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[Music]
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welcome to this episode of Opportunity
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Matters in this episode we'll explore
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the impact of the racial wealth gap on
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the healthcare industry and we'll strive
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to figure out some paths to have better
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outcomes and to close the impacts that
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that wealth Gap has on Health Care
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issues we got three great guests one is
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actually my co-pilot with the Coalition
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for Equity opportunity Dr Freda Griffith
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she's the managing director of Wharton
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CEO the Coalition for Equity opportunity
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and she's trained as a quantitative
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sociologist and demographer she received
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her PhD here at pen and uh she left us
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for 13 years to be a professor at
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Dennison and there she focused on a
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number of issues anthropology sociology
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and Global Health she returned to pin to
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work with us after 13 years thank you
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for coming back thank you for having me
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guy David
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is one of my colleagues here he's the
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Allan B Miller professor and professor
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of healthc Care Management professor of
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medical ethics and health policy at the
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proman school of
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medicine um his research focuses on the
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economics of nonprofit providers
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challenges in primary and postacute care
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and healthc Care Workforce he's been
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active in promoting diversity and
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graduate education a lot of work with
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Mahi and provides lectures about Health
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Equity in degree and non-degree programs
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at Wharton welcome guy thank you for
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having me and Seria Chlor who's become a
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good friend over the past years we've
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gotten underway with Wharton CEO he is
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the head of the Tia Institute and he A
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Wharton grad um he's been overseeing
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research on en
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enhancing lifelong Financial Security
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and organizational Effectiveness in
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higher education and the broader
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nonprofit sector he sits on the board of
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the Wharton pension research Council The
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Advisory councils of Georgetown Center
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for Retirement Research the Retirement
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Research Center of
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DCI and the M NH chapter of the US
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Alzheimer's Association he's a very
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important guy now and finally in 2021
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Sur received the president's volunteer
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service award via Amor in recognition
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for its commitment to strengthen
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communities s good good to see you again
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thank you for for joining us uh Ken
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great seeing you uh wonderful joining
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this August panel and I look forward to
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this discussion we could just stop after
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the introduction so that that that seems
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to be impressive enough uh but guys as
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the uh the the professor in this in this
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business give us some insight as to what
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the the biggest Equity gaps are in
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healthc care where do we see the kinds
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of impacts that we're most concerned
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about as we're trying to look for
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opportunities to to make things better
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for the broadest number of people yeah I
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think um it may be easier to ask where
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we don't see gaps so um I I I would
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argue the biggest gaps in in healthcare
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from a disparities perspective are going
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to be in health insurance coverage and
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in Access to Health Services and by that
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I don't just mean hospital care but also
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Primary Care uh even pharmacy now um
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it's you know you you you can argue you
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um that these are the disparities in
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healthcare but they're not just stemming
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from the Healthcare System we have to
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understand that there are disparities in
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a lot of other dimensions and I know
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we're going to touch on several of them
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today um that will affect people's
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health status so um you know lack of
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economic stability housing
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Transportation uh health and financial
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literacy uh you can think about the
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entire education system food insecurity
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um exposure to violence to
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trauma uh the justice system so all
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those
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disparities um you know are are
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basically spill spilling over uh into
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disparities in health status and if
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Health Equity means really ensuring that
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everyone has a chance to be as healthy
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as possible it really starts with
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realizing that not everyone has the same
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opportunities to achieve the same level
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of health so so guy the the whole idea
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of the ZIP code the you reside in a
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board and has a huge impact on on
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Healthcare that that that that is a true
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statement absolutely it uh the ZIP code
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you're born in will affect uh how
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Affordable Care will be for you how
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you're going to navigate health
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insurance how you're going to access
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technology your literacy level how
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you're going to Access Transportation
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the level of Outreach and prevention
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that you're going to encounter uh your
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education your mental health and your
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personal safety all of those things are
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going to have an effect and you know
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there they will translate into effects
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on the quality of life and your life
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expectancy and before I move on to to
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Pita and
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Seria you you said heal health insurance
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I I just have to ask is is are you
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saying in some cases it's the complete
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absence of insurance or is it is it more
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the UN
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underinsurance it's it's both the lack
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of insurance completely and under
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Insurance um you have uh s like
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Medicaid which um is not distributed
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evenly across States it's really State
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administered and we have a lot of issues
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with access across States and we also
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have a lot of people that just don't
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have insurance uh even after the
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Affordable Care Act we have millions of
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Americans who don't have
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insurance now now frea be before you
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joined us uh you you focused a lot on
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Healthcare issues internationally I know
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specifically you did some work um in
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your in your doctoral studies on on
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South Africa how how are these issues
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globally the same different the the
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answer is yes uh the short answer is yes
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but the question to get to that answer
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may be a little bit different right and
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so the variables and way in which we
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think about uh health insurance in the
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context of South Africa um public and
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private um and the access of Medical Aid
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and the way in which the census the
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South African census kind of denotes it
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is something that majority of the
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population does not have private access
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um and so the public access or the
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public um publicly administrated um
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Medical Aid is something that most
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individuals rely on and so my research
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really was trying to uh tackle not only
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um and and this is something that I
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think Equity Health Equity is is trying
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to also tackle is it's just it's not
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just health care but there these other
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factors that are contributing to this
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and so as we think about the the context
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of my research racially residential
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segregation patterns where people live
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right and so if we think about it in the
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post- aparti context we would imagine a
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place where segregation was no longer an
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issue and so what my research really
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tried to understand and explain is that
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even using you know even looking at data
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10 years post aparte we were still
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seeing segregation levels at the same
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level uh or higher than it was during
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aarth and so these policies that are in
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place in terms of where people live and
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once those policies were removed have
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long-term effect um on individuals not
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just where they live but how their
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health outcome so I was looking at and
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mapping um those outcomes particularly
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chronic health condition educational
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attainment social class because it's not
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just the health the health status of the
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individuals it's all those other things
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that kind of uh poke holes or uh impact
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um the overall health status of the
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individuals and if I may add had um my
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research post um pen and um something
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that I was really interested while I was
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at Dennison was looking at Somali
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immigrants so if you look at a
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population particularly Somali women and
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who are had newly immigrated to the
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United States or have been in the United
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States for several Generations what they
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talked about was in the way in which
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they kind of navigated the quote unquote
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Western Medical system and the way in
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which they um kind of felt kind of an
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outsider they talked about language they
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talked about religion and they talked
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about these custom cultural Customs that
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were Norms to them as a way to really
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understand how to navigate um this and
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then also to navigate that in the
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context of this newly kind of their new
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world um and so that was really
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something I was I remain interested in
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um and as we think about something that
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we're doing more and more you can't just
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talk about health right we have to talk
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about all of these social and economic
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factors that also are interrelated to
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that so I'm I'm fascinating I'm thinking
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about zip codes and postal codes and and
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what you just said about Somali
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immigrants and you carry those zip codes
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with you correct that that it's not
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something just because you can move from
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a neighborhood doesn't necessarily mean
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your life life transforms right and
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individual may live in a place right but
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then if they are they don't have enough
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they're not have making a livable wage
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where they can have enough to buy food
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or while they're at work they're
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stressed about child care for their
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their children all of those things don't
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just leave once you leave your house
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right those things are kind of the
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baggage that you take with you whether
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or not um and you can't you're no longer
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able to just like put them in in a
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vacuum and so those are the things that
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I was really interested and I had a
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really um in-depth conversation with the
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women um kind of talked about their
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journey and talked about this um the
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space that they were currently in as the
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head of the household and what that
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meant for their children for their
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spouses um and so that those things were
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very complex and very layered um and
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really important to kind kind of think
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about so
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Seria the work the Tia Institute does
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just has fascinated me over the course
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of of those past years I've gotten to to
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know more of it and see the kinds of
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research that you support the kind of
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research that that you've done what are
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some of the the biggest issues that that
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come to mind when you think about this
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that that we need to bring to the
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Forefront uh thank you so much Ken what
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a rich discussion so far already um so
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one mantra that I carry that we carry
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the Institute is health and wealth uh
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could be considered two sides of the
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same coin and uh for example guy was
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talking about financial and health
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literacy so let me pull on that thread
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for a second to talk about some of the
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research we' have done and and guy I'm
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happy to share this research with you
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going forward as well but we
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um
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investigated uh the topic of longevity
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literacy meaning do people have an appre
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iation of how long uh they can live uh
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and we have AAL data to be able to test
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that question against if you're a male
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or a female Etc now I'm fascinated by
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the ZIP code conversation that we can
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add some sophistication to this but what
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we learned was that a staggering number
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of
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Americans um do not have an appreciation
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of how long they can expect to live a
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retirement and if you think about uh
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what our life expectancy was when Social
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Security was path to what it is today
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we've added 17 to 20 years and so our
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knowledge is our cultural knowledge is
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not keeping up with the actual facts on
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the ground and so one of the things
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we've learned when we look at people
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with higher longevity
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literacy their financial behaviors are
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much more amable to what we would teach
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in terms of proper retirement planning
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uh at at school so for
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example uh those with high it literacy
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actually thought about how much they
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need in
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retirement uh those who had higher
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longevity
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literacy took action to save on a
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regular basis and also had confidence so
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so if you think uh you know some we can
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impact some positive
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behavior uh we think we can do that by
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enhancing people's longivity literacy in
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addition to financial literacy and the
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all the points that guy and Freda were
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making about
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disparities is showing up in this data
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uh longevity literacy levels are
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different by males and females and by
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gender uh by by ethnicity and race as
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well it it's such a a striking
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observation I I my father passed away at
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64 years old and um I'm now Beyond 64 my
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brother was beyond 64 um before me but
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but our perspective on life and and many
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of his friends were were gone at that
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now relatively early age too and when I
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when I speak to you know in my more
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sophisticated life now I speak with
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financial advisers and they're talking
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about okay let's let's uh do a monic car
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scenario and see if you you make it to
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95 I'm like wait a minute that's that's
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you know that would be phenomenal in in
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a way that I may or may not have the
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right perspective on on trying to deal
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with that reality even with all this
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education and all else that I have
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have any kind of thoughts about that
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that kind of transition again this this
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goes to that whole area cod kind of
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thing too can you move from being a
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person that that's in a world where ah
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nobody's living that long anyway so so I
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can go paycheck to paycheck and I'll be
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okay but are there any any studies out
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there that that anybody's seen that look
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at this transition there there's one uh
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Ken if I could jump in on this point um
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there's a study that U that we funded at
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Boston College Center for time research
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that distinguished between objective
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life
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expectancy and subjective life
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expectancy so again in your anecdote you
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expressing your subjective life
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expectancy my father my brother me my
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family my situation where I grew up Etc
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which is very important to your
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self-belief but to the same people if
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you offered objective life expectancy
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saying hey your your dad your brother
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Etc but here's your education here's
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your ZIP code uh here's your physical
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situation as we stand today and people
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like you unlike others in your family or
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lineage live this long is more objective
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education and we found that people's
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behavior changes if you give them that
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objective knowledge so does it sound
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like do I hear you saying that the
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objective and the subjective um real
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like the the perspective must mirror
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each other in order for this to work
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they complement each other it can beated
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but they should compliment I'm I'm ready
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to be studied we'll see if if I if I
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continue to act like I'm playing with
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house money these are extra years so I
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have I have in my in my house you know
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again show you what kind of friends I
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have there are all these books that have
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titles like die broke I have the I have
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those those in my house which is the
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counterpath Tia Institute is not
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supporting of that of that kind of way
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of of looking at life you know spend as
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much before somebody else gets their
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hands on it but but but guy I I want to
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Circle back you know let's talk some
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more more about uh interventions and
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paths that can can change what what's
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out there um now we've got a lot of the
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you know not a lot we we got a brief
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snapshot of of some of the major issues
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that are out are out there um you you
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mentioned in in your initial list of uh
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problem s that that exist also the the
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absence of of of pharmacies for example
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and and I heard so I talk about it in
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some communities again the ZIP code
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issue it's it's a Pharmacy Desert um and
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one of the things we were thinking about
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as as we're we're talking about doing
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this series of podcasts was Ai and what
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kind of techn technological
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interventions and what else what else
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can be provided to um try to add address
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these issues that we may not have
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thought of before and I only know uh
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briefly about
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Amazon's Venture into this Pharmacy
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space which is the CVS in my old
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neighborhood in La has closed down and U
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my brother and others are trying to
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figure out well why do I have to drive
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three or four miles to try to get
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prescriptions or in worst case say yeah
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never mind maybe I I'll get it tomorrow
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and they actually need it today what be
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besides the the Amazon example or maybe
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that one too what else do we see out
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there that this trying to address this
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this issue in in ways we haven't haven't
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done before we should do more
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of yeah I think there's a lot of
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innovation that is coming out um but I I
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W to I want to go back to the Amazon
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example because we're we're trying to
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look at innovation in through the lenses
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of equity and and Health Equity uh uh in
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particular so it's very easy to think
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about Innovation that serves uh to you
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know benefit segments of society but
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actually exacerbate uh Equity issues so
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I think I think this is this is a good
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question whether um Amazon Pharmacy will
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be uh improving Health Equity or not um
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my gut feeling is the answer is probably
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yes but there is um pros and cons that
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we have to weigh here so so I think that
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there's there's definitely a lot of Pros
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um the the obvious one is that um today
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over 60% of the US population are Amazon
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Prime members that's about 16 67 million
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Americans uh today and so Amazon
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Pharmacy can potentially reach
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underservice population with limited
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access to physical Pharmacy as you
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mentioned and this could be because they
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live in remote or rural areas but also
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because they face other barriers like
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Transportation or uh branches that are
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closing like you you
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described but honestly I think it goes
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uh well beyond accessibility um The Hope
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is that Amazon might actually affect
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prices so create more competitive prices
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in discount uh will make medication more
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affordable and in my perspective the the
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the study that I've uh been uh involved
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in uh around the importance of
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medication adherence so the convenience
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of having drugs delivered to you can
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have a big effect on that and this is a
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major issue uh in healthcare because um
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not having adherence to medication
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causes a lot of unnecessary
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hospitalization emergency uh room visits
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and so on and in this case these are
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activities that both expensive and
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avoidable and you know I I would say U
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Amazon has another benefit Beyond being
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just a delivery mechanism it's also a
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platform so they can leverage this
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platform to provide more health
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information and more education which we
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you know we've discussed here really
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nicely in this broadcast uh is is a key
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component for Health Equity
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now you know there's not a lot of um
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cause here but probably one obvious one
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is that not everybody in the US has
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access to the internet and um you know
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this could limit the reach of you know
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Amazon Pharmacy to only those that are
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um connected and so recent Sur surveys
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have looked at this um fortunately 92%
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of individuals in the US have access the
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internet but obviously this this problem
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of no access is more pronounced in you
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know rural States so States like
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Mississippi New Mexico Arkansas almost
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20% of homes uh are with no internet
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access so there is there is a chance
00:20:01
that our most vulnerable population will
00:20:03
not be able to benefit from this
00:20:05
Innovation uh and this this can
00:20:07
exacerbate existing
00:20:09
disparities and and tell people too I
00:20:12
that's very interesting to to think
00:20:14
about the the idea of the absence of
00:20:16
Technology there also as you get older
00:20:18
the difficulty in using technology so so
00:20:21
that that community that demographic as
00:20:24
well uh ends up having issues with the
00:20:27
Great greatest next technology that that
00:20:29
comes up freed Dania what else you you
00:20:32
see out there as interventions that that
00:20:36
we should focus on that we should
00:20:37
embrace going forward yeah I'll jump in
00:20:41
um and kind of speak a little bit about
00:20:43
um the ways in which what we're trying
00:20:45
to do here at the Wharton School um and
00:20:47
so the Coalition for equity and
00:20:49
opportunity um which Ken has so nicely
00:20:52
presented earlier in the podcast has
00:20:55
really been trying to think about ways
00:20:57
in which um individuals who typically
00:20:59
don't have access to the Wharton School
00:21:02
are now having uh access to as we think
00:21:04
about financial literacy as we look at
00:21:07
Health Equity particularly um for this
00:21:09
podcast we have been um working within
00:21:13
the West Philadelphia Community we had a
00:21:15
partnership on this past summer where we
00:21:17
were thinking about wellness and the the
00:21:20
entire being right the entire person um
00:21:23
their financial Wellness as well as
00:21:25
their health outcomes and so um we had
00:21:28
the the community event in which we
00:21:30
partner with the office of diversity
00:21:31
inclusion here at the Wharton School as
00:21:33
well as pen medicine to provide things
00:21:36
like you know fresh fruit and vegetables
00:21:38
um uh for the community uh provide
00:21:41
financial literacy um had individuals
00:21:43
who who are doing this work in the
00:21:46
community we have a lots of resources
00:21:49
that I think not only the West
00:21:51
Philadelphia Community Pennsylvania so
00:21:54
as well as nationally and globally could
00:21:56
access um as we talked about through the
00:21:58
internet and so we're also creating
00:22:00
these short uh toolkits where we take um
00:22:05
faculty research that they spend a lot
00:22:07
of time working on that sometimes is not
00:22:10
accessible to a larger population and
00:22:13
making it digestable in ways in which um
00:22:15
they're thinking about as we look at um
00:22:17
Health outcomes as doctors are uh
00:22:20
meeting and and talking with patients
00:22:22
how to think about these things on a
00:22:24
larger scale and then lastly partnering
00:22:28
with organizations like Tia Institute to
00:22:32
make sure um we are getting you know
00:22:34
touching multiple parts of um the
00:22:37
population and providing information and
00:22:39
using it to elevate um that work not
00:22:42
only within the faculty not only the the
00:22:44
research that faculty are doing but
00:22:45
creating new research that faculty could
00:22:47
be doing as well so we're continuing to
00:22:49
support those
00:22:51
Endeavors Seria closing thoughts we've
00:22:54
got two minutes left just just the
00:22:56
thoughts from all the research you have
00:22:58
the the the pieces that you want to make
00:23:00
sure uh those listening to this podcast
00:23:03
know to improve the situation in terms
00:23:06
of the opportunities that exist uh to
00:23:08
address health care and bring about
00:23:10
greater Equity indeed um we can think
00:23:12
about micro interventions and we can
00:23:14
also think about macro interventions so
00:23:17
I'd like to address a macro intervention
00:23:19
point that we are very excited about and
00:23:23
we'll call that the retirement Bill of
00:23:25
Rights so talking about health and
00:23:27
wealth being on two sides of the same
00:23:29
coin we know about the patient biller
00:23:31
rights so why don't we marry a
00:23:34
retirement biller rights with it to
00:23:36
improve access uh to retirement savings
00:23:39
so so expanding access uh would be one
00:23:43
aspect of it providing the right kind of
00:23:46
information uh so people can make the
00:23:48
right decisions and low cost investment
00:23:51
opportunities because there are lots of
00:23:52
concerns around you know things being
00:23:54
overpriced or people being overcharged
00:23:56
uh and then finally income uh you know
00:24:00
we've gotten away from pensions to
00:24:02
completely managing Investments on our
00:24:03
own so if we can give people some stable
00:24:06
income along with Social Security can
00:24:08
put them on a solid Financial footing as
00:24:11
well so so retirement Bill of Rights
00:24:13
would be the macr level Innovation and
00:24:16
intervention can be would propose sua I
00:24:19
I would really appreciate that and Guy
00:24:22
farita we've gotten some progress in
00:24:26
terms of of the things that that can do
00:24:28
obviously a lot more to cover the but
00:24:31
the idea that you you're not bound by
00:24:33
your ZIP code necessarily uh the idea
00:24:36
that technology might help uh and the
00:24:39
idea that there is this this
00:24:41
intertwining of of health and and
00:24:44
finances is what we need to address
00:24:46
further thank you for joining us join us
00:24:48
for our next episode of Opportunity
00:24:53
[Music]
00:24:55
Matters I'm farita Griffith Man managing
00:24:58
director for the Wharton Coalition for
00:24:59
equity and opportunity in partnership
00:25:01
with Wharton Works led by Professor
00:25:04
Damon Phillips business round table and
00:25:06
second chance business Coalition we're
00:25:08
bringing together Business Leaders
00:25:10
academics State leaders and Justice
00:25:13
impacted communities for discussions on
00:25:15
creating Pathways to sustainable
00:25:16
employment for individuals who are
00:25:18
formally incarcerated to learn more and
00:25:21
register go to
00:25:23
ceo. won. up.edu
