Transcripts For CSPAN3 Dr. 20240704

Thanks so much for joining us today. We are happy to present an equity in our Health Care System. Dr. David answer the death gap how inequality kills and dr. Thomas fisher the emergency a year of healing and heartbreak in a chicago e. R. With Katherine Davis with crains dr. Ansell and fishers books be available for sale and signing at the book sales and signing tent marked in in our nancy nancy on your maps david ansell is the Senior Vice President associate provost for Community Health equity at Rush University Medical Center in chicago. He is the author of the death gap how inequality kills and county life death and politics at chicagos public hospital. Thomas l is a Board Certified emergency medicine physician from chicago, and over his career, he has to improve health care as Academic Health insurance, executive health care, company and white house fellow, the first term of the Obama Administration in the emergency. Lets by Penguin Random random house our moderator is kathryn katherine is the health and Life Sciences reporter crains Chicago Business where she writes about hospitals Public Health pharmaceutical companies and biotech startup. She graduated from Columbia College with a bachelors degree in journalism and 2016. I hope youll me with granting them a warm welcome as they come before us today. Thank you so much for that warm introduction. Hello, everyone. Thank you so much for being today. Im katherine, reporter for crains Chicago Business and. Thank you to dr. Ansel and dr. Fisher for being here today. Really excited to get this conversation underway. So lets set the stage for our audience a little bit. You know, dr. Ansel, your was published in 2017. Can you tell us a little bit about, you know, what was happening with your work and with the health care sort market here in chicago at the time that made you want to write this book to begin with. Well, first thanks, everybody, for coming. If i had had been such a big crowd, i would ironed out the back of my shirt. But now i just i was its a little bit about myself, a general internist, primary care doctor. And i were ive worked in now for as a doctor since 1978, first at the public hospital, cook county, then at mount sinai. And i was recruited run an academic Medical Center, actually, you can walk here, too, to rush. But all along, one street on the west side of chicago and patients came with me and i was really struck when i got to rush where was the inaugural chief medical officer for the hospital about the one street two world of living and health care that seemed to be invisible. And so i was motivated to write the death cab to really point out that there are these large gaps of Life Expectancy, literally you can walk from one neighborhood to another and lose 30 years of Life Expectancy. But not only that, the root causes, these were not biological. They were not behaviors, but but related the conditions under which people and yet it was largely invisible all driven by two things in equality in inequity. I do want to point out in the far corner is dr. Kristen palico help write the book. She was premed and really helped me publish a book. We wrote it together perfect. And so dr. Fisher, sort of, you know, the same question for you. Your book published once the pandemic had started, you know, what was sort of going on in your personal work at that time. You were like, now is the time for me to write book about what im seeing, my experience and the inequalities that. Thanks for the question and its wonderful be here home discussing and reflecting on some of the challenges that we all face. Whether we know it or not. Ive been working on the south side of chicago in the same community where i grew up for over 20 years. What i saw in the Emergency Department was overburdened waiting rooms, people with medical problems that they couldnt solve and couldnt find the resources necessary subsequent to their injury to find, repair and. After decades of training and and working on federal policy in local solutions, precious little progress was made. The Emergency Department looked the same and 20 as it did in 2000, when i embarked in my medical career and i was frustrated and challenged by the lack of progress. And so in many ways, this book is a number of things. One, its a reflection on society that pins black folks in place and robs them of their health care and shows them, robs them of their health and shows them no mercy and when they present to the Health Care System the same structures add insult to injury and, i want it not only for me to better understand and create a compendium of the ways in which weve shaped a society towards, one that harms health. But i also wanted to explain to my patients why, is this happening to you . What is it that brings you here and makes it difficult for you to receive the health care you deserve while at the same time you see others taking different pathways, living much longer and, having experiences absent the suffering that you think is normal. The pandemic was really just an accelerant to writing in that not only did it you know, give me plenty of time to write, but also reflected what usually happens over decades in creating Health Inequity occurred in a matter of months. And so youll find stories of and challenges within the book. And so, you know, i know that, you know, you all have been very aware of the Health Inequities in chicago and around the country. You know that have plagued the u. S. For many, many years. You know, but im interested to know what was laid bare for you during that first year of the pandemic. You know, were things surprising they even worse than what you had, you know, already sort of envisioned what was that first year like . Every once to start . So i was on the front lines and, you know, in the Emergency Department, one of the things we prepare for is pandemic. I generally follow the international press, when flus begin in china or hemorrhagic fevers begin in africa, because or later with a global community, they to chicago and walk into our emergency. Id covid coming four months before it did and was quietly preparing until march when all of a sudden the nba closed and then society closed and very quickly there were no airplanes in the sky and and no television to watch. It was then that i sort of began to see the differences in who was in the patients who came to me in, the Emergency Department. You expected people to be transformed by the virus, but they were just our neighbors coughing and wheezing and short of breath, but not all of our neighbors. Some folks were protected they were sitting at home having food delivered to them, working in front of a screen, frustrated by the change, but safe, other folks were forced into to deliver food to stock and warehouses to slaughter in slaughterhouses deemed essential but not so essential. They were protected with masks and plexiglass screens in order to maintain their health. And thats who flooded into the Emergency Department in the first year before, i saw more people die than. In the previous ten years of my clinical practice on the south, those lives deserved to be more than static sticks. And so i tried to tell some of their stories in the book, maybe just want to say doctor for sure. It was a great honor for me to read your book and and the stories of page. I think one thing that we have in common, we have a lot in common, but one thing we have in common and share is is that we see patients. And so so, you know, you hear words like oppression or suffering, things like that. But they really they really come to home. Youre face to face with a patient. You know, it can be different. So i want to just tell you a little bit about sort of my experience. So i being chief medical officer at rush in 2015, my goal when i got to rush from sinai in cook county hospital, the was to be number one in quality. And so i all the work with all my colleagues at who actually move us to be like the pinnacle of quality hospital in the country and im a social epidemiologist and my patients have traveled me and i could see that we could fix quality as much as we want but if we address the conditions people would die unnecessarily. So im saying people are dying outside our doors weve got to think about this differently. And in my own hospital we named racism and economic deprivation as causes of poor health and something we should do something about that was in 16. So when covid was coming we prepared not only the hospital but what our response was going to be. We thinking about it. And so i want you to imagine this covid we were thinking about as being the great equalizer because the whole worlds population lacked immunity. Yet we knew as it was coming, that it was going to disproportionately cause suffering and black and brown neighborhoods, poor neighborhoods, general black and brown neighborhoods in the city. And we began to prepare for that inevitability. It was as if one epidemic was into this preexisting epidemic, which was largely and we did a of preparation for it. But i want to tell you a story of one of my patients. So as the patient so and as the patients are beginning to come in, im in the beginning of the pandemic, i could read the charts of every patient coming into rush. That was impossible. Two weeks later, i see one of my patients sickle cell anemia hospitalized multiple times for sickle cell anemia. But this time it was covid or presumed covid. It turned out to be covid. She at ohare lived in Garfield Park lowest Life Expectancy neighbor. The west side took the bus to the train to ohare, worked at the baggage handler because of her condition, asked her employer to wear a mask. Im going back to what you talked about. The working conditions. I was not allowed to wear a mask caught covid somewhere along the way. Her whole family got covid in and and then we saw the disproportionate impact. And then i will say the first 100 deaths in chicago, 70 were in black people. The mayor said it took my breath away and then called and together a Racial Equity Rapid Response that i got to had the honor to sit on to actually address the community conditions, try to address them that were causing the Health Outcomes that dr. Fischer talks about. And so dr. Angela, could you actually expand on that . And us a little bit about what you know came from that task force . Like what were the specific measurable metric x you knew you could go after to improve, you know, if a pandemic gives you an epidemic of any sort, gives you no time, youve got to charge into the problem and so let me just say a couple things that happened. Our medical students got pulled out of homeless shelters, shelters for, and we had a meeting. We said, well, whats going happen in the shelters whom . He met with a shelter . Oh, theyre going to move the beds theyre going to reduce the number of people in shelters by a third and separate the beds. And if you just a logical well, theres a virus thats airborne moving the beds a few feet apart in a room like this is not is going to be not going save lives. The Health Department was very clear from day one that the pandemic is a Health Department was overwhelmed, that they couldnt they they didnt have think through the problem so we actually in and not just us we pulled together a Table Community providers university of illinois the city to really think through what could we do to tampa tamp down the impact of the pandemic and those experience homelessness and we did and we executed on it and it made a giant difference in the city. So when the first hundred deaths occurred, which was early april the of chicago Lori Lightfoot asked her staff what we do about it and they gave her some ideas and she said, thats not good enough. Call side united and west side united was an organization of hospitals and Community Leaders that was formed to address the death gap in chicago by addressing community to terms of health. And that group was asked to cochair the Racial Equity Rapid Response team and suddenly the table were not the hospitals and the clinics the city but the community and Community Organizations said. What do we need . They didnt say we need health care. They said we need masks our neighborhood, we need food, we need rental subsidies, we need tests in the community and. So that mobilization to get into communities, that ultimate led to the strategy around vaccination in the city of chicago was launched that early april i dont you know say what didnt make a difference or not you know these things are hard to measure but at the level measure first year after the first year the pandemic chicago third in population, seventh in mortality was a good enough. No, but i do think there were things that were begun to don that brought the community to the table to determine did they need to survive the pandemic. And it wasnt werent icu beds thats not what they were asking for. It was for basic. And so you mentioned the you know, Life Expectancy here in chicago and, you know, as a result of the pandemic, we saw Life Expectancy for all chicagoans, but especially for black brown chicagoans, dropped to very low levels. You know, the Life Expectancy for all chicagoans dropped almost two years on average to 75 years, with even steeper declines for black and latino residents. The life at the end of 2020 for black chicagoans fell below 70 years for the first time to 69 years. And the gap between black and white chicagoans is now ten years. And so my for you, all, you know, is is where do our public and private Health Systems go from here . You know, what are the steps in turning these life expectancies. Around and, you know, even improving them from where they were prepandemic . You know, i think this is a question thats not really about our Health Systems, but really about who we as chicagoans and what we owe to one another, our health is not really constructed by health care. Its created by where we live, learn, work and play. One of the things we saw during the pandemic was not only the disrepair and impact of covid that. Dr. Hansell describes, but it was also created a rash of violence, ways that we hadnt seen in years before. You have to keep in mind our schools were closed, the Community Centers were closed. You couldnt go to church many of the elders that tamp down interpersonal violence were hiding out or killed, and people who were who had the most vulnerability were in the sorts of jobs that didnt provide insurance or time off, who were the ones who are most likely to fall ill and also ones who are least likely to provide for their communities from that led to rashes of violence across the and the spike in not only our death rate but also our ah gun violence rate. When you think back to that time, i took care of somebody who was an elder brought in from home and they were in cardiac arrest. This is not an uncommon situation for us and we took into the room where we do our resuscitation missions. We intubated them, gave them medications, gave them chest compressions, fleetingly, got their heart rate back, but lost it again. And after a course 20 minutes, we accepted the inevitable. And after a moment of silence, one of the things that i do as the attending is and talk to the family when i went into room to talk to the family, the child of this elder was, you know, in his late fifties. And i sat down and theres a process by which i do this, which i honed over 20 years where i, you know, sort of explain the circumstances, ask them their understanding, prepare for what im going to tell them. Tell them that their loved one died. And in that moment, he stopped me and said, you know, dr. Fisher, dont you remember me . And i didnt i didnt remember them all. And i felt, you know, humiliated and embarrassed because here i am in a life death situation and dont remember the interlocutor that im speaking with. He said last year had this same talk when my other parent died. We have these social conditions that are running through our communities in these intergenerational homes and, calling our elders and. Theres by the time they come to me its too late. We as a community have to not only recognize that in those moments. I feel very fortunate to see the depth of their humanity and recognize that, you know, these conversations where we have the opportunity to be vulnerable and clear we see one another as fully human as we see ourselves, which ought to lead to the sort of policy solutions that would raise all of our health. But theres a large voltage drop before we get there and we concentrated our shared tax dollars in the service of those on the north side of the expense of those on the south, in west side, we end up entrenched generation, long poverty as, a result of this segregation. We have an absence of the social services and education that lead to health and and we arent effectively creating jobs that would somebody out of these situations theres been a ton of work done in the city angelou has been a part of a lot of it, the metropolitan planning board, and they urban Institute Just recently published information that described if we got chicagos segregation, that unlinked the services, goods and resources that protect our health from whiteness and distribute them more equally, not equally, but just as equally as our other segregated cities in the chicago land here in america our violence rate would reduce by 30 . Our income would for everybody in the city. The it should be focused on who do as a society see ourselves and what is our commitment to one another and are we willing to make the hard choices that arent, you know, lurching from emergency emergency, but deciding reorganize our society towards one that is more just and equitably distributing resources. And until then, we will continue to lurch from emergency to emergency. That was so really eloquent and. I want to just take the same response and then sort of a different on it. So one is as a white physician whos been a doctor since 1978, taking care of largely my whole career in underserved patient populations and brown that it wasnt until a few years ago that i began to speak openly of racism at the as a as a root cause i actually whiteness is probably a better word that day to day so like were all here downtown today right . We dont look at were sitting around here today is an act of whiteness but were not were in a white neighborhood. You know, the events like this are Held Neighborhoods like this. I found a bad thing. Its just theyre just not held in other neighborhoods. And so you dont spend your money there. But i want to take a step. This discussion about violence and reflect on something thats known as structural violence. So as a doctor who took care of patients, i could not that how degree of illness affect it seen disproportionately the popular that i was serving compared to the people i knew and so is this idea that we think of violence as being just barrages of bullets, but a structural that is designed in to our laws are are procedures are norms are values. How day to day life actually occurs. Oh were going to have a lit fast. Lets do it on dearborn. Lets not do it in austin or on the south side right imagine of this capital was moved so it was so structural in that way and its violent because people are put in harms way as a result and then die early. What we see is the the people have their life really stolen from them and the impact of it the cost of this and money theres cost of segregation. The report that youre talking about 4 billion to the total account we all suffer as a result and now covid in a very short period of time which what something that we see in our patients occurring many many years the structural nature of this inequality. So if you looked covid just to take the but this was before covid so you look at okay in the united. States 1. 3 1. 3 Million People have died from covid. If we were canada about half that that half that many people would have been living. So there were stupid deaths they were unnecessary deaths. If we were australia, which had a conservative government, about 900 or a Million People in the United States would be most expensive. Health care, and yet the worst outcomes and maybe among the highest mortality in the world so in a lot the way that weve structured things so you the questions like what can hospitals do we have to we cant do it alone so i think its worth it. Youre see us doing on the south side russia and other hospitals west side united as a collaborative of hospitals and communities to address the death. But if you look at the the actual causes of death post pandemic of course covid was there but it wasnt number one except in the Latino Community the number one cause of death was cardiac disease. We saw a rise in diabetes deaths. We saw a rise in homicides. We saw a in overdose deaths. We saw a rise in diabetes death. So a rise in car crashes. And with those increases disproportionately, affected communities color. But to think that the pandemic was the the pandemic unveiled the preexisting fault. But if you look at a city like chicago and this is actually true across United States since 2012, Life Expectancy which up to that time had been rising, every community began to drop in chicago, most steeply for the latin x community, but for the black community, the asian community, the only community before pandemic that Life Expectancy was rising was the white community. So these gaps social in nature, theyre structural nation. We have to just like we firmly you have to go after the mosquito as the vector because you cant get rid of malaria you can have a lot of malaria, lots of ways, but you dont address the mosquito. You cure it. We have to address the vector and racism and other forms of systemic exclusion are at the root cause and theyre as violent as any other thing that we see. We just dont name it violence. So i think that thats and in what ive said are the solutions can just add to that because we all our working on a day to day basis and its one of the things i commonly hear i describe as i look, you know, not usually as eloquently as you did is these are bigger than an and even bigger than the city. This is as big as the United States. And what that often leads people to a sense of despair. Okay. So what does that mean . I dont do anything. Does that mean i just i just let go . Because when you talk about decoupling a relationship to power from a relationship whiteness, thats as though youre telling people pretend as though america has no gravity any longer and were just floating around. Its very hard for people to. Imagine that this this this construct, being white is is no longer. What defines whether or not you are living in a safe neighborhood or have have Good Health Care or are linked to the sorts of jobs give you give you good insurance . And then we have institutions that have been created hundreds of years ago. I mean, i work at the university of chicago, and theyre very proud that its founding, you know, in the 1800s, back when black people couldnt get care there and women couldnt doctors and theyre to those things are reproduced years while the language may change and the culture is one that they are very proud of and so what that leaves us with is how do we tell truth when we have a society thats in blinders . How do you acknowledge that in while we are all similarly human, we do not have similar opportunities. We dont have similar endowments, resources, and we cant by working, how you do that in a setting where in the middle of the pandemic response, instead of thinking about a collective solution of Public Health thats turned into what is your individual responsibility exactly . Do it for mama. Do it for pop up. Do it on your own, as opposed to the recognition like i see here. Well, we actually need to invest in one another and help one another. How do you do that . When what happens . The locked doors of my Emergency Department is where is where the impact these differential judgments impact bodies of our of our patients. I was in the Emergency Department yesterday, and i took care of a woman, was young and who had actually seen the day before for the same problem she a low level of schizophrenia was hearing voices and needed help. And the day before when i took care her i gave her medications and we wanted to get her stabilized on those meds and get her and came back the day later and she was still the same room, still waiting on a place to go like that is, something that our Health Care System can fix. If we, as people decide to invest in those ways and begin to open locked doors where we hide our of what were doing to one another and start to use the data to tell the truth, we have Quality Metrics that. We measure. We know door to balloon time for opening coronary in the setting of a heart attack. We know the rates at which we use restraints in the mentally ill. We know wait times we know left without being seen. Do we tell the truth about how that stratified by do institutions us particularly the nonprofit whose existence is based on our taxpayer dollars that we all similarly pay into share whether or not their this care equitably given that these are public resources. At the end of the day do they work as hard and their executives with bonuses and firings if theyre able to to give equitable care when we make it that granular we can recognize that we actually all have stakes not only in our financial because were paying not but also in the stakes that we something to one another and these institutions fundamentally ours. Its a big challenge and one thats going to require generations one that people have been struggling with before me. Right. I come american descendants of slaves folks who have been struggling to force to live up to its Democratic Values for hundreds of years. This is not going to end in my lifetime but we can at least tell truth not only animated by our humanity but animated by the data we know whats happening. And beyond telling the truth which was where it has to start. And thats why i think naming racism but also so as a white physician, i needed my own institution do the story telling of that. You know, my my parents were whole families were exterminated in europe and victims of antisemitism, white supremacism, arianism, mass incarceration and genocide. But in this country, despite that history, i was assigned to the favored group. And while i worked hard, i had to come to the realization and begin to speak about it that ive had unearned advantage, and then to understand that, the paradigms into which weve both been treated to are taught were based on, stereotypical ideas of gender and race, still deeply embedded into medical training, and that the paradigm that were operating under is, is is incorrect that is a whole set of implications for next generation and how institutions are organized. So at the institutional level there things that we can do. But at the societal level there are things that we can do as well and i want to just sort of theres an interesting sort of dynamic between between those things. So the we have a tale of two cities of at least two countries in terms of the opportunities that who gets to live in who gets to die. And then we that sort of dynamic that whiteness which is the, you know, the dominant current in this country and of course, patriarchy is another dominant current women have done done better in this country. But its that ten uis look at womens rights is tenuous in this country. But weve we we have to underscore stand that how we act both within our institutions and civically can make a difference. But its about rethinking in the org the organizational paradigm of society and how so i just want to sort of think about this if you are poor in the united of america, theres the idea that its a meritocracy is another is is a is a lie just not true. So one out of 39 poor people will make it out of poverty into the middle class. One out of 13. Thats not so good, you know, its not what we think. And that number has been dropping over time. But the black experience is even much deeper. One out of 40 black people in. The United States was born in poverty has the opportunity can make it out. Those are exceptions wisdom and that can be changed and it can be changed by the our institutions behave and our public policies. What happened in the pandemic at the beginning . The pandemic, i called up chief medical officer of the city, who is now at cdc. And shes a wonderful person and say, can you pull the institutions so we can fairly icu resources as such that people who needed extreme icu could be fairly distributed the city and a reason why i asked that question is i know that if it was left to the usual that people be in Emergency Rooms and wouldnt have access to it and it never happened. But we could do it and we could do it moving forward. And theres things that our institutions can do now and into the future that can make a difference. And were working on some of those things. I dont think that theyre big enough, but they give us. But there are things that give me a lot of hope for the potential to change this. It turns out that in United States where you live, when you make below the median income, your Life Expectancy is different its different if youre poor in new york city, then if youre poor in detroit adjusted for race. So know that Public Policy can make a difference you know Institutional Policy make it we just have to double down and do it and so this sort of brings to my next question, you know, in my report on Health Equity in chicago, you know, i have seen some of the new initiatives coming from our Health Care Institutions that, you know, really work to get at some of these causes. Right. I mean, we have Health Systems that are funding and building, you know, Public Housing for people, you know, trying to interrupt cycles, Substance Use disorders. And so, you know, my question for you is, you know, are there initiatives that youre, you know, personally involved in or your institute audience are involved in that are close to your heart and you see them making progress . And how what are they . Yeah. Do you want to start with. Well, i quit being a chief medical officer, so were just you know, no one does that. And i quit because i realized that just doing the work we were doing wouldnt make a difference and began to think what would make a how would we have to do that . So one, we have to name, name the root causes the vector. The disease is understand that. As an institution, we do think differently about health and the root causes of health and. That was the rethinking had to do with how do we use our and power as the number, the leading private employer on the west side of chicago. How do we take our community of employees, our first community, and understand their lives are like and they were suffering and what how do use our you know organizational power as a not for Profit Corporation to make a difference. And so we took on whats called an anchor mission and theres about 90 Health Systems nationally that have done to hire locally to have career paths into wealth to support businesses, to invest in Community Infrastructures in our neighborhood and we took the west side and we we said this is our neighborhood we engage other institutions to join us and then we decided equity has everything to do with access to Power Resources and money. How are decisions being made you mentioned that about power resource of the money and set a table that the community and the institutions making decision together because we realized we couldnt do it alone now we would be the Largest Corporation in in the city and west side united that entity was asked by the city to lead the Racial Equity Rapid Response to city. Was it enough . No, it was insufficient. But is it the right approach . Yes. And theres work going on. I tell you, in Garfield Park, the lowest Life Expectancy on the west side, led by the community to where were at, the to say they want to create a wellness village with food with health care. But and exercise place they want a gym, want a Basketball Court and were just trying to facilitate that. They want jobs. They want support for local businesses. You know, when when when we put rush employees in or a lot of other people who are now in Garfield Park when they go to lunch, theyre going to drop their dime on the west side because most people avoid, those neighborhoods, we have to get other businesses to do the same thing. I think whats important for everybody to understand, covid was a Massive National and it wasnt about. It was about how we organize ourselves as a country. And weve tolerated to have a country in which white people in general have do well and people have been assigned white in general. Do well. And black people and people of color have suffered. And we can redesign that. But we have to bring more than the hospitals along with this. And this is where national Public Policy can make a giant difference moving forward. So you have lot of reason to be proud of west side, united. Its one of the paradigms for the nation. And im impressed, by the way, in which its been overtly vertically integrated to impact care. So i want to thank you for that. The three areas that im trying to invest in that give me encouragement about the future are, first of all, i continue to take of sick people. I mean, i think at the end of the day, there is honor and meaning in taking care of people who health the most. It matters if you stop the bleeding and i think that people can do that no matter they are just stop the bleeding and relieve suffering. And so it is important for me to also share those moments of transcendence and grace that remind me of my own humanity, touch other people in those moments, and inform that is something bigger than all of us. And its important for us to invest in taking care of each other. Part of that is also telling the truth around this, which was part of the of this book. I mean one of the things that happened when society sort of fell apart was it created these moments of and i was fortunate the position where its not only that my patient might not do well, but i might not do in the Emergency Department those moments of challenge also create a clarity around what it is that matters and why it matters. Why does it matter that we push towards these intergenerational final goals to perfect what we claim is democracy towards one that actually represents everybody and centers our shared humanity. Why it important . To be honest about those things and that to the book and it leads to me speaking with a full throat about these challenges such two things. The third thing is ive been working on National Policy so i was very i was the Health Equity chair for the Biden Campaign and embedded a number of policy points that beginning to see turn into regular action and law. One of those that i believe most in is the importance of capturing and reporting quality data by race, by because downstream can then link that payment. You get what pay for. Lets start paying for the things we want in a setting of equity. And then the last thing that im doing that matters me is if we were to a new america one where the way we allocate our resources is a function who we are and the way we vote, where Single Person is similarly valued resources we would still need to a brand new system of care. We dont. We have a frayed safety net. We dont have enough Health Care Workers. The so after so many people have quit, we dont have technology that is usable that allows for us to bring together so Many Health Care handoffs we dont have a focus on primary care over specialty care. We have so things that we need to do thats are challenged by these old Health Care Institutions that are doing just fine the way they are. Theres very little incentive for our incumbents to fundamentally the way they deliver care when right now theyre fine. Yeah. So im trying to build new and i think, in fact you build new things you can embed in these new cultural components arent a legacy of 1892, but are a legacy 2022 and let our children in 50 years say you guys still thought and let them build new again. So i work with a Company Creation enterprise that creates Health Care Companies and im Building Solutions for our elders who need Behavioral Health solutions. Im working on new ways to get people to improve throughput in the Emergency Department and place people home when they need to be and not in hospitals. Im working on ways in which we can get people transplants, their kidneys, who need it, as opposed to ending up on dialysis for 30 years. I think theres a lot of merit in creating new things and inspired by the arts as we do it because what were fundamentally about is creating something, bringing into being something that has never existed before. Weve never had a just america. Weve never had a society that reflects our humanity. Weve never had a Health Care System that is equitable and equal thats not to come from walking away with incremental change thats going to come from, harnessing our imagination and building something doesnt exist. And so thats the main thing that really me and its where i invest a lot of my energy. And so something you mentioned, dr. Fisher, that i want to touch is, you know, the labor shortage were seeing in health care right now. And this is something ive a lot about this year. You know, i think you even just before panel you were saying you chicago is still know suffering from some of those losses that we saw in the pandemic. You know, stress and burnout pushed. Many Health Care Workers out and so you know how do we sort of rectify this issue either bringing people or encouraging you know the next generation to pursue medicine when we know it is you a lot of sacrifice, tough job, tough hours and covid likely not the last pandemic. You know think the upside is it is meaningful and people want that so many people are tired of doing that. They do not believe in. They sit in front of a screen doing something incremental and they are like. What is the point . I hear that regularly from people of all ages. I think the chat hinge around American Health care currently, particularly of us who sit on the front line is moral injury. I see it every time i come into the Emergency Department and, there are 45 people in the waiting room. Some of them have been waiting ten or 12 hours and my job is to select who comes back next. Well, theyre five people over 73, three of them have abnormal, vital signs. Many of them been waiting for eight or 9 hours. And yet im the one who says that person, not that person. And i have to do that every day. Weve been trained to first do no harm. Weve been all these skills and talents and experience says, and we want to take care of everybody. But we sit in a system that forces us to hurt people sometimes when we alleviate those sorts of challenges, we wont need wellness endeavors to bring people back to work. We just need to make it so that people can do the job that they came to do meaningful and relieve and cure people and we create that Health Care System. People will come. Yeah, thats dr. Hansell. Yeah, well, i think the pandemic a lot of things. So lets just say and its not just in health care, the medical School Applications are through roof. I mean, at the same were in a generation of, you know, nurses and doctors in and i think this whole this will get resolved. I do think the moral harm piece of it is is critical. There are people are facing problems that present themselves in beings in front of them that are in nature, that the individual cant resolve. And we face them all time. I do think the i want to talk about hope a little bit because this is easy to field discuss in all of this. And people always say, well, how do you stay positive and hopeful in this . Well, one is if you live long enough, youve change that. Youve seen things can improve and you know, you you see the increments. The most hopeful table i sat at during the pandemic, two of them the Racial Equity Rapid Response table that the city that had groups come with solutions. Let me give you an example. When we had really few tests to give out out the they we put together a committee and it was the providers, it was the Community Leaders. Were going to open testing sites around the city. Chicago not enough, but we insist that they be in black and brown neighborhoods. And what should be the criteria for testing at that point in time the only way you could get tested if your russia you would see if you had symptoms so said it should be people with symptoms. The Community Folks said no way anyone who shows up should get a test and what we did and that became the standard of care around the city anyone who wanted a test gets a test. And thats what we did. And it was that Community Voice us gives me a lot, gives me a huge amount of hope and there were other things during that period of time we very early in the pandemic, there was Community Spread in shelters and it was asymptomatic. We would borrow tests, wed go to the command center right and said, we need to tests to go test in shelters. And we found that 40 around one positive person was positive i called together a meeting. The Infectious Disease person you will find someone from. Say what . These were our findings. Do we do mask everyone that next weekend to thousand masks were distributed to all across these shelters before there were mask mandates from cdc or the state in the the idea that people at the front lines can make a difference is a huge thing. I mean those are those in those moment things but but the most optimistic table i sat was was not the Racial Equity Rapid Response this there was a group in Garfield Park when they saw the Life Expectancy in our neighborhood was the lowest on the west side. And there was a 30 year gap between loop. They said we want to do something it. And before the pandemic, an Informal Group began to meet that formalize itself and to be the Garfield Park right to wellness collaborative. And this met every other week our. Town halls did covid work, but planned for the future plan for what this neighborhood should look like that has had no investment since Martin Luther king was assassinated and the neighborhood went up in flames. No and this was im in this table is so optimist. Everyone loves people from covid and yet they had a vision for a neighborhood that that gives gives me hope to carry on and. So hope is a muscle we have to hope is not some abstract idea and that you cant get hope is a muscle that you have to exercise and its pragmatic and im see there are Pragmatic Solutions that are going on ultimately have to find their to Public Policy that that leads to sort of the kind Capital Investment that neighborhoods need to lift the health of everybody. And at the end of day, im hopeful because i know that when we take the lives of those who have been most systemically marginalized and make them the center of public, everyone better, everyone does better. And you just have to look at the 1. 3 Million People who died on this necessarily from covid in this country. To know thats true, white suffered after black and brown suffered. So i am hopeful because i know the solutions are within reach. Right. We just have to decide were going to double down collectively to do this well. Were getting close to wrapping up, so i wanted to leave some time and see if theres any questions from audience members for dr. Fischler, dr. Ansel. And. Youve talked about reform a lot in that just the whole time. Im thinking about the Affordable Care act wasnt our attempt to make Health Care Accessible all and did that stop emergency from becoming the first place you went to to get health . And what about the Affordable Care act . Didnt the Affordable Care was an amazing step forward in reshaping the Way Insurance works in United States. It reduced folks being dropped in the middle of treatment. It allowed young to stay on care until they were 26. It added regulations that made Companies Better actors, but it didnt transform American Health care. In fact, the most impactful component was probably medicaid expansion. The challenge with, the way we pay for health care is depending on who you are. You are the dollars you bring to Health Care System are different. If you have one of these high paying jobs that insurance you 50 or more, youre able to bring 50 or more dollars to your doctor than if youre on medicare and maybe 75 to 100 dollars more than if youre on medicaid aid. And so if youre a Hospital Administrator or a physician and you love everybody, but youre just narrow mindedly making decisions based on finance, youre going to diferente only care for those who have insurance over those who do not even those who have medicare and the challenge becomes, we know theres plenty of good literature that describes the way you get those good jobs related to your race is related. Americas racial caste. Theres plenty of studies that demonstrate that white without a High School Degree are more likely to be hired to these sorts of than black men with the college degree. And so race blind and disinterested any sort of, you know people can reify and deepen these Health Inequities simply by making Financial Decisions and the health the Affordable Care act didnt do any of that. It wasnt designed to we have to keep working. We have continue our progress. And just to add to that, you know inherently, since the beginning of slavery in this country, weve had different Health Care Systems in general for white people, black people and those whove been assigned white and whiteness is and is an idea theres no is a social construct and so we have an inherently a apartheid Health Care System. So one of the things that happened during covid i called up the ceos of safety net hospitals and said transfer your patients to us. We open it, we created a giant icu, didnt happen at every hospital in the city nor in the country. Many of these hospitals were swamped. They were overwhelmed. People died. But they have if you look at the care anybody gets in these hospitals, no, in themselves or clinics, its different than the care that you get it a northwestern or a u. S. Or a rush. And that differential is racialized to the for the reasons that a man said and. So you end up with bad outcomes. The good news is, for the first time in this countrys history, medicare, cms and the joint commission have regulations that put out some regs that are going to make institute patients look at their outcomes by race, ethnicity and language and other things, and then have some hopefully accountability. But its never happened before. And so just having a card itself is not the answer. And then if you add the experience, the experience of mistrust and care people are reluctant to come when theyre sick. So its not just insurance helps, but not enough. Thank you both. Well, thank you both for here. Its funny that you mention one of your statistics about 2012, up until then, we were going up in in inequality and then we started going down from there because that was right around time when chicago, a large part of illinois, decided to close down their start closing down the Mental Health care facilities. And i was wondering, you had anything to say about mental care as far as disparagement can get . Well, you know, we shut down the state. The Mental Health clinics in chicago at a time when psychic was and from all kinds of reason racial trauma and other is rising. So i do think its a factor. And if you look at the covid, if you dive down but thats thats death you im talking i was talking about when you look at that if you go down you look at grief in psychic distress huge levels across chicago but double and triple the levels in the black in the Brown Community so psychic distress is that you know when you look at it you Say Something has been going on. Theres a secular trend and its probably i wonder if it was related to the downturn of 2008 in 2009, when a lot of wealth was due to foreclosures, to explain that began to show up in 2012. What i want but the point is nationally, prior to covid we saw Life Expectancy drop in, this country largely because of many factors but white people without college degrees, they began to experiencing drops and not seen it in any other developed country. So theres something thats happened. Its not just local in chicago so its a National Secular and were unique among the developed countries of having that and thats the urgency to sort of get to the bottom of it i think is tied to wealth inequality at the root and the social inequality that racism in its ongoing perpetuation and policies and things today have cost. Well that is all the time that we have so thank you so much to dr. Fisher. Dr. Ansel, this has been truly and insightful and so happy could talk today. So thanks for beingnow, i am soe tonights speakers. Jamie mccallum is associate professor of sociology, Middlebury College and has work has been featured in the new york times, new yorker, washington post, jacobin, dissent and, numerous scholarly journals