As we come to a close of the summer season with Labor Day weekend in our rear view, what is the current state of the union regarding the coronavirus pandemic in the United States?  How do we prevent needless loss of life as we head into the winter flu season?  What are the prospects for an effective vaccine before years end and how long can we expect to have impacts to our current social culture in America - including education, sports and business convening? Many community health activities have enormous value for preventing adverse outcomes and advancing equity. As major healthcare institutions, hospitals and health systems can play a direct or indirect role in supporting this work.

Show Topics and Highlights

• “What is the idea behind anchor institutions working together knowing that, at times, the only anchor institution in some of these communities is the faith based community? How do we draw that knowledge and power in and use it as leverage to move us along.”

• “The first thing I want to make clear is that medicine and health are NOT synonymous.”

• Hospitals are recognizing more and more that if we are to make the biggest impact of health it will not be within the confines of the four walls of the hospital.

• What does a hospital mean in the 21st century? What does a faith based organization mean in the 21st century?

• “Food choices are so often rooted in access and that is rooted in community investment.”

• Medicine’s trust has been broken countless times for certain populations.

• Healthcare needs to be delivered effectively, equitably, appropriately, and it needs to be accessible in a just way. 

Profound Conversations Executive Producers are the Muslim Life Planning Institute, a national community building organization whose mission is to establish pathways to lifelong learning and healthy communities at the local, national and global level.   MLPN.life

The Profound Conversations podcast is produced by Erika Christie www.ErikaChristie.com

Full Transcript

Erika Christie

Welcome to Profound Conversations, a dynamic broadcast platform focused on building healthy communities. content for programming is developed through our interests and involvement in education, economic development, culture, and governance. Profound Conversations is a listening and discussion space, which brings thought leaders into a conversation to address the vexing challenges of our times. In an ever evolving world. New ideas and transformative ways of being are the lights at the end of the tunnel. Please join us as we participate in critical and Profound Conversations impacting humanity.

Karim Ali

Welcome, everyone, to season two episode one of our Profound Conversations. My name is Karim Ali, and we're happy that you joined us today. We're very happy to bring you another season of Profound Conversations I want to explain a little bit about what Profound Conversations actually is. Profound Conversations is a listening and discussion space, which brings up for most thought leaders into a conversation to grapple with the vexing challenges of today to profound conversation uses intercultural dialogue, extensive community and organizational engagement to initiate valuable cultural, educational, economic policy outcomes in an ever evolving world. New ideas and transformative ways of being are the lights at the end of the tunnel. Today, we are honored to have number of guests with us from the John Johns Hopkins School of Medicine and School of Public Health on baby Medical Center. We have a Dr. Panic kind of gets G, who was going to talk with us today. Regarding COVID-19 to COVID-19 update. We also have Dr. Rachel Thornton, and we have Dr. Kara plot she's actually a four year in her fourth year of medical school. And we were expecting Dr Scharf, Dr. Josh Sharfstein today as well. However, he called last minute with an emergency and so unfortunately, we won't have him today. Today, sitting in for normal host than to Howard is Mr. Andre Robinson, CEO of the Radisson group, community developer in the city of Baltimore. And we're so happy to have Andre today working with us. Profound Conversations. I wanted to I wanted to just start out this conversation really quick with some breaking news. I heard an announcement today from Governor Hogan, the governor state of Maryland, regarding the a new state of the art rapid testing, that I believe that the state is about to inked a deal with a corporation to actually produce suit some 250,000. They call it vertical tests, and diagnostic systems. It's called a rapid point of care, energy testing. And it it promises to actually speed up on the to it. And as we're all used to, in this virtual world, we have family that pops in and out when we you know, least expected. So this this virtual world, this antigen test, I like Dr. G to talk to us about that the really the impact, you know, of actually having a test that will create the results so quickly on a number of levels. So Dr. GP talk to us had you heard about this, this new deal of that the governor announced today and talk to us a little bit about this rapid point of care energy testing.

Dr Panagis Galiatsatos

Yeah, no, thank you. So this one in particular, I I have heard about trying to get more efficient testing done. So I'd have to evaluate which one specifically this one is meant to be. The one I'm probably most versed with is the one that the Yale School of Public Health actually put forward with the NBA, and with regards to the saliva testing. But overall testing is key to this right. It's key to understand where there's clusters of potential hotspots that could be going on that we can allocate resources to mitigate the spread. They're testing to allow us to also kind of phase in, right I mean, how great would it be to have a rapid testing where we can let family members who loved ones were in there nursing homes were in rehabilitation centers say, for this testing, yes, you can come in and see your loved ones and so forth. So, you know, I, I'm excited that our governor and our government is investing in more testing, the rapidity is going to be important to this is one of the drawbacks that I, for instance, as a lung doctor, today, I saw patients both in intensive care unit and an outpatient and the challenges about getting COVID testing are so obvious. I mean, there's two patients in our Intensive Care Unit, who, when he got tested, and they were admitted two days later to the ICU, and then a week later, their test results came back, like I mean, by that point, like, you know, it, what good is a test if it's going to take that long to come back. So if we have the ability to have an increased volume of testing, where the answers can be delivered in an efficient amount of time, ideally, within 48 to 72 hours, it allows a population to make public health conscious decisions in order to, you know, either care for themselves, or to recognize, okay, I'm not infected, and I can continue phasing. And so long story short, I'm excited, I will look into more thoroughly this specific test that they're doing, but it's on par with a lot of other rapid tests that are available. The one last comment that I'll make, sometimes with rapid testing, you do sacrifice a little bit of the sensitivity of the test with the rapidity. However, that can easily be made up if you test patients a little bit more frequently. So if it allows for that, that the sensitivity that's lost is oftentimes gained from it.

Karim Ali

Interesting. So, Andre, I want you to jump in. But I did want to ask a follow up question. Well, one on efficacy in terms of this new testing, will this actually replace the molecular testing as a legacy method? And what impacts? Will this rapid testing have, you know, in terms of school, for example, and like business convening? Is that actually going to have a direct impact on our ability to actually send students back to school and for businesses to actually increase in terms of the convenience?

Dr Panagis Galiatsatos

Oh, that person still directed to me? Yes. All right, perfect. So the out let me answer the last part, first, you know, the impact will have on schools and businesses, I imagine it's, it's going to have an impact. But you raise a point like, Julio, are these more abundant tests with a rapid turnaround? Who are we going to allocate them to first, my suspicion is, it's probably still going to be given to populations who have been disproportionately impacted by this virus, right. Nursing homes in particular, I mean, I was in the intensive care unit and the COVID units in the spring, seeing a disproportionate impact on nursing homes, in addition to certain races, and ethnicities, of course, are African Americans and Hispanic Latinos, but definitely a lot of nursing home patients. I'm in September, and I'm still seeing a disproportionate impact on nursing home residents. So my first, you know, I love that our government here in the state of Maryland is getting a lot more of these tests, my thought is, it's likely going to go to places that need more infectious control policies, or more infectious control stringent implementations, and so rapid test will help out a lot with nursing homes and so forth. So my suspicion is that so will it help schools and businesses? It might, I just don't know if that's their immediate plan to use it in that case. So, you know, the fact that we got the Greenlight, we also have to cherry pick the brain and see, well, what is your intention? My immediate thought is, let's get this out to the communities who have been disproportionately impacted. Same thing will go with the Hispanic Latino communities. I know you have Dr. Rachel Thornton on here, she could definitely speak to a lot of the engagements that we often do to get the populations the these testing, I mean, testing, we've always emphasized as part of the key. So I, I'd like to say it's gonna help the schools and businesses, I just can't see it immediately impacting them. Maybe, you know, some kind of a trickle down effect, but I can't see it immediately impacting it. 100?

Andre L Robinson Jr

Yes, I have a sort of a broader question. I guess this is Dr. G. And Dr. Thornton. Because this must be creating a little bit of a nightmare for the rest of you that so much of what the science would have produced as a way to move forward feels to us on the outside a little blocked because of course, you've got all these other political considerations, tinkering around in the medicine world where there's certain certainly don't have any sort of standing. So it feels to me like an extraordinary amount of lack of cooperation and coordination at that level. And so I know that neither of you have like a magic wand to fix these things. But if you could suggest something to those of us on the other side, who have the community side of it, if you will, not so much at our disposal, but we may have some influence there. We always see the hospital as an anchor. institution partner, so that a community that has been visited with all these historical multiple morbidities, over over long time, we were, I think, making a certain amount of progress. And then it's stalled in the middle of this, you know, sort of tsunami of, of impact hitting the entire globe at the same time. So if you could suggest anything in a post pandemic world, and you had the magic wand, and Dr. Throne, I'll go to you first, what would be some of the things that we could use to catch up if you will, to, to make up for some of the ground that we think we've lost because of all of these machinations going on on the national level?

Dr. Rachel Thornton

Well, you know, I think my my colleague, Dr. G referred to this in broad terms. But we're, we're very much aware of disproportionate impacts of COVID. And I don't want to insinuate that the disparities we see today are remarkably are significantly different than the health inequities and disparities that predated the pandemic. But certainly this moment in time, has brought them out of the shadows into the front of everyone's consciousness. And I think that it's a real call to action, frankly, for healthcare delivery systems, for hospitals, for everyone in the healthcare industry, frankly, to think differently about how we work together and what we should be accountable for in to the communities that we serve. Another thing that I just want to pick up a thread from Dr. Galliano's is this idea of a system working well together so that the resource is where it needs to be to have maximum impact from a prevention standpoint. You know, a big part of that is having the testing period available. But the other piece of that is having it accessible in the places where we have a high suspicion before testing, that there are risks either in terms of how severely affected people will be if they are infected with COVID-19, but also in terms of how susceptible and at risk they are of infection. And, and so I think one of the other things that this pandemic is shining a light on in the US healthcare system writ large. And particularly, you know, I'm, I'm sort of like channeling Dr Sharfstein here bemoaning his absence. But it's also that this is about the combination of public health systems and health care delivery. And, and so there, it's, it's also kind of shone a light on the places where, you know, we think of hospitals as being the full continuum of expertise and resources to deal with health challenges. But frankly, many of these challenges start outside of healthcare delivery systems, and either in the community domain or are sort of like known under the purview of public health infrastructure. And, and there's a real imperative here to connect public health and health care delivery, and create more of a connect a stickiness within the system as a result of what we're learning from the pandemic. You know, I could go into great detail. And I hope we'll get to this in a little more detail later, some of our sort of forward thinking that the Bloomberg American Health Initiative and the Hopkins Center for Health Equity, are doing in partnership with IBM Watson Health to think about ways to create measures that can sort of incentivize hospitals to take on this, this role as a partner in promoting health across the community. But before we delve too deeply into that, I'm going to pass the baton back to Dr. Galliano's, who I know has done a lot of this kind of work on the ground locally in Baltimore to to elevate the way we think about healthcare delivery systems and health care providers and the whole infrastructure as, as a as a part of communities and as having a you know, not just you know, we're Hopkins where, like, both of us are in the Hopkins system. There's a lot of cachet around being part of that system in terms of the national and international stature, but we're also institutions that are intended to serve the needs of the immediate community surrounding us. So I'll stop there and yeah, no, I passed the baton to him.

Andre L Robinson Jr

Yes, I didn't want it and Dr. G in your answer. Would you also include the the, the idea about these sort of multiple multiple anchor institutions working together including Sometimes the only anchor institution in a lot of these communities, the faith based community, so how do we draw all of that knowledge and power in and, and use it as leverage to get us to where we need to be later on?

Dr Panagis Galiatsatos

No, Andrea, great question. And Dr. Thornton, a colleague, and every time I've listened to speak, I'm like, at some point, you got to campaign for presidency at some point, Dr. Thornton, gonna

Andre L Robinson Jr

stop Mayor first, okay. And then we'll work our way

Dr. Rachel Thornton

up to no politics here, no politics.

Dr Panagis Galiatsatos

Um, so the first thing I want to I want to make clear is the two points that may seem obvious, and, but I'll just share them to have them out there that medicine and health are not synonymous, you know, health for the community can mean anything from jobs to, you know, having your grandkids over, right. And it's just purpose of well being and a purpose over overall. And then the other component of this is, you know, hospitals specifically, right, we have such like little to do with regards to certain variables that impact health outcomes, from housing, to transportation to neighborhood quality. But at the same time, while these impact health hospitals are always the first to be blamed for poor health outcomes of a community, right, and I see this because we have to engage with the community to promote health and prevent disease. And I think hospitals are recognizing more and more that if we are really to make the biggest impact of health, it's not going to happen within the confines of the four walls of a hospital. So those two notions out there, I think, a hospital, especially the ones here in Baltimore, Hopkins, in particular book on Broadway, and on Eastern Avenue, we've begun, you know, to change that, to recognize that, you know, community engagement is part of the strategy of public health outcomes. And then COVID. Right, and I think it's resulted in a massive catalyst to expedite this. The reason for it is, I mean, what are we asking people to do to into battle COVID is to just not get so you're saying physical distancing, or saying, hand hygiene, masks quarantine, you know, let's get to resources. All of that is whenever shoulders have the responsibility to the community, there's no way a hospital can impact that many lives. Right? You're right, we're going to have to rely on who are the pillars in the community that we can turn to. And from my standpoint, and Dr. Thornton's work in the community as well, I mean, we recognize, you know, housing units are great, but oftentimes, to challenge. There's pros and cons, right? The challenge sometimes with working with housing units, as there isn't a really unified community leader that people turn to schools is another one, good, good reach to certain communities. But leadership oftentimes is challenging there. This is why we love working with faith based organizations, you know, we're asked to get a sense of community right off the bat, oftentimes, because of the culture and the faith that people are part of almost a weekly gathering of adults, that's great, who all have an innate sense of wanting to help one another. And the leadership there is key, I mean, I cannot emphasize that enough, you know, when you work with these leaders, you know, in from moms to rabbis, priests to reverence, you know, when he or she understands that message, and more importantly, can translated into what the community will gravitate to, right, we want to stop COVID-19 know, there are translation there might be, we want to keep people safe, you know, their their online standpoint, they're on par with two public health outcomes, discuss in two different ways from community health and population health. So I agree, Andre, if we're going to make an impact, if we can, moving forward kind of in a transformative way of medicine. From my standpoint, let's, let's find some silver lining in this pandemic. So these lives last won't be for nothing, these lives have been changed forever, won't be for nothing. And if we can redefine what a hospital means in the 21st century, that could be a massive win for this. And it's needed. I mean, you we're seeing this right now in the pandemic. I mean, we we need these redefinition. So I love working with various organizations. And so the last part, I'll add to this and stop for more questions, is that especially your listeners who are listening or watching this later, this will mean you know, think about like what these congregations can begin to do, right we we hold a lot of we hold community calls twice a week with a lot of faith based leaders, we call them to tunity calls, right? Because their telephone calls, but also it's the call from the community. And we make it clear, like have these, you know, congregant individuals rise up and be the COVID leaders right now. Right. So if they need a phase in their congregations that can work with us in order to do that appropriately. Later tonight, we're going to be talking to a synagogue about how to phase in for the for the for the Jewish holidays that are coming up. So I think this is a great time where we all can kind of reassess or, you know, what does a hospital mean in the 21st century? What does a faith based organization mean? In a 21st century it can all become these transformative roles to evolve to promote health and prevent disease and the maximal effort.

Andre L Robinson Jr

Great question. I mean, great answer. Thank you very much for that. And I'm going to get Are you am I allowed to call you Dr. Plot yet? You? Are you. You're in between I cannot call you Dr. Plot.

Caroline Plott

Yeah, I your you can call me care and medical.

Andre L Robinson Jr

Just call you care for right now, you'll let us know when you when you come all the way. Your particular specialty in in nutrition is actually also one of those morbidities that were already addressed with the lack of healthy food and communities lack of access to healthy foods that sometimes are tied to cultural norms, right, that that, that he clips, the good sense that we need to implement. Sorry, the device is tied to my telephone. So sometimes it cuts me off. So that we are you are you able to see any advancements, if you will, on the understanding about the impact that solid Nutrition has when the hospital actually, the doctor, in particular can't do anything about the access to available food that's available in a lot of the communities around the institution?

Caroline Plott

Yeah, I mean, I think that, you know, food choices are so often rooted, and access, and that is rooted in community investment. And our country has systemically chosen to not invest and men, several communities, including those of African American, Hispanic communities, low income communities, and that is created something that some some people call food apartheid, which essentially, is also called food deserts. Although I don't usually use that term, because I think it kind of connotates there's something wrong with the community. But of course, it's really

Andre L Robinson Jr

more accurate, actually, the food is actually more accurate.

Caroline Plott

Right. And, you know, I think, often too often the conversation goes to individual the choices that individuals make, but there's this larger infrastructure that is impacting the ability to even make a choice. And a lot of us, myself included, are, you know, privileged to not have to, to be in a situation where we don't have a choice, but many individuals do not have that choice. And so I think it's important to continue to advocate for investment in local grocery stores, especially supporting those smaller businesses during this time, and understanding how we can other ways in which to provide helpful health promoting foods to communities. And instead of, you know, having any blame or judgment on the individual, think about the large scale system that's that's leading to these inequities.

Caroline Plott

Great. Great. Karim, did you have a follow up?

Karim Ali

Yes, I did. I didn't want us to step over a lot of the great work that Dr. G and his team has been doing probably for a better than six months, consistently, at least twice a week, or the COVID-19. A community partners call. I believe they're on Mondays and Fridays. So I wanted to bring attention to that. And I believe that will have the link to that phone call in our in our chat bots. I mean, over the weeks, you brought doctors to discuss ailments of the heart Safe Schools of post symptoms of COVID-19, healthy community partnerships on ophthalmology, and safe schools, geriatric medicine, tell us a little bit about the genesis of that community call and what you've seen as the impact over the weeks and months that you all your team have been doing this work.

Dr Panagis Galiatsatos

Always got to make sure that you're not muted in this zoom world. So I love that question. Because, you know, one of the things that you recognize when you work with a community, you when you get to, you know, you may not be able to be in their shoes, but if you walk by them, you know, side by side and understanding their day to day struggles. You're going to hear a lot. And so March 13, it was a Friday here, and it was a Friday throughout the world. But March 13 is when Governor Hogan of the state of Maryland, revealed here we're gonna go into lockdown schools, everyone, so forth, stay at home. Saturday morning from one of our community partners, Mark Carter. He calls me about 730 in the morning, I see a call from him. Something's going on. So I pick up the phone. And he made it clear there's two concerns he had one, this is going to affect African Americans more than anyone else. He's like, you know, they already have high rates in my community of Intensive Care Unit visit visits from infections and so forth. It's Gonna ravage us. And to. He's like, all I heard from the governor was we're gonna need more testing and ultimately vaccine. He's like, Well, who is going to trust, you know, these institutions to do testing, he's like, You can't come at this at an eight historical way, like medicines. trust has been broken countless times for certain populations. And certainly with this pandemic, and wanting to do the things that cause them as trust in the past, we can't turn this new chapter without recognizing the priors. My heart sank. I mean, he was spot on, I mean, everything he was predicting over the phone, I mean, it's come to fruition. I'm sad. And so I say this because I call my colleagues at Bayview and I was like, the community is going to struggle with this. I mean, especially certain populations. And I know like Dr. Thornton and student Dr. Plot, like we recognize, it's like when when you're out in the community, you're know, this pandemic, before even immediates wave for the first case in Baltimore City on March 14, we knew it was going to impact disproportionately certain populations. And so you know, what came of that was, let's just start off with one simple task, because up until that point, other part of that was making a lot of physicians and scientists and nurses and public health officials, will their hair was just an inconsistency on messaging. You know, you have the World Health Organization, talk about how bad this is going to be. You had Italy, in physicians from Italy being like we are ravaged by this here, you know, the same thing out of China, and so forth. And you had inconsistent messaging here in our state. So we were set, the first thing we can do, while it may seem like low hanging fruit, but at least let's start here was let's set up calls where our own partners that we formed over the last decade that you can call in and we can give them the most updated messaging about COVID-19. And what they can do, right, from our standpoint, can we provide a sense of hope and a time of hopelessness and a sense of power and a time of the many feel powerless, and we started off, like, I will never forget, we sent an email that Monday morning. So now we're March 16, right? We send it off to our needy, you know, congregations and so forth. We had a call at three o'clock. And I promised when that call ended, I was certain there was like six people on that phone because I heard to community members and my colleagues were the other four. But we found out there was 125, then Friday's call, we got 275. You know, by the following week, we're at 200. And we're still averaging about 80 people on these calls. And to see this because it clearly showcases that the community is hungry for consistent messaging from a trusted source that is actionable. It's not just it's bad. COVID is here for what can it be and getting to do like every physician, every healthcare professional comes on these calls, we make it clear, like we're gonna make this into a q&a, but we got to provide some information that they can act on. And so yeah, no, that's what we've been doing for the last six months feels like forever. But the point I want to make an emphasis here, and we discussed earlier, so much social reengineering has to happen to stop the spread of this virus. And so that to me, like let's use that, like the buyout, like let's turn the tables on this virus that's trying to empower as much as we can the populations have been ravaged by this, get them the information, get them the resources. I mean, that's what we've been trying to do with these calls. And from these calls, we help congregations with phasing in we started a curriculum for the schools like it's, you know, this these, like, the community has our heart and people like Dr. Thornton, student, Dr. Plot, I mean, like that's, that's what we we know this because you tell us this, you tell us how important it is to work with the community.

Karim Ali

Excellent. Yeah, I wanted to just let you know, we're gonna open up the phone lines, or the internet lines, if you will, at about a quarter till five for any questions, as we begin to close out at their time. Something you said earlier about redefining what hospitals actually mean 21st century and it sort of brings me to the work that Karen duck thought and Archie involved in it's a proposal a currently measuring hospital contributions, community health and equity. So I wanted to give him the floor to talk a little bit about that proposal. And what you see actually coming from that. And we can go a little bit deeper, in as much as Andre Robinson is a community developer, and I'm certain that he's got a lot more that he'd like to add on to that conversation. So Dr. Thornton, would you want to lead off on that? Survey that con survey?

Dr. Rachel Thornton

Sure. Thank you so much for the opportunity, Karim. I think it is essential to get feedback from organizations like yours from the faith based community on this concept. And frankly, there's I think there's no better time to introduce it then in the context of the pandemic, as I was saying earlier. And really the idea here is that so there are a variety of different ways that hospitals get ranked in terms of their quality or their performance. And the Bloomberg American health initiative led by Dr. Josh Sharfstein and the Center for Health Equity led by Dr. Lisa Cooper, with me as the lead from the Center for this particular project, are partnering with IBM Watson Health, in reimagining how they can hold hospitals accountable, and incentivize hospitals to invest in community health and equity, on par with the investments they make in health care quality and patient experience. And so the idea behind this proposal is to really use evidence to inform the development of an additional measure to be counted on par with the other measures in this ranking system, that IBM Watson Health Care stewards called the 100, Top Hospitals ranking. And really, we are coming from the standpoint of what Dr. Dr. Galliatso's mentioned earlier, which is this notion that health is more than access to health care or delivery of health care. Our premise is that healthcare needs to be delivered equitably, effectively, and appropriately. And it needs to be accessible, and adjust way. But hospitals are also a major economic engine in many communities, the health care, the healthcare sector, the healthcare industry, is a, you know, contribute significantly to government spending and sucks up a lot of economic resources and communities. And so the idea here is to propose measures and performance measures that reflect the hospital's commitment to investing in the community where it's located. So there are four components that we're proposing as part of this measure, which I just want to rattle off quickly. And hopefully, the current the participants on on this conversation will have convert will have questions and comments for us, as well as yourself and and Andre,

Dr. Rachel Thornton

because we really want to hear how to improve our proposal. But the four components of the measure are holding hospitals accountable for population health outcomes, and here, we would be holding them we would be assessing the progress and dental trends. So trends over a 10 year period in life expectancy, and in preventable hospitalizations in the county where the hospitals located, we would be providing them opportunities in Component number two to report on their role as a health care provider in promoting community health. And in this face, we've identified best practices like offering smoking cessation services, to end treatments to every patient who enters the hospital, you know, for whatever diagnosis they're presenting with things like being a Baby Friendly Hospital doing appropriate screening for intimate partner violence, and a variety of other things. In the third component, this is really about the hospital as a community partner. And here, we're talking about the ways that hospitals partner with other organizations in their community outside of what they do within the walls of the hospital. So to some of Kara's earlier comments, this would be a place where a hospital, hospital could partner and meaningfully invest in improving access to healthy foods in the neighborhood. To Andres expertise, this is the place where hospitals could contribute meaningful investments to affordable housing, quality, affordable housing and their communities to community development, to supportive services in supportive housing in their communities. And so we've given examples of all of these things, I think, Kara may have already chatted some information about the proposal into into the chat, but if not, I think she she will do so momentarily both a link to the proposal itself and a brief explanation of the proposal. And then also opportunities to comment either by completing a survey that's available online, or simply by emailing us at hospital measure@jhu.edu. And then the fourth component of this, the measure that we're proposing is around this idea of hospitals as anchor institutions. And frankly, I think this is where those reversing some of those structural inequities that hospitals as institutions have contributed to over time is potentially on the table. So this is where hospitals can demonstrate their commitment to to equity and to community health, by having demonstrated stands for improving the diversity and representation in the board the Board of Trustees of the hospital in the you know C suite positions and top level management positions within the hospital in demonstrating that they're committed to procurement practices that would prioritize, you know, investing in local businesses and minority owned businesses in their community, and making commitments to provide compensation that is aligned with living wage metrics in their geography, providing access to affordable quality childcare for their employees, if COVID has done nothing else, it's shone a light on all of the essential workers the healthcare workforce, who themselves are food insecure housing insecure economically and financially struggling. And then this in this in this anchor institution domain, we've also highlighted things like paid sick leave, again, something that is essential here in the context of the pandemic, but there's a significant evidence base to support its value to community health otherwise, and then things like Do No Harm collection policies. So in all four of these domains, we have highlighted examples that some hospitals and health systems are already implementing, that are based on the research evidence around the social factors and the intervention approaches that positively contribute to community health and frankly, in many instances also are designed to compat and combat inequities and health disparities. So I've sped through a lot of information there. But I think, you know, the idea is to open this up to the floor, I will say, and I would love particular engagement, to the extent that people are interested from your constituencies is ways that we can think about further demonstrating through breath practice examples, what community faith based partnerships with hospitals and health systems look like and the essential role that those play I think Dr. Ghali, Otto's made a really incredibly important point, which is, you know, hospitals are not always trusted sources for every community, for good information, they're not always seen, as, you know, without some accountability for the ills and wrongs of the past, which is something that I think Hopkins as an institution continues to work to reckon with itself. But this idea of engaging people who do have trust, who are embedded and committed to the spiritual health, the physical health and mental health, every aspect of health and well being of other faith communities, and what those partnerships might also look like. So our proposal is really a framework, we sort of demonstrate in the proposal, what we think, you know, the criteria will need to be for each of these measures. They have to be largely transparently reportable and relatively easily reportable by the hospitals and health systems in, you know, in submitting questionnaires for consideration in this ranking system. But I think that also provides an opportunity for community partners to weigh in and say, Yeah, this is really an accurate depiction of their engagement as a community as a partner with the community or, you know, or to the contrary. And so, you know, so we hope this opens a conversation, we think we, in addition to informing the ranking system, that this is also a way to inform the broader community at some of the best practices that are already out there and recommended either by, you know, healthcare subspecialties by public health departments by, you know, other sectors like housing and community development sectors, and in sort of raise the game for every hospital and health system out there. So I'll stop there. I don't care if there's any finer points you want to pull out and I and then I'll pass the mic back to Karim to keep us on track here with the conversation. But I think we're very, very interested in your thoughts and your feedback, both now. And once you have a little more time for folks on the line who are hearing about this for the first time to process the information in more detail.

Andre L Robinson Jr

Thank you, Dr. Thornton.

Caroline Plott

That was a wonderful summary. Thank you. No, I don't have anything to add. And I'm eager to hear your thoughts.

Karim Ali

I know one of the things that actually came up for me as a question was, are there currently any working models of the hospital community collaboration that perhaps need to be expanded unfunded?

Dr. Rachel Thornton

Yes. So I think we we identify a variety of models in our report from around the country we try to be in our proposal, we try to be comprehensive about what what hospitals in different places are doing. I see Dr. Ghali ounces. Also wanting to make a comment here, I think, you know, in the housing space is one example we we hold up bond scores here in Maryland and some of the work that they've been doing to invest in a way that is focused on the interests of the communities, I think, you know, the, the housing, constituents, constituencies that we've heard from so far, agree with us that that is one example of a good model for a hospital as a community partner. And then nationwide, Children's Hospital is another example that is doing a lot of innovative work around community development, and affordable housing access and expansion. Again, I think, you know, part of the challenge here is that hospitals oftentimes have a lion's share of resources and proportion to some of the other essential safety net services that people need. And so the idea is not for the hospital to usurp the expertise of other sectors, but really to effectively and meaningfully partner with people who do have the right expertise to address some of the social factors that are fundamental to health inequities.

Dr Panagis Galiatsatos

Just go off of Dr. Jordan, amazingly, spelled out without hinting at an example, I just want to, it's more of a general concept, you know, the we redefined in the hospital. And it's been emphasized, but when we target these health goals that we recognize there, they're in line with a population health strategy for a public health outcome. If we can do it on, if we can do it in accordance with a community health interest, we will have such an impact. And that's what Dr. Gordon is emphasizing right? Housing, we know, stable housing promotes a lot of wellness, and to prevent a lot of morbidity and disease. So we have to recognize this in the two examples I want to provide is one working with Southern Baptists, a congregation in Baltimore City, behind Hopkins Hospital, their senior center was, while it was being constructed, was burned down during the pretty great uprising. And I see this because we partnered with their robber who's now a bishop and we work with him. And I'll never forget a very key example of when we wanted to do, for instance, flu vaccines for the community. And you know, one of these community members was just like, we have so many other things concerned about, you know, and we were like, well tell us, and I just remembered them telling us like jobs, like the community is struggling to find jobs, and so forth. And there's the Community Health interest, what we ended up doing was giving a minor presentation a week later, when we were, you know, for the weekly meetings. And we talked about how, you know, flu vaccines have been shown to prevent schools, school miss days, as well as adult miss days of work. And the committee heard that they're like, you get it like, if we miss Perkins, miss a day of school, then we have to miss a day of work, if we miss a day of work, then you know, we're not going to get our paycheck. So I see this, because when we work with a community, these models are great. But at the end of it, we have to make sure that the community's health interests are in alignment with the population health strategies that hospitals trying to achieve. When you have that amazing relationship where the hospital seems like it's working for the community, then you're going to get the biggest impacts. So all the examples that was already laid out, those are key examples, but at the heart of them, it's that alignment, you know, that's the emphasis. That's what needs to be recognized. That you guys

Karim Ali

know that that was really good. I, you know, I was also interested in understanding the it, are there models of how you actually connect with the community? I mean, do you have a current a deep discussion forums or, you know, listening sessions, where you're actually carrying the voice of the community to really understand, you know, what's there for them? And in their minds, you know, what would actually be the redefining, you know, of hospitals as supporters of community.

Dr Panagis Galiatsatos

I think Dr. Dorner now are really well positioned to answer this, but I'm going to answer it as if there wasn't a pandemic, because we're trying to figure out what community engagement looks like in a ton of a pandemic at the same time to see this because the simple answer is you got to go to them. We can hold listening to it, there's nothing I'm not trying to take anything away from them. Those are all important. But at the end of the day, you got to go to them. I was interviewed a few years back with Reverend King he's a local Reverend, but he runs this fantastic marching band called Christian warriors out of Ponce, a home out of West Baltimore. And I just remember the reporter asked him like you know why why work with you know, Dr. G's group and he And he responded in it and which seems so simple at the time, but was as to me, like, that's the bedrock. He's like, they just show up. He's like, you gotta show up. If you don't show up, why would we work with you? And that is always stuck with me. So yes, whatever. No label unit presented listening session, just show up. Like, that's it. Like I said this in the beginning, we can't be in their shoes, but you gotta walk with them. And so that that's the key, you know, whatever, you want to label it fine, but just show up. Dr. Thornton, your thoughts?

Dr. Rachel Thornton

Yeah, no, I think and I'm, I'm just looking at some of the some of the comments in the chat as well. I think that showing up but also like, you know, inviting those voices that even within community organizations that may not always come to the fore. And I think that we are, you know, one of my hats is as a researcher, and in the research community, there has been growing, growing imperatives to, you know, to be able to demonstrate that the things we're studying, the interventions we're testing out, have, have been kind of gut check, gut checked, validated are, are consistent with the priorities of communities. And, and I think a big part of that actually, is the listening cream and ensuring that people feel heard in that process. And one thing I will say in our work, and it's an admittedly, it is, it is sort of a couple of levels above the level of grassroots community engagement. But in this proposal, I think another way of doing that is connecting across sectors with the organizations that really are working on the priority issues in different places, you know, sometimes what happens when help with health and health care, is we just kind of come in and take over, like, you can't have anything without health, and, you know, but health may be having a job or having self determination or freedom, it may really be about some other fundamental value that is more important than, you know, a blood pressure measurement. And so I do think another way of approaching it is to think about, you know, connecting health to people's everyday lives. And, and making it tangible in the context of things like work, like education. And so in that regard, I think part of what we're doing is demonstrating best practices that cross those divides almost more for the consumption of the hospital and health system consists constituencies in some regards, and for, you know, communities, I think it's intuitive to us all, as members of the communities were a part of that, you know, if I don't have a job, if I don't feel like I can do what I need to do for my family, if I don't have a place to lay my head every night that feels safe and secure, and, you know, and, and affordable and healthy. What what what kind of health could I possibly have? So I think part of this is about getting away from, you know, those biological measures of health, that tend to consume a lot of attention in the healthcare community to some of these fundamental contributors and factors and both through through outreach to sec to other sectors. But then I think also through more inclusive approach of engaging communities and describing what their priorities are, and, and and giving those more weight than potentially, you know, what the health insurance companies want to pay us for in terms of population health performance. And I might get in trouble for saying that, but But fundamentally, I think that's, that's a big part of what this is about.

Karim Ali

Yeah. And Andrea wanted you to pick up on this thread. And thank you for that. You know, I had asked you earlier, if you had read similar philosophies where she's actually with the Federal Reserve Bank of Atlanta, and that she wrote a few papers, you know, regarding hospitals, anchor institutions and these opportunities to actually collaborate and create impact on this way. Specifically, one of the papers that she wrote, was entitled anchor institution strategies in the southeast, working with hospitals and universities support inclusive growth. I wanted Andre to take a little bit deeper as a community developer Well and having experience in the development area, how is it that we can actually make progress in terms of creating these collaborations and these cohorts to actually move projects from our planning and from, you know, are proposals to actually digging in the ground and getting things done in the community?

Andre L Robinson Jr

You know, that's always the $64 million question. Right, we have Baltimore's a great place to see the preponderance of the knowledge economy that's here, right, we have an extraordinary output of intellectual capacity here. What we're also able to observe pretty quickly is where that fails on the implementation side. So I think that one of the things that we could learn from this particular moment that we're in is that, to a certain extent, culture, Trump's policy, right, forgive the the old word, I didn't invent that Trump was already in there. But certainly that, you know, they're all we have a preponderance of philanthropic organizations, we have these wonderful institutions here, all with wonderful mission statements on the wall. The challenge comes when you step outside of that institution, and you're in this sort of deep and murky, almost a poisoned sea of these historical structural issues, that the hospital alone does not have the power to do anything about. So to a hammer, of course, everything looks like a nail, right? So I'm a housing guy, and I'm a workforce development guy and a business development person. And so all those ecosystems around the hospital, which also, of course has to be what has to be included, there is the impact on people's mental health, that if I'm hiring people that are not healthy enough to stay in that job, they won't have that job for long. And if in fact, you are underpaying that person while they're trying to feed a family of four, or five, or six. And we found that looking at the Philadelphia rowhome strategy, that after asthma, the number one thing that impacts on hospital visits is false. So you're most of our hospitals are surrounded by almost 100 year old housing, much of which is in desperately poor repair, because of redlining, all the issues that tie to that, and the hospital does not have the engine to do something about all of those things. So you really need the hospital, the builder, the school, the politic, political structure to be in sort of a chord with each other. And they're not always different seasons, different policy impacts different rules. And so those of us that are on the outside, as community developers have to look at all those conditions, and rely on first leadership to do something beyond just stating wonderful things and pulling from this phenomenal research to say, therefore, we shall do what and in what order, and sometimes those prior priorities will be competing. And so I think that what we're looking for in this post pandemic world is really a commitment and resiliency on the part of the institution, which may have some complicity in those practices on the backs right there, you pull these threads that in these hospitals, and you're going to quickly come to policies that are should embarrass the institution, all the way down to the bedside manner that is not always conveyed to, to populations of different ethnic Miss mixes in the same way. But if you're not resilient in that conversation, when you face that thing, then you're going to back away from who wants to be continued to be blamed for something that happened in 1955. Right. But to be robust in your in your ability to look at those things and address them. So if I'm

Andre L Robinson Jr

trying to mitigate a building that has fallen down, I can't just slap a bunch of shiny stuff on top of that broken foundation, you have to excavate, you got to get it out, you got to clear it all out and start all over. And I think that's also going to be the case with life after this pandemic, we're not going to be able to do very much about the multiple morbidity, striking communities that are filthy, that are indeed wrapped in roach infested, that are falling apart and then are harming the very people that live in those communities. So we think that housing has an outsized impact on the health of those people going to work coming to and then when they're going to the hospital, they're not coming when they're already at stage four right there. You're going to they're going to come when they are actually adopting some of the policies and practices that Dr. Plot is talking about, where am I eating my cancer? Am I is my house actually making me sick? And those practice communities and that sort of knowledge comments that we have here in Baltimore coming together, I think make what would make Baltimore one of the most attractive cities in America because there's just enough housing available. And we have to break the the sort of racial tie that says that afford With liens for black people, because your researcher who is got a $75,000 student debt load needs an affordable housing platform. And that Well, I don't see very many medical students coming out and lighting cigars with $100 bills. So I think that there's a broader context that's available to us now, particularly here in this city, that's known as an ads in Midtown. And that's very, very true. To look at all of those things. Now, I'm not saying who's responsible for pulling all those things together. I think we all have a role in that regard. But I think that the the builders and the planners and the researchers and the political structure could be taking better advantage of the things that we know, and moving us all to at least the 27 priorities that say that this is the way that you actually build the community South up. And actually, we have found in the social determinants of health business, that the same determinants of health are those the same as well, it doesn't really matter how much money I have, if I start to if I approach stage four, all my money is going to go to that. And so I think that's really the opportunity that we have, with all of this great stuff that we have here available to us in Baltimore, to implement strategies that pull communities out of this historical morass that they're in. And as we build it, the house has to have telehealth in it, and the communities have to have ease of access to certain things. And we look at all of those conditions, without being overwhelmed by the enormity of it. So I know that's asking a whole lot. And I know nobody has the but the sort of magic bullet on this. But I think that it's some of this research that we can pull from it. Notes, was he asking a question here, when I'm making a statement, that we can pull from some of that research and really pull the things at the top of the strategy that say that these are the things that we must do, we must do them right away, and here comes COVID, to force us to do it right now or otherwise, we know that it doesn't end with a discovery of a vaccine, there's going to be years and years of this thing grinding to a halt over time, and to look at the other things that will actually impact on it and, and intersect with it that will maintain these communities in very poor health. So I'm, I'm excited to tackle the work of that. But you know, we can finish a house in about six months. But it doesn't necessarily mean the person moving in that will be able to be there two years from now, if they don't have a job or in poor mental or physical health, that children are not able to compete in the modern age where everybody was sent home. But I'm loaning Wi Fi to my next door neighbor's for them to do their homework. And that doesn't go very far. So

Karim Ali

I just want to I just want to pull those things. I want to thank you for that. We're coming to a close to the time of what I do here before I actually read the acknowledgments. And we want to let everyone Yeah, jump off on time, is that it sounds like there's an openness for ideas coming from the university, this openness to actually have deeper listening sessions with the community and the creation of collaboration as a cohort. So I want to thank Dr. panish G, and I'm sorry, I don't pronounce your last name as fluidly as Dr. Horton. Thank you. Thank you, Dr. Thornton. Oh, and thank you, Kara, a doctor apply for joining us today. I want to thank Andre Robinson for filling out for Linda Howard. today and I've got some other acknowledgments that I'd like to read. I promise you will take longer than 30 seconds of Profound Conversations that is executive produced by the MLP AI executive team. Samuel Shareef, Linda Howard and myself Karim Ali programming is written and produced by Mr. Sanatory. In the Ilia network webinar, technical logistics as produced by Erika Christie. Khadija Ali, today's host, again, was Andre Robison, the CEO of the Robinson group, am I correct on that the Robinson group. Community developers are guests with Dr. Josh Sharfstein Dr. Pedagogy, Dr. Rachel Thornton, and Dr. Caroline plot. Without the support from these individuals institutions, our program would not be possible special Acknowledgments to Kimberly Munson from the community program coordinator, John Hopkins Bayview Medical Center, John Hopkins Bloomberg School of Public Health and colleagues at the Henry Ford Hospital System, who are actually in attendance today. And a special shout out to a good friend. Miss Kelly, random hailing from Louisiana, the Louisiana organ procurement organization. Again, my name is Karim Ali, I'd like to thank you for coming to our season opener Profound Conversations and we look forward to seeing you on next week in the coming weeks for programming. Thank you so much.

Andre L Robinson Jr

Thank you for that

Erika Christie

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