09.20.2018

Prabhjot Singh Discusses the U.S. Healthcare System

Hari Sreenivasan sits down with Mount Sinai’s Dr. Prabhjot Singh to discuss the United States’ broken healthcare system and how to fix it.

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What are we seeing today in the United States that most people watching wouldn't know about.

Well the thing I've been alarmed by is watching for example in South Texas the rise of parasitic diseases that come through soil into the feet of kids- hook worm other sort of parasitic worms tropical diseases that as a nation we eradicated 100 years ago.

We're starting to see we're fighting this overseas where we have USA we've got we've got a president you know former President Carter who has put a huge amount of effort in eradicating these diseases in West Africa.

And right as we're doing that we're watching this rise.

Back here in the U.S.

and these are really diseases of poverty.

And the lack of basic essential health systems and social support.

Along with that, we're seeing rises in maternal mortality- moms dying.

Particularly African-American mothers.

And we're also seeing in this in some groups for example even in white middle age males drops in life expectancy.

For the first time in decades in America due to alcohol suicide opioid use.

And as you start to see this picture come up it's a it's a just a deep reminder that we have to really rethink how we're building our health system- it isn't always just about payment and access.

It's actually about how we are designing our relationship with places and how we're addressing the challenges that communities are facing as primary issues not as afterthoughts.

Did you ever think when you were coming up through med school that you'd probably heard of doctors volunteering their time overseas somewhere and an eye clinic that's mobile some far off land that could be happening here in the United States in West Virginia and in New Mexico.

To be honest I had no idea.

I grew up in Kenya.

And we came to Michigan when I was young and if you told me that this was happening in the United States I would have would not have believed you.

But as I've gone through training and as I've seen firsthand now the need for basic healthcare essential healthcare which includes basic basic social needs.

It's been it's been eye opening.

It's been concerning and it's also we have to just level set- that's where we are.

Give me some examples of lessons that you're learning from places that are developing countries that don't have the healthcare system infrastructure that we might have but are actually doing some things better?

You know one thing that's always amazed me is that if you go to Liberia or Uganda and you go to rural settings where you have a trained community health worker with a mobile phone equipped with a diagnostic test in their backpack they go to a household where there's a kid who has a fever and we've all you know all of us who are parents have had a kid who has a fever and we're wondering should we go to the doctor should we wait this out.

And what they're able to do is go to the doorstop go into the house use that rapid diagnostic test to look for whether it's an infectious cause what type.

And they're actually treating with antibiotics people on the spot.

And then referring them to the hospital.

And what's amazing is that this group this network of community health workers is connected by mobile phones has their quality assessed on a very regular basis and is often put on a map.

Where you can see how all these mobile networks have community health workers are actually working and where they're working and are they effective and what's the quality.

And so you know you look at these sort of systems and they're saying why aren't why don't we have things like that here in the U.S.? And in some ways when you look at Liberia Uganda they've they've had been under so much pressure to create these systems because they can't build the big towers that they have instead pushed that energy that innovation that ingenuity into building these very flat networked community based mobile systems.

And frankly I think that they're better than what we have and a lot of the United States.

And I hope that we can bring them in to our own work while we're still exchanging the advances that we're making here in the U.S.

There's also been programs in the United States remote access medical.

Right? I mean reaching out to communities in Appalachia that are totally under served.

Does that scale up?

Do we end up having to maybe invest more in that model?

First of all I'm constantly away by Remote Area Medical.

I mean this is a group that was started in order to take care of people in the Amazon and in places like Liberia.

And Remote Area Medical now sets up camps.

Sophisticated camps but here in Appalachia, in New Mexico, doing the work that they would have been doing abroad.

But the demand here is so high for free medical care that they have people that line up thousands of people that come to these camps in the middle of America in order to get health care.

First of all I think it says like it's amazing that they're doing that.

It's you know it's God's work and it should be supported.

And it says it we've got a huge hole in our healthcare system and there are a lot of them.

And people come out by the thousands when they have the opportunity to access high quality care.

How do you make sense of this how do you reconcile this? I mean here we are blocks away from us are probably some of the best medical facilities on the planet.

You know the fanciest gadgets the smartest people the most accomplished in their fields.

And you're describing parts of our country where we are seeing diseases that the developing world is almost beaten and we're getting them now.

You know I find it staggering.

I feel like as a country we're so we're so blessed and we're drowning amidst riches.

People are you know they can see you know what how advanced this country can be they can see what the best looks like in this country.

And yet it's not it's not getting to where people need it most.

And you know I think that is a question of organization and design.

And we're we just realize the work is it's at the frontlines.

In communities where we need to focus our efforts.

And until we just realize that all the smart people all the policy makers all the inventors the makers the designers.

Has that attention shifts to where the real challenges are at the person level at the community level.

We'll start to see progress and until we really start to make that mental shift.

We're going to be holding up our hands and saying what's going on.

Right now the system doesn't allow for a lot of time that a doctor can spend with a patient to ask those- it might be peripheral, but.

Questions that might lead you to answers that diagnose a problem differently.

If you just received a prescription again for insulin for instance something that was invented decades ago but whose prices just shot through the roof over this last decade.

And you say look I'd like you to take this insulin.

I'd like you to eat better.

And good luck to you.

Which is actually you know how a lot of the conversations feel on the other side.

What you are going to be missing is potentially somebody who's ashamed to say that they can't afford.

That insulin.

Somebody who may say look I want to eat better but I don't know how to do it.

On somebody to say that look you're an authority figure.

I don't have any power in this discussion.

And I don't I can't even ask the questions I need to navigate the situations I'm going to be quiet and just go home.

When that happens in the Old World.

Healthsystem will still get paid.

In the world we're moving to hopefully steadily.

Is that if they don't get healthier then you know there's no payment. But I think more importantly.

We are more deeply understanding that like nobody's better for that situation.

When you start to look at some of those peripheral reasons you're starting to pick at class, social inequality, race, gender race lots of other things that we don't associate with health care.

So how would a doctor or a nurse or a community health worker be on the front lines be able to kind of tackle all of those really significant challenges that put that person where they are today?

I think what is becoming very clear is that health care must be an advocate for the challenges people are facing.

Let me give you a practical example.

If you're speaking to if you're noticing that you see a lot of African-American young children with asthma.

That happen to all cluster in a building of public housing.

And they are coming in very frequently.

It's incumbent upon us as people in public health and health care to say well why is that happening.

Let's go upstream to the root of the challenge and as we start to inspect look at these houses we might find that there's mold.

And there's other issues and we actually have to be pretty proactive in saying OK let's work with the housing authority to get that done because no individual may have the power to do that.

If people google you after this they're going to find possibly your TED Talk and then they find articles that you were a victim of a hate crime in New York City near where you work and live. And I want to ask.

How did being a victim in that circumstance get you to rethink or influence how you thought about people who go through the healthcare system either about their physical health or even their mental health?

Well thanks for asking Hari.

So in 2013 I was attacked by about 20 to 30 men in a hate crime in Harlem where my jaw was fractured.

And at that time I was a Professor of International Affairs at Columbia and I was thinking about the big picture arena of community health across the world.

And so for me that event in 2013 actually precipitated a huge shift professionally for me. I said I wanted to move closer to doing work actually in the communities where I was working or living.

And I wanted to focus much more on what's happening on the frontlines and in the United States.

So in short you know the incident was I think it was traumatic.

And it was also revelatory.

One of my favorite writers Flannery O'Connor says grace changes us and change is painful.

And you know I look at that incident and I say wow my eyes were opened up.

And I was able to see also where I lived in a very different light.

And professionally that said oh I've got to change what I'm doing.

And I think what I hope is that as we have these very tough social questions about race about gender equity about class in America we in health care have to realize that hey we need to engage these questions.

It's going to take a long time but.

But the best way to do that is to actually go with and start to say OK how do we redesign how we interact.

Prabhjot Singh thanks for joining us.

Thanks so much for having me.

About This Episode EXPAND

Christiane Amanpour interviews Doris Kearns Goodwin, U.S. Presidential Historian and Pulitzer Prize-winning author whose most recent book is “Leadership: Lessons from the Presidents for Turbulent Times;” and Haifaa al-Mansour, director of “Nappily Ever After.” Hari Sreenivasan interviews Prabhjot Singh, Director, Arnhold Global Health Institute and author of “Dying and Living in the Neighborhood.”

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