A few years ago, when Vivian Calloway had a life-threatening allergic reaction to something she ate, she was lucky to be at a church breakfast, surrounded by friends and medical professionals.
“We were all eating and all of a sudden, I could feel my body swelling up,” said the 64-year-old Lakeland resident. “I couldn’t swallow.”
She wasn’t carrying an epinephrine injector to stop the allergic reaction because she couldn’t afford the several hundred dollars it costs to get just one. They called an ambulance to have her rushed to the hospital.
Her church, New Mount Zion Missionary Baptist Church in Lakeland, not only bought her epinephrine prescription but also took care of her emergency hospital bill.
“They said, ‘Don’t worry about it,’” said Calloway, who works as a care assistant with Comfort Keepers.
The paramedics admonished Calloway for not carrying an epinephrine injector. “The paramedic asked, ‘What’s more important: Your life or an EpiPen?’ If you don’t have that kind of money, though, what could you do?”
Calloway’s medical scare and lack of access to affordable medicine are part of a much larger story repeated daily among Black residents in Polk County. Blacks, data shows, carry a higher incidence of disease burden than others.
U.S. News & World Report also began assessing health equity in its annual Hospital Rankings released this week, and Lakeland Regional Health Medical Center as well as nearby hospitals are now evaluated on minority patient representation and preventive care.
Racial health disparities have been around since before Blacks were enslaved in the U.S. However, the issue is beginning to receive increased attention as well as government backing and financial support. In June 2021, Florida Gov. Ron DeSantis signed a measure to improve inequities in the state’s healthcare system by better equipping the Office of Minority Health and Health Equity, established in 2004.
Several hospitals and universities throughout Florida also have undertaken research and initiatives to try to lessen gaps in care. Among those efforts is a study of marginalized populations, announced by the University of South Florida in April 2021 and involving Lakeland Regional Health, that focuses on transitions from hospital to home for Black and Hispanic patients.
Perhaps the most recent glaring example of how disease disproportionately affects Black residents in Polk County is the COVID-19 pandemic. The number of COVID hospitalizations and deaths continues to be higher in the Black community, with 19% and 17%, respectively. Polk County is home to approximately 117,400 Black residents, about 16.2 % of the population, according to the U.S. Census.
While this is concerning, it is not at all surprising, health officials say. Blacks often have more underlying health issues, putting them at high risk of complications from COVID-19.
The Polk Health Department and Polk County government continue to offer pop-up vaccination clinics in at-risk communities.
“The county, vaccination partners and the (county health department) have worked hard to make vaccinations available in minority communities. Numerous outreach events have been held in African-American churches and neighborhoods,” said Dr. Joy Jackson, director of the Florida Department of Health in Polk County.
One of those churches is New Mount Zion.
“These disparities didn’t just happen, but what COVID-19 did is it exposed a national crisis more than it had ever been exposed before,” said Barbara Harrison, a nurse and retired Lakeland Regional Health vice president who leads the health ministry at New Mount Zion.
How Did We Get Here?
Many factors determine someone’s wellness, said Lauren Springfield, manager of Community Health for Lakeland Regional Health. That includes the area they grew up in, where they currently live, their support system.
“You are exposed to so many things that shape someone’s whole health story,” Springfield said.
The history of racial health inequity stretches long before the civil rights movement and includes segregated hospitals, economic redlining and food deserts along the way. Dr. Lonna Gordon, chief of adolescent medicine for Nemours Children’s Hospital, explains how inequitable healthcare can plague multiple generations and how all aspects of work and life play a role in a person’s well-being and upbringing.
“So, for example, an individual’s family was redlined 60 years ago,” Dr. Gordon explained. “Since schools are funded by property taxes, that family had access to schools that were under-resourced. This then limited the access to jobs, and since the type and amount of healthcare you have access to is determined by your employment, there is increased likelihood of receiving healthcare less often and when disease is more advanced. This individual gets delayed prenatal care. Their child is born with increased likelihood of serious medical conditions. This then requires more appointments and more time off from work. This time off is more likely to be without pay for individuals with jobs that do not require an advanced educational degree – thus making families who live in under-resourced communities less able to proactively tend to their children’s healthcare needs, which increases (the prevalence of disease).”
Systemic racism is a term that evokes a strong reaction from many, and some residents may say they have a hard time believing it dwells in Polk County and throughout the nation. It refers to deeply instilled and persistent practices and behaviors that promote one race over another. Systemic racism can be as overt as racial profiling by police or as passive as grocery stores being built near predominantly white neighborhoods.
“Some people, they say, ‘That doesn’t exist,’ because it is so ingrained. But it’s time to start the conversation – and not out of anger,” said Harrison, the retired LRH vice president..
Systemic racism, health officials said, continues to cause health issues for Blacks in Polk County.
“For people of color, systemic racism has led to higher incidences of obesity, diabetes, mental illness,” Springfield said. “When we ask, ‘Well, why do people of color have these higher risks?,’ it all relates to different factors that were never addressed. Sometimes it’s even just lack of access to fresh food.”
Breaking Down Barriers
The term “health equity” refers to each person receiving the resources, services and healthcare needed to thrive physically, mentally, socially and emotionally. The U.S. Centers for Disease Control and Prevention describe it as a person having “the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
Accessibility and affordability, said Harrison, are what “health equity” means to her. Lack of both means that healthcare becomes a low priority for many Blacks.
“The last thing on their mind is the pain in their side. They’re thinking about surviving,” Harrison said.
To achieve health equity, Polk’s health leaders said, much work needs to be done. Some of that work, such as New Mount Zion’s health and wellness ministry and Lakeland Regional Health’s Congregational Health Partnership, has already begun. To be sure, noticeable change will take decades, health officials said.
To make matters more challenging, Polk County has a dire shortage of healthcare providers.
“Access to affordable health care is also a local barrier,” said Dr. Jackson of the Department of Health.
The Department of Health has focused on a few areas where there are significant health inequities in Polk County. The first is maternal and infant health. In Polk, Black infants are more than twice as likely to die before their first birthday than white infants. Also, black moms and infants have worse outcomes than white counterparts for preterm births, births with low or very low birth weights and prenatal care. The Department of Health in Polk provides prenatal and OB clinics, runs the Healthy Start program and offering breastfeeding counseling through its Women, Infants and Children (WIC) programs.
In addition, the Health Department offers clinics for HIV and sexually transmitted diseases in an effort to reduce infectious disease rates among minorities. The rate of HIV cases in Polk County is nearly seven times higher among Blacks than whites, and the rate of HIV deaths is more than five times higher.
Despite these efforts, many Blacks remain hesitant about visiting a doctor or clinic. When they are sick, Blacks often wait until their illness is at its worst to seek care.
“The doctor is a very last resort,” Harrison said.
Dr. Gordon of Nemours agrees.
“Systemic racism impacts how well different groups of people know, understand and trust each other,” Gordon said. “Trust is critical in the doctor-patient relationship. As a result of the breached trust, the confidence minorities have in the health care they receive can be compromised. Research shows patients are more likely to accept recommendations and follow treatment plans as directed when there are high levels of doctor-patient trust.”
Having more Black medical professionals also can go a long way in establishing more of a connection with Black patients, Harrison said.
“A lot (of medical professionals) have not felt comfortable in our community,” said Harrison. “They are here two to three years, and then they are gone. We need to be willing to recruit and retain Black doctors. We need to do greater work to get more physicians to come here and stay.”
Breaking the cycle of biases in education, employment, housing and healthcare begins with dialogue, said both Harrison and the Rev. Dr. Edward Quary Jr., pastor of New Mount Zion Missionary Baptist Church and a Walgreens pharmacist.
“Breaking down systemic racism begins with people being willing to listen, and that conversation is not us saying we are mad at you personally,” Harrison said. “This is our experience. We are asking for empathy and hopefully action. We want to be heard so there can be a change, and some of those changes need to be made structurally.”
Health Education as the Next Step
As for New Mount Zion’s health ministry, “We may not be able to change it all, but we can do our part,” said Harrison.
Church, Harrison and Quary said, is traditionally at the heart of African-American life, so starting a health and wellness ministry allows the biggest outreach.
“We have a responsibility to those around us, and not just speaking about eternal life but tending to the quality of that life. We have to be at our very best, and it’s hard to be at our best when we are unhealthy. As a church, we are in a prime position to help people,” Quary said.
While that ongoing dialogue continues, both Harrison and Springfield said that health education is the next vital step. Most importantly, the information needs to come from reliable and trusted resources.
“One of the ways we do that is with culturally tailored education involving both those who provide healthcare and those who need the healthcare,” said Springfield. “It includes conversations where everyone is speaking the same language in order to educate them on what they should be seeking.”
In addition to its Congregational Health Partnership, Lakeland Regional Health will be launching Shop Talk in barbershops and salons across Polk County. Springfield said clinicians will educate hairdressers and barbers on healthcare issues so that important, easygoing conversations on prevention and wellness can take place with customers.
“People have to feel comfortable to ask questions, especially Black men. Black men come in (to receive care) with more advanced stages of cancer,” Springfield said.
Lastly, Dr. Gordon suggests health systems internally assess ways to promote equity.
“It is critical for doctors, healthcare systems and hospitals to engage in discussions around race and racism,” Dr. Gordon said. “The World Health Organization defines health as ‘being in a state of complete physical, mental and social well-being, not only the mere absence of disease.’ The experience of racism or other types of discrimination impacts mental and social well-being directly.”