An Eye-Opening Moment

How a Foundation and Health System Teamed Up to Fight the Local Scourge of High Rates of Disease, Early Death for Blacks

By TED HARTZELL

ST. JOSEPH, Mich. — “Lynn, it’s too much. Too many people are dying around Benton Harbor.”

Lynn Todman recalls this remark made about a year ago by a Benton Harbor woman. The woman, unfortunately, was seizing on a truth.

The truth is that in certain areas of Benton Harbor and Benton Township, which are predominantly African-American communities, people are dying early at far greater rates—up to two-and-a-half times higher—than the average for Michigan.

Todman is executive director for population health for the Lakeland Health system. As such, she is broadly charged with helping guide how Lakeland can improve the health of the population it serves.

The “too many people are dying” remark came around the time Lakeland and the Berrien County Health Department in October 2016 jointly published a “Community Health Needs Assessment.” Such a report is required every three years for non-profit hospitals under the federal Affordable Care Act.

It risks understatement to say that this data-rich study was eye-opening.

As Todman recalls: “This is the first time people actually knew people were dying at such high rates (in areas of Benton Harbor and Benton Township) when I documented it. Here’s the U.S. and Michigan and county average, and here’s what’s happening in Benton Heights. Once it was documented, it became real for people here.”

The Elephant in the Room

“And the elephant in the room is: We’ve known this, (that) poor black and brown people are sicker, right? But it wasn’t actually until I had the maps and the data to say, ‘These people are dying, and they’re dying at twice the regional average.’ And everyone said, ‘Oh! Oh!’ Once I put numbers to it, it became real for the (Lakeland) CEO, for the board, for my colleagues.”

It became even more real for Todman when Brandi Smith-Gordon, Lakeland’s vice president for philanthropy, asked if Todman and her husband Michael, a retired Whirlpool Corp. executive, would make a donation to Lakeland’s huge construction project for the Medical Center Pavilion in St. Joseph. (Through their family foundation the couple already had pledged $100,000 for an art installation in the Pavilion.)

Todman declined the request to donate for the construction. She says Smith-Gordon responded by asking her to “think differently about this. Get creative about this. What’s important to you?”

“I said, ‘OK, let’s talk about racism,’” Todman recalls. “She (Smith-Gordon) happens to be black. She said, ‘Yes, let’s talk about racism.’”

The Todmans, Lakeland’s President and CEO Dr. Loren Hamel and Smith-Gordon met for dinner. Ultimately, Lakeland’s board and leadership agreed to address that “elephant in the room” of health disparities at Lakeland’s doorstep in Benton Harbor and Benton Township. Lakeland agreed to collaborate with the Todmans. The couple will be spending $150,000 for a 2018-2020 series of speeches by national and local experts entitled Community Grand Rounds: Healing the Trauma of Racism. The first presentation was in April 2018.

Community Grand Rounds is primarily a way to educate and sensitize Lakeland’s medical staff and the population it serves to what the emerging fields of epigenetics and social genomics are uncovering about the harm to the body that can come from living in conditions of chronic racism. People living in these conditions of social isolation and exclusion are at a higher risk of suffering life-harming, even life-shortening changes that occur in the body’s very “building blocks”—its cells.

The chronic stresses of racism can lead to higher incidences of diseases, including asthma, diabetes, depression and heart disease, as a person’s DNA responds to the stresses. Damaging changes can even be passed on genetically to children and grandchildren.

Why Now?

Todman says “a perfect cohesion of factors” helped give birth to Community Grand Rounds.

For one thing, she felt compelledas an African American woman who has the resources—I’m not just talking about financial resources,” but also colleagues she could work with in addressing the problem.

“Second, before I got to this point in my life I didn’t feel emboldened enough and safe enough to say, ‘You know what? This is a real thing, and I’m going to take the risk, and if you fire me, I’ll be OK. If you marginalize me, I’ll leave.’

“The other thing is I had a health system leadership that was willing to have this conversation” with no reservations, or perhaps only “minimal pushback.”

Todman also says the timing was right because in recent years Lakeland had been sensitizing its staff to issues of race through classes, modules and other formal means. The organization was poised for just such an educational challenge as Community Grand Rounds. It only seemed natural that she would lead this effort. “If I don’t do it …” Todman says, not finishing the sentence.

‘The Fault Line in Berrien County’

Even though Todman is approaching the whole subject of the harmful biological effects of racism academically, a fire inside her burns with impatience.

“So my position is, are we going to wait for the science to tell us stuff we already know: Stress kills you? Right? We know this. Isolation kills. Loneliness kills.

“And racial discrimination is a form of all of that. Look at Benton Harbor. It is completely socially isolated and disconnected from a lot of the (things that promote healthy living), certainly the health care facilities, and the things that make you healthy, like a decent grocery store and nice parks and effective schools.”

Todman draws on earthquake terminology in describing the dramatic racial polarization of Berrien County.

“What I say is that— race is the fault line—for this country, really, and in this community. However, if you want to apply this concept in other domains, you can. But I’m picking this because it is the fault line for health in this community. If you consider that a huge, disproportionate number of black people in this county live in that little Benton Harbor and surrounding area, that’s what we would call hyper-segregation.”

‘A Business Imperative’

There is another force giving momentum to Community Grand Rounds, and that is a financial incentive.

Like other health care systems, Lakeland Health has bottom-line considerations for improving the health of the population it serves. A healthier population means a healthier bottom line because of health care reimbursement rates.

“We have to figure out a way to keep populations healthy, because the current business model isn’t sustainable—going when you’re sick is not sustainable,” Todman says. “So there’s this business imperative to deal with these racial inequities. People with the worst health outcomes, who happen to be black or happen to be poor, impose a greater financial burden on health systems than others, because of the low reimbursement of Medicaid, and to a lesser extent Medicare, and the non-reimbursement from people who have no healthcare insurance.

“That’s very burdensome on health care systems. So that also creates the case for addressing disparities.”