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�ǿմ�ý equality can benefit us all (11:59)

Heather Simonsen: Yeah, and it's like insult to injury, really, because you're already dealing with perhaps the most difficult thing in your life. And can you help us understand how it's helping some patients? Can you think of some patients who you've been able to help through these programs? Can you give us some scenarios?

Chelsey Schlechter: Yeah, I can start. We often think about with our work that we're not only helping the individual patient, but we're trying to help the settings that serve those patients, too. So, we've done work with the safety net health care systems to make it easier for them to implement technology into their health care system. We know that most of the recommended guidelines for things like tobacco screening or colorectal cancer screening, they work best when there's some sort of change in the electronic health record. But those sorts of changes can be difficult to implement because they have limited staff who have the expertise in actually using that technology. They have limited resources in terms of things like, do they have access to fit test that they can give to uninsured patients? Because those are costs of the community health center.

We try to help the community health center also provide the best care to their patients. One project that we're working on is trying to make it easier for clinic staff to identify patients who use tobacco and then get them connected with evidence-based resources that are already being delivered by the state of Utah. So, we've helped them create changes in their electronic health records, we've provided them trainings on the resources that are available to patients. And then to follow up with patients, we've also provided them things like just giving brief reminders to patients that the resources are available has been shown to be really effective in increasing use of these evidence-based interventions. So, we use a lot of what we call low tech approaches that are available to a wide variety of populations regardless of their insurance status, socioeconomic status, geographic location.

Heather Simonsen: Well, and you mentioned the rural component, and that that really adds another layer of difficulty. And with us, you know, serving the Mountain West and the five-state area, really, those health inequities are at the top of our priority of addressing. So, I really commend the work, the really important work that you're doing. Let's talk to the person who may be thinking, “well, that's all great, but how does that benefit me?” How does that, if I'm professional, you know, an employee doing well, I have a savings; because it strikes me that we know that poverty can also lead to crime. We know that that communities are safer when people are happy and healthy. I mean, this is really work that that affects the entire community. Would you agree?

Dave Wetter: Absolutely. There is a wide variety of what are called social determinants of health or social drivers of health. And they are really about inequities, and educational opportunities, and job opportunities, and access to, you know, safe housing, and access to fresh foods. So, providing those things actually benefit society tremendously. The cost of health and health inequities in the U.S. is close to a trillion dollars that we pay extra by not having equity across different population groups and health.

Heather Simonsen: Well, and especially like, if you can't, you know, catching a cancer early when it's the most treatable rather than on the back end if somebody's got a late-stage cancer and all that that entails and the treatments. So, it's addressing those inequities upfront. Is that it?

Dave Wetter: I'm going to do a personal, hopefully it won't be TMI here, but yeah, I had my colonoscopy last summer. I had two polyps that are the kind that could translate into cancer, so they kicked up my screening schedule from 10 years to seven years. If I was uninsured in the population, there's no way in heck I would have been getting a colonoscopy. Because, you know, I wouldn't have anything to pay for that. And it's likely then, that a few years down the road some of those polyps would have turned into cancer. So, the cost is huge, because it's so you know, I mean, a colonoscopy cost versus treating colorectal cancer is, you know, magnitudes of difference.

Heather Simonsen: Gosh, I mean, that's just so important, too. When you think about that, you know, to society, and also just that human life. Thank you for sharing that, I really appreciate that. Chelsea, does that bring up any other thoughts you have, or examples of how you think your works are really making a difference already?

Chelsey Schlechter: I'm just going to add some data to the very nice story that Dave provided. In the US nationally, people who are uninsured have a 22% colorectal cancer screening rate, being up to date on their screening. Those who are insured are at 64%. So it's huge, that difference in screening. With examples like Dave, we're seeing that all the time. I think a lot of the work that we do, it brings me back to growing up in rural South Dakota and seeing what the quality of care was like there. Knowing, like, my mom getting a mammography having to drive three and a half hours because the mobile screening unit doesn't come out to the small rural town that we're in.

I think oftentimes it comes back to those little pieces that I can connect to what I've experienced. But I've hardly experienced any sort of the impact of these inequities that we're seeing with our patients. And I think one of the most rewarding pieces of the work has been working with the Community �ǿմ�ý Centers, because day in and day out when we have advisory board to our members of the clinic staff team at these clinics and patients at these clinics and they tell us about their day-to-day experiences and about some of the stigmas they may experience in receiving care. It's just incredibly, incredibly valuable, I think, to hear and understand their perspectives, because they're the ones who are going through it.