Hi my name is Piri Ackerman-Barger, I served as the Associate Dean for Health Equity, Diversity and Inclusion in the Betty Irene Moore School of Nursing. It's a pleasure to be here today with you to talk about telehealth and how health and equities create health disparities. In this session, we will focus on the ways in which telehealth is designed to address health inequities. The learning objectives for this session will be to define health disparities and discuss the impact of health and equity on health disparities. So let's first talk about the concept of health disparities, health disparities are an important metric for understanding health outcomes. They exist when a health outcome is seen to a greater or lesser degree between populations, it asked the question is the difference in health outcomes too large? Health disparities are a crucial data point to help us understand the history and current state of health outcomes. We need to continue to gather and examine these data keeping in mind that this act in and of itself does not change the outcomes for communities. It is by taking actionable steps based upon this data that we can create different outcomes. Let's now focus on the concept of health inequity or health inequities. Systemic and structural inequities can be considered the root cause of many of the health disparities that we see. These include but are not limited to laws, policies, wealth imbalances, political and social influences, redlining and zoning laws. Rural and urban infrastructures and access to resources such as health care, food, housing and education. In this concept, we ask, is the distribution of resources fair among a society or communities. Metal and Hansen in 2014 argued that in order to improve health outcomes, health care providers need to be as versed in structural competencies as they are in physical assessment, diagnostic and point of care interventions. The concept of health and equities is part of an upstream approach to understanding how disparities come to be. When we can begin to understand the root cause of health disparities, we are in a better position to think about the things that will help mitigate those disparities. We will explore some examples in the upcoming slides. So the first thing I want to say is that telehealth offers an opportunity for us to mitigate some of the health disparities that we've seen. An important article about this is called no patient left behind considering equitable distribution of telehealth. So telehealth holds a promise for better outcomes, however, if we don't look at telehealth through the lens of health equity. We might be in peril of continuing or even exacerbating some of the health outcomes that we see. Healthy people 2020 said the following sometimes people don't get recommended healthcare services like cancer screenings because they don't have a primary care provider this is an issue of access. Other times it's because they live too far away from health care providers to offer those services again, an issue of access. They go on to say that interventions to increase access to health care professionals and improve communication, whether in person or remotely can help more people get the care that they need. So this really underscores this idea that telehealth holds promises and it also holds some perils if we're not looking at it wisely. So what I'd like to do now is go over a couple of examples of health disparities versus health inequities. I'd like to use the following example about African-American women's maternal health. So, a health disparity is that black women in the United States are three times more likely than white women to experience a pregnancy related death. Examples of inequities that helped lead to the health disparity that we just talked about are black women experience many forms of racism. Both systemic and individual, both of which have been associated with higher allostatic load meaning an increased risk for Hypertension, Diabetes and Obesity. Another health inequity is that black women are paid approximately 63 cents for every dollar made by a white man. Another black women tend to have less access to and poor quality of health insurance than white women. Black women tend to have less access to prenatal care. Though all of these are examples of health inequities that can lead to the overall health disparity that we saw and maternal health outcomes. So this image provides a comprehensive though not exhaustive view of the many factors that impact maternal health outcomes or eventually health disparities for black women in the United States. You can see by looking at this visual that the causes neither singular nor simple, but this type of view moves us away from an assumption that there is something biologically wrong with black women. And that's what is the cause of poor maternal health outcomes or that it's a matter of choice or lifestyle. Really, these health disparities are a result of a combination of systemic health inequity. As you can see everything from education to housing, to food stability, to rates of incarceration, to the many, many bills and policies that have influenced our society today. So let's look at another example of health disparities and health inequities, this one is about telehealth and health care disparities. So the first one is that black and Latino patients are less likely to have access to or use telehealth services. The other one is, people living in rural communities are less likely to engage in telehealth encounters. So the health inequities that are associated with that are black and Latino patients are less likely to have access to or have a traditional computer in their home or broadband services. Another inequity is that rural residents have fewer health care services, fewer trained physicians and worst broadband coverage. So what do we do about it? So recommendations for equitable access to telehealth, this is a quote from the National Health Law Program. They say all populations should have the resources and support to have the highest quality of care available through a telehealth interaction. For the telehealth promise to become a reality broadband or high speed internet must be available and affordable to every individual. Low income households, rural areas as well as black and Latinx populations disproportionately lack access to broadband that enables telehealth utilization. We must bridge the digital divide if telehealth is to be fully adopted by those who need it. So, to summarize, health disparities are an important metric used to understand health outcomes. Health inequities are systemic and structural inequities that can be considered the root cause of many of the health disparities we see. In the upcoming modules, we will dive deeper into both the promise of telehealth and the perils of telehealth if not viewed from a lens of health equity. Thank you so much for joining me, it's been a pleasure.