Lisa Fitzpatrick, MD, MPH, MPA, is a board-certified infectious diseases physician and a medical epidemiologist. She began her public health career in 1998 as a member of the CDC’s elite Epidemic Intelligence Service. She has served as a foreign diplomat in the Caribbean, an academic researcher, and the former chief medical officer for the DC Medicaid program. Dr. Fitzpatrick is a member of the Institute of Medicine/National Academy of Sciences Roundtable on Health Literacy and an Aspen Institute Health Innovator Fellow. She is the founder and CEO of Grapevine Health.

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Dr. Lisa Fitzpatrick:

But the truth is, it’s our responsibility in the healthcare system to make sure people have access to information they can use and that they’ll understand, so this is really the fault of the healthcare system.

Leon T. Andrews, Jr:

Welcome to The Measure. I’m your host, Leon Andrews, president and CEO of Equal Measure. At Equal Measure, we help foundations, nonprofits, and public entities advance social justice through evaluation, strategy and communications. On The Measure, you’ll hear conversations with leaders and practitioners about their social change work, and how to support more equitable communities through place-based systems change and centering racial equity. I’m thrilled to welcome Dr. Lisa Fitzpatrick, medical epidemiologist, former global health diplomat, founder of Grapevine Health, and a former board member at Equal Measure. Welcome, Lisa.

Dr. Lisa Fitzpatrick:

Hi, Leon. Thanks for having me today.

Leon T. Andrews, Jr:

Thanks for joining us. I’d like to start as we do our podcast from a personal perspective as we talk about place, history, and context. I always find it important for people to give context about your own personal experience of how you think about place and how that’s influenced your own life’s journey. We’d love to hear how you would talk about place.

Dr. Lisa Fitzpatrick:

It’s such a good question. My career has been so diverse and varied and I’ve learned so much from every place I’ve been, and it’s hard to pick one instance that really defines or frames how I think about this, but if I had to pick one, it would be moving into an underserved community to really understand what it’s like to be in a food desert, in a place where you hear sirens all the time, in a place where there’s a lot of noise pollution, gun violence. Because in healthcare, we are always trying to figure out how to improve access for people. We’re trying to understand why people make the health-related choices they do, but it’s devoid of context. So, being in that place for three and a half years really helped me ground some of my thinking around how we should be helping people, particularly in underserved communities. I think place is essential.

Leon T. Andrews, Jr:

Yeah. I love that you share about what it means to live in a place that people could look at that community and can speak to all that it’s lacking, as it talks about access to food, access to capital and resources. But there’s also, as you look at that place in a community, a narrative and a story that’s not told about the assets that they do have, as you think about what connects that community and what makes that place a community for someone that lives there. But I don’t want to miss viewers getting a chance to hear about your own personal journey of place, as you think about where you grew up, how that has influenced you as you think about who you are today.

Dr. Lisa Fitzpatrick:

Well, I grew up in St. Louis, Missouri in an underserved community, but when you’re a child, you don’t realize what you don’t have. You just seem like you have everything you’re supposed to have. We moved to a different community when I was a middle school student and in that community, we had an opportunity to interact with people from all walks of life. I grew up in all Black community, and then we moved to a mostly white community, and it really gave me an opportunity to really understand different people from different backgrounds, and I’m glad I had that experience.

It’s actually served me well now because things are not always what they say. There are a lot of stereotypes about different people, different places, and you realize after moving from underserved community to one that’s… It was really a middle class or a middle upper class community, but just that shift from one community to another, even as a child, you still feel like you have everything you need, but you also realize that the same things I was doing in that other community, I’m also doing them here. And what that means to me as an adult is we’re all still the same. We all still have the same needs, wants, desires, and we forget about that when we’re so racially and socially polarized. It’s something that colors everything I do because most of my work is about putting people at the center, and I think having these diverse interactions with different people in different communities growing up has stayed with me in my work now.

Leon T. Andrews, Jr:

Yeah. Thanks for sharing that. Again, I so take the time to make sure that we appreciate the lens all of us bring to this work because we don’t just show up in silos. Right. We are connected to so many different things that have influenced who we are and how we see the world and how we do the work that we do. Among your many accomplishments, you’re a physician, medical epidemiologist who worked at the Center for Disease Control. Just sharing a little bit about your bio, but after leading the Washington DC’s Medicaid program as chief medical officer, you founded Grapevine Health in 2019. I’d love for you to tell us about Grapevine and I’m particular curious about what were the issues you saw as a practitioner that you wanted to address with the work you’re doing now?

Dr. Lisa Fitzpatrick:

Well, Leon, the healthcare system is overly complex and often lacks transparency starting with the language we use, and because the language can be confusing, it can erode trust and it can discourage people from engaging in healthcare. I saw this over and over again through the questions people were asking me, whether it was my friends or my family and even patients I had inherited from other doctors who didn’t understand their health conditions and they didn’t understand basic things about how their body worked, why they were taking medicines, and what those medications were supposed to do. So, there’s a lot of confusion and the healthcare system is, in general, not very good at speaking in plain language and making health information accessible. So, I wanted to do something about this. I’ve been thinking about this for a long time.

But one day, many years ago, I was at a community panel in Atlanta, Georgia, and after the panel was over, a man came up to me and said, “How does someone like me access someone like you on a regular basis?” And he wanted to know how he could find someone who was just as relatable as I was, who didn’t speak in medicalese or medical jargon, who was relatable and helped him understand what was going on with his health. And I realized there were probably millions of people like him who would go to the doctor month after month, year after year, and we’re just confused and sort of nodding along, and not knowing what questions to ask and not knowing what to do next. And I wanted to create a resource for Black and brown communities, particularly the Black community, to ensure people had a go-to source for trusted health information. So, that was the origin story of Grapevine Health.

In that job in Medicaid, the gentleman’s question came rushing back to me, with all the different patients and community members I was hearing from and listening to about their distrust of the healthcare system, how they didn’t understand how insurance works or how their doctors weren’t explaining their health conditions to them, and I realized this is still very much a need in the community. I don’t see anyone doing this, so let me take a leap, and I did. I quit my job and I started Grapevine Health.

Leon T. Andrews, Jr:

Well, if anyone has not checked out Dr. Lisa on the Street, I encourage you to Google that or search that. As I hear you speak about the purpose, it really is speaking to the importance of health literacy and how important health literacy is, so I’d love for you to speak to that.

Dr. Lisa Fitzpatrick:

I really appreciate you saying those words, health literacy. Nowadays, I tend to use less jargony words because people aren’t always sure what I’m talking about, but that’s exactly what this is. Health literacy is the ability to understand and use health information in a way that makes sense for you. What I’ve been describing up to now is what we call low health literacy or some say limited health literacy, meaning people need resources to help them understand, including medical professionals like me who can talk in plain language to make sure people access the information they need.

The reason it’s so important to address, health literacy, first of all, it’s very costly. Studies have been conducted that demonstrate low health literacy costs the health system and taxpayers over $280 billion a year. That’s billions with a B. And these costs accrue as a result of delays in care. So, if you have a health issue arise and you’re not sure what to do or you’re afraid or distrustful, all of these things often stemming from low health literacy, you might end up in the intensive care unit, which is much more costly than if someone had diagnosed and helped you with the problem before you needed a hospitalization.

There’s a story I often tell about, a gentleman who didn’t realize the importance of getting routine dental exams, and in his case, he developed an infection in his mouth, and when you develop an infection in your mouth, that can spread to other parts of your body like your heart and set up a really severe heart infection that basically shuts down the rest of your body. So, he died in the ICU because he never got his teeth cleaned. The question is, how preventable was that? I think it was wholly preventable.

I recently wrote about this on my Forbes blog because I think we undervalue the importance of health literacy and how critical it is because if we don’t address people’s understanding of why they should even care about their health or how they should engage in healthcare, we’ll never increase or improve engagement and care the way we want to, which ultimately will save money and save lives. But it seems so simple. Well, information is everywhere, so what is the big deal about addressing health literacy? It’s critical and it’s time we really start to pay close attention to this and support the resources and interventions needed to make sure people get the information they need to be healthy.

Leon T. Andrews, Jr:

Well, thanks for sharing those examples, the tragic examples of what happens when we talk about the impact of health literacy. It made me wonder and I’m curious if you have any reflections on this. Do you see any connections to health literacy, health equity and systems change or place-based systems change? Because the reason I’m asking is, is there more that the system needs to do to transform to address the health literacy as we think about these stories, and if so, what does that look like as we think about a systems change?

Dr. Lisa Fitzpatrick:

There absolutely is a connection between health literacy, health equity, and the need for systems change. When people talk about folks having low health literacy, often, it’s discussed in sort of a demeaning way as if, how could you not know these things? But the truth is, it’s our responsibility in the healthcare system to make sure people have access to information they can use and that they’ll understand. So, this is really the fault of the healthcare system, the pamphlets we create, the way we communicate, whether it’s an insurance company, a healthcare provider, maybe you’re in the hospital. You know how many people are discharged from the hospital and can’t tell you what happened or why they were in the hospital? This is our fault.

These things seem very obvious to me because I’m in community and talking to people and understanding why they make the choices they make, so many of them are related to something people don’t know. But if you’re a bureaucrat in a healthcare organization and you’re not looking at this from a granular level and trying to understand, okay, this hospitalization was avoidable, but what were the steps or what were the circumstances that led to this $1 million hospital bill? So, if there are no systems in place to collect the qualitative as well as the quantitative information, people won’t have this understanding.

Leon T. Andrews, Jr:

Thank you for that. I’m curious, as you reflect on where we are as we’re coming out of the pandemic, I’m curious if you feel that the pandemic has either changed any of your thoughts about health equity, has validated any of your thoughts about health equity? Are you seeing any change for the better or for the worse as we’re coming out of the pandemic, as we talk about where these communities are?

Dr. Lisa Fitzpatrick:

I think the pandemic validated everything. Those of us who’ve been working in underserved communities, our whole careers, we’re not surprised by what we saw throughout the pandemic. You could replace coronavirus with heart disease or diabetes or obesity or cancer. We always see the higher rates of these preventable and sometimes not preventable health conditions disproportionately in underserved communities. I think that a positive that came out of that though was that people are now more curious and more aware about healthcare systems, about science, about research or clinical trials because it was really unfair the way we imposed all of this information. There was a dull use of information on people during the pandemic, as if we expected people to have some baseline knowledge about what was going on. No one thinks about how you actually make a vaccine, and because the entire thing was so politicized, people didn’t know what to believe, who to listen to, so that made them more curious. Sure, it made people more skeptical and in some ways more distrustful, but it also made people want…They were hungry for more.

I think the other positive is that no one can say they’re unaware. The world now knows. So, if we are not doing everything we can to figure out how to address health equity, then shame on us because it’s not that we don’t know. My big concern coming out of the pandemic though, with all of this new awareness is that when we talk about health equity, everyone seems to be obsessed with making sure we have the right data. Now, you’ve mentioned to the folks listening, I’m an epidemiologist. I love data. Data tell a story. Data helps you establish credibility. Data validates things, so this is not just about more data. This is about systems. This is about infrastructure. This is about culture. Those are all the things we need to be focused on if we want to address health equity because we have plenty of data to help point us to where the disparities are.

My favorite one is zip code. You can learn so much from where someone lives, what resources are available in their community. That’s the biggest frustration I have right now. Every health equity conversation, someone is talking about how we can’t do anything until we first have to get the data, and I just push back on that because to me, it feels like a scapegoat because it’s hard and it’s nebulous. And some of the things we might have to do to address health equity are going to be uncomfortable and we don’t like to be uncomfortable.

Leon T. Andrews, Jr:

Amen to that. As you reflect on doing this work, what keeps you going in the face of these complex challenges? What gives you hope?

Dr. Lisa Fitzpatrick:

We spend a lot of time on the street making video content with communities, and during those, when we’re on the street, we also have a lot of side conversations with people, people who don’t want to be on camera, and they come up and say, “Thank you for doing this.” And then, they’ll say, “Well, since you’re here, doc, can I ask you this question?” So, they’re getting their second opinion right there on the street because they’re still lacking something they need, something to give them the comfort or the courage to move forward with whatever health decision they have to make. So, every time we’re on the street, it’s a shot in the arm because you realize that there’s a powerful reason we’re doing this and people need access to what we’re doing. I just get impatient though because I feel we have to scale what we’re doing faster because people are dying and so many of these things are preventable.

Before I leave, I just want to tell people listening, we all have to pressure the health system because if our voices aren’t heard as patients and community members, the status quo, it will remain. And I think when we encounter all of these barriers and getting the care we need or getting access to the information or the resources we need, one of their responses is to just give up and say, “Oh, I’ll deal with this later,” or, “I can’t be bothered with that. I don’t have time.” And that’s an understandable human response, but when that happens, that’s a story that’s not being told to some healthcare executive who’s making a choice about where to put resources or what the community needs. So, if there’s ever an opportunity to share your opinion, someone asks for your feedback, please give it and be honest. So, it’s up to us to create this demand in the healthcare system for the kind of healthcare access we want. Because if they don’t hear from us, they’ll just keep doing what they’re doing.

Leon T. Andrews, Jr:

Yeah. Thank you for that, Lisa. We all have to pressure the healthcare system and give feedback when you have the opportunity. Thank you for sharing. Thanks for the conversation, Lisa, for joining us today, and thanks to our listening audience for tuning in to another episode of The Measure.

Dr. Lisa Fitzpatrick:

Thanks for having me, Leon.

Leon T. Andrews, Jr:

I’d like to end my conversation with Lisa with a quote inspired by the former president of the United States, Barack Obama. Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek. Please rate, comment, and subscribe to the podcast. You can also learn more about Equal Measure by visiting our website equalmeasure.org. Until next time.