Last week, the Nashville Health Care Council and NashvilleHealth hosted “Conversations on Health Equity and Action to Eliminate Disparities: Part Two,” the second in a three-part series exploring health inequity and its long-standing threat to business and community growth and vitality. The conversation featured U.S. Surgeon General Jerome M. Adams, M.D., MPH, and was moderated by Bill Frist, M.D., former U.S. Senate Majority Leader; Founder and Chairman, NashvilleHealth; and Partner, Cressey & Company.
As the 20th surgeon general of the United States, Adams oversees nearly 6,100 uniformed health officers who serve more than 800 locations throughout the U.S. and around the globe. He has created several initiatives to tackle our nation’s most pressing health issues, including: the opioid epidemic, oral health, and the links between community health and both economic prosperity and national security. During his time as an Indiana health commissioner, he led the state’s response to the Ebola virus and HIV. He is also a member of President Trump’s COVID-19 task force.
Adams began by addressing the COVID-19 pandemic and its effect on public health. “The pandemic has hit us hard, but it has particularly affected people of color, people with underlying conditions, and those who are older. There are a multitude of factors we could go through to explain this, but from my standpoint — and there’s good data to back this up — all of these reasons are rooted in social pre-existing conditions that conspire to reduce our resilience, opportunity and health,” he said.
In a vicious cycle, social determinants of health including access to transportation, childcare and safe and affordable housing can contribute to chronic medical conditions like diabetes, lung disease, kidney disease and high blood pressure. It should come as no surprise, said Adams, that these diseases are more common in vulnerable communities with higher concentrations of people of color. During the pandemic, social determinants of health make people more susceptible to COVID-19 and its more severe complications, including death.
As Nashville makes strides against COVID-19 and addresses social determinants of health, so too does the nation. Adams shared that as of September 30, the United States has opened more than 1700 community-based testing sites, 65% of which were intentionally located in socially vulnerable areas; supported testing at Federally Qualified Health Centers which offer COVID-19 testing at 94% of their centers and 67% of these community health centers serve predominantly low-income areas and people of color; and completed 113 million tests. In the previous week, 97% of commercial lab tests were completed within 3 days and almost 99% of all tests were completed within five days. For the same timeframe, the national COVID-19 positivity rate was 4.4%.
“Every time you turn on the TV, you see death tolls and case counts. You see people arguing over how things have gone so wrong,” said Adams. “We need to acknowledge the missteps and learn lessons, but also help people understand that we’ve made progress and encourage them not to lose hope.”
Adams attributed the “record pace” of progress toward a vaccine, therapeutics and diagnostics to the Administration’s emphasis on public-private partnerships. This advanced timeline is “nothing less than historic” as it can take decades to develop a vaccine, Adams said, but he noted this is only the first step. Ensuring all Americans have an equitable opportunity to be vaccinated and promoting vaccine confidence are key the protecting against COVID-19.
“It would be real shame if we did all this work, spent all this taxpayer money and actually have a vaccine to stop the pandemic, but it rages on because people aren’t able to get or willing to accept the vaccine,” he said. “Vaccines work. They are the safest and most effective public health intervention we’ve had in the last 50 years in this country and they play an important role in preventing the spread of disease. But they can only protect communities when all of those who are able to receive a vaccination are willing to do so.”
Frist also addressed the topic of trust, citing a NashvilleHealth community and wellbeing survey that found when a person of color interacts with health care personnel, they report three times the sense of discrimination compared to whites. He asked Adams to identify how a community — especially health care providers and leaders — can alleviate bias and encourage trust among patients. Adams encouraged NashvilleHealth to publish the survey results in a peer reviewed journal to justify and encourage taxpayer spending on this issue and reminded the audience to pay attention to the pipeline.
“There are fewer Black men going to medical school now than there were 40 years ago,” Adams said. “We know from the published data that ultimately no matter the color of your skin, you’ll have a more satisfying health care encounter and be able to let down your guard, engage and trust if the provider comes from your community — if they think like you, look like you and talk like you. Representation matters. We shouldn’t be going backward, we should be increasing the diversity of our health care workforce.”
Frist and Adams agreed mentorship programs can play a significant role in this effort. Adams referenced a personal story to emphasize the magnitude of representation. “I had a 4.0 grade point average throughout most of my K-12 education. I never dreamed I could be a doctor because I grew up in a rural area and had never met a Black doctor. I didn’t meet a Black doctor until I went to college and met Dr. Ben Carson. It is incredibly important that we look at the pipeline and mentorship programs because even if you have the skill set, if you don’t see it, you don’t believe that you can be it.”