Health Divides

"We didn't just come to this place where Black and brown people are disproportionately likely to live in resource deprived environments. It is racism."—Dr. Tiffany Green, Associate Professor, UW-Madison School of Medicine and PUblic Health Population Health Sciences and Obstetrics and Gynecology

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Health Divides

S1 Ep4 | 26m 31s

Wisconsin's Black residents face serious health issues, with high rates of maternal and infant mortality, chronic diseases and mental health struggles shaped by generational trauma, all impacted by deep and overlapping social factors. Medical professionals, community activists and religious leaders are working to expand access to pregnancy care, health clinics and healing through learning and joy.

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[solemn music]

Nathan Denzin:
Across the board, Black people in Wisconsin suffer disproportionately from bad health and/or barriers to health care.

Black children in the state are four times more likely to have lead poisoning than their white peers.

Also in Wisconsin, Black people die younger than almost all other races, and Black women are far more likely to die during pregnancy or in childbirth than white women.

The statistics are so bad for Black people that in 2019, Milwaukee County declared racism a public health crisis.

– We can say all health disparities are a direct consequence of being an American descendant of slavery.

Tito Izard is the president and CEO for Milwaukee Health Services, where he opened a clinic in an underserved neighborhood.

He says that because racism impacts every aspect of Black Wisconsinites’ life, it affects their health.

– Health is, again, the narrow consequence of the condition or the environment that has been created.

– Black people, Indigenous people are disproportionately likely to be in impoverished and socially-stratified circumstances.

Tiffany Green is a professor for population health sciences at UW-Madison.

– We know that having unstable housing, not having enough food, being poor, those contribute to outcomes.

– Health is not just things that are going on in your physical body, but it is your emotional well-being, your mental well-being, your spiritual health, even your social health.

Dr. Jasmine Zapata is the chief medical officer for community health at the Wisconsin Department of Health Services.

She says health is much more than trips to the doctor.

– The things that happen outside of the clinic walls have more of an impact on one’s health outcomes and quality of life than the very things we do in the hospitals and clinics.

All of those factors outside of the clinic are known as the social determinants of health.

Dr. Zapata:
Broadly, social determinants of health refers to non-medical factors that influence one’s health outcome.

Where people are born, where they age, where they grow, where they live, where they work.

Things outside of the traditional medical model that we think of when we think about health outcomes.

When it comes to where Black Wisconsinites live, only a quarter of them own their own home, and they face one of the highest income gaps in the country.

A gap that has persisted since 1968.

Another important social determinant, how close you are to fresh food.

Black Wisconsinites are five times more likely to live in a food desert than white residents.

– We generally don’t have control of the food that we have in our community.

You know, grocery stores, full service grocery stores are oftentimes far away from our communities.

Reggie Jackson educates people about diversity.

He says that living in a food desert means much of your food comes from gas stations or convenience stores, where the only options are highly processed.

People don’t have access to healthy food or they can’t afford healthy food.

– We didn’t just come to this place where Black and Brown people are disproportionately likely to live in resource-deprived environments.

It is, it’s racism.

But despite the declaration that racism is a public health crisis, Izard says not much has been done in Milwaukee since 2019 that brings parity to health outcomes.

– Making that declaration without subsequent steps though, is disingenuous.

So for most people in the community, it’s like, “Okay, well, we hear that statement.

Tell us something that we don’t know already,” right?

For Izard, the only path forward is to improve all of the determinants of health.

The Madison-based Nehemiah is a community group working to take those subsequent steps.

– When you start to shift systems, then you start to actually impact the outcomes.

Kim Neuschel is now the community outreach facilitator at the UW School of Nursing.

When she worked as a public health nurse, she enrolled in Nehemiah’s Justified Anger: Black History for a New Day course.

The nine-week course teaches the community about race, history, and justice.

– I think something like this course helps us zoom out and recognize that we all are who we are because of everything that came before us.

Neuschel said the course helped her realize the full scope of how racism has affected health care, and shifted her perspective to see patients more holistically.

– Health care is important.

Your genetic makeup is important, but significantly more important are the social, economic, and environmental factors, and these are the things that we know racism is, you know, embedded within.

The course also helped Neuschel’s public health team find out why young Black students in one grade school were repeatedly absent from class.

And one of the main factors was the walking route to school didn’t feel safe.

So the team worked to make the path safe and inviting again.

First, they installed better lighting in a tunnel that felt unsafe, but then went further.

– We raised money to respond to their idea of putting in a mural that the kids designed.

After adding the lights, the mural, and a few other improvements, absence rates improved.

– And we did show at the end of that, kids’ sense of safety and sense of belonging and connection both to the school as well as to their community and that walking route really shifted for them.

That shift brought healthy change and access to opportunity in the children’s lives who now felt safe enough to walk to school every day.

– It’s good to become aware; it’s better to actually transform that into actual actionable items.

What are you specifically going to do?

[solemn music]

The harsh reality is from the first day they’re born, Black babies are much less likely to thrive and more likely to die than white infants in Wisconsin.

The same holds true for their mothers.

In fact, this has been true since the first infant and maternal mortality data was gathered in 1912.

– I think one of the big things that people don’t realize is that this is a problem that we have identified more than a century ago.

Tiffany Green is a professor for population health sciences at UW-Madison.

She says that while overall, maternal mortality has greatly decreased in the last century, the gap between Black and white mothers and infants has persisted, especially in Wisconsin.

We still unfortunately have among the highest Black infant mortality rates in the country, meaning Black babies that don’t reach their first birthday.

Black birthing people have about five times the pregnancy-related mortality rate relative to their white counterparts in Wisconsin.

– In general, we are leaders in the nation as it relates to many of the inequities that we see.

Dr. Jasmine Zapata is the chief medical officer for community health at the Wisconsin Department of Health Services.

– There’s no one answer.

We could talk about this for hours and hours.

It’s multifactorial.

Advocates say one potential reason we see disparities is because health care providers can carry implicit biases into the clinic.

– So a lot of times when we talk about implicit bias and talk about racism in our health care system, a lot of people think about, like, direct, interpersonal racism where somebody would come up to me and say, “I don’t want you to treat me ’cause you’re Black.”

That’s not a lot of what we see.

A lot of it is unintentional.

Because of those unintentional biases, Zapata says Black people are less likely to go to a doctor when something is wrong, which can lead to worse health outcomes.

– There are many people, especially in the maternal and child health fields, that have access, that have insurance, and they’re still not attending their health care appointments.

Just because you have insurance and you can physically make an appointment, is it somewhere that you feel safe and comfortable?

But while access to quality health care can be a large driver in outcomes, national data shows that even the infants of the richest Black mothers suffer worse health outcomes than the babies of the poorest white mothers.

– I think we focus a lot on hospitals and doctors because that is something we can easily wrap our heads around.

But the reality is there are a lot of reasons, and I think they have a lot more to do with the social environment.

And the societal environment for Black Wisconsinites is one defined by racism.

When it comes to where Black Wisconsinites live, only a quarter own their own home.

They face one of the highest income gaps in the country and are five times more likely to live in a food desert than white people.

– A lot of people have linked things like segregation, things like the resource-deprived environments, to the risk of prematurity, and those things matter.

Dr. Zapata says she experienced this difference in outcomes firsthand when she had her second child.

– I got pregnant with my second child, a little baby girl.

I was so excited, and she was due on January 2, but on September 20, I had a sharp pain in my lower abdomen.

When it happened, she was in class for medical school and knew something was wrong.

Doctors told her that it was just false labor, but when she saw blood a few minutes later, she went to the hospital.

– Ultimately, within two hours, I was in an emergency C-section, and I delivered a one and a half-pound baby who didn’t cry when she came out.

When babies come out, they’re supposed to be kicking, screaming, crying.

It was completely silent.

Her daughter was then taken to the neonatal intensive care unit to start her breathing.

– It was so hard for me at that moment because I knew all the statistics about Black birth outcomes.

After three weeks in the NICU, Zapata’s baby was able to thrive and is now a very healthy teenager, but Zapata knew the outcome could have been much different.

– I knew that it was a honor that she was there with me because there are so many other birthing people and families, particularly Black women, Black birthing people who do not have that same outcome.

– There are reasons above and beyond sort of these individual-level characteristics that don’t explain why we are seeing these disparities.

But there is work being done to bring parity to birth outcomes for Black mothers and infants.

In 2022, Governor Evers announced $16 million in additional funding for DHS to work on closing those gaps.

– We’re currently working on this with intensity and passion.

Dr. Zapata says there are three big things that money is going toward: increasing access to health care for Black mothers and infants, educating current health care practitioners about the issues, and increasing the number of Black doctors and nurses.

– We will have a bigger impact if we can go upstream and focus on how can we eliminate some of the very factors and social determinants of health that cause some of these health outcomes in the first place.

Along with the $16 million, health care providers in Dane County have another effort to improve the social determinants of health called ConnectRx.

ConnectRx is a program that provides support to pregnant Black people at risk.

– Making sure that families at risk of losing their places are getting housing, making sure that they are getting food.

I’ve heard, been privileged to hear stories about people getting employment that they need.

The program also connects mothers with doulas if they choose, and with an individual community health worker, both during pregnancy and after.

– I’m just stunned at the work that they’ve been able to do that addresses these social determinants.

But even with these programs, Green says more needs to be done.

– When we talk about things like Medicaid expansion, which we have refused to do in our state, despite the fact that places like Georgia and Mississippi have expanded postpartum Medicaid for up to a year.

The Wisconsin legislature removed Medicaid expansion from the governor’s budget again in 2023, making Wisconsin one of only a few states which has not expanded postpartum coverage.

– If we live in a Wisconsin where everybody is able to reach their highest potential, everybody needs access to a provider.

While expanded coverage remains elusive, health officials look to fill the gaps and improve the outcomes wherever they can.

[solemn music]

In the summer of 2004, Aaron Perry watched an Ironman competition in Madison and it changed his life.

– I remember looking and watching and I thought, you know, “I wish I wasn’t diabetic,” ’cause I wanted to do it.

Perry has diabetes, something that he shares with about 13% of Black Americans.

In fact, Black Americans are 60% more likely to be diagnosed with diabetes than white Americans.

Black men are nearly twice as likely to die from diabetes than white men, and are two and a half times more likely to be hospitalized.

But diabetes isn’t the only health issue facing Black men.

– You know, we face ’em from A to Z.

We’re everywhere in that, you know, hypertension, diabetes, heart disease, stroke.

We’re starting to see a lot of lung cancer and prostate cancer.

Black men also have the second-lowest life expectancy of any group in America, at about 67 years.

To take back control of his own health, Perry found a running group to help him train for the grueling race, which includes a 2.4-mile swim, 112-mile bicycle ride, and a marathon 26-mile run.

And one of my mentors, Dino Lucas, said to me, he said, “Aaron, join our running club.

We’ll get you to the finish line.”

By the time race day had come, Perry felt better than ever.

– I remember thinking as I’m getting ready to get in the water, “Aaron, you have taken yourself “from poor control of your diabetes “and within 360-plus days, you’ve transformed yourself into one of the fittest athletes in the world.”

Just over 16 and a half hours later, Perry became the first African-American diabetic to complete an Ironman.

After the race, he started to get questions from diabetics around the world asking for health advice.

That’s when Perry started to get serious about his peers’ health and founded the Rebalanced-Life Wellness Association.

– When I started doing this work here in Madison and Dane County, the average age of death was 51 years of age for Black men, and if that’s not a crisis, I don’t know what it is.

Around 2009, Perry had the idea to put free health clinics in Black barbershops to catch men for a quick screening as they came and went for their cuts.

I did the research and back in the early 1900s, the barbershop was everything.

The barbershop was where the pharmacist was at.

That was where the doctor was at, and so I looked at that and I thought, “How can we bring that full circle?”

Perry says cancellation rates for barbershop appointments is less than 1%, a far cry from the high cancellation rates clinics see from Black men.

– The fact that we’re not treated the same when we go to the doctor, we don’t receive the same level of care.

Reggie Jackson educates people about diversity.

He says that Black men can be reluctant to see a doctor because of experiences where medical professionals didn’t take their concerns seriously.

– A lot of doctors assume that, well, if I give this Black person a specific protocol to follow because of this condition they have, well, they’re not gonna follow it anyway, so I’m not gonna even put them into that space.

A barbershop, on the other hand.

All of these guys, they trust their barbers.

They trust them with their life, they trust them with their kids’ lives.

So he started writing grants to the state government, asking for seed money to jumpstart the idea, but that idea took time to catch on.

– Keep in mind, I’m a former cop.

I came into the barbershop saying, “I want to help you get healthy.”

You know, that was not well-received.

It took me quite a few years.

Then in 2016, after being denied another round of state grants, SSM Health decided to give Perry’s idea a shot.

The first barbershop to get a clinic: JP Hair Design in Madison.

His idea was simple.

In the extra office space JP had available, Perry would set up and catch men as they finished their haircut.

Guys could get blood pressure screenings, flu shots, diabetes, glucose, and cholesterol testing, all for free.

So we literally have changed the culture in the barbershops on how the conversations go.

It’s no longer sports and politics; it’s health, sports, and politics.

Perry now has clinics in four Madison-area barbershops, which he says reaches about 30% of the Black men in Dane County.

Erin Hall:
The initiative that we’re working on is to try to bring health care to as many people as possible.

Erin Hall owns Resilient Hair Designs and says he’s dedicated to Perry’s vision for health care.

– It’s bringing health care back into the community.

We’re taking it away from the clinic and hospital walls, and we’re bringing it back into the community where it belongs.

Along with the barbershops, Perry started his own health center next to JP Hair Design that can do more for patients than a small clinic could.

– Thank you.

– Thank you.

Appreciate it.

The clinic’s trained nurses work with men to get them healthy.

– What we tell them right up front, as of today, whatever’s going on with you, we’re gonna stabilize you.

You will not get worse.

You’re going to get better from this point on.

If it’s a concern with housing, we wanna help them have housing.

If a concern with, you know, whether it’s you know, relationships, we are gonna have them connected with a mental health counselor.

Even with the clinics and barbershops and his standalone health center, Perry wants to take his idea further.

The next step, opening a clinic in Madison’s Second Baptist Church.

The culture with the Black community, you know, we are naturally, you know, a faith-based people, you know, and the majority go to church.

The clinic opens in the fall of 2023 to serve the community on Sundays, though Perry says more days may be added as needed.

– We want these neighborhoods to be health villages.

We want them to be places where low income and uninsured people can still have access to care, and by bringing this back into the community such as churches, barbershops, and free clinics, that is what we’re hoping to achieve.

By combining all three, Perry is launching what he calls Brother Care Health, a health care model designed to operate in underserved neighborhoods.

– When you walk out your front door, you should be able to walk out your front door and see health in your community.

While Perry is working on seeing health in Dane County communities, he says he’s given advice to people all over the country, including places like Maryland, California, and Washington, D.C. – This model has been replicated all across the United States, you know, and it started right here, so we’re proud of that.

[solemn music]

– If I’m talking about it and I’m not embarrassed about it, then you don’t have to be embarrassed either.

The mental health of so many people, you know, myself included, are just being, I mean, it feels like you’re just being constantly attacked.

Reverend Everett Mitchell is a pastor at Christ the Solid Rock Baptist Church in Madison, and also a Dane County judge.

– I don’t know what it is, but people are feeling darker now.

– Mental health is so, so extremely important, especially in the aftermath of COVID.

Dr. Jasmine Zapata is the chief medical officer for community health at the Wisconsin Department of Health Services.

– Younger people, and in particular our Black youth, where we see increases in overdoses, mental health concerns, adverse childhood experiences.

– I grew up, there was a lot of trauma, but nobody talked about it.

There was a lot of pain; nobody expressed it.

We saw cycles of people, you know, alcoholism and drug abuse, just kind of going through the same cycles.

Repeating cycles in families that go way back.

For Lilada Gee, many of the mental health issues facing the Black community today can be attributed to the generational trauma they hold.

– I think there is not a Black American that is not touched by generational trauma.

Gee is the founder of Defending Black Girlhood, a nonprofit that works with Black girls and women to unpack and heal their trauma.

As part of that work, she creates art depicting resiliency.

She is also a lecturer at the Madison-based Nehemiah’s Justified Anger: Black History for a New Day course.

The nine-week course teaches the community about race, history, and justice.

– In the way I would define it is something has happened to an ancestor that was so devastating that the impact reverberates to today.

Even if you aren’t aware of the trauma you carry, Reggie Jackson says it can affect your life.

– It teaches you to see yourself in a very specific way.

It teaches you that somehow, you can’t think of yourself in a positive way.

Jackson is a community leader in Milwaukee.

– You are going to be told by society, generation after generation, even after slavery ends, that you are an inferior species, that you are not deserving of being treated as a first-class citizen in America.

– If you don’t have the experience to be able to heal, then that trauma remains there.

– It passes down in terms of the way that you interact with your family members, your children, your grandchildren, your great-grandchildren.

All of those things are impacted by the people that came before you.

Generations of people being treated as second-class citizens, often expressed by what are known as microaggressions.

– Microaggressions from my definition, are these small, insidious experiences that happen on a regular basis.

Some are small and insidious; others are overt, and they can happen in every facet of life, like trying to schedule appointments.

– The lady I’m talking to, she puts her hand over the phone and says to somebody in the background, “I don’t mean to be racist, but I think I’m talking to an angry Black woman here.”

We thank you, God, for all these blessings… – Nathan: At Christ the Solid Rock, Mitchell says the trauma his parishioners carry is always on his mind.

– I prioritize not only education about the faith, but also your mental health, mental well-being as a spiritual priority.

While church attendance is declining, nearly 70% of Black Americans still go to church at least once a month.

– The Black church is essential because it speaks to the issues that people experience.

The Black church has been part of American life before America was even founded.

The first Black church was founded in 1773 during slavery.

– In many ways, the Black church is a response to the, you know, the brutality of slavery in our American history.

Mitchell says the Black church differs from most white churches because they often talk about religious practicality.

– What you experience on the outside of the world should be brought in here so we can better understand how we deal with it, how we talk about it.

To help his congregation through the trauma they may have, Mitchell gives a five-week sermon every year to help define and heal from trauma and resulting problems with mental health.

– You don’t have to pray it away.

It is something we identify and we live with, and it’s the living with it that gives us the courage to be able to transform it into something that can be useful for us and for our families that we serve.

He says the sermons have had a tremendous impact on his congregation.

– But it’s something within us.

That in and of itself has given people permission to move in and out of the space of trauma without thinking that this is something that they need to get rid of or that one sermon or one prayer is gonna just release it.

For Lilada Gee, the most important healing work is with Black women.

– It’s hard for the Black community to move forward if Black women are not healed, and if Black women are not healed, then they continue to pass that pain on to generation to generation.

But she says that healing is possible if you’re willing to put in the work and lean into joy.

– Joy is something that you feel, you just get to feel when you lean in, and comes from gratitude, and it comes from hope and the belief that your life can be better.

– Our messages have to become brighter, and the only way that we can do that is to give people a demonstrated experience in our local community to offset all of the crazy stuff that they’re hearing about.

– The trauma that we’ve experienced is not something we have to carry for a lifetime.

For Here & Now, I’m Nathan Denzin.

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