Tawny Jones: Chronic disease doesn’t work in isolation. One in four has two or more.
Dr. Mark Hyman: Welcome to the Doctor’s Pharmacy. I’m Dr. Mark Hyman. That’s Farmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And today’s conversation I think matters to many because it’s about health disparities and lack of equity in health care and the disproportionate suffering for the poor and minorities in this country.
Dr. Mark Hyman: That is really unconscionable in a society that is focused on equity and wealth, which we certainly don’t have evenly distributed. And our guests today are an extraordinary crew from Cleveland Clinic. We’re here at the Cleveland Clinic in Cleveland.
Dr. Mark Hyman: There’s many Cleveland Clinics. Our first guest is Dr. Charles Modlin, who’s been a great partner with us at the Center for Functional Medicine. He’s a kidney transplant surgeon, a urologist. He’s the executive director of the minority health program here. He’s the lead for public health at the Cleveland clinic. He’s one of the member of the Board of Governors, the Board of Trustees.
Dr. Mark Hyman: He’s a big shot here at Cleveland Clinic and I’m just honored that he’s been interested in our work. And we’ve been partnering with creating a minority men’s health program and part of the Functional Medicine Center to help minority men, which are often neglected and don’t talk about their health and aren’t comfortable sharing, putting them in a group that allows them to actually get healthy together.
Dr. Mark Hyman: And we were very skeptical if they would want to do it or participate, but they all want more and keep coming back. So, he’s been named by the Atlanta Post as one of the top 21 black doctors in America. He’s graduated from Northwestern University in Northwestern University Medical School. And he’s really an extraordinary physician and leader in healthcare.
Dr. Mark Hyman: Dr. Leonor Osorio is also here at Cleveland clinic. She’s internal medicine physician, she received her license from the state of Ohio in 2001. And she’s been instrumental in opening Lutheran Hospital Hispanic clinic, which connects to Spanish speaking patients and Spanish speaking physicians.
Dr. Mark Hyman: She’s really has a place in her heart for the Hispanic population here in Cleveland and is really focused on trying to create better and improve services. And the other day we were part of a meeting which was trying to understand how we better serve these needs and address these health disparities in this community.
Dr. Mark Hyman: And lastly, but not least is Tawny Jones who has been here with me since the beginning of the Center for Functional Medicine and has literally helped me stand it up and is a pioneer in thinking about how to bring functional medicine into Cleveland clinic into the world.
Dr. Mark Hyman: And has developed something called functioning for life, which is a powerful model for community-based solutions where put peoples in groups and helps them create healthcare change. She’s been leading our center here and is really, I think one of the most guiding lights here at the clinic and in her community.
Dr. Mark Hyman: And we’ve done a lot of community stuff together. We’ve worked with cooking classes and underserved areas. We’re creating a program at Langston Hughes, which is really serving the needs of these really poorly served patients, African-Americans who are struggling with obesity and diabetes. So, just as a little background, welcome all to the podcast.
Dr. Leonor Osorio: I’m so glad to have you all here and be able to talk about these issues. I just want to get a little background about where we stand as a country. Public health research has documented that racial disparities in health and healthcare is a real problem in this country.
Dr. Leonor Osorio: When you’re looking at the 10-leading cause of death, including cancer, stroke and heart disease. If you’re African-American or Hispanic, you’re far more likely to get sick and die than white Americans. They have a lot of negative health predictors.
Dr. Leonor Osorio: Genetically, there’s more predisposition to these diseases or lack of access. There’s lack of understanding of healthy health behaviors. And I think there’s just discrimination throughout the healthcare system. And also, in our policies and when you look at the data, it’s pretty scary.
Dr. Leonor Osorio: African-Americans are twice likely to get diabetes or probably you can tell me more Dr. Modlin, they’re probably three or four times more to have a need for kidney transplants. They’re more to have amputations. And if you’re African-American, you’re more to be obese and have more infant deaths.
Dr. Leonor Osorio: And so, many different issues that also affect the Hispanic community like diabetes and obesity and hypertension. And it’s a problem access. These communities don’t have access to good food, they don’t have education, they have culturally embedded ideas that keep them from actually getting out of this situation.
Dr. Leonor Osorio: When you’re looking at food insecurity, these communities are far more to be food insecure, I think twice 22% versus an average national food insecurity rate of 12%. And they don’t have supermarkets. We walked around Cleveland here.
Dr. Leonor Osorio: Tawny and I went around to a place called Rally’s which is a very poor-quality McDonald’s and they wouldn’t even have McDonald’s because that’s an upscale restaurant in these communities and it was frightening. They had lack of access to anything that was resembling food in there.
Dr. Leonor Osorio: And Hispanics and African-Americans are less likely to own cars and they’re less likely to have grocery stores in their communities. And when you look at the data, if you don’t have access to these things, you’re not able to actually change your life. So, I want to sort of get into this because it’s embedded in our policies.
Dr. Leonor Osorio: It’s embedded in our healthcare system and it’s this neglected area where we really live in the third world in this country, in these communities. It’s not really what we’d expect as part of American healthcare. So, Dr. Osorio and Modlin, these communities are really impacted by health disparities. What do you think the biggest reasons for these disparities are?
Dr. Leonor Osorio: Okay. Well, I think speaking for the Hispanic population, we tend to live in a tight knit community. In general, we live more in an impoverished area. You said, we don’t own cars, so we rely on public transportation. Our Hispanic culture too. We brought up the women that we take care of the family first out ourselves.
Dr. Mark Hyman: Not themselves.
Dr. Leonor Osorio: And then, the men are brought up to provide and they don’t want to miss work. I have a lot of men that do factory jobs and they get points taken out from their jobs. So, they’re afraid of getting these points that can lead to them being fired so they won’t come even if we evening or Saturday hours.
Dr. Leonor Osorio: So, our culture is that we take care of the family, but not ourselves. So, Hispanics are really unlikely to get preventative such as mammograms, colonoscopy, pap tests, blood work. And there’s also this culture of face. The church is very central as it is in the African-American population, but God will heal me, I feel good. I don’t have to go to the doctor-
Dr. Mark Hyman: Not dying yet.
Dr. Leonor Osorio: … because I’m not dying. I’m young. There’s nothing wrong in my families.
Dr. Mark Hyman: And you mentioned they’re afraid to go and they won’t go to last minute often.
Dr. Leonor Osorio: Right, right. Yeah. Because they’re afraid to lose their jobs. They’re afraid of they’re going to find something. And I don’t have time to keep taking off work because if I’m a diabetic, almost two thirds of Hispanics are more to be diabetic.
Dr. Mark Hyman: Two thirds of Hispanics are likely to be diabetic.
Dr. Leonor Osorio: Yeah. And one third are likely to die from complications of diabetes. And when I started my Hispanic clinic, I’m Bolivian by descent, but the most of the patients I see are Puerto Rican. And I was seeing people in their 30s, 40s, getting stents, being on dialysis, getting amputations.
Dr. Leonor Osorio: And I’m thinking it’s, I started practicing in 2000 I’m, Why are we still getting amputations? And If we have so many medications, so many hospitals. But I just wasn’t understanding the disparities in the Hispanic community.
Dr. Mark Hyman: And so, besides the fear of losing their job or the focus on taking care of themselves and not in… and on their family and not themselves. What are the other drivers that are the social determinants that are limiting their ability to get care or to actually do self-care?
Dr. Mark Hyman: It’s not just access to our healthcare system, but it’s the 80% of the things that happen in their community that are driving them towards disease that aren’t the healthcare.
Dr. Leonor Osorio: Right. And it’s a big part, you were mentioning is the food. There’s bodegas or little convenience stores that have the foods from Puerto Rico let’s say. And so, they’re not eating healthy because they’re afraid to lose the culture.
Dr. Leonor Osorio: Also, in our communities, in our Hispanic communities, there’s a lot of fast food places. So, if you have a limited budget, if you can go to McDonald’s for five bucks and get a lot of food versus getting Kale versus getting Quinoa is a different price range.
Dr. Leonor Osorio: And also, if you don’t have a doctor that understands your culture, because a lot of Hispanics, if we’re very touchy, we’re very close. If a doctor sits way far and is at the computer and not looking at you, a patient will not come back. You can be the best board certified, have so many degrees.
Dr. Leonor Osorio: But if you’re not close proximity and you’re not paying attention to this, the patient will think that you don’t care about them. A lot of Hispanics do want their families to be in the exam rooms. So, and some doctors get intimidated. Why are there five people? So, and if you don’t let those family members in, they won’t come back to you either.
Dr. Leonor Osorio: Or if you don’t speak the language or have a way to translate why you’re taking certain medications. Because if you’re a diabetic, you’re going to be on five, six medications already. And if you don’t explain why they’re taking that, they’re just not going to take.
Dr. Mark Hyman: So, Dr. Modlin, what’s your sense of what the reasons for the Hispanic or in the African-American community?
Dr. Charles Modlin: So, you touched on lack of access to quality care. I mean, that’s a huge one. And poverty obviously plays into that. So, there are health system factors, there are health provider factors, there are patient driven factors, genetic hereditary factors.
Dr. Charles Modlin: But also, health literacy plays a major role. A lot of times in the black community, people don’t necessarily know what they need to know to take good in health care of themselves. For example, black men don’t necessarily know that they should start screening for prostate cancer at the age of 40. Whereas white men, unless they have a strong family history, need to start screening not until they’re about 55 years of age.
Dr. Charles Modlin: So, health literacy, lack of awareness and knowledge of how to take care of oneself plays a major role in the when what we’re seeing in terms of the incidents of the health care disparities that we see. Hypertension is a silent killer. We all know that can untreated hypertension can lead to heart attack, strokes, kidney disease, peripheral vascular disease,
Dr. Mark Hyman: And these don’t go and they get checked?
Dr. Charles Modlin: They don’t get checked out. They think if you don’t have any signs or symptoms or pain or discomfort-
Dr. Mark Hyman: I feel fine.
Dr. Charles Modlin: You feel fine. I mean, prostate cancer, you don’t have to have any signs or symptoms or pain or discomfort to have prostate cancer. Nowadays, most prostate cancer is diagnosed with a blood test, the PSA, the prostate specific antigen blood test. And we also like to do what we call a digital rectal examination.
Dr. Mark Hyman: That’s fun.
Dr. Charles Modlin: A lot of black men… And we don’t actually have to do the examination. But the blood test is more sensitive. But a lot of black men, if they think you’re going to do that examination on them, they think you’re going to violate them. They don’t want to have any part of that. So, there’s a lot of fear and anxiety about that examination. Also-
Dr. Mark Hyman: Spoken as a good urologist.
Dr. Charles Modlin: Yeah. So, a lot of lack of health literacy, a lot of myth and misconception, a lot of stories about what’s going to happen when you go to the doctor. There’s also a lot of distrust that many African-Americans and minorities have about going to the doctor. We’ve all heard of the Tuskegee syphilis experiment.
Dr. Mark Hyman: Can you just give a background on what that is for people to-
Dr. Charles Modlin: Yes. So, that was where the Department of Health and Human Services, the Public Health Service, Department of the United States, that was back in the ’20s or ’30s, I forget the exact decade. Where they actually treated roughly about 800 men, Black men.
Dr. Mark Hyman: It went up until the ’70s.
Dr. Charles Modlin: Yes. Right. They followed several hundred men, black men who they knew had syphilis because they wanted to study the natural consequence of untreated syphilis in this patient population. And during that time period-
Dr. Mark Hyman: And may had penicillin, they could have cured them but they didn’t.
Dr. Charles Modlin: Oh, yeah. They actually had the cure. The cure was available. They could have cured these men. And actually, during that time period, the men suffered and many men died and they actually passed this disease to their partners. And the word got out in terms of what was going on and that spread across the black community in terms of what was going on, those experimentation. And so, that still resonates amongst the black community and other minor-
Dr. Mark Hyman: That whole story of Henrietta Lacks is also present in that.
Dr. Charles Modlin: Oh, yeah, exactly. Experimentation. And so, a lot of people are in the black community are really fearful of going to the doctor. And they’re fearful that the doctor is going to use them as a Guinea pig. And that really contributes to a lot of the healthcare disparities that we see because a lot of the medications on the market have been developed and designed and tested just in-
Dr. Mark Hyman: For white people.
Dr. Charles Modlin: Especially, just in white men in particular. A lot of disparities that we’re talking about actually exist in women also. But no. So, a variety of reasons for healthcare disparities. Some of them are a lot of there… there are a lot of genetic determinants of some of these disparities that we talk about also.
Dr. Mark Hyman: So, Tawny… And I worked together a lot. And you’re someone who grew up in the inner city in Cleveland. You saw firsthand what these communities are like. You grew up in an underserved community and you saw the challenges that are faced by the people who live there.
Dr. Mark Hyman: And this legacy of repeated cycles of this thing happening over and over with poverty and lack of access and obesity and disease. I mean, we were recently at an event where there were a bunch of young students learning how to cook. It was a culinary school as part of the community college.
Dr. Mark Hyman: And there was a young woman was there and she was an African-American woman who lived I think in the projects. And said her mother had to take two buses, two hours round, sorry, four buses, two hours round trip just to buy vegetables for her family. And then, in her family, there were people with amputations and who can walk and diabetes and kidney failure.
Dr. Mark Hyman: And it was just heartbreaking to hear because even though there’s some level of awareness, people have a hard time getting out of that. So, there’s a lot of assumptions that it’s just because people are lazy or they don’t want to do anything for themselves or they don’t want to get healthy and they just wanting to have their soda and Doritos. How do you address that?
Tawny Jones: Yeah. So, I definitely don’t think it’s… that they’re lazy or unmotivated or don’t want to move in the right direction. I think we have a broad assumption in society that all opportunity is equal. And that’s not true. So, racism, unconscious bias, prejudice and stereotyping all play a role in the opportunities that are available to individuals.
Tawny Jones: And if you just think about unemployment for example and compare it to… in comparison to Caucasians, African-Americans are still at risk for the same level of unemployment today as they were in the 1960s, that’s a reality. So, let’s talk about the cascading effect of being unemployed.
Tawny Jones: Well, now, I’m at risk for poverty. If I’m at risk or poverty, then I probably don’t have access to or I won’t be able to retain my housing or transportation or I won’t have access to those things. And so, if I don’t have that, then how am I going to get to the grocery store to get healthier food options?
Tawny Jones: Taking a bus. That young lady story was my story as well. I remember taking it. We had five children and two adults in my home growing up in the inner city and taking a bus and carrying bags as much as you could put in your arms was what we had to work with. And so, you opt towards getting processed foods or the… at least-
Dr. Mark Hyman: Little Debbie’s.
Tawny Jones: Yeah. Least healthy options because they have fresh fruit foods and fruits and vegetables have a shelf life. And so, you’re going to get the sugar latent foods that will keep you full and you feel satiated, you feel really good about that. But you don’t realize the impact is having on your health. So, very much a cascading effect. And then, if you’re-
Dr. Mark Hyman: Do they connect the doses, okay. I’m eating these foods and this is why I’m overweight, or have diabetes.
Tawny Jones: Not at all. Not in most cases because-
Dr. Mark Hyman: We believe, okay. Well, that seems a obvious thing to most people. It really is-
Tawny Jones: Is not. We’re healthcare workers. And then, you also have to think when you’re in that mind space that I’ve lost this, I don’t have that. I don’t have access the opportunity while I was passed over for that. You’re probably not seeking out the social support that you need in order to help you manage those issues and concerns.
Tawny Jones: And if you don’t have that social connection, then you’re probably going to move into a space of psychological distress and depression. And so, once you get there, it’s just a matter of time before you move into isolation and that feeling of loneliness.
Tawny Jones: And for many people, the point where they just give up. And so, it’s not that they don’t want to do better. I know a lot of hardworking people who are struggling to make ends meet. I interact with individuals every single day who are gainfully employed but struggling to make ends meet.
Tawny Jones: And their reality is, well, health, my health takes a back seat when I’m trying to figure out if my lights are going to be on next week and my gas is going to be on next week. So, those are realities we have in our community, African-American community.
Tawny Jones: And I’m sure it’s the same for Dr. Osorio in the Hispanic community. We have just normalized these feelings of not having or depression or discontent with life. We just deal with it. And as she said, we rely on our spirituality to keep us grounded and keep us from totally checking out of life.
Dr. Mark Hyman: So, is there any insight in these communities about the way in which our society, our government policies, food corporations are targeting them in ways that are making them more sick and fat and disabled? I mean, we know for example that based on good data from Yale that in the targeted marketing it’s focused on African-Americans and Hispanics for all the worst foods.
Dr. Mark Hyman: We know that the availability in these communities is less of these foods. We know that the grocery stores, I want to go there. We know that there’s a level of almost also internalized racism where they don’t actually know this is happening and I think this is their normal culture.
Dr. Mark Hyman: I just was sharing a story earlier about a Hopi chief who I was on a rafting trip with. And he was very overweight. I mean, severely overweight, diabetic on insulin, he was throwing up sick just walking down to the boat. And I said, well, you can fix this.
Dr. Mark Hyman: And he’s, Wow. I said, Well, you have to just of give up starch and sugar and flours. He said, Well, how are we going to have our traditional Hopi ceremonies? And I’m, Well, what do you mean? He says, Well, I mean, we have foods, we have our ceremonial foods.
Dr. Mark Hyman: I’m like, What are those foods? He goes, Well, cake and cookies and pie. And I’m like, Those are not traditional [crosstalk 00:19:18]. Where he’s an African-American guy. And he’s very into health and good food and he goes to the south where he’s from.
Dr. Mark Hyman: And his family makes fun of him bringing all the white people food. And I think what they don’t realize these communities is that they are eating the white people’s food. That it is all this processed industrial food is basically another form of racism.
Dr. Mark Hyman: And how do you address that in these communities? How do you get them to sort of wake up and see, oh, this is not what’s good for us and this is keeping us down that our kids can’t learn, that we can’t focus, that we’d get all these chronic illnesses that we can’t work because we’re disabled. I mean, how do they see that?
Dr. Leonor Osorio: It’s a tough battle because the media. So, even if you’re on YouTube or you’re on your iPad or your phone, there’s a lot of information with food. And in our cultures too, we have celebrities that are endorsing-
Dr. Mark Hyman: Junk.
Dr. Leonor Osorio: So, we have Sprite, we have Burger King. And our young people look up to these African-American and Hispanic celebrities. And so, that has to be one of the reasons that we have to stop those endorsements because kids are looking up to these celebrities. Well, that LeBron James looks good. And he’s-
Dr. Mark Hyman: He’s drinking that Sprite before he goes into the court, it’s not.
Dr. Leonor Osorio: Right. Right. So, that has to stop. And we don’t do a good job of educating people about sugar grams and fat grams and reading labels. So, we try to do that and with each office visit as well to really know what you’re putting in your body because there’s no way we’re going to make a headway with obesity or diabetes or hypertension if we’re not being accountable what we’re feeding ourselves.
Dr. Charles Modlin: Yeah. We need to start them young in the schools with the young kids also probably, educate the young kids. And I think the same is true. I mean the advertisers that target the black community for smoking as well. We’ve seen that in the past as well.
Dr. Mark Hyman: Yeah. So, chairman, I was there recently to under some school in Cleveland here. And one of the… They’ve failed, you got an F last 15 years in their school district. And I walked in, said to the CEO of the school system, I said, Well, can I go see the kitchen? So, we walked through this massive kitchen in this high school, there was not a stove or an oven, there was a deep fryer.
Dr. Mark Hyman: They’re reheating ovens like microwaves. And he didn’t even realize that. I’m like, Look where, where is the cooking stuff? Where to cook anything? It’s deep fries or microwaves. And then, I walked down the hall, I mean, he said 43% of those kids are absent from school, 1% are ready to go to college and they’re prepared by the time they graduate, which is 1% is ready.
Dr. Mark Hyman: And I walked down the hall and there was this young Hispanic girl walking down the hall with a double fisting a slushie in one hand, it was 32 ounces and have 32-ounce soda in the other hand. And she was very overweight. And it’s just so embedded in the schools, 50% of them have fast food in the schools, Domino’s pizza and McDonald’s Monday and Taco Bell Tuesday and-
Dr. Leonor Osorio: Gatorade.
Dr. Mark Hyman: Gatorade. Yup. And they have these competitive foods which is a kid has to compete between a pizza and a healthy food. They’re not going to pick the healthy food. And it’s 80% of contracts with soda companies have ads in the stalls of the bathroom, Coca Cola as. And that it just, it’s so embedded and it’s so deliberate and it’s so insidious that it becomes part of their culture.
Dr. Mark Hyman: And they essentially hook them like addicts early on. And that’s right. You’re right Dr. Modlin, schools, that’s the place to start. But it’s very tough because, you know?
Dr. Charles Modlin: I think what you’re doing here today to raise awareness in the minority communities that this is a social injustice as you’ve named it and you’ve term it. Actually, I think it was in 1964, I forget the exact year. Dr. King actually said of all the forms of injustice, inequities in healthcare are the most shocking and the most inhumane. I mean, of all the civil rights activities in which he was engaged, he said these health disparities are the most shocking and the-
Dr. Mark Hyman: It is.
Dr. Charles Modlin: … most inhumane. So, I think what we’re doing here today to raise awareness that this is a social injustice is a starting point. Because I think here to for, I think the minority communities have not really seen this as a form of racism. I think this is the starting point where we can actually make a big difference.
Dr. Mark Hyman: I agree. I think it’s a form of food racism.
Tawny Jones: I’ll add to that. I personally had not heard that perspective until you raised it. And to have more physicians because physician in the black… any community is a well-respected individual. You consider smart. You considered at the top of your game.
Tawny Jones: And so, you as an individual, getting in front on stage, in front of African-American’s and I’ve seen this done dozens of times, they’re captivated by that perspective you bring that you are being targeted, you are. These companies are going after your race. It’s a form of prejudice that you might not see.
Tawny Jones: You consider it to be what’s quoted as white people food. But it’s not food [crosstalk 00:24:32]. Food is not white or black, it’s… Language is not white or black. These are not white or black things. These are true issues that we just have not been able to address.
Tawny Jones: And if I recall when I was in school, we never had access to healthy food options. I never remember having a salad as part of my lunch. I never remember having a choice of vegetables or a choice of fruits for my lunch. Pizza was prime hamburger, similar to what we saw in the school system that we visited. All the apples were sitting there, but the hamburgers were almost gone. The French fries were almost gone.
Tawny Jones: And the students were there and they were all… 90% of what we saw. The students were overweight. But I can’t blame them because they’ve not been exposed, their parents have not been exposed. So, we have a long way to go on education and we have to be comfortable naming it what the problem is. And that’s where we lack. Nobody wants to call it out.
Dr. Mark Hyman: I mean, it’s true with food. Our food system is a form of social injustice. And it particularly affects the poor and minorities in this country in ways that are causing so many deaths. I mean, we’re talking about gun violence and that’s real. I mean, 70,000 people die every year from guns.
Dr. Mark Hyman: But you know, 700,000 people die every year just from bad food, from heart disease alone. And when you add it all up, it’s literally half the country is suffering. Maybe more African-Americans, 80% of African American women are overweight, it’s-
Dr. Charles Modlin: And I think what you pointed out also, what you’d written your zip code is the bigger determine of your health outcome than your genetic code.
Dr. Mark Hyman: That’s right.
Dr. Charles Modlin: So, I mean, moving forward, I’m actually going to actually be a champion in terms of getting the word out about this social injustice. I mean, we’re the leaders in this area. And I mean, I applaud you for actually bringing this to the table and to our attention because we can make a difference.
Dr. Mark Hyman: Yeah. It’s huge. I mean, there was a Baltimore pastor, an African-American pastor who said, we’re losing more people to sweets than the streets. And that’s really true. And I think it’s not something that these communities really understand.
Dr. Mark Hyman: And it’s insidious. In New York state, when the Bloomberg wanted to pass a law that was going to prohibit large amounts of volume of sodas, didn’t saw more than the 16-ounce soda. Guess who came out against him?
Dr. Charles Modlin: See, I don’t remember that.
Dr. Mark Hyman: The African-American and Hispanic communities. Why? Because the NAACP and Hispanic Federation are funded by Coca-Cola. Why? Why are food stamps, which are supposed to help food insecurity and help provide nutrition spending?
Dr. Mark Hyman: Why are we spending $7 billion a year on soda, which is $30 billion a year, 30 million servings a year for the poor, or why are we spending 75 billion most of which is for junk food. It’s making these patients sick and fat and instead of helping them eat real food.
Dr. Mark Hyman: Why? Because the big food hunger networks, which oppose any restriction on any of these junk foods or soda and food stamps are funded by the food industry. So, it’s a really insidious thing. And I remember being in Atlanta when the movie fed up, came out about sugar and obesity.
Dr. Mark Hyman: And I was met with Bernice King and she was very excited about this. And she talked about how nonviolence also means nonviolence to yourself as a value. And we decided to show the movie at the King’s Center. And a few days later after we organized the whole event, I got a call saying, no, we can’t have the showing of the King’s Center.
Dr. Mark Hyman: I’m like, Why? She said, Well, King’s Center is funded by Coca Cola in Atlanta. I went to meet with the Dean of Spelman College, which is the largest African-American college in the country I think and for women. And the Dean said to me, 50% of the entering class of African American women has a chronic disease, hypertension, diabetes, obesity.
Dr. Mark Hyman: These are 18-year-old girls. And I said, Well, why are there Coke machines all over the campus? Dispensers and fountains. And it’s a carnival. And she said, well, because a lot of our funding comes from Coke. And one of the board of trustees is from very high up person in Coca-Cola for Spelman College, an African-American woman. And I just like, how does the community not rise up and say, how do we stop this?
Dr. Leonor Osorio: Because I think the sugar industry is causing a genocide in our population. And sugar and fat are addictive, the more you eat, the more you want and you’re craving it and you don’t even know you’re doing it to yourself. And that’s the hard battle too with patients because they feel with all the anxiety, depression, and stress, they feel relieved when they have-
Dr. Mark Hyman: For a minute.
Dr. Leonor Osorio: For a minute. Right. Right. But they eat more because they want… it’s like a heroin, right? They want that high again and feel relieved. So, and it’s very hard to stop it in our patients.
Dr. Mark Hyman: It’s true. I mean, it sends, it’s a new form of slavery. And that slavery actually in part was built for the need to produce sugarcane. So, a lot of our slave trade was driven by the use more sugar. And now, that very sugar is causing another form of slavery. And I think injustice, it’s pretty scary.
Dr. Mark Hyman: So, how do you think we can be begin to address these and these big issues and get these communities to wake up and say, Hey, wait a minute. We’re not going to let the man do this to us anymore. We’re going to rise up and understand this as a social justice issue.
Dr. Mark Hyman: And whether we’ve got Cesar Chavez about farm workers’ protection, you’ve got groups around Black Lives Matter, advocating for justice in different ways or environmental racism is now understood as a thing. But food racism is not really understood.
Dr. Leonor Osorio: No. And I mean, you bringing it up as an excellent point. And I think there has to be education in medical schools for future doctors because that was never taught. I think the churches have to play a big role. I think the pastors should have a sermon about that.
Dr. Leonor Osorio: Because if we say your husband would be alive today, your child would be alive today. Your uncle wouldn’t have to have bilateral amputations if they gave up the soda. If they gave up the Twinkies and sugary cereals. If we made it personal and say that this is… we’re trying to create memories and our life and be a healthy.
Dr. Leonor Osorio: We don’t want ADHD. The lack of exercise too is an amazing to me because people say, I have back pain, I have knee pain and I can’t exercise. I’m like, Yes, you can. You can get up. Really such a sedentary lifestyle where everything where have apps that deliver food.
Dr. Leonor Osorio: So, I mean, I don’t under… I’m like, I want us to… because we were just killing ourselves. In the Hispanic community, there’s so much fatty liver, which can lead to cirrhosis. And the amount of liver transplants and deaths, I mean-
Dr. Mark Hyman: Liver transplants are from sugar, I think.
Dr. Leonor Osorio: Yes, yes, yes.
Dr. Charles Modlin: But we have the apps that deliver bad food, I guess. I don’t know if there are any apps deliver good food.
Dr. Leonor Osorio: Yeah, that’s what I’m saying. Yeah. Give me some stacked Quinoa and deliver it. No. These are all fast food, not here. And I think we need to stop the sugar industry. I mean, they’re lining our politicians. Nobody’s protecting us.
Dr. Leonor Osorio: There’s a website called the Dirty Dozen that shows what’s full of pesticides. Why is that and that? And why do we have to buy non-GMO and know what pesticide is. I think if I go to a supermarket and I want to buy fruit, I shouldn’t have to decide if, okay, do organic or not organic, right?
Dr. Leonor Osorio: I mean, why is nobody protecting us? I think that’s why cancer is on a rise too because our food is contaminated, but our politicians are not doing anything about it.
Dr. Mark Hyman: Yeah. I mean, the other thing that people don’t realize is that a lot of these health disparities exist in food and farm workers, which comprise more workers than any other industry. There’s 20 million food and farm workers and they’re often brown and black. And they’re often unprotected.
Dr. Mark Hyman: And the Fair Labor Act, which is in the 30s under Roosevelt have just developed to protect workers, did not cover food and farm workers. Why? Because they were African-American for the most part, so they weren’t protected. And that’s why they often earn less than minimum wage.
Dr. Mark Hyman: They have no health benefits. We have to cover them with Medicaid and food stamps. And they’re often at high risk for diseases such as pesticide related conditions. And they’re struggling. And again, we’re eating all this food, but what is happening to people who actually provide the food? That’s a whole another level of health disparity that exists in those brown and black communities.
Tawny Jones: But I think we have to help people connect the dots. We know this because we’re health care workers, we’re exposed to the impact of what unhealthy options do to our bodies. We can suggest to someone that if you don’t change your diet, you’re probably going to die, that’s hard for a person to receive. It’s hard for a person to understand.
Dr. Mark Hyman: How, where, why?
Tawny Jones: They want to know the why, how. How do I change considering my limitations? You want me to exercise? There are no parks in my community. I can’t walk to the corner because-
Dr. Mark Hyman: Not safe to go outside.
Tawny Jones: Yes. I can’t send my children out because human trafficking is at an all time high. I just watched that on the news last night. So, people are aware of their surroundings and the issues that are plaguing their communities and them as individuals. And so, they start to layer these excuses on excuse, excuse, excuse.
Tawny Jones: And not to their fault, but in their world it’s their reality. And they don’t have a way out. They don’t have an option. And I think this is where the community-based talks where we get out front, in front of these individuals and start to share very candidly share this information and say, this is the number of patients that have died as a result of this.
Tawny Jones: And let me tell you how that could have been prevented. And really have an opportunity for them to share in that conversation. We don’t see that in our communities. We’ll do a health fair where we have one, one snapshot in time where we bring that information to them. And then, months or another year will go by before we get back in front of those individuals.
Tawny Jones: And I think that this needs to be a more concerted effort where it’s ongoing. There should be weekly meetings, whether it’s at the church, whether it’s at the community center. Whether it’s in a space where they feel comfortable going to where we can share all of this information in a way that they understand it.
Tawny Jones: Health literacy is real, so they don’t necessarily receive it well from physicians. But where the community workers who can help with this. Those coaches or individuals who are just inspired to be in the health space and who want to partner with healthcare organizations.
Dr. Mark Hyman: So, let’s start with the Center for Functional Medicine. This program at Langston Hughes with the very underserved African-American community. Can you tell us how that’s going? What the response has been?
Dr. Mark Hyman: Because I think people say, oh, people don’t really want get better. They just like the way that they’re going and they don’t… maybe they know already what to do. They’re just not doing it. Tell us what happened?
Tawny Jones: Yeah. So, when you know you do better. And I’m a firm believer that people will do the right thing if you guide them in the right way. And so, we were able to partner at one kudos I will give to the Cleveland Clinic is that it has a strong footprint in its community.
Tawny Jones: And it is really focused on community-based initiatives to help improve the health and provide self-preventative measures and teaching and education for individuals that we would either serve out there or we’re going to serve in here in the hospital settings. So, one way or the other, we’re going to get them. Yeah. So, we can take a preemptive strike and do it the right way or we can see them on the backhand. And I think we prefer the farmer, so.
Dr. Mark Hyman: And how are those people responding?
Tawny Jones: Very well. We were-
Dr. Mark Hyman: It was sold out, right?
Tawny Jones: Yeah. We were reticent about offering a shared medical, a group visit appointment in this underserved area in this community center. We were a little bit unsure of how the uptake would be. But these were individuals who were somewhat invested in their health because they do go to the community center.
Tawny Jones: There’s a gym there. They do line dancing and they do some yoga. And you may see a few on the treadmill. So, they have some sense of, Okay, I need to do something differently. But we were able as functional medicine to bring the medical management component to them and say, You know what? We’re going to dive into your nutrition.
Tawny Jones: What are you eating? If you leave from yoga and line dancing and you go to McDonald’s down the street, you probably just undid all of that effort. And you have to be comfortable to say that. So, we spent a significant amount of time training our team on what the issues were in the community.
Tawny Jones: What the disparities were, what the challenges were as far as the food desert and their access and their understanding of what the concerns where why individuals weren’t opting towards healthier lifestyles and these individuals who were selected to be in the program.
Tawny Jones: We only had capacity for 15 due to the space. And now, we have a waiting list. They have been so engaged in their health. They didn’t know what a health coach was. They didn’t know that sleep was tied to their overall wellbeing.
Tawny Jones: They didn’t know that stress management was important for them to help their blood pressure. They had no clue that movement and simple moving movements that they can do at home, even if you can’t get outside that they were able to do those and it would affect their health.
Tawny Jones: So, we were able to really drill down into their concerns, create a safe space for them to come together, share their stories, get provide access to food for them. So again, sometimes we have to help individually [crosstalk 00:38:27]. They’re loving-
Dr. Mark Hyman: Resisting it.
Tawny Jones: … the food. They’re not resisting it.
Dr. Mark Hyman: They want to learn.
Tawny Jones: They are eager to not only learn, but to bring their families in and to bring their friends in. And so, I visited the center. And one of the ladies tapped me on the shoulder and she said, I need you to make sure you get my family on that wait list.
Tawny Jones: And so, now, it’s creating a demand that wasn’t there before for these types of services in the community. So, it’s not that people don’t want it, it’s that they don’t know that they have access to it. They haven’t been exposed to it. But once we-
Dr. Mark Hyman: It’s just hard to believe, right? For the average person listening. I imagine it’s hard to believe that people don’t know that soda is bad for you or don’t know that eating a lot of processed food is not good for you.
Tawny Jones: LeBron James drinks it. So, this is my vision.
Dr. Leonor Osorio: He’s got muscles.
Dr. Mark Hyman: He fakes it. He fakes it. He fakes it.
Tawny Jones: Right. And diet Coke is, it’s a diet. So, why can’t I have a diet Coke? Unless someone is explaining to them which is what our dieticians and our coaches go in to do unless someone says no, actually that’s worse than a regular Coke. Yeah, they don’t have that sense. It says zero calories on the label. Well-
Dr. Mark Hyman: Because a lot of the messaging goes out there. It’s your fault. It’s just about personal responsibility. If you used any allied junk and you exercise and got off your couch, you’d be fine. And that’s what the food industry tells us.
Dr. Mark Hyman: What our government tells us that all calories are the same. And then, if you just manage that, you’ll be fine. And in truth, it’s not so simple. And I was shocked when I worked with… it was a poor white family in South Carolina.
Dr. Mark Hyman: How they just did not know what they were eating and they didn’t know what to do and they were desperate to do the right thing. And once they got a little bit information, they literally able to transform their lives. And the young boy was morbidly obese.
Dr. Mark Hyman: I mean, had diabetes practically at 16 years old, adult also diabetes. And he was worried because I said you’re 50% body fat and the guy should be 10% over is terrible. And he’s like, Am I going to be 100%? I’m, No, you have bones and you have some muscle.
Dr. Mark Hyman: But he got to understand what was going on and he wasn’t stupid, he says, But I feel I’m an alcoholic, being working in a bar, living in the community I mean. But he was able to figure it out. He lost 138 pounds. And now, he’s in medical school. And if you just give people a chance to and he was one of the… we know in a poor community, they’ve done food stamps and disability.
Dr. Mark Hyman: They had no education. I mean, it was really an extraordinary story which helped me understand that it’s not about personal responsibility. It’s about being in a toxic food environment, not knowing that you are, and not knowing how to get out of it.
Dr. Charles Modlin: I saw that story. But the thing about the Langston Hughes thing that when you go into there and educate the community, you do it in a special way. You’re not going in there. You’re not accusatory. You’re not pointing the finger. You’re not blaming them. You talk about the food deserts but you also talk about the food swamps also.
Dr. Mark Hyman: It’s food apartheid.
Dr. Charles Modlin: Yeah. It’s food, apartheid. You have to be culturally sensitive, culturally competent. You have to establish a relationship with the community. And so, I just want to emphasize that you have to be very careful in terms of how you engage the community because you could actually do more harm.
Dr. Charles Modlin: And you could really, you have to be able to resonate with the community. It says, nobody knows how much… nobody cares how much you know until they know how much you care. So, that’s very, very important.
Tawny Jones: Yeah. Racially and ethnically, sensitive is my first step in creating programs in our community and creating pro programs for our providers. Because I think about the patient experience first. The patient is always paramount. I know we were trained at the Cleveland clinic. The patient is our North Star.
Tawny Jones: So, it’s the most important person that walks through our doors. And so, when I think about that, I want them to reclaim their life. I want them to have access to a program that makes them feel comfortable coming into. These individuals at Langston Hughes come back every week.
Tawny Jones: And this is a 10-week program, but they have made the commitment because we are one removing the barriers and we’re creating a space where it’s very comfortable for them to come in and learn. We’re not using terminology that would be offensive to them And we’re not-
Dr. Mark Hyman: How do you make sure I don’t?
Tawny Jones: We’re not putting information in front of them, 12 syllable words that they would have no idea. We go over their laboratory testing because you hear H… and you hear hemoglobin and you hear lipid panel and you hear all of these terms and it’s just overwhelming and you think, Ohm my God, is that bad, good or indifferent?
Tawny Jones: But you don’t want to ask your doctor because you feel, Well, he’ll think I’m stupid. And so, we have those social stigmas that we carry around with us. So, I don’t want to do that. But in this space, we just assume that we’re going to start everybody at square one. And let me tell you what a hemoglobin A1c does to your health. Let me tell you what a-
Dr. Mark Hyman: Don’t want to know.
Tawny Jones: … people… and they are-
Dr. Mark Hyman: That was just striking-
Tawny Jones: … to watch them. They’re so immersed in this conversation. And they’re like, Oh, my God. For years, I’ve been wondering what a lipid path, that’s what that means. And so-
Dr. Mark Hyman: And they’re doing it. And their blood sugars are dropping and their blood pressure’s dropping and their weight is dropping, they feel better, right?
Dr. Leonor Osorio: That’s awesome. Yeah. And I think, I was saying before too, produce and vegetables are expensive. You have to teach people what to do with this and this and that it’s simple. Because you don’t want to spend a lot of money and then it doesn’t taste good or I don’t know how to cook it. So, doing little simple recipes and we’re trying to incorporate in the Hispanic clinic, the Puerto Rican flavors.
Dr. Leonor Osorio: So, it tastes better actually than some of the starchy foods that they have. But we have to show people we can’t assume that they know how to cook these vegetables because it’s intergenerational. If you grew up eating processed foods and your grandmother feds, you didn’t cook, you don’t know how to cook vegetables.
Dr. Mark Hyman: So, Leonor, you’re a doctor, you work at Cleveland clinic and you’re teaching people how to make Puerto Rican food?
Dr. Leonor Osorio: Yes.
Dr. Mark Hyman: Okay.
Dr. Leonor Osorio: I love it. I love.
Dr. Mark Hyman: Tell us more about how you’re actually breaking through these barriers because that’s one of the beautiful things about Cleveland Clinic is there’s all these innovators here who were thinking out of the box and who are starting to bring food as medicine into their practices. And how is that being received? And how do you break through the resistance in these populations and get them enrolled?
Dr. Leonor Osorio: Yeah. Well, I founded the Hispanic clinic in 2013 with the blessing of Cleveland Clinic. And I founded it because I wanted to break down the barriers of transportation, of language, of the culture. And we have a lot of doctors there that do colonoscopies.
Dr. Leonor Osorio: We have GIs, we have surgeons, we have psychiatrists. Because in the Spanish population too, they don’t want to use a translator to say I’m having suicidal thoughts or I’m depressed because it’s shown as a weakness usually.
Dr. Leonor Osorio: So, they don’t want family members also to be translating. And so, when I started practicing, I was just seeing the high amount of diabetes and high cholesterol. And the key, what I found out is the food, because there’s a lot of starch, there’s a lot of fat. There’s even a drink called-
Dr. Mark Hyman: A lot of refined oil.
Dr. Leonor Osorio: Refined oil. Yes. And there’s a drink called Malta, which is like a glorified Pepsi and it has like 48 grams of sugar. But that is a staple in the Puerto Rican. So, I was just taking that away and getting used to the ingredients in the Puerto Rican. Because I didn’t grow up eating their foods. But that was the impetus to deal with this population because otherwise, if I don’t deal with the food, I’m just like a dog circling my tail.
Dr. Mark Hyman: Well, that said.
Dr. Leonor Osorio: I will never ever get the hemoglobin A1c, their diabetes under control. So-
Dr. Mark Hyman: You can put all the medications you want, not going to work.
Dr. Leonor Osorio: More medicines are not the answer. It’s getting at the crux of where are the closest grocery stores, what can we substitute? And people love Quinoa. We’re substituting that with the rice food.
Dr. Mark Hyman: That’s a Bolivian food, right?
Dr. Leonor Osorio: Yeah, exactly. Exactly. And so, and I told him it’s filling just like rice. Or if you don’t have money, you can eat more beans, more fiber than because in-
Dr. Mark Hyman: Yeah. And quinoa beans cheap as-
Tawny Jones: But if you don’t know what it is. I grew up, I didn’t know what quinoa was until I grew up and became an adult. So, if you’ve never been exposed to that, I didn’t have avocado until I was an adult.
Dr. Mark Hyman: Yeah, that’s true. Although the quinoa story is tragic because it’s become a… in hip food. And now, the people in those countries that grow it can’t afford it because the price has gone up. And they’re all eating processed rice and other food. And they’re all gaining weight and becoming obese. So, it’s these interconnected consequences, so.
Dr. Charles Modlin: I’ll just say and another contributor and we don’t really think about this. Medicine now, is we’re all sub-specialized. I mean, that’s the tendency. I’m a urologist in addition to a transplant surgeon, we have all types of surgical specialists. And a lot of times we don’t really act as Dr. Osorio is a primary care provider. I don’t know nearly as much as she does about primary care.
Dr. Mark Hyman: But you’re the kid you’ve has been, you’re the guy.
Dr. Charles Modlin: But the thing is when a patient comes to us, we have to still remember that we’re, we’re physicians. And so, I say that because I recently saw a patient with a hemoglobin A1c of 14.
Dr. Mark Hyman: That for those who are listening that is ridiculously high, normal is less than five and a half. And that means your blood sugars is 800 or something.
Dr. Charles Modlin: So, he came to me with urinary frequency, getting up at night, nocturia and all these kinds of symptoms. And as you [crosstalk 00:47:55]. I mean, I could be filled… fooled to think that maybe that’s a prostate issue. I mean, it could be. But probably because of his blood sugar being high, spilling sugar in his urine and so-
Dr. Mark Hyman: Not everything’s the prostate.
Dr. Charles Modlin: Not everything is in prostate. So, we have to not just think along our specialty lines. We have to step back and think about general medicine and think about the type of foods that we’re eating, the environment they’re in. And that’s how I got interested in overall health and healthcare disparities.
Dr. Charles Modlin: After I finished my transplant training, I was able to look at the medical landscape. And that’s when I really became aware of this healthcare disparity crisis. In the next 2030 years, the majority of the populations are going to be minorities, African-Americans, Hispanic-Latino populations-
Dr. Mark Hyman: We’re not going to be minorities anymore.
Dr. Charles Modlin: Yeah. And exactly, we’re going to be the majority. But we have a seven, or eight-year shorter life expectancy. I mean, you look at that zip code profile.
Dr. Mark Hyman: And in the poorest communities, it’s 20 years left. It’s being in the third world.
Dr. Charles Modlin: Exactly. And so-
Tawny Jones: There’s a link now. You can go online and check your zip code-
Dr. Charles Modlin: Oh, exactly? Yeah.
Tawny Jones: … and determine how what your life expectancy is.
Dr. Charles Modlin: So, what we’re talking about is a national crisis. I mean, you’re talking about the gross domestic product and how it’s going to really affect the overall economy and bankrupt America. I mean, we have to solve this crisis now.
Dr. Charles Modlin: And again, as you’re adequately pointing out, a lot of this is related to the food that we’re eating and not having adequate access to healthy nutrition in these minority populations. But it’s only going to get worse if we don’t do something about it.
Dr. Mark Hyman: I mean, you’re a kidney transplant doc. The main reason for kidney transplants is high blood pressure-
Dr. Charles Modlin: And diabetes.
Dr. Leonor Osorio: And diabetes.
Dr. Mark Hyman: … and diabetes which are caused by diet.
Dr. Charles Modlin: And it’s untreated. It’s unrecognized until late stages. People showing up in the ER with kidney failure. They didn’t even know they had kidney disease.
Dr. Mark Hyman: So, you’re trying to put yourself out of business basically.
Dr. Charles Modlin: Well, we need to.
Dr. Leonor Osorio: We need to, yeah. We need to shut down the dialysis centers, that would be a dream to just-
Dr. Charles Modlin: And they’re expanding the number and it’s going the opposite direction.
Tawny Jones: And I think more of these multidisciplinary approaches to health care is necessary. Dr. Modlin and the Center for Functional Medicine, we partnered on this minority man shared medical appointment and really thought through the mail.
Tawny Jones: The experienced from a male perspective. And his specialty is just that. But we also have the nutrition and the behavioral health and lifestyle management component locked down. So, when we marry our two areas together, the program is just unbelievably welcomed by the individuals who have participated.
Dr. Mark Hyman: I mean, and typically, African-American men avoid healthcare.
Tawny Jones: It’s a nonstarter.
Dr. Mark Hyman: And then when you started the program, you’re like, Well, we better only do six weeks, because they’re not going to want to come and they don’t want to talk about their problems. And we’re pretty skeptical. So, what happened?
Tawny Jones: Well, I told Dr. Modlin, I said, Dr. Marlin, We don’t really do six weeks, it’s not enough. And he said, No, Tawny, it’s going to be hard getting these people in and let’s just start here. And I said, Okay, I respectfully stood down.
Tawny Jones: But you know I know what I know. I’ve done this for a very long time and sure enough these men are, when is the next program? Why did it only last six weeks? How can we come back together? So, we’ve created reunion opportunities for them to reconnect.
Tawny Jones: That power of social connection married to medical management is something that you don’t see that you don’t experience. Especially in the African-American community. You don’t have a place that you can go to and talk about your prostate issues or your blood pressure issues where you have-
Dr. Mark Hyman: You’re all isolated.
Tawny Jones: Yeah, absolutely. We are in silos, you know? And-
Dr. Charles Modlin: In men, a lot of these issues cause also ED issues that-
Tawny Jones: Sexual dysfunction. And they don’t want to talk about that. And so, we were very sensitive when we put the curriculum together. And Dr. Modlin said, Do you have any men who can facilitate? And I said, Uh-oh, we’re in trouble. But I tell you what we’re going to do.
Tawny Jones: We’re going to have one of the top… one of our top physician assistants was very culturally sensitive. Who is well-trained, well-skilled, she’s going to work with him. And I promise you they will be receptive. And he sat in every single one of those sessions. And you tell them what you learned from the physician assistant.
Dr. Charles Modlin: Well, first of all, she established a great report on day one. I mean, she pulls them out individually and does a physical examination and goes over the labs, explains what each laboratory analysis means why they’re doing it. And I mean, they open up to her quite nicely. I do an individual session with the men with her outside of the room and we open up and they talk about certain issues. Kevin, the educator, I mean it is-
Dr. Mark Hyman: Health coach.
Dr. Charles Modlin: Yeah, health coach. He’s quite great. But they have no hesitation opening up to, to Sarah. I mean, there’s no issues there whatsoever.
Dr. Mark Hyman: And to each other.
Dr. Charles Modlin: To each other, yes.
Dr. Mark Hyman: And to each other and that help them feel connected in ways that they hadn’t and talk about things that were hard. And, they got over the… that traditional historical aversion to healthcare, right?
Dr. Charles Modlin: Absolutely.
Dr. Mark Hyman: And their health improved.
Dr. Charles Modlin: Yeah. We’ve had some men stop smoking.
Tawny Jones: Yes. Weight loss. It’s significant weight loss, blood pressure lowered. Their A1c lowered, lipids lowered. So, and it’s hard getting them out at the end of the class. They’re oftentimes staying behind to talk with each other and share their stories.
Tawny Jones: They’re motivating each other. And so, it’s just a beautiful to witness how engaged they are in their health. We need to do more of that. Now, who would have thought functional medicine would have been connected to urology in such a way and deliver this program 10 years ago, you would’ve never thought to do that.
Tawny Jones: But today it’s the best way to manage chronic conditions. And as you said, when we have 50% of our population suffering from chronic disease. And chronic disease doesn’t work in isolation, one in four have two or more. So, if this is how we’re trending, then we need to think very differently. We need to be outside of the box. So, either we need to make that box a lot bigger in order to combat these issues. And I think that’s what our goal was.
Dr. Mark Hyman: And we know these populations are far sicker. As I mentioned at the beginning, they’re costing our healthcare system far more money and yet it’s not something that’s even on the radar of how to address within the healthcare system.
Dr. Mark Hyman: So, you’ve talked Dr. Modlin and Dr. Osorio about how do we create health equity performance measures that incentivize health care organizations to reduce these health disparities. In other words, how do we make it worth their while financially to do the right thing? So, what are the kinds of things that we could measure?
Dr. Mark Hyman: And what could be happening as we moved towards this value-based payment system where we’re going to be paying for outcomes, which is going to change the way we’re going to think about these issues could be for the more reputations you do, the better you are. I remember there was a program in New York, there’s 800,000 diabetics in New York.
Dr. Mark Hyman: And they had a nutritionist in the hospital and they were seeing dramatic reductions and imputations and they shut the program down because the hospital revenue is going down because they weren’t doing amputations. You don’t want to pay $50 for nutritionist, but they pay $5,000 for an amputation. So, how do we begin to sort of change that?
Dr. Leonor Osorio: Well, I think we have to have, as Tawny was saying, a multidisciplinary approach. We have to get the big three, the diabetes, obesity, hypertension down. And we can measure that. How low has your hemoglobin A1c dropped?
Dr. Leonor Osorio: Because we’ve been able to provide fresh food and recipes. We’ve been able to provide exercise because even doing 15 minutes in your home of cardiac exercise three times a week is better than the nothing on. So, but we have to teach people what type of exercises or show them the apps if they have a smartphone, what they can do.
Dr. Mark Hyman: Dancing.
Dr. Leonor Osorio: Yeah. Dancing you can do, it’s free. You put your music up and you can work up a sweat. And I think if we do get money, a lot of my patients are Medicaid, Medicare. If we get incentives for the hospitals, they will continue to support us.
Dr. Mark Hyman: So, you think shifting Medicare and Medicaid reimbursements to pay for these kinds of community-based programs? Pay for nutrition classes. Pay for cooking classes to actually help people learn the skills and change their behavior together is what’s going to shift things.
Dr. Leonor Osorio: Right, right. And the cost of that is not nearly the cost of any hospitalization or any transplant at all.
Dr. Mark Hyman: Are you hopeful?
Dr. Leonor Osorio: I’m very hopeful. I’m very hopeful. That’s what wakes me up in the morning is that drive to help other people and make a difference in their lives. And it’s just, we have a long way to go but, I’m hopeful. But I feel the opiate crisis, it’s an obesity crisis. It’s a diabetes crisis and we have to wake up and we have to work together because we’re just all our… a lot of our family members are dying way too soon.
Dr. Mark Hyman: Yeah. How about you Dr. Modlin? How do you see this shifting?
Dr. Charles Modlin: Our, our primary-
Dr. Mark Hyman: You’re in the leadership, Cleveland clinic, you’re thinking about these issues or the organization.
Dr. Charles Modlin: And the primary care providers, they have a program called stamp stop now and manage patients. And they have a certain amount of time every week where they can actually look at their patient profile and they can determine which patients have not been getting their labs drawn, which patients have been missing appointments. And they can proactively call those patients that just say, Well why haven’t you been coming in?
Dr. Charles Modlin: Why haven’t you been getting your bloods drawn? And just try to proactively manage those patients to stay on top of them to prevent them from getting ill to prevent them from getting readmitted to the hospital. It’s really to the hospital’s best advantage to keep patients out of the hospital. It’s cheaper for the hospital to try to manage patients in their homes and not-
Dr. Mark Hyman: It’s going to that direction.
Dr. Charles Modlin: Oh, exactly.
Dr. Mark Hyman: It hasn’t been that before.
Dr. Charles Modlin: No. That’s the way it’s going to be. Hospitals, you’re going to be penalized by having patients readmitted. When patients are discharged and readmitted within 30 days especially, there’s going to be penalties.
Dr. Mark Hyman: So, how’s your initiatives around health disparities? And raising awareness been received by the leadership at Cleveland Clinic?
Dr. Charles Modlin: Yes. I think over the years, I think it was a little slow initially. We started the health fair back in 2003. And there was a ramp up several years to get the health fair started and then the Minority Men’s Health Center. But I think in recent years, I think it’s been more accepted. Now, we have a population health program. We have our community relations community outreach program is more proactive these days. So, it’s definitely being more well received now-
Dr. Mark Hyman: Because what you said is true that majority of our diseases are these lifestyle diseases caused by diet. And if the predominant population affected by this are the minority populations. And they’re the ones we are seeing here at Cleveland Clinic, we’re taking care of them, we’re going to lose out if we don’t actually figure out how to get them healthy.
Dr. Charles Modlin: Exactly.
Dr. Mark Hyman: So, it seems there should be a more focused approach on addressing this from an organizational perspective. How do we think about where the cost centers are for us because where the disease centers are and how do we actually fix that? Is that? It seems it would put a lot of fire underneath addressing these health disparities in the community because it’s in our best interest.
Dr. Charles Modlin: Sure. Well, I’ve actually had several meetings and I’m happy to say this with our Chief Strategy Officer, Joesette Beran. And I’ve met with several of our Institute chairs to start specialized centers throughout the organization. I call it a multicultural health center of excellence. We’ve started a minority stroke center. For example, in our neurological institute, heart and vascular multicultural cardiovascular care center and our program and our DDSI center.
Dr. Mark Hyman: The Digestive Institute
Dr. Charles Modlin: Digestive Institute. Different centers and different institutes throughout the organization to address a lot of the disparities in the specific specialty areas. We’re going to… That way, we can actually work together, patient navigation, patient education, research.
Dr. Charles Modlin: We also have to train the new and upcoming generation of healthcare providers around a lot of the stuff we’re talking today about the healthcare disparities. The diverse causes of these healthcare disparities. But the leadership really is aware of this. Dr. Mihaljevic, the CEO, Dr. Wiedemann, Dr. Sabanegh, I mean, the-
Dr. Mark Hyman: Oh, so, all the leadership.
Dr. Charles Modlin: … leadership here at Cleveland Clinic understands this. Now, they’ve embraced it. And because we understand that this is the way we have to do it, value-based medicine. So, I’m appreciative of the fact that you’re here. We have a strong functional medicine program, five years now [crosstalk 01:00:46].
Dr. Charles Modlin: We had party last night. And I didn’t know that you guys could dance so well. So, we were Langston Hughes leading the way? No. I mean, things are actually heading in the right direction here at Cleveland Clinic. A great Hispanic clinic. Now, you started one day a week. Now, you’re five days a week. So, I mean, things are really… we have an LGBTQ clinic over in-
Dr. Leonor Osorio: Lakewood.
Dr. Charles Modlin: … Lakewood because they have a lot of health disparities that are unique to that patient population also. Disparities in the pediatric population. We have to be aware of some of those disparities also. But a lot of it does rest in the food and the food deserts that you’ve so rightly pointed out. And it is a social injustice. You’ve actually raised awareness in my mind. So, I’m going to go out and raise awareness in the community, so-
Dr. Mark Hyman: Thank you, yeah. That’s so great. So, final question, all of you. If you are a King or Queen for a day and you had the power to change something in health care or our policies to actually improve this system and what would they be? And I’m also going to jump in even though I don’t usually, but I’m going to jump into it.
Dr. Leonor Osorio: Okay. I’ll start. I would implement since I’m going for the day, no fast food at all in any-
Dr. Mark Hyman: In the entire United States.
Dr. Leonor Osorio: … in the entire United States.
Dr. Mark Hyman: Just bomb McDonald’s.
Dr. Leonor Osorio: Yes. Yeah. That is no longer allowed. Alcohol prohibition, we’re not going to allow that.
Dr. Mark Hyman: That could work out though.
Dr. Leonor Osorio: Nice. And then, I would have the resources take down the sugar industry because they control our politicians. And we need policy change. Our government needs to be able to protect us and not-
Dr. Mark Hyman: So, get rid of fast food and shift policies that address the sugar crisis.
Dr. Leonor Osorio: Right. And that can make food, fruits and vegetables affordable.
Dr. Mark Hyman: Affordable. Yeah. Fantastic. Okay, great. Dr Modlin.
Dr. Charles Modlin: I would actually echo what Dr. Osorio said. But I would actually elevate this to a crisis status so that the United States Congress, president of United States, every healthcare organization would recognize this, that this is a crisis state that we need to address this right now immediately. And allocate the funding so that we can address this.
Dr. Mark Hyman: I think that’s right. I think that what’s needs to happen. It needs to be a national and obviously global awareness and bringing together stakeholders to solve this problem, which is affecting all of us. Whether you’re Democrat, Republican, black, white, Hispanic, it’s killing us. All our economy, our families, our communities. Yeah. Our children’s future.
Tawny Jones: So, I’ll speak from an administrative standpoint first. And then, I’ll jump into a personal wish since I am queen for the day. Coverage, reimbursement for the services, nutrition and health coaching. Just so the world knows, health coaching is not recognized in the industry as a billable service. So, I guess that’s-
Dr. Mark Hyman: So, we got to pay for doing the right thing instead of the wrong thing.
Tawny Jones: Right. Stress and lifestyle behavior change is not a recognized as important enough for coverage through insurance companies. So, we have to offer those services without payment. In addition to that, I would request that nutrition be covered. Today, if you bill with an obesity code to an insurance company, no payment.
Tawny Jones: So, you mean to tell me if I go to see a nutritionist and I’m obese and I want to change my health, I am at risk of receiving a bill that I can’t afford to pay. So, it would be unlimited nutrition, unlimited health coaching. And then from a personal standpoint, there would be funding.
Tawny Jones: So, that when Dr. Modlin does his fairs or when he opens his multicultural clinics or Dr. Osorio wants to expand her diabetes clinics. We can do that on a larger scale. It’s not once a year, twice a year. It’s every month. It’s as often as necessary to bring these individuals together. We get them here. That’s our opportunity to impact change in their lives.
Dr. Mark Hyman: Well, those are great. I think all of those are fabulous. I would add that I think that healthcare organizations, doctors and need to stand up and understand and speak out about the power of food to cause disease and the power of food to cure disease. And to call for a national emergency to actually address this because before, doctors and hospitals got paid, the sicker patients were.
Dr. Mark Hyman: Now, with changes in the Obamacare legislation that pay for people to be healthy instead of sick. In other words, if people kept coming back in the hospital, you kept getting paid so it was fine. Now, you don’t get paid if they come back, you’re out of pocket.
Dr. Mark Hyman: And so, that’s going to drive the change. And I think if we can get doctors and hospitals to really speak up about the food and to make basically hospitals healthier. Because I was admitted here and this is one of the best hospitals in the world and I was terrified at the breakfast menu. I really had to call him to get food from somewhere else. Anyway, this has been a fabulous conversation. Thank you all for joining us on the Doctor’s Farmacy.
Dr. Charles Modlin: Thank you.
Dr. Leonor Osorio: Thank you.
Dr. Mark Hyman: And if you love this conversation on the Doctor’s Farmacy, please leave a comment. We’d love to hear from you, share with your friends and family. I show some media where you’re going to subscribe, you can subscribe to these podcasts and we’ll see you next week on the Doctor’s Farmacy.
Tawny Jones: Thank you.
Dr. Leonor Osorio: Thank you.
Dr. Mark Hyman: Hi everyone. It’s Dr. Mark Hyman. So, two quick things. Number one, thanks so much for listening to this week’s podcast. It really means a lot to me. If you’ll love the podcast, I’d really appreciate you sharing with your friends and family. Second, I want to tell you about a brand-new newsletter. I started called Mark’s picks. Every week I’m going to send out a list of a few things that I’ve been using. Take my own health to the next level.
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