Dr. Miguel Ruiz
speaker
84 appearances
1 recordings
1 series
first heard Jul 2024
last heard Jul 2024
Dr. Miguel Ruiz’s voice in public audio — every appearance, attributed to the second.
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But the question is, what can I do where I am, like you with your podcast today, to raise awareness, to bring the points, to make a call and appeal for change? And I think I can perhaps speak a little more about what can we do from my position in terms of being within healthcare about some of those healthcare disparities. But just to throw a couple of numbers, if you give me 30 more seconds here.
Health outcomes, health disparities. One of them is for example, survival or life expectancy. I mean, what other health outcome more final and more direct that how long a human being lives. So life expectancy, a clear gap in between black and white, people of color and white.
At the level of the country, you look at a map of the U.S., very stark differences in between different regions of the country about a baby that is born, how long it's going to be expected to live, based on where you live, based on the color of your skin. In the Twin Cities, for example, just to bring it local, healthcare, I mean, life expectancy difference in between
Let's say a few blocks west from the hospital where I work in the Frogtown area of St. Paul, just north of I-94. You compare life expectancy of the community living there with the life expectancy of individuals living three and a half miles going west just before you cross the river. In that neighborhood, also north of I-94, just by the University of Minnesota, 13 year life expectancy difference.
Wow. In the very core of our cities. So why? Why that stark difference? You know, many of our inner cities in the US have life expectancies in certain neighborhoods, similar to life expectancies in Haiti or some other countries, limited resources countries. And that's a reality in the very midst of our society in our country. So why?
Well, because if we are talking about what are we going to do about it, we need to figure out what are the... What are the causes of disparities? What causes disparity? What causes health?
And something that I think many people are not aware, because we believe health is all about healthcare, many people are not aware that actually the medical care we physicians provide, our care system providing medical care, accounts for 15 to 20% of the health of a community.
Again, the care with authors within, we are making the big difference here, but we need to be humbled by the fact that what we do basically is creating the health of the community for no more than 15 to 20% of the health of that community.
So the question is, what else are the determinants of the health of the community? And that's back to our social determinants of health. So it is those economic and social factors, is the environmental, the neighborhood, the safety, the ability to have
clean environment with less pollution, the ability to have parks where people can exercise safely, the health behaviors of these communities and individuals. Those are the main contributors to the health of a community.
Thank you, Barry. I think you bring up very important points and obviously coming from your own experience, a realization that, boy, this is a challenging area to tackle today. and yet is actionable. There are things that one can do that are specific and that make a difference. I think COVID-19, I think this pandemic has really given us another view of the
of the impact of this social- It was a wake up call. Totally. I mean, the impact of the socioeconomic and educational level and so forth. We saw clearly that Latino black were not only affected more by infected more than whites, but also got sicker and had higher mortality.
So a lot has gone into why, and I remember reading a study from Harvard, looking at their population in Massachusetts, in which they clearly identified for the Hispanic Latino was the fact that they were living in overcrowded houses with multi-generational members of the family.
meaning children that were going to school and going out with elderly parents who were living under the same roof and without little ability to do more isolation when one was infected, with less health insurance to go and be tested, with perhaps less means to drive to a testing site, that somebody who may have access to a car.
And also with some of those middle-aged individuals in that same house working in a meat processing plant where high noise requiring to shout and scream to communicate also contributed to higher transmission. And then you look at the black community living in high-rise apartments using more public transportation, and they identified all these
totally socioeconomic factors that made a difference into and obviously with under higher rates of underlying comorbidities diabetes and pulmonary diseases that place individuals at higher risk for complications from covid so just to give you yet one more in case we didn't have enough one more view and taste of how these factors do impact uh these uh these communities uh and who are um
been marginalized and who are at a disadvantage. So I think, glad that you mentioned Barry, the issue of cultural competence, because, and again, one of the factors for COVID was new arrivals. You talk about the new waves of people arriving for the Hispanic Latino newcomers have not only no connections in the community to know where to seek care, but also no health insurance.
The Hispanic Latino is the most uninsured community in our country. therefore delaying care. I had so many cases during COVID-19 coming to the hospital with an advanced case of COVID with complications, having to be intubated in the medicine department because they were not able to be tested because they didn't have the
the health literacy to be able to understand where the risk factors of the symptoms were. But what can we do? And you mentioned the word cultural competence. And I think I have a bit of a special feel about that concept because in my mind, I prefer to use the term cultural humility.
And just to make the point very, very, very quickly, the one aspect that I don't like about the term cultural competence is that the word competence assumes some degree of mastery, of expertise, of arrival. We got it. We are now incompetent.
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