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MODULE 4: Andrew Suggs, Live Chair Health
Public Health and Wellness

Introduction

Racial disparities in chronic diseases like hypertension and diabetes are exacerbated by an uneven distribution of social resources and a lack of trust that stems from the historical exploitation of Blacks by the White medical and political establishment.  According to the Centers for Disease Control, up to 60% of a person’s quality-of-life and health risks are based on the social determinants of health in their zip code. One of the most important social determinants for Black men is health literacy and the access to quality health care.  Andrew Suggs founded Live Chair Health on the idea that trusted barber shop conversations can be used to support the long-term health of Black men who are less likely to seek out primary medical screenings and care on their own.  

Behavioral Objectives

After completing this module students should be able to…

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  1. Identify the anti-Black private, legal, and public health structures that created and sanctioned racial segregation and exploitation in predominantly Black U.S. towns and cities  (Origin and Cause)

  2. Understand how the cumulative impact of long-term anti-Black structures and institutions led to widespread historical trauma and mistrust in the public health system by Black residents and businesses in cities like Baltimore (Impact)

  3. Compare and contrast the impact of historically racist public health policies and institutions on incidence of chronic disease, health outcomes and wealth creation for White and Black communities (Disparities)

  4. Collect and contrast examples of marketing and communication methods, products, or services that serve to either address or promote racial disparities in health related behaviors, stereotypes, or outcomes. 

  5. Use economic and non-economic metrics and indexes to evaluate the efficacy and outcomes of previous and current public health strategies for creating racial equitable health outcomes in cities like Baltimore (Previous solutions)

  6. Identify the unmet needs and opportunities that still exist to improve access to healthcare and improved health outcomes in redlined neighborhoods (Potential opportunities)

  7. Describe the benefits of using a human centered, community owned process to create social, communal, and economic wealth for companies and existing residents in redlined communities.  (Framework for solutions)

  8. Determine the most impactful types of economic and personal investment for Black founders and entrepreneurs who are creating inclusive models of public health and civic wealth creation. (New Inclusive solutions

  9. Reflect on your own personal bias' and the growth required to be an informed, empathetic ally to Black entrepreneurs who are creating social and civic wealth for residents in historically redlined communities.

Interview with Andrew Suggs, founder of Live Chair Health

Suggested Questions, Activities, Assignments, and Reflections

REFLECTION

  1. After listening to Mr. Sugg's story regarding roadblocks with investors, how can the principle of curas personalis drive your journey to be a more a more empathetic and socially aware ally, partner and investor?

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CASE STUDY

  1. Complete the following exercise comparing the expense of chronic disease on two similar couples. Couple A and Couple B.  Assume the following:

    • Each member of the couple is 30 years of age.

    • Both couples earn $50,000.00 per year in combined income after taxes.

    • Both couples live in the same Baltimore neighborhood.

    • Both couples have the same monthly expenses (i.e., housing, internet, cell phone, gas an electric) of $1,100.00 per month.

    • One of the partners in Couple A has a chronic health condition which requires medical expenditures (i.e., medications, doctor visits) that cost a total of $75.00 per month.

  2. Suppose both Couple A and Couple B put all of their post-tax income after they pay their monthly expenses in a simple savings account with interest rate of 6% per year compounded annually, which is equivalent to 0.5% each month and the initial amount in the savings account is $1,000.  What is the total savings for both Couple A and Couple B after 50 years?  Use the formula New Balance = Old Balance + Interest + Monthly Contribution.

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QUESTIONS

  1. In what ways do past and present anti-Black laws, unethical medical medical care and treatment, and implicit biases impact health outcomes of past and present African Americans?  

  2. Examine the ways anti-Black practices in the early and mid-20th century lead to African Americans and other historically-excluded groups being disproportionately impacted by COVID-19.  Consider the impacts of housing, land use, education, and more.

  3. Compare and contrast at least 3 health are systems around the world.  Which aspects of the systems provide (1) the most equitable access and (2) best health outcomes for all of that nation's citizens?

  4. Considering past and present anti-Black medical practices and largely segregated American healthcare system, what might be the most impactful forms of innovation, entrepreneurship, and investment to provide better access to health to African Americans?

  5. What economic and and social metrics or outcomes would indicate whether a company, program or intervention was making a measurable impact on the public health of residents in urban and rural communities?

Resources

  1. Racial Disparities in Health Care and Disease, Alcindor Y, et al. PBS News Hour. Feb 24, 2021 With a History of Abuse in American Medicine, Black patients struggle for equal access

  2. Bailey ZD, et al. Lancet. Apr 8, 2017. Structural racism and health inequities in the USA: evidence and interventions 

  3. Brown, L.T. Black Butterfly. The Harmful Politics of Race and Space in America. Johns Hopkins University Press. Baltimore, MD. 2021. pp 73-79, 93-95, 149-150, 159-165, 170-174, 209-215

  4. Garrett B & Gangopadhyaya A. Robert Wood Johnson Foundation. Dec, 2016. Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live? 

  5. Gomes  C, McGuire  TG. Identifying the source of racial and ethnic disparities. In: Smedley  B, Stith  AY, Nelson  AR, eds.  Unequal Treatment. National Academies Press; 2003. 

  6. Interlandi J. An Essay. A Broken Health Care System. in The 1619 Project. The New York Times Magazine. 2019. pp 44-45.

  7. Johnson A. Black Perspectives. Aug 12, 2020. Syllabus: A History of Anti-Black Racism Medicine

  8. Nelson, A. Journal of the National Medical Association, Vol. 94(8), Aug, 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

  9. Reid TR. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin Books. New York, NY (2009).

  10. Reid TR. Fresh Air with Terry Gross. Looking Overseas For 'Healing Of America'. April 24, 2016.

  11. Thomas SB & Casper E. Am J Public Health. 2019 October; 109(10): 1346–1347.The Burdens of Race and History on Black People’s Health 400 Years After Jamestown

  12. Villarosa L. An Essay. Medical Inequality. in The 1619 Project. The New York Times Magazine. 2019. pp 56-57.

  13. Washington H. NPR. Feb 24, 2021 'Medical Apartheid' Tracks History of Abuses

 

Racial Disparities in Covid Incidence, Prevention and Treatment.

  1. Thebault  R, Ba Tran  A, Williams  V. The coronavirus is infecting and killing black Americans at an alarmingly high rate. Washington Post. April 7, 2020. https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/ 

  2. Yancy CW. JAMA. 2020;323(19):1891-1892. COVID-19 and African Americans

  3. Hooper MW. JAMA. 2020;323(24):2466-2467. COVID-19 and Racial/Ethnic Disparities

 

History of Racial Exploitation and Consent for Medical Testing

  1. BBC REEL: Henrietta Lacks: The 'Immortal' Cells That Changed the World https://www.youtube.com/watch?v=pgB1IqGp8BE

  2. Dusher T. The Journal of Law, Medicine, and Ethics. Sep 29, 2006 Lessons from History: Why Race and Ethnicity Have Played a Major Role in Biomedical Research

  3. The Historical Memory Recovery Channel: The Tuskegee Experiment (1990) https://www.youtube.com/watch?v=Fl4yDMJhpAM

  4. Lynch S. USA Today. Jun 19, 2020. Fact check: Father of modern gynecology performed experiments on enslaved Black women

  5. NEWSY: The Unknowns About the Tuskegee Syphillis Study https://www.youtube.com/watch?v=J3tQ93fQf8U 

 

Social Determinants of Health

  1. Baltimore Life Expectancy by Neighborhood: Baltimore Neighborhood Indicators Alliance https://bniajfi.org/indicators/Children%20and%20Family%20Health/lifexp/2018

  2. Centers for Disease Control: Social Determinants of Health: Know What Affects Health https://www.cdc.gov/socialdeterminants/about.html

  3. National Community Reinvestment Coalition https://ncrc.org/your-zip-code-is-more-important-than-your-genetic-code/

 

Innovation and Social Entrepreneurship in Public Health

  1. Hernandez D. Public Health Rep. 2014 Nov-Dec; 129(6): 477–481. Public Health Entrepreneurs: Training the Next Generation of Public Health Innovators

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