“Conversations with Al McFarlane” on November 18 was broadcast from the Bigelow Building in St Paul, MN, which is home to Community Action

Partnership of Ramsey and Washington Counties. The program focused on an issue of vital importance to our community and to our country: health disparities in outcomes and access for Black people in America.
Participating in this important conversation were stellar leaders in the world of health and policy. Joining the broadcast via videoconference from Encino, CA, was well-known surgeon Dr. Richard Allen Williams who recently published the book Eliminating Healthcare Disparities in America.” In 1974, Williams founded the Association of Black Cardiologists, and served as its president for a decade. He also established the Minority Health Institute and in doing so, created a new paradigm for addressing health disparities, a paradigm that takes a holistic approach to patient care, tailored to the specific, unmet needs of African American communities. In 2001 he was cited among Black Enterprise Magazine’s top 100 doctors. Joining the program from the US House of Representatives in Washington, DC, was the Hon. Donna M. Christiansen, the first female physician in the history of the US Congress, the first woman to represent an offshore territory, and the first woman delegate to the United States from the US Virgin Island. Christiansen is a member of the Congressional Black Caucus (CBC), and she chairs the Congressional Black Caucus’s Health Brain Trust, which oversees and advocates minority health issues, nationally and internationally. The Congressional Black Caucus Health Brain Trust has long established itself as an authority on African American and minority health policy on Capitol Hill, and as the CBC Health Brain Trust, under able leadership of its chair, embarks on health legislative efforts, it does so knowing that racial and ethnic health disparities and the absence of racial and of health equity and justice have long plagued health care and life opportunities of African Americans and other people for the last century. Clarence Hightower, William Davis, and Mitchell Davis responded to the presentations of Williams and Christiansen. Mitchell Davis heads the Office of Minority Health in Minnesota Department of Health. Davis is Executive Director of Community Action of Minneapolis, and Hightower is Executive Director of Community Action Partnership of Ramsey and Washington Counties. The forum was sponsored by Pfizer, Inc., which joins NorthPoint Health and Wellness Center; Hennepin County Medical Center, and UCare Minnesota as sponsors of the Health & Wellness Broadcasts of “Conversations with Al McFarlane.”

Health Disparities and Solutions

Clarence Hightower, Mitchell Davis, William Davis, and Al McFarlane
Following are excerpts of the broadcast interview: AL MCFARLANE: Dr. Williams, what are the challenges, and how do we get to where we have eliminated the gap in health for minority people? DR.RICHARD ALLEN WILLIAMS: Well, first of all, Al, let me congratulate you for making it possible for us to focus on these problems of health care disparities today. I think this is something that we need to see more of around the country, and I’m sure Congresswoman Christiansen would agree to that. We need more information going out. Today we’re talking about health care disparities, and the first thing we need to do is define the term and also give an indication of the nature and severity of that problem. Health care disparities really is a term of convenience which is used to describe the differences that occur between racial and ethnic groups in regards to what we call morbidity, mortality, incidence and prevalence of disease and certainly outcomes of disease processes. There are tremendous differences that go along ethnic and racial lines. One of the things that we need to identify is where these health care disparities come from. They emanate really, from something that is deep in the roots of our country, of our history, and that is slavery. It all started back at the time when African Americans were in bondage, and I won’t go into great detail about that, but I want to simply indicate that it all started with the maltreatment and poor treatment of slaves who were in bondage and who were not able to do for themselves as far as health care treatment is concerned. And it has come forward to today, where we see problems occurring in every area of our lives. I want to make sure that everybody realizes how serious a problem this is, and connect the history to the current situation. In the 18th century, a man named Hoffman, took a look at the slave population of the United States, and looked at their health care and their living conditions, their chances of survival. He made a prediction which rattles our consciences to this day. He predicted that the slave population would not survive beyond the year 2000 because of the health care problems which were present at that time. Now obviously African Americans have survived, but with great difficulty. What we can take from that message is the fact that these problems were, and still are, so important that we need to give a great deal of attention to trying to solve them. AM: Dr. Christiansen, take a public policy viewpoint and describe the challenges. How do we move towards eliminating health disparities? What are the legislative strategies to move our country forward? DR. DONNA CHRISTIANSEN: Well thank you and thank you for having me back again, and it’s great to be here with my good friend Dr. Williams. We’ve been on several programs together and he’s been a guest in our Health Brain Trust as well. Dr. Williams has laid out the history, but even today, the last national report on health disparities from the Department of Health shows continuing

Suluki Fardan

gaps in health care and health care services. African Americans and other people of color are more than 50% of the uninsured, and we still face discrimination in health care even when we are insured. There was a report from the American Public Health Association, last month, showing bias for, towards white patients and against Black and other ethnic minority patients, just in the review of articles and reports. So we face a lot of challenges. The Congressional Black Caucus bases its health care agenda on four principles. One is that health care is a right. Understanding that acknowledgement needs to undergird any efforts that we have moving forward. Second, is that to address health disparities, we must address the social determinants of health care. That is something that we have not really focused on. We’ve focused on disease for a long time. To the extent that we have ignored the social determinants of health, we find ourselves in a position that we’re in today where over 200 people of African descent die prematurely from preventable causes every day in this country. The last one is that an investment must be made. I’m very glad to see that our Presidentelect has said that he is committed to ensuring universal coverage and health care access for everyone, and equal education —which is really tied to it— for every child in this country. We in the Caucus are going to continue our push for an investment in prevention because we know that is the only way, not only to eliminate the disparities, but to reign in the skyrocketing costs of health care. The principles involve coverage for everyone,

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“He [Hoffman] predicted that the slave population would not survive beyond the year 2000 because of the health care problems which were present at that time.”
-Dr. Richard Williams

http://weblog.themadeiratimes.com/images/slavery%202.jpg including immigrants, and making sure that our providers are taken care of – that they get the kind of support that they need to continue to practice in our communities. We must make sure that we increase the diversity in the health care workforce. That is a critical piece of eliminating disparities: we must have health care workers on all levels, from the community health worker all the way up to the policy maker, that represent us, if we are ever going to close the gaps in health care. AM: Dr. Richard Allen Williams you outlined the pervasive and historical issues associated with disparities in health outcomes for African Americans in your book, Eliminating Healthcare Disparities in America. What are the findings of the essayists in this book? RW: Well first of all, I want to mention that all of the scholars are not African American. There are several other ethnicities represented as co-workers in producing this book. And I think that’s important because we wanted to present a broad perspective on this problem from several vantage points. The book is based on, and emanates from, what is called the Institute of Medicine, or IOM Report, which came out in 2002, from the Institute of Medicine. It was a report on the medical treatment specifically of minorities in this country, and the disparities in their treatment. It was subtitled “unequal treatment,” in fact. What it found is what you might expect from that title, and that is that our healthcare delivery system is imbalanced and unequal. The recommendation was that that must be changed. My book took off on that, and extrapolates data to give more evidence about the health care disparities which I have been finding. We talk about not only what the background of the problem is, and the status of the problem, but also what we might look forward to from the standpoint of solving this problem. And I think what we have to do is to focus on that aspect of things. AM: Mitchell Davis, you just finished an important conversation that mirrors the concerns discussed by our esteemed speakers from the east and west coast. You recently conducted an Office of Minority and Multi-Cultural Health Discussion and Conference on disparities in Minnesota. Tell us about what you did locally, here. MITCHELL DAVIS: Last week, Al, we had the 2008 National Health Disparities Conference, which was entitled “Health Equality: Honoring Culture While Closing The Gap.” Dr. Gail Christopher from the Kellogg Foundation talked about the racial dynamics that sit at the bottom of this health disparity. We talked about social determinants, which means my education, my income, where I live, what air I breathe. DC: We have introduced, with the other minority caucuses, a bill called the Health Equity and Accountability Act. It was introduced with the Hispanic Caucus and the Asian-Pacific Caucus, and it addresses several areas that we feel are important to address if we are going to eliminate health disparities. It speaks to data collection by race, ethnicity and socio-economic factors, addressing individuals with limited English proficiency and setting some standards and some training around translating for medical offices. It has a large section on increasing under-represented minorities in the workforce on all levels, including policy fellowships. There’s a title that addresses some of the leading causes of health disparities and how we provide comprehensive care from

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The Congressional Black Caucus
prevention all the way through to support for our facilities and our institutions. And there are other special provisions like border health and Indian Health Services. There’s a title that deals with accountability that would strengthen the Office of Minority Health, and would strengthen the Civil Rights initiatives in the Department of Health and Human Services. The bill creates health empowerment zones, which put the resources and information in the hands of the community that is suffering from these health disparities, and enables them, with help from all agencies in the Federal government, according to the plan, if they’re designated as a health empowerment zone, to address those challenges and reduce the disparities in their own community. AM: Bill Davis and Clarence Hightower you all are charged with organizing people in the community. Community Action Partnership in St Paul and Community Action of Minneapolis, have major responsibility in translating and delivering assistance, aid and opportunity, to people of color in Hennepin, Ramsey and Washington counties. How do we organize from the ground level so that

http://www.house.gov/kilpatrick/cbc/images/cbc_members.jpg ties – figure out how it is that you reach down and allow them to be part of the solution. AM: Bill Davis you, among other things, have been a leader in environmental awareness: the abating of lead, and heating energy issues. It seems that the country is acutely aware of the need to merge our understanding of health, energy and employment. Is there opportunity to organize, teach and transfer knowledge you’ve gained around imparting environmental solutions to the health equation? BD: There’s no doubt now that the people that we serve have a multitude of issues and problems that they’re confronted with on a day-to-day basis. One of the things we know is that the fastest growing of poverty is children. Parents come into our office with health related concerns looking for ways of relief. They’re dealing with nutritional issues, they’re dealing with energy issues, being able to keep warm in the winter time, being able to have proper nutritional meals for their children, and also how they deal with the healthcare related issues. Not only on the front end, but on the back end, long term, chronic problems like lead abate-

our people both understand and can access or acquire the assets, resources, solutions, we need to improve our quality of life? CLARENCE HIGHTOWER: Al in 2004, when I was president of the Minneapolis Urban League, I produced The State of Black Minnesota Report, the first comprehensive exploration of how disparities are impacting people of color in this state. We looked at how health disparities analysis shows we do less well than the white population. I think the issue about how it is that you mobilize people around this is something that we have not spent enough time talking about. I really am impressed with and interested in this health empowerment zone. Years ago, there was this economic empowerment zone strategy that impacted places like North Minneapolis and South Minneapolis where folks were doing less well economically. The Federal government decided to infuse resources in that area to help lift folks out of poverty. To even think about something like that around health disparities is tremendously exciting to me. To make it work, you have to be able to involve those who suffer from the dispari-

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“The Federal government decided to infuse resources in that area to help lift folks out of poverty. To even think about something like that around health disparities is tremendously exciting to me.”
-Clarence Hightower
ment certainly is one of the areas we’ve been addressing in older homes that tend to be occupied by lower income people. The risk factor there is multiplied but we know that these things are preventable. We just need the resources and wherewithal to begin to tackle these mammoth issues. Like Clarence I love the idea about having health empowerment zones. I think that’s the type of forward thinking we need to begin to put in place mechanisms and vehicles that are going to enable us to address these problems on the front end, as opposed to allowing them to become chronic and out of control. Poor people, low income people, people of color deserve to have adequate and preventive health care treatment, and affordable health care treatment, and that’s always been an issue. We’re looking optimistically forward that with the new administration, we’ll have a level of receptivity for servicing the middle class, low income people, and people of color with life supporting and sustaining of services. Health care clearly is one area where we need to invest not only the resources and capital to change the overall health of our community. AM: Dr. Christiansen, how would you charge local communities to be in sync with the legislative considerations that you and the CBC health brain trust have advanced? How would you advise and direct local communities to connect with what you perceive to be the direction of President-Elect Obama? DR DONNA CHRISTIANSEN, MD: Well, I’m going back to something Mr. Hightower said that reminded me that the biggest obstacle to eliminating disparities and bringing about change in our health is the lack of a political will. So mobilization is absolutely necessary. When the Congressional Black Caucus Health Brain Trust, as well as our foundation and the institute that Dr. Williams chaired, goes out to our communities we have conversations on health and in addition to screening we try to engage the community. We want our people to understand that we don’t have to dye prematurely from preventable causes and that there is help available. But mobilization is a very important part of it and we really need to do a lot more.

Bill Tendle (L), and Mitchell Davis
I was on a panel last night. We were discussing the Congressional Black Caucus in the context of having President-elect Barack Obama. I think what his success in this election has meant and will mean a lot, not only to our community but to our country and the world. One of the things that it has shown and I think it will do, is empowerment. It will show and it has shown everyday people the power to create change. When that is unleashed, we will see change. I think it’s going to have a great impact and one of our roles is going to be to continue to engage our communities. The health empowerment zone, because it does reach down into the community, requires the community to form a broad-based coalition of stakeholders to identify the challenges and to create the plan and then to implement the plan. And so it does get to the heart of the community taking ownership of their health and creating that change. I feel that, from having worked with President-elect Obama, within the Black Caucus, and knowing that he has also been involved in minority health legislation and issues, that we have a great opportunity here we need to take advantage of, especially since he is determined to find the funding, wherever it comes from, to make sure that we invest in the health and education of our people. Mobilization has to result in our people’s representatives in the House and their representatives in the Senate supporting the kinds of leg-

Suluki Fardan

islation that I’m talking about which we will be re-introduced next year. We invite anyone to come and follow the progress of the bill and to make recommendations. When we introduce the bill it’s still open to change and we invite people to change it. We are developing principles that we want to see included in any health reform package that comes forth from all of the discussions that are taking place around the country. We will post those on our CBC web site, so that people really can be engaged, even if we can’t get to you. But also, we need you to speak to the people who represent you, the people who depend on you for votes. DC: We need their vote. When they come to Washington. DR. RICHARD ALLEN WILLIAMS, MD: So they need to go to their congress-people and talk to them DC: Absolutely, members of the House and members of the Senate. CLARENCE HIGHTOWER: Al, Congresswoman Christiansen and I continue to be on the same page regarding mobilization. Here in St. Paul we have been working with low-income people and training them to advocate for themselves. We’ve figured out that once

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“We have a great opportunity here that we need to take advantage of, especially since he [President Obama] is determined to find the funding, wherever it comes from, to make sure that we invest in the health and education of our people.”
-Hon. Donna Christensen D-VI
you do that, you need three things: First they need training or the jobs of the future. So we provide the training. The second thing our folks need is confidence. Once they’re trained they have confidence to go out and speak for themselves, tell their own story and advocate for themselves. The third thing they need is opportunity. When our communities figure out how to do that … how to give people confidence, opportunity and skills, then I think we can move the health disparity down, especially on a local level. AM: Mitchell, does that ring true to you, in your experience at the Office of Minority Health here in Minnesota? MITCHELL DAVIS: It certainly has. As we talk about the health empowerment, as we talk about mobilization – we have 52 partners with the Office of Minority and Multi-Cultural Health, and they’re spread out over half of the counties in Minnesota. They’re working in eight health areas of disparity: cervical cancer, cardiovascular disease, diabetes, healthy youth development, HIV, AIDS, immunizations, infant mortality and also unintentional violence. And these – our partners, are funded by the taxpayers of Minnesota. They’re doing exactly that. They’re mobilizing, they’re training, and they’re doing community education. AM: Bill Davis? BILL DAVIS: Well, I think the thing we keep seeing is the affordability of health care. We’re talking about the underinsured or not insured at all. There are people who make a determination whether to take their child in, or take themselves into the hospital or see the doctor based on the dollar, bottom-line. And sometimes they will forego necessary treatment simply because they can’t afford to make that commitment or make that sacrifice. And until we are able to provide preventive health care to people… it’s akin to those who are able to take their cars to the garage for a daily or maintenance update on a regular scheduled basis vs. those who take their car into the shop when it’s absolutely on its last

Hon. Donna Christensen D-VI and Dr. Richard Williams
leg. What happens quite often is we have people in our community that do not seek health care, because it’s not affordable, until it’s absolutely imperative and at total peril of them and their family. In this day and age people should not have to live like that. They should not have to be confronted with that kind of decision. The other thing we’re seeing when we talk to people in our community is the mental health issues. I think that’s also something that sort of flies below the radar, that people are dealing with drug abuse issues and battering issues and other issues that preclude them from being healthy and being able to be productive members in our society. When we start sitting down and doing an assessment with individuals who come into our office, to do an assessment to determine how we can best serve them, we find that there are issues of mental incapacity or mental health that precludes them or disables them from being full, productive citizens, and so that issue also needs to be addressed, and any kind of funding or discussion about health and health disparities. CH: Al, we’re curious about whether or not this health empowerment zone idea is gaining legs across the country. AM: Dr. Christianson, the idea of a health empowerment zone is intriguing. Has that taken root, or will it be presented in the next legislative session? DC: We certainly hope so. Whenever we speak of it to different health advocacy and professional organizations everyone thinks that it’s the right way to go. To approach health comprehensively like this we have to talk about housing, we have to talk about a lot of things. This approach would enable communities to get help from Housing and Urban Development (HUD) and from Environmental Protection Agency (EPA) for environmental issues. We’re going to introduce it as a stand-alone bill again because we think it is really the key to turning things around in our communities. AM: Dr. Richard Allen Williams what is the duty of our people? Too often we hear people say: “we want to wait on Washington to do for us.” But at some point individuals, families, neighbors and communities have to take responsibility. How do we mobilize and organize at the street level and produce policy that serves our interests long-term? RW: Well, the wildfires here in California have been a point of interest across the nation, and we’re still suffering from them by the way. I would like to hope that we can create a wildfire of interest in health care disparities at the community level because when you get right down

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(From left) Clarence Hightower, Mitchell Davis, Bill Davis
to it, it’s what happens in the grassroots level that’s important. These changes that we’re talking about, in health care reform, have to be applied at the grassroots level, and to a large extent the leadership for this has to come from the community. The community can’t just stand there and be victims, as they have been for so long. The community has to be mobilized, just as Dr. Christianson has mentioned, to carry out the programs that many of us in academia and in political life, have tried to lay out. But the changes have to emanate from the people. That’s the importance of having someone like Congresswoman Christiansen –she’s a political leader who is very, very interested in what we are doing. One specific issue we need to look at which is one of the most important aspects of the whole health care disparities argument is insurance coverage. It is at the very center of the problems that we see. At least 47 million people in the United States are uninsured or underinsured. That is a tremendous problem which inhibits our progress in eliminating health care disparities. I think we need to talk about what the insurance problem is. It’s not just a problem of people not having insurance, but a matter of how their insurance, when they do have it, is handling them. AM: Bill Tendle, you are the front line in health care at South Side Health Services, in South Minneapolis. How do you instruct our community to engage and utilize the services you provide? What is the impact, negative or positive, of insurance or lack thereof, and what legislative remedies would support you in delivering quality of life to your stakeholders, your clients? Bill Tendle: Two things that are really a problem are access and trust. People don’t have access, or they do have access and they don’t have trust, and therefore access and trust are two big issues in the African American community. For example, there’s not a lot of trust in health care providers, especially if they don’t look like African Americans, so that’s a problem. It’s trust for other people, as well. If you get into the Hispanic population, it’s a matter of trust because some people maybe not have the right papers or they’re afraid they might be turned in. AM: Let me understand that. You’re saying that African American patients don’t trust physicians or providers that are not African Americans? Or

Suluki Fardan

they don’t trust other African Americans who are providing the service? BT: They don’t trust providers who are not African Americans, that don’t have cultural competency to work with them. AM: I see. BT: And that’s been a problem since the studies that have been done with African-Americans in Alabama – AM: The Tuskegee syphilis studies. BT: Every African American knows about that. Native Americans know about the smallpox blankets that were passed out to them by the US government. So it’s a legitimate matter of trust that’s an issue within the community. But more importantly, I think that this is a new day, and people need to have more education about health care and how health care models are put together. Bottom line, if you really get down to it: people have to have a base to move up from. Most African Americans who are in poverty don’t have a base, and if you don’t have a base, both educationally and monetarily,

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“Further, there is a criticism of this practice of cost-based drug switching which doctors in New York have stated, has impacted their practice and are making worse medical outcomes for 92% of the patients that they treat.”
-Dr. Richard Williams
and economically, it really impacts your health care. AM: Bill Tendel, what can Congress do to support your vision and work to serve, enable and empower your communities, your customers? BT: I’m seeing a need for more community health workers. You have to have someone who knows the community, who interacts with people on a daily basis in that community and who can help set up lifestyle changes that will have the most dramatic impact on health care. When I say lifestyle changes, I mean social health. No one’s ever talked about social health. But it means when you leave any health institution and you go back to your home, how does your social environment help maintain your health. That means diet and your living conditions. What we need to do is change the paradigm of how people live, and really attack their social health. AM: Dorii Gbolo, Executive Director of Open Cities Health Care Centers in St. Paul, please explore the same question from your point of view. DORII GBOLO: In our country, we’re rewarded for being ill. We’re not rewarded for being healthy. We need to change that. I would hope that this Health Empowerment Zone would kind of change that and enable that paradigm shift. People can be empowered to be healthy and rewarded for being healthy. We should strive for that. But when you’re in the bonds of poverty and discouragement or whatever socially is going on with you, you don’t think about being well. You just expect to be well, until something happens and then people too often say: “oh, I’m not well, how do I fix it?” We need to help people while they’re well so that they can stay well, so that they can be better contributors to their families and to this community. I do agree with Bill about community health workers. That’s what we’ve utilized in http://www.usarpac.army.mil/SoldierFamilyWellBeing/Reintegration/pills1.jpg our clinic because we want people to be well and we want our community to be well. We want to empower our community with those tools that they need, no matter what is going on in their lives, so they can strive for wellness. So if somehow we can change shift from rewarding when you’re sick to when you’re well, that would be a great accomplishment. AM: Congresswoman Christiansen, how do you respond to these managers, these leaders of community health services here in Minneapolis and St Paul? DC: This country spends somewhere between 3 and 5% of all of its healthcare dollars in prevention. Let me start with that. We are going to mount a very strong legislative and advocacy effort here to change that. That would make a world of a difference if we can focus on prevention. We do want people to have access. Part of it is insurance and part of it is having a health care workforce that is culturally competent, and sensitive. The best way to do that is to have physicians, nurses and community health workers that look and speak like the person being served, that come from the same cultural background and speak the same language as the person being served. We need to address all of those areas, but we are going to try to make a really concerted effort to increase our prevention dollars while we work to get everyone covered. One of the first things we’ll do, I’m sure, [when we start the next session], is to try again —successfully this time I’m sure— to pass the Children’s Health Insurance bill that President Bush vetoed twice. It doesn’t go as far as we’d like it to go, maybe we can expand on it. There are approximately 9 million children that are uninsured, 6 million of whom would be eligible for State Children’s Health Insurance Programs (SCHIP). So we will be doing that.

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http://www.cdc.gov/ncipc/dir/Image/EmergencyRoom.jpg I can remember when Howard Dean was governor of Vermont and every child born in Vermont got a health visit. The mother and child got a home visit, and it made a world of difference. It made a difference in their preparedness for entering school. It made a difference in enabling them to address some of the problems that were occurring at home through referrals. So a community health worker has got to be the bedrock of our health care system if we’re going to see change. People from within that community will have the trust of that community, and will not only help people get to the health care that they need, but also support them. Sometimes it’s difficult to test your sugar every day and take your pills on time and eat properly. Some people need support to live healthy lives. AM: Dr. Williams, let me ask you to respond to that as well. You recently caused a firestorm in national media by challenging whether health plans are switching to lowercost generic drugs, rather than the items being prescribed by doctors. You questioned whether the health of patients is being put at risk, and you were saying that people who are maybe less knowledgeable, less aware, are more easily switched for the advantage of the health plan and provider, not particularly for the advantage of the patient. RW: Well let me begin with something else and then segue into that very quickly. What I’d like to begin with is kind of tying things together in regards to what has just been said. It seems that there is obviously a linkage between poverty and poor health care or substandard health care and we must be very vigilant to make sure that we observe that linkage. I like to think of this as being a system of wealth care rather than health care. It’s a matter of how much money you’ve got as to how good your treatment is, and that should not be in this country in this democratic society. Now that also ties in with what you indicated about this situation which I call drugswitching. Let me also begin by stating that the issue is not a matter of criticizing generic drugs. Generic drugs, in many cases, are very good medication, so I don’t want anybody to think that I’m putting out a blanket criticism of the use of generic medications. What I deplore is what is happening based on insurance company practices of switching patients or requiring the switching of patients from branded medications which their doctors might have prescribed, to a generic drug which may not be an equivalent of the drug that the doctor intended the patient to have. What that means is that someone other than a medically trained individual is making a decision as to how this patient is going to be treated, because the outcomes may be different depending on what kind of medication is given. There are some specific instances of that. You don’t have to just believe my criticism. There’s been an outcry against this kind of practice for instance, by the New York delegation to the American Medical Association, which called for the development of a code of conduct on the part of insurance companies, and is asking the full body of the American Medical Association to make a determination there. Further, there is a criticism of this practice of cost-based drug switching which doctors in New York have stated, has impacted their practice and are making worse medical outcomes for 92% of the patients that they treat. That’s an enormous number, and I think it needs to be recognized that we need to do something about the insurance company practices, not only in regards to this situation about drug switching, but in regards to things like treatment of certain conditions, and in their patients who are already insured. And certainly we need to make sure that insurance

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“This country spends somewhere between 3 and 5% of all of its healthcare dollars in prevention. We are going to mount a very strong legislative and advocacy effort here to change that.”
-Dorii Gbolo
companies are more amenable to insuring patients who don’t have necessary financial means to pay for their medical care. CH: I am particularly keenly aware of the linkage that Dr. Williams just mentioned. It is a fact that those who are less well off are often times those that constitute the pool of those involved in the disparity. And that’s the work that Bill Davis and I do. Our work is to lift those that are in poverty out of poverty. As you begin to work to lift folks out of poverty, then you will also be lifting folks out of the mass array of disparities that we find ourselves caught in. And so I appreciate the fact that you brought full circle the notion of the linkage between those who are in poverty and those who have disparities. DC: We will be electing our new chair of the Congressional Black Caucus this afternoon, and the likely person is Congresswoman Barbara Lee from Oakland, and we will have a poverty elimination agenda, in the caucus. CH: Good! DC: And our Whip, who is very close to our President-Elect, is also very much an advocate for poverty elimination agendas, and we are sure that he is going to make sure that the White House has a poverty elimination agenda. And I also want to say, just on behalf of the Congressional Black Caucus, thank you for having me as a representative here, and to assure you that whatever field, whatever committee or sub-committee all of us serve on, our goal is always elimination of disparity, whether it’s economic disparity, job disparity, educational disparity, housing disparity. All of those things are part of the overall Congressional Black Caucus agenda. And so we do address them relentlessly. AM: Thank you so much, Dr. Christianson. Bill English is the co-chair of the Coalition of Black Churches/African-American Leadership Summit. Bill, you and I have talked for years about the money side of this equation. We think it’s important, as business

Bill English
people, to analyze problems and solutions in terms of the revenue streams associated with them. To attack problems involves deploying financial resources. How do we benefit? How do we align ourselves so that we, not only deal with the misery but also benefit from commanding the resources required to eliminate misery? BILL ENGLISH: First of all, money is the underpinning at the base of the health care problems in America. It is at the bottom of it. At one point, health care was a charitable thing in America. When money came in, it became on the largest profit-making sectors in this country. While we’re all excited about Obama, it is


interesting that the word poverty did not enter into this campaign. So I’m glad to hear the Congresswoman say we really have to deal with the issue of poverty in America. The idea of Health Empowerment Zones is interesting. Clarence and Bill spoke to that. But you and I both know that the Economic Empowerment Zone in Minneapolis was a disaster for Black folks. It was built on our poverty, but the people who benefited were the developers. Public policy must assure that there is equity in anything that comes out of this. Clearly as we go forward, we have to pay attention and be vigilant, mobilizing our community and using the court to address the issues of equity.

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