LISC Emerging Leaders Council member La Tasha Barnwell describes her work in public health and the imperative of a holistic strategy for closing the racial wealth gap.
La Tasha Barnwell (pictured above), a member of LISC’s Emerging Leaders Council, has worn several hats within the Johns Hopkins medical system. In addition to pursuing a doctorate at the Johns Hopkins Bloomberg School of Public Health, Barnwell has served as senior administrative manager for the Division of Addiction Medicine and co-chaired the hospital-wide Health Equity Strategic Action Team at the Johns Hopkins Bayview Medical Center.
Barnwell spoke to Anna Alekseyeva, VP of Strategy at LISC, about the value of the social determinants of health framework in addressing health outcomes, the imperative for health care institutions to build bridges with the communities they serve, and how the barriers of racial injustice must be dismantled for our country to achieve health equity.
Can you start by describing your work and your area of focus within public health?
I work at Johns Hopkins Bayview Medical Center as a senior administrative manager. Fifty percent of my role consists of serving as the division administrator for our addiction medicine division. There, we have an inpatient detox unit where community members and patients can come and detox from alcohol and benzodiazepines. We also have an outpatient clinic called the Comprehensive Care Practice, where we specialize in addiction medicine, HIV, and Hepatitis C treatment.
This practice is truly comprehensive: you can come to our practice with your chronic care maintenance concerns, Pap smear concerns, addiction concerns, infectious disease concerns, and leave with a bag of food or be connected to a resource to help with any of the social determinants of health. We are pretty much a one-stop-shop where we service the true community of Baltimore.
The other 50 percent of my role is centered around population health initiatives and health equity. I'm the co-lead of Bayview's Health Equity Strategic Action Team, which is responsible for diving into clinical data and reviewing it from a REAL perspective – that's race, ethnicity, and language – to identify inequities. I also support our community engagement network. Anything to do with the community and its intersection with the hospital, I try to get involved in. That's where my passion lies and where I see the most change occurring.
You mentioned social determinants of health. Can you explain what you mean by this, and how you apply the social determinants of health model in public health practice?
The model that I love to use when educating people about the social determinants of health is called the County Health Rankings Model. It explains that four health factors contribute to health outcomes: health behaviors, clinical care, social and economic factors, and physical environment.
Most people would say, when you think about the determinants of health, you get the biggest bang for your buck in the clinical sector. But this model explains that clinical care makes up only 20% of the total health outcome.
You actually get the biggest bang for your buck if you concentrate on improving health behaviors, like tobacco use, diet and exercising, alcohol and drug use, and sexual activity, which make up 30% of the model. Social and economic factors, which make up 40% of the model, include education, employment, income, family support, and community safety. So, when you focus on improving both health behaviors and social-economic factors, you can get at 70% of the health factors that contribute to the quality of life and life expectancy. I think healthcare is starting to realize the value of investing in social determinants of health.
How are you seeing the social determinants of health approach changing the ways in which health institutions operate?
I think I may have misspoken when I said social determinants are new to healthcare. I was on a panel at Ohio State's health policy management conference, and one of my co-panelists was an executive from a Federally Qualified Health Center. She corrected me onstage. She said, "this might be new to hospitals, but it's not new to Federally Qualified Health Centers. We've been in the community and working on the social determinants of health. We have existing models that are evidence-based and show positive results." I also used to work for a Federally Qualified Health Center: it's a comprehensive, co-located center that can provide health care, case management, and social services all in one spot. I saw that this holistic approach really did make a difference.
Healthcare more broadly is starting to understand that we cannot come in with our swords and knight outfit and say to the community, "we're going to save you." The community needs to be involved in every step of the planning, development, execution, and evaluation of a health program. This more comprehensive view also has implications for partnerships between healthcare institutions and other organizations. As a sector, we need to extend our hands and look at other partners and leverage their expertise so we can develop comprehensive solutions for our communities.
We're currently in the midst of a global pandemic, and one of the things that many people understand at this point – even those outside of the public health space – is that the pandemic has disproportionately affected black and minority communities. What trends are you seeing with the patient populations you work with?
Like you said, black and brown communities are disproportionately seeing the effects of COVID. And while I think COVID is a horrible disease, it's really acting to highlight the disparities and inequities that were already in our system. Our black and brown communities are most vulnerable because of exactly the social determinants of health model we were talking about. We have higher comorbidities and poorer outcomes that are risk factors for COVID.
With respect to addiction medicine, unfortunately, with COVID, a lot of care providers were closed. People were afraid to go to the emergency department where we typically hand out Naloxone kits, so there's less distribution of Naloxone in the community. As a result, we're starting to see higher rates of overdoses.
If you look at maps of overdose calls throughout the city, you usually find them in clusters because drug activity often is a social activity. But now we're starting to see them much more spread out, meaning people are using in isolation and are at higher risk for terminal overdose. This is just one example of a trickle-down effect of COVID.
In the current public dialogue around policing and criminal justice reform, there is a growing point of view that police are too often called on to address issues that are really quality of life issues and do not merit police intervention. I imagine that overdose calls fall into this category. What are some alternative models when it comes to addiction interventions?
Obviously, there's a tension between police and community members that we're seeing across the country. It's not unique to Baltimore. But I think the question of system-level break-downs extends beyond the police. With respect to addiction, the EMS world has been somewhat jaded by the number of overdose calls they get. And it's become a very cyclical, negative process that when an overdose patient calls for support, when the help comes, it's not the type of resource the individual needs to achieve recovery.
I do believe community health workers have a role to play here, partnering with EMS and the police force to respond to overdose calls. Community health workers can provide a patient with access to resources right then and there. In Baltimore, though, two community health workers are called in to respond to overdoses. Last year there were 888 overdose deaths related to opioids in Baltimore City alone. Given these astronomical numbers, two community health workers can only do so much.
I want to shift gears to talk about the REaL framework that you mentioned earlier. This seems like a useful tool to analyze the unequal health outcomes in communities of color that COVID is highlighting.
REaL is an acronym for how you can stratify data to look at inequities. As I said, it stands for race, ethnicity, and language. I personally like to add zip code because that's a major determinant of health.
The framework is a way for us to stratify data to identify inequities. So, for example, we dove into hypertension among the patient population in our general internal medicine resident clinic. The clinic overall looked like it was doing well. But when we evaluated the data using the REaL framework, we found a higher rate of maintenance – which leads to lower blood pressure – among white men compared to their black male counterparts. Based on this finding, we needed to ensure faculty were educating patients and directing patients to resources in the community to support their hypertension disease maintenance.
Another acronym in the diversity and inclusion realm is SOGI: sexual orientation, gender, and identity. We are starting to collect this data to do some additional analysis here as well.
That sounds like a powerful framework.
It is, but the challenge – in my opinion – is institutional culture. We need to have the systems to facilitate data capture along these dimensions and do this on an automatic basis. Our little group – the Health Equity Strategic Action Team – can't do this all on our own. Right now, we're searching for inequities, but if we were systematically collecting and reviewing this data at the hospital level, then inequities would be highlighted and we could immediately act on them. That's what I'm working on now: from a systems perspective, can we have our hospital data teams apply the REaL framework to any project they're working on?
Finally, can you talk about what drew you to LISC and the Emerging Leaders Council?
LISC literally has one foot in the community and one foot in the corporate institutional world. I admire LISC's efforts to bridge the gap between these because that's how I've tried to strategically frame my career. From a health institution's perspective, I've seen examples of saving money, being able to invest in the community, building stronger relationships, improving outcomes for the community, and serving as an anchor in the community.
I think LISC helps build those relationships between institutions and the community by translating community needs into corporate priorities. This is an art, but it's essential and it's doable. I think LISC has shown the world that it can be done and done successfully. We just have to be open to have those conversations and be transparent enough to dig into historical issues and institutional barriers to truly create change.
Leaders and entrepreneurs from a diverse range of sectors working to bring fresh perspectives, networks and attention to LISC’s work.