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Hey, what's up? This is Corey Dion Lewis, founder of Healthy Project Media and the host of the Healthy Project podcast. Join me as I speak with the change makers who are doing the work and sharing their stories, insights and innovations to close gaps in healthcare for everyone.

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Hello everybody. Welcome back to another episode of the Healthy Project Podcast. I'm your host, Corey Dion Lewis. This is the first recording of 2025. So I'm excited. It's been a minute since I've been in my, uh, have my Healthy Project Podcast hat on. So I'm happy to be here. I have, um, a great guest with me, someone that I just recently started connecting with. And as soon as our first conversation, bro, it was like, boom.

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We are, we're going to do something big. Um, I have Dr. Julian Lee with me today. Dr. Lee, thank you so much for being here, man. I really appreciate it. Oh, absolutely. Thank you so much for having me, man. Like you said, I've been excited. I've been, I've been looking forward to this for the past few weeks. Great connection with you so far. Just super excited to be on this platform and connecting with you and sharing ideas and talking, so thank you for having me. 100% man. So, um, you know, before we get into our conversation.

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Can you tell the people a little bit more about yourself and what gets you up in the morning? Sure, sure. So again, as you said, Corey, my name is Dr. Julian Lee. I'm originally from Houston, Texas, but I'm now a Sioux City, Iowa native. I serve as a director of diversity, equity, inclusion, and process improvement for a fairly qualified health center in Iowa. And I do a lot of specific health equity work as it relates to really trying to advance and improve health outcomes, eliminate health disparities, and things like that. So

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social justice advocate, a part of lots of different task forces. I serve on the national association of community health centers, task force on undoing racism, which is really focused on, again, looking at concepts of racism and eliminating those in healthcare. And really just a, just easy going guy. I'm passionate about health equity. I'm passionate about wellness. I'm passionate about justice and I'm passionate about creating a world where everybody can thrive, regardless of your race, gender, ethnicity, social economics, tax, all those types of things.

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Love sports sports fanatic uses sports fanatic and different things like that even though I know those aren't the topic of the podcast today, but Die hard sports fan just love people One of the things that gets me up in the morning is really being able to just serve others service You know one of the best quotes I always heard or learn somewhere was you have to serve before you can leave So I try to dedicate my life to service and helping others Because once you serve others then you can lead and you're seen as a leader. So

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One of the things that gets me up every day is just the opportunity to serve and opportunity to help somebody else, bring somebody else up. Oh, that's real, man. And what I appreciate about the work that you do, you know, Julian, is you focus on a lot of things and we're going to get into a lot of your background and the research that you've done specifically around the African American community and diabetes.

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You know, a part of my history is growing up, bruh, and, you know, my grandmother had diabetes, my mother has diabetes, and it was just normal, right? It was just like, my grandma just took medicine. Not understanding the impact. But can you share kind of an overview of your research on type 2 diabetes among African Americans in the tri-state area and what inspired you to, you know, to focus on that? Sure. Absolutely.

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So yes, as you said, and starting in 2018, all the way through 2023, I established some literature. It was titled, Discrimination and Unconscious Bias Towards African-Americans Living with Type 2 Diabetes in the Tri-State Area of Sioux City, Iowa, South Sioux City, Nebraska, and North Sioux City, South Dakota. And this study was focused on exploring the impact of discrimination, unconscious bias, aversive racism, disparate treatment, and really exploring how those types of issues

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impact type 2 diabetes outcomes for patients. With this study, I had more than 25 different people in these different communities, African-American, living with type 2 diabetes, shared lived experiences about experiences with racism in community settings, experiences with racism in health care settings, and really cross relating that to how that impacted type 2 diabetes outcomes, such as management behaviors, overall outcomes, perceptions about the condition, things of that nature, with the whole goal of really trying

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How does everyday racism, things that our people experience, how does it impact their diabetes condition? I learned so many things along the way. I think there's some fantastic recommendations that my study uncovered that if applied could really help change things, particularly with our community. We know that African-Americans disproportionately suffer from type two diabetes and everything that's associated with it, whether it be contracting it at a point where it's at a...

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nearly uncontrollable state, the different complications that come along with it. You think about limb amputation, blindness, our people not only are more likely to contract the disease, but we're more likely to suffer at more significant or some more significant rate in other racial and ethnic groups. Now getting to my passion about the work, as you talked about my passion for health equity work really starts with my father. I lost my father in 2017, a few years ago to prostate cancer. He died of stage four prostate cancer.

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was interesting about his story was that there were a lot of different things along the way. He was a younger individual, but there were a lot of different things along the way on his journey, signs, so to speak, that weren't addressed because of different social economic barriers that we face that we talk about all the time that ultimately led to him passing away way too soon. This happened while I was actually in the doctoral program at my university and losing him and really seeing a love one pass away really kind of sparked my thoughts about.

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thinking about why that happened and exploring African-American health and exploring these topics of social determinants of health and health disparities, because it was a very popular topic in the clinic or a very well discussed topic in the clinic. And so that's where I just kind of started thinking about it quickly as I really dove into reading about different types of health disparities, different types of chronic conditions, whether it be cancer, hypertension, diabetes, all the cardiovascular disease, all these types of things. One thing popped up across everything.

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advocate Americans being the number one or the highest rated individuals that are suffering from these diseases, dying from the diseases, living with the diseases. And very quickly I said, this, this is unacceptable. This is unacceptable. There should be no way that, you know, one goal of people that's disproportionately suffering from these conditions went at the end of the day. We are all 99% genetically identical. We're all human. We all are made up of the same gene. So what is getting in the way? So that was early in my health equity journey where I still had so much to learn.

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But I would say my past for this work all started with seeing someone that looked like me, seeing someone so close to me pass away sooner than I thought they should. And just wanting to really think about, you know, what could have been done differently and how can we change things so that other folks don't lose mom, pop, uncle, grandma, you know, too soon because of things that could have been prevented because of, you know, the perpetuation of things that happen that, you know, cycles that can be changed. So.

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That's where my passion started with the work and I've been really diving and learning ever since. That's what I mean, I appreciate that story, Dr. Lee, because, you know, a lot of people that I have these conversations with, unfortunately, I say unfortunately, but unfortunately, a lot of our passion for the work, the kind of the antecedent to that was something negative.

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Or like the question, like, why is this happening to my dad? Why is this happening to my mother right now so soon? And then you start digging into understanding that a lot of it, you know, calling a spade a spade is because of racism. Right. And starting there, but now taking the information that you have and turning that into an action in that next step.

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Have you kind of, what have your feelings been around health equity? Now, when you started with that question, why to now putting it into action? How are you dealing with the ups and downs of trying to solve the problem? Absolutely. Great question. You know, thinking back to when I.

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When I first started exploring this work and diving in, it's almost like I was in kind of this major learning phase, right? Reading about different statistics, learning about the different history, historical contributors to help this bridge for African-American, just kind of learning the stuff that, you know, obviously you don't get taught in school. You have to go dig for it in research libraries and different things like that. I went from this kind of learning phase of, wow, how could I have not known this? All the way into now I'm in a phase of

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Okay, what can I do about this? But along the way, I'm also learning that there are a lot of areas to doing something about it. There's still a lot of work to be done around helping people understand that these health disparities actually exist. It's so fascinating to me that we can look at data and numbers for years and years and years, and yet there are still people that don't realize that certain groups are disproportionately suffering from medical chronic conditions and others. So I'm in a space right now where it's like.

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You know, how do we move the needle from just one, an awareness perspective to a application action perspective collectively for a problem that really is structural systemic and so much bigger than little things. And also, you know, what's wrapped up in all that is what I like to call convincing people to care. I feel like, you know, a lot of this work in the health equity space, you spend a lot of time convincing people to care, convincing people

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shouldn't suffer more than other groups of people. So you get wrapped up in this conundrum of what does it mean for me? Why should we care? This zero sum game of if we do extra to help eliminate the sprays on this end, who else are we taking from? Versus which we know that's not true. And it's really about how do we all collectively work together because we all want nice things. We all wanna live healthy. Heather McGee wrote a really good book called The Sum of Us. I don't know if you've heard of it, The Sum of Us, What Racism Cost Us All.

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Heather McGee, and she talked about how we all want nice things. We all want nice things. We all want to eat good food. We all want to be healthy. We all want our kids to go to good schools where we get lost in this conundrum of this zero sum thing, zero sum game that, you know, by helping one, we have to take away from another. So that's your question. Where I'm at now in health equity space is I'm really passionate about it. I mean, I'm really passionate about the teaching part of it, because I think we still have a long way to go helping people understand.

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the reality of what we're really talking about when we're talking about health equity and health disparities. I think people get caught up in thinking that we're talking about this buzzword that's about a couple of small little things that are happening from time to time that people don't understand that health inequity is deeply ingrained into how this country was started. And when people don't have those deep learns and deep types of things, you find yourself in a situation where you're always trying to convince people to care.

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Right. So I'm in a space right now where I'm just passionate about the fight. I'm passionate about continuing to teach and do everything that I can to help, to help educate around this and help eliminate disparities because, you know, I don't want people that look like me to continue to die too soon. I don't want people from other racial, ethnic or demographic or identity groups to not be able to live up to their fullest potential and realize their fullest health potential. So the health equity discussion or my mentality around it really has gone from my own personal understanding and learning about it.

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triggered from losing a loved one all the way to where I'm at now with how do you bring people along? How do you really educate and advocate? Because we both know, I think we're in a situation right now where there's not a whole lot of advocacy specifically around what we're talking about. The advocacy is around other kind of more soft terms and more soft topics that at the core of them is racism. I think one of you brought up a really good point on one of your other podcasts about

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We utilize these terms of social drivers of hell, these different kinds of things, and they're kind of more sensitive or more soft terms for lack of better words, but at the root of all these things is racism. So to answer your question, I'm in a space right now where I'm trying to, I'm trying to do everything I can to advance and advocate because that's what I think is missing right now. Yeah, and I'm curious too, you know, because of where you are,

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What is it going to take, and this is a hard question, I understand, it's a loaded question. But what does it take to get people to care without them being defensive? And what I mean by that is, I'm passionate about

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this group, right? Passion about black people and improving the lives of African-American people. That does not mean I'm not compassionate about other groups of people. But when we want people to be compassionate about group A, it's almost like this feeling of, well, what about these, it's almost combative. Right, right. And we want people to be compassionate for all. Like, I'm not gonna say the,

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You know, I'm not gonna say it. Right. But.

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When you're in those rooms and you're trying to educate people on what's going on in the African American community and why it's important for everybody, what are those conversations like? Because I can see people getting defensive, especially where the state that we live in, just keeping it a buck, right? Not everybody feels the same way we feel about it or they think it's exaggerated.

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or they don't think there's, it's not fair, whatever they think, or they don't wanna talk about racism because it doesn't feel good, right? It's uncomfortable. But how do you keep pushing on, how do we have this conversation in the meaningful way that everybody involved still learns something without it being a big, big issue? Right, absolutely.

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That's a great question. You know, as you asked that question, one of the first things I thought about was when I started my journey around this work, one of the things I noticed when either teaching about diversity, equity, and inclusion, specific teaching specifically about health equity, teaching specifically about different identity groups and why it's important to understand their lived experiences and things like that. One of the things I noticed is that at the end of the day, other times people don't really care until it directly impacts them.

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People don't care about diversity. People don't, or they, you know, they don't have the same emphasis or, or approach towards it, uh, that we do until it actually is impacting them. Until one of their loved ones is being discriminated against. Until one of their loved ones that maybe has living with a disability or needs something is in a situation where they need that extra help. It seems like one of the things that we have to do, or I try to do is I try to make it real for people. Here's what this could look like for you. One of the quotes I like to use with people all the time is.

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When we talk about equity, inclusion, access, those types of things, we have to be everyone's advocate because one day something could be happening to you and you might need somebody to advocate for you. You might, you might want someone to advocate for you could be in a position tomorrow where now you are a part of a different identity group, different group, they're different situation that needs advocacy. That's now, you know, a part of a situation where, yeah, you need help.

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And you're in that group that people seem to be like, why does that matter to me? Why do I care about that? So I try to think about it from the perspective of, we have to be everyone's advocate because we never know when there's gonna be the time where we need somebody to advocate for us. So in navigating situations, like you said, where you might be in rooms where specifically with the state that we're in, the state of Iowa, where we're talking about different racial and ethnic disparities, in a state where the specific African-American demographic

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lower compared to other racial demographics. It's almost like you do, you do experience that. Well, why them or there's really not that many of them here or those types of perceptions, and you have to try to flip that and say, here's how this impacts you though, you know, we might be talking about how type two diabetes outcomes influence or disproportionately influenced African-Americans, but you know what?

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living in rural areas also disproportionately impacts type 2 diabetes for particularly maybe white Americans that live, you know, 30, 45 minutes away from a primary care clinic. So what we're talking about here, when one racial and ethnic group also can impact you as well in this particular situation, just in a different way. So for me, sometimes I try to make it real for people for lack of better words, help them understand that, yeah, this involves you too.

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You know, or I sometimes I use the different analogies that we talk about how just basic things like the sidewalk where they built ramps on sidewalks for to really help with folks that are in wheelchairs get from street to street. I always use the simple analogy when they made and they created that. Yes. The intention of it was to help folks that with mobility issues that are in a wheelchair. But guess what? Whenever people have those baby strollers that are walking, they don't just drop the baby stroll off the side of the curb. They go down the ramp. People that have other mobility issues, they walk down the ramp.

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people riding a bike or whatever, they roll down the ramp. What was done and put in place to help one group that was struggling ultimately benefits all. And I think sometimes people don't think about if we were focusing on one group, it's only gonna benefit them. But these things are really focused on helping all of us. So that's my approach to some of these settings and discussions where we might be talking about one particular disparity with one demographic group in a group particularly where maybe that demographic isn't really represented.

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It's like, how do I switch it up and say, hey, but here's what it means for you too. And part of me sometimes feels like I'm playing the game a little bit. I'm circling around from the deal, the impact, because our group is really significantly more impacted for some of these things. But I found that when you make it real for people and you really tie it to them a little bit, then you start to get a little traction. Then you start to get a little bit of, oh, okay, I never thought about that way. This is a problem for me too. It's not just their problem. It's also my problem too. So that's my approach.

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if that helps and that answers your question. Oh, that's real. That's real. And it's called the curb cut effect. Yeah. Right. We should, I love that analogy. It's such a beautiful analogy because it makes so much sense. What you know what I mean? Like just one simple thing for one community can help just helping everybody. I love that analogy.

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You pointed out that various forms of racism, I'm talking about the document that you sent me about, that you sent me which was great, great information. You pointed out that various forms of racism, adverse, overt, and structural racism as root causes for disparities. And can you tell me, how do these forms manifest in the healthcare setting and impact patient outcomes?

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Absolutely, absolutely. So this specific question was probably some of my greatest learnings along my research and talking with participants and people that are a part of the study. And one of the things I think it's important to, starting with the aversive racism perspective, I think one of the things that's important to understand is that, particularly with the African-American community, nearly 75% of the time, whenever you are in a clinical interaction, you're gonna be in a clinical interaction that is racially discordant.

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meaning that the provider that you're seeing or the clinician that you're seeing is from a different racial and ethnic background than you. And what comes with that oftentimes when we think about aversive racism, so just to define aversive, aversive racism is subtle, unintentional, unconscious behaviors, actions, or perceptions that someone that might be vocally egalitarian, I don't discriminate, but still can portray aversive, subtle, racist behaviors

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patient care. So from the aversive perspective, you think about things like such things that patient interactions where maybe there's not, you know, good intentional eye contact between the clinician and the patient. Body language related things where it's like, I'm not really paying attention to you. I'm kind of dominating the conversation because unconsciously I'm already maybe thinking that you don't necessarily know a whole lot on your end. So let me go ahead and just tell you what you need to do and how we're going to do this. Those kind of subtle

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kind of body language and communication interactions between patient and provider. While well-intentioned, do send a kind of a diverse message that I need to do these things or act a certain way because you were from this racial and ethnic background. And oh, there are all kinds of different things. I remember an amazing story that a participant talked about was with experiences in clinical interactions where she could just feel the, maybe the judgment or the tone of the visit change.

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once the provider learned that they were on this type of insurance versus another, or uninsured versus having insurance. And so things like that through body language or behaviors or the way clinic visits get navigated can adversely and unconsciously and subtly send a discriminatory message to the patient. So what does this mean? Now that patient leaves that clinical action feeling disrespected, maybe not necessarily

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fully trusting the advice or the clinical instructions that they were given. And really it takes away from, they walk away from a sense where they didn't have the opportunity to really co-design what's happening in the situation. They aren't being empowered and being seen as the CEO of their own health or how they feel. You know, not feeling heard, not feeling seen. So those are just a few body language and things like that that happened during the.

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The visit can be a verse of subtle things that are taking place that send messages to not only African American patients, but pictures of all kinds of identity groups. If you're not aware of that, thinking about kind of from a truck structural perspective, you know, we can talk all night about the structural pieces starts all the way back with historical racism, redlining and things like that structures that were put in place a long time ago that are still manifesting themselves today. But some of the things I think about just kind of on every day.

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structures or policies or things that you see across health organizations are. Sometimes we have policies and procedures in place that in and of themselves, they, they seem well intentioned, but they create structural or, or, or disproportionate structural discrimination towards groups. So I think about things such as like no show policies or different things like that, sometimes where, you know, we might have somebody coming in or trying to come to a visit there one minute late because we don't know what they had to deal with to get to the appointment.

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They might have to get on three bus lines. They might have to leave work. They might have had, this might have been the only time they could have came and we'd no show them, we don't see them or it happens multiple times, we penalize them. Now they're not getting care that they've seen. So that's just exactly one small policy that while it's well-intentioned, it's in place to make sure that we are able to kind of ensure access and manage schedules, but it also structurally disproportionately or could discriminate against folks who have different barriers and it keeps them out.

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of the clinic or the health environment, we want them to come in. So things like that, hours of operation, offering services only at certain times, not really thinking about your patient population and what schedules they might work. I think about, sometimes if you think about hours of operation, right? And most places are open, eight to five, eight to six, we close. That's our normal operations Monday through Friday. The weekend, everybody's gone.

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But when you think about particularly in the area that I'm in, we've got lots of different meatpacking plants and organizations that work well into the night that have three different shifts and things like that. So in and of itself, just by the way, and when you're offering services, there are people that structurally based on how you were designed can never come see you because when you're open, they're at work, you know, just different things like that, that I think oftentimes they're well-intentioned things that are just the way we operate or the way our structures and policies and systems are built. But

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They do, they're set up in a way that disadvantages people and leads to them not coming in and receiving preventative care, which continues them down that road of developing chronic conditions and things like that, that ultimately get exacerbated and then once finally understood, or maybe at a condition where it's nearly impossible to manage or people are suffering from complications, and then ultimately passing away. So from a structural standpoint, those are some of the kind of subtle everyday things that I think

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are in place that probably anybody that's working in a health environment has maybe experienced as far, but maybe haven't thought about it through the lens of how does the way we have these policies design, who does it benefit and who does it leave out and things like that. So that's what I think from a structural perspective. And then I also think that oftentimes in the healthcare environment, we make assumptions about clients based on an experience with another client.

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One of the things I've seen that might be not so much unconscious, but even a little bit more as we talk to talk about overt. Maybe we've had an experience or clinicians had an experience with a patient that was maybe not favorable, something happened for whatever reason that was our favorite interaction, but now they're carrying that on to the next patient that they see that comes from that same particular identity group and the next patient that they see, the next patient that they see. So now you're starting to create this microcosm of.

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you know, actions based on one experience. And I'll give you an example of how that can be turning a change into a structural issue that can go beyond one organization. So there was some really good research I read years ago about what can happen whenever people are putting discriminatory or biased information in medical records and documentation. So let's talk about maybe the term that people like to use non-compliant, right? So.

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maybe medical providers or clinicians, they have an experience with a patient that maybe for whatever reason, a patient might have these social barriers that are preventing them from taking their medication consistently. Like maybe they can't afford all the time, or maybe they don't like the way they make it feel. They have other competing priorities that keep them from always perching their medication. But what happens though, is that we mark that patient as non-compliant. This patient is a compliant. We're creating this perception about this person that they don't care, right? And things like that. Now when that patient goes to another health professional,

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and another health care setting, and they called and they wanted to receive those records. Now they see, oh, I see in their chart that this is a non-compliant person. So now that clinical action starts with, hmm, I have in front of me somebody that doesn't care that's not going. So little subtle things like that that can even turn into things that are built, that become built into the systems that we use, perpetuate bias and aversive behavior in the health care setting. And that's not just for African-Americans. That's for, you know,

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identity groups of all types. So those are some different structural types of things that happen in the healthcare setting that perpetuate bias, discrimination, and ultimately negatively impact health outcomes for folks living with different chronic conditions. And in this case, we're talking about type two diabetes. So what's the solution? Like what is the solution to improve that interaction? Because I've seen it. I've seen those notes.

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You know what I mean? And it can, you try to go into each conversation with everybody, um, with the same energy, but it's hard to do. You know what I mean? And what, what's the solution there? Like, what is, is it an education solution? Is it when we say structural change?

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Um, is it something, is it a system, like an overall system change, not just a hospital can do this, is it an overall language thing? Like what's the, what's the solution there? Yeah. So I think that last you said, this is a, this is a problem that has so many tentacles facets, um, like you mentioned in one of your, in one of your podcasts. This is like one branch on a tree that has a thousand branches, right? But one of the things I think about that we can do as far as the structure is, if you think about.

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I always talk about how people are ultimately influenced, not by an educational pamphlet that you gave them, not by, you know, some of the things that are influenced by people. So in the healthcare space, we know that in different racial and ethnic groups, there's a lack of medical providers from different racial and ethnic groups, things like that. So ultimately, you hear this concept of trying to make sure that our workforce is more closely represented in the communities that we serve. And there's a lot of importance in that.

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You know, people, there's trust built in people when you can go to a provider and there's someone that looks like you, someone that shares your culture, someone there that understands your perspectives. And not that somebody that might be in a discordant cultural position as you can't, but there's value in it. There's literature that tells us that whenever a client sees a provider that has concordance, whether it be racially, culturally, language, they're more likely to come to their appointments, the patient interaction is better, they're more likely to listen and follow treatment recommendations.

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They're more likely to feel like they're real with a code design, their treatment recommendation with them. They are more, they are at least having better health outcomes. So one of the things I think from a big structural thing is how do we, how do we diversify the healthcare workforce more? We've got to get more folks in the healthcare space, more closely reflecting folks that, that they serve. And not that, that, that racially or ethnically discordant or interactions can't be done well. I think with good education and good understanding about cultural norms,

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Any interaction can be good. If I have a deep understanding of the background of the person that I'm sitting in front of me, I can have a great interaction with them because now I understand where they are, what they're coming from, and those kinds of things. But those things do take deep, intentional training and learning and understanding, not only about the basics of someone from a different identity group, but what are the cultural norms? What are their perspectives on how they view medicine? What are the different, what matters to them? How do they review the world?

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I know in the space that I work in, we have clients from around the world that might have a whole different worldview about healthcare coming into our system. And so when we're not aware of that, that's when we have these scenarios and situations where we're not on the same page with how to help folks and people get left behind and there's these interactions that don't lead to better patient outcomes. So that's one of the things that we can do. It seems cliche, but we got to figure out how to...

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how to help our workforce be more closely representative of the clients that we're serving. And that can look different in every geographical area, right? 100%, 100%. Oh, go ahead, I'm sorry. No, go for it, go for it. One of the things I was thinking too is just kind of leaning back kind of to a, from a maybe structural policy perspective, I think one of the things that could dramatically change the health disparity discussion is if we started to see more things that we're starting to see as it relates to

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accrediting bodies and places coding, not necessarily hold people accountable, but having standards for improving health equity. Having actual standards and accountability around improving health equity that might be built into accreditation, built into payment, built into these types of things. So ultimately we're in the health system right now. We're still, we're still fee for service. We're still pay for, get a man, get him out. We're still in a payment structure that doesn't support the importance of

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really trying to improve equitable health outcomes for everyone. We're paid to see the patient, not ultimately paid to improve the health outcomes, particularly in the discussion we're talking about for different diverse populations. So policy change and structural change around how we're paid, um, ultimately would make an influence. But we know that in and of itself would be a huge undertaking, but that is ultimately what drives healthcare is how, how it's, what, how it's getting paid for. So that's one thing I think about as well. And

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And to kind of bring it back to something you said earlier, the way that payments, that system that we're in, what happens? You have providers that have faster 15, 20 minute appointments, right? Maybe sometimes less. I think the average is still 15, 20 minutes, but I think, or maybe even less than that, something like that, right? But what happens though? You have a patient that really has questions, wants to learn more.

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Got go, boom, now what? They feel disrespected. They didn't get nothing. Now they're not, oh, my provider doesn't care about me? Oh, I'm not coming back. You know what I'm saying? Or they schedule appointment knowing they ain't coming back. Right, right, right. Right, right. You know what I mean? And it creates this ugly pattern of we were there to serve the patient, but in order to serve,

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the patient, it's all about the money. And if they ain't got insurance or, or, you know, I, I ain't got time. I got, I got three other patients. All right, what you got? Or nope, boom, we'll have the nurse call you out of here. Next one. Well, I don't know. I'm not in the rooms. I don't know if it's like that, but they, they turn them out because of the system that we're in and that's causing more issues. Absolutely. You're exactly right.

35:28
You couldn't have said it better. At the end of the day, our system is designed as an assembly line system to see patients, see patients prescribed, get them in, get them out. It's not designed to be intentional about education, trust building, relationship building, the things we talk about that helps people be truly influenced by the person that's delivering the care for them. So I think you're totally, you're 100% correct. And you know, I think another thing just kind of, if I could get back into a little bit about

35:57
Some of the things I learned with my research is I learned so much about the tattoo diabetes condition in the African-American community. So one of the, one of the major themes from the study was that ultimately the negative impact of a versus racism, discrimination, those type of behaviors. It is live and prevalent in the area of Iowa that I'm in. Every participant talked about, um, experiencing racism in community settings like the grocery store with law enforcement.

36:27
you know, outside walking my dog and someone treating me some type of way, all those kinds of things. That was, that was a major theme that came up with the study and I'm going to explain in a minute why I think that's extremely important. The second theme that was super important is that a lot of the folks that I've worked with talk, what the stories they told ultimately emphasize that there is still a level of African-American mistrust in the health system overall that goes all the way back in history to the days of Tuskegee, to the days of

36:57
Dr. J. Marion Sims, to the days where African-Americans were treated as property and not human and unethical medical experimentation and things that have been done to our people, that mentality has been passed down through generations. Those stories are still told. So we have to understand that from African-Americans' perspective, a lot of people we've been taught that, hey, we don't go there unless our arm is literally falling off. We don't go into those spaces because your grandpa, your great-grandma, they were a part of the situation that this happened to them.

37:26
So that was a major theme that emerged in the study, which I'll talk a little bit about why that's really important. The third thing is that income barriers consistently keep folks from accessing routine care. And what's wrapped up in that is, there's literature out there that talks about how the single most important or the single most prevalent social determinative health barrier is income inequality. So,

37:55
When we have situations where certain groups disproportionately earn less than other groups, when we look at the literature, African-Americans typically earn less than all other racial ethnic groups across most industries in all facets. That's why we see these situations where there's a lack of consistency in being able to consistently afford the access and care. So income inequality as a big theme. Another very significant theme that I think is important to talk about is,

38:25
Most of the clients I worked with or what I learned along the journey is that nearly 75% to 80% of them, they found out that they had type two diabetes because of an emergent and crisis type situation that happened to them. So they passed out in the grocery store. All of a sudden they lost feeling in one of their limbs and they went into the doctor and found out they felt really sick in the middle of the night and had to go in and were finally told that you actually have type two diabetes. So what that means is our.

38:54
population, our folks, our people, we're finding out that we have these conditions once they've reached the point that they're nearly unmatchable. Once you start finding some of these conditions, finding out these conditions, when you start having some of these side effects, this is typically after you've had the condition for years. You've had this for years and now it's gotten to a point where you're starting to have, you know, physical reactions in these crisis emerging things. So that was the theme. And then the final important thing that I think is important to talk about is what you talked about right in

39:23
how growing up in your family, learning about the condition, you know, your grandma had diabetes, those folks, they just took medication. They're like, oh, that's just, it's a normal thing. In our community, through this study, I learned that there is that feeling or mentality of a sense of inevitability, right? Because mom and grandma had type two diabetes, I'm gonna get it too. I know I'm gonna get it, right? So you go, so we have folks in our population going into this mentality that why go into doctor? Why care? Because since they had it, I'm gonna have it too. And

39:52
that narrative is pushed too. Yes, you might be more predisposed to capturing this chronic condition because more than likely you were in those same social and economic conditions that led the person that maybe is your aunt or uncle down that road. But just because someone in your family had diabetes, that doesn't mean that you are gonna attract diabetes. So that's a learning in me tie that I think is wrapped up in some of this that, that sense of inevitability that I'm gonna get this condition because they got it. So why care?

40:22
And then when you layer all these other things that we've talked about over the last 30 minutes on top of that, that's, you know, at this makes this probably even worse. Imagine you have all these factors and then you've been taught or you've been conditioned to think that, you know, because your skin is darker, you're going to get it anyways. You know, you put all this together and it's like, you know, what the heck, right? So I say those things because one of the biggest learnings, getting back to your question on.

40:49
the forms of racism that manifest in the healthcare. One of my biggest learnings going along this journey is that whether the racism be aversive, so subtle, unintentional, unaware of, whether it be kind of overt, like intentional acts that, whether it be historical things that happen that have longstanding impact today, or whether it be just kind of overt, specific things that actually are doing, they all have...

41:18
the same impact. They all lead to worse health outcomes for people of color. They lead to them dying sooner with lower life expectancies and things of that nature. And why I say that is that I think sometimes in society we kind of try to categorize the different types of racism, right? This type of racism is way worse than this type of racism, is way worse than this type of racism. But at the end of the day, if a person is being perceived that they are being discriminated against in any form,

41:46
the outcome and the road and the perpetuation is the same. So that was one of my biggest learnings around this is that no matter what form of racism we're talking about, the impact is the same. And a great thing that I thought about and I learned is that when somebody influences or they experience racism in a setting, so, Corey, you've gone to the grocery store and you had an experience where you felt like somebody was kind of following you around and watching you, you know, because of the color of your skin and.

42:14
perceiving that they're maybe thinking that you're going to shoplift or whatever. That experience that you experienced there, you're going to carry that with you whenever you show up at the doctor, whenever you're around somebody else that might have looked like that person that was at the grocery store. So now when we think about discrimination in the community settings that are outside of healthcare, people carry those experiences into the healthcare setting. Even if we solve the problem of beings particularly super intentional about

42:44
how we address racism in healthcare, in the healthcare setting. If we don't address racism in other community settings, those things are gonna come into the healthcare space. They're gonna come into the health setting between the clinical interaction. So like you said, a systemic approach, that's why we have to have the conversation, as you say, name racism so that we can change it because racism happening in all settings, different settings, they all intertwine and it affects each other. So I just wanna share those learnings because those are some different types of things as it relates.

43:14
to the research and to this condition that we have to think about and address if we wanna really eliminate health disparities. Health disparities are more than just things that can be tackled in the clinic when you're in the office with the doctor, right? This is systemic, structural, societal work that has to be done that takes a collective approach. Man, Dr. Lee, thank you so much. This was such a great conversation.

43:44
For those that want to learn more about the work that you're doing, connect with you, where can they find you? Absolutely, well, I'm located in the Sioux City, Iowa area. Again, I'm a medical professional working for FQHC in Sioux City, Iowa. I can provide my email information, contact information to you that can be maybe posted on this blog or this podcast so I can provide that with you. But I'm always...

44:13
down to have a conversation with people to share learnings, to learn from others. I'm always open to learning about what have others done to really try to improve this health disparity, this health inequity equation with the goal of trying to improve health equity for all. I've been blessed to be able to work for an organization with the mission of organizations inspiring and empowering our community to help equity for all. So to be able to work for an organization where the organization's mission is aligned with my personal values, I feel lucky.

44:42
Any opportunity that I can get to connect with people, share ideas, talk about things just as we did today. I'm all for it. So, you know, you'll have my contact information. We can put it out there. Sure, we can jump on another one of the healthy podcast. Fantastic. This platform and we can share ideas. So, yeah, absolutely. I'm not hard to find. Awesome. Awesome. Well, again, Julian, thank you so much for being here on the podcast. Everybody.

45:10
Thank you so much for listening to the Healthy Project podcast. Please like, subscribe, review. All that stuff helps the podcast grow to get to more people and to spread this valuable information to all. Again, thank you so much for being here. I'll highlight you next time. Thanks bro. I appreciate you.

45:34
Hey, thanks for joining us on the Healthy Project podcast. At Healthy Project Media, our mission is to connect with the next generation of health leaders and innovators. If you're interested in advertising with us or exploring collaboration opportunities, please reach out at hello at heal We look forward to growing this community together. Until next time, keep pushing the boundaries of health.