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Research and Justice For All is a podcast from Health Affairs that provides perspectives on how to dismantle unjust systems and structures that have long impacted health outcomes in historically marginalized populations. Hear how to challenge injustices in health care – rooted in racism, sexism, ableism, and other forms of exclusion – through research, evidence, community-building, and other potential and innovative solutions.
Each season of the podcast is sponsored by organizations dedicated to eliminating health inequities.
This is Research and Justice for All, season 2. I'm your host, Rhea Boyd. Thanks for joining us today. So today, we're gonna be talking, really for the first time this season, about health equity. You know, we've technically been talking about health equity all season long, and that's really the purpose of this podcast.
Rhea Boyd:But we've been having that conversation without often explicitly using the term. And so today, we're gonna talk about what that term means, how it's being used, and most importantly, perhaps, how it's being operationalized and realized at a population scale. To lead us in that conversation, we're grateful to be joined by doctor Philip Alberti. Philip is the founding director of the Association of American Medical Colleges, or as many of us refer to it, the AAMC's Center For Health Justice. He is also the senior director of Health Equity and Research and Policy at the AAMC.
Rhea Boyd:Philip, welcome to the pod.
Philip Alberti:Thank you, Rhea. It's great to be here.
Rhea Boyd:So let's just jump in. Tell us a little bit more about the AAMC Center For Health Justice and what brought you to doing this work.
Philip Alberti:Sure. So the Center For Health Justice was, I guess, given the green light in 2019, and we officially launched in 2021. And our motto is that health equity is our goal, and health justice is the path that gets us there. So we really interpret that, the the work of achieving health equity to be grounded in community wisdom and multisector partnership in order to cocreate the kinds of evidence that can be baked into organizational, local, state, federal policy in such a way that it creates true, genuine health opportunity for all communities, particularly communities made marginalized. I've been a health equity researcher and policy person for coming up on 25 years.
Philip Alberti:It's been a very long time, and seeing the the interest wax and wane and explode and recede, I'm sure, as you know, the work is personal, so we all have our own personal entry points, into how we we got here. I think for me, it was a combination of lived experience, upbringing, and and a family focus on on justice and fairness. I'll I'll shorthand it that way.
Rhea Boyd:I mean, now I think me and our listeners are curious about some of your lived experience or just your family's focus on justice and fairness. Do you are there any stories that come top to mind that you wanna share?
Philip Alberti:Sure. I think both of my parents had a real kind of recent ish they weren't immigrants themselves. Their parents were and kind of had a real, focus on making sure that no one was being taken advantage of. Everyone's needs were met. And that was just something that was very ingrained in me from a young age.
Philip Alberti:I grew up very working class. Dad was a barber, mom as a homemaker. And through their perseverance, some luck in my nerdiness, I ended up going to some of, like, the the greatest schools you could attend, and learned some really important lessons about classism and racism along the way, from my own friends, from my own personal experience, being a, you know, a barber's kid, a queer barber's kid at some of these places like Exeter and Columbia, and observing, where privilege was, how it was allocated, who knew how to access it and who didn't, and really thinking about opportunity. And for me, I think a seminal moment came in my freshman year at Exeter, which for folks who don't know is a a fancy boarding school in New Hampshire. And we had Peggy McIntosh, who was an activist and a sociologist, come and speak to the school at a at an all school assembly.
Philip Alberti:I was in 9th grade, so 14, 15 years old. And she had just written this is the late 90 late eighties. Sorry. She had just written about the invisible knapsack of white privilege. It was a a shock to me that no one was really listening, and no one was really paying attention.
Philip Alberti:And for me, given, you know, when I was younger and I had seen my black and brown friends, you know, searched at Newbury Comics at Tower Records when I got to slip right in, so having those, vicarious experiences, looking around this room filled with privilege, and I felt that I was the only one that was absorbing what this incredible activist and organizer was was trying to teach us, that was a very early moment for me to say, I don't know what I'm gonna do or how it's gonna be, but I'm gonna dedicate myself to unpacking my own and others' invisible knapsacks to really create pathways of opportunity wherever I can.
Rhea Boyd:I mean, this is a fascinating way to start this conversation because I think, as you noted, you've been on this professional path for, you know, over 2 decades. 25 years is so incredible. And so you've also watched professionally medicine, honestly, as a field, and health care as a larger industry, also not want to unpack that knapsack. And sometimes that reticence, that avoidance, we call willful ignorance. You know, that people are just unaware, kind of blissfully unaware of the conditions under which most people in this country live and suffer and die early.
Rhea Boyd:But then there's also this frame around the production of ignorance that for that to live at a place like Exeter, which, you know, I have to say in full disclosure, I don't know a ton about Exeter, but I absolutely know the name. I don't know the graduates by name, but I'm sure pretty prominent, powerful, wealthy folks have gone through there. That to have a place like Exeter be a place where it's a choice whether you learn from somebody as incredible as a professor Macintosh and you take those lessons in or you can proceed on your path to success, to health, to intergenerational wealth likely, is is a part of the problem. Right? And it's one that we faced in medicine that I have to imagine also lived at the AAMC.
Rhea Boyd:So given all of that, as somebody who was steeped in that as such a young person who then followed it throughout your career, who then kind of, I have to imagine, maybe confronted it at AAMC in the creation of the center. Can you give us a sense of, like, how did we get there from here and and where are we? Are we still in a place where, you know, medicine is actively producing ignorance around things like health equity?
Philip Alberti:It's such a that's a huge huge and wonderful question, Ria. You know, I think if if we take it, how did the AMC get here? So I joined the AMC almost 13 years ago. They were looking for someone to start up a health equity research and policy shop. And I think some of the I won't say I'll use the word controversy, but I don't mean it as deep as that.
Philip Alberti:I think part of the the way that it was set up was I report to our chief scientific officer, and I don't report into the equity, diversity, and inclusion cluster. I think there's still, even 13 years later, some question, why does that exist? And so I think, you know, part of that is how our member institutions, so the AAMC, medical schools, teaching hospitals, large academic health systems, I think for a long time, there's been a history of, well, we'll start with a diversity office and then a diversity and inclusion office, then we'll kind of add all the words, diversity, inclusion, equity, community engagement, social determinants, etcetera, and kind of bundle it all into a place where it can be either, depending on your perspective, highlighted or siloed, right, lifted up or pushed down depending on context and and climate at the time without understanding that, a, the work should pervade both kind of organizational equity, diversity, and inclusion as well as what I see as the a complementary field of population health, health equity, science, policy. Right? That should infuse everything that we do.
Philip Alberti:And so now we are at this time when I think medicine has been relatively late to the population health game, relative to other fields, other sectors even. And, you know, the statistic that I'll bring is, you know, when I joined the AMC, I think there were maybe 6 or 7 departments of population health within schools of medicine. Now they're over 50. Right? So there's been this explosion of population health maybe conflated with population health management and value based payments and all that, but still this kind of community deepening in a way, new requirements, for health care organizations to at least be thinking about community benefit and community health needs assessments, and and being asked to participate in this world of population health via screening and referrals for health related social needs.
Philip Alberti:And yet I I still wonder that if there's not this conflation of the 2. So I think at the AAMC, I sit in scientific affairs making sure that folks are aware that the full spectrum of science that goes from fundamental discovery through clinical research and health services research extends into population health science epidemiology. And then at that far end of the spectrum, population health equity is a real pillar of how I was trained in my training in graduate school, not just because I was seeking it out, but because that is something that population health scientists consider in their models and have done so for a very, very long time, to assess kind of that descriptive epi way, where these gaps are, how large they are. And I think the AMC has appreciated that focus and the broadening of the aperture to think about the complementary nature of how our organizations absolutely must become more diverse, more inclusive, foster that sense of belonging, ensure that populations within an academic health center have that true opportunity to advance for promotion, for pay equity, promotion equity. And that is as important as, but maybe separate from the way that the organization itself behaves in place and space.
Philip Alberti:What are the organizational competencies in a community to humbly partner in service of that multi sector health equity agenda. It's just a slightly different complementary skill set. And so I think, when we undertook a strategic planning process in 2019 and developed these 10 areas of focus, we call them action plans, And we had input from all of our members and input from all of our staff. The Center For Health Justice bubbled up as one of these 10, as an outgrowth of, I think, first, the the addition of community engagement as the AAMC's 4th kind of mission area, right, alongside research, clinical care, med ed. Now we talk about community alongside that traditional tripartite mission.
Philip Alberti:So that was, I think, a big impetus to green light the center and then really helping our institutions that are increasingly being asked, and we can talk about whether it's the right ask or the wrong ask or a modifiable ask to do more work in this space as a place to model and influence a process that can produce that equal opportunity for health. And that's that health justice framework that I that I mentioned at the beginning.
Rhea Boyd:So maybe now is a good time to dip into the terms because I think we're gonna be using them. So tell us, when you use the term health equity, population health equity, health justice, and maybe even, like, diversity, What do each of those terms mean, at least at the AAMC?
Philip Alberti:Well, I'll speak for myself because I I'm not I don't wanna speak for everyone at the AAMC. So I I I think the keyword for me for equity is opportunity. And I think that's really important, and maybe we can talk later about how we frame this work, really informs support for this work. So, historically, I've talked about 3 flavors of equity as it relates to medicine in general. So I think about you know, so you mentioned diversity.
Philip Alberti:So general. So I think about you know? So you mentioned diversity. So diversity kind of characteristics, whether they're socio, demographic, geographic, kind of individual, group characteristics being well represented in a place. That's how I think about diversity.
Philip Alberti:I think about organizational equity, that first flavor, as opportunity within an institution. And so for a hospital or a health care organization, that could mean opportunity for advancement, opportunity for mentorship, opportunity for a fulsome salary, right, opportunities for your staff, your learners, your administrators, etcetera, that that that kind of opportunity. I also then talk about health care equity, which I think medicine owns, and we don't explicitly talk about that flavor enough, which is really about opportunity for populations of patients. Right? And I think that's a a through line for all these flavors is that in the equity conversation, we're not talking about individuals.
Philip Alberti:Right? There's not a patient or a person that suffers from an inequity or disparity. These are really only defined for populations. So for health care equity, it's really looking at, is there an equal opportunity to avail oneself of high quality, easily accessible health care at the population, the patient population level. And then we move into kind of population health equity outside of the walls of a health care organization or a hospital, thinking about are there true equal opportunity to be healthy and to thrive for broader communities, whether we define those communities geographically, or sociodemographically.
Philip Alberti:I don't think of those three flavors as distinct. I think there's a story that that weaves them together. Right? So a health care organization that's truly living its best, most equitable organizational life, of course, that's going to contribute to its ability to treat patient populations more equitably. It's not the only thing that matters.
Philip Alberti:Right? Right? You still need your QI processes and your data, and and pathways and clinical workflows, etcetera, that support it, but it's certainly a huge contributor. Right? And then social science tells us that, what, 15, 20% of what makes a person or a community healthy is related to medical care.
Philip Alberti:Right? So that's the the rest of it, the remainder, that 80% is what we're talking about, when we talk about when I talk about population health equity outside the walls of of a health care organization. And so to achieve that opportunity is when we talk about health justice, which as I said, we say we keep one foot in community wisdom and multisector partnership, the other in that evidence to policy action imperative, and that you have to do that work in a very intentionally anti racist and anti discriminatory way, which for us in the center means who has the power, right, to decide what research questions we ask, what policies we interrogate, what programs we initiate or stop doing. It can't just be Philip and the team. It really needs to be a much broader group of folks if we're trying to walk that talk authentically.
Philip Alberti:And so I think not just our membership, but I think health care in general is struggling with you know, that we have a role to play. It is an important role to play in that broader health equity conversation, but it is no more important than community based organization's role or the education sector's role or the transportation sector's role. And so, again, I think it's about how how do we define the right size role of health care in this broader, understanding of of population health equity.
Rhea Boyd:I mean, I love how you're approaching this. I think from what you just said, what it made me think is, can there be a right sized role for health care, which kind of refers to the fact that because health care has so much so many resources invested in it, so much power as an industry, that they have had an outsized role that likely well, historically, we know, displaced other voices, silenced other people, took resources from some groups, and just used them inside health care. Right? Like, that role has been not just a problem. It's been, like, a part of the problem of why there's not health equity.
Rhea Boyd:Mhmm. At the same point, how do you deal with if you're gonna right size the role, how do you deal with the power imbalance that just exists? How do you deal with an industry that is, you know, approaching a 5th of the nation's GDP and nonprofit organizations who, year to year, don't know if their organization is still gonna exist. Could there be do you get do you see what I'm saying? Like, could there be a right sized role for health care?
Rhea Boyd:Like, are they should they just shrink down? Because I think they have an outsized responsibility because of their outsized power and their outsized resources beyond what I would expect of a nonprofit. How do we, like, square those things?
Philip Alberti:Totally agree. And I think the power and the resources that we provide now I'm going way outside. But I'll say it anyway. I think that's a choice that we've made. Like, we as a nation have decided that it is very easy to throw more money at health care, and it is very difficult to throw more money at other sectors like housing, like transportation, like public education.
Philip Alberti:So we have made these choices. And so I am a deep believer that health equity is not it's not some Robin Hood social justice. There's not some zero sum game. We're not stealing health from a to give it to b. That this is we have enough resources to fund kind of the multisector movement because really what we're talking about is a movement.
Philip Alberti:Right? It is a community centered, multisector movement to achieve this goal of all communities thriving and all communities having that authentic opportunity to thrive. I think health care's role, particularly in the health care equity contribution, is hugely important. I think you're absolutely right. Today, given the imbalance of resources, there is an increased responsibility for sure.
Philip Alberti:Do I think that that should be the way that it is? I, Philip, personally do not. I think that that we're never gonna right size the role if there is not right sizing of the money. Right? One of the core one of the core tenets of authentic community engagement is equitably financed.
Philip Alberti:Right? That is one of the top like the core ten principles of meaningful engagement is making sure that all partners in the work are paid for the work in a fair way. And so when I think about what does it mean for the incentives right now for health care, to be we're going to give you money for screening for social needs, maybe we'll bake in some payment models for those referral programs, we'll test it out. Okay. But you're referring to community based assets.
Philip Alberti:So who's giving them money to actually provide the services to patients and community members? And so I think it is a larger and this is I am I am not an economist. I am not a in any way, shape, or form, but I think you've you've hit a nail on the head is that the money and power imbalance will not get us to health equity because it is not medicine's job to achieve health equity. It's impossible for any one sector to achieve on its own health equity. That is not the game.
Philip Alberti:Now health care could absolutely perfectly achieve health care equity. That's a difference, and I think CMS has done a lot of work and is still developing work in that space to think about what it means to look at patient populations and inequities that exist in access and in outcomes and referrals and and and the like. But there is no one sector that can achieve health equity on its own. So I I often I like to say that in this space, in the health equity space, partnership is leadership. And I think that's, doubly important for health care, that have not and there are, of course, exceptions and bright spots to every rule.
Philip Alberti:I would say, historically, when you go into many communities that are characterized by having, like, a large health care system, they've not always been the best, most humble, most transparent, most respectful partners in these kind of multisector collaboratives that are really needed to change local, state, and federal policy.
Rhea Boyd:It's such a perfect time, honestly, to be talking to you because you're tying together some threads that came out through this season. So earlier this season, we spoke to this wonderful social entrepreneur, Dionne Dawson, who founded this program called Dion Chicago Dream, which is a novel food distribution system in Chicago. And he said something parallel to what you're saying. So you just said, it's impossible for any one sector, including health care, to achieve health equity. And he said something similar about food.
Rhea Boyd:He said, trying to solve hunger is impossible. And then he was like, we don't have a food problem. We have a food distribution problem. That there's enough food to feed everyone in the US, but the distribution system is built for profit and not people. And, honestly, that sounds like a bit of what you're saying minus what he said about profit, so I just wanna pose it straight to you.
Rhea Boyd:Do we have a profit problem in health care, and is that problem getting in the way of us actually serving people?
Philip Alberti:So the first thing that came to mind was I used I used to work in the South Bronx for the for the health department, and I just on the food distribution tip. So all the food for the 5 boroughs comes in to, the South Bronx, to Hunts Point. That's the market. Right? And then it gets distributed through all the other boroughs.
Philip Alberti:All the fancy restaurants get the grade a, and then the last stop is back to the South Bronx. That's what it was when I was there 20 years ago. And so that just really rang true to me. I so my training, and I'm gonna answer your question in this way. I'm not I'm not skirting it.
Philip Alberti:I'm gonna answer it in a roundabout way. My training was, around social conditions as fundamental causes of disease. The way that we talked about that, so what social conditions am I talking about? I'm talking about racism, classism, sexism, cisgenderism, all the isms. That's what we're talking about.
Philip Alberti:And these are fundamental causes for a couple of reasons. One is that they are clever. So if you close off one pathway for racism to operate, that's cool. It's going to find some other pathway. Right?
Philip Alberti:We read that in Michelle Alexander's book. Right? We went from slavery to Jim Crow to mass incarceration, different pathways. Racism will find its way to habits downstream impacts. The other thing that these -isms do, is that they control resources to help for health promoting, we call them flexible resources in the theory, like power, voice, money, beneficial social connections, information.
Philip Alberti:Right? Who has those things, and who does not have those things? And so rather than a financial problem as you framed it, I forget the the words you used, kind of a too much money to health care problem, I would say we have, like, for all of our sectors in our society, we have an ism problem. Right? It's classism and racism that that that are why South Bronx sees the food first but gets the food last.
Philip Alberti:It's why some of whether health care organizations up until recently had separate waiting areas for Medicaid patients, and some might even still have that. That is an -ism problem. It's not just a funding problem, it's the way that these -isms work their way into what Daniel Dawes calls the political determinants of health to then maldistribute that opportunity across our communities. So I think in some ways, yes, of course, money is always a carrot and a stick and can be a problem or a boon, but I frame it around classism and not just a financial problem. Right?
Philip Alberti:So why are we making choices that don't allow certain communities to have a true opportunity to access high quality health care or a true opportunity to buy affordable, nutritious food or a true opportunity to have reliable transportation or humane housing. Right? What what we call and we and we don't we didn't name this, like, the vital conditions for health. We don't talk about social determinants in the center anymore. We only talk about these vital conditions for health because it's not about health care addressing housing.
Philip Alberti:It's about all communities deserve humane housing. That's it. That's the goal. How do we get there? It's probably not through health care addressing housing.
Philip Alberti:There's some other work that needs to be done to make sure that communities at the community now it is crucially important for health care to understand whether your patient and their family does not have stable housing. Otherwise, your clinical care cannot work. That patient cannot get better. Right? But it's not the same thing as ensuring that a community has humane affordable housing.
Philip Alberti:So, you know and, again, if you wanna get real picky you and because it drives me crazy when we talk about, oh, hospitals and health care systems and physicians are addressing social determinants, you're not. You're addressing patients' health related social needs, and that's crucial work. And health care should absolutely be on the hook for that. Should health care be landlords? Should health care set up food pantries?
Philip Alberti:Let's let's have that conversation about what that means. I might be provocative on that on that front.
Rhea Boyd:And I love it. Let's absolutely go there. Right? Because these models exist, And they don't just exist. They're celebrated.
Rhea Boyd:These models are funded. They year after year, in the face of alternate models that come out of the community, these models that originate in health care are supported, which leads to it kind of contributes to that problem you're saying earlier about the power imbalance that exists in health care. It's like, these are the smart people with the solutions. We are always in the position of helper, and then we serve communities that are always in the position of the helped, without ever addressing what you're calling, like, the isms or what historian at University of Chicago, Michael Dawson, calls systems of domination. Right?
Rhea Boyd:Like capitalism and, like, our political economy in the United States or white supremacy and racism, the hegemony that certain groups get more out of society because of the ideology that they deserve more than other groups or patriarchy, the advantages, material, and psychological that men carry worldwide, frankly. And so we'll have these programs that hand out food that are never really about challenging the systems of domination. And in the way they hand out food we just spoke to Dion Dawson, and he said the same thing. Why do we have a food pantry model? Right?
Rhea Boyd:The way we give out food reinforces, actually, food insecurity. And I was just like, Wow. Break it down for me. And he was like first of all, he was unhoused and food insecure. So he had a say about how he received food.
Rhea Boyd:And he was, like, really calling into question even just the dignity of what it means to walk into a pantry to get leftover groceries that are just excesses. Like you said, what's happening in New York, you get the leftover supply at the very end. You don't have choice over what you eat, regardless of your food preferences or allergies, and when it's gone, it's just gone. Like, you are not a part of the actual food distribution system, and how that can also lay into people's psyche in a negative way and probably reflect what we, as a society, feel about people who are poor or made to be poor. And so there's these models that we have in health care where people are still investing in that.
Rhea Boyd:And so I would love to just unpack this just a little bit to say, like, can we really put, like, a pin on that to say, what's wrong with those models when health care says, you know what? We wanna fix housing. Or we're gonna come up with an app to connect people to food. Or we're gonna have a pantry. You're gonna walk out of here with a bag of groceries.
Rhea Boyd:Because, like you said, at a certain level, that's good. If you had somebody who came in hungry and you handed them food, that is the right thing to do. But at a population level, at a systems level, can you tell us again what's wrong with that?
Philip Alberti:Yes. It's it's the distinction between the important work of helping a person and the important work of helping a population. So, you know, I I wanna say the spirit behind kind of health care's investments in these social needs, whether it's food or housing or transportation, is beautiful and it's well intended. And it's by people that see the impacts of health injustices, right, day to day, and coupled with their own kind of caregiving spirit and these new requirements, right, particularly for not for profit hospitals that are kind of moving into this space. And then when you add in population health management, right, and the shared savings that will accrue to health care entities if they don't spend as much money on health care, which then somehow does truly incentivize prevention in some way and screening in some way, which is, again, all good.
Philip Alberti:It's good for patients. It's good for bottom lines. I've got no problem with that. But it is not a deep structural change that is needed to actually create sustainable, authentic opportunity for health for communities made marginalized. And that's why it's uncomfortable, I think, because really what we're talking about is like a law and policy agenda.
Philip Alberti:Right? We are talking about changing laws that intentionally or inadvertently remove opportunity for health and replacing them with laws that actually promote equal opportunity. And I keep stressing opportunity, and I wanna just put a really fine point on this because I I hear in the health equity world too many folks focusing on outcomes. Like, we wanna get to a place where we have I haven't heard equal outcomes, but I hear equitable outcomes. We're focused on outcomes.
Philip Alberti:Our measurements are about outcomes. We track the size of the health gaps, and if they're narrowing, we're achieving health equity. I think that's really dangerous, especially in this political and cultural climate, So and and I'll say what I why why I think that. So one, not every health difference between groups is rooted in injustice. So the idea, the concept, not a lot of them are, but not all of them.
Philip Alberti:Right? And so the the idea that if you just had any population of the same health outcome as the other that we know that we've achieved equity, that's not really doable fully. So just kind of mathematically, that's that's the truth. So Doctor. Ben Carson wrote an op ed in 2021 in the Washington Post where he basically said Health Equity is the New Racism.
Philip Alberti:I think that's actually the title of the op ed. In it he said that because the health equity movement is focused on equal outcomes, which we're not. Like, that is literally not what we're focused on, but we talk about it in that way. And that's how entities measure their progress. Right?
Philip Alberti:CMS sends disparities dashboards, all of our work at kind of stratification, the models that we build as scientists incentivize looking at the outcomes and not at the opportunity. He said because we are focused on mandating equal outcomes, we are un American. Now the slide that I use that we are un American because we're not about creating or America is a land of opportunity, and we're not about opportunity, which implies kind of individual's ability to navigate and through their own skills or the individualism, right, that opportunity benefits from individual because we're not focused on that, we are we are un American. And so I think making clear that what our goal my also what my goal is. My goal is for sustainable, equal opportunity to thrive.
Philip Alberti:And if we actually had that in all communities, I have no doubt that all the outcomes we want will follow if that opportunity is authentic and genuine. So what do I mean by authentic? I don't mean that mayor that says, to your point about food, oh, well, I built you that supermarket. It's I built you the supermarket. It's 5 miles down the road.
Philip Alberti:You have no public transportation to get there, and I am not building your neighborhood sidewalks. But it is clearly your fault that you did not access that grocery store for the fresh fruits and vegetables. Like, that's not what I'm talking about. I mean opportunity as a default, right, where you just know that your basic needs and I'm not talking about making everyone millionaires and put them in mansions. Right?
Philip Alberti:Those basic vital conditions, humane housing, meaningful work, reliable transportation, breathable air, drinkable water. Like these fundamental building blocks, we have enough resources, back to your money question, we have enough resources in the big US pot, even the global pot, really, to make that true, and yet we have we have made choices that that in some ways require, I would say, health care to step up because of the power imbalance, because of the financial imbalance. That is the only sector, that is the only anchor institution that could play such a role in many of our communities. So because we've made choices to not create sustainable, authentic, genuine opportunity for health across our communities, health care is stepping up, which is beautiful, but it's not a sustainable health equity strategy for true opportunity.
Rhea Boyd:Again, you're tying together so many threads of what came out of our season this year. And another one that you've brought up now is a conversation we had, with doctor Sarah Heminger, who has a nonprofit called Thread in Baltimore that connects young people with kind of a network of support across class lines. And they're doing that drawing upon Raj Tedi's work about, kind of, the relationship between upward mobility and access to opportunity then, And how that was hampered by segregation early on, that racial segregation and the history of segregation in the country kind of, impeded the ability of well, interestingly, impeded the ability of poor white kids to be exposed to interracially among white groups in a segregated society to be exposed to other high income white folks. But for folks of color in a segregated society, there was enormous class diversity because, right, all the folks of color, particularly for black people, who lived in the Jim Crow South and parts of the Jim Crow North. Right?
Rhea Boyd:No matter what your profession was, no matter what your income was, you could only live a certain area. And so then your social communities and your neighbors and the people you went to church with were of various classes. And because of their various classes, they might suggest to you a job that would work or suggest to you schools that might be good for your kids. And that that then, over time, contributed to upper mobility to a point. And then his data now is about how can we post, you know, legal residential segregation?
Rhea Boyd:How can we continue to promote these cross class social relationships, to your point, so that opportunity is shared with everyone. Because as his research notes, right now, kids of all racial backgrounds are less likely if you're in the lowest kind of quintile of income. If your family and your parents earn the least among all American earners, you're the least likely to be exposed to somebody who earns in that highest quintile or whose parents earn the most. And that what that really does to you is it doesn't just keep the money from you. It keeps all of these intangible experiences that might teach you and help your family, right, make have op have opportunities, have access to opportunities you otherwise wouldn't see.
Rhea Boyd:So I love this this focus that you guys have had on opportunity because it's supported by research, again, outside of health care as well, that it really is opportunities for everyone that matters.
Philip Alberti:That is that is my lived experience. Right? A working class barber son being exposed to different levels of opportunity throughout my education. But I wouldn't be on this podcast with you today, Ria, if it weren't for being exposed to other avenues of opportunity that folks that stayed in Revere Beach, Massachusetts where I grew up would never have seen or known. So I definitely wanna check that out.
Philip Alberti:And I love that you mentioned youth because I think that is part of the health equity agenda. It is a it has to be. It is a forward think it is not about the folks in power now or even tomorrow. It really is the next generation where some of these policy divisions don't exist in the same way. We do we do a lot of public opinion polling in our center to really understand how this work plays out across, different communities, different states, and we did a a a a poll that just exclusively looked at 18 to 25 year old members of Gen z.
Philip Alberti:That was the entire sampling frame. And I was stunned and super heartened by the areas of agreement. Right? 79%, and maybe I'm fudging the percent by 2 or 3. Forgive me.
Philip Alberti:So high 70% of self identified conservative members of Gen z said health care is a human right. Right? And that everyone in the US should have insurance. Right? There are just not the same level.
Philip Alberti:On some things, there were still divisions, but on some of these big ticket areas of of opportunity for opportunity, there was real agreement. And so I think how do we I think a goal of our center is also to really amplify youth power and youth voice and make it clear that it is that future, their future, that they should have an active role in cocreating that sustainable opportunity for themselves because we have failed.
Rhea Boyd:Gosh, Philip, it was such a pleasure talking to you today. Thank you for coming on.
Philip Alberti:Thank you. It was, I had a lot of fun. I really did.
Rhea Boyd:All season long, we were talking about health equity without explicitly talking about the actual term health equity and what it means. And so it was wonderful to have a conversation with doctor Philip Alberti from the AAMC, the founder of the Center For Health Justice, who explored with us health equity, not just as a term that applies to individuals, but as a term that applies to populations and what it means to achieve health equity across sectors, and not just as a responsibility within the health care industry. I'm sad to say this is our last episode, but I wanna thank all of the guests who joined us this season. It was truly my honor to hear about your work and to learn from all of your wonderful experience and expertise. If you, as our listeners, missed any of these conversations, you wanna click subscribe.
Rhea Boyd:This was a great season, and I hope everybody enjoyed it. Thanks for joining us. This is Research and Justice For All, a health affairs podcast, season 2. I'm your host, Rhea Boyd. If you like what you heard today, or you're interested in our future upcoming episodes, be sure to click subscribe or send it to a friend.