[00:00:00] Adam Walker: This episode of the Real Pink Podcast is brought to you by AstraZeneca. AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all of its complexities to discover, develop, and deliver life changing medicines to patients. Learn more at AstraZeneca-US.com.
From Susan G Komen, this is Real Pink, a podcast exploring real stories, struggles and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
Welcome to another powerful episode of the Komen Health Equity Revolution podcast series. Each month, we invite patients, community organizations, healthcare partners, researchers, and policy advocates to spark conversations about strategies and solutions that drive the health equity revolution forward for multiple populations experiencing breast health inequities.
People often talk about social determinants of health, the conditions in which people are born, grow, work, live, and age, and how they affect a person’s health, wellbeing, and quality of life. However, there are political determinants of health that impact our health and longevity as well. Rebecca Birch, Director of State Policy and Advocacy at Susan G Komen is here today to help us understand how political determinants of health ultimately determine and affect social determinants of health and how we can all get involved to create a healthier tomorrow. Rebecca, welcome to the show.
[00:01:42] Rebecca Birch: Hi. Thank you for having me.
[00:01:45] Adam Walker: I’m so glad to have you here. I should say welcome back to the show, but last time it was more of a conversation with you and another guest. Today I get to interview you, which is going to be super fun. I appreciate that and appreciate the work that you’re doing. I think it’s really important. I’m glad that we’re getting a chance to showcase it today. First off, can you start by explaining what social determinants of health are and how they differ from political determinants of health?
[00:02:09] Rebecca Birch: Yeah, absolutely. Well, you shared part of it, right? It’s the conditions in which people are born, grow, work, live, and age.
For example, quality education, access to transportation. Built and lived environments, access to nutritious foods, all of those impact our health. They could be good or they can be bad. Whereas your political determinants of health
are, the drivers that create those social determinants. So as you have policies that are put in place that can impact some of those, whether it be the access to the neighborhood and if they put a highway right through a neighborhood, or whether they decide to build a grocery store in a certain location or not to build a grocery store, whether all is family dollars and convenience stores and fast food versus a whole foods or similar type locations to buy your nutritious foods. So that’s the difference between them. One is the environment that exists already. The other is the drivers that create that environment for you.
[00:03:11] Adam Walker: Okay, and do do you have any more specific examples of what a political determinant is?
[00:03:16] Rebecca Birch: We know that having lack of access to nutritious food impacts your health in general.
High diabetes, high hypertension, increased risk of cancer, the ability when you’re in cancer not to maybe get, go through cancer as smoothly as you should if you don’t have the nutritious foods that you need.
Lack of access to transportation to get to a doctor’s appointment, or to work, which might provide health insurance for you to be able to afford the health care that you need.
We know all of those things exist. We see them, but we rarely stop to take a look and see how did those come about, what decisions were made, because they aren’t just made out of broad cloth, right? They don’t just happen. There’s a reason that they happened. That answer is systemic policy. That answer, and it starts from the very beginning.
So, the decisions that were made in each of those situations impact somebody’s health, either positively or negatively. And those come down to state, local, federal policies.
[00:04:18] Adam Walker: Got it. And, so, just to add some additional context, can you offer any historical context for these laws or policies as they relate to specific populations?
[00:04:28] Rebecca Birch: Absolutely. So political determinants health can be traced back to the origin of our, to our founding as a young nation. We built inequality, racism, structural barriers into the fabric of our nation, starting with 1787 and the three fifths compromise going to the homestead act in 1862, moving into the 1930s with the homeowners loan corporation.
All of those can, those political determinants, all of those decisions that were made can still be felt today. But it’s also your local things. It’s your city council, your county commissioners, where they decide to put a bus stop, where they decide to put a trash dump, where they decide to allow for zoning efforts to happen, so that those zoning can either be positive or negative to your community.
Do they put green space in an area, or do they just build everything up? That’s the historical context when it comes to the political determinants of health and how they’ve come about.
[00:05:26] Adam Walker: Yeah, I think for those of us that don’t necessarily use public transportation, like just where you provide public transportation dramatically impacts the health of communities and the health of people in those communities.
And I think that’s something that a lot of us that don’t actively use public transportation miss as we think about these things, right?
[00:05:45] Rebecca Birch: Absolutely. If you have to take four buses to get to a doctor’s appointment. The likelihood that you’re going to be able to do that, whether to take off work or whether to find child care that whole time or whether to physically, if you’re ill, to physically make four different bus stops impacts your health. Those decisions were made by somebody at a policy.
[00:06:05] Adam Walker: Yeah, that’s right. Yeah, that’s and honestly, like even talking it out like I’ve never even thought about, are there people that have to do multiple bus rides just to get somewhere? Like it never even occurred to me like even in this conversation,I would have thought one bus ride maybe but not three or four but you’re right, it totally makes sense they’d have to do several bus rides just to get to the doctor, which is wild.
[00:06:26] Rebecca Birch: Absolutely. If you’re traversing south side chicago sometimes it can be and it seems like it’s like, “Oh, it’s all in there.” But you have the way that they designed the stops. There’s all of these things that go into place and we don’t think of them in as an, on a normal basis. Because we’re trying to live, we’re trying to pay rent, we’re trying to do the things that we need to do. But somebody made those decisions.
And those are what are the political determinants of health.
[00:06:51] Adam Walker: Yeah, all right. So how do these impact health equity in marginalized communities, specifically breast health equity? And why do folks need to care about the political determinants of health?
[00:07:04] Rebecca Birch: Let’s look at an example. So if we look at redlining, which was developed in the 30s along with the homeowners loan corporation, which really looked at, they were charged with defining categories for certain neighborhoods. Green was the best place that you can be, blue was still desirable, yellow was definitely declining and red was considered hazardous.
And this ranking system impacted who could live in certain neighborhoods, what banks would approve loans, like what type of loans would be approved by the banks in those neighborhoods, where there would be investment, and where there would be de investment. And all of those can still be felt today. If you take a map of the 1930s Homeowners Loan Corporation and the redlining and overlay it to a metropolitan, a major metropolitan area now, you will see some of the very same similarities for your time. And that’s where you see the lack of access, the lack of nutritious foods, where you see high levels of fast food and convenience stores, but nothing that you can actually go buy foods that will benefit, nurture you. You’ll see the lack of transportation in those areas. You’ll see the lack of healthcare access in those areas, but you will also see heavy pollution.
You’ll see lots of concrete, little green space, little tree cover space. All of those things impact an individual’s ability to live a healthy life. And once you’re a breast cancer patient, your ability to try and do the best you can to live through this, right? And so if you were in one of those neighborhoods as a breast cancer patient, you’ll most likely struggle getting to your doctor’s appointment.
You will most likely struggle getting that food that you need. The reason you’ll struggle finding a physician that’s located close to you, which means that you will have to have that transportation that you’ll struggle to get. And so those are the things that, those are the best way to explain how it might impact somebody with breast cancer and how
the ability to, ultimately, you have better outcomes with the disease changes based on where you live. Potentially, it’s not the only factor, but it is a very big factor in some of those areas. The funny thing is we make, I find it interesting that in this society, we really don’t pay attention to those areas, right?
It’s so far, a lot of times when I start talking policy, because it’s my world, I geek out on policy, I love policy, people start to gloss over, right? Their eyes are like, oh, or they think it’s political, right? They hear, they think it’s, they think it’s the campaign, they think it’s the sniping back and forth.
But really, policy impacts everything we do from the time we wake up in the morning until the time we go to bed. The mattress you sleep on, the water that you use to make your coffee or brush your teeth, the roads in which you drive to work on, the building in which you work. All of those things and so on are impacted by policy in some way or another.
If we don’t become engaged in that process, then somebody’s making those decisions for us or about us, but not necessarily for us, right? They don’t necessarily think of it and I know being busy and trying to just survive which is a lot of us have, we’ve created a culture where that’s the main thing is trying to survive. We don’t always think to take that step and say what about this or do I need to say something?
Do I need to tell somebody and I think if there’s one thing you say that’s important for people to understand this is, if you want your outcomes to be better, then you have to voice that. You have to make sure that you are, and I’m not saying like you have to go to all the rallies or you have to go like you have to be at the capitol all day long telling legislators, right? But there has to be some way for you to be able to engage and then voice that opinion and I know it’s difficult.
[00:10:59] Adam Walker: Well, and not only that but I would imagine that a majority of legislators are somewhat like myself with less experience with public transportation, for example, and therefore might not even recognize the impact that some of these policies are having on communities, and therefore they need to have their eyes open to that, which is I would imagine a big part of what you do, right?
[00:11:21] Rebecca Birch: Exactly. It’s like letting them know. Hey, these are the things that are impacting it. Do you understand this? And so to your question about what is Komen doing, right?
[00:11:31] Adam Walker: Yeah, tell me, what are we doing?
[00:11:35] Rebecca Birch: We, and a lot of it is so much larger than one organization can do, and so a lot of our work is done in coalition, but we realize some of the immediate efforts that need to be done.
So if an individual is having to pay an exorbitant amount of out of pocket for a medical service, so for instance, they have a screening mammogram and they need to have a follow up mammogram or a supplemental depending on their high, their risk or their findings of their screening mammogram. That can cost hundreds to thousands of dollars out of pocket.
We understand that is an additional stressor on everything else that’s going on and can ultimately delay the diagnosis, right? Because if you don’t have the money to pay for that, then you hold, you wait, but that doesn’t mean that the abnormality goes away. That doesn’t mean that your increased risk goes away, right?
You have to do that. So we’ve been working to eliminate those costs, making sure that an individual doesn’t have to also worry about that. We work in coalition on Medicaid expansion, making sure that the states that haven’t yet expanded Medicaid do so for those vulnerable populations within the states.
Surprisingly. Many of our Stand for Her top 10 cities that have been identified as having the highest mortality for black women, many of those are in states that haven’t yet expanded Medicaid. So there is definitely an overlay in a corollary to those. And so Komen works in that space, but we also work to ensure that there’s equitable access to clinical trials.
So that drugs that are being developed with the people who are using those drugs in mind. We know there is a abhorrent, lack of participation in clinical trials from under resourced and underserved communities. A breast cancer drug that impacts mostly women, black women that get triple negative breast cancer, had less than three percent of black women in the trial.
So, we try to work on those things and hopefully by doing some of those things we can help alleviate some of the other stressors that happen within the piece and within the determinants.
[00:13:39] Adam Walker: Yeah, that’s great. That’s I love the work that you’re doing. That’s great. No, all right.
So listen, so we’ve talked about a lot of stuff and, so I just want to boil it down for a second. If listeners of this episode could walk away understanding one thing about the political determinants of health, right? What would be the key thing you would want them to walk away with today?
[00:13:59] Rebecca Birch: I think that we’re all impacted by political determinants of health and we all have the ability to engage and to try to shift some of those, we can’t undo redlining, but we can start to request services that have been denied us. We can start to request that things that have been put into our neighborhoods that have been killing us can be moved out.
We can request healthy access foods, we can do those things. And I think that’s the thing is we just need to be engaged to get there. The community that we
deserve and that we have a right to and all of and sometimes that’s simply just shifting some of the policies that’s requesting things like you’ve been incentivizing policymakers incentivize things on the other side of town all the time.
Why can’t they incentivize on our side of town? Why can’t I have those things? And I think the most important thing is everyone deserves those things. Not just a certain population. And so I think that’s it, once we realize that we deserve those, then we can start fighting for them.
[00:15:03] Adam Walker: I love that. I love that. And let’s imagine there’s some listeners of this episode that want to get involved. how would they get involved with advocacy?
[00:15:12] Rebecca Birch: Absolutely. So we had talked about sharing your story and making sure policymakers are engaged. And sometimes we have just a very short amount of time. If you text KOMEN to 40649. We will make sure that you get text messages, really quick text messages, that you can send your policymaker saying this means a difference to me. I need you to pass this. I need you to understand this. So it can be as simple as texting KOMEN to 40649 and that can be your first step to engage in these areas.
[00:15:45] Adam Walker: I love that. Super simple. We can all do it right now. So if you’re listening to this episode right now and you want to get involved, I would encourage you to shoot off that text at this moment. Rebecca, I love the work that you’re doing, it’s so important. I really, I just really appreciate the work that you’re doing.
It’s so valuable and so needed, and I’m glad we’re getting a chance to talk a little bit more.
[00:16:05] Rebecca Birch: Absolutely. And I love talking about my work, so thank you for having me. But I, it is important work, and I think it’s sometimes less known work, right? Some of the other things, the research and all of the immediate things you can see.
And sometimes you don’t know these pieces, but we hope that we’ll get some people that will want to be engaged. And it’s a simple step to start taking that step.
[00:16:29] Adam Walker: If you want to get engaged, make sure to send that text and really, Rebecca, I appreciate you joining us on the show again today.
[00:16:36] Rebecca Birch: Absolutely. Thank you.
[00:16:38] Adam Walker: And thank you listeners, for joining us on another episode of the Komen Health Equity Revolution podcast series. We will continue to galvanize the breast cancer community to support multiple populations experiencing breast health inequities to advance and achieve breast health equity for all.
Because ending breast cancer needs all of us. To learn more about health equity at Susan G. Komen, please visit komen.org/healthequity. And if you need resources and support, please contact Komen patient care at 1-877-465-6636. The number again is 1-877-465-6636 or email helpline@Komen.org.
This episode of the Real Pink Podcast was brought to you by AstraZeneca. AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life changing medicines to patients. Learn more at AstraZeneca-US.com.
Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit realpink.komen.org and for more on breast cancer, visit komen.org. Make sure to check out @SusanGKomen on social media. I’m your host, Adam. You can find me on Twitter @AJWalker or on my blog, adamjwalker.com.