Dr. David Satcher, former U.S. Surgeon General and Director of the Satcher Health Leadership Institute at the Morehouse School of Medicine, on eliminating health disparities.

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, we could know by the week’s end, if the Health
Reform Bill will become the law of the land. Well, last time, any sweeping social
change was made of this size to the American landscape was decades ago with
a passage of Social Security in the 1930s and with the passage of Medicare and
Medicaid in the 1960s.

Margaret Flinter: That’s right, Mark, and it’s an exciting time. We were joking
around this morning that it seems like every week, we have told you that there
was a big moment in Health Reform on the horizon and in fact there were a lot of
them over these past months. It’s hard to say when but it does look like there will
be a historic moment soon. House leaders are working and gathering support
from Democratic lawmakers and even the President is out on the road talking
with House members and talking with communities about the Reform Bill.

Mark Masselli: Well, this is the week that is or wants to be. Democrats must
come together on this. Republicans are unified against the legislation. The
challenge this week is getting enough House Democrats to support the
underlying senate bill and then to make amendments to improve the legislation.
For weeks, Democratic House leaders have been fashioning ways to deal with
the senate language. This has not been made easy as all eyes are around the
House, but the Speaker has committed herself to move this legislation forward
this week and she usually gets what she wants.

Margaret Flinter: Well, it’s no secret that the House preferred is version to the
senate version of the Reform Bill. So Speaker Pelosi is looking at all the
alternatives on that vote. The self-executing role which she proposed earlier this
week would let the House vote just once on the reconciliation corrections. Under
that vote, passage would signify that the lawmakers have deemed the health
care bill as passed. In other words, they wouldn’t need that formal up or down
vote on the actual senate bill. Speaker Pelosi also outlined some of the
amendments to the senate-based health care bill last week. They largely
followed the proposal issued by President Obama such as doing away with
controversial provisions that affect one particular area, like the Cornhusker
Kickback, speeding up the closing of a gap in Medicare’s prescription drug
benefit, and limiting the text on so-called Cadillac health care plans.

Mark Masselli: This new procedure is certainly one way to appeal those House
Democrats who have principal concerns about the language in the senate bill
and who are withholding their vote unless certain changes are made. These
groups include like Michigan Congressman Bart Stupak who wants stricter
abortion language. Some members of the Congressional Hispanic Caucus are

concerned with prohibiting illegal immigrants from using their own money to
purchase insurance in the exchange. And progresses like Ohio Congressman
Dennis Kucinich don’t support the bill because it doesn’t offer universal coverage.
There is also Pennsylvania Congressman Paul Kanjorski who has threatened to
vote “no” after Democrats attached a student-lending overhaul to the bill that
could cost jobs at the Sallie Mae processing center in his home district from
principal to local politics, they are all driving how people will vote.

Margaret Flinter: And we are learning a lot about what matters to individual
Congress people. And Mark, remember, there are those freshman Democrats
who are hesitant to vote for the bill because they have got upcoming midterm
elections in their conservative districts. But House Majority Whip James Clyburn
is pretty confident that he can get the bill passed and he is the one in-charge of
rounding up those house votes. Congressman Clyburn was on our show back in
January and he said in the interview with us that if we get rid or fax that tax on
the working people’s plans irrespective of whether we call that the Cadillac or the
Ford Taurus, I think we can pass a plan that the American people can be proud
of. Despite that difficult task of lining up 216 House votes, the Congressman said
that he can do it. The maximum number of Democrats who can defect is 37 if
they are going to still make that 216 threshold vote.

Mark Masselli: These votes are going to be a nail biter. In the meantime, let’s
turn our focus to another very important issue in health care, eliminating health
disparities, the difference in health treatment and outcomes based on race and
ethnicity. It’s been part of our mission at the Community Health Center to fix this.
It’s also been the lifelong effort for our guest Dr. David Satcher. Dr. Satcher
serves simultaneously as U.S. Surgeon General and Assistant Secretary for
Health from 1998 through 2001. He now directs the Satcher Health Leadership
Institute at Morehouse School of Medicine in Atlanta, Georgia, which is
committed to fostering and supporting the diverse group of public health leaders
and influencing policies and practices, in that reducing and ultimately eliminating
health disparities.

Margaret Flinter: No matter what the story, you can hear all of our shows on our
website Chcradio.com. You can subscribe to iTunes to get our show regularly
downloaded. Or if you would like to hang on to our every word or read a
transcript of one of our shows, come visit us at Chcradio.com.

Mark Masselli: And as always, if you have feedback, email us at Chcradio.com,
we’d love to hear from you. Before we speak with Dr. Satcher, let’s check in with
our producer Loren Bonner with headline news.

Loren Bonner: I am Loren Bonner with this week’s headline news. Back in
campaign mode, President Obama was on the road again this week trying to win
support for his health care overhaul that could be voted on by Congress as early
as Friday. The President traveled to a senior center in Ohio on Monday, a state

that is home to several swing Democrats, to speak directly and personally to the
American people. President Obama said he came to Ohio because of Natoma
Canfield, a Medina cleaning woman who wrote him to say that she was dropping
her health insurance because of soaring premiums that coincided with her being
diagnosed with leukemia.

President Obama: I am here because of Natoma. I am here because of the
countless others who have been forced to face the most terrifying challenges in
their life with the added burden of medical bills they can’t pay.

Loren Bonner: But there were other reasons that President came to Ohio. He
wanted to visit a senior center to address in person criticisms that his bill will
make cuts to Medicare.

President Obama: Every senior should know there is no cutting of your
guaranteed Medicare benefits. No ifs, ands, or buts.

Loren Bonner: The President is also on a mission to round up House Democrats
who would vote on the bill, like Ohio Congressman Dennis Kucinich who doesn’t
support the bill because it doesn’t offer universal coverage. And House leaders
are trying to propose a rule that would let Democratic House members cast just
one vote on the reconciliation corrections leaving out the up or down vote on the
controversial senate-passed bill. The reconciliation bill has already advanced for
the Budget Committee when they voted for fast track rules for health care
legislation that set the rather complex process in motion this week. At the Budget
Committee meeting Monday, Republican Congressman Paul Ryan said the
committee vote was a sham.

Paul Ryan: We are right here creating a legislative Trojan horse in which a
handful of people hidden from public view will reshape how all Americans receive
and pay for their health care.

Loren Bonner: The rules committee is expected to meet Thursday to draft new
language for the reconciliation bill compiling a package of fixes to the bill that
passed in the senate on Christmas Eve.

Loren Bonner: This week, we are exploring eliminating health disparities and
one specific approach we are looking at directly involves the community and
addressing their own health problems. I visited a food cooperative in the South
Bronx that’s working to make a difference in their community by working together
to provide healthy and affordable food to everyone who wants it. The South
Bronx has New York City’s highest rate of obesity with residents facing an
estimated 85% higher risk of being obese than people in Manhattan. It’s one of
the country’s capitals of obesity and is also synonymous with poverty and a list of
health-related disorders.

Julio Pavon: You know, this is the most unhealthiest community or one of the
most unhealthiest communities in the country, and all the statistics that we have
in terms of health are some of the worst in the country.

That’s Julio Pavon. He is purchasing a few items at the South Bronx Food Coop
after coming from a yoga class next door, a class that started because of the
coop. He has been a member since the coop began in 2007 in the basement of
Nos Quedamos Community Center. The coop is now housed in an actual store
front with regular store hours and an expanding membership base, about 200
now up from 16 when it started. As a member, Pavon must work a monthly shift
since coop members run the store in order to cut out the cost of labor and make
nutritious food more affordable. As a result, the community has ownership of the
store and they make all the subsequent decisions about how to run it. Pavon
says the idea is slowly catching on in the community. People have become more
health conscious, but he says, it’s still hard to resist buying something cheaper in
a neighborhood that’s overrun by fast food joints and bodegas.

Julio Pavon: You go across the street, you buy a Coca Cola, a Pepsi Cola, which
is terrible for you, but it’s cheaper. Or a woman who is on a fixed income, she
goes to supermarket and she buys little juice things that are all sugar and water,
she gets like maybe a dozen or two dozen for the price of what you might get for
maybe one or two items here. But it’s a long process and the thing is to try to
teach people that in the long run. This is more inexpensive because that will
(Inaudible 9:57) spending time in the hospital or getting sick.

Loren Bonner: The coop has tried to address these issues in various ways. Not
only are they open to non-members, but they also accept food stamps and offer
a discounted membership rate to those who are on public assistance. Isaac
Purdue, a founding member who is working in shift today, says there is a good
reason behind this.

Isaac Purdue: The idea is not to make like a lot of money, the idea is to get
people (Inaudible 10:25) and be healthy.

Loren Bonner: The store and all its offerings is entirely open to the public. This
includes the cooking and nutrition classes and workshops on hypertension and
diabetes that are held regularly. Purdue says they get a lot of walk-in customers
who come in off the street because their doctor told them they need to start
eating healthier and they need advice on how to get started. Purdue says the
coop is a necessary and growing community in the South Bronx because people
have finally decided that they need to take care of their health. Let’s listen to the
interview with Dr. David Satcher to learn more about how he has paved the way
in reducing health disparities.

Mark Masselli: This is Conversations on Health Care. Today, we are speaking
with Dr. David Satcher, former U.S. Surgeon General and Director of the Satcher

Health Leadership Institute at the Morehouse School of Medicine. The institute is
an extension of your commitment to improving public health policy and
eliminating health disparities. Do you think the same kinds of health disparities
you faced while working as surgeon general still exist today? And do you think
as the Commonwealth Fund research suggests that high performing health
systems can substantially reduce or even eliminate health disparities between
ethnic and racial groups?

Dr. Satcher: There is just no way you are going to eliminate disparities in health
until we as a nation make the commitment to universal access to care. And the
more and more we learn about this, it has to be more than just access to care, it
has to be access to healthy environment.

Loren Bonner: Dr. Satcher, there are a lot of people out there who have a good
idea about ways to improve access in health care. You have a reputation as
somebody who gets things done, doesn’t just talk about them, and your
curriculum at the Satcher Health Leadership Institute seems to be twofold, both
research and also a very action-oriented component. Would you describe for our
listeners some key initiatives on both of those fronts, action and research?

Dr. David Satcher: Now, action is centered around the fact that we take on
community health issues. We engage our scholars and fellows with community
health issues. I have just finished talking with one of our scholars who is doing
some work with the transgender population. So we take on the problems that
many people would not take on. We don’t invite an action but that includes
research because we are a learning institute. So, the only way we can know
what leadership works best, for example how best to influence policy, we have to
really look at, we have to ask the question why did they take 45 years from the
time that the Surgeon General’s report on Smoking and Health came out in 1964
for Congress to give the FDA the authority to regulate tobacco as a drug. So our
scholars and fellows learn that it’s not just the sign that it takes to get policy
change, but it also takes different forms of influence, clear communication,
innovative presentations.

Mark Masselli: You have established a national program at the Institute that
works with underserved poor communities. If you go back as far as the War on
Poverty in the great society days of the 60s, we find the roots of the concept of
maximum feasible participation or they stated more simply in showing that
academics don’t go in and study communities and leave, but rather that the
community itself is empowered to both study and address their problems. How
does your model address the active participation of communities that you will be
working with? And are there any specific models that you implement that
address quality health care and health outcomes?

Dr. David Satcher: Dr. Regina Benjamin, the President’s Surgeon General, when
she was sworn in, talked about the fact that she got involved in community while

a student here that the faculty didn’t send her, they went with her, this institution
has a mission that embraces community intervention. But you give me an
opportunity to announce the newest program coming out of Satcher Leadership
Institute, hopefully starting in July, will be the community health leaders
development program. In this program, we will invite our partners in the
community, churches, schools, sororities, fraternities, community groups, housing
groups, we will invite them to send representatives, if you will, who are interested
in becoming community health leaders and we will spend time with them. We will
learn from them. They will hopefully learn from us.

Loren Bonner: Doctor, while you served as surgeon general, you released the
Surgeon General’s Call to Action to Prevent and Decrease Overweight and
Obesity along with your prescription for healthy living, which outlined that need
for physical activity and healthy eating that you are just speaking about. Now,
fighting obesity has been getting a lot of attention recently, certainly from Michelle
Obama and Let’s Move campaign, and we know that the obesity epidemic is not
going to get solved in the clinical exam room. So, what are the community-based
policy interventions that can help prevent and hopefully even reverse obesity?
How are you approaching that with your institute?

Dr. David Satcher: Well, let me say we had a little bit of a head start on that.
When I left government in 2002, I worked with the group to develop what we call
Action for Healthy Kids and that program centers primarily around working with
schools to try to get them to a return or an engage in physical education K-12
and to model good nutrition. In other words, our argument is that we are guilty of
addicting out children to sedentary lifestyles and poor eating habits, and our
argument is that the schools are supposed to be the great equalizers, whether
the children come from a poor home and an unsafe community or whether they
come from a community in which they are walking trails and biking trails.

Mark Masselli: We are speaking with Dr. David Satcher, former U.S. Surgeon
General and Director of the Satcher Health Leadership Institute. Well, fighting
obesity is certainly urgent, there are other dramatic examples of health disparity
in our country. Birth outcomes with persistent higher rates of infant mortality for
African-American babies is one, the rate of HIV infection in minority groups is
another. Are you addressing specific areas of health disparity or addressing the
issues on a global perspective? And then how do you decide where to focus the
institute’s attention?

Dr. David Satcher: We do try to deal with the global issues related to taking on
any such problem in terms of leadership. One the one hand, we try to have
people on our team who have special strengths and interests in various areas.
At the same time, overall, we try to make sure that we are preparing people to go
out there and deal with global issues.

Loren Bonner: Dr. Satcher, while in medical school yourself at Case Western in
the 60s, I have read that you helped convince the administrations recruit minority
students and you are doing the same thing today at Morehouse. Tell us about
why this has been a life’s mission for you to recruit and teach a generation of
diverse public health leaders and health care professionals.

Dr. David Satcher: I have been concerned about the lack of diversity in the
health profession. I don’t believe again that we can eliminate disparities in health
without diversity in health profession. And I am not one who believes that you
have to have a white doctor for a white patient or a black doctor for a black
patient, I don’t believe that. I believe that the health system has to present a
diverse picture to the communities we save in order for people to feel
comfortable.

Mark Masselli: Speaking of the health system, Dr. Satcher, you were involved in
rebuilding the health infrastructure in New Orleans after Hurricane Katrina. The
disaster highlighted a broken public health care system and a lack of health
resources for poor and minorities. How can these lessons be applied
elsewhere?

Dr. David Satcher: You know it’s interesting because we are talking about New
Orleans and we are still involved in that by the way. We talk about the health
problems before, during, and after the storm. Louisiana had some of the worst
statistics in the country in terms of obesity and diabetes and HIV/AIDS before the
storm. And so, what happened was of course the storm exacerbated those areas
of disparities. And so, what we are trying to do is to make sure that we rebuild
the system in such a way #1 that it uses technology appropriately that the
records will be electronic, they can’t be washed away by water, but also that we
put as much emphasis on health promotion and disease prevention as on
treatment. So we have gotten involved with some clinics where we are trying to
model the use of electronic health records and this outreach for community
education.

Loren Bonner: Dr. Satcher, you are well acquainted with Healthy People 2010
which began in 2000 by United States Department of Health and Human
Services as a nationwide health promotion and disease prevention plan that
could be achieved by the year 2010 and here we are of course at the year 2010.
In your mind, what was achieved and what are the objectives now proposed for
the Healthy People 2020 initiative?

Dr. David Satcher: I think we have focus on disparities in a really great way
throughout the country. We have all the federal agencies beginning with the
CDC and NIH funding programs, specifically target disparities in health. We have
community programs. Almost every major foundation that deals with health is
now targeting disparities in health and many of the health plans of course have
implemented programs to make sure that there are not disparities in the quality of

care that their patients receive. So I think this heightened awareness and
engagement with the issue of disparities in health has been the most important
outcome. The downside of all that of course is that here have been so many
negative factors at play since that goal was released and I mentioned before, you
have added people to the uninsured roles, you have made it more difficult for
people with insurance to get care. So if you just take that one thing alone, you
have more unemployed people, so obviously it becomes sort of social
determinants of health. For many people, they have gone worse. You can argue
that the goal didn’t stand much of a chance in that environment. And now, of
course, we have an opportunity hopefully to change that environment. I think
that Health People 2020 would focus much more attention on social determinants
of health following the lead of the World Health Organization.

Mark Masselli: Dr. Satcher, you have been a strong proponent of universal
health care. What are your thoughts about the pending Health Reform Bill in
Washington?

Dr. David Satcher: Let me start with the positive things. If the President bill that
came out of the senate were passed today, it would do three things. It would
certainly include over 30 million more people under the umbrella of the insured.
It would immediately make it impossible for people to be excluded because of
preexisting conditions. Almost immediately, it would prevent the insurance
companies from dropping people from coverage once they will severely yield.
So, if we had to settle for the situation as it is today, it would be a tremendous
step forward, even though I am disappointed that we haven’t talked enough
about the opportunities for prevention and wellness.

Loren Bonner: Dr. Satcher, our listeners are a curious group, so when you look
around the country and the world, what do you see that excites you in terms of
innovation and who should our listeners of Conversations be keeping an eye on?

Dr. David Satcher: I thought about this recently because Chile was one of the
first countries that the team from WHO that I was on visited, and the reason we
started our journey on how to achieve health equity in Chile was that Chile had
made a commitment that for the children of the poor, starting at three months of
age, it would invest in day care, good nutrition, and as they got older, physical
activity and learning. So, Chile had said in essence, we would rather invest in
these children in terms of their education and their physical activity than to wait
and invest in them when they get sick or when they get on Medicare, on welfare.
And not only is it more cost effective, but it’s more humane because we have an
opportunity to prevent violence, to prevent ill health. I hope that Chile would be
able to pursue this and they are obviously trying to just do it aftermaths of the
earthquake.

Mark Masselli: Today, we have been speaking with Dr. David Satcher, former
U.S. Surgeon General and Director of the Satcher Health Leadership Institute at
Morehouse School of Medicine. Dr. Satcher, thank you for joining us today.

Mark Masselli: Each week, Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. This week’s bright
idea focuses on creating Safer Routes to School. The Safer Routes to School
program has been making it safe and enjoyable for children to walk and bike to
school in several communities across the country. For the past five years, the
program has assisted communities with strategies and creative ideas for
implementing Safe Routes to School programs. Travel to school by walking and
bicycling has declined dramatically over the past several decades. The adverse
impact on this trend on air quality, traffic congestion and childhood health are
alarming. These programs can bring a wide range of benefits to students and
the community. These include an easy way for children to get regular physical
activity they need for good health and even to ease traffic jams and reduce
pollution around schools. To highlight just one example, the small town of
Wharton Borough, New Jersey, started their Safe Routes pilot program in 2005
with a small grant from the North Jersey Transportation Planning Authority.
Wharton Borough is a compact community where students are not bussed to
school and safe alternatives to driving were needed. The community kicked off
the program with an annual walk-to-school day. The event was a huge success
and attracted parents, teachers, community volunteers, and 58% of the student
body. The following year’s walk-to-school day attracted even more. 70% of the
student body and Law Enforcement officers participated to ensure safety. After
experiencing success with walking, the community went on to organize an annual
bike rodeo. Education components were also added. Teachers included
environment impacts and mathematics involved with walking to school in their
lesson plans. After two successful years with the program, the North Jersey
Transportation Planning Authority gave two of the schools funds to pay
infrastructure improvements like a raised crosswalk at the three-way intersection
in front of the school and sidewalk extensions and repairs around the school
grounds. The two schools have also received money for helmets and new
bicycle racks. The National Center for Safe Routes to Schools is now accepting
grand applications for creative youth-focused ideas that support safe walking and
biking to school. To learn more or see how your community can start a Safe
Routes to School program, visit Saferoutesinfo.org, creating safe routes to school
to reduce traffic, improve health, and make communities more livable, now that’s
a bright idea.

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of Wesleyan
University at WESU, streaming live at Wesufm.org and brought to you by the
Community Health Center.