Health inequity: America’s chronic condition? | Esteban López | TEDxSanAntonio

may the odds be ever in your favor obviously you're familiar with this message this message rang hollow for those who never stood a chance of surviving the Hunger Games but what you may not know is that it rings hollow for millions of Americans who suffer from lack of access and equity in the US health system I think a conversation about equity is especially timely this week as it affects all of us the u.s. lags behind most industrialized countries with regards to health indicators and some not so industrialized countries we ranked 42nd and overall life expectancy and we're dropping we ranked 26th in infant mortality but in 1953 we ranked sixth in the world but we're the number one most obese industrialized country and we also spend the most in terms of total healthcare dollars and as a percentage of our GDP so what are health inequities health inequities are systemic ingrained and most importantly unjust barriers that prevent whole segments of the population from achieving their highest level of health really from the opportunity to health some examples include the lack of doctors in hospitals in low-income and minority communities or if they are available oftentimes increase wait times and sometimes folks face unequal treatment in those facilities lack of affordable high-quality housing that leads to subpar densely packed communities which increase the risk of infectious disease the most important are the policies that are put in place policies like stop and frisk or the need for voter ID cards or mandatory minimum sentences for nonviolent drug crimes you know health inequities affect communities big and small it's important for us to take a look at those because they cause health disparities meaning that some communities will have a higher burden of disease and death associated with those diseases for instance african-american women have a higher likelihood of dying from breast cancer Latinos have a higher likelihood of dying from chronic kidney disease and Native Americans they have the highest rate of diet of obesity at forty two percent of their population now today I want to focus on just one inequity I want to focus on birth outcomes for black women I want you to meet my friend Nona Nona is an upper-middle-class highly educated professional she runs a non-profit for at-risk girls called the pace center for girls her husband is a minister and a pastor at open door ministries Church they live in a nice neighborhood in Gainesville Florida Nona is an avid runner she exercises she doesn't drink she doesn't smoke and she doesn't use drugs in her second pregnancy she went to the doctor regularly she ate right and followed her doctor's advice but at the end of the second trimester she gave birth to her son Timothy Timothy was 2 pounds and 9 ounces he stayed 90 days in the neonatal ICU you know as a pediatrician and as a parent I know far too well the stress the heartache and the fear associated with having a premature infant Nona and her husband live that stress but thankfully Timothy is now 6 years old he's doing great and giving his mom a really hard time as he should be the problem is that Timothy and Nona are not an anomaly you know we see this in the african-american community black women have a three to four times higher likelihood of having what's called a negative birth outcome that may include a premature infant a lower low weight infant or their child dying from what we call all cause infant mortality so why do black women suffer these negative birth outcomes you know you might think that it's genetic but this proves that it's not genetic because when we look at African born women could not live their entire life in this country they have birth outcomes equal to white women but in one generation their daughters are going to have birth outcomes that are equal to the general african-american population so that tells us that there's something in the social milieu of the United States that's contributing to these negative birth outcomes and not genetics well the medical and scientific answer lies in this molecule cortisol cortisol is a hormone that you release in your flight or fight response you increase your blood sugar so that you can fight or run it also increases your heart rate and your blood pressure so you can pump blood and nutrients to your muscles to stay alert in a dangerous situation we've used it through evolution too to be able to react to dangerous or stressful situations it's like keeping your foot on the gas pedal and staying constantly revved up now for short periods of time cortisol is great it allows us to deal with some of those dangerous situations but imagine having it on for four hours or days or weeks it would be like having your foot on the gas pedal of your car while in part for that period of time the other thing that we know is that cortisol can cause low birth weight and it's a hormone that's released during pregnancy so it can cause prematurity this is called the cortisol effect the cortisol effect is a well-established hypothesis in the public health literature and promoted by the CDC as the cause for these negative birth outcomes in african-american women now why why does it happen well the cortisol effect is a result of racial bias we see that african-american women Latinos and Native Americans have higher cortisol levels than the general population but African Americans in particular have some of the highest cortisol levels and sustained and it's not genetic when we work with women especially pregnant African American women through support groups to be able to deal with the stress of racial bias we actually see their cortisol levels go down and improve their birth outcomes you know it's concerning that these are challenges that we're facing in this country in 2017 and have huge public health ramifications but what can we do about it what's the solution well beyond changing racial bias in this country there are a variety of different things that the health care system can offer first for individuals we need to be able to deal with the daily stress of living in a in this country especially if you're suffering from racial bias now there are some simple solutions to deal with stress and anxiety one of the things I like to promote that I've been using a lot this week with friends and family has been something very simple practicing biofeedback when you're feeling especially anxious or stressed take a deep breath in through your nose do it with me and out through your mouth empty your mind focus on your breathing if you do that for one or two minutes you'll actually start feeling your heart rate decreasing you'll start feeling some of that initial anxiety start melting away now that's a short-term solution it doesn't solve a problem doing daily meditation quiet moments of meditation for a few minutes every day also will reduce your cortisol levels but probably the most important thing individuals can do is create social networks not the virtual ones those are great but as my kids like to say IRL in real life social networks with your friends and neighbors to be able to deal with the social stressors that are affecting you in your personal community we know that people that have these social networks actually have better health outcomes for the healthcare community we have to treat patients in a culturally competent manner and recognize that racial bias affects their health we have to be able to offer our patients opportunities to get treatment for their stress and anxiety but if we don't recognize it we don't know that it's there and for the health care system we have to pay doctors and hospitals for value not just fee-for-service meaning that we've paid for how they manage their entire population of patients because when they improve the health outcomes for their entire population they actually have a byproduct of improved health equity for communities you can't wait for someone to come and solve your problem you have to stand up and do it yourself in Atlanta the business community created Archie or the Atlanta Regional Community Health Initiative the business community decided that they were going to address health inequities and health disparities because they saw the cost too so seated with that so they invested real dollars and had goals by 2040 to solve this problem in their community you can do the same thing in your community health inequities are not an impossible solution my friend Nona did everything right but in the end the odds were stacked against her let's work together to improve health equity for our community giving our residents the opportunity to achieve their highest level of health for themselves and their families because in doing so we allow them the freedom and liberty to lead the lives they want to live thank you you


  1. Thanks

  2. What does voter ID have to do with healthcare…If you going to vote and influence the country direction is it too much to ask to get an ID…

  3. I  have  to get  data   on: coverage …sustainability….equity…access  of health  care in U.S. vs. Canada Health  care  system…Assignment  due  : semester  #  2

  4. Inspiring! 🙂

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