Season 4 Episode 11 – Health Inequities

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Health Inequities Description

Drs. Williams, Guthrie, and Green discuss health inequalities that became better recognized during the COVID-19 pandemic and how these inequities have impacted the world. They will also discuss the racial and ethnic issues surrounding discrimination that can have implications for health equity and how healthcare professionals can have a positive impact on these issues.

Health Inequities Transcription

Dr. Mironda Wil…: Welcome to Take Good Care Podcast.

Dr. Deanna Guth…: An endeavor that grew out of our love for obstetrics and gynecology.

Dr. Karen Green…: Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.

Dr. Mironda Wil…: I am Dr. Mironda Williams.

Dr. Deanna Guth…: I am Dr. Deanna Guthrie.

Dr. Karen Green…: And I am Dr. Karen Greene.

Group: Welcome to our show.

Dr. Mironda Wil…: Welcome to today’s episode of Take Good Care Podcast. I’m Dr. Mironda Williams.

Dr. Deanna Guth…: I’m Dr. Deanna Guthrie.

Dr. Karen Green…: And I am Dr. Karen Greene.

Dr. Mironda Wil…: As those of you who have followed us for now three, going into four, seasons, we try to mix up what we do in terms of things that are health-related that may also be a social issue that is going on at the time, personal issues, and sometimes everything kind of all blends in together. On today’s episode, we thought we would tackle a topic that has really been in the news during the COVID time, and now this post-COVID as we’re coming out of the pandemic phase and moving into the endemic phase where COVID is no longer a healthcare crisis across the world. It’s still present, but it’s not in that crisis level. During that time period of COVID, many things, many inequities, many inequalities, many things that have been going on for decades really became revealed and accelerated in a fashion because of the worldwide pandemic.

One of those topics is the question on health equity. And again, health equity is not just about health issues, medical issues, processes, healthcare policies. You really are looking at something that crosses a number of levels: cultural, economical, political, as well as science. So what we want to do today is to, again, just provide some more voices from our point of view about health equity or health inequities, whatever your viewpoint is, to give some of the definitions so that when you hear these things talked about, it makes a little more sense for you. And then we’ll probably wrap it up about how these things have now impacted us or how we’re more aware of them.

Dr. Guthrie is going to begin our discussion today looking at definitions and what are some social determinants of health. Dr. Greene is then going to take up the discussion, taking that information, Dr. Guthrie is going to present and start looking at it in the light of COVID-19 and how that did or did not cause any changes. And then I’ll come in with more discussion about how implicit bias and racial and ethnic issues surrounding discrimination also can have implications for health equity, and then, again, how as healthcare professionals can have a positive impact on these things. Dr. Guthrie?

Dr. Deanna Guth…: Thanks, Dr. Williams. So as Dr. Williams just said, this is a very, very complex issue. It’s not just simply based just on healthcare or policy or things like that. The first thing that you want to distinguish is that equity does not mean equal, and that’s the first thing you really have to understand. For people to have health equity, it’s not just, for instance, having a doctor in the area. So if there’s a doctor in the particular area, everybody has access to that doctor “you think.” But there are other factors that come into play that would affect healthcare for different people. Where is his office located? Can everyone get to his office easily? That could be transportation.

Culturally, is there an issue with the doctor communicating with patients? So it’s not just, “Here’s a doctor. Everybody can come see this doctor.” There are several definitions for health equity, and certain groups and foundations have their particular definitions. The World Health Organization describes equity as the absence of avoidable, unfair, or remedial differences among groups of people, whether those groups are socially, economically, demographically stratified differently. Okay? So it’s not just race. It’s not just money. Robert Wood Johnson Foundation says health equity means everyone has a fair and just opportunity to be healthier. It means removing biases like poverty, discrimination. It gives access to good jobs at fair pay. It also has to do with education, housing, neighborhoods, and things like that.

Dr. Karen Green…: Those definitions, in and of themselves, kind of make you realize how complex it is.

Dr. Deanna Guth…: Yeah.

Dr. Mironda Wil…: And it also helps you to understand why something like the pandemic blew the lid off of everything.

Dr. Karen Green…: Yeah.

Dr. Deanna Guth…: Exactly. Johns Hopkins, which they were the author of this article that I read, their definition was the fair achievement of good health and wellbeing … and that’s just the beginning of the statement, but if you just take that in and of itself … and it’s not the equal distribution of healthcare.

Dr. Mironda Wil…: Equity is not … What’d you say in the beginning?

Dr. Deanna Guth…: It’s not equal.

Dr. Karen Green…: It’s not equal.

Dr. Deanna Guth…: They showed a picture where there are three people trying to look over a fence. One person is tall, one person is medium height, the other person is short, and they gave everybody the same box to stand on to look over the fence. Well, obviously the tall person would be able to see, but the other person was barely looking over the fence, and the short person didn’t even see over the fence.

Dr. Karen Green…: So the tall person really needed to hand their box to the short one.

Dr. Deanna Guth…: Well, it’s not so much handing. But again, it’s not, “Everybody, get a box.”

Dr. Mironda Wil…: Everybody doesn’t need the same thing.

Dr. Deanna Guth…: Everybody does not need the same box. So then the next picture was what equity was, where the tall person didn’t even need a box, or needed a smaller box.

Dr. Mironda Wil…: Here.

Dr. Deanna Guth…: The medium person had the same box that was given. He could see over the fence. And then the short person had two or three boxes so that they could see over. And so you would think initially that that’s not fair. One person didn’t get anything. The other person only got one, the other person got three. But in terms of health equity …

Dr. Mironda Wil…: For equity.

Dr. Deanna Guth…: For equity, for everybody to get the same outcome, there needed to be a difference in what was given.

Dr. Karen Green…: Exactly.

Dr. Mironda Wil…: And had that example because that’s really what helped me understand the whole thing about this “equity.” What does equity really mean? So that really was a great visualization. And again, the equity piece is, “What’s the goal?” In that illustration, the goal was to see over the fence. The goal wasn’t to give everybody the same thing.

Dr. Deanna Guth…: The same thing. Exactly. And in politics now, that’s what you hear people shouting at each other. “It’s not fair,” and, “I need this,” and, “You got this,” and, “I want this,” and, “We didn’t get the same,” and that sort of thing. When even people who are demanding more, they don’t even sometimes even understand what they need to ask for.

Dr. Mironda Wil…: The goal.

Dr. Deanna Guth…: So yes, you may see something in another community that you want because they got it, but that may not even be what you need. You probably need something else to get you to the same place as the other person. It’s the end goal. It’s not what you’re actually getting.

Dr. Karen Green…: And it also has nothing to do with those three individuals as to what they did. It’s just you want to get what’s on the other side of the fence because that’s equity.

Dr. Deanna Guth…: Right.

Dr. Karen Green…: Those three people may not be equal, but they all need that equity.

Dr. Deanna Guth…: Equity. Exactly.

Dr. Karen Green…: They need something on the other side of the fence.

Dr. Deanna Guth…: On the other side of the fence. Exactly. And so there’s several problems that affect equity. The first thing we think of is money, poverty. So of course, people who have money will probably have insurance and better access to certain things. So poverty, transportation, things like that. Unemployment. So again, with healthcare, health insurance policies, and things like that. Education. And it’s not just that you need a degree to understand, to get medical care. It’s just that you may not even know, but you don’t know.

Dr. Karen Green…: Right.

Dr. Mironda Wil…: Exactly.

Dr. Deanna Guth…: And so you don’t even know what’s even available. In our previous podcast, when we were talking about in infertility, do you even need help?

Dr. Mironda Wil…: There may not be a problem.

Dr. Deanna Guth…: There may not even be a problem. Exactly. Talked about inadequate housing. That’s another problem affecting equity. Public transportation, like I said. So there may be a doctor in the neighborhood, but if no one can get to his office, healthcare is not being given. Another surprising one is exposure to violence. It’s the stress of living, also, that can affect health equity. And it’s not, again, getting medical care. It’s just how you’re living your life and how it affects you. That people who live with constant violence, their health is different than other people who don’t.

Dr. Mironda Wil…: And therefore their needs are different.

Dr. Deanna Guth…: And therefore their needs are different. And then they talk about neighborhoods. That it could be the physical neighborhoods and how the neighborhood is set up, but it’s also the social neighborhood also.

Dr. Mironda Wil…: Exactly.

Dr. Deanna Guth…: Living with your neighbors and things like that and how it affects you. They call these social detriments of health. And so these, they can affect, like I said, health outcomes. The statement is the conditions where you are born, where you grow, where you work, where you live and age, and these wider set of forces shape the conditions of your life.

Dr. Mironda Wil…: Say that again.

Dr. Deanna Guth…: Social detriments of health are the nonmedical factors that influence health outcomes. These conditions compare where you’re born, where you grow, where you work, live, and age, and the wider set of forces and systems that shape the conditions of daily life. So like you said, it’s not just money. People think you just throw money at a problem, or you argue about budgets and things like that, like our government is doing right now. They’re talking about Medicare and the work requirements that are going along with Medicare. But it’s not just money. Again, it’s just all the factors that go into living a healthy life. And people don’t realize, or they take for granted things that can affect health.

Dr. Karen Green…: Yeah. Because when you have everything that you need, for a lot of people, you don’t realize that other people just may not have that. And as Dr. Williams said, COVID kind of blew the lid off of all the things that were covered up that we knew that were a problem. Now, all of a sudden, it’s like, “Well, wait. I didn’t know that was a problem. Wait, I never knew about that.” And for some people, it matters. For some people …

Dr. Mironda Wil…: It doesn’t.

Dr. Karen Green…: It doesn’t.

Dr. Deanna Guth…: So those are the main definitions about equity. Like I said, the main thing to remember is that equity is not equal.

Dr. Mironda Wil…: Thank you, Dr. Guthrie. That was excellent.

Dr. Karen Green…: So the Lancet article is called Health Inequities After COVID Turning Point. And so I read the article because I thought the title was interesting, and I really thought, “Okay, it’s going to get to the end of the article and it’s going to tell us that we’ve made all this progress.”

Dr. Mironda Wil…: We’ve turned the corner.

Dr. Karen Green…: “We’ve turned the corner.” That’s not really what it said.

Dr. Mironda Wil…: Sadly.

Dr. Karen Green…: Sadly. But it did highlight some of the things that I already knew, and kind of gave me the data to support what I already thought about … Going into COVID, let’s just say for those of us who knew that there was health inequity and health inequality in general in the US, we knew about it. And COVID really put a spotlight on that. Basically, there was already existing issues. And so for some of the existing issues, it accelerated the, “Okay, we really need to do something about this because this is serious.” It’s just that there was always a concern. It wasn’t anything new. It’s just that 2020 put a spotlight on it. And so we now have the opportunity to reassess what our understanding is, as you said, about health: what we need to do or what we can do and what we should do.

And so the article poses three questions, and Dr. Guthrie has already gone over what do we mean by health and health inequality and health inequity? She’s already discussed that. And then, what are the structures and policies already put in place to support or promote health? How effective are they? So the example of the fence is a great one. So here we are, we have the healthcare on the other side of the fence, and what are the policies for those three people to actually get to the other side of the fence? Are those really effective? Giving people the same box is not effective. And that is such a basic illustration of what some of the issues are that we realized during COVID. Because all of a sudden, people were at home, not working, not able to go to work, and or not in school, not able to go to school. Realizing that the social construct that we have for a lot of people of work and school and childcare really broke down.

Dr. Mironda Wil…: And it was integral, right?

Dr. Karen Green…: Yes.

Dr. Mironda Wil…: Because just about the whole education piece, kids are home.

Dr. Karen Green…: Yes.

Dr. Mironda Wil…: Well, you had a whole subset of kids who rely on school not just for education, but for meals.

Dr. Karen Green…: But for meals, right.

Dr. Deanna Guth…: Or socially.

Dr. Karen Green…: The social interactions.

Dr. Deanna Guth…: They’re talking about the kids are …

Dr. Mironda Wil…: COVID kids.

Dr. Deanna Guth…: COVID kids, going backwards. The kids who just needed that social interaction, that it wasn’t just, “Okay, we can still have school.”

Dr. Mironda Wil…: Reading, writing.

Dr. Deanna Guth…: “Just look in front of the computer.”

Dr. Karen Green…: And that, in and of itself, is multifactorial. So then, “Okay, we can just look in front of a computer. But can we?”

Dr. Mironda Wil…: Does everyone have a computer?

Dr. Karen Green…: “Does everyone have a computer?”

Dr. Mironda Wil…: Do you even have a wifi signal?

Dr. Karen Green…: “Do you have a wifi signal?”

Dr. Deanna Guth…: Well, it’s not even, “Do you have a wifi signal?” The amount of towers to give you wifi in certain areas more than others.

Dr. Mironda Wil…: They just don’t exist.

Dr. Karen Green…: They don’t exist. They may not exist in the same home.

Dr. Mironda Wil…: Right.

Dr. Karen Green…: Now, all of a sudden, it’s not just the kids at home on the computer. It’s the adults at home on the computer.

Dr. Mironda Wil…: Nobody had wifi.

Dr. Karen Green…: And nobody got wifi.

Dr. Mironda Wil…: Everybody’s signal dropped.

Dr. Karen Green…: Everybody’s signal dropped. And so those type of things that needed to be put in place. We all know when COVID started, in my mind, I guess as a parent, I realized in talking to other students that had … because my kids were able to access the wifi. But the school realized that not everybody had that opportunity, and so a lot of things didn’t matter towards the end of the year because it wasn’t that the students could do it. They couldn’t do it because they didn’t have a computer. So yeah, they gave them the work. The work was there. But could they access it? And it took them a month or so to realize not really.

Dr. Mironda Wil…: Not really. Not everybody.

Dr. Karen Green…: Not everybody. And that, to me, was very sad. And then even in the following year, when we’re trying to adjust to the new hybrid model of, “Some people at school, some people at school other times,” that didn’t do well for certain socialization skills for kids. And for kids that were going from middle school to high school, which is a big transition.

Dr. Mironda Wil…: Big jump.

Dr. Karen Green…: Being at the end of middle school and coming into high school, still in COVID, some kids did not do well. There was a lot of violence in my school. They were just getting a handle on in 2023. People would ask, “Why are these kids fighting?” Because they don’t have any social skills.

Dr. Mironda Wil…: Well, it’s that, and it’s just everything else. The stresses-

Dr. Karen Green…: All of it.

Dr. Mironda Wil…: The COVID, what’s going on at home, what’s not going at home. And then they come to school and now they’re just mad.

Dr. Karen Green…: Right.

Dr. Mironda Wil…: They’re just mad. They’re angry and they don’t know how to express it. They may not even know what they’re feeling. They just know something’s not right.

Dr. Karen Green…: So the structures and the policies that we think we had in place for a normal timeframe really weren’t there because here we are, thrown with into this whole situation of people doing things. And I think that for a lot of kids who were probably more tech-y than their parents, a lot of people thrived in that environment. And so for some kids, that was good. And some peers, that wasn’t. But really understanding what kids thrived in that type of new environment and the new normal really was key to changing how they did a lot of things. Changing how they did things electronically so that they were able to get access to all of the things they’re supposed to get out of school.

And then the other question that the Lancet article proposes is, “Who actually has the power to shape these things?”

Dr. Mironda Wil…: That part right there.

Dr. Karen Green…: Who actually has the power? The people that are already in the situations where it’s not a big deal don’t really understand those people that, “Well, why can’t they get on the computer? Why can’t they go to see a doctor? Why don’t they have food again?” Because they go to school and that’s their lunch. So now, we have to have them get the lunch in the parking lot because they wouldn’t get lunch.

Dr. Mironda Wil…: And the reason why they may not have enough food at home is because yes, you have parents who are working, but they don’t have a livable wage.

Dr. Karen Green…: Right. They don’t have a livable wage.

Dr. Mironda Wil…: So they got to pick and choose, “What am I spending money on right now? So I pay the bills and keep a roof over their head, or do I go get some bologna and cheese?”

Dr. Deanna Guth…: Or people and medication. “I won’t get my medication this month because I got to pay my rent.”

Dr. Karen Green…: Right.

Dr. Deanna Guth…: And health suffers because of that.

Dr. Karen Green…: And that just ties in with people suddenly not working and thinking, “Okay, I don’t have a liable wage and I was paying all this for childcare, and now I’m home taking care of my kids. Maybe it would be cheaper just to stay at home because it doesn’t balance out.”

Dr. Mironda Wil…: Because I know that’s been a big discussion about a lot of people, “Why aren’t people coming back to work? Why do we still have all these vacancies?” Well, for a lot of us, the pandemic shifted some things.

Dr. Karen Green…: Yeah.

Dr. Mironda Wil…: It refocused some things. And women were making up a huge part-

Dr. Karen Green…: Huge.

Dr. Mironda Wil…: Of that workforce that was found to be truly “essential,” right the people who do the work of the cleaning and the cooking and the preparing. They’re home now because it’s actually more cost-effective for them to stay home with the children who are now home than to try to find childcare, or they may not have the transportation to get the child to the childcare so they can then go to work. So what are you doing? You’re getting on the bus at 5:00 in the morning, which is what some people do because they got to get up, get the kids ready, and they got to get to work, and that’s on public transportation. And if you’re not in an area that has broad public transportation that allows that to be easily accessible so that you can do all these things … That’s the equity piece.

Dr. Karen Green…: That’s the equity piece. Because we live in an area where … Well, I live in an area because I live in Fayette County … there isn’t public transportation.

Dr. Mironda Wil…: Fayette County, give a state.

Dr. Karen Green…: Georgia. Sorry, I forget. We live in Fayette County, Georgia.

Dr. Mironda Wil…: Yes.

Dr. Karen Green…: Fayette County, Georgia. For those of our listeners who live in other states, our practice is located in Fayette County, Georgia and I happen to live in Fayette County, Georgia. And so it is considered rural in that respect because it doesn’t have public transportation, and a lot of people that actually live in Fayette County work downtown in Atlanta Proper. So leaving in the morning, kids get on the bus to go to school, they’ve got to go downtown. So that whole dynamic changes when they don’t have a job to go to.

Dr. Mironda Wil…: Or a school to go to.

Dr. Karen Green…: Or school to go to, and so they’re staying at home. And they probably, just like I did, drop the kids off at daycare, go to work, or put the kids on the bus, go to work. And so all of a sudden, when there’s no daycare, especially for the smaller kids … And for those essential workers that really do work those odd hours, suddenly not having that daycare that’s open at 6:00 AM or at all. And for the daycare provider to actually be able to continue to do that, because now they have to do it in a different way because we have COVID.

Dr. Mironda Wil…: Right.

Dr. Karen Green…: So all of those things just kind of compounded on it. The article points out that there were definitely two opposing forces when it came to COVID, that, “Here it is. It’s a pandemic. We’re all together in this. We’re going to fight this because it’s all affecting us.” And then, “Well, it’s not really affecting us equally.”

Dr. Mironda Wil…: That part.

Dr. Karen Green…: That part. “Some people are doing better, and why?” Why are people doing better?” I wish we could go into the details of why people are doing better and why people aren’t doing better, but the article goes into a lot of information as to how healthcare and health inequity really affected why certain groups of people didn’t do well.

Dr. Mironda Wil…: Exactly.

Dr. Karen Green…: And the certain groups of people that didn’t do well were usually Black and Brown.

Dr. Mironda Wil…: That’s right. And female.

Dr. Karen Green…: And female. And female.

Dr. Mironda Wil…: And we’re gynecologists so we kind of care about that.

Dr. Karen Green…: Yeah, we do. We do kind of care about that.

Dr. Deanna Guth…: It’s our demographic.

Dr. Karen Green…: It is! It is. The comment is, “After the initial shock and response, we realize that the virus was not a great equalizer. Yes, everyone was vulnerable, but there were stark inequalities in our ability to mitigate the potential effects of the virus: unsafe work, crowded housing, income, and other pervasive and systemic forces, including racism, all affected access to the resources required to create safety, and also affected the ability to continue functioning.” So it provided a spotlight, but it provided a spotlight on things we have been talking about.

Dr. Mironda Wil…: It wasn’t new.

Dr. Karen Green…: It wasn’t new. It just acted like an accelerant to a smoldering fire.

Dr. Mironda Wil…: Exactly.

Dr. Karen Green…: And it also showed the tears in our safety net.

Dr. Mironda Wil…: That’s exactly right, Dr. Greene.

Dr. Karen Green…: That we thought, “Oh, we got this covered. We’re the big country. We can do all this.” No, not so much.

Dr. Mironda Wil…: No. Everything broke down.

Dr. Karen Green…: It really did.

Dr. Mironda Wil…: Because of a little bitty virus.

Dr. Karen Green…: A big virus.

Dr. Mironda Wil…: So shut it down.

Dr. Karen Green…: And so the article left me with a question. Now, we’re at this point. What are we going to do about it?

Dr. Mironda Wil…: What do we do?

Dr. Karen Green…: What do we do? Do we go back to the old normal, knowing that the normal was not working for significant parts of the population?

Dr. Mironda Wil…: It was unsafe.

Dr. Karen Green…: It was unsafe. And sadly, we do kind of have short-term memory. There was SARS.

Dr. Mironda Wil…: That’s right.

Dr. Karen Green…: And we knew what a virus could do, even on the smaller scale.

Dr. Mironda Wil…: Right, right. The difference is that that didn’t hit everywhere at the same time.

Dr. Karen Green…: Exactly. Exactly. Now we have the opioid epidemic. And so it’s like, “Okay. Are we going to do something about this? What are we going to do about this?” So if we have commitment to reducing inequities, we have to focus on what really matters and recognize that these are societal choices, not an individual one.

Dr. Mironda Wil…: That’s the part right there, Dr. Greene.

Dr. Karen Green…: It’s not an individual choice. It’s not about, “Well, we’ve all got to get the same thing because if I don’t get it, that means someone gets more.” Well, someone actually might need more. It’s not a zero-sum. It’s not supposed to be. In that sense, equal and inequity are different.

Dr. Mironda Wil…: Right. And you’re making some great points, but I just got to point this out. I always hear pushback whenever somebody says, “There’s systemic racism,” or, “There’s systemic this,” or, “There’s systemic whatever,” and people don’t understand what you said. This is not the result of an individual’s bad decision.

Dr. Karen Green…: Right.

Dr. Deanna Guth…: Right.

Dr. Mironda Wil…: This is the result of societal bad decisions or poor planning, which by definition is systemic. That’s why it’s systemic. Because the individual can’t change that. My individual choice and decision …

Dr. Karen Green…: “I’m not racist. I’m not racist. I’m not racist.”

Dr. Mironda Wil…: Yeah. But the systems in place are racist.

Dr. Karen Green…: They are. They are.

Dr. Mironda Wil…: Or elitist or sexist.

Dr. Karen Green…: We could go on with the ists because we’re female.

Dr. Mironda Wil…: Oh, goodness.

Dr. Karen Green…: And Black.

Dr. Mironda Wil…: That part.

Dr. Karen Green…: That part, so I digress. One of the things that, after reading the article, I remember that affected me personally was nursing homes. And it is a good example of here you have a crowded condition with elderly patients that are more susceptible to the ails of COVID, and the nursing homes in this particular area that were more affected happened to be nursing homes that were in African-American communities. And the reason it affected me was because my mom was in assisted living in 2020. But as I said, I live in Fayette County …

Dr. Mironda Wil…: The dynamic.

Dr. Karen Green…: Which the dynamic is different. And so the assisted living facility that she was in was able to put things on lockdown and make sure that these employees were vaccinated if they could be, and did the policies and procedures that actually would prevent the spread of the virus in this small, little area. What that meant for me is I didn’t get to see my mom, but either on FaceTime, which she couldn’t figure out, or window visits, or if I happened to have to take her to dialysis. But she didn’t get sick and she didn’t get COVID, and those things that they did and were able to do were very helpful to the residents so that when they were able to reopen, those residents were able to go on about their lives in their crowded living condition that didn’t give them COVID.

Dr. Mironda Wil…: Right.

Dr. Karen Green…: But you look at a place like Fulton County, where there were outbreaks of COVID. Elderly patients died.

Dr. Mironda Wil…: In large numbers.

Dr. Karen Green…: In very large numbers. And I think that it is a turning point, in respect of COVID that is. Large numbers of people died during COVID and we really can’t forget that. It wasn’t a movie. It wasn’t Marvel, where Thanos snapped his fingers and people disappeared and then came back.

Dr. Deanna Guth…: Right.

Dr. Karen Green…: It wasn’t a blip. These people are gone. They’re gone because of the disease.

Dr. Mironda Wil…: In the next movie.

Dr. Karen Green…: Right. A disease that yes, the disease happened. Yes, we were affected by it. But we’ve got to figure out what to do if it happens again.

Dr. Mironda Wil…: And it will happen again.

Dr. Karen Green…: It will happen again.

Dr. Mironda Wil…: It will happen again.

Dr. Karen Green…: The last pandemic was 100 years ago. And some of the things that were done in the last pandemic, we figured out that we probably should have done sooner with this one. So clearly, again, with the short-term memory. Because you think, “Oh, that’ll never happen again,” you don’t change what should be done so that when it happens, we’re ready for it. That’s my hope, but this article didn’t give me much to go on in terms of whether or not the turning point really made a turn or we’re just kind of going around in a little traffic circle.

Dr. Deanna Guth…: Another example of equity versus equality is voting. So every American has the right to vote, but how we vote is not equitable. So when they’re talking about voting precincts, they lack some. There’ll be many in one area, some in another. The equipment in those areas is not the same.

Dr. Mironda Wil…: Same thing with health. You don’t have transportation to get there.

Dr. Deanna Guth…: Right, exactly. Access there, like Dr. Williams just said. And so that’s another example of that.

Dr. Karen Green…: And COVID illustrated that because we had an election. And where were the long lines? And then, places that only had a few precincts.

Dr. Mironda Wil…: So they’d mail them in, but they didn’t like that. But let’s bring it back in. As we start to wrap up this episode, we don’t want to leave anybody feeling down. We like to bring hope. That’s what we do. So as it relates to healthcare and health equity … which is what we really wanted to, again, shine a light on as healthcare providers, as African-American women, and as gynecologists …` to Dr. Greene’s point, how is this a turning point, or how can we, as healthcare providers, impact what’s been highlighted so that we can have a positive change and turning point?

And I think what we’ve all illustrated in various ways is that there is no one thing. There are just a number of things that will have to happen across many subsets and groups and entities. But as my partners know, one thing I’m very big about in our practice, and it’s really been something that I’ve learned being a part of leadership in the hospital system, is that when you focus on a person as a problem, “That person made a mistake,” “That person didn’t understand the order,” “That doctor removed the wrong limb,” when you focus and make it that individual person’s fault, nothing changes. The only thing you do is denigrate that person. The only thing you do is beat that person down, shake their confidence, make them question their self-worth, and as a physician could make us question, “Am I even supposed to be doing this?” It doesn’t solve the problem.

So what we have learned in the healthcare system, and in the healthcare system that we are associated with in particular … and this has been a 10+ year culture shift in how we look at and evaluate issues and challenges. Everybody’s got to use new terminology.

Dr. Karen Green…: Opportunities.

Dr. Mironda Wil…: Opportunities. They’re not problems.

Dr. Karen Green…: They’re opportunities.

Dr. Mironda Wil…: They’re opportunities. And also, we don’t attack the person. What we do is say, “This highlights an opportunity,” and, “What process can be put in place?” or, “What policy can be put in place?” so that healthy outcomes are not dependent on personal memory or personal performance. So when you talk about, “What happens now? How do we make this a turning point?” and how can we … because I can’t fix the education system. I ain’t running for office. I ain’t going to do politics.

Dr. Deanna Guth…: Maybe you should.

Dr. Mironda Wil…: No. But I’m a physician and I like policy. I like processes. There was a presentation that was presented that talked about, to Dr. Greene’s point, “Okay, this needs to be a turning point. How, in the healthcare community, can that be facilitated?” And so there was a presentation that talked about one of the ways that we can begin to impact this system that needs to shift is by training healthcare professionals so that we understand the impact of implicit bias that could be linked to racial or ethnic-based discrimination, and can become … Physicians are hard to change our ways, but we have to be open to understand that these are not person issues or individual issues. These are systemic issues. And the way we can affect real change that is lasting and sustainable is to make policy and procedure.

So the big picture, as it results to building equity across the healthcare ecosystem. And I like how this presentation put that. This is an ecosystem. So that means not one thing is important, all the things are important because all the things have to work together in a harmonious fashion that gets us to the goal. I think to Dr. Guthrie’s illustration about the fence, don’t worry about how many boxes you got. The goal is to get over the fence. If you don’t need a box, okay. Because you can get over the fence. If Dr. Greene needs three boxes because she’s a shrimp …

Dr. Karen Green…: It’s okay.

Dr. Mironda Wil…: It’s okay. Her having three boxes does not prevent me from getting over the fence.

Dr. Karen Green…: And it doesn’t take away anything from you.

Dr. Mironda Wil…: That’s what I’m saying. It doesn’t stop me from doing what I need to do. So healthcare providers, we can affect change by participating in the process, being involved, as a lot of us are, on committees, boards. To your point earlier, Dr. Greene, who’s making the decisions? Too often, people who are at the tables of decision, as I like to call it, are White, male … I’m not going to say old because now I’m in that age. We’ll just say …

Dr. Karen Green…: Seasoned?

Dr. Mironda Wil…: Seasoned. And because of that, they only have their perspective. And nobody’s hating on that, right? You can only know what you know by your lived experience. Their lived experience is fine. It’s also valid. But my lived experience is valid. And so people who look like me, people who understand and have my kinds of lived experiences, your lived experiences, a broad variety of people’s lived experiences, all these people need to be at the table of decision because this helps us to build equity in a systemic fashion that can then be effective and sustainable. So this is why things like diversity, equity, and inclusion matter. People always say, “Wise guy.” This is why it matters is because I don’t know what it’s like to be a White man.

Dr. Karen Green…: So I need their opinion.

Dr. Deanna Guth…: I need their opinion.

Dr. Mironda Wil…: I need their opinion. I need their viewpoint. I need their perspective.

Dr. Karen Green…: The same way they need ours.

Dr. Mironda Wil…: But you don’t know how I got here.

Dr. Karen Green…: Exactly.

Dr. Deanna Guth…: Right.

Dr. Mironda Wil…: And you need to understand that I have a valid opinion and a voice. And this is not about a person. This is about we’re trying to get together so that we can establish effective policy. So that’s one of the ways. You have the healthcare system. You have different organizations where there are hospital groups that band together, medical groups that band together. Then we have practices, individual practices, as well as hospital practices, that take into account cultural differences from all participants. Not just those who avail themselves of our healthcare services, but the cultural differences of the providers who provide the healthcare services. All of it is important. Not one is more important than the other. And then, we have to develop procedures. Procedures that have been verified and tested as effective to reach the goal. Not anything else.

If we just, “Let’s get to the goal,” and not let ourselves get distracted by other things, then we can build equity across the healthcare ecosystem. And then on an individual basis, physicians and other healthcare providers need to understand we all have biases, some that we don’t really know that are implicit and some that we may know. And so it’s important for us to do what we need to do, whether it’s through reading, through articles, through whatever, so that we build our own cultural competency so that you can begin to address some of your own individual inherent biases.

Example: I was on an emergency room call on a particular evening. I get called to the emergency room. And we say all the time that as a gynecologist, the only emergency we have is an ectopic pregnancy, which is a pregnancy that’s the wrong spot. The baby should develop in the uterus. If the baby develops anywhere outside of the uterus, that’s a problem. And that’s a potential medical emergency for the patient so that typically requires immediate action. So I found myself being judgmental about this patient that I hadn’t even seen yet because I was reacting in a way that demonstrated my bias about patients who come to the emergency room to get care. So I’m like, “Why is she here? Why is she coming to this hospital? She lives in da-da-da.” So I’m making assumptions in my mind.

Now, it’s based on history and experience so it’s not like I’m pulling rabbits out of a hat. But when I then met this patient, I was like, “Dang, Ronda. You are so wrong because everything that you were already assuming about this person, totally wrong.” And I just say that to say that’s what we mean by bias. When you make assumptions about whatever without knowing the facts.

Dr. Karen Green…: Right.

Dr. Mironda Wil…: You’re biased. So it’s not just about race. It’s about whatever it’s about. Now because of all the things that we have done related to this podcast and just other things that I have participated in, I can now recognize that and I have a name. You know how we talk about naming things? And when you’re able to name something, you say, “Oh, wait. This is a bias. I got to address this,” right? And that is how, a individual practitioners, we can make an impact on the healthcare system. And then when it comes down to the patient, this still involves the patient. Patients can also participate in building equity across the healthcare ecosystem. And they can do that by participating in shared decision making with their provider, expressing what their needs may be.

If I am prescribing you a certain course of treatment. And I don’t know that there may be some barriers in your life that would prevent you from really being able to complete that course of treatment. I don’t know that. So I need the patient to say, “Dr. Williams, I know you want me to go to see the endocrinologist that’s in Norcross.” And I’m just using it as an example, audience, because we work and practice in the southern county area of the metropolitan Atlanta area. Norcross is on the north end of the metropolitan Atlanta area. So for me to tell a patient who lives down here that I need her to go see a physician that lives up there, if that physician doesn’t have a way to get there, if that patient doesn’t, even because of fear and other things, “I don’t want to go to Atlanta. I don’t want to,” then even though that is a wonderful course of treatment that I have prescribed for this patient, it’s not going to help her.

Dr. Karen Green…: It’s not going to.

Dr. Mironda Wil…: Because there are barriers to her being able to follow through with that. But unless the patient tells me some things … and it’s okay to say, “Dr. Williams, that sounds good. But right now, I’m unhoused.”

Dr. Deanna Guth…: Yeah.

Dr. Karen Green…: We need to know that.

Dr. Mironda Wil…: Okay. We need to know that.

Dr. Karen Green…: And it’s okay.

Dr. Mironda Wil…: And it’s okay because I said, “Okay, then let me readdress.”

Dr. Karen Green…: Yes, right there.

Dr. Mironda Wil…: Then we just redirect. So that’s how the patient can help us by if we don’t know it, if we don’t ask it, tell us if it presents a barrier to your being able to adhere to the course of treatment, or whatever that’s needed. As this wide-ranging discussion we’ve had illustrates, “This is a complex issue. No, it’s not going to be solved overnight, nor is there one magic bullet,” but it can be changed. And yes, people, it’s going to require a systemic change. And systemic change means coming up with effective policies and procedures that are sustainable, long-lasting, that are not person-dependent. So as we had a conversation in our office recently, this is about establishing principles and policies and procedures. What are our principles? What policies and procedures are in place to support that? It’s not about the person. Any other thoughts, ladies, before we get ready to wrap this episode up?

Dr. Karen Green…: I guess the only thing I would want to say is what Dr. Williams was saying at the end in terms of giving the patient permission to tell when they can’t do something.

Dr. Mironda Wil…: There’s a barrier.

Dr. Karen Green…: There’s a barrier.

Dr. Mironda Wil…: There’s a barrier.

Dr. Karen Green…: Because they may not even recognize it as a barrier. They just kind of say, “Well, I don’t want to say anything about it,” knowing they’re not going to, and so they come in the next year and you ask them why, and then you finally find out. Most physicians, they’re willing to help you figure it out.

Dr. Mironda Wil…: They can let you know about resources you may not know about.

Dr. Karen Green…: Exactly. If suddenly the medication is cost-prohibitive, let us know because, again, we may have resources to get you a different medication.

Dr. Deanna Guth…: Or help to get the same medication.

Dr. Karen Green…: At a lower cost.

Dr. Deanna Guth…: A lot of drug companies have programs.

Dr. Mironda Wil…: Lower or no cost, depending.

Dr. Karen Green…: Yeah. So I think that just to emphasize that they do have a role in this so that we can help them out. Because we really do want patients to get care, and that’s the whole point of our Take Good Care Podcast.

Dr. Mironda Wil…: That’s our podcast. That’s our goal.

Dr. Karen Green…: That is our goal.

Dr. Mironda Wil…: And we stay focused on the goal.

Dr. Karen Green…: We focus on the goal. Help us help you.

Dr. Mironda Wil…: Help us help you. And it’s okay. Like I said, a barrier, I tell people all the time. Because I think, Dr. Guthrie, she said something about … You were complaining about something, “We’re all our worst critic,” and I was like, “It’s not a character flaw. You’re just tired so you didn’t want to exercise. Okay.”

Dr. Karen Green…: It’s okay.

Dr. Mironda Wil…: You’re not a bad person. That’s not a character issue. You’re tired. You’re allowed. So for our patients, we want you all to know, if you don’t hear anything else, this ain’t your fault. The barriers that have been presented that you’re having to navigate, it’s not your fault.

Dr. Karen Green…: Really.

Dr. Mironda Wil…: We just need to know barriers so then we can help you avail yourself or resources that you may not know about, so that we can all get to the goal, which is health and wellbeing. Dr. Guthrie, for the closing statement, why don’t you read … It was that one briefer. I can’t remember if it was the Robert Wood Johnson about health equity.

Dr. Deanna Guth…: Health equity means everyone has fair and just opportunity to be healthier.

Dr. Mironda Wil…: That part.

Dr. Karen Green…: Say that again.

Dr. Deanna Guth…: Health equity means everyone has a fair and just opportunity to be healthier.

Dr. Mironda Wil…: Yeah. That’s equity.

Dr. Karen Green…: That’s it.

Dr. Mironda Wil…: And that’s what we’re trying to achieve. So on that note, we thank you, as always, for listening to us, for taking time out of your busy days to log in wherever you get your podcasts and check us out. We have several seasons, so we would invite you to go back and listen to some of the earlier episodes and see what we’ve been talking about for the last three years. Continue to share this with your friends and family. Come to our website at There’s other information and resources for you there. You can also reach us at that point. If you’re looking for healthcare and you need a gynecologist, we’d be happy to see you. But the main thing is that we want to encourage you to see somebody, to develop relationships with healthcare providers. Let them know what your truth is. Help us all make impact on health equity. So thank you. I’m Dr. Mironda Williams.

Dr. Deanna Guth…: I’m Dr. Deanna Guthrie.

Dr. Karen Green…: And I am Dr. Karen Greene. Take good care.

Jul 12, 2023 | Podcast Episodes