Our world is at a watershed moment. Fractures in the public health system that have been present for decades have recently become apparent to us with the impact of the COVID-19 pandemic. We have seen public health statistics associated with fear of vaccination, health disparities, and racial inequities. What’s been revealed to a broad audience ranging from people and families trying to stay healthy to business and government leaders is that our health system extends into every aspect of our lives in ways that we never considered before — and that we can no longer delay the fixes that it requires us to make.

Clinical leader, cardiologist, voice for public health and chief medical officer at the well-known global consulting and advisory firm EY — Yele Aluko, MD, MBA — shares thoughts on these pressing health urgencies in this exclusive Q&A with Medika Life contributing author Gil Bashe.

Gil Bashe: Dr. Aluko, you’ve been in clinical practice as a leader in cardiology for many years and you have served as a leader in several important health industry organizations, including the American Red Cross, American Heart Association, American College of Cardiology and Association of Black Cardiologists, and we are both members of the International WELL Building Institute. One key question: What led you to make the transition from clinical practice to industry and join EY as chief medical officer?

Yele Aluko, MD: I left the patient’s bedside with the deliberate intent to develop a broader platform and louder megaphone for messaging on the imperatives for the health industry to re-engineer its business models in a manner that places patients at the center of its focus. I don’t make this assertion lightly. It is time for the health industry to be able to define and deliver high quality outcomes, be held accountable for those outcomes, understand the cost of care to deliver those outcomes, eliminate unnecessary care variation and by so doing, deliver the best outcomes at the best cost across the value chain consistently and reliably. By so doing we shall be successful in delivering value-based care to all.

Bashe: The whole experience of COVID-19 has brought to light some of the greatest struggles we’re dealing with in public health, particularly with health inequities. You’re the coauthor of an article that lays out three pillars with which people have to engage: testing, vaccination and education. That’s broad territory. Why did you decide to choose those three pillars?

Aluko: The intent really was to sensitize the reader to understand that COVID-19 is likely here to stay at some level (even when the pandemic is over), and to do this with three very targeted messages. The first is the awareness of the need to be able to diagnose COVID-19 not just efficiently, but more cost-effectively through testing going forward. Second, the importance to continue to educate people about the merits of vaccination, about its science and its safety. The third is to emphasize the imperative of vaccinating as many people as possible, with the goal to achieve herd immunity to prevent widespread transmission. That’s the rationale behind those three pillars.

Bashe: Three very necessary pillars, and yet, we are dealing with a sudden slowdown in the rate of vaccination. When the first two mRNA vaccines became available people rushed to get an appointment as if we were giving away free movie tickets. What are the challenges that we need to define right now and what might we do about them?

Aluko: We do know that there is a percentage of people that aren’t sure about the vaccine, about safety, about the science. Those are the people now that need to be further educated about the merits of vaccination. This is likely to require more nuanced, targeted and customized communication strategies to provide credible information about the safety and the science of the vaccine, so that people can then make informed decisions.

There’s also the logistics issue around vaccination, where certain rural communities are harder to penetrate with infrastructure and where the lack of needed logistics have also compounded the delay in getting more people vaccinated. Then there’s the historical issue of vaccine hesitancy within vulnerable populations; even though this is an established and age-old problem, public health systems and the health industry itself have not invested resources to truly understand the complexity of the vaccine hesitancy problem, let alone develop strategies to solve for it, and as such it still remains poorly understood and minimally impacted.

Employers must realize they’re in the health business

Bashe: Two questions about the role business leaders can play in health. What role do employers have in encouraging their employees to get vaccinated? Wouldn’t it be a better investment for employers, instead of paying out for sick care, to get into the well care initiative? To start to work with their employees to reduce their weight, to monitor their cardiovascular health, to exercise and build muscle mass as a way of preventing the need for hip replacement or knee replacement?

Aluko: Employers need to be aligned on the imperative and the role they can play around the test-vaccinate-educate pillars. They can facilitate testing and vaccinating, as well as provide education so that people make informed decisions. While there’s a whole lot of swirling conversation around the pros and cons of mandating or not mandating vaccines and all that, fundamentally employers can facilitate the processes of engaging the people within the context of those three pillars.

This pandemic has paralyzed several businesses and has adversely impacted most. All companies as such are now realizing that they are indirectly in the business of healthcare, and to develop workforce resiliency, businesses need to do a better job around understanding the health risks and vulnerabilities within their workforce and develop proactive resiliency processes.

Most large businesses now have employee assistance networks to provide support resources, but questions are now arising: What percentage of people are actually using these resources? How do we track that and should we? And if then we find that 25% or 30% of people have never had a physical examination in the past five years, what should we do?

There’s now a shifting conversation about what is the responsibility of a business in understanding the vulnerability of the workforce and incentivizing their employees to be more proactive about engaging in healthy lifestyles and diminishing their risk for disease.

Bashe: For leaders in executive positions at a global enterprise who need to have informed choice and to share wise counsel with their organizations, would you mind sharing some of the authoritative voices that are important to you?

Aluko: I would hesitate to do that without informing them ahead of time, but let me just say that we draw from our internal competencies as a leading global health consulting firm, but we also have access to global insights and best-in-class practices depending on what questions or problems are posed. When needed we leverage our access to health industry and public health leaders. We tap into an entire national network and, when necessary, a global network of health industry intelligence. We seek information, evaluate it, distill it and apply it with a reference source as needed. I don’t have a static portfolio of specific people; what I do have is the ability to customize insight that is relevant to problems that are important to us and to our clients done in a manner that we can provide actionable solutions.

Variants of interest, concern and high consequence

Bashe: There’s a lot of conversation about COVID-19 variants right now. What are your thoughts on the variants and vaccines? Do you feel that we have a good safety net at this point? From your perspective, do the current vaccines work against emerging variants?

Aluko: The CDC follows variants’ activity very closely. Variants are generally considered in three categories as defined by the CDC: the first is a variant of interest, where the viral structure has changed through mutations but infectiveness of the virus or its response to available antiviral treatment has not changed in a meaningful manner. The second is a variant of concern, where the mutated virus is identified to be less responsive to standard anti-virus treatments or other types of interventions, but in addition this variant may be more transmissible from one person to another. The third and the most worrying category is the variant of high consequence, when the mutated virus variant is now seen to be more infectious, may be more deadly, and may not be responsive to vaccines.

The current evidence suggests our vaccines do work well against variants of interest and variants of concern. Thus far, using genetic sequencing of the viruses, no variants of high consequence are being identified in the United States. This is important to know because it does have impact on the need for potential booster shots going forward. If we do present with a circumstance where the virus mutations are so overwhelming that it’s a new virus over time intervals — such as one year, 18 months, or two years — then a different architecture of vaccines will need to be reengineered within those determined intervals.

Differences between health disparities and health equity

Bashe: Switching to questions that we’ve talked about before: health disparities and health equity, and if there’s a difference between the two. Could you define the difference, but also why it’s important that we differentiate?

Aluko: This is a very important question because it should not be presumed that audiences understand what health equity is, and indeed we shouldn’t presume that our audience at large is aware about the impact of health disparities.

Health disparities speak to different outcomes from a medical condition that different groups of people experience. We saw that in COVID-19, more Latinx and African Americans died from COVID-19. This is an example of disparity in outcomes (death) in different populations (black and brown people) with the same disease (COVID-19).

It’s important to understand that there is a myth that health disparities as just described are driven by genetic differences in black and brown people. Indeed, these disparities are, more often than not, not genetic. More commonly they’re driven by what we refer to as the social determinants of health: where people live, the type of work they have access to, what community, societal and environmental exposure they experience that impacts their financial or health literacy, or exposes them more to disease risk and vulnerability, etc.

Health equity is an aspirational yet achievable goal, where we are able to eliminate health disparities so that each person — irrespective of their background, socio-economic status, gender, race, station in life — has an equal opportunity to achieve their best health outcomes in their lifetime. Achieving health equity requires eliminating health disparities.

Bashe: What’s your level of optimism around health equity in the United States?

Aluko: My optimism, on a scale of one to 10 is about a 7.5. But that’s a good place to start. The needle moving towards health equity is predicated on society being willing to dismantle the systemic drivers and resultant behavioral issues that have led to the current structures we have that perpetuate health disparities and keep us far away from achieving health equity.

The current conversation going on nationally about societal justice, about health equity, drives a moral imperative. This conversation is going on across health systems, big business, government, and in philanthropic organizations. Everybody’s talking about how we need to fix this wrong, so the time is now. We have a convergence of goodwill that drives my optimism. But we must seize the moment and translate it into actionable solutions.

Bashe: One last question: In addition to test, vaccinate and educate, what other things would you state to America that we need to start on right now to achieve health equity?

Aluko: I will speak to three action items that address your question. The first would be for business, community and political leaders to acknowledge the health disparities problem to be real, and that ignoring it (as has been done) has consequences for all of us. This problem has existed for centuries: it is serious, and it is dangerous, it is impacting the health of our society. Recognize the problem, understand it and empathize around it, and commit to being a part of solutioning for it — that’s number one.

Secondly, what needs to happen is that all businesses, not just those in the health industry, need to develop strategies to address this. We spoke about moral imperative: businesses now have an imperative in seeing, having a lens and a better understanding into the resiliency of their workforce. All businesses should consider developing health equity strategies and this needs to be driven from the C-suite.

The third would be to hold society at large — government, advocacy, corporate and philanthropic organizations — and of course the health industry itself that dispenses healthcare, accountable for the execution of strategies developed and programs implemented to reduce and ultimately eliminate health disparities.

People must be held accountable, and by doing so on these three imperatives, we will move the needle over time towards health equity. I am optimistic that if we have these three imperatives in place, we will be successful over time.

Bashe: I think that you have mapped out a strategic roadmap for corporate America to not only get past the pandemic, but the waves of public health pandemics that we’re facing: the pandemic of obesity, the pandemic of heart disease, the pandemic of noncommunicable diseases, the pandemic of health inequities. I think you’ve given us a grand plan, much like when the President goes before Congress and gives the State of the Union address.

Dr. Aluko, thank you for your words and direction and inspiration.

The post Time for Health Industry to Deliver Value-Based Equitable Care appeared first on Medika Life.

We treat the patient in front of us. No matter who they are.

The Arkansas legislature decided to toss this principle tenet of healthcare out the window. 

Doctors and nurses in Arkansas can now refuse to treat patients based on moral or religious objections. Arkansas Governor Asa Hutchinson signed, The Medical Ethics and Diversity Act, SB 289, into law on March 26th.

The law states its purpose is “to protect all medical practitioners, healthcare institutions, and healthcare payers from discrimination, punishment, or retaliation as a result of any instance of conscientious medical objection.”

Health providers’ moral objections are the focus of the new Arkansas law, but the law does not protect patients from discriminatory practices from a healthcare provider. Instead, Governor Asa Hutchinson relies on federal law “that prohibits discrimination on the basis of race, sex, gender, and national origin.”

The Arkansas Medical Ethics and Diversity Act, SB 289, does not include language protecting against discrimination based on sexual orientation or gender identity. 

Most media reports have framed the law as blatantly anti-LGBTQ legislation. The Human Rights Campaign fought against the bill because it allows doctors to refuse care for transgender and LGBTQ patients. Arkansas health providers can now legally refuse services to anyone based on a moral objection as long as it is not an emergency or violate federal EMTALA guidelines.

But the wording of the law goes way beyond issues of sexuality and gender. The law permits any healthcare provider to deny any medical services based on religious or moral objections.

ACLU of Arkansas Executive Director Holly Dickson pointed out the risks stating, “making it easier to deny people health care isn’t just wrong, it’s dangerous.” 

The Arkansas law fails to acknowledge one of the most challenging aspects of medical care. Doctors, nurses, and other healthcare providers work hard to avoid value judgments when providing care. We work to see all patients as worthy and try to avoid bias. 

Medical care is about placing value on each person’s life. Although challenging, health providers try to avoid considering patient culpability when treating people. Our personal feelings must be checked at the door. We treat the person in front of us. 

Pulmonologists do not refuse to treat or blame a chain smoker for getting lung cancer. Trauma surgeons treat drunk driving victims and the perpetrators equally. We do not refuse care to gang members who get shot or deny Covid-19 treatments to those who refuse to wear a mask. 

In Obstetrics and Gynecology, we provide care to pregnant women who use illegal drugs and prescribe PrEP therapy to those with multiple unprotected sexual partners. We don’t insert personal bias or value judgments into patient care. We try very hard to do exactly the opposite.

Our job is to counsel patients on the risks of their life choices. We do not deny care to those who live their lives in ways differently than we do even if we find certain choices morally offensive. 

Patient care is about the patient. Not the provider.

Multiple medical organizations are speaking out. So far, the Arkansas law is opposed by the American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association, the American Medical Association, the National Association of Social Workers, the University of Arkansas for Medical Sciences, and the American College of Emergency Physicians. Other organizations are likely to oppose the law as well. 

This statement by the Arkansas Chapter of the National Association of Social Workers summarizes the general consensus saying, “no patient should ever be obstructed from receiving legal healthcare based solely on a provider’s personal values.”

Arkansas legislators and Governor Hutchinson must know this law will be challenged in court. Let’s hope the court remembers when it comes to patient care, the patient always comes first. 

The post The Anti-LGBTQ Arkansas Health Law is Dangerous for All of Us appeared first on Medika Life.

Covid-19 has, in many ways, provided really useful insights into the underlying mechanics of the American healthcare system. Not only has it exposed glaring systemic inadequacies, but it has also highlighted the strength and character of the second most important tier of healthcare, the people that provide the care. They never wavered.

The first group on that healthcare tier, in any system that seeks to ensure equitable public health, is the patient. Healthcare exists to care for, treat, and to heal the patients it serves. That is, or should be, the mantra of every individual caregiver who signs up at the door of healthcare. 

Yet, for various reasons, quality-of-care disparities based on race, gender and ethnic classifications still exist within American healthcare. Covid-19 has highlighted these in ways the industry can no longer ignore. Race-based health outcomes have gone public.

The simple process of vaccine distribution, for example, has been an object lesson in the power of external forces, outside the sphere of healthcare, to dictate the quality of care certain patient groups experience. 

Harsh fact. If you’re poor, Black, Asian, Hispanic, or a member of any other minority group in modern day America, expect inferior care and poorer health outcomes. We know this to be fact. Covid data has removed any wiggle room from the argument. 

The American healthcare system is biased in favor of middle class and wealthy white patients. 

Feels uncomfortable reading that, doesn’t it? Fact though. You can’t argue with figures, only interpret them with the intent of obfuscating the truth or seeking it. 

The only question that now remains to be addressed is this. 

Is healthcare itself to blame for the bias or does the bias stem from healthcare’s dependency on external agents? Governments, politicians, agencies, and other parties linked to healthcare. In the end, the question itself is moot. Healthcare has to be accountable for what happens in healthcare. 

Only when the industry is able to assume responsibility for its failure to provide equitable care, will it be able to effectively coalesce toward solution-driven action. Allocating blame to third parties is tantamount to the indefensible ‘he made me do it’ plea. It is “our house” and we are honor-bound to ensure the safety of all who enter it.

Amplifying the ills that ail us

It’s a Rosa Parks moment for healthcare and WE, the privileged, need to stand and offer our seats. Those petitioning for change within the industry, crying out for equitable and accessible care, an end to gender bias, and seeking to bring balance to the industry, need to be heard. It is our responsibility to ensure they are. That their concerns and the demographic they speak for be placed front and center where we can shine a spotlight on the decades of shame we have enabled through our silence.

We cannot, in good conscience, move forward with an industry that is not fit for purpose. It detracts from the good we achieve and history will judge us accordingly. How can progress truly be described as progress, when we continue to contradict the very premise that led to the creation of the profession. First, do no harm. 

I know what I intend to do. I know what Medika intends to do. We have assumed our responsibility, along with the rising crescendo of voices seeking equity for the people they care for. No more. 

The world will not change to accommodate the lofty goals of healthcare. Healthcare needs to change the world. Together, one united voice and the walls of Jericho will tumble. Only, and only if, we call out in unison.

Let’s look back in pride, ten or twenty years from now, knowing that we’ve taken ownership of our profession, assumed responsibility, and empowered change. It is so simple and yet so hard. Will you join us?

The post Color Based Care Still Taints American Healthcare appeared first on Medika Life.

Just imagine if we could cure everything. We could all pack our bags and go home.

You assume you have a right to be healthy, or at the very least, expect health as a prerequisite for a good life. We are all born with this assumption programmed into us and if you don’t believe me, ask yourself this question. When you are sick or unhealthy, what tends to be the first thought that crosses your mind? Why me? It is as though the gods of ill intent have personally singled you out for a dose of pain and misery.

We use the term ‘health’ freely to describe, well, pretty much anything related to our ‘health’, but what do we actually understand of the word, in terms of definition. What does your ‘right to health’ actually entitle you to? Does it relate just to your physical state and being free of disease or does it encompass more? Should you be considering your social and economic conditions when you pose the “why me’ question and are they a part of your ‘health’?

How does the ‘healthcare’ industry interpret this term? It’s an important question as this directly impacts the treatments and outcomes you can expect from your health providers. Are doctors, for instance, tasked simply with your physical wellbeing (illness and disease), or do their duties extend beyond that. 

Let’s turn to the organization that is arguably seen as our global gatekeeper for health, the World Health Organization (WHO) to explore the answer. How do they define their very reason for existence? How do they define ‘health’? 

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 

World Health Organization

That’s a pretty tall order and a seriously extensive scope of responsibility for one single term and to bring home the further complexities of modern healthcare, this diagram from America’s Health Rankings (AHR)shows the overlaps of various disciplines considered in the field of health when they compile their data

What’s important about the little diagram above is the center, entitled health outcomes. It’s become a watchword for American healthcare. Successful outcomes are how we now gauge healthcare in America. The factors listed in the diagram, Behaviours, Physical Environment and Social Factors shouldn’t be confused with your understanding of health or the WHO definition. These environmental, social, and geographic factors are however crucial in developing healthcare’s responses and planning with regards to the care they provide you. So indirectly, they do affect your ‘health’.

Let’s explain this through the use of an example. America, in global terms, ranks terribly for infant mortality at birth. In fact, out of the 36 OECD countries measured, America comes third from last. Let’s use the 2020 data provided by AHR to support this statement. 

As an aside, if you’re wondering which state is best for pregnancy care, Vermont scores the highest, and statistically, your birth is safest in Massachusetts (3.8 deaths per 1000) and most at risk in Mississippi (8.7 deaths per 1000). According to the AHR 2020 report;

In 2018, over 21,000 infants died in the United States. According to the Centers for Disease Control and Prevention (CDC), the leading causes were birth defects, low birthweight and preterm birth, maternal pregnancy complications, sudden infant death syndrome (SIDS) and unintentional injuries.

The U.S. infant mortality rate has been consistently higher than other developed countries, and 1.5 times higher than the average (3.8 deaths per 1,000 live births) among Organization for Economic Co-operation and Development countries. Research indicates socioeconomic inequality in the United States is likely a primary contributor to its higher infant mortality rate.

According to the CDC report referenced above, race affects these figures in the following way. Sections in bold added by way of explanation.

Black women had the highest mortality rate (10.75), followed by infants of non-Hispanic NHOPI (Native Hawaiian or Other Pacific Islander: 9.39), non-Hispanic AIAN (American Indian or Alaska Native: 8.15), Hispanic (4.86), non-Hispanic white (4.63), and non-Hispanic Asian (3.63) women.

So that part of our diagram above, entitled Social and Economic, is actually the driving factor that increases the risk of your baby dying at birth. Does this have anything to do with your health and your child’s health, other than implying you move to Vermont for your pregnancy and deliver the baby in Massachusets? What if you’re black? Will moving help or is your race a fixed determinant in your child’s chances at birth? 

This where it gets complicated and where healthcare treads on quicksand. Your race, from a genetic point of view, does not affect your risk of infant death at birth and that is what makes the figures above so damning. These figures have nothing to with genetics or you but are rather an indictment of how the color of your skin, your sex, and your economic and social situation determine your access to healthcare and a healthy lifestyle. In effect, your right to ‘health’.

Racism, it turns out, kills babies, not race. Being socially disadvantaged kills babies. Being financially impoverished kills babies. 

In terms of health, the above are all classic WHO indicators of physically healthy people living in an unhealthy society. If we are to judge by the WHO definition, then American healthcare, in its current state, fails to live up to the lofty goals set, and it isn’t just in the field of infant mortality that it falls short. 

The question is, can we blame the American healthcare system for social and racial disparities? How can you hold doctors responsible for generations of institutionalized racism, sexism, and social inequality? No fair.

There is a quandy at the heart of modern healthcare. Is your provider merely required to treat your symptoms or do they have a moral and ethical responsibility to look beyond the diseases, to identify the causes and address these, to seek cures, rather than treatments? Where does their remit begin and where does it end?

The dangers of mixing the fields of medicine and health with finance, economics, societal politics, and race are that the lines begin to blur. Boundaries are necessary for the effective functioning of any system. Act beyond the scope of your boundaries (profession) and you dilute both your efficacy and your impact.

While we cannot hold Healthcare accountable for societal racism, sexism, and general inequality, we most certainly can expect the industry not to engage in any of these practices. That is sadly not always the case, but the industry is beginning to assess itself more introspectively with a view to rooting out these practices. Empowering and recognizing the voices of women within Healthcare is a massive step in the right direction.

Patients can also, and rightly so, expect health care providers to address the imbalances in their communities that lead to the racial disparities so clearly underlined by infant mortality in America. 

Let’s clarify that statement as it’s a weighty one. This expectation does not involve doctors and nurses dropping their stethoscopes and picking up banners for the next BLM protest. It refers to them addressing these imbalances from within the scope of their professional abilities. A clear set of “non-medical symptoms” or parameters exist to identify the at-risk and healthcare needs to respond accordingly by pre-empting the 8.7 dead babies for every 1000 born in Mississippi.

The healthcare profession is about exactly that, health. It isn’t about creating a revolving door of repeat business, but rather seeking out the lofty aspirations of the WHO. To treat a ‘sick’ society as their primary patient, particularly if that patient lies at the heart of burgeoning illness and disease. 

Providers need to encourage free weekly clinics in marginalized communities, governors need to increase budget allocations for communities that are in dire need of healthcare, free medication needs to be made available for those unable to provide for themselves., courtesy of a cash-rich Pharmaceutical industry. All of these things and more need to be put into action. Not to act is to be aware of the growing tumor and refusing to treat it. 

It leaves the industry with blood on their hands.

By now, I hope you understand that your ‘health’ means far more than simply waking up in the morning with all your fingers and toes accounted for. To be truly healthy, you need to strive for a stable social and economic environment, for you and your family. Achieving this is within everyone’s reach and when we encounter obstacles intentionally placed in the way of people achieving their true health, it falls on everyone’s shoulder to speak out and speak up.

Not just healthcare.

The post Racism, It Turns Out, Kills Babies, Not Race appeared first on Medika Life.