- JUST AHEAD ON BLACK ISSUES FORUM, A LONG-SERVING HEALTH PROVIDER TO THE HISTORICALLY BLACK SOUTHEAST RALEIGH CELEBRATES 50 YEARS, WE'LL EXPLORE ITS HISTORY TIED TO SAINT AGNES HOSPITAL, ITS INNOVATIONS THROUGH COVID, AND POLICIES IMPACTING THE WORK OF COMMUNITY HEALTH CENTERS.

STAY WITH US.

♪ ♪ WELCOME TO BLACK ISSUES FORUM, I'M DEBORAH HOLT NOEL.

AND TODAY WE CONTINUE TO CELEBRATE BLACK HISTORY MONTH WITH A FOCUS ON BLACK HEALTHCARE.

LOOKING BACK, WE CAN SEE WHERE RACE SPLIT EVERY ASPECT OF AMERICAN LIFE, INCLUDING WHERE YOU COULD GO TO SEEK MEDICAL TREATMENT, AND WHO YOU COULD TREAT IF YOU WERE A HEALTHCARE PROFESSIONAL.

IT'S THE REASON WHY, IN 1896, THE HISTORICALLY BLACK ST AUGUSTINE'S COLLEGE IN RALEIGH ESTABLISHED ST. AGNES HOSPITAL AND TRAINING SCHOOL FOR NURSES.

AND IT WAS ACTUALLY INTEGRATION IN THE 1960S THAT BROUGHT ABOUT THE CLOSURE OF THE HOSPITAL.

THEN IN 1972, A FEDERALLY FUNDED HEALTH FACILITY CAME TO THE REGION TO SERVE THE SURROUNDING COMMUNITY, WHICH WAS, AND STILL IS, PREDOMINANTLY BLACK.

THAT FACILITY TODAY IS CALLED ADVANCED COMMUNITY HEALTH, AND THEY'RE CELEBRATING THEIR 50TH ANNIVERSARY.

THIS MILESTONE IS A GOOD MARKER TO EXAMINE THE HISTORY OF HEALTHCARE IN BLACK COMMUNITIES, THE IMPORTANT MISSION OF COMMUNITY HEALTH CENTERS, AND THEIR ONGOING CHALLENGES INFLUENCED BY POLICY AND PERCEPTION.

JOINING US FOR THIS BLACK HISTORY PANEL, I WANT TO WELCOME SCOT MCCRAY, CHIEF EXECUTIVE OFFICER OF ADVANCED COMMUNITY HEALTH, DR. DERRICK L. SAULS, ASSISTANT PROFESSOR IN THE DEPARTMENT OF PUBLIC HEALTH AND EXERCISE SCIENCE AT SAINT AUGUSTINE'S UNIVERSITY, AND COMMUNITY ACTIVIST, BREE NEWSOME.

I AM SO EXCITED TO HAVE ALL THREE OF YOU HERE BECAUSE THIS IS AN IMPORTANT CONVERSATION.

DR. SAULS, ONLY THE SHELL OF ST. AGNES REMAINS ON THE CAMPUS OF SAINT AUG. A LOT OF PEOPLE HAVE SEEN IT, BUT THERE IS A VITALLY IMPORTANT STORY TO BE KNOWN ABOUT WHAT TRANSPIRED WITHIN THOSE WALLS.

WHAT CAN YOU SHARE ABOUT THAT?

- WELL, PRETTY MUCH WITH ST. AGNES HOSPITAL, WHEN IT WAS FIRST ESTABLISHED IN 1886, IT WAS ESTABLISHED BECAUSE AT THAT POINT IN TIME THERE WAS, AFTER THE CIVIL WAR, A LOT OF INSTITUTIONS REALIZED THAT THERE WERE NEEDS FOR HEALTHCARE IN NORTH CAROLINA.

SO HE SAID THAT THE VETERANS FROM THE CIVIL WAR WERE GETTING TREATMENT THROUGH DIFFERENT TYPES OF VETERANS CENTERS AND THINGS OF THAT NATURE AT THAT POINT IN TIME.

THE EPISCOPALIAN CHURCH DECIDED THAT THEY WERE GOING ACTIVELY GET INVOLVED AND WITH THE FORMATION OF SAINT AUGUSTINE'S UNIVERSITY AND THEN FOLLOWING IT WITH ST. AGNES, IT WAS A SITUATION WHERE WITH SEGREGATION THAT IT WOULD ALLOW HEALTHCARE, SOME TYPE OF HEALTHCARE TO BE THERE FOR AFRICAN AMERICANS AT THAT POINT IN TIME.

AND WITH ST. AGNES, AGAIN, IT DEVELOPED INTO A NURSING SCHOOL ON SITE, AND PLUS IT WAS ALSO A TRAINING GROUND FOR LEONARD MEDICAL SCHOOL AT SHAW UNIVERSITY, WHERE THE DOCTORS THAT GRADUATED FROM LEONARD MEDICAL SCHOOL WERE ABLE TO DO THEIR RESIDENCY AT ST. AGNES HOSPITAL.

- AND ST. AGNES DID NOT JUST SERVE THAT PARTICULAR PORTION OF RALEIGH, THE SOUTHEAST RALEIGH COMMUNITY, WHO ELSE DID IT SERVE?

WHO ELSE WAS COMING THROUGH AT ST. AGNES?

- WELL, THE REPUTATION OF ST. AGNES WAS KNOWN, SO WITH THE REPUTATION OF ST. AGNES BEING KNOWN, YOU HAD VARIOUS TYPES OF DOCTORS THAT CAME FROM MEHARRY, AND ALSO HOWARD UNIVERSITY, TO DO THEIR RESIDENCIES THERE.

AND THEN YOU HAD PEOPLE WHO WOULD COME FROM FAR AND NEAR TO COME TO ST. AGNES, BECAUSE IT WAS KNOWN THAT ST. AGNES WAS INNOVATIVE IN ITS TECHNOLOGIES, AND TRIED TO SERVE THE AFRICAN AMERICAN POPULATION.

AND THEY KNEW THAT THEY COULDN'T COMPETE WITH SOME OF THE WHITE HOSPITALS.

SO THEY HAD TO BE INNOVATIVE IN HOW THEY UTILIZED INSTRUMENTATION, AND ALSO DEVELOPMENT OF INSTRUMENTATION FOR HEALTHCARE.

- SO QUITE THE LEADER IN HEALTHCARE, AND ALSO HEALTH TOOLS.

SCOT, CAN YOU SHARE WITH US A LITTLE BIT ABOUT THE DEMOGRAPHICS OF THE COMMUNITY OF PEOPLE THAT ADVANCED COMMUNITY IS SERVING RIGHT NOW, AND HOW THAT'S PERHAPS TIED TO THIS HISTORY?

- OH, THANKS SO MUCH, DEB.

SO THE DEMOGRAPHICS OF THE COMMUNITY THAT WE SERVE DIRECTLY IN SOUTHEAST RALEIGH, THAT 27610 ZIP CODE, HAS REALLY BEEN CONSISTENT OVER THE 50 YEARS OF OUR EXISTENCE.

YOU'RE TALKING ABOUT A PREDOMINANTLY AFRICAN AMERICAN COMMUNITY, A COMMUNITY THAT HAS A RICH HISTORY AND A WOVEN FABRIC OF BEING COMMUNITY AND FAMILY, BUT ALSO A COMMUNITY HAS THAT HAS SEEN ITS TRYING TIMES OF ECONOMIC DOWNTURNS, RACIAL STRIFE, SOCIAL INJUSTICE, ET CETERA.

AND THAT'S WHAT THE FQAC MOVEMENT IS REALLY BUILT ON, THE SOCIAL JUSTICE MOVEMENT.

SO OVER THE LAST 50 YEARS, WE'VE BEEN THROUGH OUR BOUTS OF ADVOCACY AND LOBBYING BECAUSE WE KNOW THAT PROBABLY 50% OF THAT POPULATION IS AT A HUNDRED PERCENT OR BELOW THE FEDERAL POVERTY LEVEL.

WE KNOW THAT WE HAVE A GROWING NEED ACROSS HEALTH EDUCATION AND HEALTH EQUITY.

WE HAVE A GROWING NEED OF ACCESS TO PRIMARY CARE FOR THOSE COMORBID CONDITIONS THAT IMPACT OUR COMMUNITY MORE THAN OTHER COMMUNITIES, AND RACIAL GROUPS, AND THOSE DISPARITIES AROUND DIABETES, HYPERTENSION, HEART DISEASE ISSUES, ET CETERA.

AND EVEN TODAY, 50 YEARS, MARKING THIS YEAR OUR 50TH ANNIVERSARY, EVEN THOUGH SOME OF THOSE DEMOGRAPHICS START TO SEE A TURN WITH, SOME WOULD CALL, GENTRIFICATION, DEVELOPMENT, AND HOW WE'RE RELOCATING FAMILIES THAT HAVE BEEN IN THAT COMMUNITY FOR A LONG TIME.

THE HEART AND SOUL OF THAT COMMUNITY ALSO COMES COUPLED AND MARRIED WITH THOSE HISTORIC PROBLEMS OF HEALTHCARE INEQUALITIES AND ACCESS PROBLEMS.

- THAT IS SO SIGNIFICANT.

AND BREE, I WANT YOU TO KINDA TIE IT TOGETHER AS WELL, TALKING ABOUT THE EQUITY PIECE ON THIS.

SOME MIGHT SAY, WELL, YOU KNOW, INTEGRATION ENDED WAY BACK IN THE SIXTIES, SEVENTIES, IF WE WANNA BE ACCURATE, REALLY.

AND YET THESE INEQUITIES PERSIST.

ARE THERE INEQUITIES IN TERMS OF HOW, SAY, CHCS ARE FUNDED, AND THE HEALTHCARE THAT IS PROVIDED TO THIS PARTICULAR SEGMENT THAT IT SERVES?

- YES, AND THANK YOU SO MUCH FOR HAVING ME JOIN YOU FOR THIS CRUCIAL CONVERSATION.

AND ABSOLUTELY, I THINK THAT ONE OF THE GREAT MISPERCEPTIONS IS THAT SEGREGATION WAS SOLELY ABOUT SEPARATING PEOPLE BASED ON THEIR RACE, BUT IT WAS SPECIFICALLY ABOUT ENSURING THAT PEOPLE HAD INEQUITABLE ACCESS TO THINGS, THAT THE PLACES WHERE BLACK PEOPLE WERE, WERE UNDERFUNDED, DIDN'T HAVE THE SAME KIND OF RESOURCES, AND THAT PART OF SEGREGATION WE HAVE NEVER ADDRESSED OR RESOLVED.

AND SO THAT'S WHY WE STILL SEE THIS INEQUITY SHOWING UP IN EVERY ASPECT OF OUR LIVES.

I THINK IT'S A MISTAKE FOR US TO ASSUME THAT RACISM AND AND STRUCTURAL RACISM IS SOMETHING OF THE PAST, SIMPLY BECAUSE THE ERA OF SEGREGATION CAME TO AN END.

AND I THINK HEALTHCARE IS ONE OF THE MOST GLARING EXAMPLES OF THAT.

YOU KNOW, WE LOST A LOT OF THE HOSPITALS THAT WERE BLACK OWNED.

AND EVEN THOUGH WE HAVE ACCESS NOW TO THE HISTORICALLY WHITE HOSPITALS, WE'RE STILL NOT RECEIVING EQUITABLE TREATMENT THERE.

AND THEN THE FACILITIES THAT HAVE BEEN SET UP SPECIFICALLY TO CATER TO BLACK AND LOW WEALTH COMMUNITIES ARE NOT RECEIVING ADEQUATE FUNDING.

WE'RE ALSO NOT ADDRESSING THE ISSUES THAT RESULT IN THE COMORBIDITIES THAT WERE JUST NAMED.

THAT IS NOT BECAUSE OF SOMETHING GENETIC, OR BECAUSE OF OUR RACE.

WE KNOW THAT RACE IS NOT BIOLOGICALLY REAL.

THAT IS BECAUSE OF HAZARDS THAT WE ARE FORCED TO LIVE IN BECAUSE OF OUR RACE.

THINGS LIKE LIVING AREAS THAT ARE PRONE TO ENVIRONMENTAL HAZARDS.

THAT'S WHY WE ARE SEEING A HIGHER RATE OF COVID ILLNESS IN BLACK AND BROWN CHILDREN BECAUSE THEY ARE MORE LIKELY TO LIVE IN AREAS WHERE THE AIR IS NOT CLEAN, WHERE THEY ARE MORE LIKELY TO HAVE ASTHMA.

SO WE HAVE TO REALLY TAKE A MORE ROBUST AND THOROUGH APPROACH TO DISMANTLING ALL OF THE STRUCTURES THAT BRING ABOUT INEQUITY IF WE'RE GOING TO HAVE EQUITY IN HEALTHCARE.

- IT'S A REALLY GREAT WAY TO KINDA TIE THINGS TOGETHER AND HELP WITH THE TRANSITION AS WE TALK ABOUT COMMUNITY HEALTH CENTERS AND REALLY, THE IMPACT OF COVID.

COMMUNITY HEALTH CENTERS LIKE ADVANCE HAVE BEEN IN THE VANGUARD OF HEALTHCARE PROVISION DURING THE COVID PANDEMIC AND THERE HAVE BEEN NUMEROUS DISCUSSIONS AND STUDIES ON THE DISPROPORTIONATE IMPACT OF COVID, OF COURSE, ON BLACK AND LATINO PEOPLE AND COMMUNITIES AND WE CONTINUE, AS A NATION, TO GET CONTROL OF THIS PANDEMIC BUT IT'S NO SECRET THAT POLITICS ARE PUSHING PUBLIC HEALTH DECISIONS AND DR. SAULS, WHEN ST. AGNES WAS ESTABLISHED DURING SEGREGATION, IT WAS RACIAL POLITICS THAT INTERFERED WITH FAIR AND EQUITABLE DELIVERY OF QUALITY HEALTHCARE, SO DO YOU THINK THAT THE POLITICS THAT WE SEE RIGHT NOW CONTINUE TO IMPACT THE ABILITY OF CHCS TO DELIVER EQUITABLE CARE?

- I TRULY DO THINK, YOU KNOW, THAT POLITICS ARE STILL, YOU KNOW, SUBLIMINALLY, YOU KNOW, INVOLVED BECAUSE IT'S SOMETHING THAT ONCE SOMETHING IS INGRAINED, YOU KNOW, IN A SOCIETY, IT TAKES A LONG TIME FOR IT TO BE, YOU KNOW, TAKEN OUT AND EXPOSED AND ERADICATED.

AND RIGHT NOW YOU FEEL LIKE THERE'S, YOU KNOW, THERE'S A BLOWBACK, YOU KNOW, WHERE THEY'RE SAYING, HEY LOOK, YOU KNOW, YOU HAD ENOUGH YEARS TO CATCH UP, BUT YOU KNOW, THERE IS NO SUCH THING AS ENOUGH YEARS TO CATCH UP, ESPECIALLY WHEN IT COMES TO HEALTHCARE, BECAUSE, YOU KNOW, WE'RE DEALING WITH CYCLES, YOU KNOW, GENERATIONAL CURSES OF HEALTHCARE, WHERE ONE OF THE REASONS WHY I GOT INTO HEALTHCARE AND GOT INVOLVED AND STARTED STUDYING INSTITUTIONS LIKE, YOU KNOW, YOU KNOW ST. AGNES HOSPITAL, BECAUSE I GREW UP IN BOSTON AT MASS, YOU KNOW, AND I WAS ALWAYS AROUND MASS GENERAL HOSPITAL.

AND THEN WHEN I COME DOWN DURING THE SUMMER, YOU KNOW, AND SEE WHAT WAS GOING ON, I WAS WONDERING, WHY IS IT, YOU KNOW, THE SOUTH IS NOT GETTING THE SAME TYPE OF HEALTHCARE THAT I WAS, YOU KNOW, GETTING.

SO I STARTED, YOU KNOW, I WANNA BE A HISTORY MAJOR.

SO IN STUDYING, YOU KNOW, ST. AGNES AND SEEING WHAT WAS GOING ON AND SEEING HOW PEOPLE MINDSETS, YOU KNOW, THEY SHIFT AND IN OUR SOCIETY, IT'S LIKE A PENDULUM.

WHEN ONE WAY, HEY LOOK, YOU KNOW, LET'S, YOU KNOW, LOOK OUT FOR THOSE THAT DISENFRANCHISED, BUT NOW IT'S LIKE YOU KNOW, HEY, EVERY MAN FOR HIMSELF.

GOD SAVE US ALL, EVERY MAN FOR HIMSELF.

SO WITH THIS, YOU KNOW, THIS PARADIGM THAT WE IN WITH HEALTHCARE NOW, WE NEED THESE COMMUNITY CENTERS SUCH AS ADVANCE BECAUSE YOU KNOW, IT IS LIKE ANYTHING ELSE.

IF YOU HAVE A GRASSROOTS ORGANIZATION OF HEALTH CENTERS, PEOPLE CAN WALK OUT AND KNOW WHERE TO GO BECAUSE YOU HAPPEN TO HAVE DIVERSITY IN THE HEALTHCARE, BECAUSE SOME PEOPLE THAT I CAN REACH, OTHER PEOPLE CAN'T REACH AND SOME PEOPLE OTHER PEOPLE CAN REACH, I CAN'T REACH.

AND THAT'S JUST THE WAY SOCIAL BEHAVIOR IS.

PEOPLE, YOU KNOW, FEEL, YOU KNOW, WHAT TO CALL IT, HAVE A DISCERNMENT OF WHERE THEY CAN GO FOR HEALTHCARE AND WHERE THEY FEEL COMFORTABLE.

- WELL, THERE'S ABSOLUTELY THAT COMFORT, BUT ALSO JUST THE ACCESS PIECE THAT YOU TALKED ABOUT AND BREE, I WANNA BRING YOU IN ON THIS BECAUSE, YOU KNOW, WE'RE TALKING, IT CAN SOUND AS THOUGH PEOPLE ARE IN A POSITION TO MAKE THE CHOICE AND THE DECISIONS FOR THEMSELVES TO TRY TO HAVE HEALTHY LIFESTYLES, THAT KIND OF THING.

BUT WHERE DO THE INEQUITIES AROUND US BEGIN TO IMPACT AND ENCROACH UPON THE ABILITY OF PEOPLE IN COMMUNITIES TO GET AND TAKE CARE OF THEMSELVES AND RECEIVE THE HEALTHCARE THAT THEY DESERVE?

- YEAH, SO I THINK IT'S VERY IMPORTANT TO RECOGNIZE THAT STRUCTURAL RACISM IS A SET OF POLICIES.

I THINK A LOT OF TIMES IT IS FRAMED AS BEHAVIOR AND SOCIAL ATTITUDES AND THAT IS ABSOLUTELY A COMPONENT OF IT.

BUT A LOT OF THE LIFE OUTCOMES THAT WE SEE, WHERE WHEN YOU CAN ACTUALLY PUT DATA POINTS ON A CHART AND SEE A CLEAR CORRELATION BETWEEN YOUR RACIAL CLASSIFICATION AND YOUR LIFE OUTCOMES, THAT'S A RESULT OF POLICY.

SO YOU'RE TALKING ABOUT A COMMUNITY THAT IS UNDERPAID, RIGHT?

THEY ARE RECEIVING LOW WAGES THAT DO NOT KEEP UP WITH THE COST OF LIVING.

THEY ARE OFTENTIMES FORCED TO LIVE IN SUBSTANDARD HOUSING.

THEY ARE FORCED TO LIVE IN AREAS THAT HAVE ENVIRONMENTAL HAZARDS.

THEY ARE LESS LIKELY TO HAVE ACCESS TO ADEQUATE TRANSPORTATION.

SO ALL OF THESE THINGS IMPACT YOUR LIFESTYLE.

AND IF YOU ARE ALREADY IN A SITUATION WHERE YOU'RE HAVING TO MAKE DECISIONS BETWEEN LIKE, CAN I AFFORD MY PRESCRIPTION OR CAN I AFFORD THE RENT OR THE UTILITIES?

YOU'RE NOT LIKELY TO HAVE THE KIND OF TIME OR THE RESOURCES TO REGULARLY ACCESS HEALTHCARE, RIGHT?

YOU ARE MORE LIKELY TO BE DEALING WITH A HIGHER LEVEL OF STRESS AND ANXIETY BECAUSE OF THE SITUATION YOU HAVE BEEN FORCED TO LIVE IN.

AND YOU'RE MORE LIKELY TO RESULT OR TO RESORT, RATHER, TO OTHER FORMS OF COPING MECHANISMS THAT ARE NOT HEALTHY RIGHT?

YOU'RE NOT LIKELY TO HAVE ACCESS TO THE KIND OF PREVENTATIVE CARE THAT YOU NEED.

AND I THINK IT'S IMPORTANT FOR US TO REALIZE THAT THOSE ARE, THAT'S A SET OF POLICY DECISIONS, RIGHT?

WE COULD, AS A SOCIETY, SAY, WE WANT TO PRIORITIZE PUBLIC HEALTH AND QUALITY OF LIFE.

AND SO WE ARE GOING TO CREATE A FEDERAL BUDGET THAT IS RESPONSIVE TO THAT.

THAT FUNDS, YOU KNOW, PEOPLE WHO CAN GO OUT AND CONNECT WITH PEOPLE IN THE COMMUNITY WHO TEND TO BE MARGINALIZED AND CONNECT THEM TO HEALTHCARE.

AND INSTEAD, WE CHOOSE TO PRIORITIZE THINGS LIKE POLICING AND PRISONS, WHICH IF YOU LOOK AT THE STATS, YOU'LL SEE THAT THE MAJORITY OF PEOPLE WHO END UP IN ENCOUNTERING POLICE OR ENDING UP IN PRISON, HAVE MENTAL HEALTH ISSUES.

SO ALL OF THESE THINGS ARE CONNECTED.

WE ARE CHOOSING TO RESPOND TO IT WITH RACISM INSTEAD OF CHOOSING TO RESPOND TO IT IN A WAY THAT IS SPECIFICALLY DESIGNED TO DISMANTLE RACISM.

- YOU'VE HIT ON A LOT OF THINGS THERE, BREE, AND I CERTAINLY WANT TO GET YOUR FEEDBACK ON THIS, SCOT, BECAUSE IN ADDITION TO, YOU KNOW, AS FAR AS THE EQUITY PIECE IS CONCERNED, I WOULD IMAGINE CHCS, IN TRYING TO SERVE THE SPECIFIC AND UNIQUE NEEDS OF COMMUNITIES THAT COME INTO CHCS, YOU FACE YOUR OWN SHARE OF, I GUESS, DISCRIMINATION OR POLICY ISSUES THAT AREN'T SUPPORTIVE.

BUT YOU SHARE ON THAT.

IS THAT TRUE?

AND IF SO, WHERE'S THE GAP?

WHERE DO YOU REALLY NEED THE SUPPORT AND IT'S NOT COMING?

THAT'S THE CASE?

- WELL, YEAH, THAT'S QUITE A LOT TO UNPACK.

AND I THINK, YOU KNOW, BREE AND DR. SAUL WERE BOTH SPOT ON WITH, YOU KNOW, SOME OF THE SCIENCE AND THE EVIDENCE THAT WE SEE AROUND POLICY, POLITICS, ADVOCACY, AND REALLY, HOW DO YOU FOLLOW THE MONEY.

AND WHO IS RESOURCING AND WHO IS ACTUALLY VALIDATING THE FACT THAT FQHCS AND COMMUNITY HEALTH CENTERS WERE REALLY AN ANSWER TO A HISTORY OF ACCUMULATED INEQUITIES.

AND DR. SAUL, I ACTUALLY STOLE THAT PHRASE FROM THE PRESIDENT OF ST. AUG, DR. MCFAIL.

BUT I THINK WHEN YOU THINK ABOUT THAT, YOU KNOW, A HISTORY OF ACCUMULATED INEQUITIES.

WE ARE THE PRODUCT.

COMMUNITY HEALTH CENTERS ARE THE PRODUCT OF THE COUNTRY UNDERSTANDING THE FACT THAT PEOPLE THAT ARE IMPOVERISHED, RIGHT?

AND WHEN YOU TALK ABOUT THE AFRICAN AMERICAN COMMUNITY OWNING MOST OF THAT SPACE, UNFORTUNATELY.

WE HAVE TO BE ON THE FRONT LINES.

WE HAVE TO DEMAND A BALANCE.

WE HAVE TO DEMAND THOSE RESOURCES.

FORTUNATELY, THE FQHC MOVEMENT, OVER THE PAST 65 PLUS YEARS, HAS ENJOYED A LOT OF BIPARTISANSHIP SUPPORT.

BUT AT THE SAME TIME, EVEN WITHIN THOSE POLICY MAKING DECISIONS, REGIONALLY, WE SEE BIASES.

REGIONALLY, WE SEE UNEQUAL TREATMENT AND WE SEE UNEQUAL RESOURCES THAT ARE SHARED.

REALLY, IF YOU LOOK AT THE DEMAND AND THE NEEDS AROUND ACCESS, AROUND HEALTH EDUCATION, AROUND WORKFORCE DEVELOPMENT, ET CETERA.

SO THE FQHC MOVEMENT IS ONE THAT EVEN THOUGH IT'S A PRODUCT OF A HISTORY OF ACCUMULATED INEQUITIES, WE DO SEE THAT THE POLICY AND ADVOCACY NEED IS FIRST AND FOREMOST.

RIGHT HERE IN NORTH CAROLINA, WE ARE THE ONLY FQHC IN WADE COUNTY.

THERE'S ANOTHER LOOKALIKE BUT WE'VE BEEN HERE FOR 50 YEARS.

- YOU HAVE TO HELP ME OUT.

FQHC?

- FQHC, I'M SORRY.

THAT ACRONYM STANDS FOR FEDERALLY QUALIFIED HEALTH CENTER.

SO WE ARE FUNDED, NOT WHOLLY, WE ARE FUNDED BASED UPON DATA, THE NEED THAT WE PRESENT OVER TIME IN THREE YEAR BLOCKS OF FEDERAL FUNDING.

NOW, HERE'S AN INTERESTING TAKE ON THAT.

IF I WAS TO SAY, WE'RE GONNA OPEN UP ABC HEALTHCARE IN SOUTHEAST, IN SOUTHEAST RALEIGH.

I'M GONNA GIVE YOU, FOR SAKE OF ARGUMENT, $1 MILLION TO START THIS HEALTH CENTER.

BUT THE CAVEAT THERE IS THAT YOU CANNOT DETERMINE OR DENY CARE TO ANYONE.

THAT MEANS THAT YOU CANNOT DETERMINE YOU'RE GONNA SEE THEM BASED UPON THEIR ABILITY TO PAY, WHETHER THEY'RE INSURED OR NOT INSURED.

SO THAT'S THE HOOK THAT WE'RE ON.

SO WE'RE NO DIFFERENT THAN ANY OTHER PRIVATE PRACTICE OR LARGER PRIMARY CARE OUTFIT THAT'S ATTACHED TO A HOSPITAL.

BUT THE DIFFERENCE IS IS THAT WE PROVIDE COMPREHENSIVE WRAPAROUND SERVICES AND WE HAVE TO SERVE THE UNDERSERVED AND THE UNINSURED.

NOW, ON AVERAGE, FOR US AT ADVANCE, LET'S JUST SAY WE GOT $1 MILLION DOLLARS A YEAR FROM THE FEDS.

WE'RE PROVIDING PROBABLY A MILLION AND A HALF TO $2 MILLION IN FREE SERVICES, OKAY?

SO YOU'RE ALREADY STARTING FROM A STANDPOINT IN A BUSINESS MODEL THAT IS ALREADY WHAT, YOU'RE ALREADY LOSING.

- SO WHERE DO YOU MAKE UP THE DIFFERENCE?

WHERE COULD YOU MAKE UP THE DIFFERENCE?

- SO YOU REALLY NEVER MAKE UP THE DIFFERENCE.

YOU ALWAYS MAKE UP THE DIFFERENCE THE BEST YOU CAN WITH YOUR VOLUME AND GETTING PEOPLE IN AND PROVIDING ACCESS.

YOU KNOW, THIS ISN'T A BUSINESS MODEL THAT IS A MONEY MAKING BUSINESS MODEL, UNLIKE HEALTH SYSTEMS OR LARGER TEACHING HOSPITALS.

THIS IS A BUSINESS MODEL THAT IS REALLY INGRAINED IN THE COMMUNITY, HENCE THE COMMUNITY HEALTH CENTER.

SO YOU HAVE HEALTH CENTERS THAT ARE VERY LARGE.

YOU HAVE HEALTH CENTERS THAT ARE VERY SMALL, BUT WE ARE IN SOUTHEAST RALEIGH BECAUSE THERE'S STILL A NEED.

AND THAT NEED EXIST IS BECAUSE WE STILL HAVE NOT FOUND THE SECRET SAUCE OR WE STILL HAVE NOT EMPHASIZED WHAT PRIORITIES ARE IMPORTANT TO ACTUALLY BALANCE OUT THOSE INEQUITIES AROUND ACCESS, AROUND THE CULTURAL DIFFERENCES AND THE CULTURAL SENSITIVITIES THAT WE SHOULD BE DELIVERING TO OUR FOLKS FOR BETTER HEALTHCARE.

- WELL, IT SOUNDS AS THOUGH THERE IS ANOTHER SOLUTION OUT THERE.

AND YOU KNOW, ARE COMMUNITY HEALTH CENTERS DOING A SERVICE TO THE PROFESSIONALS WHO WORK INSIDE THESE CENTERS, AS WELL AS THE PEOPLE WHO COME COME TO SERVE?

ARE THESE, HOW DO YOU FILL IN THE GAP?

YOU CAN'T PROVIDE QUALITY HEALTHCARE WHEN YOU ARE OPERATING AT A DEFICIT, I WOULD THINK.

- YOU'RE RIGHT.

SO ONE WOULD THINK THAT YOU CAN'T BUT WE DO.

WE FIGURE IT OUT EVERY DAY.

YOU KNOW, THERE'S ALWAYS THE ADVOCACY ROUTE.

AGAIN, I WILL CONTINUE TO STAND ON THAT BECAUSE 80% OF MY JOB IS TO MAKE SURE THAT PEOPLE UNDERSTAND WHAT WE DO AND THAT WE ARE FUNDED.

AND EITHER FUNDED WHOLLY FROM THE FEDERAL GOVERNMENT, BASED UPON THE NEED THAT WE PRESENTED, OR WE DEVELOP PARTNERSHIPS AND WE FIGURE OUT HOW TO LEVERAGE, YOU KNOW, COMMUNITY PARTNERSHIPS.

WE FIGURE OUT HOW TO LEVERAGE A HISTORY OF JUST CONTINUITY AND COMRADERY ACROSS ALL OF OUR SITES.

YOU KNOW, 46% OF OUR PATIENTS ARE UNINSURED, OKAY.

OR SELF-PAID PATIENTS.

WE ONLY COLLECT ABOUT 10 CENT ON EVERY DOLLAR FROM OUR SELF-PAID PATIENTS.

SO WE KNOW EVERY DAY GOING IN WE ARE NOT IN THIS BUSINESS FOR THE MONEY.

WE ARE TRULY IN THIS BUSINESS FOR THE MOVEMENT BECAUSE WE UNDERSTAND THAT THERE ARE GAPS IN HEALTHCARE.

WE UNDERSTAND THAT THE POLICY THAT DRIVES HOW WE'VE BEEN TAUGHT TO NAVIGATE THE HEALTHCARE SYSTEM IS WRONG.

SO EVERY DAY WE GO ABOUT THIS KNOWING THAT BEFORE WE CAN EVEN DEAL WITH A PATIENT'S HYPERTENSION OR UNCONTROLLED DIABETES, WE ARE DEALING WITH A GOOD, RIGHT, 90% OF THAT VISIT IS SOCIAL DETERMINANTS.

HOW DID YOU GET HERE TODAY?

ARE YOUR LIGHTS ON?

DO YOU HAVE HEAT?

IS YOUR WATER BILL PAID?

RIGHT?

WHAT OTHER SKILLS DO YOU NEED TO BE ABLE TO MAKE BETTER DECISIONS ABOUT YOUR HEALTHCARE AND YOUR FAMILY'S HEALTH?

DR. SAULS, SCOT, HAS SHARED A LOT.

WHAT ARE YOUR THOUGHTS ON THIS?

- WELL, I'VE BEEN ACTIVELY INVOLVED WITH ADVANCE FOR SIX YEARS NOW, AND I, YOU KNOW, I HAVE BOUGHT INTO, YOU KNOW THE MISSION STATEMENT OF ADVANCE BECAUSE A LOT OF TIMES SOME THINGS YOU DO, YOU CAN'T GET PAID FOR.

AND I KNOW THAT THEY ARE ALWAYS OPERATING AT A LOSS.

SO, I BASICALLY HAVE STATED THAT, HEY, SAINT AUGUSTIN'S UNIVERSITY IS THE THINK TANK.

AND ANY WAY WE CAN THINK ABOUT, YOU KNOW, HELPING YOU AND WITH DR. MCFAIL, SHE HAS BROUGHT IN THIS REIMAGINING, YOU KNOW, WHAT WE CAN DO.

AND IN THE PROCESS OF REIMAGINING, YOU KNOW, JUST REIMAGINE, IF, YOU KNOW, WE HAVE A WORKFORCE THAT'S STUDENT LED, YOU KNOW, AND ALSO, ACADEMIC FACULTY THAT ARE INTELLECTUAL THINK TANK TO HELP, YOU KNOW, TRY TO MAKE THINGS BETTER FOR ADVANCE, AND NOT ONLY ADVANCE, BUT FOR THE COMMUNITY, FOR THE ONGOING HEALTH DISPARITIES THAT WE JUST SEEM, JUST CANNOT, YOU KNOW, ERADICATE.

BUT WE HAVE TO STILL KEEP OUR SHOULDER TO THE WHEEL AND TO THE PLOUGH ALSO, AND JUST KEEP PUSHING FORWARD NO MATTER WHAT IT COSTS.

- AND IT COSTS A LOT, BECAUSE THESE CHCS HAVE A LOT RESTING ON THEIR SHOULDERS, AND THEY ALSO ARE SERVING A VERY VITAL NEED THAT'S COME TO THE FORE DURING COVID AND THAT'S MENTAL HEALTH.

BREE, YOU KNOW, WHAT CAN YOU SHARE ABOUT THE FACT THAT MOST OF THESE CHCS ARE LOCATED IN COMMUNITIES THAT ARE LOW WEALTH, AND YET THEY ARE BEARING A REALLY STRONG BURDEN HERE?

- YES, I MEAN, FIRST I THINK THAT ADVANCE HEALTH, ST. AUGUSTINE, LIKE I THINK THEY ARE TESTAMENTS TO THE BRILLIANCE, TO THE RESILIENCE OF OUR COMMUNITIES.

WHEN YOU LOOK AT HOW MUCH HAS BEEN DONE WITH SO LITTLE, MY FIRST REACTION IS LIKE MY GOODNESS, WHAT COULDN'T WE DO IF ALL OF THIS WERE PROPERLY FUNDED?

WE WOULD CHANGE THE ENTIRE SOCIETY.

THE ENTIRE COMMUNITY WOULD BE TRANSFORMED.

AND I THINK, YOU KNOW, BUDGETS REFLECT VALUES.

WHEN WE LOOK AT THE FEDERAL BUDGET, WHAT WE SEE IS ABOUT ROUGHLY 2 BILLION OR SO, BEING GIVEN TO COMMUNITY HEALTH CENTERS ANNUALLY.

BY COMPARISON, WE GIVE ABOUT 123$ BILLION TO POLICING ALONE.

AND WE KNOW THAT A LOT OF THE POLICE RESPONSES ARE TO MENTAL HEALTH CRISES, RIGHT?

SO, HOW CAN WE ADDRESS BOTH OF THESE ISSUES AT ONCE?

AND ONE OF THE MOST OBVIOUS WAYS WOULD BE TO INVEST IN MENTAL HEALTH CARE.

LET'S PROPERLY INVEST IN ADDRESSING MENTAL HEALTH, ADDRESSING THE CAUSES OF MENTAL HEALTH.

WHY ARE PEOPLE EXPERIENCING A LOT OF STRESS?

ONE OF THE POSITIVE THINGS THAT HAPPENED DURING THE COVID PANDEMIC, IS WE GOT AN INCREASE IN FUNDING TO ADDRESS THESE THINGS.

THERE WAS THIS RECOGNITION THAT PEOPLE, BECAUSE OF THE PANDEMIC, ARE EXPERIENCING GREATER STRESS.

AND SO, MORE MONEY WAS GIVEN TO THE STATES THAT THEY COULD THEN DIRECT TO MENTAL HEALTH SERVICES.

- SO, SCOT ARE YOU SEEING THAT?

- BUT THE ISSUE IS THAT THAT MONEY DRIES UP, LIKE, WE NEED THE PERMANENT INVESTMENT.

- SCOT, DID YOU SEE ANY OF THAT FUNDING?

IS IT HELPING?

TO PROVIDE THAT KIND OF SERVICE TO TO THE FOLKS WHO COME THROUGH THE DOORS AT ADVANCE?

- DEFINITELY, WE'VE DEFINITELY SEEN AN INCREASE IN FUNDING OVER THE LAST THREE YEARS AROUND MENTAL HEALTH, MENTAL WELLNESS, BEHAVIORAL HEALTH, SUBSTANCE USE DISORDER.

BUT THE NEED OF OUR COMMUNITY, AND THE VOLUME THAT WE'RE STARTING TO SEE IN SPIKES, ESPECIALLY IN OUR PEDIATRIC COMMUNITY, WE ARE STARTING TO SEE TONS OF CHILDREN THROUGHOUT THE PANDEMIC THAT ARE MENTALLY TAXED, MENTALLY STRESSED, SOCIALLY STRAINED.

AND AS THE SCHOOL YEAR STARTED THIS YEAR, WE STARTED TO SEE A LOT OF THESE ISSUES COME UP IN OUR SCREENING.

SO WE'VE SEEN A LOT OF OUR PEDIATRIC PATIENTS, A LOT OF OUR MINORITY PEDIATRIC PATIENTS OUTPACING, OKAY, THE FUNDING.

AND WE SEE THAT ACROSS OUR COMMUNITY.

WHAT WE ALSO SEE IS JUST OUR OWN CULTURAL BARRIERS, AND HOW WE NEED TO DESTIGMATIZE THE FACT THAT MENTAL WELLNESS AND BEING AWARE OF YOUR MENTAL HEALTH IS NOT A BAD THING.

AND WE SO OFTEN THINK THAT IT'S FARFETCHED WHEN WE HEAR ABOUT, YOU KNOW, CERTAIN HOLLYWOOD STARS OR CERTAIN PROFESSIONAL ATHLETES BATTLING THIS, THAT AND A THIRD, YOU CAN ONLY IMAGINE THE IN IMPACT OF MENTAL STRESS AND MENTAL STRAIN IN THIS SOCIALLY TAXING ENVIRONMENT WHEN YOU TALK ABOUT, YOU KNOW, DO I HAVE SHELTER?

DO I HAVE FOOD?

DO I HAVE A JOB?

SO YOU ACTUALLY OVERLAY BEING AFRICAN AMERICAN, RIGHT?

BEING PREDISPOSED TO SUCH, WHETHER YOU BELIEVE THE SCIENCE OR NOT, BEING IN AN ENVIRONMENT THAT'S ALREADY PUTTING YOU A STEP FOR TWO BEHIND, AND US NOT BEING EVER ABLE TO ADDRESS THE DESTIGMATIZATION, THE DESTIGMATIZATION OF MENTAL WELLNESS AND MENTAL HEALTH.

WE'RE REALLY STARTING TO SEE A REALLY UPTAKE IN VOLUME, BUT WE HAVE A GREAT STAFF AT ADVANCE COMMUNITY HEALTH.

WE'VE ACTUALLY STARTED TO WORK IN SYNERGY WITH THE ST. AUG. WELLNESS DEPARTMENT OVER THERE.

AND ONE OF THE FIRST SERVICES THAT WE'RE BRINGING ON CAMPUS IS GONNA BE OUR BEHAVIORAL HEALTH AND WELLNESS CENTER.

SO, WE'RE REALLY EXCITED ABOUT THAT RELATIONSHIP AND THAT PARTNERSHIP, BUT ALSO ALLOWING OURSELVES TO EDUCATE THE GREATER SOUTHEAST RALEIGH COMMUNITY AT LARGE ABOUT THE SERVICES THAT WE OFFER, THE GREAT WORK THAT WE DO.

- AND IT'S ALL GOOD NEWS, ALL GOOD NEWS.

- [SCOT] IT'S ALL GREAT NEWS.

- THANK YOU SO MUCH.

SCOT MCCRAY, ALSO BREE NEWSOME BASS AND DR. SAULS FROM ST. AUGUSTINE'S UNIVERSITY.

THANKS TO THE THREE OF YOU FOR JOINING US.

I WANT TO THANK TODAY'S GUESTS FOR JOINING US TODAY.

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FOR BLACK ISSUES FORUM, I'M DEBORAH HOLT NOEL.

THANKS FOR WATCHING!

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