“If you care about health, you must care about health equity.” This sentiment was shared by Dave Chokshi, MD, former New York City health commissioner, during a day-long child health equity symposium in Orlando, Florida. The event was sponsored by the Ginsburg Institute for Health Equity at Nemours Children’s Health.
Today’s episode features insights from Dr. Chokshi who emphasized that health inequities are preventable and solvable through systemic change. The conversation highlights lessons from the COVID-19 pandemic, including reduced child poverty and improved access to health care, showcasing what’s possible with collaborative action.
Alongside Dr. Chokshi, Kara Odom Walker, MD, MPH, MSHS, from Nemours Children’s Health, reflects on actionable strategies to make a measurable impact in eliminating health disparities and ensuring a brighter future for children nationwide.
Guests:
Dave Chokshi, MD, Sternberg Family Professor of Leadership, Colin Powell School for Civic and Global Leadership, City College of New York; former Commissioner of Health and Mental Hygiene for the City of New York, NY
Kara Odom Walker, MD, MPH, MSHS, Executive Vice President and Chief Population Health Officer, Nemours Children’s Health
Host/Producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked Children’s Health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week we’re joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
Music:
Let’s go-o-o, Well Beyond Medicine.
Carol Vassar, podcast host/producer:
In this increasingly divided world, there’s a good bet that we can all agree on this. Every child deserves the chance to grow up healthy regardless of their background or circumstances. Yet in practice, children’s health equity remains elusive. But it doesn’t have to be this way, and there are people working right now toward a future state where children’s health equity is a reality. People like Dr. Dave Chokshi.
Dr. Dave Chokshi, City College of New York:
Inequities are disparities that are avoidable, unjust, and unfair.
Carol Vassar, podcast host/producer:
If you don’t know him, Dr. Chokshi is a practicing physician, a Rhodes Scholar, a White House fellow, and a public health leader who served as the 43rd Commissioner of Health and Mental Hygiene for the city of New York at the dawn and height of the COVID-19 pandemic from 2020 to 2022. Facing and successfully addressing significantly complicated issues, like health equity, doesn’t frighten him. In fact, it inspires him and always has.
Dr. Dave Chokshi, City College of New York:
I’m the first doctor in my family, and so I didn’t really have early role models when it came to knowing what it meant to practice medicine. But I had so many experiences that showed me how health is fundamentally linked to opportunity. I grew up in Baton Rouge, Louisiana, and I saw the devastation that Hurricane Katrina brought on New Orleans and my hometown and learned that in a very visceral way, in times of crisis, the people who are most likely to be marginalized are those who have already been living on the margins. And so all of those have convinced me that it really is about health beyond medicine in order to pursue that notion of opportunity.
Carol Vassar, podcast host/producer:
For Dr. Chokshi, the COVID-19 pandemic laid bare, once again, the concept that those already left on the outside of society, including children, are those who suffer most from the ravages of disease unless something drastically changes.
Dr. Dave Chokshi, City College of New York:
One thing I’ve learned from my experience during the pandemic is that people who are living on the margins are most likely to be further marginalized during a time of crisis. And so what that means is that we have to make it so that health equity is not seen as a sideshow or an add-on or a nice to have, it is the main event. If you care about health, you must care about health equity.
Carol Vassar, podcast host/producer:
Health equity, specifically children’s health equity, is our focus on today’s edition of the Nemours Well Beyond Medicine podcast. We’ll feature excerpts from a fireside chat and post-chat interview between Dr. Chokshi and Dr. Kara Odom-Walker, Executive Vice President and Chief Population Officer for Nemours Children’s Health. It was part of a day-long child health equity symposium held in Orlando and sponsored by the Ginsburg Institute for Health Equity at Nemours. The Ginsburg Institute is a multidisciplinary team of experts that sparks new programs, engages in national policy discussions, and provides intellectual and practical leadership through clinical care, research, education, and quality improvement initiatives. The institute is funded through a $25 million grant from the Ginsburg Family Foundation, headed by Florida philanthropist Alan H. Ginsburg.
Alan Ginsburg, Chair, Ginsburg Family Foundation:
It is amazing that in the United States of America, greatest country in the world, there are kids that go to bed hungry, there are kids that don’t get medical care, there are kids that have no treatment for mental anguish or mental conditions. What we need to do is to find a way to take care of these children so they never have to see the inside of a hospital. And in 10 years from now, I would think that our younger population would have a sound physical and mental capacity. And in general, we will have filled some of the gaps that exist now that are needed by children and families in our community.
Carol Vassar, podcast host/producer:
Children’s health equity and what’s being done to achieve it, right now on the Nemours Well Beyond Medicine podcast.
Dr. Kara Odom-Walker, Nemours Children’s Health:
One of the overarching themes I heard, and I think you said it, Dr. Chokshi, inequities are avoidable, unjust, and unfair. Does that also mean they’re solvable?
Dr. Dave Chokshi, City College of New York:
Absolutely. I think the fundamental thing that we have to realize about so much inequity in our society is that it is soluble. And in fact, inequity as it exists today is often a choice that has been made. We have to infuse these conversations with agency, both the status quo has a certain agency, there may be people who are benefiting from the status quo, but also we all have agency in changing that for people and communities who too often have been marginalized in these conversations. When I think about child poverty in the United States, it’s something that we know is bad for health, period. We know the reverberating effects that growing up not knowing where a child’s next meal will come from or whether it will be healthy, or if someone will have a safe place to go out and play on the playground or a healthy place to live so that they don’t suffer from illness as a result of their home or their neighborhood.
I think about one of the first patients that I ever took care of. I went to medical school in Philadelphia, and so the very first rotation that I did as a medical student was in pediatrics. And I will never forget this patient, this little boy, and his mother because he presented with lead poisoning. And he had what sometimes happens with severe levels of lead toxicity: he had lines on his gums. They’re sometimes called Burton lines when the levels of lead get too high. And I remember seeing the boy, I remember talking to the mother, and the way that her shoulders shook as she cried when we explained what it meant for her beloved little boy to have lead poisoning.
And then we did something miraculous, as we often do in healthcare: we did chelation therapy to get some of the lead out of his bloodstream. But it was one of the first times that I thought about what I consider the five whys. Why did he present in that way in the first place? I derive inspiration from my five-year-old daughter when I think about the five whys because she asks why not once, not twice, not even three times, but further succession still. And when we apply the five whys to tragic cases like that little boy who I helped take care of, we get to things like child poverty because a little boy or girl living in poverty is two and a half times more likely than another child to suffer from lead toxicity.
Dr. Kara Odom-Walker, Nemours Children’s Health:
Dr. Chokshi and I have connected on this over the past decade in so many ways. That one, we can address the inequities that we see, we can measure them, and we can actually create a plan around solving them. In this nation, we have resources that can be deployed differently, and it is up to us to bring the conversation together to create a dialogue that allows us to create new ways of solving and eliminating health disparities. Dave, one of the things that you have underscored in so many places and conversation points is the importance of social factors. And I wondered if you wanted to reflect a bit on what health systems and public health needs to think about the social needs in driving health equity.
Dr. Dave Chokshi, City College of New York:
Certainly. I do think that we have to be a bit more unvarnished when we talk about the core drivers of health. And the reason is that we’re facing an unprecedented crisis when it comes to the health of Americans, and particularly the health of our children. But sometimes, we sort of hide behind the jargon, particularly in medicine or public health. It irks me so much when we talk about years of life lost or we even make an acronym for it, YLLs. We are talking about birthdays lost of the people whom we love, of our elders, of our neighbors, of our family members. And we need to start talking about it in that way because, for example, the decline in life expectancy that we’re seeing in this nation is happening on our watch. We have the front row seats to that, and so we have to be the ones who are bearing witness and giving voice to it in a way that makes everyone stand up a bit straighter and feel those hairs on the back of our necks rise because it is something that is unconscionable.
We have to not just point out that infant mortality is rising for the first time in 20 years in our country. Or that, as you know, maternal morbidity is at a level unseen in any other industrialized nation. We can’t hide behind this jargon of infant mortality and maternal morbidity. We have to talk about the fact that our babies are dying and our mothers are suffering, and it’s up to us because we’re the ones who are seeing it. To be able to connect the dots in a way that helps people understand that there’s only so much that the healthcare system can do, and the rest is up to building partnerships in our communities, dissolving silos, crossing traditional boundaries, and organizing groups for purpose in a way that is fundamentally different than what we’ve done before.
Dr. Kara Odom-Walker, Nemours Children’s Health:
This is achievable. And we actually saw much of this work during COVID where specific efforts allowed us to reduce immunization gaps, to make sure that testing was available in those communities who were least likely to receive them, and that health systems like Nemours could be part of making sure we’re deploying our resources differently.
Dr. Dave Chokshi, City College of New York:
We saw an alternate reality when it came to the pandemic. We cut child poverty in half during COVID-19. We curbed homelessness among the age group that is most likely to experience eviction: youth. And we nearly accomplished universal health insurance for kids. All during this time of extraordinary tragedy. So it is possible. It is possible. It takes a sense of will and a sense of volition, and that is something that, again, is up to people like us because we saw what happened during the pandemic, right? We saw the benefits of the federal child tax credit and what it meant for families. Beyond any abstruse notion of tax policy, this was something very tangible for the families that we are helping to take care of. And so these are far from being impossible or out of reach. They are eminently feasible things for us to be able to accomplish. We know this because we’ve already seen it.
Dr. Kara Odom-Walker, Nemours Children’s Health:
During COVID, we saw child immunization gaps be reduced to unprecedented levels. We saw kids who didn’t have access to technology have new resources so that they could study and be successful in school. And we also deployed mental health resources at unprecedented levels to make sure that kids could receive those services through telehealth and telemedicine. These were policy decisions, they were resource decisions, and they were leadership decisions. And I think we’ve seen examples of how that’s possible.
Dr. Dave Chokshi, City College of New York:
There’s simply no way that we would’ve been able to vaccinate over 6 million New Yorkers in a little bit over a year were it not for partnership between our hospitals, health plans, and the health department, our community-based organizations and community clinicians, our physicians and pharmacists. So we saw these artificial walls that too often separate the various parts of our health system; those walls tumbled down seemingly overnight, and that is the health system as it should be. And what I’m seeing now is that too often, we’re kind of snapping back to where we were before the pandemic. In this respect, I think it’s incumbent on all of us to essentially not accept that as a static reality and instead to say strengthening partnerships, for example, between healthcare and public health in the way that we saw during the pandemic should just be business as usual. This is what our health system should look like every single day.
And so, one of the initiatives that I’m working on as part of this is something called the Common Health Coalition. The Common Health Coalition came about with five leading American healthcare organizations. These five founding organizations came together last year and said, we should not accept that. We should instead try to knit together this sense of collaboration and partnership in everything that we’re doing going forward, not just for a time of crisis, although as we know the next pandemic will be upon us sooner than we would like, but also for all of the slower moving disasters that our families and communities are contending with right now. Whether it’s child poverty, or the overdose crisis, or infant mortality.
Dr. Kara Odom-Walker, Nemours Children’s Health:
Dave, do you remember we would have these calls with secretaries up and down the East Coast to try to figure out how we would split our resources, share the lessons learned, and figure out how to lean into the data that we had and the questions that were yet to be answered, and we just actively leaned in and partnered. And we also did that alongside communities, and you would share stories of who could come in to deploy resources around vaccination or how we would stand up resources that we couldn’t procure because we were trying to find supplies to respond in the moment. I think that those moments really showed the capabilities and the lessons. It also shows that we have more to do around pulling in public health into the fabric of how we think about health and healthcare. We also need to think about school settings, we need to think about community-based organizations, payers and government as a new way of pulling together the right resources to take care of the whole person, the whole child, because that’s what we’re talking about today. And that is really what I see as the ongoing opportunity to push the policy dialogue and create a new model of care that really does incorporate all aspects of what it takes to create health in our country.
Dr. Dave Chokshi, City College of New York:
Let me just connect the dots in terms of health equity and this idea of strengthening partnership between healthcare and public health. I’m a primary care doc. I practice at Bellevue Hospital, which I love to talk about as a hospital that was around taking care of low-income people even before the Declaration of Independence. So, it has this storied history of serving people who often have no place else to turn for medical care. But even as I’m very proud of that and I love to take care of patients, I practice in a clinic for people experiencing homelessness. I try to always keep in mind who makes it across the threshold of my exam room in the first place. In medicine, we talk about seeing patients. When I’m making rounds in the hospital or taking care of patients in my clinic, I’ll say I’m seeing patients today, but what about the patients we do not see?
Whether because of forces of marginalization, or fear, or cost, who are those patients we do not see and why? And that’s where public health comes in. Because in public health, we concern ourselves with denominators, with communities, with whole populations, and we do things like making sure that we are outreaching so that people will come across the threshold in the first place, or better still, will bring our healthcare into the community. Community health workers were a particularly important way that we built trust during the pandemic and long before. People in other countries beyond the United States have made community health workers a fundamental part of the fabric of their health system for decades. We use mobile units and other ways of actually bringing healthcare out into communities. And so this is how strengthening partnership between healthcare and public health is tied to health equity.
Carol Vassar, podcast host/producer:
Mr. Ginsburg brought Joy this morning into his opening remarks, and he also noted that he wants to be here in 10 years, and he wants to see how his investment in child health equity at that time is doing. If you were reporting out in 10 years, we’re talking about 2034, at the 12th Annual Ginsburg Institute Child Health Equity Symposium, what do you hope to be reporting out about or seeing come to fruition, Dr. Walker?
Dr. Kara Odom-Walker, Nemours Children’s Health:
Well, I think that in 10 years, what we would be able to see is a measurable difference in those gaps and key health outcomes, and that’s what we’re talking about today, and we’re going to highlight those areas where we see disparities in central Florida. Learn what works and then replicate it, spread it beyond central Florida, go into the rest of the state, the rest of the nation. That is the goal, and I believe it’s doable, but it takes other partners, aside from Nemours, to create that momentum and make sure that we’re pulling in the right resources and the right leadership. It does require a lot of hard work and hard conversations. I know we had an inspiring discussion today. Thank you, Dave, for being here, for being a friend, a colleague, for inspiring me to do more around creating these open communication channels, building momentum, pulling in coalitions, and also just doing hard things. Just get it done. We want to do it for our kids, for our future, for our nation and beyond.
Carol Vassar, podcast host/producer:
Dr. Chokshi.
Dr. Dave Chokshi, City College of New York:
Sure. Well, that’s so well-articulated and right back at you. It’s wonderful to have people that you’re able to travel with over years to be able to try to make progress. With respect to 10 years down the road… Well, first of all, I hope to get invited back to that symposium so I can see for myself, but I think we have to start with the big vision, as Dr. Walker has articulated, to make this a region that is one of the best places in the world to raise a child. That’s what we want for our own children. And so we are the change we’ve been waiting for, as it’s been said, to be able to create the conditions where all kids can thrive. It’s about the love, of course, that we feel for our kids, but it’s also about the future that we want for everyone. And the investment and the conversations that are happening today, they’re the start of propelling toward that future but it’s going to take a lot of hard work to go from here to there.
Carol Vassar, podcast host/producer:
Dr. Dave Chokshi is the Sternberg Family Professor of Leadership at City College of New York. He also served as the 43rd Commissioner of Health and Mental Hygiene for the City of New York. We also heard from Dr. Kara Odom-Walker, executive vice president and chief population health officer for Nemours Children’s Health.
Music:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks so much to Dr. Chokshi and Dr. Walker for their leadership in children’s health equity. And thanks to you for listening. So many great guests and topics coming up on the Nemours Well Beyond Medicine podcast, you’re not going to want to miss an episode. You won’t have to; simply go to nemourswellbeyond.org and subscribe to the podcast. That way, it’ll be delivered to you each Monday morning so you can listen at your convenience. That’s nemourswellbeyond.com. Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, Steve Savino, and, from the Ginsburg Institute for Health Equity, Nancy Molello, Stephanie Avila, and Claudia Tejada. Join us next time as we learn about how dark design in social media and video games affects our kids. I’m Carol Vassar. Until then, remember, we can change children’s health for good. Well Beyond Medicine.
Music:
Let’s go-o-o. Well Beyond Medicine.
