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We Need Algorithms that Build Up Lives, Not Destroy Them

Today marks the 6th day of Black History month. This year’s theme is Black Resistance. While at first blush, the term resistance may conjure up memories of Malcom X or the Black Panthers, in reality, Black Americans resist in more subtle and nuanced ways every single day.

In the aftermath of the tragic death of Tyre Nichols, focus turns to the SCORPION Unit, tasked with targeting crime hot spots to reduce crime by utilizing man-made algorithms that target violent criminals knowing full well some criminals will not get caught, while completely innocent citizens will be incorrectly targeted.

Watching the Tyre Nichols traffic stop escalate into a five-on-one street brawl where Mr. Nichols never had a chance, made me realize that Black Americans in this country have had a history of resisting poorly developed, man-made algorithms that are more likely to harm us, rather than to help us.

Below, I describe how a similarly poorly designed, man-made algorithm almost changed the trajectory of my life and my career in an excerpt from my newly published book, The Way Up: Climbing the Corporate Mountain as a Professional of Color.

The book also shares my narrative about embracing defining moments in your life to discover self-worth and pride, as well as reclaiming your seat and reaching your full potential. For me, it was a journey that led me from the warehouse of a beauty supply store to becoming COO of a major health plan. Imagine what we all could achieve if society focused on algorithms designed to build people up, instead of tearing us down.

EXCERPT from The Way Up: Climbing the Corporate Mountain as a Professional of Color

For the rest of my life, society will not just expect me to walk on eggshells, to act mature, to forgive and be emotionally intelligent—but will also demand me to comply. My life depends on it. This lesson helped me navigate the most defining racial memory of my life, which was soon to happen.

As a senior in college, I was “stopped and frisked” at gunpoint by police on the streets of The Bronx more times than I could count. The first time I trembled in fear. By the time I graduated, it had become a routine dance. The uniformed officers would inevitably ask for identification, and I would reluctantly produce my driver’s license and Fordham ID card—always both.

Stop-and-frisk was a New York Police Department (NYPD) racially biased profiling policy that led to the temporary detention, questioning, and often search of New Yorkers just living their daily lives—whether they were suspects of a crime or not. My most severe altercation with the NYPD left me lying on a cold street in The Bronx one night at 11 p.m. My cheek was pressed between the concrete side-walk and the knee of a New York City police officer paid to serve and protect me from the very same people he suspected me of being. He was twice my size, and he used all of his body weight to pin me to the ground despite my lack of resistance. I remember the incident so clearly that the neighborhood sounds still whisper in my ears. The onlookers with their pointing fingers already condemning me. The corner bodega boys who scattered once the police sirens turned on. The cars that slowed down as they passed through the intersection of 183rd Street and Arthur Avenue, trying to get a glimpse at was happening under the glaring luminescence of streetlamps.

This corner was known to Fordham students as the “Bermuda Triangle” because there were three bars and a pizza shop at each point of the intersection. It was far enough away from campus to be cool, but close enough for drunken Fordham students to make their way home without being assaulted. Many Fordham students circled around the triangle as they traveled from one bar to another before ending at the pizza joint at 2 a.m.

As I lay on the ground considering my fate, it was in that unending moment that I realized I was truly Black in America. Guilty before proven innocent. At first, I was embarrassed; in fact, mortified. For the next few years, I told no one.

I was arrested because I matched a broad description of a Black male suspect with blue jeans and a white T-shirt. No height specifications or any other description, not even facial features to speak of. Just a generic young Black man sought in connection to a recent stabbing that had occurred nearby. This wrongful arrest led police to issue me a Class E felony charge of resisting arrest.

Resisting arrest! I was arrested by plainclothes policemen who offered no reason whatsoever as to why I was being stopped, or whom he and his fellow police officers were pursuing. Resisting becomes the first logical action when strangers step out of a car and put their hands on you. I remember realizing that I would live longer if I complied even though the police officers had yet to identify themselves. But that is exactly when I voluntarily went to the ground and put my hands in front of my head, signaling the white flag.

Despite this gesture of peace, two officers still tackled me hard even though I was already on the pavement. I know they barked orders, but I don’t recall what they said. They were loud, burly, and abrupt. Menacing in an almost demonic way. I just remember letting my body loosen so they could whip me around like a rag doll until tight cuffs were placed around my wrists.

I’d never thought about how it might feel to be shoved into the back of a cop car in front of a crowd wondering who I was and what had happened. When a police officer places his hand on your head as he guides you into the back seat, you immediately realize you’re powerless. To begin with, the back seat of a police car is covered with hard plastic, so it’s extremely uncomfortable. The way your arms are sadistically handcuffed behind you makes your shoulders hurt. The metal handcuffs are angled just right to dig into your wrists, causing maximum discomfort and pain. And it’s hard to keep yourself upright since you can’t use your arms and hands to hold yourself steady.

I remember trying to reason with the police and let them know I was a Fordham University student-athlete. That my ID card was in my wallet. It was my only evidence beyond the gates of Fordham University to exclaim to society that I was a different type of Black person. Without one, I was just a Black kid on Fordham Road. With it, I was an educated student-athlete at a prestigious Division 1 college trying to obtain an education and avoid becoming yet another statistic. Same damn kid.

What is the price to pay for fitting such a description? I paid attorney fees in excess of $5,000, which my family and I couldn’t afford. I had to assemble character witnesses from all around Fordham University. Those who would be willing to testify in-person and through written affidavits attesting to my character. Eventually, I even persuaded a student eyewitness to testify on my behalf. She nervously accepted, knowing full well what could happen if I was found guilty of a felony charge. I would have to drop out of college, no longer run track, and walk through life with a criminal record that would serve as an albatross around my neck for the rest of my days on this planet. In a blink of an eye, everything in my life could change.

I could not imagine what transpired for other Black and Brown boys just like me who could not afford an attorney and lacked people of stature to vouch for their character. In most cases, they plead down their case and accept their unjust sentences. According to a study from the New York State Association of Criminal Defense Lawyers and the

National Association of Criminal Defense Lawyers, 99% of all misdemeanors and 94% of all felony charges are resolved by a guilty plea. These are the souls who end up populating prisons in America. To add insult to injury, approximately 90% of all stops based on a suspicion of a crime in New York involve people of color.

Fortunately, I was a member of the 6% minority of felony cases. My case was dismissed. But before I could celebrate, the judge told me my arrest record wouldn’t be expunged until after 10 years of “good service.” That is, 10 years with no further crimes or infractions.

I was a 21-year-old senior in college—a soon-to-be college graduate with a waiting job offer at the largest health insurance company in New York. Yet, for the next 3,650 days, I would effectively be paralyzed as I navigated the streets of New York. My then goal: to avoid a New York City police force that was hell-bent on targeting young Black males. In fact, in 2005, the year of my graduation, there were 398,191 stop-and-frisk incidents in New York City. Of those, 352,348 (89%) of these individuals were found completely innocent; 196,570 (54%) of them were Black, even though we only represented 25% of the population in New York City that year. One of those incidents involved me. In fact, my Fordham hood was considered one of the top five neighborhoods in New York City where stops were done with a use of force 44.9% of the time.

Whenever you read or hear about a statistic, remember that behind those alienating numbers are red-blooded human beings with real lives, hopes, and dreams.

Errol Pierre is the author of The Way Up: Climbing the Corporate Mountain as a Professional of Color, and serves as a healthcare executive and college professor in New York. Opinions expressed are his own.

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Black History Month – From Struggle to Strength

In honor of Martin Luther King Jr. Day, I had the honor to volunteer at a COVID-19 vaccination site at the Community Protestant Church on East Gun Hill Road in the Bronx. It was an amazing experience to see New Yorkers come together for a cause bigger than themselves on a mission for Health Equity. While volunteering, we scanned the line for seniors waiting outside in the cold with walkers and canes and moved them up so they could be seen sooner. We talked through the vaccination process with essential workers to get through some of their nervousness and jitters. We helped wheelchair-bound New Yorkers get through narrow doorways and escorted them to and from the vaccination observation rooms. After this experience, I honestly believe that if we all give just a little bit, it will always be more than enough. As Aristotle, a philosopher in Ancient Greece, once said, “the whole is greater than the sum of its parts.”

However, one thing stuck out to me while I was volunteering. The vaccination line was not as diverse as the neighborhood it was in. This struck a chord with me and galvanized me even more in my pursuits of Health Equity. As we enter February to celebrate and reflect during Black History Month, I cannot help but think about the current state of Black Americans. We are a population that has been hit so hard by the pandemic in a so many ways from employment, healthcare coverage and access to the COVID-19 vaccine. Here is a look at the staggering statistics and hope for a path forward.

Employment

At the height of the COVID-19 pandemic, unemployment for Black Americans spiked to 16.7%. The only time unemployment had been higher in the past 50 years for Black Americans was back in January 1983 when it reached 21.2% at the height of the 1980s recession (U.S. Bureau of Labor Statistics, 2021). While the unemployment rate decreased to 9.9% for Black Americans by December 2020, the national unemployment rate for the nation as whole was 6.7% (U.S. Bureau of Labor Statistics, 2021).

Health Coverage

Prior to the pandemic, 11.4% of Black Americans lacked comprehensive health insurance coverage (Kaiser Family Foundation, 2020). This was 5% higher than the 10.9% national average. However, states that chose not to expand Medicaid eligibility under the Affordable Care Act had an uninsured rate that was 42% higher than the national average reaching 15.5% uninsured. Of the twelve states that still have yet to adopt Medicaid expansion, Mississippi (38.9%), Georgia (33.5%), South Carolina (28.0%), Alabama (27.8%), North Carolina (23.1%), Tennessee (18.0%), and Florida (17.6%) represent states with the highest percentage of Black American residents as a percentage of their overall population (U.S. Census Bureau, 2019). Texas also makes the list of states that have not adopted Medicaid expansion. While Black Americans only represent 13.5% of the Texas state population, it still represents more than 3.9 million Black Americans, making the Lone Star state the largest population of Black Americans to lack access to the Medicaid expansion in the country.

COVID-19 Vaccine Equity

Lastly, the United States was reawakened to the issues of racial inequities last summer after the murder of George Floyd. We witnessed that Black Americans were 2.8 times more likely to die and 3.7 times more likely to be hospitalized by the coronavirus than their White, Non-Hispanic peers (Centers for Disease Control and Prevention, 2020). Since then, policy makers have been working hard to put in pragmatic solutions that can unwind systemic racism and root out implicit bias that can be found in our healthcare system. In fact, President Biden has not only nominated one of the most diverse cabinets to the Executive Branch (Tenpas, 2021), he also has issued various executive orders seeking to advancing racial equity and support for underserved communities through the federal government (Biden, J., 2020).

However, despite our best efforts, we have begun to get our first look at vaccine equity from around the country. During the first month of COVID-19 vaccinations in the United States, 12.9 million Americans received at least 1 dose of either the Pfizer or Moderna vaccine in over 64 jurisdictions around the country. 63% were women and 37% were men. 55% were 50 years or older. Race and Ethnicity was reported for 51.9% of the vaccines. Among that cohort, 60.4% were White and 39.6% represented racial and ethnic minorities, including 11.5% Hispanic/Latino, 6% Asian, and only 5.4% Black (Painter EM, 2021).

Even states as diverse as New York have felt the pain. Based on New York City Department of Health data, only 60% of patients provided ethnicity at the time of vaccination. Of those that did, Black New Yorkers have received half the share expected for them based on the city’s population make up. Specifically, Blacks make up close to 24% of New York City but only represent ~10% of those vaccinated (Pereira S, 2021).

What Can Be Done?

These statistics need to be further researched. However, hypotheses as to why this is happening have policymakers asking questions. For example, despite the best efforts of New York State, many vaccinations are only available through online appointments via an English only website that was not written at an 8th grade reading level. Right from the start, we begin to see barriers emerging that could hinder immigrant and low-income communities from accessing the vaccine. Additionally, many essential workers do not all have the same ability or wherewithal to work from home and refresh vaccine appointment websites searching for an open slot or leverage “bots” that can crawl through various websites locating vaccine appointments. Lastly, vaccine hesitancy due to mistrust of disinformation has caused some community vaccine locations in Black neighborhoods to see out of towners take up vaccination appointments while the community wrestles with whether to get vaccinated.

That is why at Healthfirst, we have created a dedicated unit that not only can answer questions about the COVID-19 vaccine but will also schedule appointments on behalf of our members and even arrange transportation for them if needed. We are also focused on bringing vaccines to the community by supporting local provider partners who are from those communities to supplement mass vaccination efforts. Healthfirst has provided volunteers to many COVID019 vaccination sites, including the new one recently opened at Yankee Stadium focused on Bronx residents.

This is just a few examples of how we use a health equity lens to look at the world around us. Personally, after several conversations over three months, I was elated to help schedule my 68-year-old mother for the Moderna vaccine last week. She is happy, doing well, and had little to no side effects after her first dose. She eagerly awaits her second dose later this month. Helping someone through their hesitancy takes time and takes patience. Their fears are real and should be validated. With love and patience, I’ve learned, they will slowly come around. Science always win.

There is Still Hope!

There are very few times in your life when you can make a monumental impact on someone’s life that will change both of you and will also help to alter the course of history. I believe in my heart of hearts, volunteering during this COVID Pandemic to help our fellow New Yorkers get vaccinated is one of those times. If you are ready, willing, and able to help, I encourage you to sign up and volunteer in your neighborhood. If you are unable to volunteer due to health concerns or have other issues, cheer on the men and women, who are essential workers, helping to fight the COVID outbreak in the field every single day and never have the opportunity to work from home. We are all in this together.

For more information on Health Equity, I will be a panelist on a free YMCA webinar on Addressing Racial Inequities in Health Care on February 23, 2021 at 3:30PM. For registration or more information, click here – https://ymcanyc.org/community-action

References

Biden, J. (2020, January 20). Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. Retrieved from U.S. White House Briefing Room: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/

Centers for Disease Control and Prevention. (2020, November 30). COVID-19 Hospitalization and Deaths by Race/Ethnicity. Retrieved from COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

Kaiser Family Foundation. (2020, November 6). Key Facts about the Uninsured Population. Retrieved from KFF: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

Painter EM, U. E. (2021, February 1). Demogrphaic Charateristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program. Retrieved from Morbidity and Mortality Weekly Report: https://www.cdc.gov/mmwr/volumes/70/wr/mm7005e1.htm#:~:text=During%20the%20first%20month%20of%20the%20U.S.%20COVID%2D19%20vaccination,%25%20were%20non%2DHispanic%20White.

Pereira S, D. J. (2021, January 31). City Reveals White New Yorkers Have Received Lion’s Share of COVID-19 Vaccine Doses. Retrieved from Gothamist.com: https://gothamist.com/news/white-new-yorkers-triple-nyc-covid-19-vaccine-doses

Tenpas, K. (2021, January 13). Just How Diverse is President Biden’s Prospective Cabinet. Retrieved from Brookings: https://www.brookings.edu/blog/fixgov/2021/01/13/just-how-diverse-is-presidents-biden-prospective-cabinet/

U.S. Bureau of Labor Statistics. (2021, February 1). The Employment Situation – December 2020. Retrieved from Bureau of Labor Statistics: https://www.bls.gov/news.release/pdf/empsit.pdf

U.S. Bureau of Labor Statistics. (2021, January 21). Unemployment Rate – Black or African American. Retrieved from FRED – Federal Reserve Bank of St. Louis: https://fred.stlouisfed.org/series/LNS14000006

U.S. Census Bureau. (2019). ACS Demographic and Housing Estimates, Race Alone or In Combination With One or More Other Races – Total Population – Black or African American. Retrieved from United Stats Census Bureau: https://www2.census.gov/programs-surveys/acs/summary_file/2019/data/1_year_ranking/R0202.xlsx

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What is the Future of Health Disparities After COVID-19?

PART ONE OF A TWO-PART SERIES

On August 11, 2020, I was honored to give a special lecture on The Future of Health Disparities after COVID-19 at the second annual Best Practices Conference entitled “Reconsidering Health Care in the Era of Pandemics” hosted by Healthfirst and the Icahn School of Medicine at Mount Sinai. I ask myself how can we solve our country’s healthcare disparities every morning when I wake up. I feel tackling this issue is my duty and highest calling as an employee at Healthfirst, the largest non-profit health plan in New York. We have the honor and privilege to provide high quality healthcare to over 1.5 million members in New York.

While my fellow colleagues and I were sent to work from home on March 17th due to the pandemic, not all the members we serve found themselves to be so fortunate. Our membership looks much like my parents who came to America in the 1970s. Healthfirst members are resilient, ethnically diverse, native and immigrant New Yorkers that do not always speak English as a first language. Many are essential workers, whom on average earn less than New York State’s minimum wage ($15/hour). Many work in industries that are the least likely to be done while working from home, representing families in New York City that live together in close proximity, in housing complexes that do not lend themselves to proper social distancing.

It Was the Worst of Times

Since working from home, within the Healthfirst virtual halls and Zoom calls, we have said that the COVID-19 pandemic is the worst thing that has ever happened to us.

The sheer volume of deaths and sickness that overcame many of our members was heart wrenching and eye-opening. We witnessed firsthand the disproportionate share of COVID-19 cases and death rates impacting Black and Hispanic populations across the country within the communities we serve, from the South Bronx to Elmhurst, Queens (Hooper, Napoles, Perez-Stable, 2020).

We also saw, in stark reality, that the survival rates for our fellow New Yorker with COVID-19 depended more on their zip code of residence rather than their overall health. For example, Manhattan, which has more hospital beds per person than the outer boroughs like Queens (5:1,000 vs. 1.8:1,000), experienced exponentially less COVID-19 cases (16 cases per 1,000) as compared to the outer boroughs, like the Bronx (33 cases per 1,000). Even if you were fortunate enough to be in Manhattan at the time of contracting COVID-19, your chance of survival then depended on whether you arrived at a private hospital (11% mortality rate) or a public one (22% mortality rates) (Rosenthal, Goldstein, Otterman, Fink, 2020).

Lastly, during this unprecedented season of suffering, we saw unemployment skyrocket. And with it, increases in food insecurity and rent burden that disproportionally impacting the same communities hit hardest by COVID-19. These job losses impacted our communities different than the past. While foreign born workers have historically participated in the labor market more than their native born counterparts (61.8% vs. 59.6%), COVID-19 disproportionately impacted the labor sectors where immigrants found themselves working the most; restaurants, daycare centers, home care agencies, and retail/clothing stores (U.S. Department of Labor, 2020).

It was the Best of Timing

These factors were so overwhelming that as New York slowly climbed out of being the epicenter of this worldwide pandemic, on June 8, 2020, the New York City Health Department declared racism a public health crisis (Chasan, 2018). Despite this, COVID-19 also became the best-timed wake-up call for our industry because it laid bare healthcare disparities for all the world to see. What we witnessed in New York raised acute awareness of the importance of both health equity and the social determinants of health. It also renewed the health care industry’s commitment to eradicating health disparities once and for all. For example, the Centers for Disease Control and Prevention (CDC) will now focus even more on community health, cultural competence, and health equity for minority communities (Heath, 2020). Key members of the United States Congress demanded Secretary Azar of Health and Human Services (HHS) to outline his strategy of addressing racial disparities in health care access and outcomes, which is required by the Affordable Care Act (Warren, 2020). Lastly, health plans across the country committed hundreds of millions of dollars to addressing social determinants of health and health equity (Anthem, 2020; Centene, 2020; & Humana, 2020). Even here at Healthfirst, we refocused on digital tools to tackle food insecurity and improve access to health coverage through our latest mobile app release that combines the virtual visits of Teledoc and community resources of NowPow seamless through one platform. (Raths, 2020).

However, reducing health disparities is not just an altruistic pursuit for only the kindhearted. Reductions in disparities directly equate to longevity and wellbeing for many minorities in America who have not come to know or experience the same health quality I am privileged to have as an employee of Healthfirst. In economic terms, efficiency gains in lower disparity rates mean the United States could save over $230 billion in direct healthcare costs and over $1 trillion dollars in indirect costs driven by reductions in premature deaths and avoidable hospital admissions (LaVeist, Gaskin, Richard, 2011).

However, the big question remains, how do we do it?

I answer this question in Part two of this series. Click Here to Read It

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References

Chasan, A., (2020). NYC Health Department calls racism a ‘public health crisis’. Pix11 News. Retrieved on July 30, 2020 from https://www.pix11.com/news/local-news/nyc-health-department-calls-racism-a-public-health-crisis

Heath, S., (2020). CDC Unveils Health Equity Plan for COVID-19 Response. Patient Engagement HIT. Retrieved on July 30, 2020 from https://patientengagementhit.com/news/cdc-unveils-health-equity-plan-for-covid-19-response

Hooper, M., Napoles, A., Perez-Stable, E., (2020). COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323(24):2466–2467

LaVeist TA, Gaskin D, Richard P., (2011). Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 41(2):231-238.

Raths, D., (2020). Insurer Healthfirst Speeds Release of Mobile App to Meet COVID Needs. Healthcare Innovation. Retrieved on July 29, 2020 from https://www.hcinnovationgroup.com/population-health-management/mobile-health-mhealth/article/21147853/insurer-healthfirst-speeds-release-of-mobile-app-to-meet-covid-needs

Rosenthal, B., Goldstein, J., Otterman, S., Fink, S., (2020). Why Surviving the Virus Might Come Down to Which Hospital Admits You. New York Times. Retrieved on July 29, 2020 from https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html

U.S. Department of Labor. Bureau of Labor Statistics. (2020). The Employment Situation. Retrieved on July 29, 2020 from https://www.bls.gov/news.release/pdf/empsit.pdf

Warren, E., Pressley, A., (2020). Letter to the Honorable Alex M. Azar II Secretary U.S. Department of Health and Human Services. Retrieved on July 29, 2020 from https://www.warren.senate.gov/imo/media/doc/2020.07.14%20Letter%20to%20HHS%20re%20missing%20racial%20disparities%20report.pdf

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Part II: What is the Future of Health Disparities After COVID-19?

PART TWO OF A TWO-PART SERIES

Last week, I began to explain the future of health disparities after COVID-19 in Part I of this series by highlighting what the world has witnessed during this pandemic. Feel free to read Part I here.

This week, I will lay the groundwork on reimagining a healthcare system that works to reduce healthcare disparities through health equity, and begin to describe what that world would look like. I do contend that one of the leading solutions to achieve these objectives is to truly unharness the power of ethnic concordance.

Ethnic Concordance

A 2018 study in Oakland, California found that Black/African American patients in ethnically concordant physician/patient relationships were more likely to agree to the preventive care services offered up by their physician as compared to if they were in a discordant relationship. (Alsan, Garrick, Graziani, 2018). Concordance is defined as “the degree of patient and physician similarity or agreement across a given dimension. Sharing specific social characteristics (e.g. gender, race, socioeconomic status, education), expectations, beliefs, and perceptions impact health care quality” (Thornton, Powe, Roter, Cooper, 2011).

The theory builds on work from Dr. Theodis Thompson’s Social Accessibility Hypothesis, which contends that “physicians find it very difficult to effectively communicate with their patients, especially when there are cultural differences. On that premise, the psychosocial accessibility problem of blacks obtaining healthcare would be greatly alleviated through the existence of an appropriate number of black physicians to meet the black demand for healthcare services” (Thompson, 1974).

There are many research studies that show ethnically concordant physician/patient relationships lead to greater patient satisfaction scores, longer physician-patient talk times, more physician effort, and higher adherence rates (LaVeist & Nuru-Jeter, 2002; Street, O’Malley, Cooper, Haidet 2008; Hagiwara, Penner, Gonzalez, Eggly, Dovidio, Gaetner, West, Albrecht, 2013). However, there are seemingly an equal amount of studies that also find little to no statistical significance in health outcomes between ethnically concordant physician visits too (Traylor, Subramanian, Uratsu, Mangione, Selby, Schmittdiel, 2010; Stevens, Shi, Cooper, 2003; Schoenthaler, Montague, Manwell, Brown, Schwartz, Linzer, 2014).

However, the one similarity between these many research studies that find no correlation between ethnic concordance and patient outcomes has more to do with endogeneity than simply a lack of correlation. That is, many research studies in concordance fail to include one very important variable in their regression analyses. A variable, I contend, is the most important variable for this type of research in apost-George-Floyd-America; implicit bias.

Implicit Bias

Implicit bias is defined as “associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender” (FitzGerald & Hurst, 2017).

A 2017 study by the Children’s Hospital of Philadelphia found that 91% of their residents had pro-white/anti-black bias against black children and 85% bias against black adults. These biases led to poorer physician communication, disparities in medical treatment, and lower adherence to treatment recommendations (Johnson, Winger, Hickey, Switzer, Miller, Nguyen, Saladino, Hausmann, 2016).

Once implicit bias is included as a variable in research models focusing on ethnic concordance, statistical significance in health outcomes begin to emerge. A 2018 meta-analysis that reviewed 6,249 research studies found that implicit bias absolutely plays a role in continuing healthcare disparities (Maina, 2018).

Since implicit bias exists in our healthcare system, it also exists in the data we use to treat our patients. This has become clear to even New York regulators who have begun to conducted investigations into algorithms that may have been foundationally built upon bias data, which led to a perpetuation and exacerbation of bias care for Black/African American and Latinx patients (Evens, Mathews, 2019; Obermeyer, Powers, Vogeili, Mullainathan, 2019).

The Four Core Recommendations for the Future

We are at a crossroads in America. The longevity and wellbeing of millions of minority Americans hang in the balance. A near-term Presidential election looms over us as over $230 billion dollars in health care savings await to be realized. COVID-19 has galvanized and coalesced an entire industry to draw a line in the sand and commit to meaningful changes that will transform the trajectory of patient care forever. This momentum will last so long as our industry wants it to. The future is up to us.

As a result, here are my four core recommendations for the future health equity commitments post COVID-19:

1) Invest more into Concordant Research

Our industry needs to conduct more studies focused on ethnic concordance with the inclusion of racial implicit bias as a measurable variable, so we can learn more and do more around this important topic.

a. Some disease states, like Lupus, lack information around concordance all together (Delis, Corless, Young, Hildebrand, Bell, Tarbet, 2020)

b. Not all ethnicities, like Asian populations or English-speaking Hispanics, response the same to ethnic concordant physician/patient relationships (Traylor et al., 2010).

2) Increase Physician Workforce Diversity with clear Targets and Incentives

Diversity is the great equalizer to improving disparities. Most patients are more likely to choose ethnically concordant physicians regardless of ethnicity (Traylor et al., 2010) however, Black/African American and Hispanic patients are the least likely to have ethnically concordant options (Cooper & Powe, 2004). For example, as Dr. Thomas discussed in his research, in 1942 the ratio of black physicians to the black population was one to 3,377, and by 1976 it fared even worse; one to 4,000. As of 2018, approximately 45,000 Black/African American physicians only make up 6.8% of all physicians in the United States (Association of American Medical Colleges, 2018) even though 42 million Black/African Americans living in the United States make up 13% of the population (U.S. Department of Health & Human Services, 2019). While minority physicians that are underrepresented in medicine are more likely to practice in underserved areas than their White peers, internists had much higher rates of diversity as compared to family physicians (Xierali, I., Nivet, M., 2018).

3) Create Data & AI Ethic Committees

As the move to automation grows, more companies are relying on data science to be the sail that helps steer the strategic ship of growth. However, an ethical framework is required when making decisions using big data, artificial intelligence, or machine learning to ensure that the sins of our past, inherent in the data we are using, do not become the foundations for our future. (Sandler, Basl, Tiell, 2019).

4) Work with Legislatures and Policy Makers to Undo Systemic Racism & Bias

Even though healthcare is close to one-fifth of our gross domestic product (Martin, Hartman, Washington, Catlin, 2018), Health equity will never be achieved through this industry alone. As Hooper et al. (2020) noted “the underlying causes of health disparities are complex and include social and structural determinants of health, racism and discrimination, economic and educational disadvantages, health care access and quality, individual behavior, and biology”. Thus, policy makers must invest in areas that influence the social determinants of health from education, to housing, to job training, in order to help the healthcare sector achieve its goal of an equitable healthcare system that leads to long life and wellbeing, irrespective of your zip code or the color of your skin.

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References

Alsan, M., Garrick, O., Graziani, G., (2018). Does Diversity Matter for Health? Experimental Evidence from Oakland. National Bureau of Economic Research. Working Paper No. 24787.

Association of American Medical Colleges (AAMC), (2018). Percentage of all active physicians by race/ethnicity, 2018. Diversity in Medicine: Facts and Figures 2019. Retrieved on July 29, 2020 from https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018

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Featured

Errol Pierre: Providing Health Care Access From New York, To Haiti

By Sam Bojarski

While growing up in a working-class family, Errol Pierre experienced some of the same health issues many young people deal with. But at times, finding treatment for asthma and orthotics for flat feet proved financially burdensome for his parents.

“They weren’t covered under the benefits, so I just walked around with flat feet in pain because we couldn’t afford orthotics. There were just so many things that as a child growing up with my parents’ benefits that I didn’t have access to,” said Pierre, a Haitian-American who lives in the Bronx.

As senior vice president for state programs at Healthfirst ‒ New York state’s largest nonprofit health insurer ‒ Pierre has overseen the implementation of health plans under the Affordable Care Act, designed to insure New Yorkers, including families similar to his own. A dedicated volunteer who has served New Yorkers and the larger Haitian community, Pierre was included on a recent New York Carib News list of Power 100 Caribbean Americans.

The New York Carib News editorial board developed the Power 100 list to celebrate the achievements of community members. Submissions are made on behalf of nominees, who must demonstrate personal achievement in a profession, community engagement and sound character. On July 1, Carib News held a virtual celebration for Power 100 awardees.

From setting up food pantries to providing information and resources about COVID-19, Pierre has worked with a lot of community organizations through Healthfirst, over the past four months. He said this community work likely earned him the nomination.

Pierre first started with Healthfirst in 2012, initially as assistant vice president of product management.

“My job was to lead the cross-functional implementation of the Affordable Care Act, which included all of the Obama-care plans as well. That’s probably my biggest accomplishment. We launched a product called Qualified Health Plans, which are the Obama-care plans that have the different metal levels. We launched a product called the Essential Plan,” Pierre said.

Errol Pierre, senior vice president for state programs at Healthfirst. Photo provided courtesy of Healthfirst

Before briefly leaving Healthfirst in early 2018 for Empire BlueCross BlueShield ‒ where he served as a chief operating officer ‒ Pierre also led an effort to roll out a plan for small business owners. He rejoined Healthfirst as senior vice president for state programs in 2019.

“Errol Pierre is an outstanding, innovative, and energetic executive leader at Healthfirst. He is a sophisticated business professional who also cares deeply about our vulnerable members and the myriad of non-medical barriers to their optimal health. He contributes greatly to the mission of the organization through his clear thinking, vision, ability to partner with others, and his execution, and he was at the forefront of creating innovative digital solutions to remain close to our members even when COVID made us all stay apart,” said Pat Wang, Healthfirst president and CEO, in a statement.

When he needs motivation, Pierre leans on the example of his father Stuart, who came to America from Gonaives, Haiti, in the early 1970s. Along with Pierre’s mother Yolene, Stuart saved enough money to move from Brooklyn to Spring Valley, where the couple raised Errol and his brother, Stuart Pierre Jr.

As Errol Pierre recalled, his father worked a grueling schedule to support the family, waking up at 4 a.m. to work in a restaurant kitchen during breakfast hours. In the early afternoon, he would come home and prepare for his next job, running his own business cleaning offices and homes.

“So he’s my biggest motivator, you know, he didn’t speak the language, and he was in a brand new land that he’d never been in. And I saw him navigate America through all the trials and craziness. And he always was a standup guy, always had a smile on his face … taught me about being the best I can be, taught me the importance of education,” Pierre said about his father.

While Pierre’s father was in a union, accessing certain things like an inhaler and orthotics proved financially burdensome.

“It’s like, just full circle, to be able to be part of bringing New York health care, (while) growing up as a child not being able to have full benefits,” Pierre said.

In addition to his work with Healthfirst, Pierre has volunteered his time as a board member of multiple organizations.

Before joining the board of MediNova, a nonprofit that provides free medical care to residents of northeastern Haiti, Pierre would join the organization on mission trips to the country, said its president, Dr. Henry Paul. The organization currently has an operational COVID-19 treatment unit and primary care building, in the town of Caracol.

MediNova relies on donations, and Pierre has been able to help the organization with its fundraising needs, as a member of the board, Paul said.

“He’s a very bright young man and has added a lot of value to the board, both as a member of the finance committee, and he has a lot of great ideas,” he added.

“He will be an asset to any organization. Anything that he joins, I think he will bring value to,” Paul added.

Pierre is a member of the National Association of Health Service Executives, where he mentors other professionals of color who work in the health care industry. He also serves as a board member of the 100 Black Men Long Island chapter.

“I also work with Arthur Ashe Institute for Urban Health, and they do a ton of work in Brooklyn, and I’m very connected to the doctors in Brooklyn that are providing care, Pierre said.

“So a lot of the work I do is health care related, but that’s the way I kind of keep connected to the Caribbean population in New York City, to all of these different communities,” he added.

At the age of 37, Pierre has made the Power 100 list of Caribbean Americans for the first time.

“I’m humbled to be added. I know a lot of powerhouses in New York of Caribbean heritage, so it’s very humbling to be honored as part of an illustrative group,” he said.

ACA: Last Day of Open Enrollment!

Errol sat down with Arise News to discuss the future of Healthcare Reform as the 2018 Open Enrollment Period for the Affordable Care Act comes to a close.

The Open Enrollment Period ran from November 1st through December 15th, 2017, however, some states like New York and California extended their Open Enrollment Period to January 31st, 2018.

Featured

The Six Important “Exit” Polls from Last Night

The last time one political party won the presidency three terms in a row was 27 years ago when George H.W. Bush won after Ronald Reagan’s two presidential terms from 1981 to 1989. Before that, 80 years ago Franklin D. Roosevelt served as President from 1933 to 1945 and passed the baton to another Democrat, President Harry S. Truman who served from 1945 to 1953. So it was always an uphill battle for Obama to continue his legacy through a Secretary Clinton presidential win.

Six Exit Polls from Last Night

Six exit polls from the New York Times help to explain yesterday’s election results. The polls collectively show “change” fatigue across the county. President Obama promised “change” and over the past 8 years successfully delivered upon that change. However, the overwhelming results of last night’s election shows that more than half of the country does not want to continue the country’s current track despite Obama’s favorable approval ratings.

Secretary Hillary Clinton was on the precipice of becoming the first female President of the United States. Despite the historic precedent of this achievement, she only won 54% of the female vote. She actually won less of the female vote than Barack Obama in 2012 who carried 55% of that vote. Despite the controversies surrounding Donald Trump with women, from alleged sexual improprieties to the leaked tape of his lewd comments, she was not able to marshal the female vote greater than 4 years prior.
If you felt the country was on the wrong track, you overwhelming voted for Trump. Tapping into the foreign trade deals that resulted in job losses throughout the Midwest flipped states like Wisconsin and Michigan.
If you felt the nation’s economy was either “Poor” or “Fair” you overwhelming voted for Trump as well. Unemployment ratings were reported being the lowest in over 5 years at 4.9% last month. However, while more Americans are working, their wages have declined. So despite the economy performing better over the past 8 years, the positive results were not felt by those Americans that voted for Trump.
The largest cohort in the county are White Americans without a four year college degree. A 2015 census report showed that roughly 113 million White Americans fall into this bucket. This cohort was most susceptible to the impacts of trade deals that moved jobs overseas and premium increases from the Affordable Care Act. This population overwhelming voted for Trump last night. Additionally, despite some controversial statements from Donald Trump regarding several minority groups including Muslims, Hispanics, and African Americans, roughly a fifth of non-white college graduates and non-whites without a college degree voted for Donald Trump as well. For comparisons, Obama won 51% of the population that did not have a college degree across all ethnicities.
George W. H. Bush, George W. Bush, and Jed Bush all publically stated the would not vote for Trump. Speaker Paul Ryan voted for Trump but publically told his fellow Congressman to run for re-election without endorsing Donald Trump. Many other famous Republicans aligned with the “Never Trump” movement looking desperately for another candidate. Nonetheless, Donald Trump still managed to capture 90% of the Republican vote; much higher than what the polls were showing. Donald Trump actually won his party’s votes 1% higher than Hillary Clinton who only won 89% of the Democrat vote. This was despite President Obama and Senator Bernie Sanders actively campaigning for her. Lastly, 48% of Independents voted for Trump; the exact opposite results of the 2012 and 2008 elections. While 15% of conservatives voted for Secretary Clinton, 10% of Liberals voted for Donald Trump.
In 2012 Mitt Romney won 6% of the African American vote, 26% of the Asian vote, and 27% of the Hispanic/Latino vote. Donald Trump preformed better in 2016 across all categories. He won 2% more of the Black vote, 2% more of the Hispanic/Latino vote, and 3% more of the Asian vote despite his immigration policies and intentions to build a wall along the southern border.