- [Narrator] Coming up, Aging Matters, disparities and health equity.

- 'Cause the heart ain't nothing to play with.

See my mother died from congestive heart failure so.

- [Narrator] After generations of inequities, America's healthcare system faces a reckoning in the midst of the Coronavirus pandemic.

- It's hitting Black and Brown people more than usual.

Those who have pre-existing conditions and if they didn't have them under control, why is that, right?

- I have no insurance, so you know, paying for labs and different specialists, I just don't have that to do.

- [Brian] How do we deal with people's real life constraints and we're not always playing catch up?

- But then you got to understand the system and that's very difficult.

- [Narrator] For older adults, systemic inequities over our lifetime compounded by ageism is deadly, life expectancy has steadily decreased since 2014, especially among Black and Hispanic adults.

- You have to show proof that you have something wrong with you in order for you to get the medicine and I maintain, that if I was white, I wouldn't have to go through that.

- [Announcer] Major funding for Aging Matters is provided by the West End Home Foundation, enriching the lives of older adults through grant-making, advocacy and community collaboration.

The Jeanette Travis foundation, dedicated to improving the health and wellbeing of the Middle Tennessee community.

The HCA healthcare foundation on behalf of Tri-Star Health, Cigna, together all the way.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee and by members of NPT, thank you.

(light piano music continues) - There's an old saying among African-Americans that goes like this, when white folks catch a cold, Black folks get pneumonia.

That adage is now backed up by clear evidence in the fight against COVID-19.

The pandemic poses hardships for everybody but Black people and other people of color are being devastated much more.

It's a pattern well-documented for years that people of color fare worse than their white counterparts in health conditions like cancer, diabetes, heart disease, hypertension and obesity, the question is why?

Hi, I'm Kathy Mattea.

In this edition of Aging Matters, we'll explore the reasons for racial health disparities.

How do disparities during a lifetime, impact health as we grow older, what are the barriers to healthcare that result in disparities?

What is being done to improve access, trust, and knowledge about quality healthcare?

Join me as we look deeper than skin color to learn about the causes of health disparities and their impact as we age.

- [Man] Congratulations.

- [Woman] Thank you.

(light piano music continues) - [Narrator] Rarely have so many Tennesseans been so happy to get a jab in the arm.

A vaccination shown to prevent the deadly COVID-19 virus.

People like 87 year old Bernardeen Fleming are making big plans to live normal again.

- Hello there.

- Hi.

- Don't you look pretty in all your red.

You look beautiful.

- I'm not a club hanger or anything but I got, I have to, I must get out of the house.

That's a must, I don't care how I get out but I must get out.

- [Narrator] Her daughter, Alison made all the arrangements for Bernardeen to be on the schedule when Nashville Health Department offered COVID vaccinations to people 75 and older.

- I was going to make sure that at some point she was getting this vaccine.

(Allyson laughs) Get it, woo.

It's been worrisome.

I, you know, I don't want anything to happen to her as it relates to COVID-19.

I would, you know, see the media talk about all the deaths.

- [Reporter] And we are talking about the surge in Coronavirus cases, the deaths among African-Americans in disproportionate numbers to their population.

- [Female Reporter] Black, Hispanic, and Native Americans are still being disproportionately infected, hospitalized and killed by the virus.

- [Narrator] More than 500,000 Americans had died from COVID-19 by March 2021, just 12 months after the virus was declared a pandemic by the World Health Organization.

The shocking death toll continues to grow and reveals disturbing demographics.

According to the Centers for Disease Control, almost 80%, that's eight out of 10 deaths from COVID-19 have been people 65 years and older.

Compared to white people, American Indian, Alaskan Native, Hispanic and Black people have greater risk of dying from COVID-19.

♪ This future obviously dark ♪ ♪ This future obviously hurts ♪ ♪ This future all feels dark ♪ The COVID-19 disparities by race, age and social factors are a clarion call to the U.S. healthcare system, a warning, some have been sounding for generations.

- This isn't new.

This is another health condition that will disproportionately impact those that are the most disenfranchised and racial and ethnic minorities.

I think it's convenient for her get there it's just that.

- [Narrator] Dr. Aimalohi Ahonkhai is an infectious diseases physician and public health researcher at Vanderbilt Medical Center.

She has spent years sounding the alarm about racial disparities in healthcare and she sees many medical and social parallels between her specialty, HIV/Aids and COVID-19.

Fear, uncertainty about transmission, unfolding disparities by race and ethnicity.

The result is often poor quality of life and health as someone grows older, if they grow old at all.

According to the National Center for Health Statistics, life expectancy had been increasing until 2014.

When it started decreasing in small bits and in 2020, the onset of COVID-19 things fell off a cliff.

Life expectancy in the U.S. dropped a whole year from 78.8 years to 77.8 and whose life is shortest?

Hispanic and Black people with declines of almost three years and two years respectively from 2019 to 2020.

Could racism either overt or implicit be a factor?

Yes, according to recent studies.

- [Dr. Ahonkhai] One study that looked at Black men, older Black men who experienced depression and reported more experiences with racism over time, had inflammation in the brain that can be a setup for strokes.

There's another study looking at something similar in chronic kidney disease for women.

So women who were minorities and reported more experiences with racism also had worsening progression of their kidney disease.

(beeping machines) - Can you hear it?

- Hold on.

- 'Cause the heart ain't nothing to play with.

You see my mother died from congestive heart failure so.

- [Narrator] No matter the disease, Dr. Ahonkhai squelches any notion that health disparities are caused by skin color or genetics.

- The more we understand about genetics, we recognize that the meanings that we've conflated with race are not about genetic differences.

There are about social differences.

They are about the differences that we've attributed to them and so we can't say that this is in their DNA.

We have a lot of other historical data that tells us what is driving some of those differences and that's when we talk about the social determinants of health.

- [Narrator] She gives six major social determinants that impact health, economic stability, food security, physical environment like zip code and housing, education including misinformation and the language barriers, community and social context like isolation and discrimination and the healthcare system or lack of access and inequities in care.

During a lifetime, these barriers can limit opportunities and for older adults, they greatly impact health and quality of life, including the ability to live independently and age in place.

- We need to create systems that help to ensure that the way care is delivered is consistent across the board but we also need to listen.

We need to listen to our patients.

- This is the second worst day, the doctor wanted to send me home.

Ah, you don't need it.

You're not even short of breath, I said, yes, I am.

I was in so much pain from my neck, my neck hurt so bad.

I was crushed, he made me feel like I was a drug addict and he knew I was a physician.

- [Narrator] Dr. Susan Moore, a 52 year old family physician posted this selfie on social media in December, 2020 from her hospital bed in Indiana.

The video went viral and became an indictment against racism and cultural bias in healthcare after more alleged, a substandard treatment due to her race.

- This is how Black people get killed, when you send them home and they don't know how to fight for themselves.

I had to talk to somebody, maybe the media, somebody to let people know how I'm being treated up in this place.

- [Narrator] She died a few days later from COVID-19.

The hospital where Dr. Moore was treated launched an external review that was finalized in May 2021.

It found the medical care she received did not contribute to her untimely death.

However, there was a lack of empathy and compassion shown in the delivery of her care and cultural competence was not practiced by all providers and several caregivers lacked empathy, compassion and awareness of implicit racial bias.

- If we get back to the issue of listening to the patient, she told him what was wrong, if she were not a physician, she told him but instead layered on that were all these assumptions about who she was and why she was asking for what she was asking for and it's heartbreaking.

I'm not saying that there is no individual responsibility in health, that would be foolhardy, but people are operating within a system that is available to them and so I think we have to be very mindful of the system that we've created and that it's not the same for everyone.

- [Narrator] American medicine has a deep rooted troubled racial history.

For example, the Tuskegee study that began in 1932 using Black sharecroppers without their knowledge.

The men were diagnosed with syphilis and were not given treatment to see how sick they would get.

In the case of Henrietta Lacks, an African-American woman whose cancer cells were collected in 1951 without her consent or payment.

Her cancer cells to this day are one of the most important sources of medical research data.

The medical abuses include unwilling and sometimes undisclosed experimentation, sterilization, grave robbing and malpractice linked to social Darwinism and eugenics.

That history is well-documented but it is present day incidents like Dr. Susan Moore's that are creating this distrust and hesitancy among patients of color.

- There was a study published in the American Journal of Public Health that looked at 15 studies looking at implicit bias in medicine and they said, yes, physicians tend to have a negative bias towards Blacks, a positive bias towards white.

It impacts treatment decisions and it impacts patient outcomes.

COVID was the perfect storm to bring these issues to a platform that allowed discussion on such a broad scale.

I think this is an area that we'll get more and more attention, really trying to understand what is the impact of these day to day living while minority stresses and burdens on individuals.

- There's a lot of people that needs surgeries.

There's a lot of people that needs dialysis and they don't have access to that.

People do wait till the problem is in the highest level and they come here thinking that we are a clinic and we can help on that moment and we can't, we just are the connection, you know?

- [Narrator] Monica Reyna is director of Hispanic Family Foundation in Nashville, a non-profit that assists the large and growing Hispanic population in Middle Tennessee.

Today, it's a COVID 19 vaccination event.

- One of the barriers that we see here in the Latino community, first of all, is that they are afraid to go downtown.

One of the first questions that we are seeing in the phone calls is, is ICE going to be there?

That is one barrier, the second one is of transportation.

- [Narrator] The barriers are even greater for those who do not speak English, like Wilfredo Guzman.

(Wilfredo speaks a foreign language) - [Translator] We always need someone to help us with the translation of English.

To have health coverage, you know, there are Hispanics that don't have socials.

So we do not have the access to health centers.

It would be very interesting and nice for all immigrants to have that ease for the wellbeing of people, as well as the communities of the country.

- One of the things that's really important, especially for racial and ethnic minorities that are older, is lack of familiarity with the healthcare system in general.

Intensely distrustful and for good reason.

So how do we respond to that in a way that's sensitive and how do we respond in a way that's actionable, is moving the ball forward.

So making sure that patients understand we're not going anywhere, you can count on us, or if you lose your insurance, it happens, you can still come here.

- [Narrator] Neighborhood Health is one of the largest safety net providers in Tennessee with 11 locations.

CEO Brian Haile says they have only one requirement for patients to receive medical care.

- [Brian] If you have a pulse, you can be our patient and that's it, all we require is a pulse.

I'm not interested in figuring out your legal status.

Our issue is, how's your hypertension?

What's your diabetes look like?

How are you managing your sugar?

What we're trying to do is help people get ahead of those social determinants and we're not always playing catch up.

- I feel like I have neglected some things and maybe they've gotten worse since between the time my insurance lapsed and now.

- Hello.

- Hi Ms.

Page.

- How are you?

- I'm doing good, I'm Latrina, I'm the nurse practitioner.

I'll be seeing you today.

- Nice to meet you.

- Nice to meet you.

- It's a blessing in itself to have somewhere to go to have somewhere where you feel comfortable and feel like you can talk to those without any consequences or circumstances.

- And then after that, we'll step out the room and we'll let you get undressed so we can proceed with the rest of your exam, okay?

This is a no judgment zone, it brings up the whole thing of trust.

We may think that's not a barrier, but for some people it is because they'll come to the doctor and they won't exactly say how they feel it or what's bothering them because they are afraid.

They're afraid of being judged, or they're afraid that they won't get the care that they need.

- [Narrator] Nurse practitioner Latrina Blakemore says bedside manner before treatment can make for better healthcare and a patient who is more willing to follow doctor's orders, so to speak, especially when language or culture impact the process.

- [Latrina] We see people from all different nationalities, cultures.

So I asked them, is there anything in particular that you are expecting?

Is there anything that I shouldn't be doing that may make you feel uncomfortable?

We have patients that sometimes have to have someone present, or they don't like direct eye contact.

Once I know I'm going to make an effort to show you that, hey, I respect you, I respect your culture and I respect our differences.

- [Narrator] The goal is to generate trust, confidence so that patients are willing and able to comply with the care they receive.

- [Latrina] The outcome could be they take they medicine, which in turns can lead to lower blood pressure which can lead to a better A1C for their diabetes.

And what happens when you take hydrocodone?

- It hurt my stomach and I was up for like 48 hours.

- The hope out of this culture right now that we experiencing with medical care or the lack of medical care is that we build this community of safety, of trust.

It starts in our education, in the colleges.

We need to start programs there.

That's teaching you from the door, what to look for, what to expect, how to treat everybody equally.

- [Narrator] When student doctors graduate, they swear an oath that is rooted in the ancient medicine of Hippocrates, but a new generation of doctors is treating the professional oath like a patient that needs healing in a time of social reckoning.

- I will seek to repair historical harms and confront current prejudices.

- We'll uplift our communities.

- Magnify their voices.

- And advocate or health equity and justice.

- [All] And we'll give back and perform no operations.

- Without justifiable purpose.

- I think my generation and the Gen X generation have kind of decided to blow up everything that we didn't like.

So I do think my generation will make an impact 'cause we've been making impact since we got put on the planet right?

- [Narrator] Morgan Williams is a first year student at Meharry Medical College.

She's not waiting for a diploma to help cure the causes of health disparities.

- I think healthcare is a human right, right?

I think everyone should have access to it no matter where they come from, no matter what where demographic is, their race, their gender, cis, trans, I don't care, I think you should have access to it.

If we can just make it easy for you to get the access that you need, then your life could be changed forever.

Hi guys, I'm Morgan, I'm your ED tonight.

So we have four patients.

We have one Spanish speaking patient, who's gonna be with our interpreter.

So remember when you have your interpreter, you talk to your patient, not the interpreter.

Tina, you will be with Terri, Khadim.

you will be with Mariel.

- [Narrator] Williams directs the student run Salt Wagon Clinic at Meharry.

She and about 30 other student doctors volunteer their time outside of classes to provide free medical care under the supervision of a licensed doctor.

- Put your hands together like you're praying and push and does that cause that same pain?

- Mm, I could feel the stiffness.

- Okay, it just feels stiff?

- Mmhm.

- [Narrator] Mary Francis Sawyers has been coming to this clinic for years to manage her blood pressure.

She doesn't have health insurance.

- The students are wonderful.

They accept me no matter what.

So it ain't necessary if I have everything free, free.

It's being able to see a doctor willingly.

It's all about the quality of people that you're around.

Good doctors.

- We also do see the patients that are a little apprehensive because we're med students and that's a hurdle to get over, but it's also, they recognize that they're getting the best care humanly possible because we check, we double check and we triple check because we don't want to be wrong.

- [Narrator] These students are also carrying on a legacy linked to their school's origin.

The story of Samuel Meharry, who along with his brothers founded the college in 1876 to educate Black doctors.

It was a promise Meharry made years before when his salt wagon overturned on a country road and a family of freed slaves came to his rescue.

- If we at Salt Wagon can be that one niche to say, hey, let's get this under control so that you don't get hit by COVID or you don't get hit by the next epidemic or pandemic, that's literally why we're here.

- Hello there.

- Hello, first dose or second one?

- First dose.

- Congratulations.

- Black people have kind of a myth about healthcare, how they feel about it, a lack of trust, yeah, a lack of trust but for those who are out there, who are younger than I am, it's a gift.

I want to say to you that this is a gift and you need to take advantage of it.

- [Narrator] Now fully vaccinated against COVID-19, Bernardeen Fleming feels her life is getting back to normal.

- Alrighty, hey girl.

Hey, I see that little tongue, girl.

Oh, I love to get out on a day like this, mmhm.

Sun is shining this morning.

- [Narrator] This 87 year old retired nurse has seen many advances in medicine.

She also knows it's history of racism.

- I'm probably one of the first Black registered nurses that was heard at St. Thomas hospital, but not to be seen.

I worked in operating rooms so you're not seeing an operating, totally masked.

So nobody knows who anybody is.

Those were the days of segregation.

Now we've come a my since those days, but then you got to understand the system and that's very difficult.

It plays into the care of the people.

We have not yet gotten out of discrimination.

We think that we have, but we have not.

- [Crowd] George Floyd, say his name, George Floyd, say his name, George Floyd, say his name, George Floyd, say his name, George Floyd, say his name, George Floyd, say his name, George Floyd.

- The peace our community deserves is gonna come because we transform our conditions through community organizing, y'all feel that?

All right, it's gonna transform years.

- [Narrator] The racial and social awakening in this country during a pandemic prompted by violence and policing against people of color is also forcing a reckoning within America's healthcare system, to address the impact of racial malpractice and socioeconomic injustice.

- With this dawning about this moment that we're in, is we're becoming aware of just how many assumptions that we've made, some about race, but often about other things as well.

If we're really committed to being anti-racist, what does that mean, and does it stop with race?

And the answer is we've got a lot of work to do but at least we're asking some more thoughtful questions.

- So social vulnerability index is a measure developed by the CDC.

I realized that there are some very credentialed, well-meaning individuals in healthcare who simply do not get it and so I really use this opportunity to try and be effective in teaching and educating people about what structural racism in medicine is, and so that we can all be on the same footing when we talk about this.

And then most of us have lived through this year, the trauma of what George Floyd's murder and I have to admit that to this day, I have not watched that video.

I have two little boys who are pictured here.

I have a Black husband, I have a Black father and I was not capable of watching yet another video of a Black man being violently killed in this country.

This is a part of our experience so really giving a window into what our lived experience is, I think for some people is helpful.

There's no reason for them to have thought about it otherwise.

- [Narrator] Dr. Ahonkhai is seizing this moment to speak truth about health inequities and her profession's role in leveling the field.

- I'm hoping that it has allowed us to accept that common language as a platform for us to continue to build interventions and change and when we talk about structural solutions to structural racism, it won't be a completely foreign notion with words that have no bearing but it will be something that we can really start to understand as a bigger community.

- Closing the health disparities gap is like peeling an onion.

There are many layers that contribute to the problem, from birth to old age.

With growing awareness comes growing demand for action to remove historic, structural and perceived barriers to the quality of health we all want as we grow older.

To learn more and to see all of Nashville public television's Aging Matters series, visit wnpt.org/Aging Matters, thanks for watching.

(gentle piano music begins) - [Announcer] Major funding for Aging Matters is provided by the West End Home Foundation, enriching the lives of older adults through grant-making, advocacy and community collaboration.

The Janette Travis Foundation, dedicated to improving the health and wellbeing of the Middle Tennessee community, the HCA Healthcare Foundation on behalf of Tristar Health, Cigna, together all the way.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee and by members of NPT, thank you.

(plucking guitars)