The Urgent Fight for Health Equity | Yolandra Hancock | TEDxFoggyBottom

Summary

The video script narrates the tragic story of Mrs. Sarah Johnson, an 86-year-old African American woman whose life was deemed not worth saving by a doctor during the COVID-19 pandemic due to her age and race. It highlights systemic racism in healthcare, where black patients face higher mortality rates. The speaker, a physician and public health expert, shares her personal experiences and calls for action to dismantle institutional racism and health inequities, advocating for policy changes and corporate responsibility to improve health outcomes for black communities.

Takeaways

• 😔 Mrs. Sarah Johnson, an 86-year-old African American woman from Louisiana, was deemed unworthy of life-saving measures by a doctor during the COVID-19 pandemic.
• 🏥 The doctor in question prematurely recommended a Do Not Resuscitate (DNR) status for Mrs. Johnson, citing her age and alleged health conditions that were later contested.
• 📉 Mrs. Johnson's actual health conditions, as documented by other healthcare professionals, were not as severe as initially described, suggesting a potential bias in medical judgment.
• 🏢 The healthcare system involved is under investigation for similar alleged cases of racial bias in patient care during the pandemic.
• 🚑 Despite her age, Mrs. Johnson showed signs of improvement and was misdiagnosed with severe health issues that could have been managed with proper care.
• 🏡 She was sent home with hospice care, which implies a focus on palliative care rather than curative treatment, potentially due to the aforementioned bias.
• 🔍 The incident highlights a broader issue of racial disparities in healthcare, where Black patients may receive different or substandard care compared to their White counterparts.
• 🌟 The speaker shares a personal experience with their grandmother, illustrating the systemic nature of racial bias in healthcare and the importance of advocacy for patients of color.
• 📊 COVID-19 has disproportionately affected Black, Native American, and Latinx communities, with death rates significantly higher than those of White individuals.
• 🌐 The pandemic has exposed and intensified discussions about systemic racism and its impact on health outcomes, including the social determinants of health that affect communities of color.
• 💪 The speaker emphasizes the need for collective action to combat institutional racism and health inequities, advocating for policy changes and corporate responsibility.

Q & A

Who is Mrs. Sarah Johnson and what was her situation?

Mrs. Sarah Johnson was an 86-year-old African American woman from Louisiana who had dedicated her life to caring for others as a mother, grandmother, and nurse. She contracted COVID-19 and was admitted to a hospital overwhelmed with patients. Despite her age, she was independent and mentally sharp. However, she was deemed unworthy of being saved by a doctor due to her race and age.

What was the doctor's initial assessment of Mrs. Johnson's condition?

The doctor documented in Mrs. Johnson's chart that she was of advanced age, severely malnourished, had renal failure, and advanced dementia, which led to pushing for her to have a Do Not Resuscitate (DNR) status.

What were the actual conditions of Mrs. Johnson according to her medical records?

According to her medical records and other healthcare professionals, Mrs. Johnson was only mildly malnourished but significantly dehydrated. Her mental status was altered, which was not unusual for COVID-19 patients presenting similar symptoms.

What was the hospital's response to Mrs. Johnson's condition?

Instead of calling the family to inquire about her functional capacity, nutritional status, or mental status, the hospital informed the family that there was nothing they could do to save her. The family reluctantly agreed to hospice care, and Mrs. Johnson was discharged home.

What were the findings of the later investigation into Mrs. Johnson's case?

A later investigation revealed that Mrs. Johnson had improved prior to her discharge, no longer had renal failure, and her elevated blood sodium level could have been managed with IV fluids and close monitoring, potentially saving her life.

How did the speaker's personal experience relate to Mrs. Johnson's case?

The speaker had a similar experience with their grandmother, who was also prematurely discussed for a DNR status and end-of-life plan without a proper diagnosis. This personal experience highlights the systemic bias in healthcare.

What are the racial disparities in COVID-19 death rates mentioned in the script?

The script mentions that the age-adjusted COVID-19 death rates for blacks are over three and a half times that for whites, and for Native American and Latinx communities, it's at least two and a half times higher.

What is the role of social determinants of health in the script's discussion?

The script discusses how social determinants of health, such as where we live, work, and play, define 80% of our health outcomes and can either provide access to resources or facilitate the devaluation of black life due to systemic racism.

How does the script connect historical events like slavery to current health disparities?

The script connects historical events like slavery to current health disparities by discussing the transgenerational impact on the hypothalamic pituitary adrenal axes and how societal and legislative racism influence the social determinants of health.

What actions does the speaker advocate for to address health inequities?

The speaker advocates for communities to join forces, calling on elected officials to create norms, practices, and policies to dismantle institutionalized racism, and to hold big food and big soda accountable for their practices.

What is the speaker's approach to addressing health issues as a physician and public health expert?

As a physician and public health expert, the speaker uses their position to help patients with their health issues and address the social determinants driving those issues. They also work on raising the next generation of public health professionals, crafting legislation, and advocating for policy changes.

Outlines

00:00

😢 Inequality in Healthcare: Mrs. Johnson's Tragic Story

The first paragraph tells the heartbreaking story of Mrs. Sarah Johnson, an 86-year-old African American woman from Louisiana. Despite being independent and mentally sharp, Mrs. Johnson was admitted to a hospital overwhelmed by COVID-19 patients. A doctor deemed her life not worth saving due to her age and race, recommending a Do Not Resuscitate (DNR) order based on false claims of severe health issues. The hospital did not consult her family about her condition and prematurely discharged her to hospice, suggesting she was beyond help. However, a later investigation showed that Mrs. Johnson had improved and could have been saved with proper care. The story highlights systemic racism and ageism in healthcare, leading to tragic outcomes for elderly black patients.

05:00

🔍 Dismantling Health Disparities: Root Causes and Solutions

The second paragraph discusses the systemic roots of health disparities, particularly for black and brown communities, exacerbated by the COVID-19 pandemic. The speaker points out that health inequities are not just about disease burden but are deeply linked to social determinants influenced by historical and ongoing racism. Examples include the legacy of slavery, policy-driven community designs that limit access to healthy resources, and corporate practices that target communities of color with unhealthy products. The speaker emphasizes the need to address these systemic issues to achieve health equity, rather than blaming individuals for their health outcomes.

10:00

💪 Collective Action for Health Equity

The third paragraph is a call to action for communities to join forces and fight against health inequities. The speaker, drawing from personal and professional experience, emphasizes the power of collective action in achieving change, as seen in past civil rights victories. The paragraph outlines the speaker's multifaceted approach to combating health disparities, including clinical practice, public health education, legislative advocacy, and community engagement. The speaker vows to continue the fight against institutionalized racism in healthcare and calls on others to join in advocating for policies that promote health equity for all.

Keywords

💡Health Disparities

Health disparities refer to differences in health outcomes and access to healthcare services between different groups, often along racial or socioeconomic lines. In the video, health disparities are highlighted through the story of Mrs. Johnson, a Black woman who received inadequate care during the COVID-19 pandemic. The speaker emphasizes that Black and Brown communities face disproportionately higher death rates due to systemic inequalities in healthcare access and treatment.

💡Systemic Racism

Systemic racism involves policies, practices, and norms embedded in institutions that lead to unequal outcomes for different racial groups. The video underscores how systemic racism permeates healthcare, housing, and other sectors, disproportionately harming Black communities. The treatment of Mrs. Johnson, as well as broader examples like the higher COVID-19 death rates in Black and Native American communities, illustrates this issue.

💡Social Determinants of Health

Social determinants of health are the conditions in which people are born, grow, live, work, and age that affect their health outcomes. The speaker points out that factors like access to healthy food, safe spaces for physical activity, and affordable housing significantly influence health. The video ties the lack of these resources in Black communities to legislative racism and systemic inequities, which exacerbate poor health outcomes.

💡COVID-19

COVID-19 is a viral pandemic that has disproportionately affected vulnerable populations, especially communities of color. In the video, COVID-19 serves as an example of how existing health disparities are exacerbated in times of crisis. Mrs. Johnson’s experience, as well as the statistic that Blacks have a death rate over three times higher than Whites, demonstrates the pandemic's unequal impact.

💡DNR (Do Not Resuscitate)

A Do Not Resuscitate (DNR) order instructs healthcare providers not to perform CPR if a patient's heart stops or they stop breathing. In Mrs. Johnson’s case, the physician prematurely pushed for DNR status without fully assessing her condition, reflecting bias in how healthcare providers make life-and-death decisions for Black patients.

💡Gentrification

Gentrification refers to the process where wealthier individuals move into a lower-income neighborhood, leading to rising property values and the displacement of the original residents. The video discusses how gentrification is tied to systemic racism, pushing communities of color into areas with inadequate resources, poor healthcare, and subpar schools, further entrenching health inequities.

💡Legislative Racism

Legislative racism refers to policies and laws that create or perpetuate racial inequalities. The speaker connects this concept to housing policies like redlining, which historically denied Black families the ability to purchase homes, and the ongoing impact of zoning laws that concentrate poverty in Black communities. This history of racial discrimination has long-term effects on health, wealth, and social mobility.

💡Bias in Medicine

Bias in medicine refers to prejudiced attitudes and practices by healthcare providers that lead to unequal treatment of patients based on race, gender, or other characteristics. The video illustrates this through the doctor who undervalued Mrs. Johnson’s life, misdiagnosed her, and recommended hospice care prematurely. The speaker also shares a personal story about facing bias when advocating for her grandmother.

💡Big Food and Big Soda

Big Food and Big Soda are terms used to describe large corporations in the food and beverage industry, particularly those that profit from unhealthy products. The video criticizes these industries for targeting Black and Brown communities with aggressive advertising of sugary drinks, contributing to higher rates of diabetes, hypertension, and obesity. Despite public pledges to support movements like Black Lives Matter, these companies continue harmful practices.

💡Public Health Advocacy

Public health advocacy involves efforts to influence public policy, resource allocation, and social conditions to improve health outcomes. The speaker highlights their work as a public health expert, advocating for policy changes to address health inequities. This includes efforts to reduce sugary drink consumption, challenge corporate practices, and advocate for more equitable healthcare policies.

Highlights

Mrs. Sarah Johnson, an 86-year-old independent woman from Louisiana, contracted COVID-19 and faced medical bias.

A physician wrongly classified Mrs. Johnson as non-viable, pushing for DNR status, citing false diagnoses like advanced dementia and renal failure.

Mrs. Johnson’s actual medical records revealed only mild malnutrition and dehydration, which could have been treated with IV fluids and monitoring.

Her family was misled into agreeing to hospice care, and she was discharged home to die, exposing her family to COVID-19 risk.

The case of Mrs. Johnson reflects broader health disparities, particularly in how black patients are treated during the pandemic.

The speaker recounts a personal experience where her grandmother was similarly dismissed by a physician, prompting her to fly back to advocate for her.

COVID-19 has disproportionately affected black, Native American, and Latinx communities, with black death rates over three and a half times higher.

The pandemic exposed long-standing health inequities rooted in social norms, legislative racism, and systemic barriers like housing policies.

The speaker ties historical events like slavery and Jim Crow segregation to modern health outcomes, emphasizing the transgenerational impact of systemic racism.

Gentrification and policy-driven discrimination continue to affect communities of color, concentrating poverty and limiting access to resources like healthy food.

Corporate practices, especially in the beverage industry, disproportionately target black and brown communities, contributing to chronic health issues.

Despite challenges, communities of color have historically fought back and won against oppressive systems, including in areas like civil rights and campus segregation.

The speaker advocates for policies that dismantle institutional racism, calling on elected officials and corporate America to stop harmful practices.

The speaker highlights her work as a clinician, professor, and public health expert to combat health inequities and raise culturally competent professionals.

The call to action emphasizes that systemic change is possible, invoking the words of Congressman John Lewis: 'If not us, then who? If not now, then when?'

Transcripts

[Music]

mrs sarah johnson from my home state of

louisiana

was just a few years younger than my

grandmother at the age of 86

she had committed her life to caring for

others as a mother

as a grandmother and as a nurse

according to her family at the time that

mrs johnson contracted covet 19 she was

independent and feisty still able to

balance her checkbook and

recite scripture her age certainly put

her

at higher risk of dying from cove at 19.

her being black all but guaranteed it

you see when mrs johnson was admitted to

the hospital

which was overwhelmed with patients at

the peak of the pandemic

an encounter with a doctor deemed mrs

johnson's life unworthy

of being saved as was the case allegedly

for other black patients at this health

care system

now under investigation based on mrs

johnson's medical records

this physician pretty much wrote mrs

johnson off as non-viable

when she pushed for her to have dnr

status

do not resuscitate she documented in mrs

johnson's chart that

she was of advanced age that she had

severe malnutrition

renal failure and advanced dementia

except she didn't because also in her

medical records as noted by other

healthcare professionals

she was only mildly malnourished but

significantly dehydrated

and her altered mental status was not

that different than other patients with

covet 19

who present it with similar symptoms and

instead of

the hospital calling the family to

inquire about her functional capacity

her nutritional status her mental status

they informed the family that there was

nothing that the hospital could do to

save their matriarch

and so the family reluctantly agreed to

hospice and mrs johnson was discharged

home

a later investigation revealed that not

only had mrs johnson improve prior to

discharge

she no longer had renal failure her labs

did reveal that she had an elevated

blood sodium level likely due to ongoing

dehydration

or something as simple as iv fluids and

close monitoring

would have saved her life as she was

only mildly symptomatic

with covet 19. instead she was sent home

to die

and her family was put at risk for covet

infection and death

in having to take care of her when i

read this story

i was both infuriated and heartbroken as

it hit

really close to home and it left me with

questions like

what if she was younger would she have

survived what if she had been in a

different

hospital a different city a different

state what if she was white

this incident isn't specific to covet 19

and it certainly

isn't an uncommon occurrence as i've had

something similar happened with my

grandmother just a few years ago while i

was seeing patients i got a frantic call

from my aunt

who had taken my grandmother to the

hospital because of delirium and

difficulty breathing

she'd only been admitted for a couple of

hours when an attending physician

wanted to talk about her dnr status and

her end of life plan

he hadn't even figured out what her

diagnosis was but he wanted to talk to

us about

her dying so i had to leave my patients

in the lurch i dropped a thousand

dollars on a flight from maryland

to louisiana to advocate for my

grandmother

the outcome was a diagnosis of pneumonia

for her and thankfully i still have her

in my life

but it was also an opportunity to school

this position on bias and medicine

and in equities in healthcare

unfortunately unlike my grandmother mrs

johnson didn't have someone at her

bedside to fight for her

as is likely the case for numerous black

and brown people across the country

as the age adjusted covet 19 death rates

for blacks

is over three and a half times that for

once and in the native american

and latinx community it's at least two

and a half times higher

now let's be clear before march

conversations about

race-based differences in health

outcomes were limited to

public health lectures and academic

settings

then came kovit when 30 percent of a

state's population

makes up almost 80 percent of the deaths

related to covet clearly this pandemic

has revealed the ugliness within this

country that has existed

since its inception simultaneously

we beared witness to the murders of

ahmad arbury brianna taylor

and george floyd hearing yet again those

gut-wrenching words

i can't breathe

as we witnessed mr floyd call out for

his mother

as a person paid to protect us ended his

life with a knee

to mr floyd's neck

people like myself have invested our

entire careers

into dismantling the systems that

facilitate disparate morbidity and

mortality

revealed by this pandemic we understand

that these health disparities were

rooted in health inequities that existed

well before covet showed up

we also understand that this isn't

simply about disproportionate

burden of diseases like diabetes heart

disease

and obesity but about social norms and

legislative

racism that influence the social

determinants of health

those factors where we are born

grow learn live work play pray and age

that define 80 of our health outcomes

and either provide access to resources

like healthy food and

safe space for physical activity or

facilitate

the devaluation of black life society

the medical community included would

have us all believe that

disease risk police assault

and early death are all due to

individual behaviors

especially within communities of color

if we

act right if we eat right then we'll be

all right

as if the inevitability of diet-related

diseases

and dying on the streets is simply based

on personal choice

and not the systems in which those

choices are made

when i think back through what's an

excellent example of this i think back

to slavery i

think about my ancestors being stolen

from places like sierra leone

and having to travel through the middle

passage and the impact that that had on

their hypothalamic pituitary adrenal

axes

and how those effects have transferred

from generation to generation to

generation

if the dutch potato famine of 1944 in

europe

can facilitate increased risk of obesity

and heart disease among adults

born to women who were pregnant at that

time imagine the transgenerational

impact

of the combination of slavery jim crow

segregation and modern-day racism on the

health

of the black community and then you

combine that with policy driven

purposeful design of communities that

minimize access

to healthy food safe space for physical

activity and affordable housing

and instead maximize the deluge of fast

food establishments

liquor stores and dialysis centers this

isn't about individual behavior or

personal choice

but about systematic discrimination and

systemic racism with roots that run deep

from the federal government

to corporate america and it isn't simply

about

access to doctors like myself when we

know

that policies passed have implications

on health

in all ways from creating disparities to

facilitating

equity we can look at housing as a

perfect example

the federal housing administration is

notorious for having

historical institutional racial

preferences

that allow whites to have access to

capital and purchasing land

while simultaneously blocking out that

opportunity for african americans

and it isn't just at a federal level we

see it locally in states and cities like

the district of columbia

where race-based policies and

exclusionary zoning practices

have facilitated the concentrated wealth

within white communities

while shrinking it in black so much so

that the segregation created by these

policies

can still be seen now imagine

the multi-generational wealth loss based

on this institutional racism

and how that has impacted health but

i'll tell you you don't have to imagine

it

because it's still happening now it's

called gentrification

when developers partner with governments

to infuse resources and cash

to revitalize neighborhoods that results

in a demographic shift and a push of

communities of color into concentrated

areas of poverty

with inadequate resources subpar schools

and a fractured

health infrastructure this is just

limited

to federal and local policies if they're

legislating health disparities

corporate america is orchestrating them

and there's no better example

than the beverage industry they've

pledged their allegiance

to supporting the black lives matter

movement but their money speaks a

different tale

they over the past five years have

infused over a billion dollars

in advertising of sugary drinks with a

disproportionate amount of that funding

targeting black and brown youth to

increase consumption

while simultaneously vehemently opposing

any legislative action

used to curtail consumption of these

sugary drinks that are killing us

all while simultaneously making

record-breaking

profits and what's the result black and

brown children seeing at least twice as

many

advertisements for sugary drinks that

then facilitates increased consumption

and heightened risk for chronic diseases

like diabetes

hypertension and obesity but for all the

challenges within community

of color in terms of health disparities

and health inequities

all is not lost when we join our forces

together like superheroes

communities come together that's how

change happens

when they came for our music we fought

back and we won

when they came for our campus we fought

back and we won

when they came for our civil rights

we fought back and we won we're putting

everybody on notice

because now is the time to fight for our

health

our voices will not be muted and neither

will our health we will join together

and we will shut big food and big soda

down

from targeting our communities and

bringing poison to our children

we will call on our elected officials to

create norms practices and policies

to dismantle the institutionalized

racism that facilitates

these health inequities that's how

change happens

it's the foundation upon which i have

built my career as a physician

as a public health expert as a mother

and as a black woman

i use my position as a clinician to not

only

help my patients in their health issues

but to address the social determinants

that drive those health issues i use my

position

as a professor at the milken institute

school of public health at the george

washington university

to raise up the next generation of

culturally competent

community engaged public health

professionals

i use my expertise as a public health

professional to not only help craft

legislation

to decrease things like sugary drink

consumption

but i also call on big soda and big food

to stop their deceptive practices in

influencing our national and global food

policies

as a community member i advocate to make

sure that black

lives do matter and i write

testimony and give oral testimony to my

elected officials to make sure that they

legislate in a way that allows each of

us

to reach our full health potential

and when they don't i use my pin to vote

this journey although rewarding can be

quite challenging

but in the amazing words of the late

great incomparable

congressman john lewis if not us

then who if not now

then when

[Music]

you