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Closing the gap on health disparities with a local approach

The Health Foundation of South Florida, the region’s largest philanthropic organization focused on achieving health equity in historically disadvantaged communities, recently named Melida Akiti as its new Board Chair.

Akiti, the vice president of Ambulatory and Community Services at Memorial Healthcare System in Broward County, has served on the Health Foundation Board since 2014 and brings the perspective of more than two decades of experience in healthcare delivery, mental health services and correctional health. A native of Panama, but a 30-plus year resident of South Florida, Akiti is the first Black person and the first Latina to lead the Foundation’s Board of Directors.

I recently interviewed Akiti to learn more about her vision for the Health Foundation and her hyper-local approach to closing the gap on health disparities among racial groups in South Florida.

 

HM: Since definitions have broadened over time and many still may not know what we’re talking about, can you define what health and racial disparities are?

MA:
Health disparity is the absence of health just because of the color of your skin. The world is so polarized that health is given according to the individual’s socioeconomic, educational and, in this case, racial status. The lack of health because you are Black is so prevalent, and there’s so much assumption in healthcare about how the minority communities seek health or need to even understand health.

For example, sickle cell disease is an illness that affects people of color. There’s no strong program around sickle cell. So when these individuals go to the emergency room because they are in pain and seek medication, they are often seen as drug seekers. The fact that reimbursement of sickle cell is only through Medicaid tells you that so many illnesses that are related to the Black community are not given the same status of illnesses that affect other ethnic groups.

Another big example is the war on drugs. Everything changed as soon as drugs went into suburbia. It was at that point that it began to be looked at as a disease and funding started going into treatment rather than into the judicial system, where drug use was simply criminalized.

 

HM: Using the example of sickle cell disease, it sounds like the problem is so systemic that it really takes a broad and deep understanding to identify the root causes and then be able to change them?

MA: Exactly. You have to be able to invest in order for you to have outcomes, and the investment is not there. The education about sickle cell disease is not sufficiently present in healthcare. I have visited sickle cell clinics. I have seen the pain of these patients, and they’re part of the minority community. There’s not nearly enough education about this illness in the emergency room. There is not, what I call, sickle cell “day treatment,” where they are able to receive treatment throughout the day or in the evening hours. Really comprehensive sickle cell programs do not exist. There are just haphazard programs because of the population that it affects. Healthcare is very much geared according to who has a platform, and sadly, the minority community doesn’t have the platform.

 

HM: Do you think it’s difficult to identify the vulnerable population in a community?

MA: No. It is extremely clear. We’re talking about social determinants of health. The fact is that only about 20 percent of our health is in the four walls. The other 80 percent has to do with the community.

Look at our Black community. Look and see if you find a chain grocery store. That’s where health starts. It starts with what you eat. These chains stay out of these areas because, they say, there is violence and theft. There is violence and theft in every area, but that is their excuse that they don’t have chain supermarkets in the Black community. So we’re starting first with a food desert in the Black community. From their lack of proper nourishment, you’re going to see diabetes, hypertension and coronary disease.

Then, let’s go to housing and other social determinants of health. If you don’t have proper housing and a clean living environment, then you’re going to have asthma and COPD.

Just from these circumstances and their health results, you identify your vulnerable communities.

And now with the coronavirus: according to the CDC’s latest data, of the people who have received at least one dose of the vaccine, only 6 percent is Black. Well, the majority of the vaccination appointments are made on computers. In communities with poverty issues where most of your advertising is on the computer, you’re going to have problems reaching those in the Black community. That’s why some of our partners—like Jackson Health System and our grantees behind the Keeping the Faith effort—have been going into churches and other organizations in the Black community to provide COVID education, testing and now getting ready to help with the vaccine. But the truth is, the plan was never set up to make sure that there was equity regarding access to the vaccination for this population.

 

HM: What you’re saying is that the infrastructure is just not there?

MA: Infrastructure is not there, because this is systemic. Maybe I could have said that it was coincidental if it was something that had occurred only in the last 10 years, but I have been following this for 20 years. And before me, there were other people following it for 30, 40, 50 years, and nothing has changed. What does that tell you? When things don’t change, it is because people want it to continue to be the same.

It is time now to say, “Enough is enough.”

 

HM: What is the kind of work that needs to be done to start pushing this in the right direction?

MA: Right now, President Joe Biden has put together a very powerful group, and it needs to be on the agenda. It has to come from the top. The same way it was when we had HIV/AIDS, and we tackled it as a nation. That’s the same thing that we can do now.

COVID has amplified the disparities. People are dying from COVID, not because of the virus itself, but because of the underlying illnesses — high blood pressure, diabetes, COPD, coronary disease — that make the body’s reaction to the infection worse. These conditions are why people are dying now. These illnesses have been in the Black community, and now, COVID is wiping out this vulnerable community. This has to do with the lack of infrastructure and the lack of attention that has been paid to the Black community and to its health. There has been an outsized focus on crime and criminalization and not enough attention on how the Black community can access better health.

That has been the biggest problem. Grants for the Black community have largely been aimed at that criminal justice system, and less frequently at the community’s health and wellbeing. We’re afraid of saying that we have not paid attention to it, and we failed. We have not created the infrastructure for vaccination, and we have not created the infrastructure for early pregnancy programs either. We have Black women dying during childbirth. In this day and age, how can that happen? Why are Black women dying during childbirth in a country like the United States?

 

HM: Even with all the loss and tragedy of COVID, did it create more of an urgency to find the investments that are needed to put together the plans that will change the facts on the ground?

MA: I don’t think that COVID has highlighted enough to be able to do something about it. This administration is focusing on getting Black people vaccinated, but the genesis of the problem is still there. Until we focus on the reason why Black people were dying during the beginning of the pandemic, we are not going to deal with the genesis of the problem.

That is why my goal is for the Health Foundation to go into the community and start talking to the influencers to see how we can turn the community around, taking it block by block. If we can create health in one block, in one ZIP code, we can model that example in other ZIP codes.

People need to understand that we’re dealing with only what’s urgent at the time. Now, it’s getting the vaccine, but when we finish the vaccine, are we willing to go back and do a root cause analysis and see why people were dying? Because that’s exactly what needs to happen.

 

HM: What are some of the significant initiatives at the Health Foundation that you want to lead going forward?

MA: I’m very excited, because we started with a $1.5 million grant for COVID education and testing. With that grant, we were able to secure the tool that Spatially Health developed and provided to the Foundation. With that tool, we are able to identify the hotspots of the most vulnerable areas. Now that we have identified these hotspots, our next step has to do with what are we going to do with this data?

 

HM: Is the Health Foundation still going to be involved with COVID testing and education?

MA: We’re not only going to continue with the education and testing, but now, we’re going to move into education for the vaccine.

We want to go back to the hotspots your tool helped us identify and see how the social determinants of health affected those areas. Then, start working with the community and all of the organizations and the influencers who know their community. These are the groups that live and work in their community and can tell you what their problems are. We want to be flexible enough to be able to deal with simple issues that the community is bringing to us.

 

HM: So you’re looking for a broader, but smarter, approach that can help you understand what is necessary and what is available and how you connect those dots and bring in the right partners to then build out what is still necessary?

MA: Exactly, because old philanthropic models too often relied on the assumption that outsiders could parachute in and know what a community needed. That is far from reality. We need to go back to the grassroots and invite influencers to tell us what is happening in their community. That is why we are going to make changes and create best practices one ZIP code at a time.

 

HM: What you’re saying is let’s be hyper-focused and solve the immediate problems first and then go to the next problem to solve that one, too?

MA: Yes, that is correct. Because if you think of all the millions of dollars that have been spent on so-called “healthcare” with COVID, yet we still had a high index of death in the Black community. That high index was due to the increased incidence of high blood pressure, diabetes, COPD and coronary disease in this population. So, that broad approach is not working.

The goal here is to be able to take one area at a time. With the influencers who are embedded inside that community knocking on doors to make sure they understand the issues. I always say people talk to people not with people, and in the Black community, we have people talking to the Black community, not with the Black community. The influencers we identify will help us talk with the community.

The biggest problem many organizations face when they get a grant is that it’s not sustainable. When the grant money is spent, the problem may still exist. That’s because they create a program for that community instead of making the community create the program for themselves. Things that are created from within are sustainable.

 

HM: If you look ahead a couple of years, what do you want to see there that we don’t have now?

MA: I want to see that when we talk about health disparity, we can localize it. That we’re able to say that there may still be health disparity in some areas, but if you look at one particular neighborhood, you can see the health index there is higher now since we went in and made sustainable changes. We’re using that as a best practice to continue our journey of health equity in other ZIP codes that need help. I don’t see it as we’re going to impact the entire region of Broward, Miami-Dade and Monroe counties. I see us attacking one neighborhood at a time in each one of these communities and getting partners and resources to make that transformation.

 

HM: How do you see those benefits being multiplied?

MA: The concept that we’re developing will be the same across communities, but the influencers and partners we use to help that community will change ZIP code by ZIP code. For example, influencers in a Haitian-American community will be different than those in a Jamaican-American community. Similarly, our partners, such as healthcare organizations, will also be different in each community we want to help. Too often, organizations think they can apply the same formula and mixture of partners in different communities and the outcomes will be successful. It doesn’t work the same for every community.

Sometimes a solution is so simple, but we want the community to fit within the boxes that we have created. And we’re trying to rely on people outside of those areas to give us information about those areas. I want people that know what is happening in their community. We need to roll up our sleeves and look at things differently. I want to really turn the status quo upside down.

So, we’re trying to be localized. Changes happen on a local level. When we say “local level,” we’re not talking about all of Broward County but about every single community in Broward. We want to tackle each community one at a time, because each community is different.

 

HM: What do you think the biggest challenges for the Health Foundation is for the coming year?

MA: The biggest challenge for the Health Foundation is if we worry too much about protecting the corpus of $150 million, we are not going to be able to be bold. I don’t want us to be foolish. I want us to look and see how we can multiply what we have and just take the risk of being able to move forward. It’s going to be risky, but let me tell you, nothing ventured, nothing gained.

 

Visionaries like Melida Akiti recognize the value of thinking locally to solve larger social issues. Spatially Health has partnered with the Health Foundation of South Florida to pinpoint geographic areas of vulnerability to health disparities so that the Foundation can begin working toward closing the gap among these communities. To find out more about Spatially Health’s expertise in data analytics and predictive modeling, contact us.

 

 

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