Kim
Hello everyone. I’m Kim Thiboldeaux, and it’s my pleasure to welcome you to NEBGH Voices. Our guest today is Dr Gary Puckrein, President and CEO of the National Minority Quality Forum, not for profit organization dedicated to ensuring that high-risk racial and ethnic populations receive optimal health care. NMQF uses data research and strategic partnerships to reduce health disparities and create lasting change in health outcomes across communities. We’re honored to welcome Gary to the podcast today. Thanks, Gary.
Gary
Oh, thank you. Kim, glad to be here.
Kim
Okay, Gary, let’s jump in. We have a lot to cover today. Gary, you’ve been in this work for over 25 years. Really long before it was part of the mainstream conversation. So what inspired you to found and launch NMQF, and what’s kept you in it all these years?
Gary
You know, it’s an interesting story. So you could tell I got a little gray hair going on. And so I started when I was young, actually. There used to be four television stations. One of them was Walter Cronkite, came on every evening at seven o’clock and seven, 7:30 and at the end of his broadcast, he would give the stock report. And I would say to myself, “Well, you know, money’s fungible. What I’m really interested in is, how many people died today? What did they die of?” And I remain interested in that question.
Kim
Yeah, Wow, fantastic. I know, Gary, you’ve seen the national conversation around underserved communities shift in some powerful ways and some positive ways, but also really staying sort of frustratingly stuck in other ways. So what changes have felt real and have felt positive to you? And where do we still have work to do?
Gary
You know, I think you know, National Minority quality and myself, we’re looking towards 2050. We think that really what we need to put our minds to is, what does the health care system look like in 2050 and how do we begin building to that objective? We look at the legacy health care system as something that has passed its prime. Did some good things, did some things that we probably would have loved to have seen it do differently, but we don’t want to have that argument. What we really want to do now is focusing to the into 2050. Given the medical revolution that’s in front of us, given a given AI and all the tools that are coming into focus. So how do we apply all of those things into the into mid to mid century?
Kim
And Gary, you know, I’ve heard you say over the years that the current health care system was really not built to serve communities of color. Really not built to serve under, underserved communities that it sort of leans into, into averages. Can you talk a little bit about that idea?
Gary
I think you know, the current health care system was built really mid-20th century, right? Really starts during World War Two. For a host of reasons, and in that era, you know, tiered health care system inequalities were, by and large acceptable. I mean, you know, it was not thought unusual that you would provision health care so that some folks got rationed and didn’t get access to quality health care. And it wasn’t just minority populations. It was rural communities. It was a lot of folks who in that landscape didn’t get the kind of health care. Certainly, what’s changed is obviously the scientific revolution, because mid 20th century, even into the 1990s the science was still pretty, pretty small in terms of what it was capable of doing. Now what we’re talking about is denying access to life-saving therapies, to therapies that can address disabilities and keep people out of the emergency room, and so the quotient has gotten larger, and I think the need bigger. And so we’re in a different world now than we were in the 20th century. And I think also that those underserved populations are now pushing for quality health care. All of that driving the change.
Kim
Gary, you alluded this, you lluded to this a little bit, but I know that the National Minority Quality Forum has always used data as a tool for change. And you referenced big data. You referenced AI talked a little bit about, you know, what can the healthcare system look like in, you know, in 25 years? So when you think about data and some of the other aspects we’ve discussed today. What does it take to move from, from insight to impact, and how can, how can policy play a bigger role, and how can data play a bigger role in that transformation?
Gary
So data is everything, because what you can’t measure, you can’t fix, right? And so you absolutely have to have data. I think part of the challenge for us again thinking about the 20th century and the difference with the 21st century. So, so what has happened more recently in healthcare is that the focus is on financial risk mitigation. You know, sort of the money economy, private equity folks are coming into health care, and they’re focused on shareholder value, right? And so, but that’s not health care. That’s not what health care is designed to do. Health care is designed to keep you as a hospital, keep you as an emergency room, keep you from disability, keep you from dying, give you a high quality life. And that has to be the priority. And so when you introduce financial risk mitigation and that sort of value proposition into the conversation, you’re not doing healthcare anymore, and it shows up. It shows up in what happens to population. And so part of the challenge, I think, as we move towards the new healthcare system, is that the value of what we value in that system, and how we measure that value has to be very, very different from the way in which things are talked about now.
Kim
Gary, we we have a big conference coming up at NEBGH, and there’s a big focus on prevention and wellness, and a lot of conversation about, you know, not just lifespan, but about well, span. Do you see in this sort of 25-year horizon that you’re describing an increased focus on prevention, screening, early detection, some of these wellness elements that we’re not just extending life, but we’re extending quality of life.
Gary
Oh, absolutely. You know, we are getting incredibly smart, even though I have to say quickly that the human body is probably the most complex thing in the universe. I don’t know anything more complex than the human body, but nonetheless, we’re getting smart about it. We’re, we’re doing things that generations could, could never do. If you look at what’s happening with cancer, there’s a, there’s a marvelous revolution going on in cancer. And one could say that we’re starting to write the last chapter, and that war on cancer. If you look at cardiovascular disease, starting to come down. You look at those GLP1s and what they’re doing with, with diabetes, sickle cell, you know, actually we can probe it out of existence. So when you look at all of that capabilities, you have to say to yourself, well, that’s the work at hand. That’s what we have to do. And in that you just don’t want to do secondary prevention, in the sense of treating illnesses before they happen, but you want to anticipate them. You want to be able to use that data to look at. So if I go back to cancer, for example, what we’re seeing in cancer is that changes in blood chemistry is signals the onset of cancer maybe a year or two before it actually shows up at stage one. I mean, that’s the world that we’re in. We’re in the pre-cancer world. We’re not doing with stage one anymore. We’re looking at pre-cancer. That’s the medical revolution that we’re talking about. That’s what we have to do. What we don’t want to do, is pass all of this on to the next generation, to our children, to resolve when we can do this on our own.
Kim
And as part of the sort of the theory going forward around the question about how do we level the playing field so that some of these technologies and treatments and advances are available to all? Because I know some of them are quite costly, and we’re still dealing with some of those sort of access and affordability barriers.
Gary
I’m not one who actually subscribes to the affordability barrier. Here’s the deal. Um, America spends four and a half trillion dollars a year on health care. Four and a half trillion dollars. The GDP of France is $3.3 trillion. The GDP of Germany is 3.2 billion. So you’re telling me that all of that work the German population is doing and the French population is doing, can’t buy health care for the American population. I don’t believe it. I want to know what I got to see the book. I’m sorry. I don’t believe any of that mess. And that’s the point. The point is that we have folks in the system who are looking at financial risk mitigation and not looking at patient risk mitigation, and that’s the transformation that we have now.
Kim
Gary 25 years in the biz, you’ve probably heard some of the same sort of assumptions and misunderstandings come up over the years, time and time again. Can you call out maybe one myth or a blind spot that continues to get in the way of us having better health outcomes for communities of color?
Gary
I believe it’s public will. It is what we decide we want to do. And I would add to that, the fact that we’ve forgotten how to do big things together. That we’ve sort of isolated ourselves into various boxes and throwing rocks and stoves at each other. But in civil society, the essence of it, the value of it is really how we cooperate to do big things together that add value to everyone’s lives. And so if I had to point to a place where to begin, it would really be a public will, the idea that we can actually bring it into cancer, we can address diabetes, we can look at these rare diseases and find cures for them, and invest in them. I think that’s the work at hand, and we have the capabilities to do it any day we decide to wake up and do it. We can do it.
Kim
In that vein. Gary, are there, do you believe that there are lessons that we can learn from COVID, from, from coming together? Because I do feel like that was sort of a health crisis where we did all come together. Now, everyone, everyone’s sort of back to their corners, but I’m just wondering if there are lessons we can learn and things we can extend from that experience that can be helpful going forward.
Gary
Oh, can you hit the nail right on the head of it? Right? We decided, in the face of that epidemic, to figure out how to address it and how to distribute the medicines that got that disease under control, and we did it quickly. So what if we wake up tomorrow and say, you know, we should get rid of diabetes. We can, just like flat out, get rid of it. You know, we could do that, right? You know, we could do that. That’s not a maybe, that’s a fact. We could do that. And that’s the point. I think that’s what COVID showed. But part of what was happening in COVID, that’s really important to bear in mind, is, is there were conversations about the value of doing this that, you know. Should we put our resources there? Should we allow the epidemic to play out at natural cost? And and, you know, it’s a democracy. Everybody gets to weigh in on what they think it’s so this is why we have to be evangelical and persuasive. We have to say, not only can we do it, but we should do it. And here’s the value. And obviously they’ll be zoned you take a different path to it. But the point is the collective we need to step in and say, yeah, we can do this, or we should do it.
Kim
Yeah, I love that. I love that. Gary. When you look at some of the biggest health challenges facing communities of color today, what does stand out to you, and what sort of deeper you know patterns or barriers do those, you know, challenges reflect?
Gary
So this is where I step outside of medicine a little bit and talk about our social contract. Our social contract, you know, is often summarized as “Life, liberty and the pursuit of happiness.” But Jefferson actually wrote preservation of life in the early, in the early draft of that. And the reason why I’m saying that’s important is because our social contract was about us taking care of each other, and what we see in what we call underserved and marginalized communities is the fact that we have decided not to take care of them. We got a whole lot of good reasons for it, and I often summarized it by saying, I know what health care I want, but I don’t want to give that health care to my neighbor. I just don’t want to pay for my neighbors’ health care, but please pay all the health care you want to me. Got it. And really, again, this comes back to civil society. We should not give ourselves permission to allow anybody to come into a health establishment and not get the health care that they actually need, that will actually prolong their lives, give a high quality life. That’s our social contract. That’s what we agreed to. That’s what we should be obtaining to.
Kim
Yeah, I think it’s interesting what you’re describing, because you and I both worked in healthcare for, for many years, and it’s always interesting to me that we don’t consider it to be a basic human right in that social contract. I mean, for example, you know, we pay for children for a public education, right, a K to, K to 12 public education. I mean, I’ve never had kids in the public school system, but I’m very willing to, you know, make sure the kids have access to that. And I’m not sure how we as a country did not factor health care into that social contract or into that equation, when really every other developed country in the world does.
Gary
Yeah, well, you know, again, it’s democracy. And if you go back and look at the sort of the development of the legacy health care system, there were a lot of voices, hospitals, doctors, employers. There were a lot of people at the table, and you know, they were making decisions about the design of the system, and sometimes it wasn’t even a coherent discussion about design. It was the push and pull of politics and policy. And so we ended up with this thing that we call our health care system, and that’s why we need to reimagine it. We actually need to go back to the drawing board and think about, “So what is it we really want to do?” And obviously, folks like myself that you would argue we need to take care of everybody. But there are folks out there who will say, “No, we don’t want to take care of everybody.” And the question is, are they operating inside our social contract? Do they understand what that contract means? And so, you know, one of the things I love about democracy is you got to go have that conversation and be persuasive about it. Because I think we can do that. I think that that’s a good place for us to begin.
Kim
Yeah, because there certainly is no life liberty or pursuit of happiness if you are unwell.
Gary
Absolutely. That is absolutely true. Do you know that there’s zip codes in the United States where life expectancy from birth is 60 years old?
Kim
Wow, wow.
Gary
Think about that. 60 years old from birth. And I would go on to say, you know, even at 90, if you go look at the statistics, about 250, 300,000 people get to 90, right? We could do better than that. We…
Kim
I think we can do better than that. And I know, Gary, you’ve got, you guys have been really, you’ve done an amazing job of drilling down to the zip code level to look at some of these health issues and health conditions. Is that correct?
Gary
That is absolutely correct, because you want to understand obviously two things going on. One is obviously individual care, but also population health. And the way to get to population health is to understand the geography where people live. You know what? What a biologist or physicist would say to you is that it is the interaction between our biology and environment that helps to sustain life. And so when the environment’s social determinants of health are not aligned with our biology, it obviously shortens life expectancy, and people, people die prematurely. And so this goes back to that social contract. So if you are setting up those social determinants that put life in danger, elevating risk, that’s not part of what we agreed to, and we have to say that out loud, that just that’s not our system.
Kim
Yeah, yeah, staying, staying along the line of this sort of social, social contract. We talk about social conditions. We talk about referred to as sort of social determinants of health, right? Things like housing and education, and access to healthy food, these are all sorts of drivers or health or lack thereof, right? You know, we have some of our some of our employers at NEBGH who have really removed a lot of the financial barriers around accessing health, deductibles and copays, and yet we are still seeing in some low income communities, some of our communities of color, these folks are not achieving better health outcomes compared to the average population.
Gary
Sure.
Kim
So what, how much do these social determinants of health, you know, sort of play into this? And how do we put some attention on that?
Gary
So let me give you a little bit of a story of a place that we’re doing some work, and it’s the Fifth Ward in Houston, Texas. They’ve been exposed to environmental toxins, and so it’s elevated their risk for cancer. And so you’re talking about generations lost because of cancer in the environment. We could talk about Cancer Alley in Louisiana. We could talk about Michigan. We could talk about Robert Towne in Kentucky.
Kim
Or the uranium mines on the Navajo Nation.
Gary
Yeah, yeah yeah, exactly the point. And so when we talk about the social determinants, it’s a lot deeper than just housing and maybe even food and education. Um we have to make sure that the conditions of that are set up are really taking into mind what sustains our biology and what puts our biology at risk. And this is not to say that we want to take away value, and I’m not talking about shareholder value, but just say we just want to align. Just align it! And we support you. Is that’s part of the American tradition as well. We are marketing salary. We love it. We want it to work, but we need to work for all of us.
Kim
Yes, yes, absolutely. You know, Gary, I think that employers, you know, we represent many employers, and they have such a powerful voice in health care and can really play a role in closing gaps and improving outcomes for diverse workforces. And we have many companies that employ, you know, low-income workers, and working with unions, working with folks who are sort of across the system. Are there specific actions, sort of inside or even outside of the workplace, that you think are powerful, that employers can take, or examples of employers leading the way in health equity?
Gary
What I think what I want to make clear, because I think it’s important here to say. We don’t want to put a burden on employers such that it becomes impossible for them to do their business, right. And so we want to be mindful of that. But the way we want to do it, we want them to be part of the conversation, be part of what’s happening at the table. Because when you look at health care, you look at how health care dollars are acquired. They’re acquired through taxes, right and fees and and, and so we want to make sure that how all of those dollars are collected in youth get applied correctly, because the benefit to the employer is you have a healthy workforce. You don’t lose those days of absence, or people sick at work, or children, etc. And so it’s a community at work. And so when you look at healthcare, what you realize is that it takes a community to actually do that. The employees play a very important role in that. They have a very important voice in that. But they should not feel as if making sure that everyone in the community has access to appropriate care is somehow against their business interests, because we don’t want it that way. We want to make sure that a vibrant economy continues and adds value to everyone.
Kim
And I love what you’re saying about ensuring that employers have a seat at the table in this conversation, because they do have a huge healthcare spend in this country our employers and we want to make sure that they know about the power of that voice that they have, and that they do have a seat at the table as these solutions are being discussed, as decisions are being made. You know, they really are committed to a healthy workforce. So I love the reinforcement of that message, Gary, as we wrap up, Gary, we are recognizing National Minority Health Month this month. So you know, what are the messages that feel most important for our leaders to hear right now. And give us a little hope, Gary! is there a glimmer of hope for the road ahead?
Gary
Well, first, on the hope side, I’m totally optimistic. I believe that we are going to do great things, and by 2050 we will have a healthcare system that we all dream about and imagine and support. I would just say this to the business folks who are your members. I learned a long time ago that if you really want to do social change, you have to do it with the business community. It is not possible to do social change in America without the business community. Folks. I don’t know what anybody else thinks, but I’m just telling you my degree is in History. I’ve read enough history to understand that if the business community ain’t in it, it didn’t happen. So there it is. And you know what we want to say to them is that you have to be at the table as we rethink how we do this and and how we support this, particularly as you start to introduce tools like AI and other things, other capabilities into the system. We need your insights and trust in community. And so I think that’s probably the place, as we start to build this will for change of the business community, you’ve got to be a part of it.
Kim
I love that. I love that. Gary, thank you so much for joining today. Dr Gary Puckrein, founder and CEO of the National Minority Quality Forum, doing amazing work across the country. I have no doubt that this conversation will spark inspiration for many of our members and listeners. So thank you again, Gary for joining. This has been NEBGH Voices. I’m Kim Thiboldeaux. Thank you for tuning in today, as always. I wish you wellness.
Kim
And I am one of the voices.
Voices
And I am one of the voices
Voices
One of the voices of NEBGH.
