Last Tuesday, the Nashville Health Care Council and NashvilleHealth hosted the first of a three-part event series, “Conversations on Health Equity and Action to Eliminate Disparities,” to explore racial inequities in health care and drive discussion about solutions.
The conversation was moderated by Bill Frist, M.D., founder and chairman, NashvilleHealth. Panelists included Cara V. James, Ph.D., president and CEO, Grantmakers In Health; and Andrea D. Willis, M.D., senior vice president and chief medical officer, BlueCross BlueShield of Tennessee.
Frist offered opening perspective on the role of health care in our country at this challenging time, noting the COVID-19 pandemic and calling racial injustice in health disparity an even more “malignant disease.” He referenced statistics from the recent Nashville Health and Wellbeing survey as examples of poor health outcomes in communities of color.
Turning to speakers, Frist began the discussion by asking speakers to define the term health disparities and what they see from their purview. James shared that health disparities are preventable “differences” that limit a group’s ability to achieve optimal health care. She noted addressing disparities is important because it is estimated they resulted in more than $220 billion dollars in economic losses to the U.S. over a four-year period. Willis added that disparities are often based on groupings around disadvantages and that the data in her work not only highlights different health conditions by ethnicity, but also the relationship that different jobs have on health conditions – such as on mental health, available time to seek care, the impact of job stressors and more.
“Even with all the data we’ve accumulated, one of the most important things we’ve realized is that we can’t just solve based off the data, we really need to listen to the voices of the people we are generating the data from. It’s not enough to just ask the questions, it’s important to understand the why behind those answers,” Willis emphasized.
The group discussed income, age, education, sexual identity as part of the broad range of demographics that impact health outcomes, while noting the impact that food, transportation, housing, neighborhood, social support, and the environment also have on health.
“The majority of health outcomes we see are not related to the health care an individual receives. They’re related to the social factors, and it’s important to note that none of us occupy just one box,” said James.
Frist then turned to racial and ethnic disparities in rural communities noting the trend of hospitals moving out of rural areas and asked the speakers to weigh in on the state of health outcomes for those people. Willis noted that 15-20% of Americans reside in rural communities and that one size does not fit all.
James noted that 94% of African Americans who live in rural communities live in the south, and that rural hospital closures across America have disproportionately affected communities of color. She noted, however, when it comes to health conditions in rural areas it’s not always communities of color who are doing worse, “When we look at suicide in rural communities the rates are higher among non-Hispanic Whites compared to communities of color.”
The conversation then switched to data. Frist outlined the importance of data in understanding the timely needs of communities to develop solutions to problems, noting that the Nashville Community Health and Well-being Survey was conducted to fill a gap in available local health data.. Both speakers agreed that improvements on timely data collection and data sharing are needed to address health disparities.
James highlighted COVID-19 testing data as an example where a lack of data gathering, especially around race and ethnicity for smaller populations such as American Indians, Alaskan Natives, and Pacific Islanders, is hindering the ability to develop effective solutions when decisions are being made. She additionally noted the importance of educating people about the use of data to build trust that their input will result in programs that meet everyone’s needs.
Frist stressed the need for a public-private sector collaboration in gathering timely and thorough data, “The Nashville Health Care Council, NashvilleHealth, Metro Department of Health, companies, and corporations in the private sector also need to contribute to getting this data to be able to tease out the important action items. It’s not just the government’s job.”
The group then discussed the impact of society’s racism on public health, leading with a n example of pregnancy complications black women face in America just because of race from Willis and continuing with an example of how BlueCross BlueShield of Tennessee have begun to break down barriers in conversations about race, “It starts with leadership.”
When it comes to solutions to address health inequities around race, Frist asked about the role companies and philanthropic foundations can play in making meaningful change. James gave insight into the efforts of Grantmakers In Health, a national philanthropic support organization that works with over 240 foundations at the local, state, and national level to improve the health of all people through better philanthropy.
James added, “Philanthropy can step in where government cannot. It can provide seed money to incubate ideas which then can be implemented into broad programs. But philanthropy struggles in terms of being everywhere. There are gaps in areas where philanthropy is not, particularly in local funding.” Frist agreed expressing that as the needs of communities change, philanthropy always needs to change too.
To conclude the conversation, panelists discussed how c-suite leaders can build a culture of diversity within their workforces and offered closing thoughts on solutions to health equity. James underscored the importance of leadership in cultural diversity coming from the top and provided examples, “diversity is about who is invited to public meetings, private meetings and what companies track on their dashboards.”
James offered that “Never in my career have I see so much focus on addressing racial inequities. We are on the precipice of meaningful progress. We are in a situation where many of us don’t know what’s going to happen tomorrow, we don’t know the right answers, but we need to try something. A journey of a thousand miles begins with the first step. Take that first step.” Willis echoed the sentiment in saying, “Start somewhere. Don’t let perfect be the enemy of good. Start with asking yourself, ‘How would I like to be treated?’”
As part of the program, Hayley Hovious, president of the Nashville Health Care Council, shared the Council’s ongoing diversity, equity, and inclusion efforts, which the organization released a statement about last June following calls for racial equity across the nation. “The Nashville Health Care Council recognizes that health care is plagued by systemic racism, as much, if not more than, other systems and yet health care is meant to do no harm. We are committed to working toward a better tomorrow by taking these first steps to better understand the challenges we face,” said Hovious.
Caroline Young, executive director of NashvilleHealth, addressed the audience as well, “NashvilleHealth was founded, with the help of many of you, to tackle our city’s most challenging health issues in a collaborative fashion. From our very beginning we have worked to understand and address health disparities in our city. We hope that today’s conversation will inform and guide our efforts to improve health and wellbeing in our organizations, our businesses, our city, our state and across this country,” said Young.
MUFG Union Bank sponsored the event.
The Nashville Health Care Council and NashvilleHealth will continue the “Conversations on Health Equity and Action to Eliminate Disparities” series on September 30 with U.S. Surgeon General Jerome Adams, M.D. Watch for more information on this and upcoming programs at healthcarecouncil.com.
“Caste: The Origin of Our Discontents” by Isabel Wilkerson
“The Immortal Life of Henrietta Lacks” by Rebecca Skloot
“Unequal Treatment” by the Institute of Medicine
NashvilleHealth is dedicated to making Nashville-Davidson County one of the healthiest places to live in the state and the nation by achieving measurable gains in the health of all residents. Our goal is to create a culture of health and wellbeing by serving as a convener to open dialogue, aligning resources, and building smart strategic partnerships to move the needle on health outcomes and close the gap in health disparities. To achieve this, we work to collaboratively identify major population health challenges, propose transformative solutions, and facilitate and ensure execution to improve overall health.