Healing Healthcare: Strategies for Combating Social Determinants of Health

Dr. Chapa:
Welcome to Clinician's Roundtable on ReachMD. I'm Dr. Hector Chapa, and today I'm speaking about social determinants of health with Dr. Linda Bradley, she's Professor of Surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. She's also the Vice-chair of the Obstetrics, Gynecology, and Women's Health Institute at the Cleveland Clinic. 

Now Dr. Bradley, medical commentators have stated that medicine as a profession is sick.  If you had the ideal remedy for this sickness, what would it look like?  In other words, what can medicine do to change to just better impact the community? 

Dr. Bradley:
You know what really needs to change is patients having jobs and good-paying jobs because health is wealth, and wealth sometimes gets you better health.

We just have to keep talking up education, self-care, self-compassion, mental health, movement, exercise, eating well, being voting citizens to vote good things into your community.  I mean, it takes a village to raise all of us.  And I can't point to just one thing, but there are so many social determinants that keep Americans and actually the world from progressing, and when everybody has opportunities, I think the domains from which we can live in and grow in and play in also become better. It's hard to pick them apart.  It's like one continuous circle, and it's like my grandmother's quilt.  You start putting all these great things together—family, community, religion if that's a part of you, spirituality, what you eat, thinking, all those kinds of things, mindfulness, good sleep, less stress, good teachers—you know, it all sort of weaves together, and you come up with this beautiful quilt, a beautiful community—also being there to help people who may have problems with mental illness, substance abuse, all those kinds of things. 

You know, you and I, when we operate and we cut the dermis and go through the skin, we are all the same under that one-eighth of an inch or few millimeters of our dermis.  We bleed—we bleed the same.  We smile the same.  We cry the same.  We scream the same.  Our angst is still there.  And I think if we realize that we are more alike than we are different, things could be a lot better, and that's just kind of how I look at things. 

Dr. Chapa:
And really so what it boils down to is taking away some of the myths and stigmas of certain conditions or of certain communities, and that's exactly what I know that you have done.  You've been a very active member as a medical professional in your community to try to reach and educate in the greater Cleveland area, so we do definitely appreciate that.  I know I do.  So speaking of that, and in terms of that community reach, what could you tell other healthcare professionals across disciplines, not just women's health, what can they do to better impact their own population, their own community wellness amid the COVID-19 pandemic and beyond? 

Dr. Bradley:
Those are great questions.  So if I look at you and I as people of color, less than 6% of all physicians are African-American and likewise for Hispanic physicians, so we could never just take care of "our own."  We need allies.  We need people of all walks of life, all colors, to be there to help promote programs that will work to learn the metrics that work, and so we have to advocate for those  who are among us.  So I would just say to others speak up, recognize disparity, learn a lot more about the patients that you serve and their communities, get educated, learn about your own biases, work with groups to start to understand where you may have blinders on because people of color cannot take care of all the problems here.  We need allies and folks to step in and speak up and be another set of eyes and ears to promote all the good things that we're talking about.  And it's going to hurt sometimes to start because you feel so impotent about what you don't know, but I think day by day, each day try to learn something new about your community and ways that you can help others.  And sometimes it's just good to ask, "I don't know what to do, but how can I be of assistance?"  Volunteer for being a part of diversity and inclusion programs.  Learn more.  Read more.  And forgive some of the things that may have happened.  It's not that anybody today caused the problem today, but recognize America's past and its blemishes that we have to recognize, and then our idea is not to repeat some of these things again.  And I think education is powerful.  So, when you know better, you will do better. 

Dr. Chapa:
I love it.  That's great, great, great.  And Dr. Bradley, as we now wrap up the end or come to the end of this podcast, the end of this session, what are some final thoughts that you'd like to leave with our audience today? 

Dr. Bradley:
Well, I think I would just summarize that we are all in this together.  Nothing separates us from each other.  There's no fences.  There's no gated communities.  We all have to go out in the real world.  Get to know each other.  Speak up when you see things that are not just.  All of us need to take care of ourselves, our mental health, our physical health, our spiritual health, and begin to also for ourselves to set some boundaries so that we cannot get so burned out as healthcare providers and that we can keep giving.  This world needs us.  And  the word doctor means “teacher” in Latin, and we have so much teaching to do, and it goes beyond our patients, but sometimes it makes us think about being a lobbyist to speak to our leaders in our communities, whether it's mayor, congresspeople, governors, presidents.  Sometimes we have a voice, and it's important not to stay silent on things that matter. So just don't be silent.  Be active.  Be a participant.  Be a leader.  And those are the things that I would say. 

Dr. Chapa:
And what a great way to end this program, because it's such a vital reminder that the word doctor means “educator” or “teacher.”  I love it.  And now, as we come to a close on today's program, I want to thank my guest, and I have to say my friend and my mentor, Dr. Linda Bradley, for joining me in this discussion.  Dr. Bradley, it was great having you on the program. 

Dr. Bradley:
Thank you so much.

Dr. Chapa:
Absolutely.  I'm Dr. Hector Chapa.  To access this and other episodes in our series, visit reachmd.com/Clinician’s-Roundtable where you can Be Part of the Knowledge.  Thanks for listening.