Episode 2: The Case for Addressing Health Equity

Dr. Lisa Gary: I looked at what happens when you have problematic healthcare experiences. Do you voice your dissatisfaction or do you just exit the system and never come back?

MILLICENT: Thank you for joining us here, at Vital Voices, a podcast from Corning Incorporated, where we explore innovative ways companies can be a force for good. I'm Millicent Ruffin.

SISSY: And I'm Sissy Siero. In this episode, we’ll be discussing health inequities, a personal loss from one of those inequities, and medical mistrust in healthcare.

In our last episode, we heard from Angela Anderson who shared a personal story of a time she received troubling care during a health crisis and that’s putting it mildly.

MILLICENT: We did. Angela shared quite a bit about the frustrations and the risks she experienced in her symptoms not being taken seriously and just how persistently she had to self-advocate even to get something as simple as an x-ray taken, and then to have the insult of a medical professional accuse her of presenting in order to receive painkillers.

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SISSY: Yeah. It, it's just so surprising to hear that happening to her. And, one of the things I remember she said, it's like, and there she is, someone who's, you know, an educated person with a doctor, her husband with her, well able to take care of herself and they get medical healthcare. But what about people, you know, who would be more timid or, you know, intimidated or believe the doctors and they would've gone home and died.

MILLICENT: Right, right.

SISSY: She suffered through, you know, so much neglect and bias throughout this one health emergency. And her story inspired us to reach out to an expert positioned in public health, you know, in order to learn more about current issues in the health equity space.

Dr. Lisa Gary: I am Lisa Gary. I am an associate professor in the Department of Natural Sciences at Stillman College. And I also am the founder of a boutique consulting firm where we look at the role of data to analyze and understand different types of social issues and problems.

MILLICENT: Dr. Gary’s journey to public health is quite interesting. She always had an interest in numbers and after being an undergrad math major at Spellman College, she decided to try for a PhD…

Dr. Lisa Gary: And once I got there I realized like, this is just too abstract. I think I wanna do something more with more real world implications.

MILLICENT: And that's what brought her into the field of public health.

Dr. Lisa Gary: The thing about public health that's so interesting is like you're thinking about health at the population level. It's not just kind of looking at, just an individual level. How could the work that I do help large numbers of people and still kind of tap into my interest in math. So I chose epidemiology.

MILLICENT: I think epidemiology is such a cool field of study because it analyzes patterns of health and disease in well-defined populations like neighborhoods or schools or cities or states. And then uses that information to shape policy decisions because epidemiologists are able to identify risk factors for disease and targets for preventative healthcare. The real goal of an epidemiologist is to figure out what causes different outcomes in different groups of people. So in her work, Dr. Gary always finds herself drawn to the same questions.

Dr. Lisa Gary: The first thing that I'm always interested in, which is definitely a function of being an epidemiologist, is what is the root cause? We're always trying to understand, what's the evidence there that leads us in one direction to tell us what are the predictors or the risk factors for this particular situation happening. I'm always interested in kind of the pathway. How do we get here and where are the opportunities to intervene on the pathway to make things different for a large number of people - looking at how we can use epidemiology as as a data analytic tool for understanding healthcare disparities and healthcare issues.

MILLICENT: With that focus in mind, we wanted to know how Dr. Gary defines health disparities.

Dr. Lisa Gary: Health disparities basically just means there are differences in health outcomes and in health care. So there may be factors beyond the patient's control that impact their ability to get high quality healthcare and to have good health outcomes.

MILLICENT: So with that definition of health disparities, we were really interested in Dr. Gary's perspective on health equity and what health equity looks like in our daily lives.

Dr. Lisa Gary: Health equity is basically where we have created a situation in society where everyone has the opportunity to reach their optimal health and experience a healthy life. The opportunity to, doesn't mean it's guaranteed, right, but the opportunity to have a healthy life regardless of their station in life, regardless of whether or not you're a woman or a man, or you're high income or low income, or you're someone, with some type of disability or not, that there's a system in place that will help create opportunities for you to reach optimal health.

We know optimal health is very important for having optimal wellbeing, to be able to be a productive citizen in society and have good economic outcomes, if at all possible, have good educational outcomes. Cuz it's, it's kind of hard to do all of those things if you're not healthy.

MILLICENT: It's clear from an ethical standpoint why health equity is important, but it also makes sense financially.

Dr. Lisa Gary: The economic impact of failing to achieve health equity in the United States is estimated at 1.03 trillion dollars. So you think about the more excess death and excess sickness that's more people missing work, less productivity, higher healthcare costs, cause people are having to use healthcare more. So there's economic impacts there as well, which could be costly for employers and for, for families.

SISSY: For me, health equity is, of course, a no brainer. So it's hard to hear a case made for health equity that's rooted in it being a better financial choice. Though, I have to say, I’m glad there is evidence supporting this.

MILLICENT: I, I agree, right? Health equity resonates, like, with our core values. But you know, there's also a reason Dr. Gary made a point to share the economics because it may help a lot of people see the value in it, even though you and I know the value intrinsically.

SISSY: Mmmm. Right, right.

MILLICENT: And so up till now, we've discussed how health equity is important from a humanitarian and economic point of view, but we were also curious about how it affects our communities on a smaller scale.

So we decided to ask Dr. Gary what she knows about disparities in communities like Western New York, a lot of which are rural.

Dr. Lisa Gary: A big issue just when you look at geography based disparities between urban and rural is access to care. Having providers that won't accept Medicaid could definitely impact their, their access to care. And unfortunately in the last 25 years there's been a huge number of closings of community hospitals.

MILLICENT: In addition to the lack of medicaid providers and recent hospital closures, Dr. Gary also mentioned dental care.

There's huge disparities around dental care access and people going and getting their yearly dental exams and how that can lead to tooth loss that could trigger, like, an increased risk for other types of health outcomes.

MILLICENT: We'll hear more about access to dental care in Western New York specifically, in our next episode.

SISSY: Right. But first, we wanted to share a personal story from my colleague, Daniel Alexander about his father, Larry. Daniel heard that we would be covering the importance of dental health this season and was kind enough to contribute to our mission of spreading awareness. We asked Daniel if he would be comfortable talking about his father for this podcast.

Daniel: So I thought about it and first I went to my mother. She is a healthcare professional herself. She was very, uh, gung-ho about it. From there I went and talked to my siblings and said, “Hey, you know, I have this opportunity to tell people about dad's healthcare journey - would it be okay to tell?” And it was a pretty short order that all of my siblings came back and said, “Yes. Uh, please, please tell that story and, it would be an honor to, to share his story if it could help someone”.

Larry was a storyteller. In fact, I really wish he could be here to tell a story. He would, uh, do such a, a much better job than I would. He had this uncanny memory. So he could tell you what he was doing on any particular day of a month in a year. So you could give him a date and he could tell you where he was and who he had talked to. He loved all kinds of people. All walks of life. He was exuberant. He was a vibrant personality and he was larger than life - six foot seven, you know, a much deeper booming voice than the voice you hear right now. He was, you know, very active, very fit. So that's not something that we would expect even though he was in his sixties, we were surprised to get this call.

He said, you know, “Oh, I've been dehydrated, you know, and so I just was not feeling well and, and ended up, you know, having to come to the hospital”. And so, you know, among the things that they had tested him for when he came into the hospital, they also discovered that he had ongoing, open periodontal issues. And it turned out that bacteria had moved to his heart and it was affecting his heart valve.

And so his tiredness was because his heart wasn't being as efficient as it could because of bacterial infection. So what turned out to initially be treatment for dehydration was a whole regimen of antibiotics that they had to treat the bacterial infection in his heart.

SISSY: So oral bacteria caused periodontal issues, which led to heart problems.

MILLICENT: Let's take a minute and talk about periodontal disease. We frequently just call it gum disease. And it is really all about unhealthy, swollen gums. It’s most commonly caused by plaque - something we’re all familiar with.

SISSY: So once Daniel’s family figured out what was happening, the next step was to find their father a dentist.

Daniel: One of the things that my mother wanted me to mention as a practicing nurse who has spent a lot of time in hospitals - it is not often the hospital's policy to bring in a dental specialist or a dentist. And there's not usually one on staff, so just like, you know, you would have a specialist, they have to call out for a dentist and there's not a lot of dentists that practice in hospitals. I think we had to wait a couple of days to get that referral and to schedule a dentist to come in that could assess his oral health and then also, sign off on the antibiotics that would treat both the oral infection as well as the heart infection.

SISSY: You know, waiting for days for a diagnosis and care and he is sitting in a hospital with a possible life-threatening bacteria attacking his heart. That just seems, you know, beyond belief to me. I mean, they had to wait, you know, how many days to just get the right antibiotics. So his father's just sitting in there waiting for a dentist to come. You know, and as I was listening to Daniel and thinking about that they are in Tulsa. You know, why can't they just get a dentist to come sooner?

That's an emergency. If somebody's in there and they're having, you know, a bacteria has gotten into their heart, that's not something that people have never heard of before.

MILLICENT: You know, it's, it's devastating. I agree Sissy, but I'm not that surprised by it. In our rural communities where people don't have access to dental healthcare. What we've learned is that people hold off until they absolutely have to go somewhere, and that somewhere is the emergency room. And then at that point it is a serious health problem and it really expands beyond a dental issue.

SISSY: Right. Right. Sadly, even years later, Daniel told us that Larry continued to experience health complications that were triggered by periodontal disease.

Daniel: So fast forward three years. And again, my dad was living alone, not necessarily taking the best care of himself. I received a phone call from my sibling. And they weren't sure what had happened, but, my dad was having a hard time speaking. He was having challenges with just motor control and we found out later that he had had a series of what they considered “small” strokes. Over a course of weeks, there was a lot of ups and downs. During this time when they were trying to treat him for the stroke, again they found that he had an oral infection. And the oral infection had looked like there was also a bacterial infection in his heart.

And so there was a lot of care that he received. Physical therapy, you know, neurological assessments, cardiovascular assessment, but whenever there was a setback and that the situations became acute, a lot of times the care he could receive was impacted by whether or not he had the oral care and whether there was an ongoing bacterial infection in his mouth.

But ultimately those delays for him getting treatment for the heart condition, I think, impacted the care that he received around this neurological series of events. And ultimately my dad succumbed.

SISSY: And as many of us do, in the aftermath, Daniel remembers asking himself questions like "why", "how did that happen", and "what now"?

Daniel: It's one of those stories about access to insurance. He was on a combination of veterans benefits and Medicaid. So he had his VA benefits, and he also had Medicaid. And so when you are getting medical help from the VA, you know, you have to schedule and work with them. And he had a good relationship with his VA doctor but I don't know what his VA dental care was like. And I think sometimes it can be as simple as you don't want to go to the dentist. But you know, outside of, you know, having a relationship with someone, you know, do you just go on a waiting list? And then if you get on a waiting list, is it a place where you feel comfortable? So for all of those compounding reasons, I think that it was a challenge for him.

I know for myself and my family, It was news to us that oral health could have an indirect impact on heart health, that it could have an impact on cardiovascular health. I think making that known that, hey, it's important to take care of your teeth and your gums because it's important to stay healthy in general, but it's also a direct link and can lead to challenges with heart and heart valves. I think more people should know that.

SISSY: I was so grateful to Daniel for sharing his father's story. You know, while I've heard about gum disease affecting our overall health, I hadn't known anyone who was personally affected in such a devastating way.

MILLICENT: For me as well, Sissy, and you know, really what Daniel shared, touched on so many important things for me, like the importance of advocating for people with Medicaid and other government funded health insurance, but also the idea that we have to find places we feel comfortable in, in order to advocate for ourselves. And then lastly, the impact that healthcare disparities might have on people's trust of their providers.

SISSY: That is, that's so many great points and, you know, Dr. Lisa Gary studies and teaches about topics like these, it is especially important to her because she has a personal connection to a historical injustice in the field of medicine.

Dr. Lisa Gary: My dad had told me about the Tuskegee study and that we had actually had a family member that was in the Tuskegee study. And I called my dad and I was like, yeah, we were talking about the Tuskegee study. And he was like, yeah, well, you know, uncle Clay was in that study.

SISSY: The Tuskegee study was funded by the federal government, by the public health service, to look at untreated syphilis in Black men.

They basically looked at the progression of syphilis in men in this rural area in Tuskegee and even after medicine became available that could have treated them and healed them, they weren't given it because they wanted to see the natural progression of the disease.

And so people, you know, lost their fertility. They, you know, had all types of health consequences as a result of having really bad syphilis.

They kind of recruited men to be in the study and had them believing that they were really contributing to society. It was a big government project. They got stipends to participate, all of those things. He actually got a certificate. It was something that the men at the time were very proud of, not knowing that they were being exploited.

I had been exposed to that concept early on. And I always talk about that study and try to humanize it too for my students.

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Like that was my great-grandmother's brother, so that's just how many generations away from me someone was in the study.

SISSY: I'm speechless again. You know. I can't believe, first of all, I can't believe I was never taught about this, um, which now I, I understand is not that surprising. I, I just, I don't even, I don't even know what to say about that.

MILLICENT: I think this, this hits me a little differently, Sissy, because my parents, both my parents attended Tuskegee University and, you know, growing up in the South were very familiar with the Tuskegee experiment. And it's, you know, one of the, the reasons that there's such a deep rooted distrust of the medical profession within the Black community. And this was one of the things that was highlighted during, during COVID and cited as, you know, one of the reasons that Black Americans were hesitant to take up the vaccine.

And so, you know, I share your disgust. It's just not as new to me.

SISSY: Of course not.

MILLICENT: It is an old friend, unfortunately.

SISSY: I, I'm, I'm really embarrassed to admit that I didn't know what that was. I mean, that to me is equally shocking. You know, I, I mean, this is a history of Americans.

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MILLICENT: And you know, we wondered how Dr. Gary's family connection to this historical moment of medical travesty impacts her personally and the work that she does today.

Dr. Lisa Gary: I had a family member that was in a study that is talked about every day. So to me that just feels uniquely American - that we could be a country where there are all these opportunities where I could go and advance and be working in this field, but still be very humbled by the fact that I'm connected to a public health atrocity.

I think that was another piece about being a part of research and why I still do research to this day, is wanting to change the narrative around the importance of research and certainly research in minority communities - where we're at the table and playing a role in answering questions and asking the questions, and not just the people being studied or exploited.

MILLICENT: In her research, one of the questions she posed was inspired by a problem she saw in past health disparity research.

Dr. Lisa Gary: One of the things that always bothered me when you kind of would read research studies about health disparities everything was always positioned, in this very pathological way of talking about Black people and people of color. Like, if they have all of this disease, it's their fault, or it was something that the patient did.

So I was really interested in wanting to understand racial and ethnic disparities and how people voice their dissatisfaction in the healthcare system. And so I looked at what happens when you have problematic healthcare experiences. Do you voice your dissatisfaction or do you just exit the system and never come back?

And so I was really curious to understand, well, what is it really like for people when they are trying to access healthcare? What I found in my particular study is that when people were having problematic experiences in their healthcare instead of engaging in the system, right? Many times, the Black patients would leave or exit.

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So if you're feeling welcome in a healthcare system, feeling respected in a healthcare system, then you're going to have better healthcare interactions. It can impact your quality of care.

I think this issue of medical mistrust and distrust rather of the healthcare system continues to be a major issue in health disparities.

MILLICENT: So, you know, she's looking at this along racial and ethnic lines and there's a theme or a trend of Black Americans exiting the system as opposed to fighting for their rights to healthcare. And, you know, it's, it's heartbreaking. But if you try to do something to solve the problem and it becomes one more avenue that you have to fight, then I can see how exiting is the easier path.

When you're sick, when you're tired, when you are at a loss, and the thing that's frustrating for me is the healthcare system is here to serve. It is here to serve this exact population. The people that are too sick to help themselves are now having to fight for the service they deserve.

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SISSY: It's just, it's so backwards. The whole thing is so backward. You know, I, I totally understand why people hold off from getting the care they need.

You know and Daniel, in trying to understand his dad's own experience, shared with us a time when the care he personally received at the dentist made him feel very unwelcome.

Daniel: I went on Cobra and I had already had a dental cleaning scheduled. Well, while I was in the office, one of the billing managers came out and I'm in the waiting room and she starts talking to me about, “Hey, is everything okay with your insurance? We're having this problem, we're trying to, you know, run your insurance”. And, and I'm like, I'm in the waiting room with other patients. And I'm thinking, is it just me? You know, is this what they normally do? I'm trying not to be aware of how odd I felt in that moment, but I definitely was aware of being a minority in an area that, you know, this is where I live, but I was aware that I felt, singled out in a way. But just - it, it, it made me feel “other”. And I just thought, you know, how often does this happen where, you know, there's - going to the dentist is hard enough, right? It's everyone, almost to a person has trepidation or anxiety about going to the dentist, but then having this experience with the billing manager, you know, complicated that and made me feel like, well, do I even want to come back here?

SISSY: This started Daniel on a journey to find a dental office where he might feel more comfortable.

Daniel: So, as I was thinking about that and planning to schedule my next cleaning, I just did some research. I live in an area that has over a million people in, in our metro area - Tulsa, Oklahoma. There are no African-American dentists practicing in this county. There's no African-American dentist practicing in the three or four surrounding counties around Tulsa County. There's one Black dentist in Oklahoma City, a 90 minute drive away. And, I just wonder, you know, I don't know, how often that happens in the country. So, you asked me, you know, were there other things that may have impacted my dad? If you are in an environment where you don't feel completely comfortable, sometimes those other things can, may even, maybe stress that situation even more.

SISSY: For Daniel, when it comes to health equity - it all starts with representation.

Daniel: There needs to be more minority dentists. There needs to be more minority oral hygienists, you know? I think that having more minorities go into Dental healthcare, oral healthcare, dental hygienics, that's important.

And as it turns out, a Black internist made the difference for his dad.

Daniel: The internist that saw my dad that took care of him, he was the doctor that was killed during the shooting in the Tulsa, Oklahoma area, that shooting at Warren Clinic.

Dr. Preston Phillips was tragically killed in a mass shooting at a Tulsa, Oklahoma hospital in 2022.

Before that, when Daniel’s father was in the hospital for the first time, Dr. Phillips examined him.

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He was a referral, so that doctor wasn't one of the primary physicians working on my dad's case. But my brother being a lawyer is very insistent. And so he was looking for someone to say, “Hey, I want you to take a look at my, my dad's case” and when we had that doctor come in, he was able to actually give us, uh, a more specific course of care that that really helped my dad and helped kind of point us in the right direction. So, I'm thankful to him and the care he provided.

MILLICENT: You know, listening to Daniel's story and thinking back through experiences that I've had and that my, my family has even had with medical care.

I'm actually reminded of words from a student that we talked to in season one of Vital Voices, where we were exploring the importance of diversity and inclusion in education.

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So we were talking to Josh Webb, one of Corning's Edge for Tomorrow Teacher Scholars about the lack of diversity in teachers that he's had.

Sissy: Right.

MILLICENT: As he was going through his K-12 education. And so Josh is in college now. But what he shared was he felt like if he had had more teachers of color when he was in elementary, middle and high school, he felt like they would've been pillars for him because they would've had similar experiences and similar struggles.

And I think that's exactly the thing that Daniel's expressing and that Daniel’s experienced and his father experienced in finding a Black provider or provider of color. And it's not that they're trained any differently. It's those similar sets of lived experiences that enables you to relate to your patients in a different way.

And there's no other way to explain it, except that. And it's, it's true in the classroom. It's true in, in doctor's offices. Right? But that's, that's the best way I know to describe it, is that the quality of care that I receive, the way that I'm talked to, the way that I'm listened to, the way that I'm responded to, reacted to, is because the provider is either, aware of, sensitive to, has experienced the same things that I have experienced. And empathizes with it.

SISSY: And while it's wonderful to know that there's work and research being done by people like Dr. Gary to figure out patterns and causes of disparities within our healthcare systems, these issues are still very prevalent in our country today.

We've already heard some of these stories this season so far, but we'd also like to highlight some work being done to combat these disparities.

MILLICENT: Right. Like in our next episode where we'll talk about upcoming plans for a mobile dental van that'll serve Western New York. We're partnering with Mosaic Health for the project, and they have a holistic approach when it comes to dentistry.

Melissa Copella: It's not just, I'm only here to look at your teeth and that's it. I'm here to look at you as a whole person and care about you as a person and see what I can do to improve your overall health.

SISSY: Thanks for listening. You can find and listen to episodes of Vital Voices wherever you get your podcasts. For more information about the Office of Racial Equality and Social Unity and how its programs are impacting the community, click on the links in the show notes.