Advancing Health Equity: The Racial Wealth Gap

Steven Collens, CEO of MATTER (00:15):

Hello, and welcome to the third episode of MATTER's Advancing Health Equity podcast. My name is Steven Collens. I'm the CEO of MATTER, a healthcare technology incubator and innovation hub on a mission to accelerate the pace of change of healthcare. In addition to accelerating the growth of healthcare startups and helping large companies innovate more effectively, we highlight innovative thinkers who have important perspectives to share. In this podcast series, we invite leaders who have deep expertise in how various groups are served or not served by our healthcare system and what we can do to change that. On our last episode, Mary O'Donnell, president of RRF Foundation for Aging, and Robert Espinoza, Executive Vice President at PHI and Chair-elect of the American Society on Aging discussed how to reframe the way we talk about aging. Today we have Crystal Tyler and Pamela Johnson discussing how economic disparities create new and exacerbate existing health disparities.

(01:11):

As the Chief Health Officer of Rhia Ventures, Crystal oversees the organizational strategy and translates the needs of women most affected by systemic inequities into programming that fosters equitable reproductive health products and services. She's held previous roles at the University of Chicago, Michigan Public Health Institute and the CDC. In 2022, she received the Emerging Leader Award for promoting social justice and challenging inequities in health and healthcare. Pamela is the Vice President of Health Equity and Partnerships at the American Heart Association, where she is responsible for leading the strategic planning for improving the health of communities across the United States by identifying opportunities for powerful partnerships to create transformative lifestyle and community change. Pamela Crystal, thank you for joining us today.

Crystal Tyler, PhD, MPH, Rhia Ventures (01:58):

Thank you so much, Steven for that introduction. In case our listeners aren't aware, we're going to start with an overview of the racial health gap that exists in these United States of America. So just from a fundamental perspective, wealth has significant importance for economic security, but also for health and wellbeing, and not just for ourselves as individuals, but for our family, our children's, our communities. And so I will say from that perspective, we have a phenomenal expert here who's going to speak a little bit about health and economics and wealth and how that impacts individuals health and health equity. So Pamela, it is so nice to see you. I am very curious to know from your perspective, can you share a little bit on the overview of the racial wealth gap in the US and some causes from your perspective?

Pamela Johnson, American Heart Association (02:59):

Yeah, so when we talk about disparities, we speak specifically about health disparities, but there is also this wealth disparity that exists in our country and it's alarming because it coincides with health disparities. So when you think about the increasing gap in wealth, that has been a result of hundreds of years of basically specific communities having the ability to earn an income versus other groups that did not have that ability due to the structure of our country, it created and has created an increasing wealth gap. And so we know that for those that are African-American, there's a hundred thousand dollars difference in wealth between that particular group and those that are within the white community. So if you think about being able to play catch up, you almost can't. So then you look at how that affects one's health. Well, it does reduce your ability to have access to healthcare, reduce your ability to access quality food, having the same access to transportation.

(04:25):

And so you can see how the gap continues to impact both your finances but also your health. One of the things that the American Heart Association is we are transitioning into our hundred year anniversary in 2024 was looking at the trends on health disparities, and one of the top areas is around income inequality. So even what we earn in our professions with everything being the same, you're looking at 20 to 30% difference in earnings even now based upon the same qualifications. So if you refer back to my earlier statement, you're never going to quote catch up because the gap even in what you are earning is so significant.

Crystal Tyler, PhD, MPH, Rhia Ventures (05:22):

I appreciate that. And so what I hear you saying first is that there are some historical things that happened early on in this country's history. Of course, the wealth that individuals have now and that certain communities have now that wealth was off of the backs of other individuals within this community. And so now you have a situation where you have differences in wealth and that you're walking into the world with, and once you're earning money, you have differences in what you're able to earn. And so the ability to catch up, it's going to be kind of tough when you're walking in with less and you're earning less regardless of how much you're working.

Pamela Johnson, American Heart Association (05:59):

That's exactly right, Crystal.

Crystal Tyler, PhD, MPH, Rhia Ventures (06:03):

I appreciate that. And so, can you speak to how economic disparities disproportionately affect the overall wellbeing and life outcomes of people of color non-people of color? So with respect to access to healthcare or education or nutrition, can you speak a little bit to those things?

Pamela Johnson, American Heart Association (06:22):

Yes. So all the things that you just listed, we call in the public health arena, the social determinants of health, social influencers of health, social drivers of health, whatever category that you feel comfortable utilizing, those factors really do determine a person's health outcomes. So when you look at the statistics, 80% of a person's health outcomes is dictated outside of the clinical setting. So if that's 80%, then do we invest in that outside of that clinical setting because that's what's driving the poor health outcomes. So transportation, you're talking about education, you're talking about what we earn. You're talking about access to quality care and quality food. So it's not just about access to food, but quality food.

(07:22):

Because that is a key differentiator. So when you think about the impact of all of that, you can take any major city, okay? Any major city, there is usually a lifespan gap of 15 to 20 years between zip codes that are two miles apart. So you could take the city of Chicago and you could take a Lincoln Park, compare it to Inglewood, Inglewood, thank you. Compare it to Inglewood. There is a 20 year lifespan gap between those zip codes, and that is as a community, as a society, we should be alarmed because that means that families are missing out on spending this wonderful time with the ones that they love. And so each person does matter, but it can't just be restricted to one group of people because they live in one particular zip code. But it's about all of us as a society because missing out on knowing each other, even across those zip codes, we're not getting a chance to really have our full life potential just because of access.

(08:41):

And there is this notion that, oh, you're taking something from me, that there's no taking anything from anyone. What this whole notion of equity, it's about if I need glasses, then give me glasses, but if I give you glasses and you don't need them, it's a waste of resources. So provide the resources that are needed for those that have glasses like me today, I need them, right? But if you don't need them, then why would you need those glasses? It's just really that simple because then what you'll see, we waste resources because we're not allocating them the way where there is the greatest deficit. Thank you for that. And so I heard a couple things that I would love if you speak a little bit more on, and the first one really gets to this point. As public health professionals, we think about health equity all the time, and we speak health equity as healthcare professionals.

(09:44):

We speak about this all the time, but when we talk about these differences in communities, just neighborhoods in Chicago, north side of Chicago versus the south side of Chicago, it points to the question of whose responsibility is it to address some of these challenges? It's not just a healthcare issue, it's not just a public health professional issue. There are folks in other sectors, corporations, asset owners, because we're talking about economics who have responsibility for doing some of this work. And the solution might be glasses, the solution might be transportation, the solution might be jobs. So I appreciate touching on this big picture of all the differences even across communities. What's being done to address this issue specifically, can you talk a little bit about the work that the American Heart Association is doing?

Steven Collens, CEO of MATTER (10:41):

Hi, it's Steven Collens again. I hope you're enjoying the discussion. We just launched a new MATTER membership offering called Flex. With Flex, healthcare innovators can access tools and resources for building a healthcare business on their own time at their own pace. Learn more about our flex membership at matter.health/flex.

Pamela Johnson, American Heart Association (11:05):

What's being done to address this issue specifically? Can you talk a little bit about the work that the American Heart Association is doing? Yes. So one of the things that we recognize that the American Heart Association is that no two communities are the same. So you have to do an assessment and you also have to hear from the community. So this notion to do upon a community that does not work. We rarely have to have the voice of the community center to complement the data of doing the assessment of a community. And then you look at, based upon that data, determine what strategies are going to be the most applicable to that community. You recall me saying, how do you use resources wisely? That's how you utilize them. Because if in a community we have a really great infrastructure for food distribution, then coming in and applying some type of food strategy would not be as beneficial to that community if their real gap is transportation.

(12:20):

So you invest in creating that infrastructure to have a better methodology for individuals to get to and from where they need to go for work, for healthcare, et cetera. So when you think about that, that's what the American Heart Association has really been focused on because that blanket approach does not move the needle. And one thing as a society that we don't talk about is the healthcare of our country is not even in the top 10 in the world. We don't talk about it, but it is a reality. Our quality of care is because we have an infrastructure that's more of a blanketed approach and not really tailored to the individual or to a community. We miss out. I get excited. I came home from a doctor's appointment and I got to drive down Cottage Grove and over the last 18 months they've been working on an infrastructure for Northwestern that is literally a half a mile from the University of Chicago.

(13:30):

So there's two things about that that I know. One is they made sure they heard from the community before they built that. The second thing I know as a part of that particular project was that those that were weighed in from the community said, we want healthy food in this facility. We also want a place to be able to meet and to exercise. So don't put an infrastructure in if it's not going to have those components. So it's not that communities are not, they are demanding the change they want to see. So that facility will reflect the community's voice. So they will construct a facility that will provide access free parking so that those from the community can be able to utilize those services. That model is what is needed. So they didn't come in and just say, oh, let's just put up primary care. They wanted to make sure they had primary care and specialty care so that I don't have to go downtown for every scan, rehab, all of that. But you're making it play space so that I have access to it. Thanks for that.

Crystal Tyler, PhD, MPH, Rhia Ventures (14:46):

And I love everybody who's going to listen is not from Chicago, but I love the Chicago references and I promise to folks who even aren't from Chicago that this applies to your communities also. So before I go to the next question, I want to add some information here on what Avens is doing in this space. And I want to tag onto your piece on centering community voices and perspectives. And so at R we really focus on the reproductive and maternal health space, and we tend to work most closely with large corporations or asset owners and investors who people don't automatically think of as part of the players in this healthcare system. But I would say they play a huge role. So asset owners and investors are those who invest in new healthcare technologies, those digital technologies, the apps, the patient-centered services that really make sure that patients get the individualized care that they need.

(15:40):

And then large corporations like your Googles and your Walmarts that employ a lot of our community members, but who may or may not cover healthcare services that people need. And what we do in these spaces is really bring those community voices into those spaces where they're not always represented. And the thing that I heard you say, which is so important and so key is that community members or people from the community might raise issues as real issues that are impacting their health that other organizations might not think of. City leaders may not even think of, or a hospital or healthcare system may not even think of the fact that you need wraparound services. I need fresh food and primary care right here. They may not think of those things together, but when you center the voices of communities, you then are able to see, actually we need to build this in this way so that community members get what they need. So I really appreciate that.

Pamela Johnson, American Heart Association (16:39):

And Crystal, I just want to add on that. Yes, these models that you are referencing, I'm referencing, they're happening all across the country. We worked on a project with enterprise community partners that works on affordable housing and they decided to create a national strategy to work with faith communities to leverage their land to create affordable housing and affordable healthcare. So you'll see now in many faith communities where they have created health centers as a part of their construct of their particular facility, and they also have farmer's markets that are attached to that. You have a pharmacist. All of that built into one construct because I know I can reach people there, but that's what people said they need it.

(17:38):

It's hard for individuals to say, okay, I need to take off this day. I got to take off this day. So therefore they don't go.

(17:46):

So it's not because they don't want, but it is got to be accessible to them. So sometimes when we think about access, it's not even about that. It's a mile away. It's about if I am an hourly employee and I want to take off two hours, a lot of companies don't even allow for you to do that. So that means they got to take off a half a day or full day. And then you couple that with, I have kids and I want to make sure that I make their events. Then more often than not, we prioritize our kids even over our own health. So it becomes that is an access issue. And so I really like to give specificity, and I also like to give models when we talk about what this looks like in communities across the country. But I get excited when other for-profit companies and nonprofit and the government works together to then create more of an accessible type ecosystem that allows everyone the opportunity to be successful with their health.

Crystal Tyler, PhD, MPH, Rhia Ventures (19:02):

Thank you. And I think you're touching on the next question, which really pushes on innovation, like what innovation is needed. And I hear you speaking about innovations and access to care and just being broader with the definition of access. It's not necessarily ours that services that clinics are open, it's the mode of healthcare delivery. It's making sure that people can get what they need when they need it in the way that they need it. And so I think from an innovation perspective, innovating and access to care is so key. And that's a lot of what our work is pushing towards at Rhia Ventures as well, really investing in those innovations that are centering community needs and perspectives and voices to make sure that those particular needs are getting met. So thanks for pushing on that. Oh, for sure. Do you have any other innovation pieces or nuggets that you want to share? Any exciting innovations that you've seen that have made an impact?

Steven Collens, CEO of MATTER (20:09):

Hi, it's Steven Collens again. I hope you're enjoying the discussion. MATTER was founded based on the thesis that collaboration is the best way to fuel innovation in healthcare. In addition to accelerating healthcare startups, we help large organizations innovate more effectively. We help life sciences companies, health systems, insurance companies, and others find value in the entrepreneurial ecosystem, empower their internal innovators and work across healthcare sectors to advance their objectives. If you are interested in learning more about partnering with MATTER, email partnerships@matter.health.

Crystal Tyler, PhD, MPH, Rhia Ventures (20:50):

And do you have any other innovation pieces or nuggets that you want to share? Any exciting innovations that you've seen that have made an impact?

Pamela Johnson, American Heart Association (21:00):

Oh my goodness, there are so many. One of the things that, I mean, I love, love, love. I am an innovator. So whatever type of assessments that you take, it's the innovation that drives me. And then being able to work with teams to then operationalize them, systematize them, and then see them deployed and seeing the outcomes from that. And I am specific in the language that I use because it's all a part of a process to then get to the best outcomes. And one of the things when I think about innovation, I think about there's been a barber shop's strategy for hypertension for many, many, many years. And what I will say is we've always seen great outcomes from those initiatives. But now what you see is that there is a system in place that connects the barbers into a healthcare setting. So as they're taking blood pressures and they see individuals are elevated, they can refer them into a health system so they don't get lost.

(22:17):

You're not just giving them a piece of paper and say, oh, just go see about it. No, we're going to make this appointment right now. So the technology enables that. And then I'm listening to say, oh, this person is also struggling with getting a job or whatever. So these platforms allow you to refer them out to the services that they need. So from healthcare, finding a job, food access, transportation. So it's no longer about just handing a sheet and knowing, well, you may never know whatever happens to that person, but it's all systematized through a platform and technology enables that. I get excited about that because it makes it community focused, it is place-based. And so we all get to play a role in that. And if you think about even community-based organizations, them having the infrastructure to now be able to see this person did go and get this appointment. I know I saw that. And then from a clinical standpoint, when they come back in to see the clinician, they can see, oh my goodness, they've addressed all these issues and I can actually personalize my conversation and make it more relational versus transactional in my communication, which then improves the trust with that particular patient. So it all goes, all these different elements are all playing a significant role to working toward better improvement in health outcomes.

Crystal Tyler, PhD, MPH, Rhia Ventures (24:08):

Yeah, and the piece that you brought up that I really, really loved is on this, the barbershop example that you gave. We've been doing this for years and it's had all these positive impacts. The reason it works is because the perspective that really led to that barbershop intervention came from the community. And I think that really highlights the importance of first having conversations with community and seeing what works for them, but also ensuring that folks from communities are incorporated into the decision-making process when it comes to creating interventions. So there's this meeting people where they are, if people are in the barbershop, you might as well go there to meet them with healthcare services, but also making sure that those intervention designers, those solution experts and entrepreneurs are coming from those environments. Absolutely. Absolutely. And so really just highlighting the importance of representation when it comes to solution generators, decision makers and interventions and all of that. Is there anything else you want to say on that piece before we jump to the next one?

Pamela Johnson, American Heart Association (25:16):

Crystal, what you said is so important. Investing in community centered solutions and business solutions, it's great to have programs. The programs prove out the model by which you can then deploy a business strategy that enables the sustainability and scalability.

(25:44):

Those last two components have been what has been missing in for so many years, and communities get frustrated when you're in and out. So for those of us now that are using public health in the business space, we are helping to close that loop so that we are ensuring we're investing in communities. So we're going to go back to your first question around income inequality. Well, that's how you transform a community. Capital has to go into the community, therefore that's how you're going to quote, start to play catch up because there's investments there. So it is so multilayered and it's so integrated, but guess what, we figured out that this is the way to move forward. It's not anything else. Invest the capital in these solutions and we'll continue to move forward in a positive way.

Crystal Tyler, PhD, MPH, Rhia Ventures (26:51):

Absolutely. And this term of investment, I mean I want to really push on this because in the nonprofit space and a lot of public health work is nonprofit, you have these small grants that will allow you to do some programmatic work to improve some sort of outcome, but it doesn't cover overhead, it doesn't cover sustainability, it doesn't cover all of the things that are needed. And you kind of move from grant to grant to grant, and that's not really an investment in the community or investment in health outcomes. And I would challenge any large for-profit corporation that has really great outcomes to run on that same model and expect to see those same outcomes. So from an economic perspective, think it's important to push on asset owners and the powers that be to invest sustainably in some of these models, invest like you want them to work and win in the long term as opposed to investing on a project by project six month to six month, maybe a year, but no continued funding, that's not really going to be sustainable and it's not going to change economic or health outcomes.

Pamela Johnson, American Heart Association (28:01):

Oh, I talk about this quite a bit, Crystal. We are on the same page because you need multi-year commitments based upon proven models, evidence-based models in order to create that sustainability. I'm going to go back to a comment that I mentioned. We know from the evidence some of the models that are quite effective. So how do you then turn them into the ability for asset owners to invest in those models coming out of a federal grant right now, I can tell you there's two major areas that have the ability to be funded with business models to support them. And so just think if someone else may have been working on that, they may not have been thinking about the business piece of it. They may have just thought about, we're going to get to these outcomes. But I challenge us to always think about whatever project it needs to be a building block and thinking about a business model to support it. And it's these higher level strategies that we have the ability to get funded. I know that sometimes is a challenge, but what I would say is that's why there's a need for diversity at the table, meaning business people, public health clinicians, you need that diversity of thought so that you're hearing these different perspectives and creating an ecosystem that can then create that sustainability and scalability.

Crystal Tyler, PhD, MPH, Rhia Ventures (30:04):

Yes, well said. Here, here to that. I think our time is coming to a close. Do you have any other insights that you want to share with our listeners before we close?

Pamela Johnson, American Heart Association (30:17):

We are at such a pivotal stage in our country, and what I mean by that is we have the opportunity to listen more and have empathy and not make assumptions in how we make decisions. And if you're sitting in a room now, especially those with decision making power, if you look in that room and everyone looks just like you, it's not the right, it's not the right group, it's not the right group. So that is really important. And that comes from if we're all accountants, if we're all public health people, regardless if everyone is the same, it's not the right group. So we do have the ability to invite people to our tables, and it may be the unusual suspects, but having that diversity of thought really is going to enable our country to realize its fullest potential and move along that continuum to be in the top 10 of best health in the world.

Crystal Tyler, PhD, MPH, Rhia Ventures (31:32):

Thanks, Pamela. It's been such a pleasure speaking to you. We really, really appreciate your time and I'd also like to thank MATTER for providing this platform for this important conversation. I'll pass it over to Steven.

Steven Collens, CEO of MATTER (31:45):

Thank you Crystal and Pamela for joining us to discuss how we can address economic disparities and how they disproportionately affect the overall wellbeing and life outcomes of people of color. Thanks to our listeners for tuning into Advancing Health Equity. Join us next time to hear about the future of medical training.