Today on Business as Usual, we are excited to welcome Dr. Utibe Essien MD, University of Pittsburgh School of Medicine. He is an Assistant Professor of Medicine at the University of Pittsburgh School of Medicine and a Core Investigator in the Center for Health Equity Research and Promotion. Dr. Essien is also a board-certified internist, providing clinical care at VA Pittsburgh. Dr. Essien will discuss how COVID-19 is having a harsher impact on people of color. What does this mean moving forward as cases spike and the new school year begins? Dr. Essien has the insights on this and more.
Connect with Dr. Essien : @UREssien; uressien.com; uessien@pitt.edu.
Important links: http://www.ihi.org/resources/Pages/AudioandVideo/Centering-Equity-in-the-Response-to-COVID-19.aspx; http://www.ihi.org/Topics/Health-Equity/Pages/default.aspx; http://www.ihi.org/Engage/Initiatives/Pursuing-Equity/Pages/default.aspx
Transcription:
So Good afternoon. Welcome to business as usual, this is Audrey Russo and I'm president and CEO of the Pittsburgh Technology Council. I am thrilled to be here today we have a very special guests as we do every day. But I'm very excited about doing a deep dive with who is here today, we have joined with me as Jonathan Kersting. And he's vice president of all things media at the tech Council. So just a couple of things. First, I want to give shout out to our sponsors, which includeSheetz, Deloitte and Huntington Bank. Sheetz has an innovation center if you don't know that in Pittsburgh and working on all things, innovative as it relates to their business and Deloitte has been around for a long time deep partners with us with the tech Council. And Huntington bank has been on this journey with us right from the beginning, particularly as the cares act, found its way into the work of all of us that are in small business. Since COVID, so really want to give a shout out and appreciation for them. And then just to tell everyone that tomorrow we will have Valerie Cofield, and she's the eastern minority supplier Development Council. She runs that organization. And then Thursday, we have Dennis Dermis. He is Senior Vice President, head of region, America's radiology at Bayer. And he's joined with his vice president head of r&d. So we're very excited to continue having these kinds of conversations. And I want to say a couple of things. Most of all that you should know that we have muted your microphones just to make sure we don't have any noise in the background and be respectful of our guests. And then we also have an opportunity for questions in our chat. So I'm going to jump right in and just say that I am thrilled to introduce Dr. Utibe Essien. He is an assistant vice president of Medicine at the University of Pittsburgh and a health disparities researcher in the VA center for Health Equity research and promotion. He received his medical degree from the Albert Einstein College of Medicine in New York and a Master's of Public Health. from Harvard School of Public Health. He's completed residency and a research fellowship in internal medicine at the Massachusetts General Hospital, and Harvard Medical School. So if that's not intimidating enough, his academic background I think what's very interesting is that he, His research focuses on racial and ethnic disparities and the use of novel therapeutics in technologies in the management of cardiovascular diseases. Recently, he applied this research framework to the disproportionate toll COVID-19 pandemic has taken on minority communities. He is the director of the University of Pittsburgh's career education and enhancement for Healthcare Research diversity, which is also known as seed and for medical students Scholars program so cool. It's a lot and in his young life, he has accomplished a lot And it's really thrilling to know that he's here in Pittsburgh. He's been here for the last couple of years. And I think you're going to be thrilled just to hear from him. So I am going to step out of the way and just lay this up and say that in April of this year, you spoke on NPR and on on on point, which was one of their series, and about the how the Coronavirus is disproportionately impacting black Americans. So why don't you start with that? So welcome. Thank you. And let's set the stage for some of those conversations in regards to your work.
Yeah. So thanks so much for that. That introduction. I'm really honored for the opportunity to be here this afternoon. Obviously, the covid 19 pandemic has been on the minds of all of us. It's the reason we are doing this zoom series. And I think it's a virtual platform. And so since this started back in March, as a health disparities researcher as a clinician, a lot of us were concerned about the disproportionate toll that this virus was going to take on racial and ethnic minorities who unfortunately, experienced a disproportionate toll of every every disease, as I learned during medical school slide after slide which show that people who look like me were more likely to have hypertension, diabetes, obesity and other chronic medical diseases. Many of which are what is driving a lot of the disparities we're seeing in COVID-19. What I didn't really learn in medical school were the social factors that are really driving a lot of these disparities. So the challenges with housing with food insecurity with poverty and employment. And I think those factors in particular are so much more of a important lens to think about this pandemic, along with the clinical ones, that we have a lot of the tools and resources to manage in the hospital, but not necessarily the expertise to manage factors that folks like yourselves are probably caring for more than you do in the hospital and clinic.
Well, you know, it's so interesting when I think about like, you know, you were on NPR, I think it was like 10 or 12 weeks ago. And you know, the findings back then are even different than what the findings are now. Can you can you talk about that like how the datasets, what some of the disparities are in terms of data collection as well.
Yeah, definitely. So back in April, my colleagues and I wrote a paper looking at the disparities in the little data that we had. So I think one of the first states to report their data was Louisiana. And they showed that as many as 70% of their deaths from COVID-19 were black Americans. Then we start to see slow trickles out of Milwaukee. I get 70% was a number noted there for infection in black communities in Chicago, in New York, where my family grew up. And so we started to see this slow trickle and we're wondering, okay, what is going on? Is this a national issue? Or is this really just in these few individual, more urban environments, and at that point, we saw that in the 28, states that were reporting race and ethnicity data related to COVID-19 death, there was actually a three and a half times more likely to die from COVID-19 if you're black, compared to if you're white, and nearly Two times higher risk of dying if you are Hispanic or Latin x compared to your white, this is back in April. Here we are nearly two or three months later in July. And our report from the CDC just last week pretty much just confirmed those data that black Americans are still being more and more likely to be infected, more likely to die from COVID-19. So the amount of data and the clarity of the data have improved, but unfortunately, the disparities have just continued to persist.
And then in what about the data collection in terms of the reporting or they're all states are required to report the state or is there any kind of variation?
Yeah, so really important question and something that many of us working in the states have been thinking about is that, like I mentioned, only 28 states were reporting these data in April. Today, the Johns Hopkins tracker, which is the one that I use, often to follow these data showed that 47 states are reporting racism In the city data, so it's definitely increased. A big challenge with that data is the quality of the data, which is another factor that we examined in our paper and showed that there are states as many as 310 to 15% of states that were reporting these data had 40% of race ethnicity missing. So yes, they were reporting it, but they have so much data missing, that was really hard to get a full and complete understanding of what how big the problem was. And so today, we're still experiencing that across the country. The other big issue with reporting on race and ethnicity is around testing. So when I last looked, there was only four states that were recording race and ethnicity of those were actually getting tested for COVID-19. And we know testing has kind of been the original sin, so to speak of the pandemic here in our country, whether it was from the lack of tests themselves the actual way that we were sending the tests out how much material Do we have to effectively perform these tests? And so here we are, again, dealing with just a lack of data around racial race and to see who's actually getting access to testing.
There are two questions on here that it's a good time to jump in Jonathan and ask this a doctor sent.
Absolutely This is a guy, I'm really can't wait to get the answer on this one. So from Jim Hoare, he says, I can understand that black people are more likely to become severely ill and die. But why are the infection rates higher?
Yeah, so the biggest concern that many of us are having is a higher risk and lower access to protection. So the higher risk again was because of the hypertension, diabetes and obesity, that just certainly leads to more severe infection. So the first half of that question, but the higher risk is also related to exposure. So who was most likely to have worked from home over the last few months like we are many of us are doing right now. Versus over the last In 120 days, it's continued to hop on the subway in New York City and head off to work who either they had a mask at the beginning when masks were recommended, or they didn't, who are the folks who are delivering our groceries for those of us again, who don't feel comfortable going into the supermarket. So this idea that social distancing is actually a privilege. working from home is actually privilege has really increased the risk of exposure to the virus. And the same thing goes with not just having to go to work or going to the grocery store, but living conditions, who are the people who are living in multi generational generation homes are living in high rise apartments that they have to hop on the elevator or the stairs that are crowded every day. These are all issues that started way before us the housing segregation residential segregation of our our country has really led to a lot of these risks that are putting minority communities at higher risk for this disease. Interesting and any insight into the impact of COVID on Asian and Indian communities in your data? Yeah, great question. So in our specific data, we didn't look at that cohort just because the numbers were so small. Those numbers are starting to pick up in New Mexico has really experienced higher rates of infection in American Indian population. Navajo nation has reported out data showing as high as three times the rates of similar to black Americans of covid 19 infection in that population. The Asian population has been complex, complicated just because of the limits of disaggregation of the data. So South Asians differ different from Japanese Americans, Chinese Americans, etc. And so that kind of conglomeration of that group has made it difficult to kind of tease out what the risk is in that group. But I think there probably is quite quite closely related to the white populations based on national data.
So let's switch gears just slightly right so in May You were again interviewed, this time on CNBC, I believe. And so what COVID-19 Health Disparities mean to six black medical professionals? There was a conversation that I got a chance to peek in on. Can we talk about that when you talk about what those issues are?
Yeah, so I've never had my work be as, as engaged with I think over the last I have over the last three months. And, you know, that was obviously exciting for me as a new researcher who's trying to show my my boss, my chiefs and chairs that my work is important. But it's also important for me as someone who spent a lot of time in training, wondering if this was the right field for me wondering if disparities and receiving comments from people saying well, disparities aren't that big a deal, they'll go away like, we just need to raise all boats and we'll all be fine. And so I think that this virus is really drawn A sharp focus how been equities in our system can result in, in an equities that influenced the whole nation. So it's not just black or Hispanic disease, it's a disease that's affecting everyone, whether we're having conversations about starting school, about starting, going back to work, etc. But unfortunately, we know that this disease does disproportionately affect those communities. And so what that means is for me as a black physician is that a patient's are looking to me for answers. They're trying to understand how dealing with this new scary virus it's impacting me in my community, my friends and family who are continuing to like I mentioned earlier, ride the subway and go to work who are disproportionately being affected not it's not just a numbers game anymore in our communities. It's literally the fact that nearly one in three black people know someone who has been infected with this disease and how bad completely and totally disrupts one's life, whether it's having to go to a funeral having to completely reshape, or reshift the way that you think about your work schedule, think about your plans for the fall around school, around work, etc. And so I think this moment has really been powerful, obviously, after May, the end of May rather brought the national attention to physicians of color around racism and how that is a public health issue. And I think that has also added to a lot of what this pandemic means to me as a physician of color.
So yeah, I mean, how do you feel about this kind of attention on on this right now, but you as a person, and you know, as a black man, as a researcher, how has this affected you?
Yeah, so personally, it's I, you know, I'm also a man of faith. So I grew up kind of seeing examples in the Bible of people who were set up for the right moment. There's a great example of Esther I was kind of placed in the right moment for the right time, so to speak. I don't think I'm estar. But I do feel like people are placed in a position for for the right moment. And so I'm grateful for my parents raising me up to be this person who was able to go to school and was able to get a degree and was able to study something that I was passionate about. And I am excited to see that this is an area of attention for not just health disparities conference, but a technology zoom series around our community. And really, the opportunity to engage the community in this way has been meaningful. I think like everyone, it's been exhausting. And so whether it's talking to family about how to manage the disease, or it's talking to patients, it's talking to public health leaders or a news reporter. I think it's all these conversations certainly add up. But again, I've been really grateful to have family support, have colleagues support to get through really challenging times, and just Stay healthy, I think which is something that actually cannot be grateful for.
Mm hmm. Well, you know, you are very clear about this conversation around access to health for the poorest of our fellow citizens, and how it actually affects all of us. Each and every one of us even though we have many of us have now as what's called work from home privilege, right? the healthiest the healthiest we all are, you say the more the digital divide gets eradicated and the more vibrant all of us will be, but talk about some practical plans. You can describe that to achieve this.
Yeah, so I think you mentioned the digital divide that is kind of the the post COVID arrow or bucket that I think about in this like in this health disparities, I guess continuum, so we have risk of infection, we have access to care and how that's a big part of disparities. Like you mentioned. We have missed care. So what then going on to the heart disease, the diet, the liver disease, the cancer diagnoses that might be missed because people aren't coming into the hospital. And the last bucket is this area of post COVID care or digital care. A lot of us are now texting with our doctors where we're actually zooming or teams in with our Doc's about our diseases. And the reality is that not everyone has that same level of access. Not everyone has a working internet stream that they can use. Not everyone has broadband. Not everyone has the language to interact with their doctor in the same meaningful way. And not everyone has the the kind of tech savviness to open up their app and flip it open to send their doctor a picture of whatever might be going on. And so I think the for us to actually think about those inequities early on and just pry way prior to this. I should have been thinking about this two years ago, not right now. But think about again, the money We're going to put into these systems, who has access to them. And if those people don't have access, what it means down the road, the long Intensive Care Unit stays, people have to stay in the hospital for two, three months and how that eats up the healthcare system. from a financial standpoint, obviously a social and personal standpoint. And again, those dollars spent or the dollars that we can spend on really innovating around our healthcare system, whether it's related to digital or technology, or other kind of innovations in healthcare.
We're going to get some questions, but you may you also made a point when I spoke with you earlier that not everyone even has a primary care physician. Yeah, yeah, that's exactly so till today, there's 27 million individuals who don't have health insurance. The large majority of them are black and Hispanic. And so the first few words that always come in my mouth when related to cover diseases. Ask your doctor about your symptoms. And we sadly know without insurance, you can ask your doctor about your Right, even though you do have insurance are less likely to have a doctor, those be minority vigils. And so it's really important to think about,
Jonathan, there are a few good questions out there.
Yeah, let's start from the bottom here. So does john hopkins provide info on cigarette smoking hypertension and type two diabetes, with the deaths from covid.
So that tracker really just shows rates of and rates of infection rates of testing and rates of death. It doesn't get into the nuance around diabetes, I guess smoking was the other one. Yeah. So there have been a few studies research studies that have looked at that one back in May in the New England Journal, and one back in April in the Journal of the American Medical Association that looked at the relationships between those factors and race ethnicity, and didn't really show that any of those clinical factors were the big driver of the racial disparity.
Interesting. So what changes would you like to see in the healthcare system to improve the health and access to health care for African Americans?
Yeah, so really important question. I think the three ways I think about it are increasing that access. So expanding insurance access, folks talk about universal health care folks talk about Medicaid expansion. folks talk about enrolling insurance from health plans or from employment, whatever format we want to take either all three or one of the other. I think we really need to ensure that everyone has insurance so you can access healthcare. Secondly, we have to continue to train providers like myself to provide antiracist care that is a phrase that is now kind of taken off in the healthcare sphere. And I'd love to hear more about what's going on in technology sphere around that. And so it's not just being colorblind, it's not just being just an equitable but literally being the opposite of racism. Because unfortunately, there's still bias in how we treat patients. Whether you're coming in with a pain diagnosis or with a Koba diagnosis, we really need to strive away from there. And lastly, I think more long term, it's really important to increase the diversity of our workforce. Again, something Audrey and I talked about high tech spheres that 5% of dots right now are African American, compared to 13% of our country. And those are legacies legacy of challenges from segregated schools to who can actually act pay to train for a $200,000 career job rather. And so that's, I think, a really long term issue that will help address some of these issues.
Well, there there's before we get to Scott Harshman, he has he has a long question I want to launch into this piece here because I want to have your brain on this. It's a big topic for Pittsburgh, we have been Pittsburgh has been rated as the worst place. In the United States for black women to live. So can you drill into that. And then Scott talks about this new york time series on feminine equities a week long look at the biases women face. So it's both women. There's biases about women, but there's also the current state, the current city rating that we received in Pittsburgh. So Can Can you talk about that we touched upon that when we met.
Yeah, so the big one of the big things I was thinking about locally here in Pittsburgh around these disparities, back in April was that report from September of last year that showed that you know, though Pittsburgh is one of the voted the most livable cities, it's such a challenging city for black individuals and particularly black woman and those challenges were related to maternal health to some of these chronic diseases that we talked about issues around income inequality and employment. I think Those issues span across what we're seeing in COVID-19. COVID is affecting who has a job right now it's affecting incomes affecting insurance, which, in turn, like I mentioned, affects access to high quality health care. And so that was really a fear of mine as the data was starting to come out was that those disparities that were mentioned in the report would pan out during COVID-19. And did we didn't really see that early on. And it's not clear if that was just a semblance of who was getting tested in Pittsburgh early on, or if we just were spared in some way from the disparities. But unfortunately, as the cases are starting to pick up in our in our city and in our county, we are starting to see a bit of a wider gap in terms of race, who is actually getting infected right now. And that really leaning towards black Americans in this city. So the report is really critical and something I think we need to really draw our attention to as a health system and as health researchers and how to address it.
So Jonathan, has a couple more questions.
Definitely. I think we should get to Scott's question. What do you think Audrey?
It's fine. It's a long one. So we got a bit of time, but this is good. Okay. So, from Scott Harshman, he says that the New York Times is running a series seven inequities a week long look at the biases women face. He says that, for example, biomedical researchers often conduct studies on men, which means the science of mental illness is more advanced in the science of female illness. When example doctors don't know as much about woman's heart attack symptoms as men's. Can you discuss your experience with this inequity in medical research? What can the general public do? have medical research become more reflective of the general public?
Yeah, I think that's important. I think we are getting better at the gender or sex differences in our health research more specifically. And so, you know, as we The first thing a researcher does when they look at a study is look at table one, so table one chose the baseline characteristics of the participants of the study. So what is the sex makeup, The racial makeup, the geographical makeup? And we really do look for some similarities or at least representation of the general population back in the, you know, early parts of the research world. That was not always the case. It was predominantly men, predominantly white men. I think we are moving closer to 5055 for male and female representation studies. But I think to that question, we still have a long way to go and particularly around racial representation, which I think is particularly important as we're thinking about vaccination and treatment of covid. You know, we are now beyond the risk conversation, we know what the big drivers of risk are, we now are starting to look to treatment and prevention of this disease. And so who's actually represented in those trials is really a national conversation that's being had and so appreciate that. remark about this piece I didn't know about it.
Yeah, people have been putting good links in the chats too. So we will try to get some of those links linked to your recording, so that everyone can pay attention to that. You know, um, one of the things that that you said, and it really has made me made me think about and I would like you to just talk a little bit about it, you were saying? You've said to me that access to care for the poorest are just as important for the healthiest and that as a society that if if we don't have the success here in terms of health, essentially, we won't be able to bridge our divide. And I'm paraphrasing it, but that was my takeaway from the conversation.
Yeah, I think that's right. I you know, we have spent the last three months trying to understand this, this new virus you know, it's you have no clue What surfaces we can touch that we potentially could get exposed to as an aerosolized or what can be used to treat it, what can be used to prevent it? And so we're thinking about all of these questions, in some cases in a vacuum, and forgetting sometimes about who has been most affected by this disease, which again, we're talking about are disproportionately white, black, Hispanic, and Native Americans in our in our communities. And so as we think about these, like really biomedical biochemical pathways to come up with a vaccine and a treatment, etc, we have to think about how we can actually a get those treatments and Prevention's to those communities, how we can engage with trust. I think, trust at the end of the day is one of the biggest drivers of both disparities and potentially the reduction of the disparities in our health system. I think I mentioned this to you, Andre, but just because the patient sees me as their dog and is like so proud to have a black doctor in the room doesn't mean that they haven't They tend to trust the health system doesn't mean that trust that their medications work doesn't mean they're going to trust a new vaccine or a new drug that is like Wait, what is that their approval? What are all these side effects? And so at the end of the day, it does have to do with a legacy of trust that folks might may or may not have within our health system. And so kind of to your main point of the question, thinking about addressing the inequities, whether it's with COVID, or with any other chronic disease is so critical to our health system, because those inequities are what drive the cost of our system. And as I mentioned earlier, once we help reduce cost or transition costs to places that matter whether it's innovation, its recruitment of a fiery, diverse and high quality workforce, or it's really working with our community partners to engage with the social factors that help drive some of these inequities. I think that's the way that we can help address these bigger problems transitioning our funds away from Caring for long term effects of diabetes and hypertension towards really more innovative care.
And so COVID has just really created the microscope to me in terms of the disparities, and I'm I'm assuming that for the rest of the world, the question is, as we wrap up is that in the tech community where we have many of us have worked from home privilege, right. It's lots of privilege. What What should we be working on you? You have an interest around workforce, you know, you've got opinions about a lot of things that are definitely based upon research and your expertise. What do you want to tell all of us here in Pittsburgh, and anyone else who's living even beyond Pittsburgh, but selfishly Pittsburgh?
Yeah. So we do have so much innovation, so much creativity here in Pittsburgh. It's great to see that our university is one of the leaders of the vaccine trials were recruiting right here. Obviously, so much biotech comes out of Carnegie And some of the other universities around, we have, we're unique in that we are bringing in a lot of younger, more tech savvy individuals into our world. And so I think that's an opportunity to start with us as health system, weather providers or research researchers rather to engage with best systems. So I would encourage all of you all to engage with us, in the silos that we work in, whether we're going through medical school, four years or three to five years of residency training, some people do a fellowship, we get so siloed into our sphere, which I suspect me happen in tech as well. And I think there are so many opportunities for us to kind of open up our our space to engage for us and to help fields engage with you all and vice versa. And thinking about inequity as the next big problem. It's not going away anytime soon. And so, as exciting as it is to work on some of these really cool meat industry. And projects right now how to address these disparities is actually probably the biggest problem that we can face. And so I'm hopeful that those of y'all in the tech world as well as my colleagues in the health field can really get excited about it so that we can solve it and get win the Nobel Prize and grants and all those MacArthur Genius awards that we are, we all are dying to win, obviously. And really try to make a difference, more importantly for the communities that we live in and care for.
So how do we stay connected to you? How do we in the tech community stay connected to you?
Yeah, so I am on social media. Twitter is kind of my game right now as well as my website, which has some contact information and I'll put that in the chat as well. I guess that's spelled correctly. And so again, I'm in a pinch so I can also drop my email on there so folks can reach me and obviously I'm not alone and This work I have so many colleagues, mentors and peers, both locally in Pittsburgh and around the country who I'm happy to introduce folks Listen, and we're like, Nah, he's not the one for me, I can certainly pass you on to a lot of other folks, especially those working in that intersection between gender and race, which I think is really important related to that Pittsburgh report,
really, as well. Listen, it is it's been thrilling to know that you're here. I'm so glad that Ryan on our team found you to join us. And I think it's just important for us to have these kinds of authentic conversations that are tied with outcomes. So thank you, today send Dr. Sen. You've been amazing. And you will continue to be amazing. And we will keep connected with you. And thank you for your candor, actually, and for the time that you spent with us today. It matters and you're making us all wiser and making a shift our own paradigm at least you are for me, so I can't thank you enough. So thank you everyone for joining and really appreciate you listening to the discussions that we're having. And if you think there are people that we should be talking to let us know just shoot any one of us note. And we're trying to make sure that the conversations are relevant, transformative and action oriented. So thank you all. And we'll see you tomorrow.
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