Corey Dion Lewis (00:01.077)
Hello community, welcome to another episode of the Healthy Project Podcast. I am your host, Corey Dion Lewis. Today I have a great guest in the building with me. I have Dr. Sean Ross. Dr. Ross is the principal advisor at Encoding Equity Alliance, a recognized expert in the implementation science and the elimination of structural barriers to health. Dr. Ross is dedicated to achieving health justice.

through evidence-based strategies that address health disparities at their root. So Dr. Ross, thank you so much for being here. I really appreciate it.

Dr. Seun Ross (00:37.164)
Thank you for having me, Corey, I appreciate it too.

Corey Dion Lewis (00:39.625)
Yeah. So before we get into our discussion today, can you tell the people maybe a little bit more about yourself? What really gets you up in the morning?

Dr. Seun Ross (00:50.894)
I am a mother of two beautiful daughters. I have a huge dog, Titan. Those are the folks who get me up in the morning. And I think what gets me going is my work is really focused on making sure that everyone walks into a healthcare environment knowing

that they are going to receive the best care, the most optimal care, despite what they look like.

Corey Dion Lewis (01:26.721)
No, I love that. Can you talk, I know when we had our first conversation, when we were just even talking about the idea of having you on the show, the topic of health justice came up. Can you tell me a little bit about, talk about what health justice means to you?

Dr. Seun Ross (01:48.962)
You know, I think when we talk about sort of these terms, health equity, health justice, social determinants of health, think these terms are often conflated. And it's really important to make sure that people understand what they mean. So what health justice means to me is those things that prevent people from achieving their healthiest lives possible.

And an example of that is particularly in what I will call medical racism, where people who are black or minoritized populations are allowed or it is normalized for them to have poorer outcomes than others. So when I think of the term health justice, it is removing those barriers, sort of those hidden barriers that exist so that when...

Corey Dion Lewis (02:36.275)
It is removing those barriers, sort of those hidden barriers that exist so that when I go to a physician or provider for care or when someone white goes to a provider for care, that upon entry into that environment, we are looked at as people, we are evaluated, assessed as people, and

Dr. Seun Ross (02:44.418)
you know, I go to a physician or provider for care or when someone white goes to a provider for care that upon entry into that environment, we are looked at as equal. We are evaluated, assessed as equal and how our, what's the word that I want to use? How we are then,

not assess, how our diagnosis, that's the word, our diagnosis are the same no matter what.

Corey Dion Lewis (03:15.723)
Not a step.

Corey Dion Lewis (03:19.361)
As you say that Dr. Ross, to me as a warm-blooded human being feels like that just should be very, very easy to do. And as you're aware and as we know, there are so many obstacles and layers to what you're saying to make that a reality for those in our community.

What has it been like in your experience peeling back those layers to get to the next part of this or the next layer of this?

Dr. Seun Ross (04:01.144)
That's a really good question, Corey. And I think it's the way you ask the question is really important in understanding that this onion has lots of layers. It is so complex. No one can say that they are working on just one piece of it, right? You have to consider all of the parts. think it's for me, when I think of how to look at this, it's you have...

unconscious biases, you have structural barriers, you have systemic barriers, you have institutional barriers, all of those which lead to social determinants of health, which leads to the need for health equity, which leads to the folks like me working on achieving health justice. So when you think of it like that,

Corey Dion Lewis (04:53.761)
Who

Dr. Seun Ross (04:59.726)
You know that none of those four things that I have listed, institutional, structural, systemic, unconscious bias, are just, they're not easy. It is, I have to tackle all of them at the same time almost in order to give to health justice.

Corey Dion Lewis (05:20.193)
Just thinking of that, of tackling all of that, and you say at the same time, when dealing with one of that is a full-time thing on its own, it feels like a lot and it can feel overwhelming. But what I take from that is it's still necessary to do and it's still important work.

And, you know, a question I have too, Dr. Ross, you know, when thinking about the different layers and the different pieces that you just kind of talked about, sometimes it may feel like a well-intentioned program is thought of as, we're going to fix all of those different pieces. Why do you think many well-intended efforts fail to achieve

their goal at closing these gaps.

Dr. Seun Ross (06:21.154)
Yeah, I think, you know, I don't think that anyone who is in this space, who is a provider on any level have any nefarious intent, right? I think people genuinely want to help and are genuinely putting effort into creation or ideating around programs that can help. The challenge is that let's take a food program, for example.

Corey Dion Lewis (06:32.213)
Right.

Dr. Seun Ross (06:50.286)
You have a group of people who are diagnosed, let's say with diabetes or hypertension and health system decides that they are going to start giving them food. The challenge with doing that is that for that moment, right, you are meeting a need. That is the need of that patient in that moment. But that has not addressed the structural barrier. That has addressed

social determinants of health, right? But that has not addressed, say, unconscious bias, that has not addressed systemic barriers, that has not addressed institutional barriers, that's not addressed structural barriers. You've only addressed sort of the social determinant of health. And you only addressing it for a short time. So when we think of these food programs where, you know, institutions say, I'm going to give someone a bag of groceries,

Corey Dion Lewis (07:22.475)
Mm-hmm.

Corey Dion Lewis (07:29.087)
barriers that is not addressed. Institutional barriers that's not addressed. Structural barriers. You've only addressed sort of the social determinants of health. And you only addressed them for a short time. So when we think of these food programs where institutions say, I'm going to give someone a bag of groceries, and they put a time limit on it, at the end, once that person stops receiving that food, the disparity gets worse.

Dr. Seun Ross (07:48.396)
and they put a time limit on it, at the end, once that person stops receiving that food, the disparity gets worse. It doesn't improve because you haven't looked at it holistically. Now I know it's a challenge, right? Like I'm not telling, I don't want to give people the impression that you have to do everything all at once. Giving folks a bag of groceries is necessary. It meets a need.

Corey Dion Lewis (07:58.005)
Right.

Dr. Seun Ross (08:15.522)
But my statements are to challenge health systems, community-based organizations. While you're doing that, at the same time, you're lobbying for policy change or you're advocating for policy change. You are looking at the structural barrier. So is it that this person is not close to a grocery store? Are they closer to a corner store than a grocery store?

Corey Dion Lewis (08:24.851)
At the same time, you're lobbying for policy change, you're advocating for policy change, you are looking at the structural barrier. So is it that this person is not close to a grocery store? Are they close to a corner store than a grocery store? Figure out what the root problem is.

Dr. Seun Ross (08:45.196)
Like figure out what the root problem is. I always say, if you can continue to ask why, then you haven't gotten to the root. So the challenge is to continue to ask why until you get to the root and then address the root.

Corey Dion Lewis (08:49.537)
I always say, if you're just too good to ask why, then you haven't got to it. So the problem is if you're good to ask why, then you give it a root and then address the root problem. Right. And I feel like we all kind of see what the root problem is, but sometimes it feels like, and I have to take responsibility because I'm

I'm in that space. The root is ugly, but the social determinants we're trying to fix is very sexy in the moment.

Dr. Seun Ross (09:26.818)
Yes, yes. Because that is, you know, it's one of those things where it is, you know, sort of the cream on top that you can address that immediately. Millions of dollars have been spent on health equity initiatives since 2020. And we know that the disparities have worsened since 2020. Health equity is not new.

Corey Dion Lewis (09:34.837)
Yep.

Dr. Seun Ross (09:56.674)
The federal government has been talking about this since the eighties, right? It's just become, to use your words, sexy in the last couple of years. But when we think about why we've been talking about something for 40 years now, and there has been no issues, it's because the policies that are informing these things have not changed.

Corey Dion Lewis (10:04.651)
Mm.

Dr. Seun Ross (10:23.2)
And so when we talk about certain neighborhoods not having adequate access, when we talk about certain groups of people not having access is a huge thing. Health insurance, when we talk about these folks who live in these environments, not having things that are necessary for healthy living, until we get to that issue, then things won't change.

Corey Dion Lewis (10:44.001)
things that are necessary for healthy living, until we get to that issue, then things won't change. And in healthcare, particularly for, you know...

Dr. Seun Ross (10:51.98)
And in healthcare, particularly for, know, if I can talk about one of the things that I am focused on right now, which is the inappropriate use of race in medicine. Myself as a clinician, we're using those sort of coefficients or the different markers for years, for decades, as I counsel patients, only until recently realized that that

Corey Dion Lewis (10:58.177)
I'm about one of things that I am focused on right now, is the inappropriate use of race in medicine. Myself as a clinician, we're using those sort of for the different markers for years, for decades, as I counsel patients, only until recently realized that that is a structural barrier to health for my North African population. So it really is,

Dr. Seun Ross (11:19.764)
is a structural barrier to health for minoritized populations. So it really is, Corey, doing the things that are sort of the cream on top, right? The things that are sexy, but always diving deeper and doing those things too. It cannot just be what's easier in the moment, because none of it is easy, but just easier.

Corey Dion Lewis (11:44.218)
Right. And I'm glad you talked about some of the work that you have done or currently doing because a lot of the people that listen and watch this show are practitioners, public health, healthcare that

want to improve and learn, how can't, we're doing the surface stuff, what can we do to get to the root cause? And you can you successfully help remove, like you said, race as a factor and clinical guidelines at multiple institutions. Can you walk us through how you achieve this, you know, especially the challenges and the milestones? Like, what was that like?

Dr. Seun Ross (12:20.322)
Yeah, think, know, my gosh, Corey, this podcast would end up being three hours long if I tried to tell you all of the things. But I think it's, you know, in understanding how to get to that, right, to your, one of your original, earlier questions, the difference between health equity and health justice. Health equity is closing gaps for people. Health justice is removing those structural

Corey Dion Lewis (12:25.599)
hahahaha

Dr. Seun Ross (12:50.092)
barriers that lead to those gaps, right? And so as I was doing my work in health equity, realized that there is a structural barrier here that is preventing people from being healthy in normalized poor function in black people, Asian people, Hispanic people that just didn't make sense. So when you think of their groups, anthropologists, sociologists have always known

that race is a social construct, not a biological one. And using that framework and applying it to medicine, which almost always treated race as a biological thing, when you take that framework, apply it in medicine, you realize that a person who has a lab result, I should not have, if you are white,

Corey Dion Lewis (13:25.137)
And using that framework and applying it to medicine, which almost always treated race as a biological thing, when you take that framework, apply it in medicine, you realize that a person who has a lab result, I should not have if you are white and if you are black, because race is not an objective data point.

Dr. Seun Ross (13:49.708)
and if you are black, because race is not an objective data point, race is subjective. And so if I am as a scientist, right, physicians, I would say, you know, they study science a lot. And providers, if we know that science is saying that race is a social construct, why am I applying it in a biological way? And so that was the...

Corey Dion Lewis (13:55.157)
racist objective. And so if I am as a scientist, right, I would say, you know, we know that science is saying that racism is a social construct, why am I applying it in a biological way? And so that was the reason why we created the

Dr. Seun Ross (14:17.57)
the reason why we created the regional coalition to eliminate race-based medicine in Philadelphia, why I created it and started peeling back that onion on EGFR, on pulmonary function tests, vaginal birth death to C-section, race-based anemia guidelines, urology stone score. mean, there are numerous, Valles, Darcialy Valles had an article in...

Corey Dion Lewis (14:24.413)
And started peeling back that onion on EGFR.

Dr. Seun Ross (14:43.982)
the New England Journal of Medicine called Hidden in Plain Sight, which listed like 15 tools where race is used as a biological data point. so using that article, the framework of understanding that race is a social construct, not biological one, me to creating this coalition.

Corey Dion Lewis (15:00.579)
that race is a social construct, a biological one, led us to create this coalition. And we said, know, the coalition is successful, what's successful? removed, you know, when all of the hospitals in the southern Pennsylvania and New Jersey, southern New Jersey region, all updated their...

Dr. Seun Ross (15:10.446)
And the coalition is successful, was successful. removed, when all of the hospitals in the Southern Pennsylvania and New Jersey, Southern New Jersey region, all updated their EGFR equations, 700 people moved up on the kidney transplant list. 63 were transplanted.

Corey Dion Lewis (15:28.033)
Wow

Dr. Seun Ross (15:38.072)
When you have those kinds of numbers, like that type of direct impact to people's lives, you know that the work that you're doing is impactful. so removing structural barriers. So now I don't have to, as this work has done, we don't have to ever worry about that being an issue anymore because now black people, Hispanic people will now receive the same kind of kidney care that white people do.

And we say that Black people are disproportionately on kidney transplant lists. They're disproportionately receiving diabetes. Well, if we don't allow their kidneys to die by giving them a higher score than what is truly their result, then we don't have that issue anymore.

Corey Dion Lewis (16:27.919)
Right. Right. Man, and that's a, that is a significant number. Like that is, that's a lot of lives saved solely by going to the root cause of the issue. Wow. You talked a lot about, you know, bringing different people to the table. When we last spoke.

Dr. Seun Ross (16:37.622)
Yes. Yeah.

Corey Dion Lewis (16:52.289)
And how important is it to involve various disciplines? like epidemiology, sociology, specifically to the health justice movement.

Dr. Seun Ross (17:02.734)
You know, in order for us to realize health justice, we cannot operate in homogeneity, right? It cannot just be physicians at the table. It can't trying to solve this issue for healthcare. And I, you know, I am healthcare. For healthcare, it cannot just be physicians. It cannot just be nurses. It cannot just be, you know, the people who are

practitioners of health. We need to involve people who are experts in data, the epidemiologists. We need to involve people who are experts in how societies function, sociologists, anthropologists. We need these people to help us understand, like I mentioned earlier, sociologists and anthropologists have always said that race is a social construct. Applying that to medicine,

Corey Dion Lewis (17:47.243)
sociologists, anthropologists, we need these people to help us.

Corey Dion Lewis (17:57.555)
said that race is a social construct. Applying that to medicine is what helps 700 people move up on the human transplant list and 63 get transplanted. Applying that to medicine is what will allow black women, the black people, to get black scores and to prevent them from, not prevent them, but.

Dr. Seun Ross (18:02.318)
is what helped 700 people move up on the kidney transplant list and 63 get transplanted. Applying that to medicine is what will allow black women or black people to get frac scores and DEXA scans to prevent them from, not prevent them, but help us understand what their fracture risks are. And so having these different groups at the table,

Corey Dion Lewis (18:26.259)
what their fracture risks are. And so having these different groups at the table to, you know, we have a problem and every, all of these groups are giving their opinions and ideas about how to do it from their expertise is the only way that we're gonna be able to move the needle on this. But it cannot, it requires.

Dr. Seun Ross (18:31.982)
to, you know, we have a problem and every, all of these groups are giving their opinions and ideas about how to do it from their expertise is the only way that we're going to be able to move the needle on this. But it cannot, it requires everyone at the table and not just one discipline.

Corey Dion Lewis (18:53.249)
everyone at the table and not just one person. Right, no, 100%. And, you know, right now, when I'm thinking about bringing different people to the table, and I'm specifically talking about this year 2025, a lot of people are afraid in this space. People are scared to talk right now.

If you're saying the wrong thing, doing the wrong thing. But, you know, how should we as healthcare professionals, public health professionals, in your opinion, how should we move right now given the current environment where the work that you're doing is still important and it can be the wording or the verbiage may be villainized in some situations.

Dr. Seun Ross (19:50.018)
Yeah, think that we first I should say I am. I empathize with all of us in this in this time. It is very difficult to know that you are doing good work, the right work, and there is a concerted effort to. Stop your work. So I empathize with.

all of my fellow practitioners out there who are doing the necessary work to achieve health equity in this country. I will also say that this work requires perseverance, this work requires resilience, and this work requires passion. And if we have all of those things, if we continue, the Civil Rights Movement, Cori, didn't happen over the course of four years.

Corey Dion Lewis (20:39.745)
Mm-hmm

Dr. Seun Ross (20:48.502)
It happened over the course of decades. I mentioned earlier that health inequities or disparities has been talked about since the eighties when we really, you the country really started collecting data. One thing I will say to my fellow folks out there is discrimination is codified in law. And we have to tie everything that we do

Corey Dion Lewis (21:03.88)
One thing I will say to my fellow folks out there is discrimination is codified in law.

And we have to tie everything that we do back to law. Because it's law. And so if you are using, if you are doing this work, you can prove that one group is being discriminated against versus another group, then that's a win. That's where the disparities come in. And so talk about your work in the form of disparities. Talk about your work in the form of discrimination.

Dr. Seun Ross (21:18.488)
back to law because it's law. And so if you are using, if you are doing this work and you can prove that one group is being discriminated against versus another group, then that's a win. That's where the disparities come in. And so talk about your work in the form of disparities. Talk about your work in the form of discrimination.

Corey Dion Lewis (21:46.438)
The Affordable Care Act has a section 1557 that you cannot receive federal dollars unless you identify where disparities are and you work to close them. This work is protected by law.

Dr. Seun Ross (21:47.598)
Affordable Care Act has a section 1557 that you cannot receive federal dollars unless you identify where disparities are and you work to close them. This work is protected by law. So I encourage everyone to become familiar with law, know, case law. Again, a nod back to we cannot do this work.

Corey Dion Lewis (22:08.161)
I encourage everyone to become familiar with law, know, law. Again, a nod back to you cannot do this work in these closed environments.

Dr. Seun Ross (22:17.169)
in these closed environments. You need everyone at the table, all expertise at the table to help us continue to do this work. And another sort of nod to the civil rights movement, there were times they were underground, Cori. It wasn't always out front, in your face. So I encourage everyone to continue doing the work if you have to go underground and

Corey Dion Lewis (22:21.665)
We need everyone at the table, all experts at the table, to help us continue to this work. another, so an obstacle civil rights movement, there were times they were underground for us. They were the altruists, out front, in their books. So

Dr. Seun Ross (22:46.514)
and in a way continue working. And because when it bubbles up, we will have the evidence and we will have the proof that health equity focusing, working towards health justice is beneficial for this country on a social perspective, on an economic perspective, and just on a human level.

Corey Dion Lewis (22:58.844)
Right. Oh, I wish I could, I just want to drop the mic right there.

Dr. Seun Ross (23:13.87)
Yeah

Corey Dion Lewis (23:14.005)
But I got one more question for you. It's really, what are the next steps in your advocacy? Are there upcoming projects or goals you are particularly excited about?

Dr. Seun Ross (23:31.02)
Yeah, I will say that I am always excited about all of this, all of the work. As an implementation scientist, my focus right now is continuing to address the medical racism and removing those barriers to health in the form of clinical algorithms or clinical decision tools.

My work with the Encoding Equity Alliance at the Council for Medical Specialty Societies is taking this work national and helping everyone understand that there is an inappropriate use of race that exists in all facets of healthcare and helping nationally identify

Corey Dion Lewis (24:17.313)
in all facets of healthcare and helping nationally identify where those exist, it's in clinical decision tools, for medications, for diagnostic testing, for screening, for assessment, identifying them, finding the appropriate...

Dr. Seun Ross (24:24.814)
where those exist, whether exists in clinical decision tools, for medications, for diagnostic testing, for screening, for assessment, identifying them, finding the appropriate data point to replace it because race is really being used as a proxy. So what's the appropriate data point that we should be replacing that with and disseminating that.

Corey Dion Lewis (24:40.641)
the appropriate data point to replace it because race is really being used as a process. So what's the appropriate data point that we should be replacing that with and disseminating that across the nation to the point where race will be universally accepted as a social, as something social and not biological.

Dr. Seun Ross (24:53.664)
across the nation to the point where race will be universally accepted as social, as a social, as something social and not biological.

Corey Dion Lewis (25:09.161)
I love that. Dr. Ross, thank you so much for being on the podcast today. Anybody listening or even watching that wants to learn more about the work you do, maybe connect with you, where can they find you?

Dr. Seun Ross (25:25.518)
They can find me on LinkedIn. am not very savvy on social media in general, but I am on LinkedIn. And so please reach out Sean Ross in this spelled S-E-U-N last name R-O-S-S, reach out and we can continue this conversation and pushing this work.

Corey Dion Lewis (25:44.757)
Yes. And I'll also make sure I have that in the description of this episode. But again, Dr. Ross, thank you so much for being here and everybody. Thank you so much for listening to the healthy project podcast. I'll highlight you next time.

Dr. Seun Ross (25:59.31)
soon.