Taking Health Care to the Streets | Dr. Cheryl Whitaker | TEDxNashvilleSalon

Summary

The speaker, a doctor, shares personal experiences and insights on the barriers to healthcare access, particularly in low-income communities. They discuss the importance of preventive care and the impact of social determinants on health outcomes. The talk highlights the need for a holistic approach to healthcare, considering factors like transportation, mental health, and cultural beliefs. The speaker advocates for a community-focused, solution-oriented healthcare system that addresses these challenges to improve health outcomes and efficiency.

Takeaways

• 🎼 The speaker starts by singing a tribute to Dolly Parton, showing their appreciation for music and setting a warm tone for the audience.
• 🏥 The speaker grew up in a small town where medical care was only sought in emergencies due to fear and lack of knowledge about preventive care.
• 🦷 A personal anecdote about a dental decision at age 20 highlights the impact of limited medical knowledge on long-term health choices.
• 🏠 The speaker's family and community had misconceptions about hospitals and doctors, which contributed to a lack of trust in the medical system.
• 💼 The realization that having health insurance did not guarantee access to preventive care was a turning point for the speaker's interest in medicine.
• 👩‍⚕️ As a medical resident, the speaker observed patients with advanced, yet treatable conditions, questioning why disease progression was so common despite access to care.
• 🔍 In Chicago, the speaker noticed that even with insurance, patients faced significant obstacles in managing their health, leading to a deeper investigation into the systemic issues.
• 📊 Data analysis revealed that low income, more than race or ethnicity, was a significant factor affecting health outcomes, suggesting that economic factors play a crucial role in health care.
• 🛣️ The speaker emphasizes the importance of understanding community-specific factors such as transportation, child care, and mental health in addressing health care access.
• 🤝 The establishment of a company aimed at tackling the systemic and individual barriers to health care, focusing on local hiring and community engagement.
• 🌐 The speaker concludes with a vision of a global application of community-focused health care, potentially saving lives by addressing the root causes of health disparities.

Q & A

What did the speaker do to start the presentation?

The speaker began the presentation by playing a bit of Dolly Parton's music, expressing it as one of their favorite singers, and mentioned the possibility of singing 'Nine to Five' if allowed.

Where is the speaker originally from?

The speaker is originally from a small town called Washington, Georgia, which is about six hours away from Nashville.

What was the healthcare situation like in the speaker's hometown?

In the speaker's hometown, people rarely went to the doctor unless they were seriously ill or needed emergency care. There was a general fear and distrust of hospitals, and preventive care was not commonly accessed.

Why did the speaker choose to become a doctor?

The speaker chose to become a doctor after witnessing the lack of preventive care and the early deaths of people in their community from preventable conditions like diabetes, high blood pressure, and high cholesterol.

What was the speaker's first dental experience?

The speaker's first dental experience was at the age of 20, when they had a cavity and had to choose between an extraction or a root canal. They chose extraction due to a lack of knowledge about the long-term impacts of their decision.

What challenges did the speaker notice in their medical practice on the South Side of Chicago?

The speaker noticed that even though over half of the patients they saw had health insurance, they were still not managing their conditions well, leading to advanced cases of treatable diseases like diabetes, high blood pressure, and cholesterol.

What factors did the speaker identify as having a significant impact on health outcomes?

The speaker identified low income and living in low-resource communities as having the biggest impact on health outcomes. These factors often lead to limited access to beneficial resources and healthcare.

Why did the speaker decide to start a company?

The speaker decided to start a company to address the systemic and individual barriers that prevent people from accessing healthcare, with the aim of improving health outcomes and making healthcare more efficient and effective.

What is the speaker's approach to understanding and addressing healthcare issues in communities?

The speaker's approach involves understanding the community's cultural mores, disease burden, and individual barriers to healthcare access. They believe in hiring locally and building capacity within communities to improve health outcomes.

How does the speaker's company utilize technology to assist in healthcare delivery?

The company uses technology to enable its employees to access information about the specific health needs and resources of communities in real-time. This allows them to be better equipped to provide targeted support and interventions.

What is the speaker's view on the importance of mental health in healthcare?

The speaker views mental health as critically important, noting that it can affect a person's ability to access and benefit from healthcare. They believe that mental health should be given the same level of attention as chronic physical conditions.

What is the speaker's perspective on the role of healthcare insurance in accessing care?

While acknowledging the importance of healthcare insurance as a starting point, the speaker emphasizes that having insurance alone is not enough. They believe that additional support and coaching are necessary to help individuals navigate the healthcare system effectively.

Outlines

00:00

🎤 Reflecting on Early Life and Healthcare Awareness

The speaker begins by expressing gratitude to Nashville and pays homage to Dolly Parton. They recount their upbringing in Washington, Georgia, where healthcare was only sought in dire situations due to misconceptions and lack of preventive care. The speaker's first dental visit at age 20 led to a regrettable decision influenced by their limited health knowledge. This experience, coupled with witnessing early deaths in their community from preventable conditions, motivated them to pursue a career in medicine. As a medical resident, they observed patients with advanced, yet manageable, conditions, prompting a deeper inquiry into the reasons behind the progression of diseases despite access to care.

05:02

🏥 The Impact of Socioeconomic Factors on Healthcare Access

The speaker delves into the challenges faced by patients in accessing healthcare, even with insurance coverage. They highlight the significant role of low income and the environment in determining health outcomes. In Chicago, the speaker discovered that over half of their patients were insured but still struggled with managing their health conditions. This led to the realization that factors beyond insurance, such as transportation, child care, mental health, and fear of doctors, were impeding access to care. The speaker emphasizes the importance of understanding and addressing these barriers to improve healthcare outcomes, especially in low-income communities.

10:03

🌐 Establishing a Community-Focused Healthcare Approach

The speaker outlines the foundation of a company aimed at tackling healthcare access issues by understanding individual and systemic barriers within communities. They stress the importance of population health to inform interventions and the need for healthcare professionals to be aware of local health burdens and cultural perspectives on health. The company focuses on hiring locally to build capacity within communities and uses technology to inform and empower its staff. The speaker advocates for upstream investment in prevention and treatment rather than downstream management of advanced conditions, suggesting that a community-focused approach can lead to a more efficient and cost-effective healthcare system.

Keywords

💡Preventive Care

Preventive care refers to health services that are meant to prevent the development of diseases or conditions before they occur. In the video, the speaker reflects on their upbringing where preventive care was not a priority, as evidenced by the lack of regular medical check-ups and dental care. This lack of preventive care is contrasted with the speaker's later understanding of its importance in maintaining health and preventing serious conditions.

💡Health Insurance

Health insurance is a type of contract through which the insurer agrees to provide healthcare services for the insured in case of illness or injury. The speaker mentions that while having health insurance is important, it is not the only factor in accessing healthcare. The script highlights that even with insurance, many people still face barriers to receiving adequate care, such as lack of knowledge or other socioeconomic factors.

💡Primary Care

Primary care is the first point of contact for patients with the healthcare system and includes services provided by healthcare professionals who have the first responsibility for total health care. The speaker discusses the failure of primary care and prevention in managing the health of patients, noting that even with access to care, many patients present with advanced cases of treatable conditions.

💡Disease Management

Disease management refers to the methods and processes used to prevent, detect, manage, and treat diseases. The video script discusses the progression of diseases like diabetes, high blood pressure, and high cholesterol, which are manageable but often present in advanced stages due to poor disease management and lack of preventive care.

💡Socioeconomic Factors

Socioeconomic factors encompass a range of non-medical determinants of health, including income, education, and occupation. The speaker identifies low income as a significant barrier to health outcomes, noting that even with health insurance, low-income individuals often struggle to access and benefit from healthcare services.

💡Healthcare Access

Healthcare access refers to the ease with which individuals can enter and use the healthcare system. The script discusses various obstacles to healthcare access, such as transportation, child care, and mental health issues, which can prevent individuals from receiving necessary care even when they have health insurance.

💡Cultural Mores

Cultural mores are the customary values, beliefs, and practices of a particular culture or society. The speaker mentions the importance of understanding cultural mores in healthcare, as they can influence how patients perceive and engage with medical treatments and preventive measures.

💡Population Health

Population health is the health outcomes of a group of individuals, including the distribution of such outcomes within the group. The speaker discusses the importance of understanding population health to effectively address the health needs of a community, including the prevalence of certain conditions and the community's attitudes towards health and healthcare.

💡Healthcare Disparities

Healthcare disparities refer to the differences in the quality of healthcare received by different groups of people. The script touches on healthcare disparities, particularly in low-income and low-resource communities, and the need for healthcare providers to address these disparities to improve overall health outcomes.

💡Community Engagement

Community engagement involves actively involving members of a community in activities that affect their lives. The speaker emphasizes the importance of community engagement in healthcare, advocating for hiring local staff and forming partnerships with local organizations to build capacity and improve health within communities.

💡Healthcare Navigation

Healthcare navigation is the assistance provided to patients to help them access and navigate the healthcare system. The script discusses the idea of coaching patients to help them make the most of their health insurance and healthcare services, overcoming barriers to care and ensuring they receive appropriate treatment.

Highlights

The speaker begins with a tribute to Dolly Parton, reflecting on the importance of music and setting a warm tone for the talk.

Growing up in Washington, Georgia, the speaker highlights the lack of access to healthcare and the misconceptions about hospitals being harmful.

The speaker's personal experience with dental care at age 20 and the long-term impact of not understanding the importance of preventive healthcare.

The realization that even with health insurance, people were dying early from preventable conditions like diabetes and high blood pressure.

The speaker's journey into medicine and the observation of patients with advanced cases of treatable conditions due to lack of preventive care.

The discovery that primary care and prevention were failing patients, despite the presence of health insurance.

The speaker's move to Chicago and the realization that even insured patients were not managing their health conditions effectively.

The identification of low income as a significant factor impacting health outcomes, beyond just access to insurance.

The importance of understanding the community and its resources to effectively address healthcare challenges.

The role of social and economic factors in creating barriers to healthcare access, even with insurance.

The speaker's approach to understanding patients' own remedies and incorporating them into medical practice.

The cultural and community-specific factors that influence healthcare perceptions and the need to respect these in medical practice.

The speaker's decision to start a company aimed at solving the systemic issues in healthcare access and prevention.

The importance of hiring and training local employees to build healthcare capacity within communities.

The use of technology to equip healthcare workers with community-specific information to better serve patients.

The emphasis on upstream investment in healthcare to prevent downstream complications and costs.

The speaker's vision for a healthcare system that is efficient, effective, and cost-effective by addressing barriers to care.

The potential global impact of the speaker's approach to community-based healthcare, with the aim of saving lives.

Transcripts

hello Nashville thank you so much for

having me

jamming a little Dolly Parton here one

of my favorite singers so if they let me

sing I might sing nine to five if I had

a song but oh I need a clicker thank you

thank you guys so much so I grew up

actually my first time here in Nashville

I grew up about six hours away in a

small town called Washington Georgia and

where I grew up no one that I knew ever

went to the doctor for anything unless

they were seriously ill or if they went

it was definitely to the emergency room

as a matter of fact I remember growing

up my mom and family would say old that

hospital they kill people over there and

I thought okay has it become a doctor I

look back people's people's diseases

have progressed so far there was not

much that the hospital or doctors were

able to do but I also knew we had

insurance I was able to go through my

entire college career with but without

ever having a pap smear or learning

about self breast exams so we never

access preventive care when I was

growing up and I really didn't know much

about it at age 20 I had my first visit

to the dentist

I had a cavity I was in a lot of pain

and the dentist gave me a choice he said

look you can have an extraction we're

gonna have a root canal

and I was twenty years old he's playing

the root canal I'm like I don't think I

want that that sounds painful I'll take

the extraction I thought I was making a

rational decision but because growing up

I didn't know a lot about it I made a

choice that actually impacted me many

years down the line and in my 30s I was

able to take advantage of new technology

and correct it as I look back I would

hear my mom say so-and-so died this

person died and at the time these people

were in their 40s and 50s and I couldn't

put all together at the time but I knew

that many of them did have health

insurance coverage

but they were still dying early and they

were dying from preventable conditions

like diabetes high blood pressure high

cholesterol and sort of wandering there

we know what's going on it but

definitely inspired me to continue in my

career heading towards medicine and the

practice of as a young medical resident

out in California as learning internal

medicine I began to see patient after

patient again who would present with

advanced cases of conditions that were

related to very treatable and manageable

conditions like diabetes high blood

pressure cholesterol hepatitis etc and

began to wonder well why is that why is

it that people have access to care but

we're still seeing progression of

disease that's extraordinary remarkable

and it will impact their ongoing sort of

morbidity disease burden and their

ability to live a healthy and happy and

highly functioning life it was it was

clear that at that time primary care and

prevention which is what I was studying

and learning to be was failing many of

our patients many of my patients so

insurance was important but it wasn't

the only issue when I landed in Chicago

and began the practice of medicine on

the south side I realized that wow I'm

seeing over half the people I'm seeing

are actually covered what's what's going

on here what is it that we're missing as

we think about the treatment of

conditions that I was seeing over and

over what people weren't managing them

well and it really disturbed me so much

that I said gosh I've got to do

something about this I realized as I

looked at the communities that many of

my patients were from that they faced a

lot of obstacles and challenges getting

to the care that they needed it wasn't

as simple as having insurance in fact

seem to be a lot more complicating

factors as a scientist I realized as I

looked at the data that well this

transcends race or ethnicity

what's the factor there is there

something predisposing my patients to

not following up and not

in the care that they need what was

getting the way of access even when they

had health care insurance what we

figured out is that actually if you look

at all the data it's really low income

that has the biggest impact on health

outcomes in our country where you live

matters too and as we look at the data

there's a lot of data that shows you

that where people live influences and

has a great impact on their health care

outcomes low income and low resource

communities often have low resource

areas around them meaning there's not

much that they can access that's

beneficial for them sometimes health

plans or providers may have to intervene

to overcome barriers that people are

facing and obstacles that they're facing

transportation is one that we know is

important you got to get there sometimes

for families with child bear a child

bearing age child care is important

while mental health we really need to

think about it we know that it's there

and many times we don't pick it up

because we're not looking for it it may

get in the way of how people access

health care even recognize that they

have a mental health condition or and

they have a chronic condition that would

do well if it's better treated sometimes

people just don't want to go to the

doctor by themselves they may need

support some people are afraid of

doctors that's not unusual I know I took

my husband home I he's also a physician

we were in our late 20s and my mother

said to me she goes she was just staring

us she goes you all don't act like

doctors I said mom I'm your daughter she

so is as if a doctor might be an alien

right so we have to realize that there

are things like white coat syndrome or

just myths and fears related to seeing a

doctor and then follow-up sometimes you

get there but then the doctor asks you

to come back multiple times that might

get in the way if you're dealing with a

low income and low resource situation

now the social and economic factors if

you're in a low resourced environment

can be paralyzing what we know is from

us from a study get done at Princeton

and Harvard is that the the cumulative

cognate

load of excessive stress can take you

down 13 IQ points the ability to deal

with strapped with a with a doctor's

appointment or anything but an emergency

our patients just won't have that other

things are important well when I began

to really listen to my patients and

understand what I want to understand

well tell me more you you you don't want

to take the medicine I'm prescribing for

your high blood pressure

will you take anything and they say doc

I take oil

I take vinegar and garlic every day okay

vinegar and garlic how about I add a

little bit of this little water pill

here hydrochlorothiazide low side

effects you continue to take that and

let's see if together they might work

and you know what I actually want a lot

of battles just meeting people where

they are but that's real people have

their own remedies and in many

communities they may approach it

healthcare way different than the doctor

might approach it and we're gonna have

to take some of those things into

consideration in much of my medical

practice my patients would accuse me of

experimenting on them often you might

start a medicine your doctor might start

a medication on you let's say you're

taking something for cholesterol might

start you with the low dose and then

progressively increase the dose over

time well my patients would say doc why

are you doing that like don't you aren't

you really smart and then you go to all

these schools or should you know which

one works and how much I say well no we

have to sort of test your tolerance

every individual responds differently

well we often found that when I said I

had a medical practice my patients

thought that meant I was practicing on

them so these are things that you got to

think about as you as you deal in

different communities you want to

understand what are the mints the

cultural mores that influence how they

think about medicine what are those

things and we have to really think about

acknowledging those now it's not just

South Side of Chicago where this occurs

when I went home as a young

doctor and I begin to talk to my own

family I found that a lot of what I was

seeing in Chicago I saw it in Washington

Georgia so it turns out that these myths

are largely there they're around and

what's important for the medical

community is that we address those when

we are trying to meet patients where

they are to get them on track now I'm

solution-oriented

give me a problem I want to find it so I

found I'd sort of studied all these

problems over 15 years and I said you

know what I'm gonna start a company

we're gonna solve this I'm gonna do it

so first we start with individual issues

we want to understand what is get in the

way of a person accessing care we talked

about all the different obstacles that

might impact a person's approach to

healthcare then we have to think

systemically what are the system

barriers that are in a community we

talked about barriers and access in low

resource communities we have to

understand those we also have to

understand the disease burden in those

communities because we want to be well

equipped when we go in to help and

intervene and meet people where they are

that we know what they're dealing with

the science of that is called population

health you understand the broader

community and then you can really hone

in on the individual and be effective so

you armed your staff with great tools

they're able to go out and really make a

difference disease and burden is

important understanding where you are

what's going on in that community

there's a community in Chicago called

Humboldt Park it has the highest

incidence of diabetes in the city well

before you go into that community you

really need to understand how do people

think about diabetes in that community

because when you go in you're going to

want to be armed with that information

so that you're your starting point makes

sense for where you are mental health we

talked a little bit about it before

really important it is if for most a

chronic condition so it bears a nice the

same respect as diabetes and high blood

pressure and high cholesterol emia

because it's going to require ongoing

contact with the healthcare community to

support that person to get what they

need and also it can

ask other conditions and make people

less likely also to seek here for

conditions that could easily be treated

and managed so we take all this

information and we can move forward much

more effectively managing that dollar

that we're spending on health care and

getting better outcomes I much rather

spend the money upstream on prevention

and treatment of these conditions then

downstream losing a foot going on

dialysis I'm suffering from let low

exercise tolerance etc when your heart

starts to give out now at the company we

started we went really local we believe

healthcare is local right that's what

we've been talking about communities

what do you see in communities how do

you best understand him so we locate

employees locally we hire from local we

train local healthcare is local so we're

going to build capacity in those

communities by hiring people from them

to participate in improving the health

of their own communities for its

creative partnerships where do members

and patients go we want to be everywhere

they are that's churches schools other

not-for-profits that are in the

community doing great things technology

is important our folks are enabled with

technology that allows them to in the

field they're in a certain community

they can pull up a zip code and say aha

this community has this percent of

diabetes this percent of hypertension we

also know about the place they're in we

can look and see ha this community has

six churches 35 liquor stores three

playgrounds right we know what people

are dealing with is you don't want to

tell people to go exercise if there's

really nowhere for them to go right so

you want to know your community our

folks are digitally and technically

enabled to be able to do that so while

health insurance is important and I

agree it is a great starting point

our folks may not be completely enabled

and equipped to take advantage of what

that access offers so we hope we want to

help them out we want to begin to coach

them on yes these doctors are in network

this is where you can go and begin to

engage there he wasn't one to go with

you

we'll send someone with you so that you

can get the care you need it's much

better to invest upstream then to have

to go downstream and spend money on a

foot that's not working on a heart

transplant etc many things if we deal

with them upstream we then have a health

care a health care system that is much

more efficient effective and hopefully

cheaper for all of us

obstacles we have to deal with them and

think about them so while being think

the forward progressive next-generation

payer and provider who providers who are

rendering these insurance products that

we're aware of these obstacles and we're

ready to coach in place our members and

then we can take it global I think that

the science of community is something

that we can take all over the country we

learn about communities we can go all

over the world

implementing improving and hopefully

saving lives if we'd had a system like

this when I was coming up I think I

might still have that molar and the

people I thought that my parents you

know who knew who are dying early might

still be alive thank you

[Applause]

you