Dr. Garth Graham: Prescription for Better Minority Health

Dr. Garth Graham is president of the Aetna Foundation.

Dr. Garth Graham was born in Jamaica and raised in the United States by immigrant parents who stressed education and achievement. So it’s not surprising that one of his heroes is former secretary of state Colin Powell, who was raised in the Bronx by Jamaican immigrants with similar aims.

“A lot of Caribbean people could identify with hisstory,” said Graham, a cardiologist and president of the Aetna Foundation, which was established in 1972 as the philanthropic arm of health insurance giant Aetna Inc. “His parents pushed him toward education, and then the military helped bring out his capabilities. It was like me with education, and then medicine, and public health bringing out my passions.”

For Graham, 39, eliminating health disparities between racial and ethnic minorities and the general population has been his mission since he was a medical resident in Boston where he launched a program to study the obstacles that African-American men face when it comes to diet and exercise.

That was in 2001, the same year that Aetna made the issue a top priority. Aetna became the first major health insurance company to collect race and ethnicity data from its members, according to Dr. Wayne Rawlins, the national medical director of racial and ethnic equality initiatives at Aetna.

Addressing Inequality

More than a decade later, the insurance company and the Aetna Foundation have become leaders in addressing health inequalities, funding national and regional programs that focus on healthy lifestyles, health care equity, integrated health care delivery, and diversifying the health care profession. And Graham has emerged as a leading national advocate.

It’s a role that he first embraced at age 29 when he became one of the youngest people to lead a U.S. public health service agency as deputy assistant secretary for minority health at the U.S. Department of Health and Human Services. Graham, who served from 2004 to 2011, helped to develop the Obama administration’s first federal action plan to eliminate inequities in the health care system.

Graham’s move to Aetna brings together two leading forces in the effort to eliminate health disparities, Rawlins said.

 “Garth brings a significant skill set with his work in HHS, and he’s a recognized leader on this issue nationally,” he said. “We all share a deep passion for addressing and eliminating health disparities.”

Using data collected from its members who volunteer to participate, Aetna Inc. has developed culturally appropriate health programs that focus on breast health, hypertension and asthma. As of 2013, 6 million members — 35 percent of Aetna’s membership — have shared race, ethnicity and language data, according to Rawlins.

The information is used to identify gaps in care and health outcomes and hasresulted in a number of initiatives to address disparities, including community-based programs that increase access to fresh fruits and vegetables through urban farming, provide prenatal care for at-risk mothers, and use technology in a culturally appropriate way to improve health outcomes. Aetna also provides cultural competency training to its clinical staff.

At-a-Glance

Name: Dr. Garth Graham, M.D.

Title: President, Aetna Foundation         

Hometown: Miami

Education:Medical degree from Yale School of Medicine, a master’s in public health from Yale School of Public Health; bachelor of science in biology from Florida International University in Miami

Mentor: Sybil Graham (My mother)

Favorite quote:  “Speak your truth quietly and clearly and listen to others”

Something you can’t part with: Pictures of my wife and babies

“You often hear that eliminating health disparities is a social justice issue or quality of care issue, but it’s also a business issue,” Rawlins said. “The National Business Group on Health found that members of minority groups often receive lower quality of care and that will negatively affect the quality of care and the quality of life of those employees and their dependents.”

The National Business Group on Health offers tools to help employers address the problem, like an interactive online program to help them estimate the economic impact of health disparities on their workforce. The tool uses insurance data to calculate medical costs and lost workdays for a variety of health conditions, according to the NBGH website. The Washington D.C.-based coalition also offers “An Employer’s Guide to ReducingRacial & Ethnic Disparities in the Workplace” to help employers develop a strategy.

According to the Centers for Disease Control and Prevention, death rates from heart disease are 40 percent higher for African-Americans than for white people, and African-American women have higher death rates from breast cancer. And among people under age 20, American Indians have the highest prevalence of Type 2 diabetes, according to the CDC. Also, Latinos are almost twice as likely to die from diabetes, and Vietnamese-American women have a higher cervical cancer rate than any ethnic group in the country.

The underlying reasons for these differences are complex and include socioeconomic, cultural and environmental factors, Graham said.

“There are social and cultural dynamics at play that can affect your ability to have a place to exercise or to access healthier foods, for example,” he said. “If someone lives in a community that suffers from segregation, that will have a greater impact on their health outcomes than just their racial background.”

Understanding these factors is the key to developing public health programs that are culturally and socially relevant to the communities they serve, Graham said. One such initiative is Text 4 Wellness, which uses text messaging in churches to encourage African-Americans to make healthier voices. According to the nonprofit Pew Research Center, African-Americans and Latinos are more likely than the general population to use cellphones to access the Internet.

The program, which was developed by the Institute for eHealth Equity in Cleveland, was launched in April 2014 with a $100,000 grant from the Aetna Foundation. The grant is part of a $1.2 million initiative that the Aetna Foundation is giving to 23 organizations in 13 states to design digital health technology, including mobile health.

“We know that church for many African-American communities is a haven where people get trusted information, so we thought, ‘What if we were able to use technology to deliver some of those healthy messages?’ ” Graham said. “African-Americans and Hispanics use cellphones at a higher rate than the general population and are more likely to use mobile technology to access health information than the general population.”

At age 29, Dr. Garth Graham became one of the youngest people to lead a U.S. public health service agency as deputy assistant secretary for minority health at the U.S. Department of Health and Human Services.

Participating pastors ask their congregations to text the word “healthy” to receive a series of weekly health, wellness and fitness messages, said Silas Buchanan, CEO of the Institute for eHealth Equity. Other messages include information tailored to specific churches and communities, like local classes and farmer’s markets. The nine-month pilot program is underway in Columbus, Ohio, Dallas and Atlanta.

“It’s through leveraging the trusted position of the pastor that gives our programs stickiness,” he said.

For Buchanan, eliminating health disparities is more than just a professional mission; it is also a personal one. His father died of a heart attack at age 69, leaving his three adult children to struggle understanding why. Gathering information they needed to determine his best treatment options was difficult, he said.

“We felt helpless,” he said. “While doing research on my dad’s particular condition, I found information saying that people of color die of heart disease at a greater rate than the white population. I thought that maybe my dad didn’t get the care he should’ve gotten. I had no inkling that there was a difference in care for black and brown people until my dad passed.”

He’s still haunted by the thought that his father perhaps could have lived longer if his family had understood more about his disease and perhaps made different choices.

“I got hit in the face with the thought that maybe my dad’s life could have been extended had we known more intelligent questions to ask, if we could have been in control of his medical information so that we could get a second opinion,” he said. “If I knew disparities existed and I could have talked with his providers about it.”

Tech Launch

To help educate providers about health disparities, the foundation is launching several initiatives that use technology to teach them about the socio-economic obstacles that their patients may be facing.

“When I prescribe something as a clinician, there may be other factors that affect that patient’s ability to follow through with that prescription, like transportation issues and other kinds of social dynamics. What if that physician had that information at the point of care? Technology can empower health systems and providers to understand more about their patients by helping them integrate and information about the patient outside of health care,” Graham said.

Raising the awareness level of providers, policymakers, employers and the public is critical because health disparities are not only morally unacceptable, but also costly for everyone, Graham said.

He pointed to a 2014 Johns Hopkins study showing that African-American and Latino men cost the economy more than $450 billion over a four-year period because of health disparities compared with the reference groups used in the study. Lower worker productivity contributed $28 billion in excess costs and premature death accounted for $408 billion, the study showed.

“If you have a segment of the population that is getting sicker and sicker, that drives costs for everyone across the board,” he said. “All Americans like to believe we’ve created a system of equitable access for health care, and most people believe that it’s not a good thing for disparities to exist. So there is the business case but there is also the moral case to be made.”

There’s much employers can do to help eliminate these disparities, Graham said, like creating culturally targeted prevention and wellness information and tracking health outcomes for those groups.

“There is a strong business case to made,” he said. “If you have a segment of the population that is getting sicker and sicker that drives costs for everyone across the board.”