Delivery of Care

A not so beautiful day in the neighborhood

The 2023 R.I. Life Index revealed a state beset by health inequities, still reeling from the impacts of the pandemic, with racism as the major factor

Photo by Richard Asinof

Martha Wofford, president and CEO of Blue Cross and Blue Shield of RI, gives introductory remarks at the reveal event for the 2022 R.I. Life Index, with Dr. Megan Ranney looking on.

By Richard Asinof
Posted 12/4/23
The news coverage of the R.I. Life Index results failed to mention the major topic of keynote address by Dr. Dave Williams, Ph.D., which was the way that racism impacts the social determinants of health in Rhode Island. Here is comprehensive reporting of the latest research findings and the talk given by Dr. Williams.
The questions that need to be asked
Would it be possible for Dr. Williams to take a tour of health equity zones in Rhode Island, perhaps starting in Olneyville, including a stop at Clinica Esperanza, the clinic developed by Dr. Annie S. De Groot? What is the connection between the ongoing opioid epidemic in Rhode Island and the fall of life expectancy numbers? Why was Gov. Dan McKee so tone deaf in nominating someone to serve on the Ethics Commission who had been accused by at least six women of making inappropriate comments? Why was ConvergenceRI the only person wearing a mask at the R.I. Life Index event, held at the School of Public Health? Why are there not more handicapped parking spaces available in front of the School of Public Health?
Once again, it appears that the third-part prior authorization firm employed by Blue Cross Blue Shield of Rhode Island, EviCore, has denied a request for surgery by a neurosurgeon treating for ConvergenceRI.
In August, a scheduled surgery had been cancelled by EviCore,two days before the surgery. At the R.I. Life Index event, ConvergenceRI spoke briefly with the new chief medical officer at Blue Cross Blue Shield of RI, Dr Farah Shafi, saying that he would be happy to share with her the increasing level of pain endured as a result of the failure to have the surgery done. All my fingertips have gone numb; the pain constantly radiates out from my neck down both shoulders. Increasingly, I have trouble raising my right arm because of the sharp pain. Trying to walk the 200 yards from where my car was parked in order to attend the event at the School of Public Health was a veritable profile in pain; I was literally in tears by the time I made my way into the elevator.

PROVIDENCE – On Wednesday morning, Nov. 29, in a brief scrum before the beginning of the official release of the fifth annual R.I. Life Index, Richard Salit, the public relations manager for Blue Cross Blue Shield of Rhode Island, suggested wryly that perhaps ConvergenceRI should get a medal, having attended all the events related to R.I. Life Index since its launch five years ago in 2019.

It was true. ConvergenceRI has been a reporter at all of the previous R.I. Life Index release public events, when the results of the annual perception survey had been announced, documenting what Rhode Island residents truly think about their own wellness. [See link below to ConvergenceRI story, “Taking charge in health care,” which covered the release of the 2022 R.I. Life Index.]

In the past five years, ConvergenceRI’s presence as a reporter has been a constant, even as Blue Cross Blue Shield of RI has been busy evolving, including the hiring a new president and CEO, a new chief medical officer, and a new communications manager. In turn, Brown’s School of Public Health has also been going through them changes, hiring both a new dean and a new deputy dean.

A year ago, it had been Dr. Megan Ranney MD, MPH, then the Deputy Dean of the School of Public Health at Brown University, the director of Brown Digital Health, and an ER physician in emergency medicine at Lifespan, who had become well-known for her appearances on cable news TV speaking about firearm violence and the COVID 19 pandemic, who introduced the 2022 R.I. Life Index.

“I am quite optimistic,” Ranney had said at the time. “My optimism flows from the knowledge that everyone in this room, and everyone attending virtually, are committed to addressing the inequities in our health care, public health, and community in Rhode Island.” [Ranney now serves as the dean at the Yale University School of Public Health.]

Context and nuance  

It is also true that ConvergenceRI recently published a three-part series focused on data – “It’s all about the data, the data, the data…” [See links below to ConvergenceRI stories.]

The series looked at the latest data reports from HousingWorks RI and its 2023 Housing Fact Book and the dire lack of affordable housing to rent or to buy [PART One]; the observations from Neil Sarkar, president and CEO of the R.I. Quality Institute, which manages the state’s health information exchange, CurrentCare, and the problems of health care workforce burnout [PART Two]; and the large gaps in data reporting about the nonprofit sector in Rhode Island, which makes up nearly 18 percent of the state’s private workforce [PART Three].

Indeed, the release of the fifth annual R.I. Life Index, an initiative that seeks to take the pulse of the state’s health and well-being through a comprehensive perception research study conducted by the School of Public Health at Brown University and Blue Cross Blue Shield of Rhode Island, represents an important data trend often missing from public policy and legislative discussions: What do Rhode Island residents think about their own lives, focused on the social determinants of health?

“We conducted interviews in 16 languages to make sure that the voices were amplified of people who often don’t get a voice in surveys like this,” explained Martha Wofford, president and CEO of Blue Cross Blue Shield of RI, as she introduced the results of the 2023 R.I. Life Index.

“There is real power in the process,” Wofford continued. “There is power in publicly sharing and discussing data, because when you do that, you can come together [and create] a shared understanding, a shared agenda, and shared commitment to address the real problems that we have around health equity in Rhode Island.”

As the result of past surveys, Blue Cross and Blue Shield has redoubled its philanthropic efforts around affordable housing, with the messaging: housing is health care.

The comprehensive nature of the survey and its methodology – which included both random digital dialing and direct person interviews done in 16 different languages by six community agencies, with a total of 2,317 adults having completed the survey – produced statistically significant results, results  that should surprise no one who has been living in Rhode Island during the last five years.

When it comes to housing, jobs, medical care, transportation, food security, the cost of living, and programs for children and seniors, the scores were “at the lowest levels” since the R.I. Life Index first began tracking the data trends for the social determinants of health in 2019, according to the research findings.

Equally unsurprising, the 2023 R.I. Life Index results found that there were notable decreases in the scores for those Rhode Island residents who are people of color – Black and Latinx [the survey’s choice of terminology].

Translated, racism [emphasis added] was the most significant common denominator for the lowest scores found in the 2023 R.I. Life Index.

“Researchers for the last 20-25 years have been asking: What has had the most dramatic impact on physical and mental health?” said Dr. David Williams, Ph.D., professor of public health at Harvard University’s T.H. Chan School of Public Health, the keynote speaker at the R.I. Life Index event. “The conclusion they have come to is racism [emphasis added].”

[Editor’s Note: Surprisingly, the advance story about the 2023 R.I. Life Index published in The Boston Globe made no direct mention of racism. Comments attributed to Dr. Williams were added in a revised online version of the story.]

Actually attending an event, listening to what is said, interacting with the audience and the featured speakers, is what the act of reporting needs to be, in ConvergenceRI’s opinion.

Why wasn’t “racism” in the news headlines?  
The dominance of the data trends identifying and pinpointing racism [emphasis added] as the major factor in the low scores was underscored by the choice of the keynote speaker at the release of the 2023 R.I. Life Index findings. Dr. Williams delivered a stinging indictment of how racism was the biggest factor in determining health and economic outcomes in the U.S. – and in Rhode Island.

Dr. Williams framed his keynote address as “a talk about the challenges we face in health equity and what we can do about it,” by seeking to answer the question: “What does the science say?”

Dr, Williams continued: “There are large racial and ethnic differences in health in the United States. …COVID-19 has had a huge medical impact on the overall health of the United States. We have witnessed, from 2019 through 2020, the largest decline in life expectancy we’ve seen in the U.S. since 1944. The decline is [more than] three years for African-American and Hispanic males, and [more than] two years for Black and Latina females, and [more than] one year, for both white men and women.” 

Dr. Williams presented the scientific data to emphasize his points. “In 1950, the average White person lived eight years longer than the average Black person,” he said.  “In 2010, there was a four-year gap. We have made progress and we have narrowed the gap.”

Dr. Williams then posed the question: “How long did it take for African-Americans to equal the [life expectancy] of White men in 1950? It was 1990 – 40 years later – that African-American men caught up with the health of white men in 1950. And then you see in 2020, declines in life expectancy for both Whites and for Blacks.”

In the slides accompanying his presentation, Williams featured quotes from both Dr. Martin Luther King, Jr., and Robert Kennedy, the brother of President John Kennedy, to emphasize his messaging about the connection between racism and the system of segregation. [Which, in ConvergenceRI’s opinion, seemed a bit outdated. Why not feature the messaging from Dr. Mindy Thompson Fullilove, a professor of clinical psychology at Columbia University, and talk about her community-based health equity strategy?]

In the panel discussion that followed the keynote address, featuring Dr. Williams, Dr. Melissa Clark, Ph.D., the research scientist responsible for conducting the survey, and Carrie Bridges Feliz, MPH, vice president of Community Health and Equity at Lifespan. Dr. Williams offered numerous suggestions about the strategies that could work to overcome racism – things such as embedding a lawyer as part of a health care team advocating for patients, in a medical legal partnership as a way to leverage care for a child with asthma by forcing the landlord to bring their property up to code.

“All the asthma medications in the world would not help that child be symptom-free,” Dr. Williams said.

Women get shit done, as Beth Macy said  
What first came to mind when ConvergenceRI entered the third-floor conference room at the Brown University School of Public Health for the big reveal of the 2023 R.I. Life Index findings was an observation that Beth Macy, author of Dopesick, had made last year, at a conference discussing her reporting on harm reduction work: “Women get shit done, just saying.”

The audience of some 100 that had gathered on Wednesday morning, Nov. 29, was filled to the brim with talented, outspoken women leaders in Rhode Island.

They included:

  •  Cortney Nicolato, United Way of Rhode Island President and CEO
  •  Paige Clausius-Parks and Stephanie Geller from Rhode Island Kids Count
  •  Elizabeth Burke Bryant and Kate Bramson from the School of Public Health
  •  Angela Ankoma from the Rhode Island Foundation, executive vice president in charge of the Equity Leadership initiative
  •  Marcela Betancur from the Latino Policy Institute
  •  State Rep. Rebecca Kislak
  •  MLPB’s Jeannine Casselman
  •  Laurie White, president of the Greater Providence Chamber of Commerce
  •  Many on the leadership team from Blue Cross Blue Shield Rhode Island – including President and CEO Martha Wofford, Carolyn Belisle, director of corporate responsibility, Michelle Lederberg, executive vice president and chief legal officer, and Melanie Coon, managing director of corporate communications.

Translated, when BCBSRI President and CEOMartha Wofford concluded the morning’s events with the statement, “Policy matters,” it was clear to ConvergenceRI that the leadership roles played by a cadre of talented women in Rhode Island, with the ability to transform policy into action, was equally important.

What was missing?  
One of the more surprising moments of the morning event occurred when during a panel discussion featuring Dr. Williams, Dr. Melissa Clark, and Carrie Bridges Feliz, MPH, vice president of Community Health and Equity at Lifespan, a question sent in by ConvergenceRI was posed by Ms. Bridges Feliz.

BRIDGES-FELIZ: Richad Asinof submitted a question in advance: “What data sources are missing from the R.I. Life Index?

CLARK: Good question. First, we do not ask that many actual experience questions. That is by design. Our questions are almost all perspective-based. And that is intentional, so that we add to the other data sources, rather than compete with them. That would be Part One.

We currently don’t ask questions about solutions. We don’t have any questions about things like access to green space. Finally, an important topic that we have not currently asked about, are questions around climate change.

[Editor’s Note: For years, it has been the apparent corporate communications policy of Lifespan not to include ConvergenceRI in their news release distribution list or to respond to any media questions asked by ConvergenceRI. Yet at the R.I. Life Index reveal event, there was a top executive reading a question offered by ConvergenceRI as part of the scheduled event. Has the corporate Berlin Wall finally been torn down? Stay tuned.] 

What else is missing, Take Two?  
There appeared to also be a disconnect between what Dr. Williams addressed in his keynote and what was happening on the ground in Rhode Island. Call it a problem of silos and a lack of convergence.

  •  There was no mention of the ongoing success of health equity zones in Rhode Island, an initiative launched in 2014 with federal funding, directed at communities addressing social disparities of health in their own neighborhoods.
  •  There was no mention of the ongoing efforts to embed lawyers into health care advocacy in Rhode Island by MLPB, and at the Warren Alpert Medical School, under the direction of Liz Tobin-Tyler.
  •  There was no mention of the $1 million invested in health projects to be determined by participatory budgeting, where residents voted on what projects to fund.
  •  There was no mention of the cutting edge clinical research being conduced by Dr. Jill Maron, head of Pediatrics at Women & Infants Hospital, using saliva swipes of infants for rapid genomic sequencing. Or, the research of Dr. Teresa Daniels and Dr. AudreyTyrka on the neurological roots of toxic stress.
  •  There was also no mention of the work being done by Healthcentric Advisors to develop mobile apps to monitor blood pressure virtually, without having to travel to a doctor’s office, a standard of care adopted by Coastal Medical.
  •  Finally, there was no mention of the ongoing efforts to raise Medicaid rates for providers, led by OHIC and by community advocacy groups such as Community Provider Network of RI.

Why isn’t more known about these efforts and initiatives? Why does it seem that many Rhode Islanders are trapped in silos? Good questions.

Last week, ConvergenceRI published a story written by Jully Myrthil, a young woman of color who is interning at United Way of Rhode Island. [See link below to ConvergenceRI story, “Speaking up and speaking out.”] Her story talked about the problems of stigma for young people of color when asking for help with mental health issues.

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