I want to review a health equity model. In this model, I want to say that this is a very simple view of health equity. Really, health equity is very complicated with multiple interacting variable parts to it, better, more accurate model might be a bowl of spaghetti, but just for simplicity's sake so that we can talk about some key components. I'm going to share with you this model that was shared with me by Philip Alberti from the Association of American Medical Colleges. The first one is the notion of insurance. This is about the inability to pay. What this means is that when people know that they're not able to pay, they're less likely to seek preventative care. They're also more likely to wait until later in their illness to seek care, meaning that they're sicker when they come into CS. We know that this can be deeply problematic with multiple illnesses. Just take cancer for example, if an individual has access to free cancer screening such as mammograms and things like that, we might be able to catch cancer early at a point where there's something that we can do to significantly improve their health outcome. When people come in because they're symptomatic, because their breast cancer has gone to the point that they are having difficulty breathing, because it's metastasized their lungs, there's not very much that we can do about that. There are real consequences when people don't have the insurance that they need. The next concept is access. You'll hear the term access used in multiple ways. Here, we're going to talk about it in a couple of ways. It means the ability to get to the place or to receive the health care services needed. Do people have the transportation to get to where they need to go if they live in a rural area? What does it mean if the nearest health care facility is two hours away? Then what does it mean if it's two hours away and you don't have reliable transportation? What does it mean if you're in an urban area and you don't have a car? How many transfers and bus passes is it going to take for you to get to the health care service that you need? Keeping in mind that getting to a clinic or a hospital can be much different than what it's like to get to a specialty care clinic, that can pose an even more difficult issue. Then the other thing is about that fracture of care. Are there the health care providers in your area that can provide the services that you need? Under the heading of access, is where the concept of telehealth becomes really important, because telehealth offers access to people that live in areas that may otherwise not be accessible to them if people have what they need, the broadband services, etc. We will talk about that in future modules. The other concept is utility. This is about, people have insurance and they can access health care. Will they choose to enter the healthcare system? Really this is about trust. Do people trust us? When I say us, I mean health care providers and the health care system with their care. We've got to keep in mind that there are groups of people who have been historically and are currently marginalized by society as a whole and by health care. Let me just give you a couple of examples of groups of people that might be experiencing marginalization. Let's talk about people who are living with obesity. A lot of times when people living with obesity come into CS, health care professionals will give them a lecture about how they simply need to change their diet and exercise to overcome this issue of obesity. That is an underwhelming thing to say to somebody because if it were that easy, people would do it. There's many complex factors that contribute to the condition of obesity, and most likely, most people who are living with obesity have heard the lecture. That's not super helpful. If you're sick, you might be weighing, how sick am I? Am I sick enough to endure a somewhat patronizing conversation with my health care provider, to get the thing that I need? Another group of people that might be worried about interacting with us are people who are undocumented. We have no idea at what point there will be a triggering of the system, for example, as mandated reporters, are we going to bring in social services that will out a family that members of that family are undocumented. We know that African American people, we remember our history. We remember the things that have been done to us from the times of slave days when there were experiments happening on enslaved women around gynecological care, to more recently, with the Tuskegee experiment. If you think about it, the timeframe that Tuskegee was happening was between the 1930s and 1970s. That's not really that long ago. There are a lot of people who were alive then or are the children of people that were alive then, and we remember that. We wonder, what is the motivation? What is behind the motivations of the health care system? Are we safe? We see that playing out in real time as many people of color are hesitant to trust the health care system with the COVID-19 vaccination. That creates the problem. Then the other group I want to talk about are folks who maybe part of the LGBTQ+ community, particularly transgender folks, who often endure horrible treatment, judgment, violation of privacy as unnecessary, assessment of the genitalia are done, or refusal to use the name or pronouns that people would like to be referred to. All of these things can contribute to whether people decide to come and see us. Of course, we want people to come and see us, because we want to create better health outcomes. That brings us to the final point that I wanted to talk about, is the notion of quality of care. If people can pay, if they can get there and they decide to interact with us, what quality of care are they going to receive? This really does come down to some of those interactions that we're having. What are the biases that health care providers bring into the care that they provide? What judgments, what assumptions, what training do we have about different groups of people, what training do we utilize around motivational, interviewing, and really deeply listening to what individuals are telling us without stereotyping them and assuming something about them because of the group that they belong to? We know that unconscious bias is, or sometimes conscious bias is related to health disparities, and therefore is in opposition to health equity. I think that we need to keep in mind that it's not a group of people over here that are responsible for the health disparities and the inequities and the quality of care. What is most likely happening is that it's all of us, some of the time. We do have control over that. If we're willing to take a look inward and to really see who we are as individuals, and what assumptions we're bringing into our care that impacts the health care decisions that we make, we're then in a position to provide more quality of care. Remember that if we have better quality of care, we're also probably going to start changing some of the assumptions that people make about our intentions, and then we'll be more likely to utilize the health care system. In summary, we hope that you will now be able to define the concept of health equity and have some of the tools that you need to discuss some of the components of health equity. In some of the upcoming modules, you will hear us talking more about health equity, and telehealth, and some of the promises and perils that are related there. Thank you so much for joining me, take care.