Health Equity is Earned, and Learned!

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban. And today we have joining us on our show one of the emerging authors in the space of advancing health equity. We're so excited to talk to him about Health Equity: A Guide for Clinicians, Medical Educators and Healthcare Organizations. Dr. Bonzo Reddick, thank you so much for joining our show here today.

Dr. Bonzo Reddi:

Thank you so much for having me. So excited to talk about health equity today.

Brian Urban:

This is going to be so much fun. The work you do alone is dizzying to me because not only do you have multiple titles, you're an author now, you're a speaker, you're a professor, you're at the department of a state in public health leadership. You do so many things. So we want to get to know you first, and then let's get into the book and some of your exciting work as well.

So I got to mention this to our listeners first here, Dr. Reddick. Currently, you're the professor of community medicine and family medicine at Mercer University School of Medicine. And that's in Macon, Georgia. So Macon Music is a good minor league baseball team I know in the area there. And you're also the chief medical officer of the Coastal Health District at Georgia Department of Public Health. That is so much on your shoulders, left and right shoulder. But before we talk about that, who is Bonzo before you became Dr. Reddick, and before you had these amazing titles and the work you're leading? Take us through the journey. How have you come to be today?

Dr. Bonzo Reddi:

Sure. And I'll make a minor correction that'll tie into my story about who I am. So Mercer University School of Medicine actually has three campuses. So we have a campus in Columbus, Georgia, Macon, Georgia, and Savannah, Georgia. And so Macon is where the undergraduate institution is housed alone, but the medical school is actually spread across three campuses. And I'm actually in the Savannah, Georgia campus. I spent about three years as the chair of community medicine, and the community medicine department is spread across all three campuses. So I was the chair over all three campuses, Columbus, Macon, and Savannah. But right now, I am in Savannah.

And that's where I was born and raised. Savannah is my hometown. So I was here from birth through high school. So I was here for 17 years to start my life, and enjoyed growing up in Savannah, loved the beach, loved the water. And I went to Atlanta for med school and for college. I went to Morehouse College and to Morehouse School of Medicine. And so I was in Georgia for the first 25 years of my life, moved to North Carolina for residency, went to the University of North Carolina at Chapel Hill, was there for three years of residency, and then stayed in North Carolina for about 12 years total in North Carolina, doing residency and also working as a faculty member, and then moved back to my hometown about 10 years ago. So I've been back in Savannah since 2014.

Brian Urban:

Wow. And so you are homegrown in Georgia. And thank you for the geographical specificity on where you're at today. So Savannah Sand Gnats. That's the other old minor league baseball team-

Dr. Bonzo Reddi:

That's right. And now we got the Bananas.

Brian Urban:

The Bananas. And they've done a lot for the community. A big fan of what they're doing there. But for yourself, Morehouse, a great HBCU. I mean, it's obviously rooted a lot into your public health purview as well and the lives that you serve in and around the state of Georgia and the influence you have beyond. So I love to hear your roots in the state of Georgia, and I'm just so excited to understand first, off the top, why the book now? The Health Equity, it's really a guide inside healthcare. I think it appeals to a lot of other parts of the ecosystem, but why now? And why specific to healthcare organizations and health educators?

Dr. Bonzo Reddi:

Sure. So it was actually a long time coming, this book. And the seed got planted at Morehouse School of Medicine, which has a big focus on health equity. Back then, we called it ... We focused on health disparities. Health disparities being the differences in health outcomes between groups. Health equity, more of a push of not just trying to reduce every single difference, but making sure that everybody has their best chance to achieve health. So I just want to set that definition so we know what we're talking about when we talk about health equity.

So that was always in the back of my brain, just from my training from med school, about making sure that you're trying to give everybody the chance to achieve their best health and trying to undo some of these inequities that we see in society and healthcare. And then I went to North Carolina, which has a really prominent public health school. And so after I finished residency, I actually was working part-time and going back to grad school to get a master's degree in public health. And that was the time when ... I believe you have a master's in public health too, if I remember correctly, right?

Brian Urban:

I share that with you. I share that passion. Yes.

Dr. Bonzo Reddi:

So you know how public health is, and it just totally changed the way I was seeing medicine. Beforehand, we're taught to treat this individual patient who's in front of you. But public health is saying, "Hey, step outside of the walls of your building. What's going on in the community out there?"

And so my specific area I focused on was health disparities, almost by accident. I kind of stumbled on it, where I said, "Oh, that sounds like a great course to take. Let me take an introductory course to health disparities." And it just rocked my world. Dr. Hogan, just every week, was saying, "Let me tell you about differences in outcomes with Black patients and everyone else. Let me tell you about the difference in outcomes between people who are gay or lesbian and everyone else. Let me tell you about disparities for people living in rural areas." Every week, it was a different group. And it just changed the way I viewed medicine.

And so I started just spreading this word, talking to colleagues about it, talking to medical students about it. And then over time, there started being more of a push to address health inequities from the CDC, from REACH 2010, from the Health and Human Services Department, from activists, grassroots organizations. Everybody was starting to talk about it.

And it hit kind of a peak in 2020. Public health emergency from COVID, but also murders of George Floyd, Ahmaud Arbery, Breonna Taylor. And so all of a sudden health organizations, medical schools were saying, "We really need to focus on equity, but we don't have the tools. How can we talk about it?" And that was around the time where I was really trying to spread this message more just coincidentally.

And so I started a consulting business to actually go out and just do speaking engagements, talks, and do trainings for other organizations as well, because a lot of people said, "I would love to do it, I just don't have the tools. I'm a pharmacologist. I can't talk about health inequity. I don't know about it." And so that training I had from public health school, I just relayed a lot of the information. I continued to study, learn about new trends, do certain public health projects myself, just in my own work in the medical school and residency programs I was teaching at, but also in my practice as well.

And so the more I shared, it just kind of snowballed from there, where you give one talk, and I gave a talk in Florida and somebody happened to be there who had a friend in Texas, and they told them about the talk and I got invited to Texas to give a speech. And when I was there, somebody from the Health and Human Services Commission in Texas was in the crowd. And they said, "Will you come back and speak for the Health and Human Services Commission?" And then somebody from Kansas was in the crowd, and it just kind of snowballed from there.

And then finally somebody said, "How many of these talks do you have?" And I added them up and I had 12 different themes that I was talking on. And a mentor of mine, Dr. Jarret, Dr. Jarret Patton, he actually wrote the foreword in my book. He said, "That sounds like a book to me." And I kind of brushed him off, and he said, "Bonzo." He said, "You go and give a talk to somebody. How much of the content of those 12 themes are you doing?" And I said, "Well, it's one theme per talk." He said, "So somebody would have to pay you 12 times to get you to cover all the themes in your book. So that's not feasible for most people, and so why not write it in a book?"

And so it sounded like a great idea, but it sounded like a lot of work. So the final straw was that he said, "Just take your presentations that you do, your PowerPoints, put them into a book, into an outline, paste them into a Word document." So I did that. And it took me several hours to do it, but I did it and it was 75 pages long. And so I said, "Wow, I think this really does sound like a book." So I asked some colleagues who asked me to speak about it that I was ... I'm trying to remember where I was. Maybe at University of Michigan or somewhere. I was somewhere giving a talk, and I mentioned about me thinking about writing a book, and just a lot of excitement from everybody I mentioned it to. And so I just wrote a chapter per month essentially, starting in 2021. And the book happened. So that's sort of the long story short about what happened.

Brian Urban:

I love that story because it shows our listeners that this wasn't just a turnkey project. It was something that was built over time in a thoughtful way. And you consolidated it into a guide, which I take it really as a guidebook. And it comes off that way, in a really good way. And it's great that you opened your book with Dr. Jarret Patton giving the forward. I think, obviously, that relationship of influence has meant a lot to you. I want to understand that a little bit more.

And then also you go right into terminology and definitions. So you set the groundwork for the guidebook that you are constructing over the course of the reading. And I thought that was very helpful. Obviously, someone that shares the public health setting with you, I am very in tune with what you're putting down here, but for those that want to accelerate a program or an idea inside a healthcare organization, this is like 101, how you actually get to traction and start to impact lives and families in the communities that they might serve. So I love that.

And I do want to quickly understand, before I get into some of my deeper questions, what has that relationship with Dr. Jarret Patton meant to you in getting this book to market and really filling it with all the talks that you have given across the nation?

Dr. Bonzo Reddi:

Yeah. So he's written a few books himself. And so I think his most popular one was Licensed to Live. And he had written a couple, and I always thought, "That's just way too much work. There's no way I'm going to do that." For us who have worked in medical schools, who do our clinical practice but also do some academic work, even just publishing a journal article is a lot of work. So it just sounded like a lot to me.

But he was the one who really encouraged me and said, "It's not that bad. Batch it, do it in parts." He was the one who gave me the idea, just put into an outline first. And then from there said, "When you write that first chapter, just imagine yourself giving the talk, and literally write down the words you would say if you were given a talk in public, and just do that." He said, "When you're at your kids' activities, at soccer practice or basketball practice and just sitting there for an hour and you're checking emails or whatever." He's like, "Just pull out your computer and just do it then, or if you're having some downtime somewhere, waiting on somebody, just do it then. During lunch breaks or whatever."

And so I did that on just free evenings or weekends or lunch breaks or whatever. And it took me about a month per chapter. And each month, he held me accountable. He's become like a coach to me. And so he would just, each month, say, "Okay, I want you to have chapter three finished. By May 1st, have chapter three finished. Okay, chapter four next month. What are we going to do?" And so I would just go over the chapters with him, and he'd give me some feedback here and there. And so it's been big. He just was always there at times where I kind of got frustrated with trying to shop around for publishers and not sure what I wanted to do. He was always there to kind of encourage me. So it is been very important. It's been a very good relationship.

Brian Urban:

That is excellent to hear, how mentors and multiple book authors like Dr. Patton can actually encourage you but also hold you accountable too. So I love that side of it. And I thought that was so lovely that you had him open it up for you. And you actually had some recognition comments when you closed the book as well, some conclusion thoughts, that you had put him in there as well.

So Dr. Reddick, I want to get into what struck me as extremely timely and interesting from a healthcare delivery standpoint and also a population health standpoint as well. So pages 60 to 65, referencing this for our listeners here, you started to talk about race-based decision-making in terms of a calculation and what it means for treatment paths. So your big example was cardiovascular disease. And you broke this out by African Americans, males specifically, in parts of the reading there.

And what I thought was so interesting is there's really a good and a bad side of using race-based data in clinical treatment pathways. And there's some laws that were pushed out recently in California that they have to not only survey but maintain race-based data for the lives they serve. Race, ethnicity, gender language, I believe. The REGAL dataset. And there's a lot of, I think, need there, but there's also a lot of education that needs to happen upfront before we just start collecting and maintaining this data, how it can inform physicians seeing their patients on a continued basis for care. What's the bad side and what's the good side? I want to get just a good grounding for our listeners, because I think we all gravitate toward the good side. We start to go toward cultural competency. But what's the bad side here that's not maybe called out when we think about using race-based data for clinical decisions?

Dr. Bonzo Reddi:

Absolutely. So the bad part is that we use population-level data and general trends to make individual patient decisions. So for example, being Black in America is associated with worse cardiovascular outcomes, tend to get high blood pressure at a younger age, tend to have more in organ damage from that high blood pressure, less likely to have consistent treatment plan, whether that's interaction with a healthcare provider or if it's bad interaction with a physician where you don't trust them and don't take the medicine or whatever the reason might be, less likely to take medications for it, more likely to have death at a younger age from it, more likely to end up on dialysis, all these bad outcomes. And so there is a need to be aggressive with certain patient populations when you look at a general trend.

However, when you rely on that solely, then you say, "I'm going to just be essentially lazy and just make a decision just based on what color of skin I see in front of me." For example, if you look at the cardiovascular data, a lot of our data in the United States is based on this thing called the Framingham Study. It started back, I believe, in the 1950s where they just studied people for decades to say, "Let's see who dies from heart attacks. Let's see who dies younger when we look at age, demographics, gender, smoking status or not, whether or not you have diabetes. Let's see which risk factors seem to have the strongest association with death and bad outcomes, heart attack, strokes." And so that data is important. And so we say, "Hey, Black patients have worse outcomes."

But then what it's translated into is these things like these risk calculators, where you type in somebody's demographic information, you type in their race, their ethnicity, their smoking status, their age, and then from there you say, "Okay, if they are high risk, I'm going to do certain therapies for them. I'm going to give them a statin medication for their cholesterol or give them aspirin to prevent heart attacks."

And the problem with that is that it doesn't consider all the heterogeneity of a certain population. So for example, it's not considering the fact that all Black people are not the same. And so for you to have a patient in front of you and you calculate their objective data, their age, their cholesterol levels, their blood sugar, smoking status, those things that are objective and that you can't argue about, but then the final decision-maker is race. And so sometimes that race factor is just enough to tip your decision maker.

So for example, some people use a guideline where if your risk for heart disease for 10 years is above 7.5%, then you get a treatment. If it's less than 7.5%, you don't. There are times where clicking that race factor might push you above 7.5% depending on what somebody's race is. If they don't have that race, then they'll be below 7.5%. So you literally are making a clinical decision just based on somebody's race. And if you think about race, it's not based on any kind of scientific data, any kind of pattern. There's no medical definition of what somebody's race is.

So the way we identify race in medicine is by patient-identified race. So literally you're making a decision, yes or no, based on what race somebody tells you they identify with. So if somebody has a Black parent and a white parent, you say, "What race are you? White? Okay, you get this. Oh, you're Black? Oh, nevermind. You get this instead." Very, very clumsy. And that's the bad, the ugly side of it, is that we sometimes make individual decisions based on just general trends without thinking about the fact that everybody's different within that community.

The good thing is that it does allow us to highlight health disparities. So if we just do the I don't see race thing, and just say, "I'm not going to ever look at race and never think about it," then we won't know when our patients are having worse outcomes. We won't know that Hispanic children who have long bone fractures are less likely to get pain medicine when they come into the emergency room with the same exact injury as somebody else. We don't know that unless we look at race and ethnicity. So it's something that we should look at, but we should have a lot more nuance when we're treating individual patients and not make these blanket decisions.

Brian Urban:

That right there is a huge highlight and takeaway for I think anyone in our listener group here that's of the healthcare, or even really from supporting healthcare from a health plan perspective or other service models, going into social health needs, and even from a policy perspective. It's great to be able to capture this information and report on it and look at disparities by race. But not having a population, almost block-level set of data inform down to the individual level of what a care path treatment, et cetera, should be. So I love that you went to that level. I think that's a great cautionary tale for how other states, aside from California as the example I used, are going to continue to make requirements on managed care organizations to be able to collect, maintain, survey their patients for this information.

So this type of view I think is so connected into where your book continued on, which was the cultural competency. But I loved how you put this, the cultural humility. So in thinking about that term, I immediately thought of, man, how better off would our country be if we had that integrated into medical science in terms of undergrad and residency, just as a lot of different schools of medicine have in Europe, and I think a lot of HBCUs have naturally in their programs.

But if we could scale this across the continuum of education at a higher level in the US, what could that do? And you called out in your book the gap between the will and really the capacity for certain healthcare organizations to be able to address patients from a cultural standpoint. And then you talked about cultural blindness. This stuck with me immediately. So I want to hear from your experiences as a physician and what you've seen recently from conversations you've had across the US. What has cultural blindness and the discussion been to healthcare organizations? What has that been like, and what is their awareness of that?

Dr. Bonzo Reddi:

Sure. And since we're talking about vision, I do want to apologize. I have an automatic light in my office. I think I've been sitting for too long. I don't know if it's better for me to hit the light, or just go ahead and keep going.

Brian Urban:

No, this is good. You can hit the light. This is even better for our audience because they could be like, "What's going on? I got to see the video now, not just the audio." You're energy efficient, Dr. Reddick.

Dr. Bonzo Reddi:

I'm back. So my apologies for that. But yeah, so that is important. And there's a lot of jokes about that because a lot of people ... That's a common phrase I hear, is that people say, "I don't see color." But we do the same thing as well where somebody says, "Oh, I treat everybody the same." That's the cultural blindness phenomenon idea is that, oh, I just see everybody the same. It doesn't matter where they're from or what their culture or background is. I just treat everybody the same. And that's good in theory, but some people don't want to be treated the same as other people when it comes to certain things.

So I think there is a lot of importance, and the book talks about that, about the importance of cultural competence, which is understanding that people are different, and that certain countries, religions, racial and ethnic groups have general trends. And being aware of that so you're not surprised and so that when you see those trends over and over again, you don't make the same mistakes over and over again.

But the cultural humility piece is also understanding, again, the heterogeneity of groups and saying that even though these are general trends, everybody in the group is not going to always be the same. And sometimes by you assuming they're going to be the same, then you can sometimes offend people and really mess with the rapport that you're building between, for example, a physician or a healthcare provider and their patient.

So the example I use in the book was that for a lot of people who are Muslim, they might prefer ... If they identify as a woman, they may say, "I don't want to be alone with a male provider. I prefer to have a female provider." That's their preference. And that's something I've seen over and over again in my practice, in the 22 years since I graduated from medical school. I've seen it over and over again. But also there's times where somebody's like, "I don't care, it doesn't matter." And they're Muslim. So you can't make an assumption to always say that. And so depending on how you say it, you sometimes don't consider the patient's context or verify or double check things with them.

So for example, if you see a woman who is wearing a hijab and you immediately just turn around and say, "Oh, I will get you a woman provider. I'll be right back," and you just switch patients and go on about your business, that's not cultural humility. Maybe that is a certain level of cultural competence in knowing that might be the case, but cultural humility is asking the person.

When you come in and meet the person and establish rapport, and the person doesn't immediately say anything to you, you can say that, "I noticed you're wearing a hijab. Are you Muslim? Are there any things I need to know about? Does your religion impact your healthcare at all? Is there anything that I need to know that would make you have a better healthcare experience?" Yeah. Sorry, but I kind of prefer to not have a male provider. Oh yeah, sure. We have other people I can have you see. Would you like me to go talk to somebody right now? And I've gotten sometimes the answer of, "You know what? Not for today. Maybe for next time, but we can go ahead and finish today's visit." Sometimes I get a, "Oh, please, yes, thank you." And sometimes I get a, "I don't care. It doesn't matter."

So not making that assumption about every single person who's a member of that group is so important, but at the same time, not being blind to it, not being ... Just ignoring it, and not meeting people where they are. That's that blindness phenomenon. So you can't let the pendulum swing too far in either direction, where we overreact to things and say, "Oh my gosh, they're Black. That means they're going to want to do this. They're Black. They're not going to trust healthcare." There are a lot of trends where there's a lot more mistrust of healthcare systems in Black communities, but you can't just lead in saying, "Yeah, you're Black, so you probably don't trust me, huh?"

Brian Urban:

Right. Yeah. And I think that is a surface level, at best, cultural competency that then goes blind, and you're disconnected from the cultural humility as a level deeper into what you're saying, Dr. Reddick. And I think it all comes down to racism and poverty as an experience, and then what those conditions are in terms of being constantly surrounding you as an individual or a family or a community.

And something I thought was fascinating that you went into ... And you pull a lot of different graphical representations of data and great references within your book. Very thoughtful, academic, you are. So that MPH is still stuck in the way that you present information and then you share it out in a reading. So I love that. Such a big congratulations to you in staying with that mindset.

So rural hospitals in particular. You pulled a Guidehouse report looking at financial risk. And then you start to ... And tell me if I'm off here, start to attribute poverty being one of the biggest contributors toward financial risk and potential bankruptcy, or going even further into the negative for some rural hospitals, community-based hospitals. And of that, you called out infant mortality rates as well.

And for me, I look at this as a thought experiment, and I see the lack of disconnect for what we're providing physicians in a simple way of saying, "Hey, this person is economically unstable. You have to treat this or face this first before you can face them in a clinical setting." And then those two are balanced together. I think a lot of federally qualified health centers are great at doing that because those are primarily the lives that they serve that are faced with those challenges.

But for you, looking at that Guidehouse report, do you see that as one of the biggest contributors toward financial risk, is just maybe health literacy, poverty, racism that's being experienced by these families and communities? And then you can see the direct connection to ... Wow, we're losing a lot of Black mothers, we're losing a lot of babies, and we could have prevented this if we would've had better information that's on the social economic side, not just the clinical side by race. Do you think that's a big part of it, or am I reading too far? Am I going too wild with my thought experiment? But I want to get your perspective.

Dr. Bonzo Reddi:

You are absolutely not going too far. Absolutely. And that's a big point. And it's interesting because ... You mentioned earlier that I do a lot of definitions and terminology. That's important because people sometimes hear certain buzzwords in media and in politics. People throw a lot of words out there. One of the words that's been really just misused is intersectionality. And so I talk about that a lot in the book and it shows up because a lot of times, for whatever reason, people use that in the context of sexual orientation only, and they make this into some kind of culture war or whatever. But the point of intersectionality is that it's rare that you can just look at one specific thing and say, "That's the issue. It's your race that's the issue. Oh, no, no. Okay. In this situation it's just your economic status. Okay. This issue is only your gender." It's a mix of all of that.

And so all these issues come together to create a lot of these health inequities. So in rural communities, for example, the worst health outcomes are a combination of a lot of things. It's access to care. So it's not having enough people in those areas. Sometimes a difficulty recruiting people, physicians, to rural communities has to do with things like economics. So ability to pay the same salary they can make somewhere else in a place with more resources, with more financial and technical resources. So it's like I'm going to come to a place where it might be harder, more difficult to practice medicine and make less money. And then if I go somewhere, I have a critical access hospital in the rural community, but the reimbursement isn't there because there's higher rates of poverty and lower rates of insurance in those communities. So now all of a sudden the hospital has difficulty making money and keeping its doors open and paying its employees a living wage.

It just cycles from there. And as a result of that, you have to drive a lot farther to get to a hospital that provides pediatric or neonatal care, or that provides intrapartum care, in other words, delivering babies. And so all of a sudden you have a mom who says, "Gosh, that's an hour drive. Maybe I'll just try to tough these symptoms out a little bit longer and see what happens." And it ends up being something life-threatening.

So all those things come together. And the problem is we really have to address them just in a holistic manner. So we only focus on the medical care part of it when it comes to maternal, infant mortality and say, "Make sure you're following those clinical guidelines, obstetric and neonatal providers." Well, that's a part of it. But then there's also things like is your personal bias getting in the way about you applying those guidelines? And that's why there's a whole chapter on bias. And then it is also like, okay, that's great, but what about the system you work in? Are they making it easy for patients to get in? Is the political system in a way that the hospitals can actually make revenue and keep their doors open?

There's this image that doctors are making a lot of money, and as a result, the hospitals are making a ton of money, and nobody wants to hear about them losing money. But when a patient comes in who is uninsured, that hospital loses almost all of the money they spend on that patient. I mean, in some studies, 95 to 96% of that money is never going to get reimbursed.

So political decisions about things like expansion of Medicaid or access to insurance, and is that a basic right that we're going to give everybody or is it something where we say people have to fend for themselves and take personal responsibility for having insurance? That has a systemic effect on society when we don't do that.

When hospitals are required to take care of people in emergencies, there's a federal law called EMTALA that requires you to take care of people in an emergency. But you know if somebody comes in uninsured, you're probably not going to get reimbursed. And then same thing with labor and delivery services where we don't reimburse appropriately for maternity services. We have this very bizarre billing and reimbursement way we do in obstetric care.

So all those things all come together to create this problem, like you said. So poverty of the patient population, lack of reimbursement for hospital systems, lack of incentives for people to come to areas that are under-resourced and underserved. All those things come together. Inability to afford medications when people do have evidence-based treatments that can help them get better. All that comes together.

And again, it's the intersectional thing where it's very rare for any of the problems that I discuss in the book where poverty doesn't make them worse. There's rarely a situation where your geographic location can't make it worse, where your race or ethnicity couldn't make it worse, where your gender might make it worse, your sexual orientation might make it worse. If you're a religious minority, that could make it worse. It all comes together in unpredictable ways, and it's unique to each individual.

Brian Urban:

Yes. And I like how you drop everything down to the individual because I think a lot of physician executives, health plan executives, even thinking about device life science, clinical trials, they'll all stay at a population level. And they tend to stay there because it's a safer place, but I love that you drop it down because that's where things can be impacted and changed into what we're doing.

And I got to say this. If your book isn't already a required curriculum in certain schools of public health or schools of medicine, it absolutely should. I'm on my way after this podcast to highly recommend where your book should be positioned, a couple schools of public health in the northeast, because this, to me, shows ... And you go, later in the book, into this, the payment infrastructure set up right now that isn't helping address social determinants of health, help improve health equity or close disparities by race. It's not set up to be a part of the business model of healthcare in the US today.

And the other side of it is you do talk a lot about the different determinants. You go into the decision-making from a political, expanding access perspective too, and Medicaid. If we have all these gaps, no wonder why we have distrust and medical debt skyrocketing and bad debt for hospitals too accumulating. For us, it's very obvious, but your book lays it out in a very plain language of here's the challenges and here's the path to question and how can you advance this? That was in my brain when you were sharing all that, Dr. Reddick. So excited.

So with all that said, I want to look out five years from now. What do you think, from the book here and what you've laid out, would be the biggest contributor in starting to address health disparities, advance health equity from a healthcare organization perspective? Is it purely policy coming down, state, federal? Is it going to be the early adopters, health tech? A lot of social healthcare tech platforms and social safety network organizations are out there. What's going to be some of the big contributors that's actually going to heed your advice and your guidebook and turn it into reality? Who do you think is going to make a big difference?

Dr. Bonzo Reddi:

Sure. If I can piggyback on what you just said a moment ago. That's part of the answer. So it starts with the education system. And I'm not just talking about medical education, public health education. I'm talking about even before then. So things like cultural competency and cultural humility actually at a grade school level. These themes in society, because again, the way it's presented right now is that, oh ... It gets all kinds of names, right? It's DEI, it's critical race theory. You hear all these debates about kids are being indoctrinated with critical race theory. But that's why the way I wrote the book is kind of in a way where, again, it starts out each chapter in a lighthearted manner. It starts out with me poking fun at myself, where I give an example where I personally have made the mistake where I've stereotyped somebody because of their religion or because of their race and not realized it until I'd already put my foot in my mouth.

Brian Urban:

And the bungles of the month too. You have a couple of those.

Dr. Bonzo Reddi:

So each chapter, the middle ... Chapter 2 through 13 all have a bungle of the month, where I kind of tell you about an example where I did it. And they're usually lighthearted and humorous, but it's also done in a way where, again, the reader doesn't feel like they're being preached at. I think everybody who reads my book will say, "He's not wagging his finger at me and saying, 'Shame on you, racists out there.' It's him saying, 'Hey, guys, we all stereotype people. We all have unconscious biases, even against groups that we're a member of.'" We stereotype our own groups.

And so I think starting with that at a young age where you're not doing it in a way to make people feel bad about themselves, but in a way where it's lighthearted and you say, "You know what? You're going to meet people who are very different than you are." The most important thing is just listen to what they say. Listen to what their preferences are. Learn about their background. And get to know trends. Get to know other people in other groups, but also don't make assumptions about people. Let them tell you what they want.

So that's something that should permeate everything, not just healthcare. Legal system, business, finance, everything, it should. So if we start at that stage, but also for people that do go down a healthcare road, public health road, even healthcare administration, these principles from the beginning, because I can tell you the people that I have the most difficulty, the kind where it changed, where I have a difficult time convincing people and winning people over, is that switch between second and third year of medical school. Second year students are a wide open book. If you catch them about six months later, they will argue with you to the death and make you think that they're an expert, because they just do not want to buy what you're selling. And it's because they go into the hospital, start seeing patients. And all the medicine and science they've learned, all of a sudden they're seeing people, real human beings with that, and all those biases and all those assumptions get imprinted in their brains, and it's hard to undo that behavior.

So at an early stage, we need to do that, but also not give up on people who are older, because I've had people who have been seasoned clinicians for 30, 40 years come to me and say, "I never believed that. I've heard this said before, but after I read your book or after I heard you give your talk, I just understood it for the first time." So doing it from an education standpoint, trying to get people early, but also continue to give people these lessons, and then not thinking that's all, that it's only in the healthcare system. It's policy.

The short answer to my long-winded answer is that it's multifactorial. It's going to be education, both before and during the medical education process. It's going to be healthcare systems, policy, government being involved. And it's going to be a lot of other organizations outside of that. So it's going to be grassroots organizations, community organizations, federally qualified health center networks, state departments of public health, using unique ways to get care provided, looking at gaps in care, and coming together as a system and not only trying to compete with each other.

That's one thing I like about my job right now, is that I'm not here trying to say, "I got to get more patients than you have." I'm saying, "Where are the gaps in care?" And that's been my motto really for the past eight years or so, which isn't, well, I like doing this kind of care so I'm going to compete and try to take all this person's patients and customers. It's me saying, "Where are the gaps in the community? Okay, great. I'm going to slide in and fill that gap right now."

And so if we have that kind of approach, that's going to be the way we fix health inequities. Politicians working together with healthcare organizations, working together with physicians, providing trainings on these different topics, catching people while they're still learning, before they develop all these strong biases and bad habits. All that come together, and also not being so territorial, getting outside of your clinic walls, working with community organizations, not saying, "Well, I'm not going to let some strangers into my building to come talk about this. I don't know who they are." Getting to know people in your communities, working with them, and also involving patients, involving real people who are seeing care, and getting their feedback as well.

Brian Urban:

I could not agree more. And if you're watching the video, yes, I do have goosebumps just because I'm so pumped up. I don't think you're a football coach on the side, Dr. Reddick, but you could easily be one. The way that you speak, and it's very pointed, it's also very thoughtful, and it is driven with a lot of love and curiosity. I could not be more excited to be supporting your continued book tour and the impact that I believe you're going to be making across the ecosystem. Health Equity: A Guide for Clinicians, Medical Educators and Healthcare Organizations is out. You can get it. I am so thankful to have you on our podcast today. Thank you so much for being here, Dr. Bonzo Reddick.

Dr. Bonzo Reddi:

I appreciate it. Thank you so much for having me. I really appreciate it. Thanks.

Brian Urban:

And for more exciting excerpts and insights, please visit us at finthrive.com.