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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket, and welcome to the final episode of the Future of Health podcast series that we’re doing with Deloitte. We finished the last episode with Boris Kheyn-Kheyfets, touching on ecosystems and platforms, and today, we have the privilege of hosting Jen Radin on the podcast. She leads Deloitte’s Risk and Financial Advisory Health Care Practice in the US and is a founding partner of Deloitte’s Health Equity Institute. She works to enable healthcare system executives to embrace disruptive transformation, helping them leverage applied innovation to design new models of care and future-proof their businesses. Jen is passionate about navigating the rapidly changing health ecosystem and creating value in the journey to health and wellness. Jen is a nationally acclaimed speaker on the topics of Future of Health and health equity. So with that Jen, I want to welcome you to the podcast.
Jennifer Radin:
Hey, Saul, thanks. What a warm welcome, I really appreciate it. Great to be here.
Saul Marquez:
Hey, it’s really great to have you here. And you couldn’t do a Future of Health series without actually talking about health equity. So this is a topic that’s near and dear to my heart, and I’m so glad that you’re here to talk to us about health equity, but also health. Can you help us define health equity for our listeners and explain its importance in the Future of Health?
Jennifer Radin:
Yeah, absolutely, Saul. So we think about health in a very broad sense. We really wanted to open the aperture on this topic, and many people define health in terms of physical. Well, we realize as we think about humans is, health is actually much more than just physical. It includes mental health, social health, emotional health, and spiritual health, and some would also argue financial health,. And so, the definition that we’ve been working with at Deloitte and talking to our clients and our folks about is, health is the fair and just opportunity for everyone to fulfill their human potential in all aspects of health, being well-being. And so as we think about that in our country and we look at the US landscape, there’s a great deal of inequity in this space of health, and a lot of these inequities really became so visible to us through the pandemic as we hark back, realizing that both the morbidity and mortality of COVID had implications for Black and Brown people in our country in much more significant ways than it did for white populations, and the data is very, very clear, particularly in cities, particularly in my home city, New York. And so, while we saw this data emerge, it became irrefutable that there were differences and that they were driven, by the color of someone’s skin. So we began to really unpack this, and what we realized was there’s an inextricable link between health and clinical, economic factors, social factors, and environmental. And let me just give you a couple of examples in each of those four categories. So, as we talk about a health disparity, a good example would be maternal mortality, and I’ll talk more about that in a little bit because I think it’s a set of events that’s happening in this country that we really need to focus on and create impact around. Black, American Indian, and Alaskan Native women are 2 to 3 times more likely to die from pregnancy-related causes than white women, and that’s actually, regardless of socioeconomic status. An economic example, of course, is homelessness. 17% of LGBTQ Americans report that they have experienced homelessness in their lifetime, which is more than two times the rate of homelessness from the general population. And then a social example, is violence, and there is so much discussion of violence in this country right now, but I’m going to call out violence in the home. About 1 in 3 women will experience some type of violence in the hands of someone that they live with, and that could be a parent, a spouse, a sibling in their lifetime, but 1 in 3 is a pretty remarkable number. And then, of course, environmental. So what we know is that Black and Hispanic communities are exposed to 60%, in access, pollution while white communities experience 17% or less. And I know environmental racism has been in many of the readings that we have done lately, but it is really, really, really … too afraid, because of the causes of asthma and cancers and being a disparate demonstration of those kinds of conditions and diseases.
Saul Marquez:
Yeah, these gaps, these inequities, issues with access are certainly an alarming reality. I mean, as you were sharing some of the things, especially around maternal health, you know, the big thing that I just, like why, irregardless of socioeconomic status, why is it that these women of different backgrounds suffer? I want to uncover that one with you if you’re up for it. And then the question around cost, right? How do we measure the potential cost of health inequity today and in the future? How do we handle it?
Jennifer Radin:
Yeah, no, great question, Saul. I mean, to save our maternal mortality discussion for a few minutes because I think it’s an important example, but it really exemplifies what we’re talking about, but let’s talk about cost. And I talked to Andy, a dear colleague and friend of mine, we co-present on these topics all the time, But Andy and his team did this terrific analysis that I’m sure you talked about, which is to say that we are currently spending 320 billion on disparities today, because of disparities today, and if we don’t do something about it, if we don’t intervene, that will grow to one trillion in 2040. So today, that’s actually $1,000 per person in this country for all of us that we’re spending, and in 2040, that could be as much as $3,000 per person annually. And so, why are these numbers even important? Health equity is a topic that all executives in an organization and all stakeholders in the ecosystem need to lean into in order for us to create impacts and solve for. And so, for many stakeholders, the numbers are important, and the costs are important. Now, this doesn’t in any way juxtapose this with the cost of human lives because you cannot measure that or put a price on that at all, and a lot of the times that’s what we’re talking about here. But I do think the business case, if you will, becomes important as a driver to galvanize the right stakeholders, whether they be state, federal, business owners, healthcare systems, payers, life sciences organization, financial institutions, this ecosystem all needs to work together, and so that’s why these numbers do become important, and they are astonishing to many when we talk about.
Saul Marquez:
Yeah, Jen, I really appreciate that. And folks, Jen called out the episode with Andy, episode two. If you haven’t listened to it, he highlights some of those very clear cost measures and what the future could look like if we do the right things. We’ll link that up in the show notes. And Jen, how could the costs of health inequity grow if they’re not addressed? Talk to us about that.
Jennifer Radin:
Absolutely. So what we’ve learned about health, as I defined it earlier, is only 20% of our health is actually driven by clinical factors, and in fact, 80% is driven or impacted by what we call the drivers of health. And we modeled this a number of years ago, and the drivers of health include things like economic opportunity, job opportunity, which obviously creates or inverts wealth, food security or insecurity, housing, public safety. I referenced violence earlier, of course, climate change and environmental, and interestingly, even Internet connectivity. And, of course, Internet connectivity was one of the big drivers that emerged again during the pandemic when it became very clear that when you had connectivity or not good … had correlation with outcomes, and of course, transportation. So this is what’s driving 80% of our health, and in fact, I’m sure you’ve heard that I always love to ask when I’m teaching a class at Columbia or Penn what is the highest correlation … health, what number is the highest correlation with health? And of course, it’s zip code, right, it’s where you live.
Saul Marquez:
Zip code, yeah.
Jennifer Radin:
And so as we unpack that, and we look at all of these social drivers, what we’ve learned through various studies that have been really, really interesting is that some of these are disproportionately impactful in terms of eliminating disparities, creating health, right? Housing is certainly one of them, safe and secure housing, and food and food insecurity is another one, internet, certainly important, transportation as well, and, of course, fundamental economic access, which would include access to jobs and to education. And so part of why the costs continue to rise is because we need to really step back and think about the social drivers and how we’re going to shift a number of these in order to raise health versus what, in many cases, we’re doing today, which is erode health.
Saul Marquez:
And that’s really nice to, sort of, see some of what’s been happening, just programs that focus on some of these factors that look at housing and food as potential resource needs that we address to help people.
Jennifer Radin:
Absolutely. And as we think about the Future of Health, and I know, my also dear friend and colleague Neil Batra had the opportunity to talk to you a few weeks ago about that, we’re looking at really seismic shifts. So what we’re predicting is happening over the next ten years is really a seismic shifts moving the spend from true sickness, so from a sick care system into a health promotion and wellness system or ecosystem. And as we see the dollar shift over time, today, we live in a sick care system, and that’s where we treat. And as we think about how we restore health, how we promote health, how we raise health, we’ll be doing more of that, and our dollars will go there as a society, as an economy, and less in treating sickness. And so, to tie that together, along with the great question you just asked me, why don’t we talk a little bit about maternal mortality and some of the causal factors there? So, what we know nationally is, as I said, so rates for pre-term births for Black women, just to hone in on a population for a moment, is 50% higher than the rate of preterm births for white women. And infants that are born preterm actually accrue ten times, you know, higher medical costs than full-term babies. So already we have a situation in which both mother-birthing person and baby are in danger. The societal impact of preterm births is about $26 billion annually, and this is borne by all of the stakeholders that I just mentioned. Now, we also know, interestingly, that there is a very high correlation, almost a causation, a very high correlation between housing security and preterm birth. So if a woman is pregnant and is highly anxious, perhaps because there’s a threat of eviction or there is violence near or in the housing structure, that actually has been demonstrated to be highly correlated. So you can already see that there are social drivers, housing security, food security is part of that too, but housing security specifically, that we have actually demonstrated. If we can work together as an ecosystem to fix that in neighborhoods where we know women need help with that, we actually could already start moving the needle. And so, as we think about how do we shift some of these costs, that is certainly a place where we know we could help.. Respectful care and access to prenatal visits and receiving respectful care during your prenatal visits, such that you are desired to come back to finish your course of prenatal visits is also another important factor here. And then, of course, again, back to the social drivers, transportation, do you have the transportation needed to get there? If you have others at home who need to be minded, do you have access to child care for the others that needs to be taken care of at home? Do you have access to the foods that are healthy for you while you are a birthing person or pregnant? All of those, of course, are highly, highly correlated to this outcome. So there is lots to fix there, but what’s interesting about it also is that when you model the business gains, the spend that it would take to fix a number of people, clinical and social driver costs, actually outweighs the costs in certain populations, outweighs the cost that we are bearing today. So there’s a business case to make these changes population by population in the locale.
Saul Marquez:
Thank you for that, Jen, I appreciate the answer to that. Definitely shed some light on the challenge, with maternal care it shouldn’t be happening, and there’s a business case. When you learn something, you figure out it’s a problem, what can we do? It’s something that we all want to think about and approach as we form and contribute to the future of care. And the question comes up as barriers. What is it going to take to remove barriers to health equity to achieve a better Future of Health?
Jennifer Radin:
Great question. Thanks for asking that, I appreciate that. I think you started answering the question in your own question, which is to say a few things. I think, one, as you, as members of society in this country, having an understanding in all of the seats that we sit in of what the disparities are and the impacts that they’re currently having on people’s lives. And again, I talked about cost a lot because that’s often the language that we use to influence the influencers. What we have to remember behind all of this discussion is a life, a human life. And so awareness of what the disparities are, and we’ve talked through some of those today. Awareness of the intersectionality of these disparities, how housing and food and transportation violence are interlinked with the clinicxal aspects that we talked about, I think, is also incredibly important. And then, also working together to really activate public and private sectors, activate state, activate the health system, activate the community-based organizations who are already doing so much incredibly important work in these spaces and connect them to the local health system in place. Activate the health plans who are also starting to do incredible work in this space. Regulators are actually looking at different ways. Joint Commission and CMS are looking at different ways and, in fact, acted on different ways to influence the journey towards health equity And then, as individuals, I think we need to ask the right questions. We need to question why certain populations are experiencing this and make sure that we have a voice in all of this, and when we see it, to call it out, and when we read about it, to teach our children about it and bring them up in a world where we can make these shifts. So, as we think about the future of health and the data interoperability that Neal talked to you about earlier, the empowered consumer, the scientific breakthroughs, the data sharing, all of which make the Future of Health a reality for all of us, equitable access is probably one of the most important of the six truths, as we call them, the things that must be in place, conditions for success. Because if we can’t raise health for the populations in this country and we’re only focused on raising health for certain populations, then ultimately, we’re not raising health for us as a society.
Saul Marquez:
Well said, Jen, well said. And it’s a task that, I think we all need to take ownership of, and I like your point of, let’s talk to our kids about it, too, you know, and help them understand the context of this all, because it is important, and we all have a role to play. And as we talk about the multi-stakeholder parties that can make a difference here, it’d be nice to end with some examples of maybe health equity programs that are making an impact to help inspire people listening to take action.
Jennifer Radin:
So there are a couple that I’ve been impressed with, certainly. And again, the programs always focus on a local population, and they always include a number of different collaborators. But there’s an example on the West Coast where a healthcare system has created an innovation fund around social innovation and is actually using that fund, working with local constituents to create healthy housing, healthy lower-cost housing that is also sustainable in spaces that are often desolate, unused today. And so with that, of course, you get community enhancement, you create jobs, you create housing that’s healthy and safe. You also create spaces that can be shared to combat loneliness, and in some cases, you can have access to onsite primary health services as well as helping … and sustainable garden. So it’s really been a wild success and one that we’re hoping to kind of pollinate across the country. So that’s one example. Another example is a collaboration between a transportation organization that’s focused on driverless transportation and working with food pantries locally to create a way to bring food to the humans instead of always expecting the humans to go to the food. And so part of this has been creating efficiency, if you will, in the system, and they’ve seen really great results. And what’s wonderful also about it is this for-profit organization, transportation organization, has committed 5% of their driving hours to food delivery. And so, again, you know, it’s local, it’s tailored to the local population, because that’s so important in all of this work, and it’s created a … space. It’s made a good fight against food insecurity. And then the third example would be around education and childhood literacy. In my own hometown, where a health system has partnered with libraries and schools, renovating playgrounds to create reading spaces during the spring and summer, but also creating indoor spaces so that children can come, families can come as they need for literacy services, and how important that is in terms of being connected to health literacy, of course.
Saul Marquez:
That’s beautiful. I love these examples, Jen, thank you. You know, this is a great way to sort of conclude our discussion as that the problem is big, it’s well-defined, it’s quantified. And the future of it, if we don’t make changes you’ve highlighted, could be catastrophic, could go from a 300 billion problem to $1 trillion problem, not to mention the lives of the people. So this has been an extraordinary discussion, and for everybody listening, all the show notes and different references that may have come up here on the podcast will be in the show notes. So check those out. Jen, I can’t thank you enough. This has been a great discussion. What closing thought would you want to leave the listeners with as we conclude this episode and this series?
Jennifer Radin:
Saul, thank you, thank you for that. Thank you for the opportunity to have this conversation with you. I guess the thought that I would leave us all with, including myself, because we’re all on this journey together is, everyone enters this journey of health equity from a different place. Some people come to it from a long-lived experience, some people come to it because they’ve seen or experienced a disparity, have been witness to a disparity, and then realized we have work to do and we need to fix it. Wherever you’re coming from, wherever we come from together, we all need to be on this journey together, and we need to share our lived experiences such that we can understand the work that needs to be done, agree, and align on what the levers are that we should and can be moving in order to create impact, and understand that while the numbers are incredibly important, that behind each of the numbers is a human life and that life should be lived well and with a long health span.
Saul Marquez:
I love that. I really appreciate that conclusion, Jen. I appreciate your thoughtful approach and leaving us with these closing thoughts that we could all take action on on this journey, on the Future of Health. Thank you so much for joining us today.
Jennifer Radin:
Thank you, Saul. It’s been great, I appreciate it.
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