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Tavis: We continue our 'Road to Health' series tonight with a look at the state of minority health care in this country. Angela Glover Blackwell is the founder and CEO of PolicyLink, a nonprofit group at the forefront of minority health issues. Prior to that, she was a senior vice president at the Rockefeller Foundation and co-author of the book, 'Searching for the Uncommon Ground: New Dimensions on Race in America.' Angela, nice to have you on the program.

Angela Glover Blackwell: Hello, Tavis. It's nice to be here.

Tavis: Glad to have you here. I'm afraid to ask this question. I shouldn't say afraid, but just--I've asked it so many times, and yet every time I ask it--while I'm tired of asking it, it's so relevant--to talk about the fact that it's clearly and still a disproportionate impact that health disparities have on people of color. Is that ever gonna change? Am I gonna keep asking that question until I'm dead?

Blackwell: I hope it's gonna change. And I am actually optimistic that it's gonna change. Because the reality that for poor people of color, every day it's a struggle to maintain health. Physically, economically, spiritually, health is a huge challenge. But the reason I'm hopeful is that this issue is getting a lot of attention. It's not new, but it's been newly discovered. And the fact that it's been discovered and so many people are talking about it now gives me a little bit of hope just bringing it out into the forefront. But beyond that, we're beginning to shine a bright light on all the exciting work that people have been doing in local communities to change this. And if we could begin to pick up on the wisdom that's coming out of that work and take it to a level of scale that can make a difference, it may be that you'll be able to have a show a couple of years from now that's all about good news.

Tavis: I look forward to that. Tell me, though, in the meantime and in-between time why it is--what the evidence is you see that suggests that while not new, at least these health disparities have been newly discovered. Why do you believe that?

Blackwell: Well, one reason is because in 2003, the Institute of Medicine came out with a report called 'Unequal Treatment.' And not only did this report focus on health disparities, but it came right out and said that race makes a difference, that for racial and ethnic minorities, the reality, historically and current, of discrimination and the impact that that has on health and well-being is something that has to be taken into account. And it went on to say that not only are these discriminatory practices persistent and still happening to people of color and in communities of color, but that we must make sure that we take into account the impact of the stress caused by living with this kind of racism on health and well-being. That coming from the Institute of Medicine was a very big deal and, and it's actually sparked a lot of discussion.

Tavis: I wanna talk in a moment here since you just raised it about the connection between where you live and how long you live. I'll come back to that in just a second. Before I do that, though, something else you raised I want to follow up on. I don't mean to be again naive in asking this question, and maybe I'm asking it because I'm hoping that the answer has changed since the last time I asked it. We'll find out in 2 seconds here. Tell me whether or not it is still primarily race--or racism, put more accurately--that is the reason for these disparities, or are there other factors that lead to these disparities in the quality of health that Americans have?

Blackwell: I would say it's complex. The disparities come from the historical legacy of racism in that people of color--black, Latino, many southeast Asians--live in communities where they don't have access to health care, and they live in these communities because these are the only places where people were allowed to live historically, and then over time they've been the only places that have been affordable for those who are low income. And we know that people of color are disproportionately low income. We also know that we haven't had as many providers who come from communities of color and that many times providers who are not of color sometimes are blatantly racist, but many times just don't have the familiarity with the community, and people don't feel comfortable seeking out those providers. We also know that there are terrible, horrendous stories of direct racist impacts on health and well-being. So, yes, historically, it's been racism, it continues to be racism, but we also have something now in which the intersection of race and class has become a huge point of inequity, that people of color who also happen to be poor suffer not only the legacy of racism and the continuing burden of continuing racism, but they have this issue of poverty on top of that--too poor to be able to access health care without insurance, jobs not providing insurance. And so the absence of access to health care that is associated with poverty is also a huge problem.

Tavis: You hinted at something a moment ago that I want to follow up on, if I might, when you raised a notion, at least, of culturally competent care. Culturally competent care or the lack thereof as administered by the health care system. So when you talk about physicians and others in the health care industry who are still challenged to deliver culturally competent care to people of color, tell me why I should be hopeful. Tell me why I should believe in your hopefulness expressed earlier that in the most multicultural, multiracial, multiethnic America ever, what we don't have is enough health care providers who come from communities of color that we will ever on balance receive culturally competent care.

Blackwell: I hope that one day we will. We certainly know that we need it, and again, I'm hopeful, but not naive. I know that we have a dearth of people of color being trained as physicians, nurses in all of the areas of health care. We have to step that up, and there are some aggressive programs trying to do that, but we don't have enough. But the very notion that cultural competence is needed is something that is relatively new. It used to be that people felt that if you're a physician, you're a physician, you're a physician, and it doesn't make any difference whether or not you have a relationship with the community. We now know that that's different. One of the examples that was very moving to me is that many times when people do not speak English and they come in to see health care providers, the physicians and the nurses will turn to the children of adults who have problems and translate through the children. People who live in communities where language is often a barrier understand how it undermines parental authority when the children become the authority figures within an important setting like a health care setting. And so that is a story that is beginning to be well-known among health care providers, and therefore there is a growing awareness that there are many cultural issues. We need to train more physicians. We need to make sure that physicians and nurses and others who are trained understand that they have to be able to connect to their patients so that they can know what's going on. They can get a full history. They can understand the environments in which they hope their advice is going to be carried out or not, so I'm not unrealistic about how far away we are in this regard, but, Tavis, I can't tell you what a big step it is to go forward just to have you talking about it on this show and having people talking about it in many different settings. But we have a long way to go on that issue.

Tavis: Since you went there, let me follow up on this as well. You mentioned those persons whose--whose children speak better English than they do if they speak English at all. Some don't even have English as a second language; although I add right quickly that all across this state of California, at least, those classes are always overloaded where you have immigrants who are trying to learn English. That said, we've all seen the stories too many times of kids, to your point, who are interpreting for their parents, and certainly if it happens everywhere else, I assume it happens in hospital rooms and in doctors' offices all across the state and across the country. That said, I'm trying to juxtapose that reality with something I read the other day that Latinos who are U.S.-born--I don't know if you saw this study. Latinos who are U.S.-born end up having more health crises, more health challenges than their parents. You know the study I'm referencing?

Blackwell: I absolutely do, and it's shocking when you think about it...

Tavis: It is.

Blackwell: That people come to this country from countries that we think of as not having as good medical systems--

Tavis: Third world countries. Some third world countries.

Blackwell: But they come here, and it turns out that health goes down rather than improving. But if you think about it deeply, it's not as shocking as it seems on the surface because what happens is that people come from traditions of community in which the whole community takes the health of the individual into account. People are there with generations of their family, so that aunts and uncles and grandparents are able to help people understand how to remain healthy. People come to this country and they're separated too often from the extended family that often is a source of the information that helps us to stay healthy. The other thing that happens is they come to this country and they get exposed to new diets, fast food, and they get away from the traditional eating that often is associated with maintaining that health style, and very often people are comfortable with their medical systems in the countries that they're coming from, so that while the system may not be as sophisticated as the system is viewed as being in the united states, it is a system that people feel free to access, they feel welcome, they have culturally competent health care providers there. They come here where they often don't feel welcome, where the cultural competence is absent, and where there's often a fear of not being able to communicate and a fear of not being understood. And so what seems like a paradox on the surface, when you take it apart is not a paradox at all, but it suggests that people who are native to this country, particularly African Americans, are in a system that is not conducive to maintaining the health and well-being of people of color, people who are poor, and that is the issue that we have to deal with across the board.

Tavis: So finally, right quick here in a minute, for those who don't get it, share with me the link between where you live and how healthy you are and how unhealthy people tend to be.

Blackwell: In this country, where you live has become a proxy for opportunity. The national black environmental justice network has shown that half of black neighborhoods do not have a full-service grocery store. If you live in a neighborhood with no grocery store, no safe parks, no place to get recreation, no safe streets to be able to get out and travel by foot, you are increasing the likelihood that you will be obese, have heart disease, high blood pressure, and all those issues that are associated with not having a healthy lifestyle. Where you live makes a difference, and we can do something through policy to improve the quality of life in neighborhoods that are literally making people sick.

Tavis: Angela Glover Blackwell, the founder and CEO of PolicyLink. Angela, as always, a pleasure to talk to you, and, as always, I thank you for your insight. Glad to have you on the program.

Blackwell: Thank you very much, Tavis.

Tavis: That's our show for tonight. You can catch me on the radio, public radio, in fact, this weekend and every weekend on P.R.I., Public Radio International. Check your local listings. I'll see you back here next time on PBS. Until then, good night from Los Angeles. Thanks for watching and, as always, keep the faith.