In mid-August, the Nashville Health Care Council and NashvilleHealth hosted the first of a three-part event series, "Conversations on Health Equity and Action to Eliminate Disparities," to explore racial inequities in healthcare and drive discussion about solutions.

In opening the virtual event, Council President Hayley Hovious said, "The events of the last few months have highlighted longstanding inequities and injustices across many of our country's basic institutions. The Nashville Health Care Council recognizes that healthcare is plagued by systemic racism as much, if not more, than other systems ... and yet, healthcare is meant to do no harm."

Hovious added the Council is committed to working toward a better tomorrow by taking steps to understand the issues we face as a community and industry.

Cara V. James

This first conversation was moderated by Bill Frist, MD, founder and chairman, NashvilleHealth. Panelists included Cara V. James, PhD, president and CEO, Grantmakers In Health; and Andrea D. Willis, MD, senior vice president and chief medical officer, BlueCross BlueShield of Tennessee.

Andrea D. Willis, MD

Frist offered opening perspective on the role of healthcare at this challenging time, noting the COVID-19 pandemic and calling racial injustice in health disparity an even more "malignant disease." He referenced statistics from the recent Nashville Health and Wellbeing survey as examples of poor health outcomes in communities of color.

Frist then asked the guest panelists to define the term health disparities and what they see from their purview. James shared health disparities are preventable "differences" that limit a group's ability to achieve optimal health. She noted addressing disparities is important because it is estimated their presence resulted in more than $220 billion dollars in economic losses to the United States over a four-year period.

Willis added disparities are often based on groupings around disadvantages. She said the data in her work not only highlights different health conditions by ethnicity but also the relationship different jobs have on health conditions and actions - such as the impact on mental health, available time to seek care, the effect of job stressors and more.

"Even with all the data we've accumulated, one of the most important things we've realized is that we can't just solve based off the data. We really need to listen to the voices of the people we are generating the data from," Willis emphasized. "It's not enough to just ask the questions, it's important to understand the why behind those answers."

The group discussed income, age, education and sexual identity as part of the broad range of demographics that have a bearing on health outcomes, while noting the impact that food, transportation, housing, neighborhood, social support, and the environment also have on health.

"The majority of health outcomes we see are not related to the healthcare an individual receives. They're related to the social factors, and it's important to note that none of us occupy just one box," said James.

Frist then asked the speakers to weigh in on the state of health outcomes in rural areas where there has been a trend of hospitals closing. With 15-20 percent of Americans residing in rural communities, Willis said there isn't a 'one size fits all' answer.

James added 94 percent of African Americans who live in rural communities live in the South, so rural hospital closures across America have disproportionately affected communities of color. She noted, however, when it comes to health conditions in rural areas, it's not always communities of color who are doing the worst. "When we look at suicide in rural communities, the rates are higher among non-Hispanic Whites compared to communities of color."

The conversation then switched to the need for timely data to develop real solutions. Frist noted the Nashville Community Health and Well-being Survey was conducted to fill a gap in available local health data. Both speakers agreed that improvements on timely data collection and data sharing are needed to address health disparities.

James highlighted COVID-19 testing as an example where a lack of data gathering - especially around race and ethnicity for smaller populations such as American Indians, Alaskan Natives, and Pacific Islanders - is hindering the ability to develop effective solutions when decisions are being made. She also noted the importance of educating people about the use of data to build trust that their input will result in programs that meet everyone's needs.

Frist stressed the need for a public-private sector collaboration in gathering data. "The Nashville Health Care Council, NashvilleHealth, Metro Department of Health, companies, and corporations in the private sector also need to contribute to getting this data to be able to tease out the important action items. It's not just the government's job," he stated.

The group then discussed the impact of societal racism on public health. Willis led off with the example of pregnancy complications black women face in America. She then shared steps BlueCross BlueShield of Tennessee has begun taking to break down barriers in conversations about race, "It starts with leadership," she said.

Frist asked about the role companies and philanthropic foundations can play in making meaningful change. James gave insight into the efforts of her organization - Grantmakers In Health, a national support organization that works with more than 240 foundations at the local, state, and national level - to improve the health through better philanthropy.

James said, "Philanthropy can step in where government cannot. It can provide seed money to incubate ideas which then can be implemented into broad programs. But philanthropy struggles in terms of being everywhere. There are gaps in areas where philanthropy is not, particularly in local funding."

Concluding the conversation, panelists discussed how C-suite leaders can build a culture of diversity within their workforces and offered closing thoughts on solutions to health equity. James underscored the importance of leadership in cultural diversity coming from the top. "Diversity is about who is invited to public meetings, private meetings and what companies track on their dashboards," she said.

"Never in my career have I see so much focus on addressing racial inequities. We are on the precipice of meaningful progress. We are in a situation where many of us don't know what's going to happen tomorrow, we don't know the right answers, but we need to try something. A journey of a thousand miles begins with the first step. Take that first step," James implored.

Willis echoed the sentiment, "Start somewhere. Don't let perfect be the enemy of good. Start with asking yourself, 'How would I like to be treated?'"

Caroline Young, executive director of NashvilleHealth, addressed the audience as well, "NashvilleHealth was founded, with the help of many of you, to tackle our city's most challenging health issues in a collaborative fashion. From our very beginning we have worked to understand and address health disparities in our city. We hope that today's conversation will inform and guide our efforts to improve health and wellbeing in our organizations, our businesses, our city, our state and across this country."