Health Disparities: Dr. Uché Blackstock Talks About Advancing Health Equity

Dr. Uche Blackstock

[Music]
Female : Welcome to C onversations on H ealth C are with Mark Masselli
and Margaret F linter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery and the great minds who are shaping the health care
of the future. This week, Mark and Margaret speak with Dr.
Uche Blackstock , F ounder and CEO of Advancing Health Equity .
An organization spawned out of her own experience as an
emergency physician, med school professor and a member of
the first legacy family of Af rican American women to graduate
from Harvard Medical School. She talks about our mission to
address racial inequity as an American health care issue, as
well as the medical profession and the need to elevate people
of color into leadership in health care.

Lori Robertson also checks in M anaging E ditor of
F act C heck.org looks at statements spoken about health policy
in the public domain , separating the fake from the facts . W e
end with a bright idea that's improving health and well - being
in everyday lives. If you have comments, please email us at
[email protected] or find us on Facebook or Twitter. We
love hearing from you. Y ou can also ask Alexa to play the
program. Now stay tuned for our interview with Dr. Uche
B lackst ock here on C onversations on H ealth Care .

[Music]

Mark Masselli: We're speaking today with Dr. Uche Blackstock, founder and
CEO of A dvancing H ealth E quity, which she created to address
racial health disparities in the American healthcare system. Dr.
Blacks tock is an emergency medicine physician who until
recently was the Faculty Director for R ecruitment, R etention
and I nclusion at the Office of Diversity A ffairs at the NYU
School of Medicine.

Margaret Flinter: Dr. Blackstock previously served as chief resid ent in
emergency medicine at SUNY Downstate Medical Center. She
earned her undergraduate and her medical degrees from
Harvard, her frequent media appearances addressing health
inequities during the COVID - 19 pandemic have led to a new
position as medical co ntributor for Yahoo News . Dr.
Blackstock, we welcome you to C onversations on Health Care .

Dr. Uche Blackstock: Thank you so much for having me.

Mark Masselli: Yeah, Dr. Blackstock I think one of the great injustice s being
amplified by COVID - 19 is that blac k indigenous people of color
in this country have experienced far worse impacting

Dr. Uche Blackstock

outcomes from the Coronavirus, something you predicted
would happen. You're based in New York, the original hotspot
in the United States. Y ou've been chronicling what you hav e
seen in clinics across the city. I wonder if you could paint for
our listeners a picture for us of what racial health disparities
look like in a pandemic .

Dr. Uche Blackstock: Sure, yeah, and I will just say that there are many people who
have come befor e me, researchers like Dr. Kumar Jones, Dr.
David Williams at Harvard, who have just been doing this work
for decades and who , who’ s whose on who’s work has been
foundational in this movement to address health inequities,
and I'm so deeply grateful to them . I have my organization,
Advancing Health Equity a nd obviously health equity is
something that I'm always thinking about.

W hen I was seeing patients back in March here at different
u rgent c are sites in Brooklyn, I noticed with m y very own eyes
that my dem ographic of our patient population literally shifted
w ithin weeks . I t was actually quite profound, because you
know, Brooklyn is evolving as the parts of it that are
gentrifying, and so I take care of a very diverse racial, socio
economically group of pati ents. But what became very clear
was that I was mostly seeing black and brown patients, mostly
the essential workers and service workers. T hose are the
patients who were coming in predominantly with COVID - 19
symptoms, the patient s who didn't really have th e luxury of
being able to work from home. T hat was very apparent to me
in the beginning. E ven before New York City released some of
its own data on which communities are being impacted , my
own anecdotal observations have left me very concerned.

Margaret Fl inter: Well, Dr. Blackstock, I think that comports very much with
what we've seen across the country, but certainly starting in
New York. T he testing wasn't widely available in the early
phases of the pandemic to anybody, maybe especially to
communities of color. W e certainly watched from not far away
what was going on in New York as the ICUs were overwhelmed
and you had to be deeply moved by the way the essential
workers still showed up for their jobs every day at the grocery
store, in the nursing home, in the hospitals. Y ou've addressed
it, but maybe you'd like to talk a little more about the impact
of racial disparity not just within the healthcare system, but
really in the economic system and how that's now played out
over these last several months.

Dr. Uche Blackstock: No, yeah, absolutely. I have to say that seeing it with my own
eyes, and then being someone who studies in these inequities

Dr. Uche Blackstock

just -- it was moving , it was incredibly powerful and led me to
write about it and want to amplify these messages. But what
we’ve seen is that through this pandemic, it's not just a health
impact, we've also seen a huge economic impact on black
communities and other communities of color. I don't think
that's a surprise, right , I think that the factors that have caused
black communities to be disproportionately impacted are the
same factors that have caused these communities to be
vulnerable. T hey're all related to systemic racism.

But what I think is interesting is that we 've seen, while black
people just proportionatel y represented among essential
workers , we're also represented among people who don't
have job security, who were more likely to lose jobs during the
pandemic, who were more likely to have to leave health
insurance a s a result of that job loss. We've also s een similar
trends with black owned businesses that they were less likely
to have cash on hand to get them through that pandemic.
W e've seen many black owned business, small businesses have
to close. We say we're not just seeing a health impact, but a
real ly significant economic impact. I think that any strategies,
any policy that is going to address on supporting these
communities in this moment, have to not only address the
health care system, but also have to address jobs and housing
and other areas as w ell.

Mark Masselli: Well, that's such a great point of how we're going to get
people through the pandemic. W e're coming up in October,
seven months into the pandemic, and you know a l ot more
about how the virus spreads. New York continues to take, I
think, stringent public health precautions, but many other
states have been lacks in their public health protocols. We're
seeing case numbers rising in various parts of the country.
Share with us your concerns about the -- around the pandemic,
as we head ed into t he colder months with, I think, mixed
messages from the federal government and your concerned
for vulnerable populations, again, who will most likely be
hardest hit?

Dr. Uche Blackstock: Yeah, I have to agree the messaging h as been incredibly
mixed. Th e wa y it's been done, it's been incredibly concerning
as well. I think what we've seen in terms of political
interference in terms of the FDA ’s work and the CDC ’s work
has really has undermined any remaining trust s that b lack
indigenous and other communities o f color have had, excuse
me, for our health care system. I actually worry that once we
do have a safe and effective vaccine, whether these
communities will want to take it, whether they will believe

Dr. Uche Blackstock

that this is a vaccine that would be helpful to them. I t hink as
we're going into the winter, as you mentioned, we're seeing
states that are not really enforcing any of these basic public
health measures that we know actually work. I think that even
here in New York City, we can't let our guard down, which is
wh y I think that -- and although we haven't seen any
significant effort, we really need to target the most vulnerable
communities. W hat does that look like? It's not just about
getting PP E , but it's about messaging and outreach.

I've always advocated for sta te and local entities to really
collaborate with community based organizations,
organizations that are already on the ground, doing this work,
and whose leaders are considered trusted by these
communities , church based organizations . R eally forming
those a lliances, I think , will be crucial as we head into the
winter.

Margaret Flinter: Well, you are right on, we're certainly thinking about this as
we anticipate the flu season and plan for and look beyond that
to COVID . I guess, I would ask you -- totally agr ee with your
strategic sense of both the messaging and the messenger as
being incredibly important. But as you think about a COVID
vaccine being available, hopefully, in the not too distant
future , kind of what are your hopes and fears for how this is
goin g to go, both in terms of making sure that we engage
everybody in the trials that are going on , but also that we are
straightforward and honest about risks and opportunities, but
that we don't miss this opportunity to protect everybody, and
particularly th e people who are most vulnerable . It’s a huge
challenge . What are you thinking about that?

Dr. Uche Blackstock: That's such a challenge. I think what we saw actually, I think, in
the last one, two weeks, one to two weeks is the National
Medical Association , which is the oldest and largest group of
black doctors have actually taken upon itself to develop a task
force that's going to bet F D C and CDC recommendations
around vaccines and therapeutic. T his is where we are , we're
at this point where I don't think this is -- there’s ever been
precedent for this before . The National Medical Association
has never done this before, but obviously felt that there was a
p rofound need to do this because black communities are being
disproportionately impacted.

When I think about what needs to be done, a lot of it is in
terms of policy. T here's the J obs and Justice Act that the
Congressional Black Caucus is currently working on, and a lot
of the policies are addressing jobs, housing, and also

Dr. Uche Blackstock

specifically COVID - 19. But we rea lly need to get those pushed
through so that we can get funding to our most vulnerable
communities.

Mark Masselli: We're speaking today with Dr. Uche Blackstock, F ounder and
CEO of Advancing Health Equity to address racial health
inequities in the American health care system. She is also the
medical contributor at Yahoo News. Dr. Blackstock you’ve
really been speaking truth to power in terms of the needs that
and responsibilities that local, federal and state organizations
have to deal with these health ine quities. Y ou were just talking
a moment ago about the social determinants of health and
you noted in your own experience, as a frontline provider in
emergency room, that you would see patients regularly who
didn't have adequate health insurance , lacked ade quate
housing, we re facing food insecurity, working in low wage
jobs, oftentimes without the proper protection or PP E. I
wonder if you could talk about your quest to address social
determinants as one of the most effective ways to improve
health outcomes f or the black indigenous and people of color
populations b eyond the pandemic . W hat's your thinking about
the steps that we need to take to improve these disparities?

Dr. Uche Blackstock: I think that, in June, I testified in front of the F lex
Subcommittee o n the c oronavirus . S ome of my
recommendations for them , t hey weren't necessarily specific
to the pandemic . T hey were specific to what are the needs of
our most vulnerable communities. But a lot of the policies I
mentioned to them were around housing around
opportunities for home ownership, and opportunities for
building wealth and using policy to support those ideas.

E ven thinking about investing more into public housing,
investing more into mortgage programs that can provide a low
interest loans to first t ime homebuyers. I'm thinking about
how often credit is used to help people get mortgages, but
then at the same time we know that black and brown
communities are more likely to have lower credit scores and
how that influences the ability to gain mortgages, and so
w orking on programs that can address that financial literacy.

I think that when I think about what it's going to get us out of
this, this is going to be a long term committed effort. I think on
the part , it has to be on the part of this -- our feder al
government, also at the state and local levels, but we really
need to be funneling resources. I think that's what -- because
we've seen how federal policies like redlining, right, like other
aspects of the new deal, like the GI Bill ha ve essentially lef t

Dr. Uche Blackstock

these communities disinvested in for four decades. W e're
seeing the combination of that and so we need to get us out of
that is policies that will help to empower community members
to help them to build wealth, because we know that is directly
linked to health outcomes.

Margaret Flinter: Dr. B lackstock, we read your compelling piece in the
publication st at, why black doctors like me are leaving faculty
positions in academic medical centers. H ere you are member
of Harvard's first legacy families of African - American women
to graduate from Harvard Medical School, your mother then
later you, your sister, very impressive, very impressive
milestones .

B ut the overall numbers tell a different story, right, very low
representation across really all the health profe ssions of
people of color. Y ou've made some efforts previously at NYU
as Faculty Director of M inority R ecruitment , but now at
Advancing Health Equity to really change this picture to
improve , I mean the early recruitment and gaining the interest
of people and coaching them through the training pipeline and
then retention when people are in practice. Tell us about that
work that you're doing. It's very exciting work and so needed.

Dr. Uche Blackstock: No, thank you so much for asking about that , b ecause no, as
you mentioned, the numbers are still incredibly small for black
physicians, but also other health care professionals as well. I
also want to emphasize that , I know not everyone wants to be
a physician a nd that there are other opportunities within
health care such as nursing, physician assistant, physical
therapy, occupational therapy. But what I think has become
incredibly clear is that waiting until students get to college,
and are premed that it's too late. It's much too late . It had to
start -- it's s o interesting.

I had tweeted about this last week, but it has to start at maybe
even before kindergarten, right, it has to start -- not just in
terms of exposure, mentoring and sponsoring these children,
but also thinking about the educational system in ou r
communities, right. O ften the schools are underfunded, right?
W hat are we going to do policy wise about that ? Well, what
our health care institutions going to do about forming public
private a lliances and programming so that we can work with
kids startin g from when they're little to expose them to these
health care professions, because I think about my own mother
who was fortunate enough to have someone in college . S he
was the first person in her family to go to college, but it was
her chemistry professor who suggested that she apply to

Dr. Uche Blackstock

medical school. S he had no role models before that.

How can we just how can we start that much, much earlier in
the pipeline, because, as we've seen, since the 70s, since
diversity initiatives have been enacted by medical s chools, we
really haven't seen a change in the percentage of bl ack
physicians . I always tell people, the same reason that we're
seeing racial health inequities is the same reason that why we
see the very low number of black health care professionals, it's
all connected, it's all related. W e can't b and - aid program
starting in college, it's simply not going to work. W e also need
healthcare institutions to realize their part and their role in
investing in the communities they serve, but also in the next
genera tion of health care professionals, that it's up to them as
well , it’s their part as well.

Mark Masselli: I want to pick up on that theme of messaging early. O ften ,
w hile we have some advances that are happening on the
vaccine, y ou've recently said in Yahoo News that we also need
to plan for the year ahead and beyond, and that we just need
to remind people that they're going to need to be wearing
masks, social distancing, and taking other precautions. But
there is a question about the vaccine and who will ac cess it
first. I know you're concerned, I think we all are concerned
about communities of color, we'll have a perhaps difficulty in
accessing them . I’m wondering how you're thinking about it,
how you're trying to advise decision makers about their
responsi bility to make sure targeted populations are early on,
but also that were very clear early on about our
communication, about the science, and also the
responsibilities that individuals have. Could you share with us
a little of your thinking?

Dr. Uche Black stock: Sure, absolutely as I mentioned a little bit earlier, I think that
what we've seen is an undermining of public health messaging
by this administration, right, which is led to further distrust by
the public. B ut what I am seeing that is reassuring is that there
are organizations like the National Medical Association, but
also their advisory groups that are out there advising on who
should be -- on what the process should be that we should be
waiting for adequate data from our phase three clinical tria ls,
that we should not be rushing this, so to make sure that we do
have a safe and effective vaccine. But then also, the other part
of it is ensuring that we are putting -- and I think that the
pharmaceutical companies and vaccine manufacturers are a
littl e bit -- w e're a little bit late to this . B ut I see that some of
them are picking up on it that they really should have been
focusing on how are we going to recruit community members

Dr. Uche Blackstock

from black indigenous and other people color communities is
so important .

I think that -- actually, w hat some data shows is that
communities of color are actually more likely to engage in
clinical trials, if you tell them, these are the risks and benefits
to the individual , to the community , to the greater good. They
actually a re more likely to want to enroll in studies. I've been
seeing over the last few weeks more effort being put into that,
because I think because of we've been amplifying that
message , that message is getting out there.

T hen ultimately, I think , along the way we're going to have to
make sure that once there is a safe and effective vaccine that
that distribution process, as you mentioned, is a fair one,
because I think we're seeing some of the data coming out from
some -- or the recommendations from several adv isory
committees are saying that we can't explicitly say race, but
we'll say if you are a health care worker or an essential or you
have risk factors for being at -- if you're at increased risk for
being infected with coronavirus. I think that we need to h ave ,
actually more nuanced conversation about that , because I can
sense that some are difficult or some have difficulty saying
we're go ing use race , right? But what we've seen what racism ,
right, not race has done in terms of health outcomes, right.

Margar et Flinter: We've been speaking today with Dr. Uche Blackstock, the
F ounder and the CEO of Advancing Health Equity and medical
contributor at Yahoo News. Learn more about her work by
going to advancinghealthequity .com. Y ou can follow her
coverage of the c o ronavirus at Yahoo news.com . Dr.
Blackstock, we want to thank you for the work you've done
and the work that you will do to advance the cause of health
equity, and for joining us today on C onversations on Health
Care.

Dr. Uche Blackstock: Thank you so much for having me and for this thoughtful
discussion.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award winning
journ alist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what
have you got for us this week?

Dr. Uche Blackstock

Lori Robertson: President Donald Trump has touted an 85% decline in the
nation's COVID - 19 case fatality rates since April, and has
attributed the drop to improvements in treatment. But better
treatment is only part of the story. Experts say part if not most
of the decline can be explained by expanded testing an d a shift
toward younger people rather than higher risk older folks
catching the c oronavirus. Since the end of July, Trump has
included the impressive sounding statistic in press briefings
and rallies. O n July 27 briefing in North Carolina, Trump said ,
“Du e to the medical advances we've already achieved and our
increased knowledge and how to treat the virus. The mortality
rate for patients over the age of 18 is 85% lower than it was in
April. ” The case fatality rate is the percentage of deaths from
the coro navirus among the confirmed cases.

The President is correct that the case fatality rate has fallen
substantially since April. We calculated a crude case fatality
rate of 7.7% for all ages for April that dropped 83% to 1.3% in
the month of July, and further dropped to 0.9% for the month
of August for a total decline of 88% since April. But Trump is
wrong to attribute the steep decline only to treatment
improvements when other factors are also at play.

In the beginning of the pandemic when testing was still
e xtremely limited. U . S . was not capturing many of the lists of
your COVID - 19 cases, which led to an artificially high case
fatality rate. During the month of April, only about 5.3 million
tests were performed. But in July and August 23 million tests
were pe rformed in each month according to the COVID
tracking project. It also matters who is getting sick, and that
has also changed over time.

One expert told us that early on many outbreaks occurred in
nursing homes where COVID - 19 mortality is very high. But no w
more younger people are becoming infected and they are at
lower risk of death. The Centers for Disease Control and
Prevention said people ages 20 to 29 accounted for more than
20% of c oronavirus cases from June to August. T hat's my fact
check for this we ek. I'm L ori Robertson, Managing Editor of
F act C heck.org .

Margaret Flinter: F act C heck.org is committed to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, e - mail
us at www.chcradio.com , w e'll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on
Health Care.

Dr. Uche Blackstock

[Music]

Margaret Flinter: Each week C on versations highlights a bright idea about how to
make wellness a part of our communities and everyday lives.
People living in Sub - Saharan Africa have tougher odds a t
overcoming diseases. T he problem is not just the lack of access
to health care providers. But once someone is diagnosed with
an illness, access to vital life saving medicine is out of reach for
many who are sick simply because they can't afford them.

Gregory Rockson: Africa has some of the highest drug prices in the world, simply
because it's a free pricing market. Y ou can take a single
medicine and two pharmacies next to each other will sell that
same drug at wildly different prices.

Margaret Flinter: Gregory Ro ckson is the founder of mP harma, a nonprofit
organization that seeking to address in equities in drug prices
in Africa and the supply chain that often puts these life saving
drugs out of reach of the people who need them. mP harma
operates in four African countries, it decided to tackle the
problem by redirecting the supply chain that force s small
independent pharmacies and clinics to source their own drugs ,
and help offers these entities the chance to outsource their
procurement for pharmaceuticals .

Gregory Rockson: W e realized that if we could begin to bring together all these
independent pharmacies and remove the pressure that they
have to face in sourcing their own drugs, we can begin to
address the issue of medicine availability and affordability.

Margaret Flinter: Rockson says they help improve the drug procurement supply
chain by colle cting data on actual drug sales, which allows
health care entities to avoid over or under stocking, and it
reduces their vulnerability to fraud and corruption, which
sadly is rampant in d rug supply chains in parts of the world.

Gregory Rockson: The beautif ul thing about the service that we offer them is
that not only are we taking ownership of the supply chain, we
ar e also providing the financing to purchase the inventory. We
offer them a simple value proposition , pay only when you
dispense the drug to the patient. Beyond having the parts
available, we actively help them manage their inventory.

Margaret Flinter: Rockson says another important benefit more affordable drug
supplies help clinicians better manage patient outcomes.
mP harma was a 2019 recipient of the S chool Foundation's
Entrepreneurship Award .

Gregory Rockson: W ith ou r focus on bringing down the cost of drugs that there
wi ll be a systemic change that even other actors will be forced

Dr. Uche Blackstock

to reduce their prices .

Margaret Flinter: mP harma , a nonprofit en tity that utilizes reliable data on drug
usage , eliminates fraud and waste in the drug supply chains ,
makes life saving medications more readily available to some
of the world's most vulnerable people, improves outcomes
and saves money. Now that's a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm
Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and h ealth.

Female : Conversations on Health Care is recorded at WESU at
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