Health problems are not just health problems ; they embody politics, social status, history, money and more. Where there is inequality in those underpinning factors, inequity in healthcare access is sure to follow.
Professor Leonard Egede from the Medical College of Wisconsin examines the extent of social biases and their impacts on health, and the global impacts of both diabetes and racism. His research puts forward a holistic view of how healing social ills can help relieve individual health too.
Read the original research: https://doi.org/10.1016/S0140-6736(23)00909-1
Health problems are not just health problems ; they embody politics, social status, history, money and more. Where there is inequality in those underpinning factors, inequity in healthcare access is sure to follow.
Professor Leonard Egede from the Medical College of Wisconsin examines the extent of social biases and their impacts on health, and the global impacts of both diabetes and racism. His research puts forward a holistic view of how healing social ills can help relieve individual health too.
Read the original research: https://doi.org/10.1016/S0140-6736(23)00909-1
00:00:06 Will Mountford
Hello I'm will welcome to ResearchPod.
00:00:09 Will Mountford
There is a theme we'll be touching on throughout this episode, and in a few others coming soon. Health problems are not just health problems.
00:00:18 Will Mountford
There's the political decisions behind healthcare system structuring social strata, underpinning who lives well with what conditions, the geography and history of who, where, when. Once you start pulling on these threads, the interdependencies of individual well-being across society are inescapable
00:00:36 Will Mountford
Today I'm speaking with Professor Leonard Egede from the Medical College of Wisconsin about his work examining the extent of social biases and their impacts on health from local to regional to nationwide, and the global impacts of both diabetes and racism. His research puts forward a holistic view of how healing social ills can help relieve individual health too.
00:01:02 Will Mountford
And joining me from the Medical College of Wisconsin, Professor Egede. Hello there.
00:01:05 Prof Leonard Egede
Hello.
00:01:06 Will Mountford
Thank you very much for your time and talking with us today, can I take just a minute, a couple of hundred words, for you to tell me a bit about yourself? Some of the steps in your life that have led to the position that you hold now and.
00:01:18 Will Mountford
What kind of topics your research covers?
00:01:20 Prof Leonard Egede
I am Leonard Egede. I'm a professor of medicine at the Medical College of Wisconsin. I am the chief of the division of General Internal Medicine in the Department of Medicine. I'm also the director of our Center for Advancing Population Science.
00:01:34 Prof Leonard Egede
I have an MD degree. I also have a masters in clinical research and I've been doing HealthEquity research for about 24 years, started my career very early on, right after residency training. I did a fellowship and then I worked for several years in Charleston, SC looking at health inequalities in the South.
00:01:54 Prof Leonard Egede
And then I was there for 17 years, about 2017. I moved to Wisconsin, and I actually took a job in Milwaukee where our team has actually been working very intentionally in trying to understand some of the structural factors that drive health out.
00:02:09 Prof Leonard Egede
I've used diabetes as a disease model because diabetes has clinical outcomes, are easy to measure, but then also are impacted by a lot of these social factors. And so a lot of my work has really been trying to understand the interplay between medical and social needs, the issues around factors that you drive, some of the health inequalities that.
00:02:29 Prof Leonard Egede
To see, but in more recent years, I've been focused now on interventions. What kind of solutions can we bring to bear to address some of these gaps? And then are even more recently, now we're looking at structural factors, structural inequalities, structural racism and trying to understand at those higher levels what are the things that actually drive some of the?
00:02:49 Prof Leonard Egede
Inequalities that we see in the United States but also around the world.
00:02:54 Will Mountford
We are going to be speaking over the course of a couple of episodes about economic and medical devices and about health interventions and to pick apart some of the different avenues that your research covers for today. Can we set some scopes on what we're going to talk through in terms of structural racism, health inequity, and what makes that such a pressing issue
00:03:15 Will Mountford
For you personally and for the American health system today?
00:03:20 Prof Leonard Egede
I think it's really important to recognize that structural inequalities or health inequalities are.
00:03:26 Prof Leonard Egede
Well, they're not a unique to the United States. It just so happens that the US is probably one of the largest in terms of scope and a lot of work has been done here. But this is a universal issue and it's really about power and power differential. And so for me, as an immigrant coming from originally from Nigeria.
00:03:46 Prof Leonard Egede
And as an immigrant coming to the United States, and I think I was actually surprised.
00:03:50 Prof Leonard Egede
Eyes by the gaps I saw, I think coming in, I was naive to think that as one of the most richest countries in the world, there probably would be no gaps in access to care, resources for care. And then when I arrived, I realized that those gaps, the same gaps I saw in Nigeria were actually here. So that got me thinking, what?
00:04:10 Prof Leonard Egede
It's responsible for these differences and so that got me on the search to try to understand what the issues.
00:04:17 Prof Leonard Egede
And to identify what are some of the potential strategies to actually address that. So I think that's the background and and what kind of got me and my first experience was in Baltimore, Baltimore, MD, where I did my initial training where I saw a lot of these gaps in place and that really got me thinking about what can we do to bring about change.
00:04:42 Prof Leonard Egede
So I think.
00:04:43 Prof Leonard Egede
One of the things we need to start off is to really lay the foundation that race is a social construct and so the idea that race is a social construct then means that we have all this classification for race and many people have used. Up until recently they've used race.
00:05:01 Prof Leonard Egede
As a biological construct. As a result, we've actually attributed many things to race that are really tied to a social environment. So that's kind of setting the ground state. So once we agree that race is a social construct.
00:05:15 Prof Leonard Egede
Then it means that many of the things that we actually attribute to race are due to other factors that are associated with race.
00:05:24 Prof Leonard Egede
So for example, when you think when we use the word race, ethnicity, right, we in the US we say ethnicity, are you Hispanic or non Hispanic?
00:05:35 Prof Leonard Egede
The word Hispanic refers to people from multiple.
00:05:37
Mm-hmm.
00:05:38 Prof Leonard Egede
Countries with very different biological constitution. And so when you use the word Hispanic, you're actually talking about people from so many countries, very diverse groups, and yet we treat them as one entity. Now if you see Hispanic as a cultural, social construct, then yes, it makes sense. There are commonalities.
00:05:59 Prof Leonard Egede
But even those commonalities are not biological, and that's one of the things that's really important as we begin to discuss some of these structural factors. And when we talk about racism, we talked about structural inequalities. Is the idea that race is this social construct.
00:06:16 Will Mountford
So when we talk about race as a social construct, we have to then address racism as a social event and in a lot of your work as a health concern as well. And that health is a social concern and to kind of close the circle between them. So on a policy level, what does health policy pull on in terms of economic political?
00:06:37 Will Mountford
And social and cultural landscapes in terms of what then race brings into that mix.
00:06:43 Prof Leonard Egede
A lot of workers, actually, a lot of the seminar work in this space, was done in the UK by some mammoth. So the idea is that we talk about structural inequalities.
00:06:55 Prof Leonard Egede
When those inequalities are tied to race, we use the term structural racism, so the overarching framework is that there are inequalities that exist.
00:07:07 Prof Leonard Egede
Because of structures in society.
00:07:09 Prof Leonard Egede
And that those structures in society create differences in power.
00:07:14 Prof Leonard Egede
And when they are power differentials between those who have and those who have not, you create inequalities and those inequalities are usually tied to socioeconomic status, educational level, you know, essentially your position in society. Now in the US, race and poverty are highly correlated.
00:07:32 Prof Leonard Egede
And that certain groups who are poor may belong to certain minority groups. And so in that context, and because of certain policies that were put in place, we use the word structural racism to refer to that structural inequality that's tied to race. And we define structural racism as the totality of ways in which societies.
00:07:52 Prof Leonard Egede
Foster racial discrimination through mutually reinforcing systems. So this is 1 definition, and these systems include housing, education, employment.
00:08:04 Prof Leonard Egede
Benefits, credit media, healthcare and the criminal justice system. And when people talk about structural racism, it is those policies that are in place in many of these areas that then trickle down to the individual level and those trickle down effects then begin to affect the.
00:08:24 Prof Leonard Egede
Individual and their health outcomes, and so that's where structural racism then has a role to play in the individuals health and health.
00:08:32 Will Mountford
And help and notice the use of the phrase trickle down there when other people talk about trickle down economics, it's the idea that wealth will proliferate and prosper when it seems to be mostly just problems that come down.
00:08:44 Prof Leonard Egede
Yes. So I think to expect that without thinking and without intentionality that things will just fix themselves. We know it doesn't work that way.
00:08:54 Prof Leonard Egede
Things that work well have to be intentional. There needs to be a clear sense of what do we want to do to address the issue. So when I use the word trickle down, it is this idea that we have policies when these policies are established, those policies are usually designed to address maybe one problem, or maybe to get advantage.
00:09:14 Prof Leonard Egede
Certain groups, but those policies then have some of them are intentional or unintentional effects, and those effects then affect people.
00:09:23 Prof Leonard Egede
Downstream and that downstream is. So when we look at the individual level, we see health at the individual level, but many of the policies were described at above the individual level at societal levels.
00:09:35 Will Mountford
That leads very neatly onto the focus of one of your papers from 2020 about the need for new approaches in defining and tackling racism in health inequity. So could I ask for a little bit of background on some of the scope, ambition, and methodology from that paper and some of the quotes that came?
00:09:52 Will Mountford
Out of it as well.
00:09:54 Prof Leonard Egede
I think when we moved to Milwaukee in 2017, one of the first things we wanted to understand because prior to moving to Milwaukee, most of our work was in South Carolina and that was very much poverty in South Carolina was rural. And so a lot of the activity was really trying to understand access for rural populations. When we came to Milwaukee.
00:10:14 Prof Leonard Egede
Poverty. Milwaukee was more urban and more inner city environment. So with the first thing for two years, we actually conducted a series of listening sessions, focus groups. We used three methodologies. First methodology was focus groups. Focus groups are where you get people together in groups of eight to 10 individuals and you just listen.
00:10:34 Prof Leonard Egede
And understand their perspective and we have had listening sessions about many of these systems, the housing, transportation, food, healthcare, criminal justice.
00:10:44 Prof Leonard Egede
This time we did extensive focus groups. We did about we actually interviewed about 350 individuals in about 30 different focus groups and we used that as one methodology, the 2nd methodology that we actually use was something called photo voice and photo. Voice is where you give individuals a digital camera and you ask them to go to their neighborhoods.
00:11:04 Prof Leonard Egede
And take pictures of things that stand out to them.
00:11:07 Prof Leonard Egede
They then come back in a group and they discuss why they took those pictures, what those pictures meant to them, and it gives you the lens into what they see when they look around your neighborhood and your environment and what their actual value as important. But then the third component was the survey. We surveyed about 20, four, 2400 individuals, so 2400.
00:11:28 Prof Leonard Egede
Individuals and a very extensive survey on social needs, social risk, health outcomes. We measured blood pressure, we had measures of different aspects of health.
00:11:38 Prof Leonard Egede
And so just to give you context, some of these surveys were roughly about 70 pages long to the very, very detail. So when we got done, we had the qualitative component, we had the photo voice and then we also had the quantitative component. We then analyzed this data and in addition, we also had stakeholders. So we had people who were leaders in different areas in the criminal justice.
00:11:58 Prof Leonard Egede
Environment the school system in the legislators and all of those individuals, they all give their perspective. We synthesized that information and we came up with what we began to use as a conceptual.
00:12:10 Prof Leonard Egede
Framework. The conceptual framework of how does some of these historic factors lead to poor outcomes? We also introduced the concept of human capital that individuals actually have inherent value, and that when people are sick, it diminishes their human capital, their ability to contribute to society, and that actually this has economic impact.
00:12:31 Prof Leonard Egede
In the environment, so that was the framing that we actually used to establish what we did going forward.
00:12:37 Will Mountford
It does seem alarming that it's a novel idea, that humans should be treated as having respect and value and a contribution besides economically, but unlike a human level as well, to hear that that's not been thought of is unsettling.
00:12:52 Prof Leonard Egede
Yeah, I think we, I will say it's not that it's not been thought of. I think when it's really when we actually begin to function, we actually reduce people and sometimes we don't pay attention to the holistic aspect of life, especially in healthcare.
00:13:07 Prof Leonard Egede
Because we encounter people in, you know, clinical encounters, and they're in the hospital for two days, they come to the clinic once every three months. We forget sometimes that they actually have a life outside of healthcare and that the individual actually has. They have dreams, aspirations, things that actually make them human. And so being able to.
00:13:27 Prof Leonard Egede
Bring that into the mix allows you to actually understand how the individual and the environment actually interplay.
00:13:35 Will Mountford
Well, besides the numbers and the quantitative side of it, the qualitative side you mentioned, those extensive surveys, some of the quotes from this paper that really stood out to me. There's one about I've served in Afghanistan, living in inner city Milwaukee. It's like serving in Afghanistan. The difference is you do not get hazard pay. That's chilling, frankly.
00:13:55 Prof Leonard Egede
Yeah, I think we were. And then there's so many points like that that we actually highlighted in the paper. And that for me it really got me thinking about how we sometimes do not pay attention to the built environment and the environment people live in and what this individual was saying was that when I served in Afghanistan.
00:14:14 Prof Leonard Egede
And I actually was going into a war zone, and I actually got paid for hazard pay. But when I live in an environment where, you know, you have gone violence and crime around me, now am I being exposed to the same stressors I was exposed in Afghanistan. But I am actually not being compensated for it.
00:14:35 Prof Leonard Egede
So that was really concerning and really got us thinking about what can we do to address.
00:14:40 Prof Leonard Egede
Some of these issues.
00:14:47 Will Mountford
Yes. Figure one from the paper is kind of drawing all of the funnels from the poverty, the violence, all the structural problems, into the chronic stress, and then the health outcomes of that just for everyone who's not got the paper in front of them as they listen to this. Could you talk me through some of that diagram in words, in numbers and in outcomes?
00:15:06 Prof Leonard Egede
So the formula we actually used was we took this framework and we call it the vulnerability and hazards.
00:15:13 Prof Leonard Egede
Of the inner city environment and what we actually wanted to understand was based on the surveys that we did based on the stakeholder interviews and based on the focus groups that we actually had along with the photo voice, we came up with this model that we've actually now published and we've actually tested that at the core of it.
00:15:34 Prof Leonard Egede
Or you have discrimination, you have incarceration, you have poverty, residential segregation, substance abuse, housing instability, food insecurity, low educational attainment and unemployment. That these factors create a milieu that causes chronic stress.
00:15:52 Prof Leonard Egede
That running stress then leads to poor health and disability, and the poor health and disability then leads to decreased human capital. And we actually inherently believe that every individual has value, value, both on a personal level emotional level, but then also their contribution to society.
00:16:12 Prof Leonard Egede
And that sick individuals are not able to contribute to society, and that is a core part of that concept of decreased human capital.
00:16:19 Will Mountford
And some of the language through it and the approach overall he described as a disaster zone approach and with the comparator to serving in a war zone, being there already, it's hard not to kind of feel that it is appropriate, but there might be some people out there to imagine some kind of ******* who's upset about this sort of thing.
00:16:39 Will Mountford
Who will take the position that this is inappropriate language or inhumane, and I invite you to shut that kind of nonsense down.
00:16:48 Prof Leonard Egede
So I think.
00:16:49 Prof Leonard Egede
We actually have a model that we actually looked at here. So when we look at, we have what we call natural disasters and we have a model from the mental health space where they actually talk about four phases of Emergency Management. So when we have a disaster like a hurricane or we have an earthquake and we have, you know, a fire.
00:17:09 Prof Leonard Egede
We have a process that we actually this is very well established in the trauma space and in disaster response. So the first step is mitigation and in the first step is preparedness. Their response recovery and mitigation.
00:17:24 Prof Leonard Egede
The problem is that because these are designed for acute events.
00:17:30 Prof Leonard Egede
This same structure could also be applied to what we call man-made disasters. We actually argued that the inner city environment are man made disaster decisions that were made across the world and all around the world. If you go to the UK, you have some of those issues. If you go to Southeast Asia, you have some of those issues.
00:17:51 Prof Leonard Egede
We create cities where we force people.
00:17:54 Prof Leonard Egede
Based on policies, decisions into neighborhoods that are inherently unsafe, probably no sanitation, and so we believe that these decisions when we're calling man-made disasters, they are essentially based on decisions and policies that create a milieu that's not.
00:18:13 Prof Leonard Egede
Healthy.
00:18:14 Prof Leonard Egede
And so just like we, we tackle natural disasters, we believe that we also need to have this same for phase response to man-made disasters. We need to talk about preparedness. How do we prepare for an environment that is not wholesome, which is in response, how do we recover from it and how do we mitigate it?
00:18:35 Prof Leonard Egede
The problem is that in the natural disaster approach, everybody has.
00:18:40 Prof Leonard Egede
Pain.
00:18:41 Prof Leonard Egede
And so we spend a lot of resources, but when it comes to some of these man-made disasters, we don't have a smoke buying. And so we don't have the will to actually do things to bring about change that will actually cost lasting change.
00:18:56 Will Mountford
Well, to help from the acute setting they've mentioned here to some of the chronic issues and the pervasive health issues, you raised diabetes as being a model, an example of how this manifests could ask you to talk me through some of the 2022 paper there. I was looking at YL's and if we could go over some of the language, what a why L is and then?
00:19:17 Will Mountford
What kind of scope comes from that paper?
00:19:20 Prof Leonard Egede
So why is essentially years of life lost?
00:19:23 Prof Leonard Egede
And So what we try to do just to kind of follow up on this disaster zone that we actually just talked about. So in that model, we actually argue that antecedent to all of those factors, poverty and crime is structural inequality.
00:19:40 Prof Leonard Egede
But so if you think about if you actually added a box.
00:19:43 Prof Leonard Egede
That structural inequalities, however you measure them.
00:19:47 Prof Leonard Egede
Actually then lead to discrimination, incarceration, poverty. So if you are then qualified, structural inequalities and structural racism.
00:19:56 Prof Leonard Egede
Then it means that when you have structural racism, it is antecedent to some of these factors. So what we then wanted to do was we wanted to quantify how do we measure this antecedent, this structural inequality, this structural racism?
00:20:09 Prof Leonard Egede
And we use historic red.
00:20:11 Prof Leonard Egede
Right.
00:20:12 Prof Leonard Egede
To clarify, red lighting was a concept that happened in the United States and is now illegal to do that, but.
00:20:19 Prof Leonard Egede
In that era.
00:20:21 Prof Leonard Egede
And neighborhoods were classified were color-coded.
00:20:24 Prof Leonard Egede
And Enable was coded as red, green, yellow or blue.
00:20:30 Prof Leonard Egede
And each color means a red was hazardous.
00:20:35 Prof Leonard Egede
Don't buy the don't invest. The yellow was next to her and blue or green were good neighborhoods, so in in essence.
00:20:44 Prof Leonard Egede
What we wanted to do was, and in that era it was called the home Owners Loan Corporation. They essentially created maps of major cities. So what we wanted to do was then say if we take this historical event.
00:20:59 Prof Leonard Egede
That allows us to actually map how neighborhoods were structured, what is the long term impact of historic redlining as a measure of structural racism and currently health. And it turns out that one of the places you could actually find that data was.
00:21:14 Prof Leonard Egede
Seattle so Seattle had data that allowed us to link the map, the digital maps, to link them to health outcomes, to look at mortality, and to look at years of life.
00:21:25 Prof Leonard Egede
Loss. So what?
00:21:26 Prof Leonard Egede
We took this data and we actually looked at.
00:21:29 Prof Leonard Egede
109 Census tracks census level track for the years 1990 through 2014, so 25 years and what we wanted to do was to understand how does redlining lead to outcomes in terms of diabetes mortality and life loss.
00:21:47 Prof Leonard Egede
And what we found in that analysis after extensive analysis was with two things. One was that red lining was associated with increased mortality.
00:21:57 Prof Leonard Egede
And years of life loss. So neighborhoods are red lines. If you compared grade A to grade D or if you compared green to red, those who lived in red neighborhoods were more likely to die and where they actually had years of life, they essentially had less longevity. But that was not the only.
00:22:18 Prof Leonard Egede
Part of it.
00:22:18 Prof Leonard Egede
What was also surprising was that this effect persists.
00:22:23 Prof Leonard Egede
Because the argument right now is that was historical. That's the past. We are saying that from 1990 to 2014, those Rd. maps that were done in the 1960s are still having impact today. And so not only is it chronic, it's persistent in terms of its effect on outcomes.
00:22:43 Will Mountford
And if we were to kind of extrapolate that out from Seattle to.
00:22:49 Will Mountford
The whole of the northwest or to across America globally, even what kind of lifespan does injustice have? Is it something that will fade over 4050 years? Do you think it will lessen over 5-6 generations or is it deeply, deeply entrenched?
00:23:07 Prof Leonard Egede
We have hope that policy changes can reverse some of these detrimental effect. However, it has to be intentional. Right now, the data suggests that these effects are deeply rooted.
00:23:22 Prof Leonard Egede
And that it's going to take years and decades of work to reverse that effect. So is there hope? Yes. But it needs to be intentional to bring about change. And some of these policies have to be changed to allow you to have equality in outcomes.
00:23:38 Will Mountford
We're talking about diabetes here as a kind of specific model, but are there any other conditions or diseases or anything that might be specifically affecting non white Americans that could be another kind of warning flag? There's a specific term for like an indicator disease, I guess.
00:23:57 Prof Leonard Egede
We see this if you look at cancer, they're selling cancers in terms of diagnosis, time to diagnosis, mortality differences, survival benefit. We see that differences in cancer and certain cancers, prostate, lung cancer. You know, we're seeing at some of those differences. If you look at kidney disease.
00:24:18 Prof Leonard Egede
Kidney disease is more prevalent in minority groups than more likely to actually be on dialysis. They're more likely to actually die from kidney disease. If you look at stroke.
00:24:28 Prof Leonard Egede
So if you think all the big drivers hypertension, many of those cases you see a lot of differences. So that's why we believe it's not just a disease.
00:24:39 Prof Leonard Egede
It is literally the fabric of our society and that's why change needs to happen. Because what we've done over time we've we've focused on individual diseases. We've not paid attention to the totality of factors that drive across diseases.
00:24:55 Will Mountford
Well, if it is going to be a policy change that can remedy these issues.
00:25:00 Will Mountford
At what level does that policy change need to happen? State. Local.
00:25:05 Prof Leonard Egede
The thing about policy is that policy is both local, regional and national, so you need to actually want identify. So the what we're doing right now is to identify, we call them levels. What are the levels or policy levels that you can actually touch.
00:25:25 Prof Leonard Egede
That will give you the maximum impact, so an example is access to healthcare.
00:25:31 Prof Leonard Egede
Insurance is the greatest driver of access, so if people have insurance, the more likely to get healthcare. So any conversation that does not have insurance as an option.
00:25:44 Prof Leonard Egede
It's not going to fix the problem.
00:25:47 Prof Leonard Egede
So we argue that some of these policies have to be done at the national level, but some of them are regional decisions. So an example we did a study where we looked at Medicaid expansion. OK. So in the US, Medicaid is essentially insurance for the poor or.
00:26:04 Prof Leonard Egede
Disabled and people states have to adopt Medicaid. Some states adopted it and others did not. We did a study. We actually looked at states that adopted Medicaid, and we looked at a fiction rate. And you, you say, why would that matter? Well, one of the greatest drivers of your health of your income use.
00:26:24 Prof Leonard Egede
It's healthcare.
00:26:25 Prof Leonard Egede
And 70% of bankruptcies are due to healthcare. So if people are dealing with healthcare issues, they are going to have they don't have a choice, they don't have to spend money on healthcare, which means they don't spend it on something else. So we actually looked at states that adopted Medicare and Medicaid expansion states that did not a fiction rates were lower in states that had.
00:26:45 Prof Leonard Egede
Medicaid expansion.
00:26:47 Prof Leonard Egede
So that tells you that if you actually give people options to have Medicaid, they may actually have less out of pocket expenses and they may actually be able to have better housing and they may actually translate to better health outcomes.
00:27:02 Will Mountford
Looking after people looks after people.
00:27:04 Prof Leonard Egede
Yes.
00:27:05 Will Mountford
Well, to go above the local and state and national to the international level, your recent paper 2023 paper on global inequity as a literature review. So we're looking at a wide range of information and for a very long time. But can you talk me through some of the scope of the papers included there and the scope and the?
00:27:25 Will Mountford
People covered by it.
00:27:28 Prof Leonard Egede
This was Lancet, The Lancet journal, which is pretty prestigious journal that decided to actually look at global inequity in diabetes. And they brought together a group of experts around the world. And so this was just a multinational team of writers, and we're all asked to bring perspectives in terms of the issue around.
00:27:48 Prof Leonard Egede
Liabilities and some of the global inequities. And in there we actually had teams from different countries and you know, we had people from the US we had someone from Cameroon. We had people from Australia. And so at the end of the day, we actually were bringing individuals from different continent.
00:28:07 Prof Leonard Egede
To actually look at diabetes as a signature disease and ask the question what do we know about diabetes and the International Diabetes Federation publishes prevalence of diabetes data annually. So we actually have data on prevalence and we're we're finding is that the burden of diabetes is actually going to be really significant in Asia.
00:28:27 Prof Leonard Egede
And Africa?
00:28:28 Prof Leonard Egede
Middle East and Africa and Asia because that's where the population explosion is happening. That's where obesity is getting more. But it's also where they're less resources per capital to address health and health outcomes. So we then looked at some of these issues and then we.
00:28:43 Prof Leonard Egede
Asked the question are.
00:28:44 Prof Leonard Egede
Some of these things we're saying.
00:28:47 Prof Leonard Egede
What proportion of them are due to some of these social factors? These structural factors, and we actually created a model that actually asks the question, how do we then address these issues and then part of that was to then have experts from different countries who worked in the space of diabetes and equity.
00:29:05 Prof Leonard Egede
And then the idea was to actually talk about what are some of the things you're seeing in terms of prevalence of disease in terms of risk factors for disease and in terms of?
00:29:15 Prof Leonard Egede
Challenges in terms of managing disease for the future and then what types of programs will actually be helpful in addressing some of those issues?
00:29:24 Prof Leonard Egede
And so, you know, there's several components here, but at the end of the day, people from we have South Asia, we had Australia, we had sub-Saharan Africa and then we had the United States and we all talked about different challenges as it relates to inequity. But the key message is.
00:29:42 Prof Leonard Egede
There is global inequity in disease and this issue of structural factors is not a US phenomenon.
00:29:55 Will Mountford
Yes, there were some stats breaking down by continent and minority background, indigenous communities, population size, population demographics. So like, are there any trends generally that you can draw out to see where things are having that transferral? You've mentioned that.
00:30:14 Will Mountford
The population boom and the changing diet is going to be a driving factor across Africa and the Middle East.
00:30:20 Will Mountford
Are there any other overarching trends that you see as a factor of concern over the next however long?
00:30:27 Prof Leonard Egede
Yes, I think we are very concerned that in many of these countries. So in Australia amongst the indigenous community in Asia, right in Africa that many of these environments are having an increased prevalence of disease. Diabetes is a disease that causes significant complications.
00:30:47 Prof Leonard Egede
And the complications are expensive and they actually decrease quality of life and increase mortality.
00:30:53 Prof Leonard Egede
So we are we?
00:30:53 Prof Leonard Egede
Are we are concerned that as this?
00:30:55 Prof Leonard Egede
Prevalence continues to.
00:30:56 Prof Leonard Egede
Increase these countries also do not have the resources.
00:31:01 Prof Leonard Egede
The cost of treating diabetes is very expensive. Just medications alone is is very expensive. So countries that are already financially strapped are going to be less equipped to address this increasing burden of diabetes, which is why policies are going to be needed to add you manage diabetes as skill. How do you leverage resources? How do you invest?
00:31:22 Prof Leonard Egede
To minimize the future impact of diabetes, and that's what we're trying to get across in that paper.
00:31:28 Will Mountford
And to bring things back to the American focus, where a lot of the audiences and I think where a lot of the immediate.
00:31:35 Will Mountford
Action.
00:31:36 Will Mountford
From Medical College of Wisconsin and Allied Institutes could be. Is there anything that kind of brings it home for you in a very personal sense?
00:31:47 Prof Leonard Egede
Yeah. I think as we think about some of these issues around structural racism, structural factors and even chronic disease, the key is that I've been doing this for about 20-4 years. And when I look at the data.
00:32:03 Prof Leonard Egede
The gaps are still there, even though things are getting better, there are still significant gaps and when I look at data from 1960 to date, we still see these gaps. And so we talked about healthy people, 2010 healthy people 2020 and we still continue to see gaps which tells us.
00:32:25 Prof Leonard Egede
That, yes, we're making progress, but we still have significant gaps and we need to be more intentional at bridging these gaps and addressing these health inequalities.
00:32:41 Prof Leonard Egede
The inner city environment, some of the mainly of the inner city, some of the mainly of the urban environment, we've identified some conceptual framework to help us understand what needs to get done. We also help hide perspective from people who live in this environment so that that we actually live their experience. We're actually able to identify the lived experience and people have this sense.
00:33:01 Prof Leonard Egede
Of what people are going through, then the second thing we've actually done is to actually look at what is the impact of some of these historic factors. So Red line in structural racism and quantifying because I think one of the problems we have is sometimes we have conversations without data.
00:33:18 Prof Leonard Egede
And the more you are able to quantify this information, then it gives people the sense of the magnitude of the problem. But the life we've also done is not just the magnitude. The problem is to identify where are the potential opportunities, where change will actually have the most impact. So we've also identified that.
00:33:38 Prof Leonard Egede
And then we've also now done this work in in partnership with other investigators.
00:33:43 Prof Leonard Egede
Globally, to actually say this is not a unique United States phenomenon. This is a global phenomenon. Now we have more resources in the US compared to some other other countries. But at the end of the day, we need to work closely together to learn from those who have done it well and be able to leverage the experience of those who have actually been.
00:34:02 Prof Leonard Egede
Further along in this process, to prevent future disasters in other countries where this is actually just starting.
00:34:10 Will Mountford
And for anyone who's listening to this and wants to know more about your research, where can they find that and you?
00:34:16 Prof Leonard Egede
We probably will have a link sent, but the CDC.
00:34:20 Prof Leonard Egede
Has a lot of information. The Center for Disease Control has a lot of information in terms of commitment to HealthEquity. They have a lot of information about social determinants, of health, social risk, the World Health Organization actually has a conceptual framework.
00:34:34 Prof Leonard Egede
For social determinants of health, and it's available on your website, that's an area where people can go in and see the framing from a global standpoint, and then the papers we've actually discussed here are good because in most of these papers we have background information. We have conceptual frameworks. We actually have a lot of suggestions in terms of what can be done in the future, and we have a couple of.
00:34:55 Prof Leonard Egede
And I'm looking forward, I would like to talk about we have two studies right now where we are using. They are federally funded studies, NIH funded studies where we are using census track data for the whole.
00:35:10 Prof Leonard Egede
To actually identify some of these pathways and identify potential strategies.
00:35:16 Prof Leonard Egede
Then conveying a group of experts, national experts, to talk about what are the priorities, how do we prioritize and which solutions policy solutions are going to be most affected. So those studies were actually in the process of just getting them started. Now we have some results in about two to three years to be able to have some real meaningful solution.
00:35:36 Prof Leonard Egede
So.
00:35:37 Prof Leonard Egede
What I usually want to make sure that is part of this story, because sometimes this messaging can be demoralizing, can generate hopelessness is that we have made progress both in the United States and globally. If you look at where we were in the 60s in the 50s and the 40s.
00:35:57 Prof Leonard Egede
Yes, we've not achieved perfection, but we've actually made progress. I think that's an important part of this because where there's.
00:36:03 Prof Leonard Egede
Hope there is no future we need to actually pay attention to the idea that there is hope and that these things can actually change, and that's what motivates and drives us, cause we believe that change is possible.
00:36:17 Will Mountford
I think dose of optimism is sorely in need after looking back on how not great a lot of things are. So a lot of room to get better and.
00:36:27 Will Mountford
We need the people to make that happen and one of them is you and fingers crossed for more.
00:36:32 Will Mountford
Professor Egede, thank you so much for your.
00:36:34 Prof Leonard Egede
Thank you.