A Message from the President

by Cindy L. Russell, MD

SCCMA President

Hindsight

2020 is the year of hindsight, and we all hope to use more foresight going forward. While the world is anxiously waiting to see how the U.S. President responds to his treatment of SARS-CoV-2, there is much to think about in terms of disease prevention. In this issue of the Bulletin, racial disparities in healthcare are spotlighted.

The SCCMA’s recent 4 part webinar series on Diversity and Inclusion featured highly respected physicians; Dr. Danielle Hairston, professor of Psychiatry at Howard University, who spoke on understanding and dismantling implicit bias in patient care; Dr. Arghavan Salles, a Stanford bariatric surgeon and international speaker, who discussed eradicating gender bias in medicine; Dr. Keith Carter, Past President of the American Academy of Ophthalmology and Chair of Ophthalmology at the University of Iowa School of Medicine who looked at physician diversity in medicine; and local pediatrician Dr. Rhea Boyd, co-author of “Stolen Breaths” and who testified to congress in 2020, speaking to us on “Health Equity, Resilience and Leadership in Time of Crisis”. Each talk was candid, enlightening and inspiring, moving us forward to change our perspectives, culture and involvement in this issue. We thank all of these speakers for the many contributions they have already made and will continue to make to guide policy on these critical issues.

Healthcare Disparities and Marginalized Communities

Health cannot be separated from social, environmental and economic forces. Racial disparities in disease coincide with the disparities in the health and wellbeing of the local environment. Disproportionate pollution results in disproportionate adverse health outcomes. Lack of access to health care, coincides with poor health outcomes. Poverty and low socioeconomic status coincide with an increase in chronic disease. Racial bias and even the effects of childhood trauma and racism coincide with adverse childhood development, less resilience and long-term health issues. A lack of education or job opportunities are intricately tied to these issues. Social determinants of health have been acknowledged academically and studied extensively. Some progress has been made but there remain barriers to substantial long-term solutions.

Climate Change

Another issue in hindsight we wish we could have acknowledged and addressed earlier is global climate change. Our addiction to fossil fuels is unsustainable and has fueled the climate crisis. The invention of the internal combustion engine propelled us into the modern world but with an unintended unpleasant legacy of local air pollution, a warmer Earth and large-scale environmental decline which we continue to ignore. Fossil fuels produce a complex web of harmful effects on the environment and human health from drilling, to transporting and to combustion. Oil spills and pipeline leaks occur. There is contamination of massive amounts of clean water used to pump the oil out of the well, merged with highly toxic “proprietary” fracking chemicals and natural unearthed radioactive materials then disposed of as wastewater causing lifeless polluted waterways and deep well water contamination, that are not apparent to many who do not live near these areas. Fracking broadcasts fumes laced with benzene and toluene. And, of course, the transportation and burning of fossil fuels releases a myriad of toxic air pollutants, particulate-matter PM2.5 and CO2, the later which is the main climate-altering greenhouse gas.

Climate Change, Pollution and Health Equity,

Pollution and climate change affect everyone but disproportionately those in low-income and disadvantages communities, a hallmark of environmental injustice. Despite the wealth of beautiful landscapes, many do not realize California is the 6th largest producer of oil in the nation. California to date has 105,000 unplugged oil wells. Over 350,000 Californians live within 600 feet of unplugged wells that emit toxic fumes and put those with asthma, children and the elderly at risk. These wells are largely in low income areas. The Union of Concerned Scientists released a 2019 report showing that Latinos and African Americans breathe significantly more vehicle air pollution than white Californians, showing racial disparity throughout the state. These pockets of unbreathable air intensify asthma rates as well as contribute to many other modern chronic health conditions. COVID-19 has further uncovered health disparities with significantly higher rates of mortality in peo-

ple of color, that point directly to social determinants of health (Brandt 2020; Hooper 2020).

Climate change drives changes in weather patterns that promote increasingly destructive wildfires that also leave disadvantaged communities vulnerable due to lack of resources. This has been well documented in the recent California fires. The increase in intensity of hurricanes underscore that those of lower socioeconomic status are more vulnerable, as they live in areas more prone to flooding and have fewer resources to recover from natural disasters. Extractive economies take their toll on communities, ushering in the emergence of earth and climate justice movements.

Chronic Disease and Racial Disparity

Chronic disease is an epidemic in America, both in adults and children. It is estimated that in 2023 it will cost us $4.2 trillion in treatment cost and lost economic output. According to the National Health Council, about half of all adults have a chronic illness and one third of adults have multiple chronic illnesses. For children, Bethell (2011) indicates that over 50% of children have one or more chronic illnesses if one includes obesity and developmental delays. Low income and minorities have twice the level of chronic diseases (Price 2013).

Hindsight to Foresight

In hindsight we have put ourselves on a path that is not improving our health, well-being or security. Although we are now starting to shift direction, the climate change clock is ticking faster and our response should be rapid. If we address health equity and consider justice, equity, diversity and inclusion (JEDI) as broadly integrated issues with environmental health, education and the economy, we will have a healthier, more sustainable and more compassionate society for everyone. The California Medical Association has begun to address the issue of health equity with a series of policy recommendations in the last several years supporting the inclusion of implicit bias training in medical school curriculums and efforts to implement pilot programs on social determinants of health.

As we look to the horizon we should: Examine universal healthcare and community-based health interventions, reduce toxic exposures, tackle climate change, increase renewable energy, endorse green job initiatives, support healthy agriculture and local community food programs, improve educational opportunities, and engage in removing implicit bias throughout our society. We can all be involved in this solution.

Author, James Baldwin, said, “Not everything faced can be changed but nothing can be changed unless it is faced.”