From EMT to Physician Executive, Here’s How a Lifetime of Learning Shaped My Perspective on Health Equity

To address health inequity, we must first see it.

When I began my medical career, my early work experiences provided plenty of introductory practice learning how to treat people at risk and in pain. With time, those experiences also gave me something much more than expertise; helping individuals and families at their most vulnerable gave me perspective.

I grew up in Oakland, a blue-collar town in northern New Jersey. I wouldn’t say that my childhood was sheltered, but it certainly wasn’t diverse. Most of my friends looked like me. We shared similar backgrounds and enjoyed similar social activities: church, sports and Friday nights at the movies or the arcade (yes, it was the 80s!). When I was around my friends’ parents, they didn’t appear much different than my own. I was vaguely aware that my friends and I were lucky, but I really didn’t see inequity firsthand. That began to change when I volunteered as an emergency medical technician (EMT) in high school and college.?

As an EMT, I responded to emergencies in many homes. Some looked like my own, some looked very different. They all had one thing in common: they all needed help. What I didn’t appreciate then was how the shared human condition of physical vulnerability doesn’t really make things equal. While I began to see firsthand that many people faced challenges I’d never imagined, I was still too inexperienced to connect the dots between disparities in health outcomes and inequitable access to the resources that promote good health.

I wasn’t alone in my narrow perspective. It was evident every time my peers and I – and even my instructors – labelled patients as “noncompliant” when they seemed to neglect their health despite all the educational materials and health coaching they received.?If they didn’t make their appointments, they were similarly labeled “no-shows.”

Only after I began my residency did I start to see how non-medical drivers of health have a profound impact on our capacity to live the healthiest possible life. Working more closely with individuals, I began to realize that an unanticipated expense, like a car repair or medical bill, can decimate a monthly budget and disrupt even the best laid plans for routine checkups. I realized that adhering to a healthy diet to manage diabetes, weight loss or heart health is impossible when a family can’t afford to get nutritious meals on the table or has no nearby options to shop for healthy food. I realized that the trust that’s at the foundation of the doctor/patient relationship gets lost when health care providers don’t communicate in a way that respects the patient’s culture and beliefs.

With time, I began to grasp the even bigger picture: expanding access to care makes families healthier and communities stronger, and that translates into lower health care costs for everyone.

A Blueprint for Health Equity

Today, I’m putting that lifetime of learning to work closing gaps in health outcomes. I know that the causes of health inequities are complex; the work to improve maternal health serves as a case study of how addressing them requires multilateral action.

Along with the Blue Cross Blue Shield Association, Blue Cross NC is committed to reducing disparities in maternal health outcomes and infant health care by 50% in five years.?These disparities can be linked to rural geographies, socioeconomic differences, ethnicity and race to name a few. Nationally, for example, maternal mortality is three times higher among Black women and maternal morbidity is twice as high among Black women when compared to White women. In North Carolina, the rate of Black infant deaths is 2.66 times the rate for White infants and higher than the rate two decades ago.

Clearly, something needs to change, and the elimination of these disparities depends on targeting three fronts simultaneously:

1.?????Improving affordability and access. Pregnant women are more likely to encounter serious health problems if they don’t get prenatal care and information. Blue Cross NC’s My Pregnancy mobile app?provides free member support during pregnancy and after delivery. The app features vetted educational materials related to breastfeeding, labor and delivery; tools for identifying potential risks; pregnancy trackers; and more.

Our Healthy Blue Medicaid plan targets the care of populations with social risk factors by piloting doula services, promoting non-clinical support services delivered through community-based organizations and offering care management?that helps integrate services for pregnant members.

2.?????Improving quality and eliminating bias. Bias is part of the human condition. Biases aren’t necessarily intentional, but that doesn’t make them any less impactful. We’re all susceptible to it, and that includes even the most accomplished health care providers. Faulty assumptions based on race, class, gender identity or sexual preferences can seriously undermine the quality of care patients receive.

That’s why Blue Cross NC has invested in a March of Dimes educational program designed to reduce implicit bias among health care professionals working in maternity care settings. The course helps doctors, nurses, maternal care providers and doulas recognize how stereotypes can unconsciously impact decisions.

We’re also using focus groups to help us better understand the experiences of pregnant mothers of color. By hearing directly from our members, we have gotten a sharper picture of their lived experiences with physicians who treated them differently because of their race or socioeconomic background. Listening to and engaging directly with these members is an important step toward rebuilding trust in the health care system. Continued progress requires tangible action, and we are now sharing these findings with our network of physicians and working together to help build more cultural awareness and eliminate bias.

3.?????Addressing drivers of health needs. An estimated 20 percent of health outcomes are linked to medical care. The remaining 80 percent stem from socioeconomic, environmental, and behavioral factors. An expectant parent without transportation to get to prenatal care or grocery stores, or who doesn’t have adequate housing or access to nutritious foods runs a greater risk of difficulties during pregnancy.

Our Healthy Blue Medicaid plan offers breastfeeding and safe sleep support kits, in addition to providing members with free rides to doctor visits and support to help establish housing security. Through Blue Cross NC’s Drivers of Health Strategy team and our Community Engagement team, we are expanding our efforts to help North Carolinians secure improved access to the resources that are vital to healthy pregnancies, early childhood development and all-around good health.

We are rapidly broadening the scope of our efforts in pursuit of our ambitious goals, and we are not alone in our work to improve health outcomes in rural and underserved communities, not just in maternal health, but also in behavioral health and other areas. Blue Cross NC?is collaborating with non-profit organizations with local expertise and knowledge of the unique needs and opportunities in the communities they serve. Together, we are building a formidable coalition to address maternal health and other pressing health inequities in our state.

Embracing A Lifetime of Learning

Helping to transform health care so it works better for everyone requires us to see and assess the landscape for what it is … and to reimagine it for what it could be. Those formative moments early in my professional development shaped my vision of what needs to change.

Since then, each new experience over the course of my career in medicine has opened my eyes wider to the fact that the effectiveness of health care depends on a lot of things going right – often things outside of medical science. Unfortunately, because of bias, unmet needs, language differences, cost, access and many other factors, things are less likely to go right for some communities.

Looking back, I appreciate how, over the years, my observations as an EMT and medical student grew into a deeper empathy, which is the driving force behind my commitment to health equity. Learning has been a long, ongoing and rewarding process – one that has led me to a company that is proud to stake out its fierce commitment to making health care work better for all.