The Urgent Fight for Health Equity
[Music]
mrs sarah johnson from my home state of
louisiana
was just a few years younger than my
grandmother at the age of 86
she had committed her life to caring for
others as a mother
as a grandmother and as a nurse
according to her family at the time that
mrs johnson contracted covet 19 she was
independent and feisty still able to
balance her checkbook and
recite scripture her age certainly put
her
at higher risk of dying from cove at 19.
her being black all but guaranteed it
you see when mrs johnson was admitted to
the hospital
which was overwhelmed with patients at
the peak of the pandemic
an encounter with a doctor deemed mrs
johnson’s life unworthy
of being saved as was the case allegedly
for other black patients at this health
care system
now under investigation based on mrs
johnson’s medical records
this physician pretty much wrote mrs
johnson off as non-viable
when she pushed for her to have dnr
status
do not resuscitate she documented in mrs
johnson’s chart that
she was of advanced age that she had
severe malnutrition
renal failure and advanced dementia
except she didn’t because also in her
medical records as noted by other
healthcare professionals
she was only mildly malnourished but
significantly dehydrated
and her altered mental status was not
that different than other patients with
covet 19
who present it with similar symptoms and
instead of
the hospital calling the family to
inquire about her functional capacity
her nutritional status her mental status
they informed the family that there was
nothing that the hospital could do to
save their matriarch
and so the family reluctantly agreed to
hospice and mrs johnson was discharged
home
a later investigation revealed that not
only had mrs johnson improve prior to
discharge
she no longer had renal failure her labs
did reveal that she had an elevated
blood sodium level likely due to ongoing
dehydration
or something as simple as iv fluids and
close monitoring
would have saved her life as she was
only mildly symptomatic
with covet 19. instead she was sent home
to die
and her family was put at risk for covet
infection and death
in having to take care of her when i
read this story
i was both infuriated and heartbroken as
it hit
really close to home and it left me with
questions like
what if she was younger would she have
survived what if she had been in a
different
hospital a different city a different
state what if she was white
this incident isn’t specific to covet 19
and it certainly
isn’t an uncommon occurrence as i’ve had
something similar happened with my
grandmother just a few years ago while i
was seeing patients i got a frantic call
from my aunt
who had taken my grandmother to the
hospital because of delirium and
difficulty breathing
she’d only been admitted for a couple of
hours when an attending physician
wanted to talk about her dnr status and
her end of life plan
he hadn’t even figured out what her
diagnosis was but he wanted to talk to
us about
her dying so i had to leave my patients
in the lurch i dropped a thousand
dollars on a flight from maryland
to louisiana to advocate for my
grandmother
the outcome was a diagnosis of pneumonia
for her and thankfully i still have her
in my life
but it was also an opportunity to school
this position on bias and medicine
and in equities in healthcare
unfortunately unlike my grandmother mrs
johnson didn’t have someone at her
bedside to fight for her
as is likely the case for numerous black
and brown people across the country
as the age adjusted covet 19 death rates
for blacks
is over three and a half times that for
once and in the native american
and latinx community it’s at least two
and a half times higher
now let’s be clear before march
conversations about
race-based differences in health
outcomes were limited to
public health lectures and academic
settings
then came kovit when 30 percent of a
state’s population
makes up almost 80 percent of the deaths
related to covet clearly this pandemic
has revealed the ugliness within this
country that has existed
since its inception simultaneously
we beared witness to the murders of
ahmad arbury brianna taylor
and george floyd hearing yet again those
gut-wrenching words
i can’t breathe
as we witnessed mr floyd call out for
his mother
as a person paid to protect us ended his
life with a knee
to mr floyd’s neck
people like myself have invested our
entire careers
into dismantling the systems that
facilitate disparate morbidity and
mortality
revealed by this pandemic we understand
that these health disparities were
rooted in health inequities that existed
well before covet showed up
we also understand that this isn’t
simply about disproportionate
burden of diseases like diabetes heart
disease
and obesity but about social norms and
legislative
racism that influence the social
determinants of health
those factors where we are born
grow learn live work play pray and age
that define 80 of our health outcomes
and either provide access to resources
like healthy food and
safe space for physical activity or
facilitate
the devaluation of black life society
the medical community included would
have us all believe that
disease risk police assault
and early death are all due to
individual behaviors
especially within communities of color
if we
act right if we eat right then we’ll be
all right
as if the inevitability of diet-related
diseases
and dying on the streets is simply based
on personal choice
and not the systems in which those
choices are made
when i think back through what’s an
excellent example of this i think back
to slavery i
think about my ancestors being stolen
from places like sierra leone
and having to travel through the middle
passage and the impact that that had on
their hypothalamic pituitary adrenal
axes
and how those effects have transferred
from generation to generation to
generation
if the dutch potato famine of 1944 in
europe
can facilitate increased risk of obesity
and heart disease among adults
born to women who were pregnant at that
time imagine the transgenerational
impact
of the combination of slavery jim crow
segregation and modern-day racism on the
health
of the black community and then you
combine that with policy driven
purposeful design of communities that
minimize access
to healthy food safe space for physical
activity and affordable housing
and instead maximize the deluge of fast
food establishments
liquor stores and dialysis centers this
isn’t about individual behavior or
personal choice
but about systematic discrimination and
systemic racism with roots that run deep
from the federal government
to corporate america and it isn’t simply
about
access to doctors like myself when we
know
that policies passed have implications
on health
in all ways from creating disparities to
facilitating
equity we can look at housing as a
perfect example
the federal housing administration is
notorious for having
historical institutional racial
preferences
that allow whites to have access to
capital and purchasing land
while simultaneously blocking out that
opportunity for african americans
and it isn’t just at a federal level we
see it locally in states and cities like
the district of columbia
where race-based policies and
exclusionary zoning practices
have facilitated the concentrated wealth
within white communities
while shrinking it in black so much so
that the segregation created by these
policies
can still be seen now imagine
the multi-generational wealth loss based
on this institutional racism
and how that has impacted health but
i’ll tell you you don’t have to imagine
it
because it’s still happening now it’s
called gentrification
when developers partner with governments
to infuse resources and cash
to revitalize neighborhoods that results
in a demographic shift and a push of
communities of color into concentrated
areas of poverty
with inadequate resources subpar schools
and a fractured
health infrastructure this is just
limited
to federal and local policies if they’re
legislating health disparities
corporate america is orchestrating them
and there’s no better example
than the beverage industry they’ve
pledged their allegiance
to supporting the black lives matter
movement but their money speaks a
different tale
they over the past five years have
infused over a billion dollars
in advertising of sugary drinks with a
disproportionate amount of that funding
targeting black and brown youth to
increase consumption
while simultaneously vehemently opposing
any legislative action
used to curtail consumption of these
sugary drinks that are killing us
all while simultaneously making
record-breaking
profits and what’s the result black and
brown children seeing at least twice as
many
advertisements for sugary drinks that
then facilitates increased consumption
and heightened risk for chronic diseases
like diabetes
hypertension and obesity but for all the
challenges within community
of color in terms of health disparities
and health inequities
all is not lost when we join our forces
together like superheroes
communities come together that’s how
change happens
when they came for our music we fought
back and we won
when they came for our campus we fought
back and we won
when they came for our civil rights
we fought back and we won we’re putting
everybody on notice
because now is the time to fight for our
health
our voices will not be muted and neither
will our health we will join together
and we will shut big food and big soda
down
from targeting our communities and
bringing poison to our children
we will call on our elected officials to
create norms practices and policies
to dismantle the institutionalized
racism that facilitates
these health inequities that’s how
change happens
it’s the foundation upon which i have
built my career as a physician
as a public health expert as a mother
and as a black woman
i use my position as a clinician to not
only
help my patients in their health issues
but to address the social determinants
that drive those health issues i use my
position
as a professor at the milken institute
school of public health at the george
washington university
to raise up the next generation of
culturally competent
community engaged public health
professionals
i use my expertise as a public health
professional to not only help craft
legislation
to decrease things like sugary drink
consumption
but i also call on big soda and big food
to stop their deceptive practices in
influencing our national and global food
policies
as a community member i advocate to make
sure that black
lives do matter and i write
testimony and give oral testimony to my
elected officials to make sure that they
legislate in a way that allows each of
us
to reach our full health potential
and when they don’t i use my pin to vote
this journey although rewarding can be
quite challenging
but in the amazing words of the late
great incomparable
congressman john lewis if not us
then who if not now
then when
[Music]
you