health forum

8/8/2019 Health Forum

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Health Disparities and Solutions

Participating in this important conversation were stellarleaders in the world of health and policy. Joining thebroadcast via videoconference from Encino, CA, waswell-known surgeon Dr. Richard Allen Williams whorecently published the book Eliminating HealthcareDisparities in America. In 1974, Williams founded theAssociation of Black Cardiologists, and served as itspresident for a decade. He also established the Minority

Health Institute and in doing so, created a new paradigmfor addressing health disparities, a paradigm that takes aholistic approach to patient care, tailored to the specific,unmet needs of African American communities. In2001 he was cited among Black Enterprise Magazinestop 100 doctors.

Joining the program from the US House ofRepresentatives in Washington, DC, was the Hon.Donna M. Christiansen, the first female physician in thehistory of the US Congress, the first woman to representan offshore territory, and the first woman delegate to theUnited States from the US Virgin Island. Christiansen isa member of the Congressional Black Caucus (CBC),and she chairs the Congressional Black Caucuss HealthBrain Trust, which oversees and advocates minorityhealth issues, nationally and internationally.

The Congressional Black Caucus Health Brain Trusthas long established itself as an authority on AfricanAmerican and minority health policy on Capitol Hill,and as the CBC Health Brain Trust, under able leader-ship of its chair, embarks on health legislative efforts, itdoes so knowing that racial and ethnic health disparitiesand the absence of racial and of health equity and justicehave long plagued health care and life opportunities ofAfrican Americans and other people for the last century.

Clarence Hightower, William Davis, and MitchellDavis responded to the presentations of Williams andChristiansen. Mitchell Davis heads the Office ofMinority Health in Minnesota Department of Health.Davis is Executive Director of Community Action ofMinneapolis, and Hightower is Executive Director ofCommunity Action Partnership of Ramsey andWashington Counties.

The forum was sponsored by Pfizer, Inc., whichjoins NorthPoint Health and Wellness Center; HennepinCounty Medical Center, and UCare Minnesota as spon-sors of the Health & Wellness Broadcasts ofConversations with Al McFarlane.

Conversations with Al McFarlane on

November 18 was broadcast from the

Bigelow Building in St Paul, MN, which is

home to Community Action Partnership of

Ramsey and Washington Counties. The

program focused on an issue of vital impor-tance to our community and to our country:

health disparities in outcomes and access

for Black people in America.
http://www.insightnews.com/


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Following are excerpts of the broadcastinterview:

AL MCFARLANE: Dr. Williams, what are thechallenges, and how do we get to where we haveeliminated the gap in health for minority people?

DR.RICHARD ALLEN WILLIAMS:

Well, first of all, Al, let me congratulate you formaking it possible for us to focus on these prob-lems of health care disparities today. I think thisis something that we need to see more of aroundthe country, and Im sure CongresswomanChristiansen would agree to that. We need moreinformation going out.

Today were talking about health care dispari-ties, and the first thing we need to do is define theterm and also give an indication of the nature andseverity of that problem. Health care disparitiesreally is a term of convenience which is used todescribe the differences that occur between racialand ethnic groups in regards to what we call mor-bidity, mortality, incidence and prevalence of dis-

ease and certainly outcomes of disease processes.There are tremendous differences that go alongethnic and racial lines. One of the things that weneed to identify is where these health care dispar-ities come from. They emanate really, from some-thing that is deep in the roots of our country, of ourhistory, and that is slavery.

It all started back at the time when AfricanAmericans were in bondage, and I wont go intogreat detail about that, but I want to simply indi-cate that it all started with the maltreatment andpoor treatment of slaves who were in bondage andwho were not able to do for themselves as far as

health care treatment is concerned. And it hascome forward to today, where we see problemsoccurring in every area of our lives.

I want to make sure that everybody realizeshow serious a problem this is, and connect the his-tory to the current situation. In the 18th century, aman named Hoffman, took a look at the slave pop-ulation of the United States, and looked at theirhealth care and their living conditions, theirchances of survival. He made a prediction whichrattles our consciences to this day. He predictedthat the slave population would not survivebeyond the year 2000 because of the health careproblems which were present at that time.

Now obviously African Americans have sur-vived, but with great difficulty. What we can takefrom that message is the fact that these problemswere, and still are, so important that we need togive a great deal of attention to trying to solvethem.

AM: Dr. Christiansen, take a public policy view-point and describe the challenges. How do we

move towards eliminating health disparities?What are the legislative strategies to move ourcountry forward?

DR. DONNA CHRISTIANSEN: Well thankyou and thank you for having me back again, andits great to be here with my good friend Dr.Williams. Weve been on several programstogether and hes been a guest in our Health BrainTrust as well.

Dr. Williams has laid out the history, but eventoday, the last national report on health disparitiesfrom the Department of Health shows continuing

gaps in health care and health care services.African Americans and other people of color

are more than 50% of the uninsured, and we stillface discrimination in health care even when weare insured. There was a report from the AmericanPublic Health Association, last month, showingbias for, towards white patients and against Blackand other ethnic minority patients, just in thereview of articles and reports. So we face a lot ofchallenges.

The Congressional Black Caucus bases itshealth care agenda on four principles. One is thathealth care is a right. Understanding thatacknowledgement needs to undergird any effortsthat we have moving forward. Second, is that toaddress health disparities, we must address thesocial determinants of health care. That is some-thing that we have not really focused on. Wevefocused on disease for a long time. To the extentthat we have ignored the social determinants ofhealth, we find ourselves in a position that werein today where over 200 people of African descentdie prematurely from preventable causes every

day in this country.The last one is that an investment must be

made. Im very glad to see that our President-elect has said that he is committed to ensuring uni-versal coverage and health care access for every-one, and equal education which is really tied toit for every child in this country.

We in the Caucus are going to continue ourpush for an investment in prevention because weknow that is the only way, not only to eliminatethe disparities, but to reign in the skyrocketingcosts of health care.

The principles involve coverage for everyone,

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Suluki FardanClarence Hightower, Mitchell Davis, William Davis, and Al McFarlane


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including immigrants, and making sure that ourproviders are taken care of that they get the kindof support that they need to continue to practice inour communities. We must make sure that weincrease the diversity in the health care workforce.That is a critical piece of eliminating disparities:we must have health care workers on all levels,from the community health worker all the way upto the policy maker, that represent us, if we areever going to close the gaps in health care.

AM: Dr. Richard Allen Williams you outlined thepervasive and historical issues associated with dis-parities in health outcomes for African Americansin your book, Eliminating Healthcare Disparitiesin America. What are the findings of the essayists

in this book?

RW: Well first of all, I want to mention that all ofthe scholars are not African American. There areseveral other ethnicities represented as co-workersin producing this book. And I think thats impor-tant because we wanted to present a broad per-spective on this problem from several vantagepoints. The book is based on, and emanates from,what is called the Institute of Medicine, or IOM

Report, which came out in 2002, from the Instituteof Medicine. It was a report on the medical treat-ment specifically of minorities in this country, andthe disparities in their treatment. It was subtitledunequal treatment, in fact. What it found is whatyou might expect from that title, and that is thatour healthcare delivery system is imbalanced andunequal. The recommendation was that that mustbe changed.

My book took off on that, and extrapolatesdata to give more evidence about the health caredisparities which I have been finding. We talkabout not only what the background of the prob-lem is, and the status of the problem, but also whatwe might look forward to from the standpoint ofsolving this problem. And I think what we have to

do is to focus on that aspect of things.

AM: Mitchell Davis, you just finished an impor-tant conversation that mirrors the concerns dis-cussed by our esteemed speakers from the eastand west coast. You recently conducted an Officeof Minority and Multi-Cultural Health Discussionand Conference on disparities in Minnesota. Tellus about what you did locally, here.

MITCHELL DAVIS: Last week, Al, we had the2008 National Health Disparities Conference,which was entitled Health Equality: HonoringCulture While Closing The Gap. Dr. GailChristopher from the Kellogg Foundation talkedabout the racial dynamics that sit at the bottom ofthis health disparity. We talked about social deter-minants, which means my education, my income,where I live, what air I breathe.

DC: We have introduced, with the other minoritycaucuses, a bill called the Health Equity andAccountability Act. It was introduced with theHispanic Caucus and the Asian-Pacific Caucus,and it addresses several areas that we feel areimportant to address if we are going to eliminate

health disparities. It speaks to data collection byrace, ethnicity and socio-economic factors,addressing individuals with limited English profi-ciency and setting some standards and some train-ing around translating for medical offices. It has alarge section on increasing under-representedminorities in the workforce on all levels, includingpolicy fellowships. Theres a title that addressessome of the leading causes of health disparitiesand how we provide comprehensive care from

http://weblog.themadeiratimes.com/images/slavery%202.jpg

He [Hoffman] predicted that the slave

population would not survive beyond the year

2000 because of the health care problems which

were present at that time.-Dr. Richard Williams

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prevention all the way through to support for ourfacilities and our institutions. And there are otherspecial provisions like border health and IndianHealth Services. Theres a title that deals withaccountability that would strengthen the Office ofMinority Health, and would strengthen the CivilRights initiatives in the Department of Health andHuman Services.

The bill creates health empowerment zones,which put the resources and information in thehands of the community that is suffering fromthese health disparities, and enables them, withhelp from all agencies in the Federal government,according to the plan, if theyre designated as ahealth empowerment zone, to address those chal-lenges and reduce the disparities in their own

community.

AM: Bill Davis and Clarence Hightower you allare charged with organizing people in the commu-nity. Community Action Partnership in St Pauland Community Action of Minneapolis, havemajor responsibility in translating and deliveringassistance, aid and opportunity, to people of colorin Hennepin, Ramsey and Washington counties.How do we organize from the ground level so that

our people both understand and can access oracquire the assets, resources, solutions, we need toimprove our quality of life?

CLARENCE HIGHTOWER: Al in 2004,when I was president of the Minneapolis UrbanLeague, I produced The State of Black MinnesotaReport, the first comprehensive exploration ofhow disparities are impacting people of color inthis state. We looked at how health disparitiesanalysis shows we do less well than the white pop-ulation.

I think the issue about how it is that you mobi-lize people around this is something that we havenot spent enough time talking about. I really amimpressed with and interested in this health

empowerment zone. Years ago, there was this eco-nomic empowerment zone strategy that impactedplaces like North Minneapolis and SouthMinneapolis where folks were doing less welleconomically. The Federal government decided toinfuse resources in that area to help lift folks outof poverty. To even think about something likethat around health disparities is tremendouslyexciting to me. To make it work, you have to beable to involve those who suffer from the dispari-

ties figure out how it is that you reach down andallow them to be part of the solution.

AM: Bill Davis you, among other things, havebeen a leader in environmental awareness: theabating of lead, and heating energy issues. Itseems that the country is acutely aware of the needto merge our understanding of health, energy andemployment. Is there opportunity to organize,teach and transfer knowledge youve gainedaround imparting environmental solutions to thehealth equation?

BD: Theres no doubt now that the people that weserve have a multitude of issues and problems thattheyre confronted with on a day-to-day basis.

One of the things we know is that the fastest grow-ing of poverty is children. Parents come into ouroffice with health related concerns looking forways of relief. Theyre dealing with nutritionalissues, theyre dealing with energy issues, beingable to keep warm in the winter time, being ableto have proper nutritional meals for their children,and also how they deal with the healthcare relatedissues. Not only on the front end, but on the backend, long term, chronic problems like lead abate-

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The Congressional Black Caucus


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ment certainly is one of the areas weve beenaddressing in older homes that tend to be occupiedby lower income people. The risk factor there ismultiplied but we know that these things are pre-ventable. We just need the resources and where-withal to begin to tackle these mammoth issues.

Like Clarence I love the idea about havinghealth empowerment zones. I think thats the type

of forward thinking we need to begin to put inplace mechanisms and vehicles that are going toenable us to address these problems on the frontend, as opposed to allowing them to becomechronic and out of control.

Poor people, low income people, people ofcolor deserve to have adequate and preventivehealth care treatment, and affordable health caretreatment, and thats always been an issue. Werelooking optimistically forward that with the newadministration, well have a level of receptivityfor servicing the middle class, low income people,and people of color with life supporting and sus-taining of services. Health care clearly is one areawhere we need to invest not only the resourcesand capital to change the overall health of our

community.

AM: Dr. Christiansen, how would you chargelocal communities to be in sync with the legisla-tive considerations that you and the CBC healthbrain trust have advanced? How would youadvise and direct local communities to connectwith what you perceive to be the direction ofPresident-Elect Obama?

DR DONNA CHRISTIANSEN, MD: Well,Im going back to something Mr. Hightowersaid that reminded me that the biggest obstacleto eliminating disparities and bringing aboutchange in our health is the lack of a politicalwill. So mobilization is absolutely necessary.When the Congressional Black Caucus HealthBrain Trust, as well as our foundation and theinstitute that Dr. Williams chaired, goes out toour communities we have conversations onhealth and in addition to screening we try toengage the community. We want our people tounderstand that we dont have to dye premature-ly from preventable causes and that there is helpavailable. But mobilization is a very importantpart of it and we really need to do a lot more.

I was on a panel last night. We were dis-cussing the Congressional Black Caucus in thecontext of having President-elect BarackObama. I think what his success in this electionhas meant and will mean a lot, not only to ourcommunity but to our country and the world.

One of the things that it has shown and Ithink it will do, is empowerment. It will showand it has shown everyday people the power tocreate change. When that is unleashed, we willsee change. I think its going to have a greatimpact and one of our roles is going to be to con-tinue to engage our communities. The healthempowerment zone, because it does reach downinto the community, requires the community toform a broad-based coalition of stakeholders toidentify the challenges and to create the plan andthen to implement the plan. And so it does get tothe heart of the community taking ownership oftheir health and creating that change. I feel that,from having worked with President-elect

Obama, within the Black Caucus, and knowingthat he has also been involved in minority healthlegislation and issues, that we have a greatopportunity here we need to take advantage of,especially since he is determined to find thefunding, wherever it comes from, to make surethat we invest in the health and education of ourpeople.

Mobilization has to result in our peoplesrepresentatives in the House and their represen-tatives in the Senate supporting the kinds of leg-

islation that Im talking about which we will bere-introduced next year. We invite anyone tocome and follow the progress of the bill and tomake recommendations. When we introduce thebill its still open to change and we invite peopleto change it. We are developing principles thatwe want to see included in any health reformpackage that comes forth from all of the discus-sions that are taking place around the country.We will post those on our CBC web site, so thatpeople really can be engaged, even if we cantget to you.But also, we need you to speak to the peoplewho represent you, the people who depend onyou for votes.

DC: We need their vote. When they come toWashington.

DR. RICHARD ALLEN WILLIAMS, MD:

So they need to go to their congress-people and

talk to them

DC: Absolutely, members of the House andmembers of the Senate.

CLARENCE HIGHTOWER: Al,Congresswoman Christiansen and I continue tobe on the same page regarding mobilization.Here in St. Paul we have been working withlow-income people and training them to advo-cate for themselves. Weve figured out that once

Suluki FardanBill Tendle (L), and Mitchell Davis

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The Federal government decided to infuse

resources in that area to help lift folks out

of poverty. To even think about something like that

around health disparities is tremendously exciting

to me. -Clarence Hightower


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you do that, you need three things: First theyneed training or the jobs of the future. So weprovide the training. The second thing our folksneed is confidence. Once theyre trained theyhave confidence to go out and speak for them-selves, tell their own story and advocate forthemselves. The third thing they need is oppor-tunity. When our communities figure out how to

do that how to give people confidence,opportunity and skills, then I think we can movethe health disparity down, especially on a locallevel.

AM: Mitchell, does that ring true to you, in yourexperience at the Office of Minority Health herein Minnesota?

MITCHELL DAVIS: It certainly has. As wetalk about the health empowerment, as we talkabout mobilization we have 52 partners withthe Office of Minority and Multi-CulturalHealth, and theyre spread out over half of thecounties in Minnesota. Theyre working ineight health areas of disparity: cervical cancer,

cardiovascular disease, diabetes, healthy youthdevelopment, HIV, AIDS, immunizations, infantmortality and also unintentional violence. Andthese our partners, are funded by the taxpayersof Minnesota. Theyre doing exactly that.Theyre mobilizing, theyre training, and theyredoing community education.

AM: Bill Davis?

BILL DAVIS: Well, I think the thing we keepseeing is the affordability of health care. Weretalking about the underinsured or not insured atall.

There are people who make a determinationwhether to take their child in, or take themselvesinto the hospital or see the doctor based on thedollar, bottom-line. And sometimes they willforego necessary treatment simply because theycant afford to make that commitment or makethat sacrifice. And until we are able to providepreventive health care to people its akin tothose who are able to take their cars to thegarage for a daily or maintenance update on aregular scheduled basis vs. those who take theircar into the shop when its absolutely on its last

leg.What happens quite often is we have people

in our community that do not seek health care,because its not affordable, until its absolutelyimperative and at total peril of them and theirfamily.

In this day and age people should not have tolive like that. They should not have to be con-fronted with that kind of decision. The otherthing were seeing when we talk to people in ourcommunity is the mental health issues. I thinkthats also something that sort of flies below theradar, that people are dealing with drug abuseissues and battering issues and other issues thatpreclude them from being healthy and beingable to be productive members in our society.

When we start sitting down and doing anassessment with individuals who come into ouroffice, to do an assessment to determine how wecan best serve them, we find that there are issuesof mental incapacity or mental health that pre-

cludes them or disables them from being full,productive citizens, and so that issue also needsto be addressed, and any kind of funding or dis-cussion about health and health disparities.

CH: Al, were curious about whether or not thishealth empowerment zone idea is gaining legsacross the country.

AM: Dr. Christianson, the idea of a healthempowerment zone is intriguing. Has that taken

root, or will it be presented in the next legisla-tive session?

DC: We certainly hope so. Whenever we speakof it to different health advocacy and profession-al organizations everyone thinks that its theright way to go. To approach health comprehen-sively like this we have to talk about housing,we have to talk about a lot of things. Thisapproach would enable communities to get helpfrom Housing and Urban Development (HUD)and from Environmental Protection Agency(EPA) for environmental issues.

Were going to introduce it as a stand-alonebill again because we think it is really the key toturning things around in our communities.

AM: Dr. Richard Allen Williams what is theduty of our people? Too often we hear peoplesay: we want to wait on Washington to do forus. But at some point individuals, families,

neighbors and communities have to take respon-sibility. How do we mobilize and organize at thestreet level and produce policy that serves ourinterests long-term?

RW: Well, the wildfires here in California havebeen a point of interest across the nation, andwere still suffering from them by the way. Iwould like to hope that we can create a wildfireof interest in health care disparities at the com-munity level because when you get right down

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We have a great opportunity here that we need

to take advantage of, especially since he

[President Obama] is determined to find the funding,

wherever it comes from, to make sure that we invest in

the health and education of our people.-Hon. Donna Christensen D-VI

Hon. Donna Christensen D-VI and Dr. Richard Williams


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to it, its what happens in the grassroots levelthats important. These changes that were talk-

ing about, in health care reform, have to beapplied at the grassroots level, and to a largeextent the leadership for this has to come fromthe community.

The community cant just stand there and bevictims, as they have been for so long. The com-munity has to be mobilized, just as Dr.Christianson has mentioned, to carry out theprograms that many of us in academia and inpolitical life, have tried to lay out. But thechanges have to emanate from the people. Thatsthe importance of having someone likeCongresswoman Christiansen shes a politicalleader who is very, very interested in what weare doing.

One specific issue we need to look at which

is one of the most important aspects of thewhole health care disparities argument is insur-ance coverage. It is at the very center of theproblems that we see. At least 47 million peoplein the United States are uninsured or under-insured. That is a tremendous problem whichinhibits our progress in eliminating health caredisparities. I think we need to talk about whatthe insurance problem is. Its not just a problemof people not having insurance, but a matter of

how their insurance, when they do have it, ishandling them.

AM: Bill Tendle, you are the front line in healthcare at South Side Health Services, in SouthMinneapolis. How do you instruct our commu-nity to engage and utilize the services you pro-vide? What is the impact, negative or positive,of insurance or lack thereof, and what legislativeremedies would support you in delivering quali-ty of life to your stakeholders, your clients?

Bill Tendle: Two things that are really a prob-lem are access and trust. People dont haveaccess, or they do have access and they donthave trust, and therefore access and trust are twobig issues in the African American community.For example, theres not a lot of trust in health

care providers, especially if they dont look likeAfrican Americans, so thats a problem. Its trustfor other people, as well. If you get into theHispanic population, its a matter of trustbecause some people maybe not have the rightpapers or theyre afraid they might be turned in.

AM: Let me understand that. Youre saying thatAfrican American patients dont trust physiciansor providers that are not African Americans? Or

they dont trust other African Americans whoare providing the service?

BT: They dont trust providers who are notAfrican Americans, that dont have culturalcompetency to work with them.

AM: I see.

BT: And thats been a problem since the studiesthat have been done with African-Americans inAlabama

AM: The Tuskegee syphilis studies.

BT: Every African American knows about that.Native Americans know about the smallpoxblankets that were passed out to them by the US

government. So its a legitimate matter of trustthats an issue within the community.

But more importantly, I think that this is anew day, and people need to have more educa-tion about health care and how health care mod-els are put together. Bottom line, if you reallyget down to it: people have to have a base tomove up from. Most African Americans who arein poverty dont have a base, and if you donthave a base, both educationally and monetarily,

Suluki Fardan

(From left) Clarence Hightower, Mitchell Davis, Bill Davis

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and economically, it really impacts your healthcare.

AM: Bill Tendel, what can Congress do tosupport your vision and work to serve, enableand empower your communities, your cus-tomers?

BT: Im seeing a need for more communityhealth workers. You have to have someonewho knows the community, who interactswith people on a daily basis in that communi-ty and who can help set up lifestyle changesthat will have the most dramatic impact onhealth care. When I say lifestyle changes, Imean social health. No ones ever talkedabout social health. But it means when youleave any health institution and you go backto your home, how does your social environ-ment help maintain your health. That meansdiet and your living conditions. What weneed to do is change the paradigm of howpeople live, and really attack their socialhealth.

AM: Dorii Gbolo, Executive Director ofOpen Cities Health Care Centers in St. Paul,please explore the same question from yourpoint of view.

DORII GBOLO: In our country, wererewarded for being ill. Were not rewardedfor being healthy. We need to change that. Iwould hope that this Health EmpowermentZone would kind of change that and enablethat paradigm shift. People can be empow-ered to be healthy and rewarded for beinghealthy. We should strive for that.But when youre in the bonds of poverty anddiscouragement or whatever socially is goingon with you, you dont think about beingwell. You just expect to be well, until some-thing happens and then people too often say:oh, Im not well, how do I fix it? We needto help people while theyre well so that theycan stay well, so that they can be better con-tributors to their families and to this commu-nity.

I do agree with Bill about communityhealth workers. Thats what weve utilized in

our clinic because we want people to be welland we want our community to be well. Wewant to empower our community with thosetools that they need, no matter what is goingon in their lives, so they can strive for well-ness. So if somehow we can change shiftfrom rewarding when youre sick to whenyoure well, that would be a great accom-plishment.

AM: Congresswoman Christiansen, how doyou respond to these managers, these leaders

of community health services here inMinneapolis and St Paul?

DC: This country spends somewhere between3 and 5% of all of its healthcare dollars inprevention. Let me start with that. We aregoing to mount a very strong legislative andadvocacy effort here to change that.

That would make a world of a differenceif we can focus on prevention. We do wantpeople to have access. Part of it is insurance

and part of it is having a health care work-force that is culturally competent, and sensi-tive. The best way to do that is to have physi-cians, nurses and community health workersthat look and speak like the person beingserved, that come from the same culturalbackground and speak the same language asthe person being served.

We need to address all of those areas, butwe are going to try to make a really concert-ed effort to increase our prevention dollarswhile we work to get everyone covered.

One of the first things well do, Im sure,[when we start the next session], is to tryagain successfully this time Im sure topass the Childrens Health Insurance bill thatPresident Bush vetoed twice. It doesnt go asfar as wed like it to go, maybe we canexpand on it. There are approximately 9 mil-lion children that are uninsured, 6 million ofwhom would be eligible for State ChildrensHealth Insurance Programs (SCHIP). So wewill be doing that.

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http://www.usarpac.army.mil/SoldierFamilyWellBeing/Reintegration/pills1.jpg

Further, there is a criticism of this practice of

cost-based drug switching which doctors in

New York have stated, has impacted their practice

and are making worse medical outcomes for 92% ofthe patients that they treat. -Dr. Richard Williams


9/10

I can remember when Howard Dean wasgovernor of Vermont and every child born inVermont got a health visit. The mother andchild got a home visit, and it made a world ofdifference. It made a difference in their pre-paredness for entering school. It made a dif-ference in enabling them to address some ofthe problems that were occurring at homethrough referrals. So a community healthworker has got to be the bedrock of our healthcare system if were going to see change.People from within that community will havethe trust of that community, and will not onlyhelp people get to the health care that theyneed, but also support them. Sometimes itsdifficult to test your sugar every day and takeyour pills on time and eat properly. Somepeople need support to live healthy lives.

AM: Dr. Williams, let me ask you to respond

to that as well. You recently caused afirestorm in national media by challengingwhether health plans are switching to lower-cost generic drugs, rather than the itemsbeing prescribed by doctors. You questionedwhether the health of patients is being put atrisk, and you were saying that people who aremaybe less knowledgeable, less aware, aremore easily switched for the advantage of thehealth plan and provider, not particularly for

the advantage of the patient.

RW: Well let me begin with something elseand then segue into that very quickly. WhatId like to begin with is kind of tying thingstogether in regards to what has just been said.It seems that there is obviously a linkagebetween poverty and poor health care or sub-standard health care and we must be very vig-ilant to make sure that we observe that link-age.

I like to think of this as being a system ofwealth care rather than health care. Its a mat-ter of how much money youve got as to howgood your treatment is, and that should not bein this country in this democratic society.

Now that also ties in with what you indi-cated about this situation which I call drug-switching. Let me also begin by stating thatthe issue is not a matter of criticizing generic

drugs. Generic drugs, in many cases, are verygood medication, so I dont want anybody tothink that Im putting out a blanket criticismof the use of generic medications.

What I deplore is what is happening basedon insurance company practices of switchingpatients or requiring the switching of patientsfrom branded medications which their doc-tors might have prescribed, to a generic drugwhich may not be an equivalent of the drug

that the doctor intended the patient to have.What that means is that someone other

than a medically trained individual is makinga decision as to how this patient is going to betreated, because the outcomes may be differ-ent depending on what kind of medication isgiven. There are some specific instances ofthat. You dont have to just believe my criti-cism. Theres been an outcry against this kindof practice for instance, by the New York del-egation to the American Medical Association,which called for the development of a code ofconduct on the part of insurance companies,and is asking the full body of the AmericanMedical Association to make a determinationthere.

Further, there is a criticism of this prac-tice of cost-based drug switching which doc-tors in New York have stated, has impactedtheir practice and are making worse medical

outcomes for 92% of the patients that theytreat.

Thats an enormous number, and I think itneeds to be recognized that we need to dosomething about the insurance company prac-tices, not only in regards to this situationabout drug switching, but in regards to thingslike treatment of certain conditions, and intheir patients who are already insured. Andcertainly we need to make sure that insurance

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companies are more amenable to insuringpatients who dont have necessary financialmeans to pay for their medical care.

CH: I am particularly keenly aware of thelinkage that Dr. Williams just mentioned. It isa fact that those who are less well off areoften times those that constitute the pool of

those involved in the disparity. And thats thework that Bill Davis and I do. Our work is tolift those that are in poverty out of poverty.As you begin to work to lift folks out ofpoverty, then you will also be lifting folks outof the mass array of disparities that we findourselves caught in. And so I appreciate thefact that you brought full circle the notion ofthe linkage between those who are in povertyand those who have disparities.

DC: We will be electing our new chair of theCongressional Black Caucus this afternoon,and the likely person is CongresswomanBarbara Lee from Oakland, and we will havea poverty elimination agenda, in the caucus.

CH: Good!

DC: And our Whip, who is very close to ourPresident-Elect, is also very much an advo-cate for poverty elimination agendas, and weare sure that he is going to make sure that theWhite House has a poverty elimination agen-da. And I also want to say, just on behalf ofthe Congressional Black Caucus, thank youfor having me as a representative here, and toassure you that whatever field, whatevercommittee or sub-committee all of us serveon, our goal is always elimination of dispari-ty, whether its economic disparity, job dis-parity, educational disparity, housing dispari-ty. All of those things are part of the overallCongressional Black Caucus agenda. And sowe do address them relentlessly.

AM: Thank you so much, Dr. Christianson.Bill English is the co-chair of the Coalition ofBlack Churches/African-AmericanLeadership Summit. Bill, you and I havetalked for years about the money side of thisequation. We think its important, as business

people, to analyze problems and solutions interms of the revenue streams associated withthem. To attack problems involves deployingfinancial resources. How do we benefit? Howdo we align ourselves so that we, not onlydeal with the misery but also benefit from

commanding the resources required to elimi-nate misery?

BILL ENGLISH: First of all, money is theunderpinning at the base of the health careproblems in America. It is at the bottom of it.At one point, health care was a charitablething in America. When money came in, itbecame on the largest profit-making sectorsin this country.

While were all excited about Obama, it is

interesting that the word poverty did not enterinto this campaign. So Im glad to hear theCongresswoman say we really have to dealwith the issue of poverty in America.

The idea of Health Empowerment Zonesis interesting. Clarence and Bill spoke to that.

But you and I both know that the EconomicEmpowerment Zone in Minneapolis was adisaster for Black folks. It was built on ourpoverty, but the people who benefited werethe developers. Public policy must assure thatthere is equity in anything that comes out ofthis. Clearly as we go forward, we have topay attention and be vigilant, mobilizing ourcommunity and using the court to address theissues of equity.

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This country spends somewhere between 3

and 5% of all of its healthcare dollars in pre-

vention. We are going to mount a very strong legisla-

tive and advocacy effort here to change that.-Dorii Gbolo

StudioTobechi

Bill English

health forum

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