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