Welcome to Charting with Doctor McNeil.

Greetings everybody. We are here with another episode of Charting with Doctor McNeil. We have a great topic.

We're going talk about health disparities and health equity. You know disparities are differences in health outcomes between groups often caused by lack of access, social, economic, racism or other factors. Health equity is ensuring everyone has an equal chance to have the healthiest life as possible, and that's what we do here at Adventist HealthCare. We try to make sure that people have their best health.

It's a real issue in America that leads to worse health outcomes for different groups such as minority groups or rural populations or different age ranges, genders, class. It's really a hard problem to tackle, but we are very much so committed to doing so here.

Today, we have experts from Adventist HealthCare to address this topic. I am doctor Patsy McNeil, the system chief medical officer, second in command, and executive vice president of Adventist HealthCare. We also have the great doctor James Rost, chief medical officer of Adventist HealthCare's White Oak Medical Center.

Have doctor Keith Fisher, chief medical officer of Adventist HealthCare's Fort Washington Medical Center. And we have doctor Marilyn Lynk, associate vice president, learning, leadership, and organizational development, equity, diversity, and inclusion. We're gonna have a good conversation today, and we're gonna we're gonna launch into some things and talk through this issue, which is a very complex one. I will say this.

This issue was brought to light most, during the COVID pandemic, which was not that long ago. Well over a million Americans lost their lives to this illness, but realized that while the white population is sixty percent of the American population and sixty percent of the deaths of COVID happened in that racial group. The black population is thirteen percent of America, but twenty to twenty five percent of the deaths of COVID happened in that racial group. Hispanic population is eighteen to nineteen percent of the population, and fifteen to twenty percent of the deaths in COVID happened in that racial population.

So we have some work to do because there's no significant, or no genetic difference at all between these groups, and yet these outcomes were different.

Now let's start with some questions and have this conversation about health disparities and health equity.

So for each of you, I'm gonna start with you, doctor Fisher. What experiences have shaped your understanding of health equity?

Thank you, Doctor. McNeil or Patsy. For me, my basis is, my clinical practice was anesthesiology prior to my role as a CMO.

And I unfortunately cannot tell you how many operative cases we would do that essentially would represent us intervening in late stage disease processes due to inadequate access to care.

Chronic diseases that are associated with poor outcomes are always sad, right? We got into medicine to be healers.

But when you look at those things and see how they could have been averted were it not for lack of access, it's very disheartening.

So that's what really began to shape my view on equity in healthcare, and how that lack of equity, unfortunately, can result in poor outcomes.

Not because of unwillingness to intervene or have a stake in one's health, but really an inability to do so because of either inadvertent or unintentional barriers to accessing that care.

It's good that you point that out. I think it's important for our listeners to understand that your hospital that you are leading within Fort Washington is actually in Fort Washington, obviously the city, but it's also in an area that's predominantly African American as well. Correct. You spent the majority, if not all of you, were attending level career in this area at this hospital. Is that correct?

Oh, absolutely. Yeah, close to twenty five years out. Luckily this is a podcast, on video.

But yes, I've been at Fort Washington Medical Center for the better part of twenty five years now.

So you've seen that disparity Absolutely. Across the board.

Absolutely.

I'm gonna turn now to Doctor. Ross to answer that same question about what experience have you had that helped change and think and shape your understanding of health equity?

Yeah, thank you for the question, Patsy. My understanding of health equity first started in my home base, that is a busy neonatal intensive care unit, taking care of some of the most small and vulnerable patients, fragile patients. The NICU is a place where the stakes are very high and they're measured in grams, and they're measured in minutes.

In that NICU, I saw babies with the exact same diagnosis, who received the same treatments, the same technologies, but they experience very different outcomes, not just because of biology alone, but because of social and structural determinants of health that influence outcomes.

Determinants of health like access to prenatal care, like lack of social support, language barriers, trust in the system, and how well we had designed our care models to meet our families where they were.

I often say that inequity often shows up in small everyday moments.

It's that consent form that isn't fully understood by our NICU moms and dads. It's a discharge plan that assumed that the parents had access to transportation or time off work.

But then later as a CMO of White Oak Medical Center, I started to see quality and safety data confirm what I had witnessed firsthand.

And that is that variation in outcomes, they mirror our social and our structural barriers.

And it's those experiences both in the NICU and outside the four walls of the NICU that cemented my belief that health equity is not a separate initiative.

It's about building and maintaining reliable systems of care.

It's a great thorough kind of overview and answer, doctor Rost. I will say this just for our listeners once again. You know, doctor Rost is a phenomenal neonatologist, as doctor Fisher here is a phenomenal anesthesiologist. Doctor Rost also happens to be our medical director for Adventist HealthCare of patient safety as well.

So his point of view and leadership set is very much so in this space and looking through and seeing these these differences. Doctor Lynk, I'm actually gonna have you answer the same question. I know you're not a clinician. You're a PhD.

But I want you to answer that same question because you have a nice wrap wrap inclusive of data, inclusive of your personal experience. So what experiences have shaped your understanding of health equity?

Thank you, doctor McNeil. One of the experiences that I've had at Adventist HealthCare is serving as the executive director for our Center for Health Equity and Wellness. And that gave me the opportunity to interact with many of our community partners that work with constituents whose needs really reflected some of the barriers that Doctor. Roston, Doctor.

Fisher have mentioned. So barriers to access to care, for example, those language barriers very, very important for communicating, you know, health care information, but also recognizing that these constituents could have better health outcomes if their social needs were met, right? So if they had access to affordable housing and healthy food, if their experiences were also reflective of culturally competent care teams. Because they do tend to be groups that are marginalized or excluded because of social or political or economic factors.

Yeah, that's an interesting point of view. It's funny, I was doing some reading and even normalizing though for class. So if you have the same racial group in the same class, upper, middle, lower class, health outcomes in the African American population, for instance, are still worse in cancer mortality, in diabetes, in hypertension as well. And So I just wanna make sure that our listeners and everybody understands.

Some of these outcomes, people wonder what's going on. Like, what what's the problem exactly? It's not race. It's racism a lot that is impacting these folks' outcomes.

The class issue, the access issue, these are also important, but it is the structure of our society that is also impactful in this area. What what do you all just think through this question. What do you wish more people understood about health disparities? What's one of the things that comes to mind in your practice that you see at your hospitals, data across Adventist HealthCare that you wish people understood?

What I wish more people understood is that health disparities are not primarily about individual choices.

They are really the predictable result of how our healthcare systems and social conditions are designed.

Our disparities, if you think about it, really signal system failure, not patient failure. And improving them requires better, requires more reliable care processes for all, particularly the most vulnerable. Because if we fail our most vulnerable patients, we're failing everyone.

That's a great answer. How about you, Doctor. Fisher?

To lean in on what James just said. One of the things I wish people would realize, we tend to link inequity with ethnicity.

And the data shows beyond a doubt that that is a factor.

We ignore that at our own peril, so let's be clear.

But there's so many other factors that contribute to inequity.

For example, our hospital is a point of access, right? So we don't discriminate.

Anyone who can come in, can come in.

But just because there is access to care, that doesn't necessarily equate to the ability to access the care.

And I think that's what we miss when we look at inequity. It's not about just having access, it's about having the ability to access. So yes, I have an office and I'm open Monday through Friday, eight to four. I'll take anyone who comes in.

What about the person who works days and can't afford to take a day off to come? What about the person who, yes, I'm there, but would have to take three buses, a subway, and then walk a half mile to get to me? So yes, I am a point of access, but do people have the ability to access that? And that's to say nothing of the wonderful insurance system that we have, and how clear cut and easy it is to navigate.

Yes, we need to be on video to see everyone in the room smiling right now. So I wish people understood more that the determinants that influence the ability to access care are not only race, but they're social, they're economic, they're cultural, in terms of trust in institutions, educational. There's so many that we need to look at all of them. I wish people would realize that rather than only looking at marginalized groups.

That's really well said. I will say, you think through this, it's also health literacy. Twelve percent of Americans have proficient health literacy. So if, you know, doctor Ross used the great word vulnerable, if we can fix the health system and fix access and we can fix this for the most vulnerable, it fixes it for everyone.

Everyone across the pyramid spectrum has an easier way to access American health care. We can fix it for those who are the most vulnerable. Very hard to do, but worth doing because that means that the elderly patient, no matter the socioeconomic group, be able to access x care and understand care properly. It means that the mother of three who is a single mother who has to take two buses to get to the hospital will be able to get care.

It means that person who doesn't have the most dense food will be able to control, though, their diabetes or their weight. It's it's something that needs to be done across the board. It's not just about one group or or another. How about you, you know, thinking about your perspective, doctor Lee?

You know, tell us a little bit about how important it is to collaborate with local community groups and organizations to address health equity.

Yeah, I think it's very important. I think you all touched on why that's important. It's because one size does not fit all.

Right? It's recognizing that every individual who seeks health care and has a need to be seen, that they will have different needs, whether it's, you know, for clinical needs, whether it's because they're of a different age group, right, they may have multiple chronic diseases, they may have an insurance. So it's really understanding where that individual, you know, is and then how can we provide them with not only the medical care, but connect them with resources in our community. So for example, we have, lots of great community partnerships with clinics, with foundations to ensure that we can meet those needs after they have received care at one of our facilities.

You know, you mentioned the, the disparities that exist in diabetes care, other chronic diseases, maternal outcomes, birth outcomes. It's really understanding, you know, what are the drivers of those outcomes. It's not just because of a decision or a behavior from that individual, but it's all of these social economic other factors that really drive those outcomes. And so partnerships are very important with not only clinics, but local health departments, local hospitals.

So we actually do partner with a lot of the health care organizations in our communities to collect the right data to understand what are the disparities out there? What are the needs that our constituents are saying are really important for them? And then how can we address those needs, you know, with those community partnerships, with providing them with the resources that they need to to have much better health, and well-being? And that also means that we've got to be able to recognize that, you know, health disparities, and inequities actually can be avoidable, right?

They can be, avoidable and they're also unfair and unjust.

Absolutely. Think you have something to add there, Doctor.

I do.

So I am passionate about this because I think that collaboration with our local community organizations, our partners, it's essential. No one health system can address health equity alone.

And what's really important is that these organizations that are closest to our community often have the deepest trust and the clearest understanding of their needs, their local needs, which makes these partnerships extremely powerful.

And so we know that there are plenty of resources available. Can we use more? Yes. But awareness and access are what really are the challenges that we're facing today. So we've got to work together and promote these programs and bridge the gap.

I couldn't agree more.

Know, half the battle here is understanding everything about healthcare. Healthcare is extraordinarily complicated. Even for us, we have loved ones who might need to access healthcare. How many of you have made a call to me, I've made a call to you to help somebody out and others don't have that ability at all.

So providing the resource to be that bridge of folks of how to navigate and where to go to better their health, it is very important. You know, at Adventist HealthCare, we have a saying about the infinite worth of the individual. That's every individual. Tall, short, big, small, different races, different ages, different genders, different orientations.

It is very important that we take care of all of the people to an exceptional degree.

Okay. As CMOs and leaders at a health care organization, at this health care organization, you know, role do you play in supporting health equity for patients along with supporting it in the communities we serve? CMOs wear a lot of hats.

Constant, you know, and that bit about in other jobs as required part of the job description is very expansive. It's very expansive. But when you think about this particular role, as you stand in your meetings and you lead physicians and you lead clinical care and you're overseeing our quality and patient safety, what do you think of your role and what do you see? I'll go to you, Doctor. Fisher.

It's funny, we were having a chat about this.

One of the things I take pretty seriously is my role as a keeper, as it were, of the values that we hold dear.

And I don't wanna sound hammy when I say that, but you cannot prescribe your way into equity or equality. You can't make a set of rules and regulations. You can try, but if it isn't rooted in a set of values and principles that you just walk by and act by, you're gonna slip up because you're gonna miss rule 4A, subsection three.

So part of what I feel is my role as a CMO, is to constantly try to internalize this feeling that we treat the least of us, and that takes care of everything else. Also, to piggyback on what my colleagues said, I really see my role as outreach into the community, because of the fact that, and Doctor. Ross said this very eloquently, they have three things that we don't have as much. Number one, they have a cultural awareness, right? Because they're members of whatever institution it is, be it a church, a civic group, whatever. They all have that cultural insight as to how to best reach their constituents.

Second thing is they have trust, Pastor, immense amount of trust. The chairman of the local rotary group. So they have a sense of, they can bestow that trust upon us.

So if we go in there and we, by way of introduction, this is Doctor. Ross, he's from White Oak, he's here to talk about X, that bestows a certain amount of trust in it. And then finally, equity goes beyond the four walls of the hospital. That's what we've just said. By the time you come to me, it's too late many times, or the horse is out of the barn. So the short answer into what I see as my role is number one, a keeper of those values. And number two, to be the point of that spear going out and trying to gain partnership from these trusted institutions with deep cultural understanding, who can carry on our mission outside the walls of the hospital.

So being that bridge, making sure not only for resources we talked but this is a place that you can trust because I know your trusted partners.

I care about this. I'm gonna say it out loud. I'm gonna carry it in meetings. I'm gonna carry it as the flame keeper of this topic. It is important to me. It is important to Adventist HealthCare, right?

Absolutely, absolutely. And then actually to add on to that, to being the one, that bridge who brings our members across the bridge. So I'm not trying to create a bridge and saying, hey, you can walk over if you'd like.

I wanna create the bridge and then get members of our institution to go out into these areas. And there are examples of which we've done that. We've partnered with community health, community stakeholders, and brought some of our programs into their areas, so that, like a senior living facilities, we went there and did some heart screenings. We've done things at local churches around education for breast health. In fact, I'm doing something later on in the year on heart health. So not just creating those bridges, but being willing to lead the walk across them.

Yeah, it's very, very well stated. Doctor. Roth, I'm gonna turn to you now.

Yeah, thank you. So at Adventist HealthCare, I think we're extremely blessed that equity is embedded in our mission, our vision and our values.

But equity also has to live in operations.

And what I would say as CMO, my role starts with setting the tone and building the expectation that equitable care is the standard. It's not the exception.

And that we promote culturally competent care through training, ensuring that our teams have skills to recognize bias, report bias, communicate effectively and meet the patients where they are.

We serve as CMOs, as physicians, as all members of the interdisciplinary team, as advocates by partnering with our community organizations and to address the social and access barriers that directly impact them.

So I think of ourselves, the CMOs and also our physicians, nurses, every member of the team is champions for equity. Physicians, we want to do the right things for our patients.

Our job is to lead.

Our job is to invest in the right programs and to remove barriers.

So equity focused care can move our patients forward for our patients and the communities that we serve.

Yeah. It's so it's so very important, this topic and how we act in our own spaces as leaders as well. I'm going turn to you, Doctor Lynk, as well to answer that that same that same question, you know, and then bridge into another question that is very related. What role do you play in supporting health equity for patients along with supporting it in the communities we serve?

I think education actually, you raise that point, Doctor.

Rost and Doctor. McNeil, you focus a lot on ensuring that our physician leaders have the knowledge, the skills, the abilities to not only create that environment for our patients and their families, but to create an inclusive workplace for all of the care team members.

You know, Adventist HealthCare does have a strong foundation where EDI's commitment, our commitment to advancing equity, diversity and inclusion is part of our mission.

And we certainly have great examples of how we do that for our patients, like providing interpreter services, right? So we ensure that we understand the needs of our communities, the language needs of our communities, that we equip our healthcare providers with the skills that they need to provide effective communication to that community and ensure that when they leave our facilities that they are connected to those resources where they can continue to focus on their health and well-being. So I do believe that that education, that awareness around who is in our community, how diverse they are, what those disparities are that they face, is really important to equip our health care professionals to provide that, culturally competent care, you know, and we talk about culturally responsive care because it requires lifelong learning, right?

We don't make assumptions about interacting with and providing care to one population and then say, oh, that's going to be the same care for every one from that population, right? It's really about building those relationships, applying the knowledge and the skills that we have to mitigate bias, to recognize that, you know, when those biases come into play, we know how we can address that. And so I think that's a very important piece of, you know, a very important factor for us to provide that care to our population because they are. They're very, very diverse.

You mentioned a few things there about how we close the gap. And that was one question I was gonna ask. How what are we doing at Adventist HealthCare to help close this this gap? And the culture confident care, the education around bias that we all do for the workforce. You mentioned making sure that the bilingual interpretation is done and when we have health care workers that can do that interpretation, make sure they're stepping into that gap in an organized, not haphazard, not random way. You think of any other examples and that's open to the others as well, but how are we trying and what are we doing specifically to close that gap? Because it's a large one and some depending on how many factors are in play for that individual patient, whether it be language, whether it be socioeconomic group, whether it be food and insecurity, whether you know, you can really span with with certain individuals and how vulnerable they truly are.

Yeah. You're you're absolutely right. You mentioned before that this is a quality and patient safety issue. We not only collect this information as an organization and partner to look at not only our internal data, hospital data, but also the community data, local, state, national data. But we actually work within each of the entities to identify how are we going to address these disparities.

So for example, there was a birth equity initiative that focused on, the state of Maryland focused on.

And Shady Grove was a great example, of making sure that they had an initiative where they did the education for their providers. They ensured that they looked at their data and then they, had interventions, right, to ensure that they understood what were the differences, if any, among the patients who are receiving care and then how could they address those. Same thing with diabetes. That's a big, initiative for the state, but also for our hospitals so that we can make sure people have education, they have access to, education in our organization that is in different languages.

So we have that and of course, making sure that our providers who are bilingual are trained, tested and trained to provide that effective communication.

All very important.

For everybody here, I will say we all live in the communities in which we work more than less. We all live in the DMV in some some area. And particularly in this in Montgomery County, but in this area, but across this entire DMV area, it's one of the most diverse areas, if not the most diverse area in the United States, which people don't seem to understand. People think of California. They think of a lot of different places. You can find anybody from anywhere within a very short number of miles in this area.

So as you think through that, it's our patient population, but it's also our workforce as well. I I really enjoy meeting somebody and speaking to them if they're from Eritrea or they're from some obscure place that I have never heard of and their their experiences, you know, what they eat and so forth. But it makes it very complicated to manage those workforce as well as the patients, in regards to health equity and making sure everybody has a balance and their points of view are put in. So how does Adventist HealthCare address any disparities in equity in our own workforce?

And I'm directing this to you, Marilyn, mostly, but everybody can really weigh in as well. But it has to be done intentionally, not not on accident. And so I know that we really have an intentional approach. What do you have to say?

And then I'll go to doctor Ross.

Yeah. No. That's right. So at Adventist HealthCare, I was mentioning our commitment to equity, diversity, and inclusion. We're also trying to ensure that we create an environment that is the best place to work and grow for all of our employees, no matter their background.

And that does mean that we need to understand our workforce and our community.

In fact, each year we look at data to see what are the most ethnically diverse places, cities in the nation. And out of five hundred cities that are looked at for birthplace and language and ethnicity, four of the top ten are in this area, right? So we've got Silver Spring, we've got Rockville, Germantown and Gaithersburg that are part of our service area. So we need to first understand who we are serving, and then make sure that our workplace does have representation from that same community. So once we have new employees and leaders come to Adventist HealthCare, we share that commitment. We make sure that, they understand who they are serving and what it means to have an inclusive environment, so that everybody gets to have the full potential, to contribute to this organization. And that's truly how we achieve our mission.

And if we want to be the, most trusted choice for our community, then we have to make sure that we are equipped to provide patient centered care, culturally responsive care, and equitable care.

Absolutely. Doctor. Ross?

You know, Marilyn couldn't be more right. Intentionality is the operative word here. And it's about creating that inclusive, supportive environment where every member can thrive, grow and develop their career.

We focus on fair and transparent hiring, promotion and compensation. We provide a lot of training to build cultural competence and reduce bias. But I think we also another strength is that we also support our workforce in practical ways. And that is through programs that address basic needs that offer our team members mental health and wellness resources.

They provide pathways for professional growth and for leadership development.

By investing in our people and holding ourselves accountable with data and with measurable outcomes, We strengthen our workforce and ultimately the care we provide to our patients and our communities.

It's part of the secret sauce of success is what people don't tend to understand. Those points of view and making sure we're supporting everyone to grow to their best level is the way that we have the outcomes that we have and that we will continue to strive forward in every way.

You know, who better? I think diversity in our workforce is one of the strongest, and to me, most effective way to lean into inequity in healthcare. Who better to understand the impact of inequality than a diverse workforce? I don't have to ask you to conceptualize what must it be like.

As members of varying cultural, religious, etcetera, backgrounds, you can draw upon personal experience to know what it's like to feel marginalized, to know what it's like to be left out, to know what it's like to feel like you don't have the same access, whether it be in the workforce for promotion, or whether it be in income.

So I think the fact that you have a diverse workforce, they're much more in touch with the same kinds of things you're trying to promote in the patients we serve.

So I think it's an asset.

I definitely do too. And I want to remind everyone, not only us in the room, but also those who are listening to us, lot of inequity, race gets a lot of attention, deservedly so. Gender inequity, very important. Women will present differently with heart disease often than men.

It needs to be known. And we do know that as health professionals and we apply that to our practice whenever we have those those spaces that are encountered. We have at Adventist HealthCare a neonatal collaborative trying to make sure we dip into and make sure we give great care for everyone. And so the diversity of our workforce, the diversity of our approach, it all rolls up to be a strength.

Okay. Let's talk about the future. We have AI and technology that's coming in at us at a clip. Okay.

Now these are gonna impact the way we practice in the future, but it also has the potential to both positively and negatively impact health equity if we are not careful. What do guys think about that? It's I think it's an exciting time, but it's one that we must be very attentive to. So help me out here.

What are your thoughts? What keeps you up at night or keeps you excited?

It keeps me up at night and it keeps me up at night and excited.

Okay. So that's great.

There's a little bit of both. Just like anything else, without intentionality, things go awry. I think many of the challenges we have with systemic racism, again, it's not just ethnicity. It's about the fact that if you aren't intentional about ensuring it doesn't exist, you end up having unconscious or inadvertent areas in institutions where it does.

And technology will be no different. It will just be magnified. So technology will do well on equity if equity is placed into the design of that technology, right? Thinking it will somehow work its way out is fool's folly.

So I'm excited, but there has to be somebody with their hand on the lever, someone, some institutions, some healthcare systems that make it intentional about baking in equity into the design of the tools that we use? Or are we gonna be in trouble.

In trouble, I agree. Doctor Ross.

Yeah. So technology alone can't replace the issues that we've been discussing, and that is trust, language barriers, understanding and human connection.

But looking ahead, there are multiple factors that we know are going to shape health equity. We're going to have continued advances in telehealth. We know that that's going to expand access to our providers and their services, especially for our patients that we're talking about, those patients that have issues related to transportation, timing, they can't get to see their primary care provider or even geographic barriers. So I agree totally with Doctor Fisher that we have got to embed equity in the design or redesign of AI, of telehealth, of technologies, and making sure that we address the bias within those tools so that innovation continues to close, help us close equity gaps rather than unintentionally widening them.

Well said by you both. Have to say, talk to you Doctor. DeLinc next.

People don't seem to understand, you know, AI technology doesn't spring from a cabbage. There are human beings who are actually programming these tools. Human beings have their own bias that they may not be aware of going into these tools. There was a study.

Apple created a credit card, and all of a sudden, they were having a lot more denials by the AI, the tech that was within it from women than men because whoever designed it thought that the women would be less responsible with credit card, which is not necessarily true. So we have to be very careful. You know, you know, doctor Lynk, could you think through this fast paced, really coming at us like ninja stars? All of this technology is coming fast and furious.

What are you worried about? And what do you wanna make sure that we, in our governance and our processes, be aware of as we kind of step into this new world?

Yeah. So I'm in the HR space. So in human resources, you know, we're always trying to focus on, know, how are we making the employee experience a positive one? How are we ensuring that we have equitable practices when it comes to recruiting and hiring and promotion and development of our employees. So recognizing that, you know, we are in a human centered profession, right, in healthcare, that we're always going to have to have that human interaction and discernment when we're making decisions. So we have to kind of think about the responsible use of AI, no matter for what purpose, whether it's for clinical, for note taking, or for recruitment, right, or hiring decisions, we really have to make sure there's a human element there.

And I think we also have to recognize that that's what our customers, our clients, our patients, their families, that's what they're looking for, they still want that human touch.

So trying to find that balance of human plus AI is going to be very important for us in the future.

So some great things there. You know, the human element, we're not making car parts. You know, we're we're definitely pacing through people, people's newborn infants, their elderly parents as they are passing away or as they are having a heart attack. These are human problems that have a lot of emotions in them. The machine's not gonna fix all that or make it better. You have to really have the human element there.

As we're we're gonna come to a close here, I wanna give you all a chance if you have one last thing you want to say to our our listening audience, they be physicians or clinicians or whether they be the the public at large, to think through as they are in spaces or have the opportunity, whether it's to vote with their decision makings or literally vote, how would you what do you like them to know about the importance of health equity and how it impacts themselves, their communities, their families going across the board? And I can start anywhere. I'm gonna I'm gonna start with you, doctor Lynk. Okay. Let you go.

I would say that it's going to involve all of us.

Right? It's not just the individual behavior, clinician to patient. It's not, just the, you know, the systems that are in place, but it really is how historically people have been marginalized and excluded. And if we can work together to not only look at the data, look at the information, hear what people are saying to identify where those biggest gaps are, that we've got to focus on what are the outcomes that we're trying to achieve, and how are we going to achieve those results by making changes in the right places, those social factors, those environmental factors, neighborhood, any of those areas where we can address the social needs of populations that do tend to be forgotten.

Yeah, great. Well, very well said. Doctor Ross.

I think it comes down to ensuring that we have reliable systems of care. To me, equity, quality and safety are inseparable. And we have to, as I said before, make sure that our systems don't fail our most vulnerable of patients or each other.

We have to make sure because when they do, they fail everyone. We have to make sure that we are voting with our feet, voting with our minds and our hearts. And those most vulnerable are really going to determine how we treat them as how we are going to end up treating ourselves.

That's beautiful, actually. Actually, your turn here, doctor.

What I like to say is to the listener who has stuck with us through this whole podcast, when we're talking about inequity, the marginalized, the least of us, etcetera, as you're listening, I want you to understand this.

We're not talking about them.

We're talking about you.

It's you.

If you're a member of a group, it's you.

If you're not a member of a group, it's you.

Because as Doctor Ross said earlier, if we take care of taking care of the very least of us, you're good.

Because if you see it as a them problem, then you're gonna be good if we take care of them, we've taken care of you.

And if you know you're the you, then if we take care of them, we're taking care of you.

So I would like everybody on this call to really lean in with whatever you can, whether you think you're part of those affected or not. Trust me when I tell you, you're part of those affected.

So the best thing you can do is help us help you.

Oh, that's a Keith Fisher right there.

Keith Fisher right there and I'm gonna take it and say, basically everybody has stated the best. It is you. It is your elder. It's your grandmother. It's the preschool teacher who takes care of your your child. It's your neighbor.

It is your sister. It is your brother. So if it's an elderly person, it's a person who's not of the same race of you. It's the person who may not be in the same sexual orientation of you.

It's someone who's much younger than you, different perspective, who's older than you. Someone who doesn't have the same health as you, more complicated or less complicated than you. Someone who has a different BMI, someone who's larger than you, who's trying to interact with the health system and transportation. It's all of us.

The better we are, the better we are as a group in general. We at Adventist HealthCare are striving very hard to make sure that we recognize the infinite worth of the individual of every individual and take care of everyone to the best of our ability because that does mean taking care of everyone well.

So this has been, Charting with Doctor McNeil. This is the end of our podcast. I hope you've stuck with us till the end and that you understand what our role is and what your role can be in taking care of your community, yourself, and moving from there.

I wanna thank everybody for for coming and joining us here. Doctor Ross, doctor Fisher, doctor Lynk, to have this conversation. It's really an important one for us to have, and I thank you for joining me in this episode to make sure that we educated the public. Thank you very much.

Charting with Doctor McNeil.