AHLA's Speaking of Health Law

A Conversation with AHLA’s Health Care Disparities Convener Work Group Members

June 21, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
A Conversation with AHLA’s Health Care Disparities Convener Work Group Members
Show Notes Transcript

In this recording of a session that took place during Health Law Week 2021, work group members discuss notable insights and recommendations from AHLA’s April 12, 2021 virtual Health Care Disparities Convener. They share highlights from the discussions that took place on health disparities and equity in health care, social determinants of health, the impact of law on these issues, and what can be done to address these issues now and in the future. 

Panelists:

  • Dawn Hunter, Deputy Director, Network for Public Health Law
  • Vonne Jacobs, Principal & Founder, PHAROS Healthcare Consulting and Creating Equity, LLC
  • Ruqaiijah Yearby, Professor, St. Louis University School of Law

Watch the full conversation here. Access the full video and audio of the convener at americanhealthlaw.org/racialdisparitiesinhealthcare.

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

So, hello, I am Dawn Hunter. I am an attorney and deputy director with the Network Republic Health Laws Southeastern Region. And I'm glad to be here today to talk with Vaughn Jacobs and Rakaia Ybe. We were all part of the planning committee for the A H L A convener on racial disparities in healthcare that was held on April 12th. And we also wanna recognize Drew Aria and Myra Salby, who aren't able to be here with us, but who are also part of the planning committee and served as moderators during the convener. I also wanna note that, um, the full recordings are available@americanhealthlaw.org slash racial disparities in healthcare. Um, and I will just start out briefly saying that I was really honored to co moderate a panel with Ruka Ybi on social and political determinants of health. And it also moderated a closing panel on civic engagement and a final question about how to turn commitment into action. Um, and now I will turn it over to Vaughn to say hello. Um, and we'll keep going.

Speaker 2:

Uh, thanks. My name is Vaughn Jacobs. I am recently joined Call Render in the Raleigh office. I'm also the principal and founder of Creating Equity, which is a consulting firm focused on DEI work and specifically work in creating health equity for, um, people of color. And so I was on the planning committee. Um, I've been in HLA for a very long time, and this is the topic that's always been near and dear to my heart. So I was really honored to be asked to participate in the convener and I moderated, uh, the introductory panel. We really started level set and talked about what do we mean when we use the terms diversity, equity, and inclusion? What does health equity look like? What is the difference between, uh, systemic racism, institutional structural racism, interpersonal racism, cultural racism? Really sort of dug into what do these words mean and what are we even talking about? Um, so that was a great opportunity for me to just get clear about what it's, I actually think I'm doing and think I'm talking about with other people on a regular basis. And what they think that we're talking about and the work that we're doing was, I really learned a lot. I appreciated, um, a lot of the comments that were shared by the, the panel participants and look forward to talking with you guys about that before today.

Speaker 3:

Great. Hello, my name is Rakaia Ybe and I am a professor of law at the St. Louis University School of Law. I am also executive director and co-founder of the Institute for Healing Justice and Equity at St. Louis University. And I, uh, also, uh, was so, uh, thankful and honored to serve as a moderator. And on the planning committee I worked with Drew Aria on equity and covid vaccine distribution. And to me, Wyatt was key because we had so many people who were involved, um, in the planning around equity. We had Dean, uh, Dana Bowen, Matthew who worked, um, on trying to ensure the use of equity indicators as well as Dr. Harold Schmidt, who has been tracking a lot of this work and, uh, trying to get, uh, throughout the country people to use disadvantaged indexes to ensure that we are connecting access to vaccines and getting that to the people who need it the most. And so I'm excited to join with you today to talk a little bit more about what we discussed in that panel and some key takeaways that I think are important for the members of A H L A.

Speaker 1:

So l let's just dive into those takeaways. I know there is so much great content and there were really rich conversations and I know we got to the end and it's like we could have just kept going for hours,<laugh>. But, um, for me, actually the first highlight that I would wanna bring up is actually Vaughn, the opening, um, panel on language. I thought it was really great to start with grounding everyone in a common understanding of the language that we use. And really, I think people coming to this saying, you know, we, you have organizations that work together all the time that may not define health equity the same way, or may not define racial equity the same way. And it's really important to be on the same page and have a common language and understanding. Um, so I thought that opening panel was really powerful and useful. Um, I dunno if you wanted to add more about, uh, any takeaways from that panel.

Speaker 2:

No, I actually really appreciated having the opportunity to even have that conversation because what I've been finding as I'm digging more into this work is that we're all talking about the same thing, or we think we are, but we're really not. And really getting to understand what people mean when they say these words really helps me have a better understanding of the initiatives and the actions taking gives me more information through which I can judge the effectiveness of those actions. So, you know, one of the things that you brought up of panels into actual, you know, activities that actually create impact and change people's lives and, and experiences in the healthcare system. And so being able to be clear, you know, a lawyer means things, right? So being able, being able to be clear about what, say health equity is the goal and what does that actually look like from your perspective as a perspective as someone who's a policy maker, from the perspective of someone who's teaching people how to create laws and policies, what do these things mean to you? And getting all of that information and being able to really have an intelligent and meaningful conversation that goes past the intention and really gets into how do we create the right kinda impact. I, I appreciate having that opportunity, just being able to learn all of these different sectors of the industry, what people think they're talking about when they use words, social determinants of health, even though that's technically a defined term, I think bring different perspectives to it. So it was nice to hear that from them.

Speaker 1:

Well, and I think that we find too, that, especially with the, with terminology, that everyone's not comfortable with the terminology either, right? So even if you, if you understand the definition and you know what it is, we aren't all in agreement, um, about our feelings associated with it. Um,<laugh>, I say, uh,

Speaker 2:

One of the terms that even came up that wasn't originally brought up was white supremacy, right? When do we start using that phrase? And is, is that an appropriate phrase for this conversation as well? Is it a term, um, does help get to where we wanna go? That I think interesting conversation, well sort where do these terms fit in and what do they mean and introduce them into, into conversations that we're having on the ground every day?

Speaker 3:

Yeah. And I liked it because we had, uh, such a diverse, uh, group of participants. We had people from the C d C, we had people who were actually from the Minnesota, um, department of Health, the Cleveland Department of Health. And so having a discussion about what language they actually use versus what we use in academia or what non-for-profits use. We have people from change lab solutions. And so really trying to figure out what is the best language, uh, for the best venue, um, even if we are, um, caring forward the same ideas, right? And so as you said, is it health equity? Is it racism? What are we actually trying to get to? Um, and can we do that using some of the same language?

Speaker 1:

So Rakaia, I'm gonna stick with you and say, what was the takeaway for you or something that you, you know, really stood out from the proceedings from the day?

Speaker 3:

Uh, to me, I think I wanna highlight two points that came. Um, one that came from Francis Mills, who is the director, the intern director of the Cleveland Department of Health, of just really connecting what is happening on the ground with people in cities and states and counties. Uh, really trying to understand that if we are going to get to health equity, that what we do to address it must be explicitly connected to the problems that we had. And I think, uh, Dean, uh, Bo and Matthew said it quite clearly when she was talking about vaccination distribution, right? That there have been people who have been challenging the fact that we have been, um, sometimes holding back or ensuring that people of color, low income people, essential workers, get access to the vaccine first. But that's because when you look at who has been most impacted, who has died the most, who has been hospitalized the most, it is because those are those groups. And so if we're going to say we're going to give vaccines to people of color, blacks, Latinos, Asians, native Americans, it's because we are saying they have a 50% increased hospitalization risk. They have a 15 perce, uh, or 20% increased risk of death or infection. So we need to be explicit about why we are doing these health equity measures. Does that mean that then we cannot provide things for other people? No, it just means that if you have a smaller distribution, you go to the people who are most impacted, which helps us all. And then as you get more and more doses, right, you go to the next group that is hit the most. Right? That could be the elderly in nursing homes. So being very explicit about why we are doing these things because we are trying to address some barriers or inequalities, I think was key for me.

Speaker 1:

Well, I like that. Cause I think that goes to the idea that lifting up the people who are struggling most in our communities lifts up the entire community, right? It benefits all of us. And I think that came out too in the discussions, um, for the day. And actually, you know, I'm gonna use that as a segue to say one of the other highlights of the day for me was really a really rich discussion around community. Um, how do you as to build on what you were saying, connect with people who are working on the grounds, but also elevate community voices in the decision making process. Um, how do you be strategic about, um, the way you identify community priorities and act on them and engage, um, the community in those actions? You know, I thought that was a really rich discussion. I don't know if either of y'all wanna add on to that, if that was a highlight for you. I mean, there are so many great highlights, but let me stop talking.<laugh>,

Speaker 2:

I love the conversation about community engagement and particularly because we had, we took it away from just sort of, it's great to have the community involved to really talking about what that looks like. And Rakaia, I think you were a person who, uh, kept emphasizing and we need to be sure that we're compensating people for their participation in this work, right? Like, nobody does work for free. You know, just that when we talk about community engagement, we really need to think about it as there is value to what they're willing to the table. And we need to acknowledge and recognize that value through compensation, through recognition, um, and through giving them actual, um, opportunities to impact the policies and procedures that we're using and not just sort of take them on solely as advisory. Right? You know, we have a lot of organizations that do a lot of advisory conversations with the community, but the community never really feels like they have any actual power or influence and what it looks like to really truly engage the community, particularly around issues of public health. You're talking about the communities that are most impacted by something like Covid 19, you know, to give, to grant access and then to take on and provide opportunities for them to exercise power that would impact their own lives and their own communities is something that we can do as healthcare organizations in a way that's very unique. And so I really appreciated people in on the panels bringing that to the bear saying, you know, it's not just about, okay, we know you're here and we we'll hear what you have to say. Not only are we hearing you, but we're inviting you into the room, become decision makers with us to help design things. And we recognize the value in that planning to compensate you for that work because we would compensate anybody else we had doing. Um, I thought that was a really, um, powerful part of the conversation and talking about what it means to really engage for community and not just sort of bring them on from a PR group.

Speaker 3:

Yeah. And I would add that when we talk about community, we have to expand our views of what that actually is. Um, and I think Professor Heather Walter McCabe pointed this out, right? When we talk about race, when we talk about socioeconomic status, we also have to think about disability status, L G B T Q I A. Um, and so if we're talking about health equity, even in, um, a discussion about race, we need to talk about how that impacts gender identity. So a black trans disabled woman, right? What does that mean? Not just say, oh, well, because somebody's black, we're gonna do this. Right? That community has to include all the different identities that leave people vulnerable, um, and giving voice to all of those communities and not treating them as monolithic, but getting enough membership in voices and understanding of what they need. So you can understand how somebody who lives in rural Missouri who perhaps is black, um, is different than a perspective of somebody who lives in Detroit, Michigan, right? Um, and so I think to me that was so key that not only did we have a broad range in terms of where people were from, but also a broad range in terms of perspectives of not just focusing on one key identity that may be a barrier to you getting equitable access to healthcare.

Speaker 1:

The, the one thing I wanna add on to this is that, you know, we had a panel on civic engagement and, and I think people might come to the page and say like, why are we having a discussion about civic engagement at a, you know, racial disparities in healthcare, um, convener. But we, we have that discussion because there's so much good research about civic engagement, which is not just voting, it's participating in your community, it's volunteering, it's being, you know, engaged in different ways that builds social capital. And I really wanted to lift up something that Dr. Edward Eer, um, who is former commissioner of health from Minnesota, also currently with the Lang Law Foundation, um, that, you know, he shared, you know, that the importance of building social capital in communities to create change, um, really to go to both what both of y'all have been describing. And he says, you know, there are a few key takeaways. Building strategic and equitable partnerships with organizations and groups engaging the community in problem identification and solution ideation, um, translating research into action. So I think we, we also had a good discussion and, and one of the other panels about, um, more inclusive research and research that's designed, thinking about, um, the different communities who are impacted being involved in the design and conducting the research, um, also being innovative and being bold about setting goals. And then he also talks about finding and starting a coalition, right? So it doesn't have to come from the government, it doesn't have to come from a hospital or else system, um, that it really comes from these groups on the ground trying to do work. And I thought that was a really great discussion. Also a good reminder that, um, the importance of each of us in helping to advance, you know, healthy communities. So what's another takeaway that you have, um, from the convener that you wanna share?

Speaker 2:

Um, one thing that came up and, and I don't even remember which panel it was on, we were talking about again, sort of how do we engage with our communities and how do we bring people into this conversation of this work in a more broad way? And there was a discussion about what it means to be a leader, and that we as institutions in particular, need to think more broadly about what constitutes leadership characteristics and what qualifies someone to be in a leadership position with respect to this work. Because, you know, it's not always someone with a degree, it's not always someone who, you know, shows up in a suit. It's sometimes gonna be someone who could be typically not considered leadership material who has the kinda insight, the ideas that you really need to, to move the needle. And so I really appreciate, um, I think it was Heather and maybe bring<affirmative>, I'm bringing, I'm bringing in some conversation about thinking more broadly about what leadership looks like and as particularly health systems try to engage and establish relationships in the community. Not just looking for sort of your stereotypical leader per se, but really thinking more broadly about what are the skillsets, what are the levels of influence that really can bring about change? And where do we find people with those skills, whether they look like, you know, people in<inaudible> states or not. Um, and I really appreciate that being brought to bear because it brought me into a place of thinking, again, more creatively and more strategically about what it looks like when you haven't been engaged and you're trying to start that fresh. Where do we go looking? How do we build rapport? Well, I, you know, take my chip off my shoulder if I wanna build rapport with someone who's not necessarily gonna look at who's trusty, right? The

Speaker 1:

Conversation.

Speaker 3:

And I think for me it was nice having, um, people, particularly on the social and political determinants of health panel who are doing work around, uh, legal epidemiology, right? Trying to see the ways that we enforce, um, the laws that we actually enact, um, can have a detrimental impact on people's ability to gain access to healthcare or even be healthy. And so you have Scott Burr Burrs, who's a professor of law, director of the Center for Public Health Law Research at Temple Law School, Sarah Dia at Change Lab Solutions, and Samantha Ben Weber, who's at the CDC public health law program. And they are all working on trying to, uh, come up with this scientific method to be able to track the ways that laws, uh, are linked to people's health and health outcomes. And I know you've been some doing some of that work as well, Don, as well as I have. But I think it's so key just to highlight how much, uh, laws played a role into people's overall health and wellbeing. Um, and unfortunately he wasn't able to join us. But, you know, we even began to talk about Daniel dolls in his book around the political determinants of health, right? It's not just the enactment and enforcement of laws, it's also who participates in the political process, um, and who has that power and that voice, um, leads us down the road to, okay, so who can have access to their, uh, to Medicaid and telehealth and all of these things. And so to me, that was one key point again, is that, uh, we often think that law is separate, um, from, uh, these barriers, but it, it plays a key role. And so as lawyers, we need to think about if we are advising clients or if we're working on legislation, if we're working on enforcement, that the work that we do could actually increase, uh, people's inability to gain access to healthcare or to be healthy.

Speaker 1:

I like that. Cause I think it bridges both like the leadership part that Bond was just talking about, and then what you were talking about, you know, as attorneys that we're kind of in a unique position, right? To both understand and explain the law to, um, whoever we're advising, to our colleagues, et cetera. But also then to advise on ways that we can change the law to improve outcomes. Um, and that comes from this deeper understanding of the data around, um, health outcomes associated with changes in law and policy. And, and I also appreciated the discussion on leadership thinking that, you know, it's not enough to say, um, is it legal, right? Or it's, it's also now a conversation about, you know, should you do it, uh, what's the responsible thing to do? Um, and, and to be more engaged, um, in your organization in strategic planning, in task forces and work work groups, right? In developing organizational policies and practices that will help support, um, a more diverse and inclusive workforce. And I think a lot of that came out during the convener as well. And really to RA's point, I think one of the other highlights for me was that we ended with intentionally and throughout the day really talking about how we can take action. So what do you do? How do you go forward and put any of these ideas into action? Um, I mentioned policy and practice. I don't know if there are other examples, uh, um, that y'all would wanna share.

Speaker 2:

I mean, I think for me it's being, it's taking on our role as council. So, so kinda like what you were talking about, you know, we're not just the people who prepare to interpret law for people and sort of give them, uh, you know, very narrow lane discussion. It's really sort of leaning into our role as advisors and as council and people who have influence in all of these different rooms. People that policy makers and business people in particular look to for guidance. And being able to flex that a little bit and say, okay, knowing what we know about what, um, it takes to actually create health equity, let me, you know, really advise you, let me really counsel you in a way that can help us really take action as opposed to sort of, well, that's not my lane, because that's not really a technical legal question and that our role is a bit bigger than just answering technical legal questions if we choose to take that on.

Speaker 1:

So I wanted, I want y'all to think about, um, one last takeaway. I think we could probably talk all day about our takeaways from, from the convener, but one last takeaway, and then I wanna get to kind of a, a plug for why listeners should go check out the videos. Um, for me, one of the take, uh, last takeaway is really I did, man, I'm a little biased because we were co moderating it, but the social political determinants of health panel, um, I really appreciated one, just a different perspectives, um, too a deeper discussion and understanding of all the different factors that influence health outcomes and, and our roles. Doesn't matter what you're, what you're doing, whether you're a professor, um, whether you're working for the federal or state government, whether you're working for a hospital, um, that, that it was something, you know, discussion that applied to all of us. And I think also, you know, just pushing the idea in particular with hospitals and health systems to think about ways to incorporate the social and political determinants of health more in client interactions in programming and in community-based investments. Um, what I thought was a really important part of the discussion. So I wanna put out there and find out if there are any other last takeaways that you would wanna share.

Speaker 3:

And I'll jump in cuz it builds off of them, right? To look at hospitals to also think about their institutional decisions and how they, uh, perpetuate racism or inequality to look at their workforce, right? We tend to only think about the interaction between patient, physician or healthcare provider and don't think about the ways that we set up and pay our employees, particularly those who clean the floors, give out the food, um, that, that is and also creates, uh, inequities. And so, uh, Myra, Shelby, uh, moderated that panel. And I really like the discussion about, we need to think about all of the ways that our institutional decisions can lead to inequities, particularly for our workforce in the workforce. We tend to don't, we don't think about beyond the nurses and the doctors. So

Speaker 1:

That's a great point. Yeah, Vaughn

Speaker 2:

No, that was a really powerful conversation, um, in particular because Covid highlighted for us how much we need those people. And, and, and we haven't spent any time thinking about, well what does it mean? But I need someone so desperately but haven't provided, um, you know, infrastructure that supports them in being able to show up when we're in a health crisis and being able to continue to serve. Um, and it would open the door to a very different perspective from an institutional lens about what it means to really have an inclusive workforce. What does it mean to generate belonging in your workforce when you haven't even identified much less address the needs of the people who show up and serve? It was really a powerful discussion.

Speaker 1:

So, um, so I think if you're listening to this podcast right now, you can see if you, if you don't have at least one reason to check out the convener, then you've been missing out on this really great discussion here. Um, but I do wanna end with kind of a high level, you know, what's one thing you would say to listeners to, to that would, that would kind of, um, prompt people to go check out the videos? There's, um, you can watch the entire convening, um, and then you can watch each panel separately. Um, and so Vaughn maybe start with you, you know, what's one thing you would say that, hey, you y'all should check out this convener. It was besides, it was amazing and just a really rich discussion and all the other great things we can say.

Speaker 2:

Yeah, it was on that piece. But I think if you're someone who is trying to find your way, if you are someone who is interested in this work but doesn't really know where to start, what to do, there is a lot of really good resources in these panels that can give you some direction and help you sort of get yourself started and, and moving in this work. Cause there's so much of it and it can feel very overwhelming, but I feel like the information that was shared in the panels gives people a lot of really concrete things that they can start doing today that will help move the needle. And I really appreciated that part of the convener.

Speaker 3:

I would just say that if you are looking, uh, to take on intentional change to try to support efforts, your client's efforts, hospital efforts to, um, to move towards health equity, then this is key. You had so many leaders who were in the government or working with hospitals or academics, um, who were talking about things that you could use, adopt, and make your own, uh, to start working towards health equity. And, um, I think it's key to start there as you're learning to go to the experts, but then to understand that it's going to be a long-term process. And so just learning some tips as you move, uh, through this for intentional change that will help you.

Speaker 1:

Well, and I think I'm just gonna reinforce what both of y'all had said. I think, you know, for me it's, we had such a diversity of perspectives and roles that it doesn't matter what your role is, you will find content here that is relevant to you. And I promise you'll learn something new. I think you will, as a result of this, have a deeper understanding of what it means when we're talking about racial disparities in healthcare, but most importantly what you can do about it. So you heard both Juan and Rukaya just talk about that very eloquently, right? But just, you know, what are the action steps? And I would say my hope is that you watch them and then you share because I think we also have a responsibility to help share information, um, that can help, you know, other people on our team, um, to understand the issue better or to just elevate the conversation in our communities. And so, um, so I wanna just remind folks that the, the, uh, recordings are available on American health law.org/racial disparities in healthcare. And, um, this is gonna be released during Health Law week. So we hope that everyone's engaged in the different educational opportunities, um, and other ways to connect, um, during Health Law Week. And, um, von Raia, thanks so much for a great conversation and again, like it was great to work with you on putting together this convener and the entire team at H A H L A, drew and Myra, we wish you were here with us.

Speaker 2:

Thank you guys. I really appreciate the opportunity. It was great talking to you all again.

Speaker 3:

Same same.

Speaker 4:

Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts. To learn more about a H L A and the educational resources available to the health law community, visit American health law.org.