HEALTH INEQUALITIES WITH DR. MICHELLE KITSON

Dr. Animalu, Infectious Disease Specialist interviews Dr. Michelle Kitson, Internal Medicine Physician in Memphis, TN focused on the devastating statistics of health inequities in Shelby County, TN.  

Health disparities in Shelby County, TN, highlight significant inequalities affecting various populations.

Shelby County scores 0.909 out of 1.0 on the BlueCross Health Index, slightly above the statewide average of 0.907. This index indicates overall health quality, where higher scores reflect better health outcomes.

 Health outcomes vary notably by race and ethnicity, with certain groups experiencing higher rates of chronic diseases and lower access to healthcare focused on disparities related to domestic violence and racial and ethnic inequities.

@Medical Class 901

Transcript

SPEAKER_02 0:00

Welcome to Medical Class 901 with Dr. Chi. I am Dr. Chinello Animallo, Infectious Disease Specialist and HIV specialist and a professor of medicine at the UT College of Medicine. And today I have a very special guest with me. She's a close friend of mine, a phenomenal physician, and the immediate past president of the BLOS City Medical Society here in Memphis, Dr. Michelle Kittson. Welcome to the show.

SPEAKER_01 0:30

Thank you so much.

SPEAKER_02 0:32

So today we will be talking about the health disparities, not just um in total, but in our Memphis community, which is our dear community. And what this means basically is to discuss those issues that do affect the minority populations or communities here in the Memphis um area. And so I'm gonna start this off with you know talking with Dr. Kitson. She's an expert in this field, and so she's gonna give us a little bit um rundown on what health disparity is all about. Dr. Kitson.

SPEAKER_01 1:06

Thank you so much for having me, Dr. Chi. So health disparities are um social, economic, um, educational um imbalances that tend to impact um health outcomes. It impacts how people interact with the healthcare system, and uh ultimately uh can lead to uh shortening of patients' lifespans, um uh huge economic losses with time missed from work, because people are unwell, uh, they're not able to engage in the system when there is no disease, so we can work on the preventive side of things, and therefore, when they do come into the healthcare system, the cost is tremendous because due to a lack of education, a lack of access to good food and other things like understanding what our activities and actions that would lead to good health, then by the time they engage with us at the healthcare system, particularly in the emergency departments, things have gone way further than they need to. And so um, with a lot of minority um populations within our city of Memphis, there is a lack of um access to good food. There are lots of communities that do not have supermarkets, there are lots of communities that do not have uh access to transportation. If you can't go to the supermarket, if you can't go to the farmer's market, then you don't have access to good foods to promote good health. And if you don't have the right nutrition, then that leads to the development oftentimes of chronic medical conditions like high blood pressure and diabetes, which then can lead into end-stage kidney disease, which of course then can drastically reduce uh the quality of life and the length of life.

SPEAKER_02 3:18

Absolutely. This is amazing. Now, let me ask you um you were a practicing physician in your practice. Is this something that you have seen that's kind of rampant? You've seen kind of experience this amongst your patient populations.

SPEAKER_01 3:34

Absolutely. So I trained in Nashville at Maharry Medical College, and um a big part of our training was to serve the underserved, and that's actually what led me to this community. Even though it's urban and not rural, there are lots of health disparities that exist and therefore lots of underserved populations. I work in Midtown, I work with um a wide range of ages of patients, and while I do have a few who are affluent, there are many of my patients that are struggling to decide whether or not they can afford to pay for medications, buy good food, keep a roof over their head, um, the quality of the air that they're breathing. Um as we are getting closer to hot weather, it is tremendous. The number of patients that are struggling to pay their utility bills, with the cost of living rising every day. These are all things that increase stress in patients. With increased stress comes increased inflammation, and it actually does a really big number on so many aspects of the patient's life. Their mood, uh, when you're depressed, you're less likely to eat healthily because you'll be more attracted to things that are high in fat and high in sugar. Those then lead into uh the possibility of developing heart disease, developing uh obesity. And unfortunately, a lot of the treatments that are effective and available to treat those diseases are way beyond the reach of um a lot of the patients that are in the catchment area that I take care of. And so, yes, unfortunately, um it is heartbreaking, but there are many people, um, both children, young adults, middle-aged, and elderly, that are suffering needlessly because um there's such a great um disparity in the lack of access that people have to good nutrition, uh good information, and of course, there's lots of misinformation that's available readily on those devices we call cell phones.

SPEAKER_02 5:59

Absolutely. So, I mean, what you just talked about, what you just mentioned is also something that, you know, is around us that you know is very common. I do see that in my own practice too. But um, I'm just kind of curious though, you know, we talked about one of the things you mentioned was, you know, things like depression, you know, and mental health. Mental health is something that I know it's part of when we talk about health disparity and inequality, is something we tend to worry about, especially in the minority um populations. Is that something that you're you know you've seen also like um patients? Because I'm just gonna assume that someone who does not have enough food cannot do not have transportation or able to, you know, get to the supermarket, have, you know, good school system and stuff like that. I I would just assume that you know you're gonna worry about the mental health and part of that, the mental health impact. What do you think?

SPEAKER_01 6:57

Absolutely. The tragedy there is that for very many years, um society didn't value um mental health professionals, psychiatrists, psychologists, uh behavioral therapists. And um, with us recently experiencing a completely life-altering pandemic, um, where we were isolated from each other, we are meant to be community. The truth of the matter is from the beginning of time, we've always tried to um gather with people that recognize and share common goals and uh thought processes. And so when people were isolated from each other and unable to interact, it it it we saw a tremendous uptick in um conditions such as major depression. And when you don't have access to professionals to help you cope well, then people tend to turn to um coping mechanisms that actually make things worse: alcohol, smoking, vaping, the use of these substances to try and escape, but typically what then tends to happen is that they exacerbate or worsen things like asthma and COPD and heart disease. And so it's been quite tragic. The truth of the matter is if my patients, who are typically adults, come in seeking care for me for their high blood pressure or their diabetes, if I am treating them for these conditions, but I am not addressing the fact that the reason they are eating poorly is because they don't have access to things that are more nutritious for them. If I'm suggesting to them, hey, why don't you try eating this, that, and the other, but they can't actually afford it, then I'm not really helping any. And so that increases the uh depressive symptoms.

SPEAKER_02 9:04

Absolutely. Thank you, Dr. Kitsing, for that piece. This is Medical Class 901 with Dr. Chi, and we're gonna take a short break and we will be back. Welcome to Fun Facts with Dr. Qi. I am Dr. Chinello, Animal Infection Disease Specialist and Procine. So, we're gonna talk about just some basic points, you know, about HIV. So, what does HIV mean? Human immunodeficiency virus, which is a virus that we can, you know, pass from one person to another through sexual intercourse or share, you know, sharing body fluids or through blood transfusions or by sharing needles. About 39 million people are affected worldwide, and it's a major cause of mortality in the world, meaning dead because it's dead. And um, the the end part of HIV is called the AIDS, and this means somebody that has untreated HIV infection, and this would have run for many, many, many years, and sometimes some decades. You do not get HIV from kissing, from hugging, from sharing um utensils, you know, in the households with people. You don't get HIV by saying hello to anyone. This is Dr. Chinello Animal, the host of Medical Class 901 with Dr. Chi, and this is the show that talks about the major infections that plague us here in our Memphis community. So please make sure you tune in every Sunday at 6 30 to get a glimpse of this class. See you then. Welcome back to Medical Class 901 with Dr. Chi. I am Dr. Chinelo Animal, infectious disease specialist and HIV specialist. And today I have a special guest with me, Dr. Michelle Kitsen, an internal medicine physician who is joining us today. And we have been talking about health disparity as well as health equity in our community, especially in the Memphis area. And so um what when we talk about health equity, it just basically means health justice or where you have equal access to resources, power to the entire community, not just to a specific um group of individuals. And so, residents of impoverished communities, when we talk about that, we mean residents of a community with um, you know, less money than the average, um, are always at increased risk for mental illnesses, chronic diseases like diabetes, hypertension, um, they're also at higher risk of mortality and decreased life expectancy. So, Dr. Kitson is here with us, and um, she's a practicing physician, internal medicine physician, and this is something uh she deals with every day. And so she um basically has been trying to help us understand what this health disparity in our community means. So, Dr. Kitson, over to you.

SPEAKER_01 12:10

Thank you. Again, um ultimately the workforce uh is impacted. People who are unwell are unable to go to work. They're more likely to miss days of work, they're likely to miss days in school, therefore, it impacts the um future of our children when they don't have good nutrition, when they are um more inclined to develop diseases like obesity and overweight. Um, they're uh develop conditions like uh osteoarthritis, which is you know pretty bad joint pains, and they can actually find themselves with uh crippling um physical conditions um by the time they reach middle age. Uh many of our youth are not participating in um PE like we did when we were growing up. And um, with that in mind, um they are more sedentary, they are less likely to be engaging in activities that would lift their mood and spirit. Exercise is a phenomenal free way of being able to improve your health. But if you don't have a safe place in your community that you can come to without worrying about crime, theft, murders, then that robs you of your vitality and your ability to be a uh productive and um contributing member of society. So this impacts everybody. And therefore, it is important for the wealthy and those that aren't wealthy, for our elected officials, for our community and social support systems to rally behind trying to bring about justice so that everyone can do better. We're only as good, we're only as healthy as the least healthy among us.

SPEAKER_02 14:09

I'm glad you did mention that because that's something I was thinking about. Like, as a community, what can we do like for us to come together and see how we can improve this, improve the health, um, dissipate, you know, in our community. And for us as practicing physicians, you know, what do you think, what role do you think we can play? And then the community at large, every single one of us, because like you say, it's something that affects every single um person, regardless of, you know, what your race, what's you know, what job or you know, what you're doing.

SPEAKER_01 14:43

Absolutely. So one of the things that I think um as physicians, we we tend to um go from a perspective of wanting to take care of people. And sometimes we can be a little arrogant, thinking we know exactly what people need. It is really important to be out there in the community, speaking with individuals and hearing from them exactly what it is they need, where they think that we can be of assistance to them, of benefit to them. Um, we don't always have to reinvent the wheel either. There are places that will have community gardens. We are a city, but we're quite close to some rural areas. We can drive those of us who have vehicles to places where in Arkansas, where there's lots of fresh fruits and vegetables. If we can organize and arrange to get those things into communities that do not have access to transportation, I think that's one great way that we'll be able to improve some of the conditions of our patients.

SPEAKER_02 15:52

Absolutely. And so uh one of the things that we see a lot in a community would be things like obesity, um, diabetes that kind of you know affects more of the minority populations. Um, do you think this has anything to do? I mean, it's part of the health um disparity we talk about, but is this something that we can, you know, educate um our community members, the public on ways to prevent this? You know, you you talked about you know, perhaps going to places like I can store the rural areas where we can actually get uh more, you know, healthier foods. And also would I say educate our kids um on what would be considered healthy foods and uh what would be considered something um unhealthy.

SPEAKER_01 16:44

Well, that's that's huge. So a lot of times our um society has moved us towards quick fixes, things that you can grab and go. And so if all you have in your community is a convenience store that has takis and chips and cookies, and that's what you grab and provide for your children because it's a quick fix, uh, there tend to be lots of food additives, high sugar, high fructose corn syrup, and these are known things that do actually um put a burden on the body. Um, the body does not process these things very well, and so if we could sub in an orange or grapes or plums when they're in season and get natural sugars as opposed to the manufactured ones that are quick grab on the shelf, then we can actually do much better as a society. Children actually will enjoy preparing foods and eating healthy foods if someone is able to do that with them. Unfortunately, in a lot of minority communities, um they parents are working too much, they're rarely at home, and children are either led to their own, left to their own devices. So I think it's time for uh places such as community centers to be um reinvested in, reinvigorated for those who may have children who are older, grandparent ages to get more involved, to adopt a family, adopt a few children, help them to um understand, you know, the importance of drinking water as opposed to, you know, juices and drinks that tend to make you more hungry, um, cause you to gain weight, and with the additional weight comes the additional burden of the major medical conditions. So I think sleep and exercise are also things that can be done.

SPEAKER_02 18:49

Absolutely. So we are talking about health disparity in our community. I'm here with Dr. Michelle Kitsin, and this is the medical class 901 with Dr. Chi, and we will take a quick break and we'll be right back.

SPEAKER_00 19:04

Thank you for watching the Medical Class 901 with Dr. Chi. Dr. Chi M D is a renowned infectious disease specialist in the Memphis community. Without further ado, let's join the medical class with Dr. Chi M D.

SPEAKER_03 19:20

Why do they always present it as it's a uh gay black man's disease? To me, it it it caused other people, like these teenagers, you you talk about young people, to think that it doesn't affect them.

SPEAKER_02 19:34

Well, the reason you're gonna see that, you know, in the commercials would be that the group that's most affected would be the black man who we call, you know, um in the closet. Yes, you can say that, or we call it MSN, like you know, males who have sex with males, or you know, uh some people call homosexuals. And so that would be the largest you know, class in the yeah.

SPEAKER_03 20:00

So they're the largest, but people shouldn't think that it's only them.

SPEAKER_02 20:05

Oh, absolutely not.

SPEAKER_03 20:06

Because then you can fall prey to this, right? Because you think it is just about them because they never showed me.

SPEAKER_02 20:11

Yeah, and after that class will come will be black women. So, you know, heterosexual women, black women. So it does affect everybody. So it's a life of death situation here, and part of what we're doing right now is the major um, you know, hospitals or healthcare providers in this city. We are all coming together to work with the health department, Shelby County Health Department, and see what we can do. We are more than happy to go into schools and educate our young kids. Um, because I like I said, part of what we're seeing is lack of education or misinformation. So to be able to create this awareness, because this is something that nobody thinks about, you know, till you find yourself in the hospital, and then you know the doctors are like, oh, okay, your HIV positive. You're like, wait, how? How did this happen? Right. You know, so part of it would be to also, you know, uh create that awareness. We need to keep that going. We need to let our people know that this thing exists and it is hitting our community the most. I mean, we are second in the entire country. Like that, that's not funny. Welcome back to Medical Class 901 with Dr. Chi. I am Dr. Chinello Animallo, infectious disease, and HIV specialist. And today I have a special guest with me, Dr. Michelle Kitsin, who is an internist. And we have been discussing about health disparity as well as health equity or inequity in our community. And um, Dr. Kitsin is very knowledgeable and has kind of broken this down to us um to a place where we all can understand what this means for. Us for each and every one of us in the communities. And um talking about that, so there's something um that we've been getting a lot of you know um questions on social media about, and everybody has heard about the PEPSAR. What is PEPFAR? So this stands for the United States President's Emergency Plan for HIV relief. And um this is just basically funding that was made available by President Um W. Bush back in 2003, where the United States became the first and the major country to provide funding for HIV and AIDS all over the world. And so in recent time with a new government, there's been questions and uncertainties about the US pulling these funds away. And so this is also part of the health disparity talks, you know, we've been discussing because we know that minority communities have been affected the most by um this pandemic HIV-AIDS that we've talked about um a couple of times on the show. And so, what does this funding do? So basically, this is the funding that helps with PrEP for HIV. And when we talk about PrEP, we are talking about medications that we give to people who are at risk of contracting HIV. So it could be PrEP, which is the um post, you have the pre-exposure prophylaxis and the post-exposure prophylaxis. And these are just you know steps or medications that we take or we give patients to prevent um people at high risk of contracting HIV. And so majority of this medication is made available through this funding by the government, and so now we have we are all very concerned about um the government pulling this um funding. So I'm also gonna ask Dr. Kidson, we all you know, take care of our of our you know, brothers and sisters of our communities um that have HIV and what this means for us.

SPEAKER_01 24:07

Scary, scary times that we're living in. Um when you consider that you have told us that Memphis is number two, not in the south, not in the southeast, not in the lower United States, but the entire country, Memphis is the number two with new HIV infection rates. It is absolutely scary to think that at a time when our community is being affected as much as it is, that we would be losing funding of very, very necessary drugs to um prevent further spread and increase in the numbers of HIV. And so I would um desperately um appeal to our elected officials to assist us with ensuring that our federal government does not pull out of funding because what impacts one community very soon will impact another, and our future is dependent upon having a healthy population. We have done so much to curb the spread of HIV up to this point. Uh, it once was a death sentence with these drugs, we can prevent it, but it certainly is now considered to be a chronic disease. We don't want to get it back to a situation where so many of our society members are being lost because they're unable to prevent the spread and the contraction of HIV.

SPEAKER_02 25:44

Absolutely. Dr. Kitson took the word right out of my mouth, you know, scary. Um, as a HIV provider myself, I cannot begin to, you know, express how scared I am. You know, um, it brings a lot of anxiety because a lot of, you know, majority of our patients depend on this funding, you know, for their medications. And um, the thought of, you know, taking this away. And as, you know, as we all know, Dr. Kitson had mentioned it also, and I've mentioned this several times, uh, their community here in Memphis, we ranked number two in the entire nation for um, you know, new cases of HIV, especially in a teenage population. And um, one of the major fundings, one of the part of the fundings of this PEPSAR is actually um geared towards preventing new cases of HIV. So this is really very scary, but this is a huge topic, and um hopefully we're gonna be able to discuss that during another class. But um we want to keep everyone posted. Um again, HIV, as we always talk about, is now a chronic illness, and we can say it's no longer a death sentence, as Dr. Kitson had mentioned. Why? Because people will have access. And we are not just talking about people here in the United States, we're talking about Africa. Africa as a continent has been the major benefactors of this funding. So the thought of pulling this is just beyond what we can begin to comprehend. And hopefully, as Dr. Kitson has talked about, we all can come together and you know talk to our legislative team and members and hope that this is something that does not um get to happen. So, Dr. Kitsing, thank you so much for coming on the show with us today. This has been a major, major important topic to talk about because um, you know, we're talking about not just any minority communities at this point in time, but we're kind of talking about our entire communities. We've talked about um how um social you know issues, economic issues, um, you know, poor funding of our schools, you know, can affect the longevity of the individuals in this community, leading to chronic illnesses and you know, um high mortality, meaning high debt ratios. And so um, this is something that's gonna be an ongoing conversation, but I want to thank Dr. Kitsing for joining us today. And I hope that you'll be able to come hang with us some other times and um take you from there. So, thank you for joining us today. This is Dr. Chi from the Medical Class 901. Um, with us today is Dr. Kits Singh.

SPEAKER_00 28:36

Thanks for watching the Medical Class 901 with Dr. Chi M D, an infectious disease specialist and professor of medicine in Memphis, Tennessee.