Sarah Swank, Counsel, Nixon Peabody LLP, David Cade, CEO, American Health Law Association, Montrece Ransom, Team Lead, Training and Workforce Development, Public Health Law Program, Centers for Disease Control and Prevention, and Dawn Hunter, Deputy Director, Southeastern Region Office, The Network for Public Health Law, discuss the impact of racial disparities in health care, both pre- and post-COVID. The speakers review some of the data on racial disparities in access to and quality of care, and discuss how data could be used to address these issues. In addition, the podcast examines what health lawyers can do to aid the fight for health equity. Sponsored by Huron Consulting Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Sarah Swank, Counsel, Nixon Peabody LLP, David Cade, CEO, American Health Law Association, Montrece Ransom, Team Lead, Training and Workforce Development, Public Health Law Program, Centers for Disease Control and Prevention, and Dawn Hunter, Deputy Director, Southeastern Region Office, The Network for Public Health Law, discuss the impact of racial disparities in health care, both pre- and post-COVID. The speakers review some of the data on racial disparities in access to and quality of care, and discuss how data could be used to address these issues. In addition, the podcast examines what health lawyers can do to aid the fight for health equity. Sponsored by Huron Consulting Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Support for A H L A comes from huran, a global consultancy to a wide array of industries, the largest of which are higher education and healthcare. These teams leverage technology, data, and best practices to serve institutions, researchers, patients, and providers alike. Huron's education team has worked with all of the top 100 research universities, academic health centers, and healthcare systems to optimize cost recovery, mitigate compliance, risk, and improved service to faculty. For more information, go to www.huronconsultinggroup.com.
Speaker 2:Welcome everyone to today's podcast. It's, uh, August 19th, 2020. My name is Sarah Swank from the Law Firm of Peabody, and today I'm really excited to have three amazing speakers and we're gonna talk about a really important topic, which is, uh, racial disparity in healthcare. Um, so let me ha let's go first. David, um, almost don't even need an introduction, but why don't you introduce yourself to the audience.
Speaker 3:Well, good morning everyone, and thank you Sarah. Uh, I'm David Cade. I'm the c e o of the American Health Law Association. I've been in this seat for about five years. Prior to this period, I, at a short stent in private practice, most of my career I was with the US Department of Health and Human Services, variety of positions in policy, as well as in the law. Ended that tenure about 15 years as the Deputy General Counsel and the acting general counsel. And so, so these issues, the issues of today are, are in my heart and soul.
Speaker 2:Excellent. Uh, Montre, why don't you introduce yourself?
Speaker 4:Sure. Thank you, Sarah. Uh, my name is Montrice McNeil Ransom, and I serve as the team lead for Training and Workforce Development in the public health law program at the Centers for Disease Control and Prevention. Um, I've been at C D C for almost 20 years now. In the last 10 years, have really been focused on increasing the competency of public health practitioners and our partners across the health, uh, spectrum, really focused on teaching them how to use law as a tool.
Speaker 2:Excellent. And John, why don't you introduce yourself to the audio. Hi, good morning. Uh, this is Dawn Hunter, and I am Deputy director of the southeastern region of the Network for Public Health Law. I recently joined the network, but prior to being at the network, I worked briefly in philanthropy, um, with the Racial Equity organization. And before that I worked in state public health, uh, focusing mostly on legislative and policy activities for the department and health equity. Um, and I actually started out my career in Child Protective Services, which really developed, um, led me to my current career. I would say. Great. I mean, I'm very excited to have this conversation. I think, think it's a much needed conversation and I, I hope it's not just this one podcast that we'll talk about what, what with the future holds and how we can continue this and, and, uh, how we all can help contribute to this great. This work we need to do. Um, I think what we should start with is a little bit about defining the issue. What is racial disparities? And I'm gonna start with you, Montre. Um, you know, you're at the cdc. You and I have spoken on public health issues together. This is clearly one. Um, can you help define, define this for, for us?
Speaker 4:Sure. I can certainly put a frame around it. Um, from the CDC perspective, this, the issue of racial health disparities is really complex and it's embedded in the history and the legal structure of our country. Um, but it involves a lot more than healthcare. Um, when we're part of a group that has been marginalized, um, for many years because of our race or ethnicity, socio economic status, sexual orientation, gender, disability status, geographic location, a combination of these things we're more likely to have shorter, less healthy lives. Generally, we de we define health disparities as differences in health outcomes and their causes, and that includes racism and discrimination. Um, and those health disparities are particularly highlighted when we look at race across the country. Groups that have been marginalized can have unequal access to the health system, um, which can prevent us from getting the preventive care and medical treatments that can lead to longer, healthier lives. And over time, unjust distribution of resources and opportunities also prevents many of us from accessing nutritious food, good housing, and good neighborhoods with good schools and lives free of racism and discrimination. And so these factors and other factors have led to high levels of obesity, diabetes, asthma, kidney disease, and other conditions among African Americans and Hispanic Latino populations, um, relative to our non-Hispanic white populations. And so that's a little bit of background on health disparities in the country.
Speaker 2:And, and John, you know, you, you've worked in different, um, you've had different positions. You're in a new position now. How do you see the definition of racial disparities? Um, building off of what Montre just said, um, Montrice did a great job. I think it was very thorough, but I guess the one thing that I would add is that I think about racial disparities from a systems perspective and looking at the institutions and the people who work in and run those institutions and the biases they have against people of color, whether that's implicit or explicit, and how that affects the way they interact with people that they serve and affect the outcomes for those people. So a lot of my work has been censored on how do we make improvements in the systems that serve people to make them more equitable. Great. And David, obviously you, you've just said like, like how much this you care about this issue and, and how you, you're, you've worked on these, uh, issues or been around, you know, worked on these issues as in, in different capacities. Like what would you like to say about defining, defining this issue and how to frame it? Yeah,
Speaker 3:I, I agree with the definition and I, where I struggle is I wonder in today's world if the words disparities and differences is just too soft a concept that we, in this country and perhaps around the world, were a little numb and accepting of disparities and differences. And, and, and so the way I look at it is, I, the, the true impact on what is happening with health in this country and around the world is much more impactful than what one may conclude are differences or disparities. I, I, you know, there needs to be a much more impactful word, which highlights the fact that people are dying who shouldn't die. People are being treated differently and that shouldn't happen. I, I don't know what that word is, but I, and so I said I agree with the definition and it is one that we've followed for a while. And it just may mean that we in this country have become a little bit desensitized and therefore we accept differences, we accept disparities and we aren't working hard enough to address them. Perhaps because we are ignoring the fact that people are dying when they shouldn't die. People are being treated differently when they shouldn't be treated differently.
Speaker 2:I mean, it's interesting, one of the things that anyone who's worked with me knows that access is a really big concept and has really driven my passion in health law. And, um, Montrice and I were talking a little bit of this offline, but, uh, a lot of people don't know I had preeclampsia and was really sick at the end of my pregnancy. And so afterwards, you know, as a health lawyer, you wanna go and do some research. And I, I looked globally, I thought, oh, there's gonna be this global issue around preeclampsia. There's not a lot of scientific knowledge about it, and there's many people that will actually have died of it. And when I did that research, what really shocked me was what was happening here in this country around it. Uh, and, and it was life or death. And it, and it didn't have to be cuz it wasn't for me. And it was really, um, eye-opening in a way that of somebody who had done a lot of work in access and just was wildly surprised. Um, so maybe we should talk a little bit about some of these examples. I mean, there's an example, Montse, do you wanna give us a couple of examples of, of where, you know, where we're seeing the i the impact of race in healthcare and access?
Speaker 4:Well, kinda, you know, piggybacking off of your maternal and child health example, you know, we know that African Americans in this country have, um, 2.3 times the infant mortality rate as non-Hispanic whites. Um, African American infants are 3.8 times as likely to die from complications related to low birth weight as compared to non-Hispanic white infants. African Americans have, uh, twice over twice the sudden infant death syndrome mortality rate as non-Hispanic whites. And this is in from data from 2017. Um, and then that same year a study found that African-American mothers were 2.3 li times more likely than non-Hispanic white mothers to receive late or no prenatal care. So those, those are just some examples. But it's important to to point out again, that healthcare is just one area where discrimination and racism impact health outcomes. The reality is that healthcare access and delivery only determines about 25% of our health. The remaining 75% of what determines our health as a population is really our total environment or ecology. Um, this includes the social environment where we live. So we have to consider those things as we look at these examples.
Speaker 2:So Don, you are starting to talk about some of that, which is, which is true lately we keep talking about these social determinants of health. Um, again, David, it's interesting, they're kind of soft,<laugh>, softer words, but it's like people that don't ha I mean say food insecurities, like these are people that are starving and, and or don't have a home or are living, we're living paycheck to paycheck. And we can talk a little bit about pre and post covid world, but, but don like do you have examples of, of some of this and, and, and some of your work, um, real life examples of what, what this impact is? Um, well I, so I actually do a lot of work on, right now on civic engagement as, um, a health equity strategy. And one of the things we see, um, is, uh, racial disparities, of course in the criminal justice system. And so those play out in every aspect of people's lives. And you know, the simplest way to put it is disparities in civic engagement lead to disparities in health. And so we know that, um, black or African American men are incarcerated at, um, sometimes three times or higher, the rate of white men who are comparable and, um, and then that the same population is then comes out of prison and then has more limited opportunities, opportunities to get meaningful employment opportunities to vote, um, opportunities to get housing. And those are all things that impact economic stability. They impact access to education, they impact, um, how children are raised, uh, in the neighborhood they live in, what kind of, uh, whether or not people can live in safe neighborhoods with affordable housing. Um, and so we see that, um, every day. And right now, I think that it has more attention in the world that I'm working in, um, because the election is so close and I'm, I'm in the state of Florida and we're working with returning citizens who are trying to get their, um, voting rights restored. But that's because being able to vote is one of the most powerful tools we have to affect the laws that create the inequities we see for people of color. So, um, go for it. Montrice,
Speaker 4:I I just wanna say, I I totally agree with you, Don, and I'm, I'm glad that you raised that issue. The, it is absolutely a fact that action is needed to address racial inequities across all of those areas that you mentioned. If we really wanna see significant improvement in the racial health equity gap that we see in this country, the reality is we can't reach what we call our health equity goals without addressing systemic racism that exist across all segments of our society, from our courthouses to our hospitals, to our schools, to our workplaces. So I appreciate you pointing that out.
Speaker 2:Yeah, I mean, it's interesting cause you could sit here, you know, our, you know, our audience hopefully is broad, you know, health lawyers and, and also broader than that, people interested in health, um, what's happening in health laws and, and one of the things we think about is we have these laws, right? So Don, you brought up, part of it is like voting. And so the, these, these systems that are, are just so, um, entrenched in our, in in what we're doing. And if you move, you're just trying to, I mean, in healthcare, a lot of times we end up as the hospital for example, might, you know, somebody ending up in the er, the hospital may end up with this person, then they might have, you know, a social worker help and this help and that helps. And there's been a lot of people that say, well, that's like the hospital didn't create the issues, but they're the, they're the place where the, where the patient ended up in their most critical health time, right? Or their critical time in their life. When you have bad health that is, and you're in the emergency room, you're, it, it's there you are. And, and so, I don't know, da David, what do you think about this kind of pre covid world and sort of, you know, when we're, when we're looking, when we're thinking about, you know, the people that we speak to and our presentations and all, you know, we're talking about this law or that law, but tho we have laws out there that say you can't do X, Y, z and things are still happening. And we still have hospitals that are at, you know, they, it, they seem like the front line of it, but honestly, the what it people end up there ask because of all these other issues that are happening in our culture and society. What do you think?
Speaker 3:Well, I think I, I, well, a couple of points. One, I do think pre covid is just like post covid. I mean the, the, the sins of our world, the sins of our nation that we're talking about here existed pre covid, and they are existing post covid. We're still grappling with them. I, I, I see that covid like many crises along the way, has shied a, a brighter light on the problems that we have. And we're, we're having deep and thoughtful discussions now as we see the inequities, if you will, in the, in the imbalance and the death rate that is coming from Covid. So it's exact, you know, we're seeing how the sins of the past are still here today. Um, all the disparities and differences that Don and Moris talked about. Um, but I, and I would, I would say it, it may be a little bit unfair, uh, because this is such an integrated and challenging and complex issue to, to just look at the impact on the healthcare system. Although that's, that's where we sit. That's what we do every day. Um, Dawn opened it up a little bit. Uh, you know, we talk about the prison system, it's the same thing. There are many people in the prison system who have suffered from the disparities that exist in, in our world. Um, And the same causes that lead into mass incarceration and the inequities in incarceration exists in the healthcare system as well. The challenge, I think, for the healthcare system, and I think part of the frustration of the healthcare system is we seem to be looking to them to solve all the problems. So yes, you get someone in and you can fix them up, and you then need to release them. They may not be able to afford the medicine. You need to release them. They may not have safe housing or housing at all, but you need to release them because the system says your time is up and the hospital has really done all that it can do or all that it's allowed to do. You have to release them. But in many times, and, and I know you know this too, Sarah, that you know, the frustration of the hospital is I know you'll be back because where you're going isn't a safe place for you and it's not a supportive place for you for your recovery. But more importantly, you didn't have to come in here to begin with if you had had the adequate support that this country knows is available, but it isn't available to you, it's not accessible to you. And that's how you ended up in here. And so the, you know, I think, I think Montrice started out the issues are complex and if, if Covid allows us to have this conversation now, then, then this will be a positive outcome of, of this pandemic. What I hope as we look through this, this sort of lens into our past and hopefully into our future, that we will see major change coming. So God forbid, whenever there's the next pandemic, we're not having this conversation at this level of detail because we would've done, uh, we would've taken some action to find a pathway for real change.
Speaker 2:I, I, I agree, David and I, um, I, there's so many lessons that could be learned, and there's not, I mean, for, from where I sit, there's not a lot of things that are new. It's just they're getting highlighted now. Um, so I think it might be nice to talk about again, the data again, what, you know, what, what are we seeing now in the post covid world? Uh, Montre, do you wanna talk a little bit about some of the data that, and, um, uh, that you're we're seeing now with Covid?
Speaker 4:Sure. I mean, you know, as we've talked about the health differences between racial and ethnic groups are often due to economic and social conditions that are more common among some racial and ethnic minorities than whites in public health emergencies, like in Covid 19. These conditions can also isolate people from the resources that they need to prepare for and respond to outbreaks. So, um, what we're seeing, um, is that, you know, as of June 12th, 2020, age adjusted hospitalization rates are highest among non-Hispanic, a American Indians or Alaska native populations and non-Hispanic black persons followed by Hispanic and Latino persons, non-Hispanic, American Indian and Alaska native persons have a rate, um, approximately five times that of non-Hispanic white persons, non-Hispanic black persons have a rate approximately five times that of non-Hispanic white persons, um, and Hispanic and Latino persons have a rate approximately four times that of non-Hispanic white persons. So, um, we're seeing that the burden, um, is on minorities.
Speaker 2:So, um, Don<laugh>. Yeah, I mean, John, this is, I mean, we're not, I'm gonna highlight this five times, five times, four times. I mean, these are not little numbers. This is huge difference. What are you seeing, Don? And, and again, like what, I mean, how do you, how do you address this? Uh, I mean this is, I mean, I I this is people's lives. These are not just the lives of like the one person that, but this is their families. These are communities. This is, these are huge numbers. Um, you know, you just started this new job. What the, what are you, what are you doing? What are you seeing? Um, well, we have to look at also where those disparities exist. They're not just the populations. And so why are these particular groups being hit hard? Part of it is because the same group of people, or groups of people are, you know, in the essential worker positions, they're in jobs where they have to go to work every day. They're more exposed than a general population. They're also generally more in lower income jobs. So they're not getting to work from home. So again, they're more exposed than the rest of the population. Um, they also maybe don't have access to childcare, uh, and maybe they live in multi-generational family homes. So from our perspective, what we're saying is what are all the conditions that can create spread, uh, you know, spread of covid 19 within communities, um, and within families? And these are some of the things that impact that. You have people who have to go to work. You have people who don't have access to childcare. Um, you have multi-generational family homes. Um, you have people who have to take public transit. These are all things that increase their risk of exposure. And then kind of at the structural level, they often live in communities that, um, experience environmental injustice. So they have higher pollution levels, they're hotter than other places. Um, they're more susceptible to natural disasters. So right now we have hurricanes and wildfires. Um, so those are gonna exacerbate some of the issues that, that we see because these communities are already more vulnerable, vulnerable from a, an emergency response perspective. And now we're layering, you know, other emergencies on top of that. And so we look at where do we intervene to make sure that communities are more resilient, not just during the disaster, but in, in the recovery period and before the next disaster strike. So, so David, do you wanna comment on any of that? Um, about, I mean, it's interesting cuz we, again, we're coming from this sort of, and I don't wanna say just hospitals. We have all kinds of people in our, all different silos in our healthcare system or integration in our healthcare system. What do you think?
Speaker 3:I i i, it's com it's complex. What, what I would say though is a problem that is not seen as a problem that is not fixed, it's not my original line, but I think there's so much truth into that. Um, when, when you ask about the data, the data allows us to see the problem where clearly, and as Dawn just a moment walked us through, this is stuff we know. And if we didn't know it, we can say we learned it, just learned it a moment ago, uh, as we've been experiencing Covid. So now we understand it. Now what are we gonna do? Um, all all those areas that Dawn just are just addressed are areas and opportunities for action because we know that they all linked together to give us the numbers that Mont Treese gave us to highlight the disparity and the health outcomes for African American individuals in this country. So if we're gonna fix the problem that we've now just studied again, and we have data to, to, to illustrate, it's now an opportunity for us to take that information and ask why, and then to build the strategies to address it. Because as we said, I think all of us agreed the disparity, if you will, the differences if you will, existed pre covid. So everything that Dia said existed pre covid, it's worth now because this is what happens in to a country that is dealing with a pandemic. So now what are we gonna do?
Speaker 2:It's interesting, David, cause I, I'm gonna say one thing and interrupt and say this one thing, which is we're talking about the data and, and I wanna, and I'll, I'll be the one to say this. We're talking about the data. Like it wasn't like, it was getting well collected in the beginning and I realized, listen, we all, I mean, we watched a lot of laws change. We watched our lives personally change. Um, but, you know, data collection, you know, luckily it started being built into the CARES act around testing. Because if we don't actually have the right data, I mean this is data, we have it, it's sitting there, it's pretty, um, impactful to to hear it, to look at it. You know, I I I challenge the audience to Google and keep up with this issue even after listening to the podcast cause there's more and more data coming out. But, but do we even, you know, do we ha is there, could there be more? I, I think yes. Um, I hope that this will also impact like data in the future, right? I mean data collection on these issues past just covid testing or you went into the hospital, right?
Speaker 3:Right. But did we not know? I I I I I agree with you. I, I think the Care Act has allowed us to pull in information in a much more sophisticated way. We're slicing it and, and we're, we're, we're, we're, we're producing it in a much more real time. Um, but it isn't that we didn't know.
Speaker 2:Right? Right, right. I mean, we have to be able to connect. I would just say that we have to be able to connect the data that exists to other important indicators. So, you know, testing and hospitalization information is obviously very important for COVID 19. But it, we also need to know about like transportation and access to care measures. So, um, when we're talking about targeting resources to a community that is not getting adequate testing, we also need to know if they have the transportation infrastructure to get them to testing, um, things like that. We know
Speaker 3:They don't. We know they don't.
Speaker 2:Right.
Speaker 3:And so I I would say, you know, even from a CDC point of view and prevention, because now that we know this, or if you accept my premise that we do this before, other than the indifference of acceptance, we had the opportunity to address more aggressively prevention. And I suspect nobody ever thought that this pandemic would come. But we've had folks die who didn't need to die. We've had folks have injuries and disease who, who did need to have it. We've had this problem and we've had initiatives throughout our history. So I know from a, an HHS point of view and a CDC point of view, you know, you have goals for 2020, you had goals for 2010, you had goals for the year 2000 and, and so forth and so on. Um, so we've known about this and we believe that it is preventable.
Speaker 2:Right, right. So, so montre data collection, what is the impact on this? Like you're hearing us, so we're saying we know it, but like, um, somebody who does ACO work and helps, what we, we data is, is, has, does have some, some power and impact to it. What, what do you think about that?
Speaker 4:Well, we know that having, you know, this data, the data that you talked about, um, will help us to know more about who is really being affected by the disease and learning more about why covid 19 disproportionately affects people of some races and ethnicities will really help us understand and develop strategies to improve health and health outcomes. And C D C has worked with state and jurisdictional health departments to increase reporting of race and ethnicity. Um, but challenges exist in capturing race and ethnicity. And, um, a lot of this begins at the individual patient level. And some individuals may not wanna report race and ethnicity. There's also missing data and, and poor quality that can impact what analysis can be completed. Um, race and ethnicity reporting have improved. They've doubled since the start of the outbreak. But, um, but we do need more, um, electronic or automated data feeds to capture this information. Um, and there needs to be prioritization of things like electronic laboratory testing or reporting, um, and healthcare facilities, prioritizing electronic case reporting to automate rapid case reporting in a standardized way.
Speaker 2:So, so we've, we've spent, we've spent all this time like defining the issues. So I'd really like to get into like, cause there's a lot of people listening now, including health lawyers that are like, okay, it's the problem. Like, or maybe I'm still, I hope you're not grappling with it the problem. Cause we work and see this all day. But, um, we can see this like you said, David, but like now here we are. Um, and, and so what do we do as health lawyers, David? Like what do we do? What do we do as hla, what do we do as individuals? And I'll start with you David. Like, what, what can we do? Cause we can say the laws are here and I know it's just not right. That's probably, that's not good enough, right?
Speaker 3:<laugh> It's, it's not good enough. And, and I don't want to end, I don't want to be left with a call at, oh, Davis just complaining. So I, I appreciate your question,<laugh>. I think, I don't think information, I think
Speaker 2:We're talking about,
Speaker 3:Well, I, I would, I would offer this for the, the health lawyers and the health professionals and for the health institutions. One of the key benefits of having this information, having the data, is it allows all of the constituent parts of the problem to come together to work for the solution. So as we talked earlier, and I know Don spoke to this too, is we know education is a problem in this country. We know transportation is a problem in this country. And while it all comes together from our lens and from the clients we serve in, in that hospital or healthcare setting, and so it's very impactful for what we do. And Covid being a, a crisis focuses there, but we know that the hospitals can do more of what they need to do and the healthcare systems can do more of what they need to do and can do when they are partnering with the community for transportation issues, for education issues, for nutrition issues. And it deals with, you know, the daycare and those challenges. This information that is, that, that folks are gathering more of is allowing the community to come together so the hospital's not standing alone trying to solve the ills of the community by itself. And nor is the prison system for that matter. One of that's one of the benefits I see in this. And when I turn the page to where we are and what's going on, it allows us in the health law profession to have this information also so that we are, are better counselors and, and, and colleagues with our clients to help them solve the problem. Because as I said, the problem is beyond health. And, and if we just focus on health and fail to look at the social determinants that impact that we will never truly address this because the hospital and the health system cannot solve the education problem, cannot solve the transportation problem that all impact the people they see every day. So I see the collection of this information as very positive to the larger discussion. And, and where I think the, the lawyers and the health law professionals can add value to their clients is to make sure that when we are talking about these problems that we're bringing in the other partners to the solution and the hospitals and health systems that are doing that in many already are in all of our communities. They are reaching out to figure out how can we address the housing problem for folks who, whether you have covid or not and need to go somewhere, or if you have some other condition and it's time for you to get outta the hospital setting, but you're not ready to be back out on the street cuz you're homeless, some transitional housing. So this is happening and it's happening because the information has been gathered, we're gathering it, and the larger community of stakeholders and interested parties are coming together to solve the problem because this information is allowing us to see the problem and its complexities more clearly. And that's a role I think that we play is in that convening, that bringing folks together in a multidisciplined way from the hospital to the counselor, to folks who are involved in transportation, to folks involved in the, in the, in the, in the penal system so that we can understand and bring everybody together to solve the problem.
Speaker 2:I think that's great. I mean, one of the things I was, I was thinking about when you were talking David, is, um, you know, like limited English proficiency. It was, um, I remember just kind of challenging leadership in the board to take a look at that. Like, just the idea that you, that that language or the can be a barrier, right? And, and to access and, um, thinking, you know, everyone thinking we do an amazing job, which they did, but just like, Hey, let's just look at it. And when we did it, we were a hundred percent the law, everything was great, but they went, oh, well maybe we'll just do change this and we'll change this system and tweak it a little and do this. And, you know, that might've just that. I mean, think of the little, the life that changed, you know, that just moment of just as a lawyer asking that one good question, that's not, it wasn't a legal question, it wasn't even a compliance question. It came genuinely from me saying, you know, just wondering if we could do a little bit better. Like, can we just put it on the board agenda and like talk about it? And you know, and I'm sure there's health lawyers out there that have transportation where we were worried about fraud, abuse issues and, and having been in house and, and saying even in an urban area, like, um, oh, they, people can just get home. Well, maybe what is home? And, you know, taxi vouchers and things being a problem, and you're like, that's just not how our world works. That's, you know, I see that we don't wanna like, have people take taxi vouchers all over the place and, and create a fraud and abuse issue or, you know, a referral issue or we get it. But, but, but the, the, you know, and seeing that kind of changing after, you know, the Affordable Care Act and this, this idea of looking at populations, um, Don what do you think we could do as individuals, health lawyers? Um, what can we do as an organization to, to support and not to, to continue the conversation about. This is a problem though, I think we need to have it mm-hmm.<affirmative>, but what should we do about what we can do to change things? Well, I just wanna add on to what we were just talking about, which is, um, language issues in, in healthcare and healthcare delivery. And one of the most important things that organizations can do is actually assessed community feedback. Uh, hospitals and and providers do a great job of asking you how your care was, um, and what your, what your interactions were like with the staff. Um, but they don't really dive into, you know, did you feel like you could communicate with a person that you interacted with today? If there are resources in another language, were they adequate? Were they sufficient? Did you have what you need for this appoint to be effective? And not enough organizations do that. So finding ways to get meaningful feedback from the people that you serve and incorporating that in severe decision making processes will be really important. I think one of the other things that organizations can do is workplace false assessment. Um, looking at the diversity of your team, looking at the diversity of your leadership and evaluating your hiring practices, evaluating any existing policies through, you know, what you hear called an equity lens. But really if you have policies, how are they affecting your employees, but also how are they affecting, affecting your clients? Um, and that includes data collection policies. So are you collecting data in a way that it can be actionable? A lot of people collect data because they're required to collect data, um, and then don't do a whole lot with the great information that they, that they get. And so it's important to make sure that you have a policy that you're getting quality data and you're using it to inform some action. And then I think that ties into performance management. You know, every organization and most organizations have some form of performance management system in place. And so it's important that, that, that those systems incorporate health equity measures and strategies as part of measuring progress. Um, so those are just a few of the things that I would recommend. And I, and I would echo what David said, that there are already movements, do things like incorporate community health workers, established community advisory boards and hospitals and, um, to engage in supporting hou supportive housing efforts. Those things are all really important to continue as well. Great. Dawn and Montrice, um, what do you think we should do as help lawyers? I mean, I'm, I'm sitting here and I'm, I'm of course gonna, uh, focus on boards and leadership and reflecting our communities and, and having these outreach discussions. But what else, what can, what can we do? You, you come from a good, um, way of educating people and discussing the issues. What, what if we were to give like a checklist or, um, some ideas to people that are listening right now, what, what could they do?
Speaker 4:There are three things that immediately come to mind to me that I think health lawyers should, should focus on in this area. And the first is, I think it's important that, that health lawyers begin to understand and learn about the social determinants of health that we've been talking about on this call today. And the legal underpinnings of each of those social determinants of health law itself is a social determinant of health, maybe the most significant social determinant of health. Our, um, system of laws, our legal structures at institutions really have resulted in a system that significantly limits access, um, the access that black Americans have to the services and conditions that are required to be healthy in this country. And socioeconomic changes. Um, things like reducing poverty and improving education have the greatest potential impact, um, and tend to be the most effective because they re reach broader segments of society and take much less individual effort to see improved health outcomes. The second thing that I would ask health lawyers to do is to focus on learning about what legal epidemiology is. We define legal epi as the scientific study of law and its impact on health outcomes. And legal EPI is legal research, it's policy surveillance and it's legal analysis that helps us understand the laws on the books, how they're implemented and enforced. Um, and when we can overlay that data with health outcome data, we can better understand the impact of law on populations. Um, and then the third thing that I would say is kind of similar to what Dawn said, and find ways to focus on anti-bias and anti-racism principles, um, and training and find ways to operationalize those principles in your legal practice. Um, and then to the work that you do with your healthcare clients, be a champion for including anti-racism and anti-bias principles and to governance management operations and healthcare delivery. Um, I think those are the three key things that I would love to see health lawyers take on.
Speaker 2:Well, we'll do three. And I, yeah, let's do it. So, um, uh, so David, what are, what are some things that we think, you know, I mean, I think one of the things I was thinking about is like, if, you know, if you're an in-house lawyer, be a smart consumer of your law firms, like, um, talk to your board. I mean, there's some things, um, there's things in your daily life. Like I sit on a board and we're having this discussion about it, and these are not health, you know, hospital or health related Fords, you know, it's more of an arts board like, to, to have these discussions broadly in your own own life as an individual and, and to really reflect too. Um, but what, as an organization are some of the things that we may we'll start doing? I hope, I mean, I don't want this, this, this discussion to be the end of it, and I don't think you do either.
Speaker 3:No, not at all. And I, I, I accept Mont Theresa's list. I, I, I totally agree with it. I, I would just, I would note here at A H L A, our board has had unconscious bias training in the past, and we're doing it again. Uh, we are extending that training to all the A H L A leaders as well as the onboard association staff. So we recognize it. And while it is part of our daily and engagement and, and, and conversation, we recognize that, uh, as humans, you can always learn more and do more. So we're intensifying the anti-racism training that, um, Montrice talked about. And in our convening, you know, we do have, uh, activities with our practice groups and with our journal authors to produce additional content in the areas of health disparity. And in the area where, you know, we have seen the regulations impact what hospitals and health systems are trying to do. Uh, and in the larger convening, uh, as I said, uh, I think there is great power and growth when all the disciplines come together. So we're not just saying hospitals, you solve all the problems of the world. We're bringing together all the disciplines that come in. And, and I do think, therefore, from a, an in-house perspective, from an outside council perspective, and, and, and from anyone who's involved in the healthcare system, you have to think broadly and more integrated. It is a complex issue, and the problems won't be solved from one sector only. So they need to be educated and to always ask why, to push and probe. Um, and to, to, to really push on the advocacy side, pushing back on the government, the governments, whether it's state or federal, many organizations or many government institutions regulate and legislate out of fear, something bad happens, you have a law. And the unintended consequences of some of these laws inhibit and limit the opportunity to address some of the issues that we've been talking about. So I would, I would say for hospitals, for health systems, for outside council, for all of us who are involved in this, when we know and have stories of the unattended consequences, the negative impact, we have to take those issues back to the government organizations to let them know what is happening and therefore to advocate for change. Uh, and that's also an important thing that some, that, that, that these individuals can do.
Speaker 2:I think that's, um, a thank you for that. And I, I, you know, we're gonna, um, I'm gonna have you guys say your, your takeaways for the audience, but I, I wanna thank you, um, for joining me and letting me have this discussion. I feel really passionate about this. I'm so glad that American Health Law Association, um, wants you not only wants to do, to have this conversation, but is, is pushing, um, things forward. I, I'll just say that, um, David, that like, I, I think that when we do have laws, they tend to be one note. They are not in, they're on one topic, they're not interchanged, and they're not like lifting your heads up to see what is happening. Um, and that can be across a lot of different issues. So I, I'm hoping that this will change. We could really have a, um, as optimistic as I always try to be, but there might be some real positive change coming outta this. So I'm gonna go through each of you and, and please, uh, give a, a takeaway for the audience today. Um, let's start with, uh, let's start with you, Don. Okay.<laugh>, can I, a short takeaways. I have a one really short you can have, and then a follow you can have as you, I would say as many as you want, but we'll be here. But, but I'm, I'm sure I wanna hear all of them, but yeah, you may have 1, 2, 5 takeaways. How's that?<laugh>? Great. I won't take five. But, um, the first would be to think, uh, about having diversity in the healthcare workforce. We saw a, a study that came out yesterday that said, black babies are more likely to survive when they're served by black doctors, but they're three times more likely to die when they're served by white doctors. That's really significant. And we have to also look upstream at saying, how are we educating physicians in this country? And how are we promoting service in different fields to ensure that we, you know, have equitable service, um, for all kinds of people who come in to see us, all people of color, and people of different abilities, et cetera. Um, my big takeaway would be, I just wanna put a plug in that August is Civic Health Month. And one of the most important tools that we have to achieve health equity as voting and the health of individuals and communities is determined by the distribution of wealth and resources. That's just what it is. And the distribution of wealth and resources is determined by elections. So if we want to achieve health equity, we have to elect people who will enact equitable laws and enforce them equitably. So that's my plug, and I hope that people will consider civic engagement as a health equity strategy going forward. Thank you, Dawn. I really appreciate that. Um, Montrice, what are your takeaways for the audience?
Speaker 4:Sure. Really quickly, um, you know, the, the inequity in health that we see across the country today remains one of the greatest social inequities of our time. Um, as we talked about in this podcast today, access to healthcare and health behaviors are greatly influenced by societal factors, um, and the environment including housing, transportation, education income, and C d C recognizes that as the nation's leading public health agency, we have a crucial role to play in promoting the practice of health equity. And as an agency, we're committed to seeing that we put science into action to confront the gaps in health and the social determinants behind those inequities.
Speaker 2:Thank you, Montre. And, and David, why don't you leave some parting words for our audience.
Speaker 3:Um, I, I totally agree with Don and Montse, and, and I would say that, you know, racism, neglect, indifference, uh, lack of empathy, Achill people, people are dying as a result of where we are and what's been going on in this country and around the world. If you are touched or bothered by that alone, then it's time to get busy. And as Dawn said, to, to stay busy, um, the information that we've talked about today is not new, but if it's new to you, uh, and stay current validated, the information is there. But be an activist for change, be a voice for change, and, you know, we, you can do it in small ways in the boardroom with your clients, um, but constantly ask the question why the data that, that, um, that don just shared, uh, you should be asking why. And through that, we will understand a pathway to some of the solutions, um, so that this issue, uh, will be addressed and we will have health equity in this country.
Speaker 2:Thank you. And what a great note to end on, um, because it is, uh, when I think about this issue, I think it's, it's life and life or death, and we, we need to start thinking about that way. And if that spurs people into action, that we're not as active or as vocal, I hope that, that that's what we get out of this podcast. If not, you know, a, hopefully a plan for it as well. Um, and, and a, a little note of optimism that we can maybe make, we can correct what was absolutely not right, um, pre covid, um, with the, with the data and the information that's coming out. So, um, what I would say to the audience is stay tuned more to come from a H L A. Um, and I really hope, uh, that we, uh, continue this, this kind of discussions, programming, and information. So thank you everybody, and, and have a great day.