“Conversations with Al McFarlane” on

November 18 was broadcast from the

Bigelow Building in St Paul, MN, which is
home to Community Action Partnership of
Ramsey and Washington Counties. The
program focused on an issue of vital impor-
tance to our community and to our country:
health disparities in outcomes and access
for Black people in America.

Participating in this important conversation were stellar

leaders in the world of health and policy. Joining the
broadcast via videoconference from Encino, CA, was
well-known surgeon Dr. Richard Allen Williams who
recently published the book Eliminating Healthcare
Disparities in America.” In 1974, Williams founded the
Association of Black Cardiologists, and served as its
president for a decade. He also established the Minority
Health Institute and in doing so, created a new paradigm
for addressing health disparities, a paradigm that takes a
holistic approach to patient care, tailored to the specific,
unmet needs of African American communities. In
2001 he was cited among Black Enterprise Magazine’s
top 100 doctors.
Joining the program from the US House of
Representatives in Washington, DC, was the Hon.
Donna M. Christiansen, the first female physician in the
history of the US Congress, the first woman to represent
an offshore territory, and the first woman delegate to the
United States from the US Virgin Island. Christiansen is
a member of the Congressional Black Caucus (CBC),
and she chairs the Congressional Black Caucus’s Health
Brain Trust, which oversees and advocates minority
health issues, nationally and internationally.
The Congressional Black Caucus Health Brain Trust
has long established itself as an authority on African
American and minority health policy on Capitol Hill,
and as the CBC Health Brain Trust, under able leader-
ship of its chair, embarks on health legislative efforts, it
does so knowing that racial and ethnic health disparities
and the absence of racial and of health equity and justice
have long plagued health care and life opportunities of
African Americans and other people for the last century.
Clarence Hightower, William Davis, and Mitchell
Davis responded to the presentations of Williams and
Christiansen. Mitchell Davis heads the Office of
Minority Health in Minnesota Department of Health.
Davis is Executive Director of Community Action of
Minneapolis, and Hightower is Executive Director of
Community Action Partnership of Ramsey and
Washington Counties.
The forum was sponsored by Pfizer, Inc., which
joins NorthPoint Health and Wellness Center; Hennepin
County Medical Center, and UCare Minnesota as spon-
sors of the Health & Wellness Broadcasts of
“Conversations with Al McFarlane.”

Health Disparities and Solutions


Clarence Hightower, Mitchell Davis, William Davis, and Al McFarlane
Following are excerpts of the broadcast
interview:
AL MCFARLANE: Dr. Williams, what are the
challenges, and how do we get to where we have
eliminated the gap in health for minority people?
DR.RICHARD ALLEN WILLIAMS:
Well, first of all, Al, let me congratulate you for
making it possible for us to focus on these prob-
lems of health care disparities today. I think this
is something that we need to see more of around
the country, and I’m sure Congresswoman
Christiansen would agree to that. We need more
information going out.
Today we’re talking about health care dispari-
ties, and the first thing we need to do is define the
term and also give an indication of the nature and
severity of that problem. Health care disparities
really is a term of convenience which is used to
describe the differences that occur between racial
and ethnic groups in regards to what we call mor-
bidity, mortality, incidence and prevalence of dis-
ease and certainly outcomes of disease processes.
There are tremendous differences that go along
ethnic and racial lines. One of the things that we
need to identify is where these health care dispar-
ities come from. They emanate really, from some-
thing that is deep in the roots of our country, of our
history, and that is slavery.
It all started back at the time when African
Americans were in bondage, and I won’t go into
great detail about that, but I want to simply indi-
cate that it all started with the maltreatment and
poor treatment of slaves who were in bondage and
who were not able to do for themselves as far as
Page 2
health care treatment is concerned. And it has
come forward to today, where we see problems
occurring in every area of our lives.
I want to make sure that everybody realizes
how serious a problem this is, and connect the his-
tory to the current situation. In the 18th century, a
man named Hoffman, took a look at the slave pop-
ulation of the United States, and looked at their
health care and their living conditions, their
chances of survival. He made a prediction which
rattles our consciences to this day. He predicted
that the slave population would not survive
beyond the year 2000 because of the health care
problems which were present at that time.
Now obviously African Americans have sur-
vived, but with great difficulty. What we can take
from that message is the fact that these problems
were, and still are, so important that we need to
give a great deal of attention to trying to solve
them.
AM: Dr. Christiansen, take a public policy view-
point and describe the challenges. How do we
move towards eliminating health disparities?
What are the legislative strategies to move our
country forward?
DR. DONNA CHRISTIANSEN: Well thank
you and thank you for having me back again, and
it’s great to be here with my good friend Dr.
Williams. We’ve been on several programs
together and he’s been a guest in our Health Brain
Trust as well.
Dr. Williams has laid out the history, but even
today, the last national report on health disparities
from the Department of Health shows continuing
Suluki Fardan
gaps in health care and health care services.
African Americans and other people of color
are more than 50% of the uninsured, and we still
face discrimination in health care even when we
are insured. There was a report from the American
Public Health Association, last month, showing
bias for, towards white patients and against Black
and other ethnic minority patients, just in the
review of articles and reports. So we face a lot of
challenges.
The Congressional Black Caucus bases its
health care agenda on four principles. One is that
health care is a right. Understanding that
acknowledgement needs to undergird any efforts
that we have moving forward. Second, is that to
address health disparities, we must address the
social determinants of health care. That is some-
thing that we have not really focused on. We’ve
focused on disease for a long time. To the extent
that we have ignored the social determinants of
health, we find ourselves in a position that we’re
in today where over 200 people of African descent
die prematurely from preventable causes every
day in this country.
The last one is that an investment must be
made. I’m very glad to see that our President-
elect has said that he is committed to ensuring uni-
versal coverage and health care access for every-
one, and equal education —which is really tied to
it— for every child in this country.
We in the Caucus are going to continue our
push for an investment in prevention because we
know that is the only way, not only to eliminate
the disparities, but to reign in the skyrocketing
costs of health care.
The principles involve coverage for everyone,
 “He [Hoffman] predicted that the slave
population would not survive beyond the year
2000 because of the health care problems which
were present at that time.”
including immigrants, and making sure that our
providers are taken care of – that they get the kind
of support that they need to continue to practice in
our communities. We must make sure that we
increase the diversity in the health care workforce.
That is a critical piece of eliminating disparities:
we must have health care workers on all levels,
from the community health worker all the way up
to the policy maker, that represent us, if we are
ever going to close the gaps in health care.
AM: Dr. Richard Allen Williams you outlined the
pervasive and historical issues associated with dis-
parities in health outcomes for African Americans
in your book, Eliminating Healthcare Disparities
in America. What are the findings of the essayists
in this book?
RW: Well first of all, I want to mention that all of
the scholars are not African American. There are
several other ethnicities represented as co-workers
in producing this book. And I think that’s impor-
tant because we wanted to present a broad per-
spective on this problem from several vantage
points. The book is based on, and emanates from,
what is called the Institute of Medicine, or IOM
-Dr. Richard Williams
http://weblog.themadeiratimes.com/images/slavery%202.jpg
Report, which came out in 2002, from the Institute
of Medicine. It was a report on the medical treat-
ment specifically of minorities in this country, and
the disparities in their treatment. It was subtitled
“unequal treatment,” in fact. What it found is what
you might expect from that title, and that is that
our healthcare delivery system is imbalanced and
unequal. The recommendation was that that must
be changed.
My book took off on that, and extrapolates
data to give more evidence about the health care
disparities which I have been finding. We talk
about not only what the background of the prob-
lem is, and the status of the problem, but also what
we might look forward to from the standpoint of
solving this problem. And I think what we have to
do is to focus on that aspect of things.
AM: Mitchell Davis, you just finished an impor-
tant conversation that mirrors the concerns dis-
cussed by our esteemed speakers from the east
and west coast. You recently conducted an Office
of Minority and Multi-Cultural Health Discussion
and Conference on disparities in Minnesota. Tell
us about what you did locally, here.
MITCHELL DAVIS: Last week, Al, we had the
2008 National Health Disparities Conference,
which was entitled “Health Equality: Honoring
Culture While Closing The Gap.” Dr. Gail
Christopher from the Kellogg Foundation talked
about the racial dynamics that sit at the bottom of
this health disparity. We talked about social deter-
minants, which means my education, my income,
where I live, what air I breathe.
DC: We have introduced, with the other minority
caucuses, a bill called the Health Equity and
Accountability Act. It was introduced with the
Hispanic Caucus and the Asian-Pacific Caucus,
and it addresses several areas that we feel are
important to address if we are going to eliminate
health disparities. It speaks to data collection by
race, ethnicity and socio-economic factors,
addressing individuals with limited English profi-
ciency and setting some standards and some train-
ing around translating for medical offices. It has a
large section on increasing under-represented
minorities in the workforce on all levels, including
policy fellowships. There’s a title that addresses
some of the leading causes of health disparities
and how we provide comprehensive care from
Page 3

prevention all the way through to support for our
facilities and our institutions. And there are other
special provisions like border health and Indian
Health Services. There’s a title that deals with
accountability that would strengthen the Office of
Minority Health, and would strengthen the Civil
Rights initiatives in the Department of Health and
Human Services.
The bill creates health empowerment zones,
which put the resources and information in the
hands of the community that is suffering from
these health disparities, and enables them, with
help from all agencies in the Federal government,
according to the plan, if they’re designated as a
health empowerment zone, to address those chal-
lenges and reduce the disparities in their own
community.
AM: Bill Davis and Clarence Hightower you all
are charged with organizing people in the commu-
nity. Community Action Partnership in St Paul
and Community Action of Minneapolis, have
major responsibility in translating and delivering
assistance, aid and opportunity, to people of color
in Hennepin, Ramsey and Washington counties.
How do we organize from the ground level so that
Page 4
http://www.house.gov/kilpatrick/cbc/images/cbc_members.jpg
The Congressional Black Caucus
our people both understand and can access or
acquire the assets, resources, solutions, we need to
improve our quality of life?
CLARENCE HIGHTOWER: Al in 2004,
when I was president of the Minneapolis Urban
League, I produced The State of Black Minnesota
Report, the first comprehensive exploration of
how disparities are impacting people of color in
this state. We looked at how health disparities
analysis shows we do less well than the white pop-
ulation.
I think the issue about how it is that you mobi-
lize people around this is something that we have
not spent enough time talking about. I really am
impressed with and interested in this health
empowerment zone. Years ago, there was this eco-
nomic empowerment zone strategy that impacted
places like North Minneapolis and South
Minneapolis where folks were doing less well
economically. The Federal government decided to
infuse resources in that area to help lift folks out
of poverty. To even think about something like
that around health disparities is tremendously
exciting to me. To make it work, you have to be
able to involve those who suffer from the dispari-
ties – figure out how it is that you reach down and
allow them to be part of the solution.
AM: Bill Davis you, among other things, have
been a leader in environmental awareness: the
abating of lead, and heating energy issues. It
seems that the country is acutely aware of the need
to merge our understanding of health, energy and
employment. Is there opportunity to organize,
teach and transfer knowledge you’ve gained
around imparting environmental solutions to the
health equation?
BD: There’s no doubt now that the people that we
serve have a multitude of issues and problems that
they’re confronted with on a day-to-day basis.
One of the things we know is that the fastest grow-
ing of poverty is children. Parents come into our
office with health related concerns looking for
ways of relief. They’re dealing with nutritional
issues, they’re dealing with energy issues, being
able to keep warm in the winter time, being able
to have proper nutritional meals for their children,
and also how they deal with the healthcare related
issues. Not only on the front end, but on the back
end, long term, chronic problems like lead abate-
 “The Federal government decided to infuse
resources in that area to help lift folks out
of poverty. To even think about something like that
around health disparities is tremendously exciting
to me.” -Clarence Hightower
ment certainly is one of the areas we’ve been
addressing in older homes that tend to be occupied
by lower income people. The risk factor there is
multiplied but we know that these things are pre-
ventable. We just need the resources and where-
withal to begin to tackle these mammoth issues.
Like Clarence I love the idea about having
health empowerment zones. I think that’s the type
of forward thinking we need to begin to put in
place mechanisms and vehicles that are going to
enable us to address these problems on the front
end, as opposed to allowing them to become
chronic and out of control.
Poor people, low income people, people of
color deserve to have adequate and preventive
health care treatment, and affordable health care
treatment, and that’s always been an issue. We’re
looking optimistically forward that with the new
administration, we’ll have a level of receptivity
for servicing the middle class, low income people,
and people of color with life supporting and sus-
taining of services. Health care clearly is one area
where we need to invest not only the resources
and capital to change the overall health of our
community.
AM: Dr. Christiansen, how would you charge
local communities to be in sync with the legisla-
tive considerations that you and the CBC health
brain trust have advanced? How would you
advise and direct local communities to connect
with what you perceive to be the direction of
President-Elect Obama?
DR DONNA CHRISTIANSEN, MD: Well,
I’m going back to something Mr. Hightower
said that reminded me that the biggest obstacle
to eliminating disparities and bringing about
change in our health is the lack of a political
will. So mobilization is absolutely necessary.
When the Congressional Black Caucus Health
Brain Trust, as well as our foundation and the
institute that Dr. Williams chaired, goes out to
our communities we have conversations on
health and in addition to screening we try to
engage the community. We want our people to
understand that we don’t have to dye premature-
ly from preventable causes and that there is help
available. But mobilization is a very important
part of it and we really need to do a lot more.
Bill Tendle (L), and Mitchell Davis
I was on a panel last night. We were dis-
cussing the Congressional Black Caucus in the
context of having President-elect Barack
Obama. I think what his success in this election
has meant and will mean a lot, not only to our
community but to our country and the world.
One of the things that it has shown and I
think it will do, is empowerment. It will show
and it has shown everyday people the power to
create change. When that is unleashed, we will
see change. I think it’s going to have a great
impact and one of our roles is going to be to con-
tinue to engage our communities. The health
empowerment zone, because it does reach down
into the community, requires the community to
form a broad-based coalition of stakeholders to
identify the challenges and to create the plan and
then to implement the plan. And so it does get to
the heart of the community taking ownership of
their health and creating that change. I feel that,
from having worked with President-elect
Obama, within the Black Caucus, and knowing
that he has also been involved in minority health
legislation and issues, that we have a great
opportunity here we need to take advantage of,
especially since he is determined to find the
funding, wherever it comes from, to make sure
that we invest in the health and education of our
people.
Mobilization has to result in our people’s
representatives in the House and their represen-
tatives in the Senate supporting the kinds of leg-
Suluki Fardan
islation that I’m talking about which we will be
re-introduced next year. We invite anyone to
come and follow the progress of the bill and to
make recommendations. When we introduce the
bill it’s still open to change and we invite people
to change it. We are developing principles that
we want to see included in any health reform
package that comes forth from all of the discus-
sions that are taking place around the country.
We will post those on our CBC web site, so that
people really can be engaged, even if we can’t
get to you.
But also, we need you to speak to the people
who represent you, the people who depend on
you for votes.
DC: We need their vote. When they come to
Washington.
DR. RICHARD ALLEN WILLIAMS, MD:
So they need to go to their congress-people and
talk to them
DC: Absolutely, members of the House and
members of the Senate.
CLARENCE HIGHTOWER: Al,
Congresswoman Christiansen and I continue to
be on the same page regarding mobilization.
Here in St. Paul we have been working with
low-income people and training them to advo-
cate for themselves. We’ve figured out that once
Page 5
 “We have a great opportunity here that we need
to take advantage of, especially since he
[President Obama] is determined to find the funding,
wherever it comes from, to make sure that we invest in
the health and education of our people.”
you do that, you need three things: First they
need training or the jobs of the future. So we
provide the training. The second thing our folks
need is confidence. Once they’re trained they
have confidence to go out and speak for them-
selves, tell their own story and advocate for
themselves. The third thing they need is oppor-
tunity. When our communities figure out how to
do that … how to give people confidence,
opportunity and skills, then I think we can move
the health disparity down, especially on a local
level.
AM: Mitchell, does that ring true to you, in your
experience at the Office of Minority Health here
in Minnesota?
MITCHELL DAVIS: It certainly has. As we
talk about the health empowerment, as we talk
about mobilization – we have 52 partners with
the Office of Minority and Multi-Cultural
Health, and they’re spread out over half of the
counties in Minnesota. They’re working in
eight health areas of disparity: cervical cancer,
cardiovascular disease, diabetes, healthy youth
development, HIV, AIDS, immunizations, infant
mortality and also unintentional violence. And
these – our partners, are funded by the taxpayers
of Minnesota. They’re doing exactly that.
They’re mobilizing, they’re training, and they’re
doing community education.
AM: Bill Davis?
BILL DAVIS: Well, I think the thing we keep
seeing is the affordability of health care. We’re
talking about the underinsured or not insured at
all.
There are people who make a determination
whether to take their child in, or take themselves
into the hospital or see the doctor based on the
dollar, bottom-line. And sometimes they will
forego necessary treatment simply because they
can’t afford to make that commitment or make
that sacrifice. And until we are able to provide
preventive health care to people… it’s akin to
those who are able to take their cars to the
garage for a daily or maintenance update on a
regular scheduled basis vs. those who take their
car into the shop when it’s absolutely on its last
Page 6
Hon. Donna Christensen D-VI and Dr. Richard Williams
leg.
What happens quite often is we have people
in our community that do not seek health care,
because it’s not affordable, until it’s absolutely
imperative and at total peril of them and their
family.
In this day and age people should not have to
live like that. They should not have to be con-
fronted with that kind of decision. The other
thing we’re seeing when we talk to people in our
community is the mental health issues. I think
that’s also something that sort of flies below the
radar, that people are dealing with drug abuse
issues and battering issues and other issues that
preclude them from being healthy and being
able to be productive members in our society.
When we start sitting down and doing an
assessment with individuals who come into our
office, to do an assessment to determine how we
can best serve them, we find that there are issues
of mental incapacity or mental health that pre-
cludes them or disables them from being full,
productive citizens, and so that issue also needs
to be addressed, and any kind of funding or dis-
cussion about health and health disparities.
CH: Al, we’re curious about whether or not this
health empowerment zone idea is gaining legs
across the country.
AM: Dr. Christianson, the idea of a health
empowerment zone is intriguing. Has that taken
-Hon. Donna Christensen D-VI
root, or will it be presented in the next legisla-
tive session?
DC: We certainly hope so. Whenever we speak
of it to different health advocacy and profession-
al organizations everyone thinks that it’s the
right way to go. To approach health comprehen-
sively like this we have to talk about housing,
we have to talk about a lot of things. This
approach would enable communities to get help
from Housing and Urban Development (HUD)
and from Environmental Protection Agency
(EPA) for environmental issues.
We’re going to introduce it as a stand-alone
bill again because we think it is really the key to
turning things around in our communities.
AM: Dr. Richard Allen Williams what is the
duty of our people? Too often we hear people
say: “we want to wait on Washington to do for
us.” But at some point individuals, families,
neighbors and communities have to take respon-
sibility. How do we mobilize and organize at the
street level and produce policy that serves our
interests long-term?
RW: Well, the wildfires here in California have
been a point of interest across the nation, and
we’re still suffering from them by the way. I
would like to hope that we can create a wildfire
of interest in health care disparities at the com-
munity level because when you get right down

(From left) Clarence Hightower, Mitchell Davis, Bill Davis
to it, it’s what happens in the grassroots level
that’s important. These changes that we’re talk-
ing about, in health care reform, have to be
applied at the grassroots level, and to a large
extent the leadership for this has to come from
the community.
The community can’t just stand there and be
victims, as they have been for so long. The com-
munity has to be mobilized, just as Dr.
Christianson has mentioned, to carry out the
programs that many of us in academia and in
political life, have tried to lay out. But the
changes have to emanate from the people. That’s
the importance of having someone like
Congresswoman Christiansen –she’s a political
leader who is very, very interested in what we
are doing.
One specific issue we need to look at which
is one of the most important aspects of the
whole health care disparities argument is insur-
ance coverage. It is at the very center of the
problems that we see. At least 47 million people
in the United States are uninsured or under-
insured. That is a tremendous problem which
inhibits our progress in eliminating health care
disparities. I think we need to talk about what
the insurance problem is. It’s not just a problem
of people not having insurance, but a matter of
how their insurance, when they do have it, is
handling them.
AM: Bill Tendle, you are the front line in health
care at South Side Health Services, in South
Minneapolis. How do you instruct our commu-
nity to engage and utilize the services you pro-
vide? What is the impact, negative or positive,
of insurance or lack thereof, and what legislative
remedies would support you in delivering quali-
ty of life to your stakeholders, your clients?
Bill Tendle: Two things that are really a prob-
lem are access and trust. People don’t have
access, or they do have access and they don’t
have trust, and therefore access and trust are two
big issues in the African American community.
For example, there’s not a lot of trust in health
care providers, especially if they don’t look like
African Americans, so that’s a problem. It’s trust
for other people, as well. If you get into the
Hispanic population, it’s a matter of trust
because some people maybe not have the right
papers or they’re afraid they might be turned in.
AM: Let me understand that. You’re saying that
African American patients don’t trust physicians
or providers that are not African Americans? Or
Suluki Fardan
they don’t trust other African Americans who
are providing the service?
BT: They don’t trust providers who are not
African Americans, that don’t have cultural
competency to work with them.
AM: I see.
BT: And that’s been a problem since the studies
that have been done with African-Americans in
Alabama –
AM: The Tuskegee syphilis studies.
BT: Every African American knows about that.
Native Americans know about the smallpox
blankets that were passed out to them by the US
government. So it’s a legitimate matter of trust
that’s an issue within the community.
But more importantly, I think that this is a
new day, and people need to have more educa-
tion about health care and how health care mod-
els are put together. Bottom line, if you really
get down to it: people have to have a base to
move up from. Most African Americans who are
in poverty don’t have a base, and if you don’t
have a base, both educationally and monetarily,
Page 7
 “Further, there is a criticism of this practice of
cost-based drug switching which doctors in
New York have stated, has impacted their practice
and are making worse medical outcomes for 92% of
the patients that they treat.” -Dr. Richard Williams

and economically, it really impacts your health

care.

AM: Bill Tendel, what can Congress do to

support your vision and work to serve, enable
and empower your communities, your cus-
tomers?

BT: I’m seeing a need for more community

health workers. You have to have someone
who knows the community, who interacts
with people on a daily basis in that communi-
ty and who can help set up lifestyle changes
that will have the most dramatic impact on
health care. When I say lifestyle changes, I
mean social health. No one’s ever talked
about social health. But it means when you
leave any health institution and you go back
to your home, how does your social environ-
ment help maintain your health. That means
diet and your living conditions. What we
need to do is change the paradigm of how
people live, and really attack their social
health.

AM: Dorii Gbolo, Executive Director of http://www.usarpac.army.mil/SoldierFamilyWellBeing/Reintegration/pills1.jpg

Open Cities Health Care Centers in St. Paul,
please explore the same question from your
point of view.
DORII GBOLO: In our country, we’re
rewarded for being ill. We’re not rewarded
for being healthy. We need to change that. I
would hope that this Health Empowerment
Zone would kind of change that and enable
that paradigm shift. People can be empow-
ered to be healthy and rewarded for being
healthy. We should strive for that.
But when you’re in the bonds of poverty and
discouragement or whatever socially is going
on with you, you don’t think about being
well. You just expect to be well, until some-
thing happens and then people too often say:
“oh, I’m not well, how do I fix it?” We need
to help people while they’re well so that they
can stay well, so that they can be better con-
tributors to their families and to this commu-
nity.
I do agree with Bill about community
health workers. That’s what we’ve utilized in
our clinic because we want people to be well
and we want our community to be well. We
want to empower our community with those
tools that they need, no matter what is going
on in their lives, so they can strive for well-
ness. So if somehow we can change shift
from rewarding when you’re sick to when
you’re well, that would be a great accom-
plishment.
AM: Congresswoman Christiansen, how do
you respond to these managers, these leaders
of community health services here in
Minneapolis and St Paul?
DC: This country spends somewhere between
3 and 5% of all of its healthcare dollars in
prevention. Let me start with that. We are
going to mount a very strong legislative and
advocacy effort here to change that.
That would make a world of a difference
if we can focus on prevention. We do want
people to have access. Part of it is insurance
and part of it is having a health care work-
force that is culturally competent, and sensi-
tive. The best way to do that is to have physi-
cians, nurses and community health workers
that look and speak like the person being
served, that come from the same cultural
background and speak the same language as
the person being served.
We need to address all of those areas, but
we are going to try to make a really concert-
ed effort to increase our prevention dollars
while we work to get everyone covered.
One of the first things we’ll do, I’m sure,
[when we start the next session], is to try
again —successfully this time I’m sure— to
pass the Children’s Health Insurance bill that
President Bush vetoed twice. It doesn’t go as
far as we’d like it to go, maybe we can
expand on it. There are approximately 9 mil-
lion children that are uninsured, 6 million of
whom would be eligible for State Children’s
Health Insurance Programs (SCHIP). So we
will be doing that.

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I can remember when Howard Dean was
governor of Vermont and every child born in
Vermont got a health visit. The mother and
child got a home visit, and it made a world of
difference. It made a difference in their pre-
paredness for entering school. It made a dif-
ference in enabling them to address some of
the problems that were occurring at home
through referrals. So a community health
worker has got to be the bedrock of our health
care system if we’re going to see change.
People from within that community will have
the trust of that community, and will not only
help people get to the health care that they
need, but also support them. Sometimes it’s
difficult to test your sugar every day and take
your pills on time and eat properly. Some
people need support to live healthy lives.
AM: Dr. Williams, let me ask you to respond
to that as well. You recently caused a
firestorm in national media by challenging
whether health plans are switching to lower-
cost generic drugs, rather than the items
being prescribed by doctors. You questioned
whether the health of patients is being put at
risk, and you were saying that people who are
maybe less knowledgeable, less aware, are
more easily switched for the advantage of the
health plan and provider, not particularly for
http://www.cdc.gov/ncipc/dir/Image/EmergencyRoom.jpg
the advantage of the patient.
RW: Well let me begin with something else
and then segue into that very quickly. What
I’d like to begin with is kind of tying things
together in regards to what has just been said.
It seems that there is obviously a linkage
between poverty and poor health care or sub-
standard health care and we must be very vig-
ilant to make sure that we observe that link-
age.
I like to think of this as being a system of
wealth care rather than health care. It’s a mat-
ter of how much money you’ve got as to how
good your treatment is, and that should not be
in this country in this democratic society.
Now that also ties in with what you indi-
cated about this situation which I call drug-
switching. Let me also begin by stating that
the issue is not a matter of criticizing generic
drugs. Generic drugs, in many cases, are very
good medication, so I don’t want anybody to
think that I’m putting out a blanket criticism
of the use of generic medications.
What I deplore is what is happening based
on insurance company practices of switching
patients or requiring the switching of patients
from branded medications which their doc-
tors might have prescribed, to a generic drug
which may not be an equivalent of the drug
that the doctor intended the patient to have.
What that means is that someone other
than a medically trained individual is making
a decision as to how this patient is going to be
treated, because the outcomes may be differ-
ent depending on what kind of medication is
given. There are some specific instances of
that. You don’t have to just believe my criti-
cism. There’s been an outcry against this kind
of practice for instance, by the New York del-
egation to the American Medical Association,
which called for the development of a code of
conduct on the part of insurance companies,
and is asking the full body of the American
Medical Association to make a determination
there.
Further, there is a criticism of this prac-
tice of cost-based drug switching which doc-
tors in New York have stated, has impacted
their practice and are making worse medical
outcomes for 92% of the patients that they
treat.
That’s an enormous number, and I think it
needs to be recognized that we need to do
something about the insurance company prac-
tices, not only in regards to this situation
about drug switching, but in regards to things
like treatment of certain conditions, and in
their patients who are already insured. And
certainly we need to make sure that insurance
Page 9
 “This country spends somewhere between 3
and 5% of all of its healthcare dollars in pre-
vention. We are going to mount a very strong legisla-
tive and advocacy effort here to change that.” -Dorii Gbolo

companies are more amenable to insuring

patients who don’t have necessary financial
means to pay for their medical care.

CH: I am particularly keenly aware of the

linkage that Dr. Williams just mentioned. It is
a fact that those who are less well off are
often times those that constitute the pool of
those involved in the disparity. And that’s the
work that Bill Davis and I do. Our work is to
lift those that are in poverty out of poverty.
As you begin to work to lift folks out of
poverty, then you will also be lifting folks out
of the mass array of disparities that we find
ourselves caught in. And so I appreciate the
fact that you brought full circle the notion of
the linkage between those who are in poverty
and those who have disparities.

DC: We will be electing our new chair of the

Congressional Black Caucus this afternoon,
and the likely person is Congresswoman
Barbara Lee from Oakland, and we will have
a poverty elimination agenda, in the caucus.

CH: Good!

DC: And our Whip, who is very close to our

President-Elect, is also very much an advo-
cate for poverty elimination agendas, and we
are sure that he is going to make sure that the
White House has a poverty elimination agen-
da. And I also want to say, just on behalf of
the Congressional Black Caucus, thank you
for having me as a representative here, and to
assure you that whatever field, whatever
committee or sub-committee all of us serve
on, our goal is always elimination of dispari-
ty, whether it’s economic disparity, job dis-
parity, educational disparity, housing dispari-
ty. All of those things are part of the overall
Congressional Black Caucus agenda. And so
we do address them relentlessly.
AM: Thank you so much, Dr. Christianson.
Bill English is the co-chair of the Coalition of
Black Churches/African-American
Leadership Summit. Bill, you and I have
talked for years about the money side of this
equation. We think it’s important, as business
Bill English
people, to analyze problems and solutions in
terms of the revenue streams associated with
them. To attack problems involves deploying
financial resources. How do we benefit? How
do we align ourselves so that we, not only
deal with the misery but also benefit from
commanding the resources required to elimi-
nate misery?
BILL ENGLISH: First of all, money is the
underpinning at the base of the health care
problems in America. It is at the bottom of it.
At one point, health care was a charitable
thing in America. When money came in, it
became on the largest profit-making sectors
in this country.
While we’re all excited about Obama, it is
StudioTobechi
interesting that the word poverty did not enter
into this campaign. So I’m glad to hear the
Congresswoman say we really have to deal
with the issue of poverty in America.
The idea of Health Empowerment Zones
is interesting. Clarence and Bill spoke to that.
But you and I both know that the Economic
Empowerment Zone in Minneapolis was a
disaster for Black folks. It was built on our
poverty, but the people who benefited were
the developers. Public policy must assure that
there is equity in anything that comes out of
this. Clearly as we go forward, we have to
pay attention and be vigilant, mobilizing our
community and using the court to address the
issues of equity.

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