welcome to the reverend dr martin luther king community conversation with bronson healthcare i'm beth washington vice president of community health equity and inclusion dr king once said of all the forms of inequality injustice and health is the most shocking and inhumane 2020 brought us the shocking covid 19 pandemic and inside that pandemic our black brown and indigenous communities faced the injustices that dr king spoke of they were disproportionately impacted by this virus so today's conversations we're going to talk about those health disparities we'll talk about community health and we'll address and talk about the covid19 vaccine joining us to facilitate the conversation will be beatrice orns our organization development and learning analyst and we'll start the conversation with myself and our president and ceo bill manns thanks beth bronson has a large footprint in the lower part of southwest michigan with the four hospitals and three counties a number of practices the needs of the community are vast and many as a major health care system how does bronson know what the community needs it's just the short answer is we have to kindly ask people what they need and then we have to believe them when they tell us that and since 2010 the united states requires non-profit hospitals to conduct what's called a community health needs assessment where we summarize the health needs and the issues that are facing the communities that we serve one of the things we've learned about health since we've been doing these community health needs assessments is that as a country we know 80 percent of a person's health outcomes are actually influenced by the societal factors by economic factors so for instance your access to housing your access to good food your access to jobs living wages good education the the exposure you have to violence or racism or sexism or other types of trauma all of those things we know impact the ultimate outcomes of your health so in 2019 when we started conducting our this most recent needs assessment we knew we needed to talk about that we needed to understand how people thought about those determinants of health and so that would be huge right asking people what they need and then all these needs across three counties so what we didn't realize was really important was to determine who has the greatest needs is there data out there secondary data that we could identify where the greatest pockets of needs already were by zip code and then go there and ask people what they need to be healthy and they told us some pretty amazing things after interviewing about 800 or so folks in in those three communities both stakeholders and focus groups they told us things like this people need just inequitable laws and policies people need and recognize that systemic and institutional racism negatively impacts health mental health and trauma need more support especially in our black and brown communities people need living wages healthy foods safe neighborhoods people also identified quality of health care when they're talking about quality of health care and education they were talking about providers and educators who are culturally competent who listen to what people say and believe them about their needs so lots more data in those three reports but useful to know what do people want what do they need to be healthy and then we have to believe them and and take action on that so i believe the report the assessment that you're that you're identifying is called the community health needs assessment okay and we we abbreviate it called the chna okay so from the community health needs assessment sounds like you got a lot of data sounds like you got a lot of impactful quotes that were helpful for you to determine and to kind of identify some things that that the community wanted you to know so from that data from those quotes i'm sure there was also some strong emotion that you may have experienced as you dissected the report as you balance your role as vice president of community health equity and inclusion and as a person a woman of color in the kalamazoo community what responses from that community health needs assessment were difficult for you to see and why yeah beatrice um there's one i'm going to read and it was indicative of all three counties that came up in a in various formats in calhoun in kalamazoo and van buren and in it this is the quote access to health care means i'm not excluded from the care i need because of who i am and so i have a personal story with that i was 24 and engaged in first time pregnancy and really excited about that and for the first time i decided to break sort of for my family's traditions or rules and seek care at bronson because there were midwives i think that might be dating me a little bit because midwives were around the first time so so i'm in the waiting room i was there by myself that day because i no one in my family i felt guilty if i asked them to come with me to the simple appointment when they needed their their work hours right they needed to be at work and so i was there alone excited maybe a little nervous a woman comes to the desk and or a door and calls my name i walk back she takes me she says hello says my name walks me back to this little sort of cubby room that's kind of dark with a tv in it and a vcr so i know i dated myself there she put the tape in the vcr and the whole thing was about teenage pregnancy i was like wait what you you had my chart uh you you made some assumptions i think about me and so although i had great outcomes had both my children at bronson it's those little kinds of things that cause you pause and sort of weaken your trust um so lots of those kinds of things came through in our in our report so some that you definitely resonated with and then sounds like some that you definitely could empathize and have compassion for as well um so i had the opportunity to look at the four reports there was a results from each of our hospitals and the results that i saw were just as diverse as the communities that we serve so how does bronson take that information make it make sense drill down and help use it to focus the efforts on what's needed in in in the black communities or in the communities that were included in the assessment a very important question we can't do everything nor should bronson try to do everything right like our expertise is around health care and and health care is beyond just the doctor's office so where does it make sense for us to have intersection between our expertise and what the community told our needs and really looking how can we use our internal information so do we have internal capacity do we have the resources do we have um the strategic plan that matches up to it do we have um the people to to work on something does the need that we're looking at go across all three regions is it something that even though we're going to attune to the differences of each one of those counties and in areas does it still something we can systemize that's an important thing for us to consider we also have to think about our partnerships in the community where do we already have partnerships and so it's getting that alignment of all of those things covid helped us this year actually it helped us really focus in because because of the demand on our system in our resources and we also know that it showed us the disparities that we already said were in the saw in the chna that covid made them real time and so it was easy for us to take a look at the chna at the environment and say where can our greatest impact be where can we intervene early and know that that's going to have long outcomes and so we looked at trust and access to healthcare we know that we can do that work right we can we can actually get involved right away around how we interact and work with folks and and then with covid we know we could eliminate some disparities can we start doing that and so we have two priorities first is to eliminate perinatal eliminate racial and ethnic disparities in the perinatal experience and then to eliminate racial and ethnic disparities within our workforce to support families and so if we can build that trust and eliminate those disparities we know that we're going to be able to have a sustainable impact on our communities so that sounds like a internal project that is bleeding itself out into our communities bill how much of that have you had involvement with and is there a way that you're able to shape the direction of that as you are coming into our community oh absolutely so as a new ceo it was exciting to actually review the chna and more exciting to review the implementation plan i've seen a number of community health needs assessments in my career but the quality of this one demonstrated that bronson really listened to the communities that we serve the board has held management and the ceo accountable to actually making some improvements on that and so as i've come in and interfaced with beth the community the board to say we hear you and we're going to hold ourselves accountable to actually making a difference and so for me that's been really exciting we've started to see some positive results for example in our response to the covid pandemic the distinction between equality and equity is something that we spend a lot of time talking about here at bronson and i think to beth's point really meeting the community where they are and not taking a paternalistic approach to their health and saying well you really need this when they're telling us that we need they need something totally different so i think to be the president and ceo and be in a position to listen and to help shape our response is uh both humbling and exciting i think historically um health care systems have always had like a savior a savior mentality so you have the leaders the people the physicians um take on the responsibility of telling a community what they need how do we transition or start to transition from telling the black community what they need to a more allied approach to where we partner together to assess that need and then to focus on it so two things um one accepting and realizing that the african-american community in particular is very uh deserving of mistrusting the health system just kind of based on the history um so let's acknowledge and accept that and then two let's listen and so we spend a lot of time talking about the importance of listening people often say i know my body better than anyone else and so pushing against kind of that paternalistic hierarchical approach to health care and taking more of a listening we're in this together approach to healthcare and really listening to our patients and i think that'll make a huge difference in the healthcare outcomes in this community definitely a culture change definitely a culture definitely something that will have an awesome impact on the way people perceive bronson as an organization and also on the way that we care for the community um another great way to build trust right so it's about trust and building trust but with all that being said the pandemic as beth has spoken about and as as you also have noted um it has surfaced lots of disparities and when you think about trust and disparities the covid vaccine has to come up right so as it relates to that how do you shed light on something that has historically and justifiably been a mistrust in a community and then also encourage and start to build that trust specifically around that vaccine because that's what we're pressing and working toward now but including those efforts to filter into other areas absolutely so one we're going to have to listen to what is the reticence of some to take the vaccine acknowledge the past history and some of us are actually going to have to model the way and lead the way and get the vaccine ourselves this case of the vaccine is particularly interesting when you look at the number of scientists and physicians who are excited to get the vaccine themselves and so this is a circumstance in which i think as we see many of those individuals as we see leaders actually getting the vaccine i'm hopeful that the african-american community will follow us and say okay we can trust this vaccine i was talking to a pastor recently who said he was preaching to his congregation that you pray and pray and pray for something and then you get it and say well no that's not how i want it and so in this case we actually have a vaccine that's safe it's effective and i can't think of any reason not to get it so i'm grateful i was able to have my vaccine actually get my second vaccine in a couple weeks so again trying to model that behavior in the community trying to um be transparent and share information accurate and truthful information so one last question for you if you don't mind um if you had one wish when it comes to bronson meeting the well-being needs of the black community what would that be so if you will indulge me i'd say two okay um so the first is um bronson is the largest employer in the region and i had a professor in graduate school who used to say if you want to improve someone's health give him or her a job and so as the largest employer i think it's incumbent upon us to drive bias out of the hiring process when you think about dr king and his dream to judge people based not on the color of their skin but the content of their character i'd like to see us judge new hires based on their skill set and how well they'll fit within bronson and not the color of their skin and so there is an unconscious bias that exists in organizations and health systems in government you name it and to say what can we do to drive out that unconscious bias and hire the best people not based on their skin not based on their sexual orientation or gender identity but because they're the best person for that job so that's my my first dream for for bronson i think the second and we've talked a little bit about access is ensuring access for everybody um and so you think about the african-american community in particular many of us don't go to the doctor don't want to go to the doctor et cetera right and so let's raise the the level of education and awareness and then let's make it easy for people to get into their physician's office so if we can improve the access for our communities and if we can hire people based on their skills and not on their ethnicity color their skin sexual orientation or gender identity i think we'll be doing a great job sounds like a great start to some wonderful things beth do you mind me throwing you a ringer sure if you had a megaphone that could only reach the ears of the black community what would you share about the work that bronson is doing to respond to those health disparities that you were able to identify in that chna or the community health needs assessment yeah great question disparities are differences and to be able to see the differences sometimes takes a change in mindset and bill's already talked about this a little bit right i mean how many times have you heard people say oh i don't see color oh i don't see you as black or colored or you know as a latina or whatever it is right we hear that but if you don't see that difference you're not acknowledging my lived experience and how that may be impacting how i interact with systems and so that's uncomfortable for people they don't want to to see those differences we're often taught not to and so we have been doing work here at bronson to look at how we how intercultural we think we actually are and where we actually are so that gap and in that gap is that implicit bias that bill talked about so once people begin seeing they have that gap and begin learning about unconscious and implicit biases that they may have and learning to see differences as a positive versus a negative that's it's not quick work um but that's the kind of mindset culture shift that can lead to overall systemic change not only in our institution but in the systems that we interact and then therefore the communities in which we're engaged i love that you bring that up because i am had the experience of being a part of that work that that you and your department has been doing to reduce those differences to reduce and to educate on that implicit bias and and the things that surface for us that we may not know exists and so the internal growth that bronson is experiencing based on those things based on identifying those biases that you may have based on acknowledging um that we are different and we have differences and that's okay because we can use those to grow i think um i love that you bring that up because i think the community it's a great and great so uh a great source of information for the community to receive um and so it's been an honor to speak with you beth and and to speak with you bill to talk about some of these awesome things that are happening in our community and to be transparent and accountable for some of the work that is going on at bronze and that people in our community may not know about because the work is actually you know happening internal inside of the system that will have great effects for people outside of the system in the communities we serve so i appreciate your time and your insights for today in our next segment we will be focusing on the covid vaccine and we'll have the opportunity to talk with two of our forward-facing physicians who are responsible for sharing information on that thank you at bronson we understand that a level of mistrust exists in the black community related to the covid 19 vaccine to answer some of the common questions and fears heard in the black community i'd like to welcome dr richard van enk director of infection prevention and epidemiology and dr martinson arnan vice president and clinical officer for bronson medical group thank you both for joining us today dr van enk i'll start with you as one of the most trusted and familiar faces our community sees representing bronson when there's a discussion around the cova vaccine what would you tell the person who believes the vaccine was rushed into production and might not be safe yes vaccines take time to develop the technologies that we use to make vaccines take time but this vaccine actually wasn't rust as much as you might think um i can explain how the vaccine came to be and and that might might help us understand it the technology for the vaccine that we have is not new it's new in humans but it's been used in in in the laboratory for many years it was discovered many many years ago and so it's not an untested technology the application to this this disease is new but the technology is not new and it's been known to work for a long time the other issue is that it's it's only been a year since the virus was discovered and we already have a vaccine that seems fast that's true but that's because the different steps of the vaccine were done at the same time sometimes and overlapping rather than one by one and sequentially so they were able to compress the the time sequence of vaccine development and that allowed the vaccine to come to market sooner than than the typical vaccine so the question is whether it's safe or not and and i think that the the technology of this vaccine is very different than any other vaccine we've made then it's extremely safe one of the advantages of this technology is that it removes a lot of the contaminants and the problems associated with other vaccines and so you have a pure vaccine now instead of a vaccine that that has additional issues and side effects so this is probably the the safest and cleanest vaccine that we've ever made in the world wow thank you dr arnan as a physician who's researched the safety and efficacy of this vaccine and honoring the validated fears and concerns of the black community as it relates to vaccines is getting covid 19 really that bad and is the vaccine riskier beatrice thank you so much for this question i think this question touches on a very important issue and the issue of trust i think that uh events that have happened in america recently speaks to the fact that some of our institutions get shaken and we get shaken to our call and we ask ourselves can we trust what we are hearing on tv or from the so-called experts and so i come to your audience today not as an agent of the government or an agent of the state i come as a physician a practicing physician who cares very deeply about this community and my neighbors and as a son of a reverend or preacher and hence i hold my integrity very dear to my heart and so i can i can speak clearly and truthfully to the fact that i believe that this vaccine gives us an opportunity to be able to put this pandemic behind us touching on the issue of which is worse getting the disease or the vaccine i would say that although most people who might get infected by covid might survive it there are some who do not survive it and it is difficult for you to determine which group you might be in and being in the unlucky group that might not survive it has an impact not just on you but all your loved ones and perhaps some of the people that you might care for that you take care of who rely on you and so that's a high risk to take in addition to that we have found that there is uh an aspect of covid that a lot of people have been talking about you may have heard about it by the name of long covid that means people might have covid and they'll continue to have symptoms for a long time often symptoms that are affecting how their brain functions like their memory tiredness forgetfulness and all of these issues and so when i think about all the devastation that this disease has rot on people both in terms of the community and as individuals and i see that the science around how this vaccine was developed and its effectiveness which has been shown to be extremely high i can say confidently as someone who has received the vaccine that i think that we all do ourselves a huge favor by getting this vaccine so that we give ourselves an opportunity to avoid all the devastation that this disease can cause on you personally and also to your loved ones thank you dr arnan one more thing does the vaccine actually contain the coronavirus and if if you receive the vaccine will you get covid 19 that's a good question and i think that that's one of the exciting new technology about how this vaccine was made that is worth touching on it is called an mrna vaccine and i'm just going to explain how this is different for the longest time the way we have created vaccines is either we take the virus that is causing the problem we weaken it pretty much beat it black and blue and then we give it to you so it can't hurt you but at least your immune system recognizes this beating up weakened virus and develops an immunity to it or sometimes you might take a subunit a part of it and again introduce it to the body in this particular scenario they used very unique technology that was developed as far back as 1990 it's when they started publishing papers about this and basically got a genetic code of one narrow segment of the virus which is pretty much a pointy spike that is on the head of that virus and took that message it's almost like giving a person a book to read and so you give that message to your own cells and say read this line and your body reads it and says ah this is the picture of the spike on the head of that virus and that information is sufficient to make your own body create an immune response to fight the virus so that if the real virus should come your body is already ready because it saw a picture of what that virus could be and so there is no viral component that is used in the development of this vaccine wow thank you for the response i think that answers a lot of questions as it relates to contracting the virus from the vaccine dr van enk there are a lot of wait and see or you go first people in our community what are the dangers in that approach and what would you say to change that mindset yeah i i think it's understandable that people might think this is a brand new vaccine it's never been given to humans anymore uh yet and so maybe i don't want to be the first one i would like somebody else to take it first and then i'll find out what this vaccine does to see if it has any harm that's a reasonable approach but now we're beyond that the vaccine's been given in kalamazoo for four weeks now it's been given you know in in other parts of the country for a long time we have millions and millions of people who have taken this vaccine now and so now we know what the vaccine does and it's it's very safe and so we have that experience we have that observation we know what people how people respond and they do just fine and so i would say now is a good time to make your decision to get the vaccine because you have all the information you need to make your decision you know that it's safe and you know that it works so let's make a decision and let's decide to take this vaccine when it's available a follow-up question to that is after getting the vaccine how long will people need to continue to wear masks practice social distancing washing their hands continue to do those things and the all the ex the bonus question to that is i guess when will we get back to normal yes get back to normal that's right everybody wants to get back to normal that's that's absolutely true it's a a difficult question to answer because some of the some of the answer depends on us and some depends on the virus some of you might be aware that that there's a new strain of virus that arose in england and it's here in the united states now and it's spreading very fast so that gives the virus an advantage um the vaccine will work against that strain but that means that the virus will probably be here a little bit longer the more people get the vaccine and the sooner they get it the sooner the virus will go away so to some extent how long the pandemic lasts depends on us it's our decisions our personal choices that we make that will make the vaccine go away or allow it to hang around and so far we've done a lot of things that allow it to hang around we haven't socially distanced we've gone to parties we've gone to family gatherings some people won't wear masks so all those things allow the virus to hang around in our communities and we don't want that so the sooner we we do the things to make the virus go away the sooner the virus will not be able to to find another susceptible person and then it will leave so in a sense the way we operate as a community as an individual we're our own saviors when it comes to accepting the vaccination and doing the proper things around it exactly one last question and this is a toss-up for either of you or for both of you an opportunity to respond there is a clear push to encourage people in the black community to receive the covid 19 vaccine what effects of this virus have you seen in the black community that compels you to keep that intentional focus i think one of the most unfortunate things that we learned as this virus was visited upon us was the disproportionate mortality rate among african americans compared to other racial groups in the united states and this was something that was seen in michigan seen in new york seen all across the united states of america it is not because uh african americans have weak genes it's because there are systems in place that have put some people in this nation at a disadvantage and so a virus such as this just exposes the disparities in care that have always existed however because that reality exists that's why people such as myself dr van enk are so vigilant and persistent in making sure that all communities including african uh american communities have an opportunity to get this vaccine so that you might get a leg up against a disease that might uh disproportionately target you in terms of its impact on our communities and so that is the uh the driver if you will that makes us feel that we want communities that have been so devastated by this virus because of other structural issues that are in america to have an opportunity to get this vaccine so you can have a leg up over the vaccine yeah yeah this week is the first week in january we are planning vaccination programs for our communities right now the next week we'll be putting the plans together to deliver that vaccine to our people in our communities and i can tell you we are very very aware of the disparity between between different communities and we're very will be very vigilant and aggressive about making sure that communities of color have great opportunities to get the vaccine in terms of of access getting into those communities making sure that those people are are talked to so that they understand their concerns are addressed they understand what the issues are we make it very easy to them because frankly they've been excluded for many years and often are and so we need to address those issues and the county and the hospitals are working very hard to achieve those goals as we wrap this up do you have any final things that you want to add to the conversation that we've had today i can start i think basically um again i would touch back on the issue of trust that even though uh trust in our systems at some point might be shaken we have to also trust in what america represents it's really the land of freedom it's the land of opportunity and it's a land where uh amazing things have been accomplished as america led the way to the moon and also helped for us to really stand up this vaccine we continue to set the pace for the world and i think that it's incumbent upon us as citizens of america or people who live here to take advantage of these opportunities and one of these opportunities is we have access to a vaccine there are people in the world who are begging to have a chance to have a shot and so i think if you have an opportunity you should take advantage of it it is your for lack of a better word a god-given right as someone who lives in america and your taxes are paid for it so take advantage of it yes yes we hate covid we hate it so much it's it's been a terrible thing for us for our communities so many people we've lost because of covid we want it to go away so now we have a tool to make it go away so it's our responsibility to use that tool so that we can never have to deal with covid again and we can get our lives back to normal again it's been such an honor to speak with the both of you to have this conversation about the you know the covid vaccine and the effects and the importance of this specifically for the black community again i just thank you so much for your time and questions i know it's important for bronson to have these acknowledgments in these conversations to and to improve on the trust that we have and can build in our communities and that starts with leaders with scientists and with physicians like you so thank you very much for your time today and i really appreciate your conversation thank you be interesting you
2021-01-26