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Yahoo Finance Presents: Dr. Marcella Nuñez-Smith

On this episode of Yahoo Finance Presents, Dr. Marcella Nuñez-Smith, the White House COVID-19 Health Equity Task Force Chair, sat down with Yahoo Finance's Anjalee Khemlani to discuss how the COVID-19 pandemic has brought to light the imbalance in America's health equity.

Video Transcript


ANJALEE KHEMLANI: Lots going on in that health equity space these days, especially with the focus from the Biden administration. Joining me now to talk about all that and more is Dr. Marcella Nunez-Smith, the chair of Biden's Health Equity Task Force. Dr. Nunez-Smith, thank you so much for joining us today.

MARCELLA NUNEZ-SMITH: A pleasure. Thanks so much for having me.

ANJALEE KHEMLANI: Of course. Let's start off with what's going on with what we've learned from the pandemic. That is the clearest point of reference for everyone who is either just waking up to or just learning more about health equity. We know we've seen the disproportionate impact. And you said yourself recently at an event that we cannot unsee what happened in 2020.

So let's go from there. What are the steps moving forward? How do we not repeat the past of what's already been done in research and actually start moving forward?

MARCELLA NUNEZ-SMITH: Absolutely. You know, it is so true. We've had this collective witnessing. And this has been most certainly a difficult year for everyone and even more so for some among us. I mean, we talk about, again, whether risk has been with exposure in cases of hospitalizations. We say even death and loss.

And so the grief gap is even real across our communities. So important, I think it's a rallying cry for us. It's urgent. We need this moment. And we recognize and acknowledge all that got us here. When we talk about disproportionate burden, that it is this reality around social structural drivers, determinants that got us here.

And so, I mean, the president has been really clear. He signed day one, really, in office his first full day, executive order that brought the task force into existence-- a deep honor to share that and work with everyone in that space but also to be working with the White House COVID-19 Response Team as a senior advisor and to just be here to say equity is at the center of all of the work.

And you're right. We cannot just sit around admiring the problem anymore. As a researcher, I challenge my colleagues. I said we cannot just continue to describe these inequities, disparities. We have to all be committed and recommit now to the interventions. And that's a policy and practice that will get us to a different and a better normal we have to.

ANJALEE KHEMLANI: Well, let's talk about those interventions and practices because from my experience covering this, I've seen a plethora of pilots. And some of them stay really small scale. Or some of them just die out without funding, without really any backing.

There seems to be no incentive in the health industry to keep some of these efforts going. How do we change that? What is needed? Is it financial? Is it policy?

MARCELLA NUNEZ-SMITH: Yes. And so it is absolutely all of that and more. We need that will. We have to be thinking about where incentives line up. I'm a practicing internal medicine physician.

I certainly work. I'm part of a health care system, understand this on the ground, and see where oftentimes within the systems, there are not by intention, right, but that there are systems and centers in place that really complicate this and often work counter to the goal that I think a lot of us share and a value that we share, which is equity. And certainly within our health care systems, we want to deliver equitable care.

Within that larger pie, we know that clinical care is about 10% to 20% of the variants of differences we see in terms of health outcomes. So often as we'll say, well, that's a little bit. I mean, it's not the majority. But certainly, I think it's areas that shouldn't be there.

We have to get rid of that, right? Why should that matter and of what door you walk through? What should it matter the zip code you live in and the health care that's closest to you. We have to be sure we're incentivizing quality as well as equity.

We have to have to, have to get set up. What who is now the National Academies, what was Institute of Medicine said equity is a core component of quality. And I think now's the time for us to really go deep there. But also, that same pie, we're looking at the majority-- 16% to 80% of what drives differences in health outcomes-- just another way of saying inequity is the social structure reality.

And this is intergenerational legacy. You know, the limited access to resource and opportunity that has been the reality for far too many communities that has tracked with things, like housing segregation. And so in this moment, We have to be able to lift up all of that and address all of that.

And President Biden, Vice President Harris-- they have charged the whole of government to be able to anchor, to center, and equity in all the policies. And that's what it's going to take for us to make a difference.

ANJALEE KHEMLANI: Well, clearly, you're part of it is going to help advise those policies. I'm sure we're going to see something run through Congress or through executive orders come out. But then when it comes to the financial incentive side and really the financial burden side, going back to the pilots that I've seen we've talked about-- food trucks that deliver produce, food pharmacies, housing. And all of this is taken on either by the payers themselves or by hospital system.

There seems to be no central point of agreement of who is shouldering the cost for this. And it looks to me there is no answer right now. And that also mirrors what we see in the data world. We have researched for years and years, decades and decades, pointing to the problems, pointing to potential solutions. And nothing has been done. How do we get unstuck?

MARCELLA NUNEZ-SMITH: Yes, absolutely-- couldn't agree more, right? And I'm so grateful, because we have to name them, right? When we talk about these drivers-- or what are we talking about? It is what you said. It is housing, right? It is thinking about nutrition, access, nutrition, security.

When it comes to housing, it's stable housing but also, housing that is a good stock, right? So how do we push? And this is a challenge that we have almost uniquely in our country, right? Sort of the barriers that we put between where health ends and begins.

And too often, we default to this assumption that health and health care is synonymous. And we know that, in fact, other countries-- are pure nations have taken an approach that says, look, it's about the social service sector and safety net in combination with health care delivery. That's how you ultimately get to health.

So I think you're right. We have to push on these conversations about what exactly is a health dollar in our country? How do we think about the financial ownership of important-- what we hopefully are all going to understand or just key.

So really, the ROI is there. When you mentioned the pilots you see where health care systems have stepped out and said we're going to take charge of nutrition access-- we're going to take charge of housing stability-- you know, certainly good people, but also good business sense.

And so being able to recognize that the ROI for us on a grander scale when we really make the investments, we need the infrastructure. We need-- and that is whole of society. That is multispectral, right? There is a role certainly for government to play, but also the private sector. And, of course, nonprofit, as well, to get to those solutions that we rightly need and go from pilot to default practice.

ANJALEE KHEMLANI: And I feel like they've gotten some of that practice in for that with the COVID vaccine experience, looking at community centers, looking at the pharmacies, trying to figure out really how to get in touch with a broader spectrum of people and especially considering the digital divide and the low tech solutions that needed to be brought to light.

So all of that put together kind of sets a tone, I feel, like for what you're looking for in that three-part solution. But when it comes to looking at the data part of it as well, you have said most recently that there is still a lot of data that is yet to be seen. What you were able to glean from the vaccine data and able to target areas then, how do you translate that into the very complex health care space, because it could apply to health services or prescriptions. There just so many options.

MARCELLA NUNEZ-SMITH: Yes, yeah. And absolutely. And once again, I think this is an end scenario, right? We have to be able on all these fronts. I think you're so right. We are learning a lot in terms of the vaccination campaign and what it takes and, of course, the degree of intentionality, which we all knew, and being able to understand what role each player is going to be able to contribute.

Understanding equity is hyperlocal at the end. But there needs to be resources. There need to be infrastructure to support that and push that. So I do think there are a lot of lessons we can take and translate from the vaccination campaign. To health care and moving forward-- and I think just critical.

Just a spawn of an opportunity, quite frankly, if we don't. And it is. Whether we think about and of what will still, what will go even from this past year, the access people were able to get from telehealth and telemedicine platforms. But again, not everyone.

What were some of the barriers to people being able to access services in that way? What, again, were some of the incentives that maybe were misaligned? When we think in the early days of telehealth coming out and that you needed to have a video, right, in order to get kind of full reimbursement and knowing that everybody had a smartphone in that capacity.

So having that interrogation of the policies and practices going to be really key for us moving forward without doubt. But it is true that the work around the data infrastructure fundamental, I've had such a learning in terms of data architecture in these past months and understanding where some of those limitations are.

Most certainly, we have to have conversations about why these data are important, like equity data are important to them to drive our resources to target what we need to do to hold ourselves accountable, quite frankly. We need those data. But there's a lot of work to do on the data architecture front as well.

So we have those resources-- data modernization resources. But we need to implement those. And it is about not just health departments, as you say, but providers and health care delivery systems to be able to modernize, prioritize the data collection and not stop there.

We have to collect these data. But we have to think about our data sharing. We have to think about data privacy. We have to think about data governance. There are many communities that have been harmed by data. So that's an important part of the sentence.

Who's going to be at the table to think about data usage? And then how do we make sure that those data drive metrics drive changes in behavior, drive outcomes, and accountability?

ANJALEE KHEMLANI: That and so much more we could continue talking about what will have to end in here. Dr. Marcella Nunez-Smith, the chair of the Health Equity Task Force in the Biden administration. Thank you so much for joining us today.