

(20:01):
You're just going to be, youknow, predisposed to all kinds
of inequities, but it's notreally how it works.
I mean, of course, there's alittle bit of individuals maybe
born with and things like that.
That's somewhat different, butthere are a lot of different
reasons for health inequity.
So it's your environment.
You know where you live, thetype of housing that you live

(20:23):
inside, do you have access togreen space around your
community?
Your income, you know, becausethose individuals with lower
income often don't have theresources needed, the time
resources, as well as physicalresources necessary to help

(20:44):
support better health outcomes.
Transportation, food insecurity, right.
So all of these things play arole.
So you know there's not onesewer bullet solution that we at
Humana that I'm leading, thatis going to be the one solution,
right, that covers it all,because it's integrated.
It's very complex, but what wedo know is that you can't do

(21:06):
health equity because of thosereasons.
You can't do health equitywithout also having a really
strong community engagementstrategy, and so that's the
other part of my role, which isleading community engagement
work and really defining whatthat looks like for us as a
national health insurer.
And so, yeah, there's a lot ofstrategy, very, very heavy on

(21:30):
strategy and strategicimplementation, but also
thinking about what goes on inour market.
How can we best support thoseneeds in the market and how do
we really pull the thread allthe way through to communities
and making sure that we areinvesting in communities and
taking a look at, you know, howwe can improve the environment

(21:50):
in some of those social needsthat are impacting individuals'
ability to have the sameequitable health outcomes.

So, on the idea of community, it seems like,
with all the benefits andupsides of technology, it seems
like over the past I don't know,maybe it's happened for a
longer period of time, but the Ifeel like communities are
becoming less and less connectedbecause a lot of it has sort of
shifted online.
Do you have any advice on howto build stronger community

(22:18):
engagement, because I've beenhaving a lot of conversations
around social determinants andit seems like yet there needs to
be policy change, for sure, andinstitutional change, but so
much of it needs to happen atthe community level and with the
community leaders, and I haveso little experience with
community leadership andengagement, so you seem to be a

(22:40):
great leader.
So, kirit, like, are there anytips or do you have any advice
on how to sort of become aleader, or are there
organizations that would be goodto get involved in to start
building that sort of communityleadership piece?

That's a great question and actually you're
right on target with a growingbody of research coming out
right now related to communityengagement and healthcare
justice and, just you know, alot of justice and type of
fields of work in general, whichis thinking about how you

(23:16):
redistribute power back into thecommunity Power.
There's a few health equityframework out there, but there's
one in particular that I'llhave to get the name of it for
you because I can't think of itoff the top of my head, but
there's an element of theframework that describes power
as a critical element increating and sustaining health

(23:38):
equity.
And within that power it's bothhow people are, you know,
distributed and as far aspositions of power, political
power, city councils, thingslike that but then also how
resources are distributed.
I've heard it said so manytimes, and I'll say it again

(23:59):
here, that we don't have.
When we think about all thedifferent food deserts in the
United States and certaincommunities, we really don't
have a food problem.
There's plenty food in ourcountry.
We have a food distributionpower problem and that is as a
result of how power isdistributed, policies that

(24:19):
basically make the decision forwhere grocery stores are and why
there are some communities thathave too many grocery stores,
to be honest, I mean in otherswhere you have to go two miles
just to get to any kind of freshproduce, and so within that

(24:39):
framework, there's a lot of workhappening right now.
That's really taking a look athow do you redistribute power of
communities because,conceptually, if communities had
the power that they need inorder to make decisions and
change policies to ensure thatthey can have a grocery store in

(25:02):
their community or sidewalksbuilt, you know that also
requires would enable theredistribution of funds into
those communities to invest inthose communities and make them
healthier and safer and morelivable, and so that is a huge
issue.
That, I think, is a huge partof the solution in order to

(25:27):
create health equity.
So, community organizing and aneffort to redistribute power,
networks of power Now the howbehind that is really where the
research is trying to articulatesolutions right now and
frameworks right now.
So that's a little bit more.
I think there are some casestudies out there that are

(25:50):
really compelling for how it'sworked in certain communities,
but I would say, at the mostbasic level, it is listening to
the community.
I cannot underscore howimportant it is as business
leaders, really no matter whatyour spheres of influence are,
is to go to some of these spaces, and what I used to do.

(26:12):
Priority joining Humana, Iworked for a large provider down
here in the southeast.
It's a hospital and primarycare network and we used to set
up these community listeningsessions, and afterwards I found
out that there's ongoing sortof community sessions that
happen in Charlotte, but inthese spaces it's the

(26:35):
opportunity to ask one or twoquestions to the community and
let them talk back and reallyunderstand what are the
challenges that you're facinghere and what is the role that
the corporate community and thatothers can play in addressing
those challenges.
There are coalition,neighborhood coalition lots of
different community leaders thatmay not have the title from a

(26:58):
corporate standpoint, but have alot of power and a lot of trust
in the community that acorporate giant coming in will
never have right, and so workingwith those individuals is
really the key to making surethat you can actually create
sustainable on-sale solutions.
Now, the other thing I will say,though on that note is on the

(27:22):
issue of trust is I think a lotof times Maybe not a lot of
times, but in some cases I'veseen different organizations try
to come in and work with thecommunity just so that they can
achieve their own business goal.
And that's not what this is,because one thing about the
community is that they're usedto groups coming in, making

(27:44):
promises and then leaving aftertwo to three years, and that is
a significant challenge.
That has played and contributedto your lack of trust in the
healthcare system and a lack oftrust with many of these
communities.
And I think that if we're goingto be serious about this, then
there's in any business exchangethere's a little bit of give

(28:06):
and take, but you have to bewilling to understand, going
into it, that you might not beable to get all of your business
goals achieved if they don'talign with what the community
actually needs.
And then that's the questionthat goes back to the question
of well, what are you reallyhere for?
And are we really here forhealth equity and healthcare
justice and for communityengagement, or is it just a

(28:28):
business object?

Yeah, the two notes I had jotted down were
corporate slash government, andI feel like there can be
concerns or misalignedincentives where maybe the
people making decisions aren'tdirectly connected to that
community.
Definitely from a governmentstandpoint, I can see that being
the case where, within a city,the people making decisions

(28:53):
about what resources are goingto be allocated to a particular
district for roads, green spaces, sidewalks, things like that
they may not live there and theymay not be adequate
representation.
And then on the corporate side,I'm always concerned within the
healthcare space, of for-profitmotives.
Where are these like communityoutreach programs, just kind of

(29:18):
designed to increase a RAF scoreor anything like that?
So it's like you said, it's amultifactorial problem and it's
layered on so many differentlayers so it's tricky.
Is this some of what you'reexploring with your you're
getting your doctorate from?

(29:38):
UNC which is one of the best,like one of the best, or if not
the best, public health schoolin the country.
Is that what you're exploringthere?

It is actually.
It's funny.
I went into the program notreally knowing specifically what
I would want to study, but myjourney in my career has just
sort of left me feeling like thework is so unfinished and

(30:10):
there's something more that Ithink I study, learn, do right
To really make an impact.
And so, yes, I am pursuing mydoctorate in public health at
UNC, Gilling Skull Public Health, which is actually the number
one public health school.

I wasn't sure.
I knew it was always like topthree.
I knew it was up there.

And I'm looking, I think, broadly, at both.
What does it really mean toorganize well, organize in a way
that can advance health equity?
I think to be able to answerthe question through a
dissertation does this achievehealth equity is really tough,

(30:55):
right, Because health equity isso layered and I would never
finish my dissertation and I'dbe, like you know, 100 years old
still trying to finish.
But, however, I think there arethere's a lot, I believe, from
what I was studying, that we canbegin to put in place from the

(31:16):
research that has been done.
I mean, we stand on theshoulders of giants, right Alks,
that have been in this anddoing this work for years.
And how do we really take fromwhat we've learned over the past
you know, several decades andwhat we're learning now, and
develop the right sort offrameworks to help us organize,

(31:37):
whether it's in the community oreven in the corporate space, in
the payer space?
You know, what do we know frombest practices that can help us
organize and understand how toset ourselves up to advance
health equity work?
So it may not be that, again,no silver bullet or this is the
single most effective solution,but we know that these things

(32:00):
have contributed to successfuloutcomes related to, you know,
closing guests in care or youknow all of those leading
indicators of achieving healthequity.
So I'm sort of in that spaceright now where I think I am in
full position to really look atthe corporate community and

(32:21):
especially the payer community.
But my first love and passionis community engagement, like
the actual, you know, sort ofgrassroots boots on the ground
work.
So I'm figuring it out, but Idefinitely think that that is
where my research is going tolead me.

Yeah, that's great.
I think it's really importantto have sort of a foot in both
worlds, as you mentioned, whereyou know being able to operate
in that corporate space whereyou're going to have that
influence, but also having theexpertise and experience and the
original like love and passionfor the community engagement
side of it as well.
I'm sure it's going to be avery interesting dissertation.

Challenging, Challenging.
For sure, let's have my finishso.

I'm sure you will .
Can we kind of get into some ofthe specifics around this, Like
, can you just kind of rattleoff some of the current barriers
?
And then I'd love to be able tocircle back to trying to kind
of root cause analyze, likewhere do these all come from?
Because I think to move forwardis really important to
understand how we got here.

Yeah, so I'll actually take that from maybe a
slightly different lens.
So we know that you know,social determinants, appell, are
sort of what we know are themidstream sort of barriers to

(33:46):
affecting health equity.
So what we see sort ofdownstream are things like
mortality rate, differences inmortality among racial groups or
higher prevalence of certaintypes of cancer and LGBTQ

(34:06):
communities.
We may see, you know,differences based off of zip
code, from chronic disease rate.
Those are the things that wesee downstream, on the surface.
I think you know, a lot oftimes it's used this iceberg
picture is used to describe whatwe can see on the surface.
But we know, underneath thesurface of this there's like
this massive structure, right.

(34:28):
So to ask ourselves why we seewhat we see on the surface, it's
just, you know, asking why youknow, why does that exist?
So why does it exist?
Because, well, you know,perhaps there's we already
talked about a lack of healthyfood, which you know if you are
in a community where you knowit's not very walkable, you're

(34:51):
working a sedentary job, there'snot healthy foods around you,
you know you are sedentary andyou know you're got diabetes and
the foods that you're eatingare not helping right to manage
that well.
So I mean it's all those things.
So it could be food, it couldbe housing, kind of things we
talked about earlier.

(35:12):
It could be just healthdiscrimination, just in general,
our own implicit biases.
So when you're going to ahealthcare provider to seek care
, there are multiple unfortunatedocumented instances of
healthcare providers Just eithernot taking seriously the

(35:38):
concerns that the patient haswhen they present them, thinking
that individuals are just beingproblem patients.
So there's a lot of function,our implicit biases, that are
brought to the table becausewe're human and it's just the
way that our brains are designed.
And if you're not trainedappropriately to check those

(35:59):
biases and to understand thatyou may be practicing and making
decisions when biasing and youneed to just sort of practice
what they questioning attitudeas a value, then what we see in
the iceberg is just a lot ofinequities with the rates in

(36:23):
which certain individuals mightbe diagnosed late for certain
conditions or diseases or justgo completely misdiagnosed right
Because the providers may havethought that they were just
making things up, or just drugseeking, which is something that
we see a lot in literature.
There's a lot out there aboutusing AI to detect bias in

(36:46):
electronic medical work and thata real thing that we're seeing
today is that there is bias inthe way that certain patients,
either by race or sexualorientation, their notes are
written differently incomparison to white patients
being concerned.
So racial discrimination, right?

(37:07):
So when you started thinkingabout, well, why do these
individuals live in areas or aresubjected to lives where
resources are limited, theanswer to why goes back really
to racist policies and reallytruly discriminatory practices

(37:29):
that have occurred justhistorically in the United
States, where we've gotcommunities that were
historically redlined during JimCrow, the Jim Crow era, and
where minority communities wereintentionally disinvested in
during that period of time.

(37:49):
Well, that was years ago and Ithink a lot of times people say,
well, I mean, come on, we'vegone so thin, why haven't it?
These groups of people moved onsince then?
I think anybody out there issitting there to station.
Another thing that is really keyfor us to understand is really

(38:11):
the true impact of years ofsystemic oppression, because
that happens in the mind and sowhen you think about really the
root to why some families andare just separated from
generations of poverty, cycle ofpoverty and it's just so hard

(38:32):
to get out of that cycle, it'snot like, oh well, we're just
going to brush it over to aschool in a different district
and you'll be fine.
You know, good luck.
It's not quite that simple,because they and their families
have been subjected to trulyyears of oppression that have

(38:52):
changed the way that individualsthink, move and feel and move
about the world around them, andso what we're talking about is
really, really complex, but I dothink that it begins like we
started off.
It begins with awareness.
Having that initial awarenessabout really what the root to

(39:15):
many of these problems are,which is largely rooted in
policy and largely rooted injust culture of racism and
discrimination.
We can address those issues, wewill do ourselves a lot of
justice and we will go muchfurther in actually impacting

(39:37):
health equity in the long termthan trying to create like quick
fix solutions here and there inthe middle, which is concerning
because it seems like in the US, in particular in the
healthcare system, so much of itis.

let's treat the symptom and not the root cause.
So I do worry when it comes tothings like this.
It's like there's going to be alot of band-aid solutions where
it's.
I mean, I think it's good toaddress things from sort of the
top of the iceberg perspective,as you were describing it, where
, if you're talking aboutmaternity care so just to give a
concrete example, I think blackwomen are three times more

(40:15):
likely to die after giving birththan a white woman.
So obviously you can dotraining in maternity wards
around that, and that's sort ofthe top of the spectrum sort of
trying to address that.
But it goes down to why arematernity wards generally money
losers in hospitals?
Why are OBGYNs generally thelowest paid procedural

(40:38):
specialists?
That's a gender issue.
So there's so many more layersyou can go down to and I think
this is what you're getting atwhere it's.
How do we address those?
And this is where I come to thequestion.
I don't know what to do, right.
So we can have theseconversations and I'm like
what's the next step?
I think awareness is good andI'm still learning.
I think a lot of people arestill learning.

(41:00):
What do we do next?
Like I understand, this is likethe premise of your
dissertation and so muchresearch.
It's like where do we go?
It's such a challenge.

Where do we begin?
Where do we start?
I think I get asked thatquestion daily, honestly, and
it's not just individuals likeyou, individuals that I work
with, you know individuals inthe community, folks from other
sectors that are trying tofigure this out as well, and so

(41:34):
I would say that because it doesfeel really overwhelming when
we start really thinking aboutwhat's underneath the surface
and where all this began.
And, like, these are peoplethat made decisions before I was
even alive and you know likenow we're here to clean up the
mess.
So, first and foremost, let mejust say that I completely honor

(41:57):
and I think we just need tolike respect the fact that this
is really really complex andhard.
But just because something isreally really complex and hard,
I would challenge us to notthink like, oh, it's just too
much to deal with, like I can'teven begin.
I think that what I tell peopleis that the place where you

(42:19):
begin is where you have, anddon't try to go somewhere else
where you have very littleinfluence or expertise.
You know and try to dosomething there.
Begin where, exactly where youare.
So you know, invite someone onyour podcast, for example, to
talk about these issues and helpthat witty, because you never

(42:39):
know what level of awarenessthat might contribute to someone
else that's listening.
Another place that you canstart is right in your community
, as you are.
You know hearing about policies, you know everybody sees those
little zone thing.
You know, as you're drivingaround in your community, why is
being zone and why.

(42:59):
You know and it's notnecessarily to say like, don't
walk around you with a tablet,you know, write down all the
zoning codes, but have a levelof awareness about the decisions
that your city council ismaking, your local politicians
are making about your community.
And join groups in thecommunity.
And in this day and age you canGoogle, okay, you can Facebook,

(43:22):
whatever community you are, andI am telling you, if there's an
organized group that's talkingabout it, you will be able to
find them.
And if that's a little bitoutside of your wheelhouse,
start where you are in yourprofession, begin the
conversation.
What are we doing?
When I first joined Humana, Iwas listening to these weekly

(43:46):
calls.
We have all of the differentpilots that get tested in the
organization and I love thatsemi-ideals person.
I just love to hear about allthe different patients that are
being tested.
But one of the things that Irealized very quickly is that
there was not a race ethnicityview on really any of the pilots
.
Is that every time I would haveto come up with you and say,
hey, have you guys consideredthey're really looking at race?

(44:08):
Hey, you know, hey, there'ssomething about health like what
do you see?
You know?
So it's such a small question toask, even fate, but in the
grand scheme of fate, it's kindof like one of those you know
pictures where there's like amillion dots up close and then
they could step back and seethem out and you'd be like, oh

(44:29):
my gosh, this is a masterpiece,you know.
So it's one of those situationsthat you got to think about what
you're able to do, where you'reable to do it, because now
there's an entire cultural shiftthat we're experiencing inside
the organization, where we'relooking at things differently
from the health activity.
I'm not saying that, you know,my little question was the thing
that shifted it, but it goteveryone thinking about it.

(44:51):
Right, that was all those calls, and they go back to their
fears of influence and they'rethinking about it and they're
talking about it.
That's all.
This is really sort of beingcomfortable and courageous
enough to ask the question right, and then from there, what can

(45:12):
we do here in order to make asmall change?
Don't try to attack the wholeiceberg.
Come on like a small change.
We're taking one step at a timearound this sort of behavior
and you know stages of change inorder to get to that
masterpiece that we can all zoomout on.

I think that's great.
Yeah, because I think anytimeyou're taking on something new
or challenging, you're going toneed some small wins in order to
keep going.
If you don't see any progressfor eight years, nobody's going
to do it.
So I think it's great advice tokind of work within your sphere
of influence.
Talk with your friends, havethese conversations, and then
you know, you'll be able toslowly but surely change minds,

(45:52):
and then they're going to beable to do the same thing.
You can sort of get thiscascading effect.
Tamara, I could talk to you forthree hours.
I want to be respectful of yourtime, though.
Do you have any closingthoughts for the listeners
before I let you go?

Oh man, this has been a dream Really enjoy.
I mean, I actually can talkabout this for hours.
Clearly, I'm not sure thateverybody would want to listen
to me talk about it for hours.

I think they would.

Yeah, well, if you are interested, it's helpful to
me about it for hours.
I do have a podcast called OurJourney to Equity.
You can find us on YouTubereally anywhere where you get
your podcast.
I'm on Instagram at our journeyto equity, where I just do very
similar things.
You know where I'm looking at,who's doing this, where, what

(46:38):
their experience has been andhow can we chip away at the
iceberg, one chip at a time.
If you're interested inlearning more, listening more to
me, go on and on about this.
That's where I can be found.

It's excellent.
I watched a few episodes thispast weekend with my partner.
It's very well shot.
You're a great host, a greatcommunicator on this topic.
I'll certainly link to that inthe show notes as well.
I just want to genuinely thankyou.
This was really helpful for me.
I hope it was helpful for thelisteners and I really
appreciate you coming on.

Thank you.
Thank you so much for having me.

Hey everyone.
That's all for today's show.
I want to thank you so much forstopping by and watching,
especially if you've made it allthe way to this point.
If you'd like to be notifiedwhen new episodes are going to
be released, feel free tosubscribe and make sure you hit
the bell button as well.
To learn more about today'sguest, feel free to look in the
description.
You can also visit the podcastwebsite, which is
exploringhealthpodcastcom.

(47:34):
That website will also belinked in the description.
As always, likes, shares,comments are a huge help to me
and to this channel and to thisshow.
So any of that you can do Iwould really appreciate.
And again, thank you so muchfor watching and I'll see you
next time.

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