CBHN’s Rhonda Smith talks about what they are doing to address health disparities in Black communities
The past year and a half have shined a light on the systemic inequities that exist in the U.S. health care system. But for Rhonda Smith, executive director of the California Black Health Network, this is the beginning of what she hopes will be a shift in how the health care system treats traditionally marginalized communities.
In this Q&A, Smith tells State of Reform about how she got involved in the health equity space and what changes she hopes to see in California and the U.S. in the future.
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Sydney Kurle: You started your career in marketing and operations management for companies like DuPont and Eli Lilly. What pushed you to make such a dramatic shift to focusing on health disparities?
Rhonda Smith: “I was an independent consultant for about 20 plus years. And I, for the first half of that time, I did a lot of work in learning and development and working with pharmaceutical companies. And then I had a breast cancer diagnosis in 2008. It really was that pivotal point in my life that put me on this course, because I went through treatment the last half of the year. And coming out of that the economy had tanked and I couldn’t find work as a consultant. So I just started thinking about what I wanted to do next. And I knew that whatever that was had to be something that I was passionate about, and an extension of how I was living my life every day and not seem like work.
So I reframed my consulting practice to focus on health and wellness education for women diagnosed with breast cancer, and focusing more so on survivorship and what happens after someone’s done with treatment. I really focused on the education components and all the events that I did on helping women understand how to recover from treatment, restore their lives back to normal, and then live their lives beyond breast cancer and a more holistic way.
Then I ended up working as a consultant on a NCI funded research study that focused on evaluating the impact of stress management and wellness education, specifically on the diverse population of black women in South Florida, who were within 12 months of completing breast cancer treatment. So what started out to be a survivorship research study — was for me — my first introduction to health disparities. And so I’m really intrigued with the difference between what happens with Black women and women of color versus white women in terms of health outcomes, because I was not consciously aware, nor had I seen any data [on these disparities]. And I just became really interested and curious and learning more and really wanting to do something to have an impact that was passion and purpose led, and of course my personal connection to breast cancer was kind of the impetus for me to do that.
I was living in Miami at the time, so I wanted to do more and just couldn’t find the right opportunity — or any really — to do the work that I was passionate about and make a living doing it. So I uprooted my life and moved to California. I often jokingly say [the move was] in quest of my dreams or to pursue dreams, but not entertainment, hoping for better work in business opportunities. I ended up landing a consulting role as the project director for a breast cancer disparities initiative here working with Susan G. Komen [Circle of Promise California Initiative]. Really trying to close the gap in disparities for African American women, but really, it was aimed at helping women to get screened, and breaking down some of the barriers to facilitate access to screening. So again I had an opportunity to really learn more about breast cancer disparities and learn more about what was happening here in California while doing that project and really having a greater impact for women like me across the state.
And then after that project ended, I became the project director for an integrative health initiative based in Orange County that really changed the way that health care centers –community health care centers — delivered care to their underserved patients. So I really got to have more of an insight and a perspective from a healthcare delivery standpoint, as to what could be done to have an impact on disparities through the health care system, and community health care centers in particular, to improve health outcomes.
After that, I became the interim executive director for an organization called Integrative Medicine for the Underserved, and then had a short-term stint with another nonprofit until COVID happened. And then I had this opportunity to be the interim executive director [of the California Black Health Network] for just a short period of time last year. And then I realized that this is where I really wanted to be, and the kind of work that I wanted to do for the community that I wanted to do it for. I decided to throw my hat in the ring for the permanent executive director role and started in January of this year in that position.”
SK: What are some of the main disparities you see in health outcomes for the Black community?
RS: “For so long, and many, many decades, and many, many dollars have been spent on health disparities projects, on research programs addressing health disparities, and we’re still talking about it. And so I often asked the question why are [outcomes] still getting worse when we look at the African American community, because here, like the rest of the country, we have the lowest life expectancy of all racial and ethnic groups. So why is that? So when I started to really try to respond to that question I realized that a lot of the work on disparities that I’m aware of has been mostly focused at the individual and community level, which is great. But when we look at the whole infrastructure, there’s the individual, community and system level.
And so I haven’t seen the issue being addressed at the system level until of late. And I think that’s primarily because of COVID. And so when you think about it, there hasn’t been as much emphasis or investment or policies around changing the system of care to really break down those barriers and eliminate the racial and implicit bias that people experience when they go to seek care. And I think it’s important to really focus on that piece of the equation if we’re really going to see an improvement or change in outcomes.”
SK: California has a huge wealth gap. How does that gap negatively affect Black communities?
RS: “It’s all about access, right? When we have money, we have more freedom to choose where we live, right? It’s about where you can afford to live here in California. And, you know, unfortunately, if there’s income inequality and the huge gap that you referred to, then you can only live where you can afford to live and usually it’s an underserved, under-resourced community. And then you can talk about, so you have sometimes inadequate housing that’s a result of that, and that home might be in a place where there’s a food desert, so then you have lack of access to healthy fresh foods, and then it often can be a medical desert.
So then you have a lack of access to health care. And then if you are not able to afford a car, then there’s transportation issues. So even if you do need to go see a health care provider, you have to travel. And now with COVID, that’s an even greater issue. And then when you talk about place based issues, certain communities are cancer clusters, or there’s a high degree of respiratory issues just because of the industrial facilities or highways that run through those communities. That is what happens as a result of the wealth gap.
And then there are certain policies that create inequities that then, in turn, create social determinants of health, and then, in turn, impact the health and well being. We know that there’s evidence to prove that certain zip codes dictate life expectancy and longevity for individuals within those communities. And underserved communities have the greatest issues pertaining to social determinants of health.”
SK: When thinking about the compounding issues that create these health disparities, what are California Black Health Network’s goals regarding decreasing these disparate health outcomes?
RS: “We’ve launched the campaign for Black health equity, which is a multi-year campaign that aims to do a number of things, but overall, to garner support, so that we can do the work that we need to do every day to have an impact on the community. And that impact ultimately will lead to increasing life expectancy for Black Californians.
Like I said in the beginning, we know that like the rest of the U.S. — Black Californians have the lowest life expectancy, and then COVID has only exacerbated that. It’s one to three additional years of loss of life that has resulted because of COVID. But we will be focusing on maternal health and infant mortality disparities. We’ll be looking at disparities when it comes to chronic conditions, and also cancer disparities, and also possibly rare diseases. Then end of life issues related to access to palliative care and hospice care, and those conversations that typically do not happen just because of who someone is. And so looking at the entire health equity lifecycle, so to speak.
For us, addressing things at the individual, community and system level in particular, especially as it relates to advocating for policy changes that can drive change at the system level. So we see a really good example of the beginning of that, last year, with SB 464, which is the perinatal equity bill that requires perinatal providers to go through implicit bias training. But there’s still a lot of work to do, but at least there’s something in place there. We hope that that can be something that is extended across all health care, not just in the perinatal space.
Other things that we’re doing under the campaign umbrella is we’re creating the new black health agenda, which will be a statewide plan to address health disparities and achieve health equity, really utilizing our health equity framework, which is that we view health equity as sitting at the intersection of racial justice, social justice and environmental justice. And they all are interconnected. So we’ll be launching a program, a health education series to address and improve health literacy.
We’ve started the health equity forum, which features subject matter experts that are in the health equity and public health space. We’ve had a few. We’ve had three so far. We had Dr. Kizzmekia Corbett, who’s the African American woman who oversaw the development of the majority of the vaccine. We had Jeri Lacks-Whye, who’s the granddaughter of Henrietta Lacks, speak at one of our health equity forums to really help mitigate the medical mistrust that exists within the Black community and tell a more positive side of Henrietta Lacks’s story, how one Black woman has really helped advance medical research all around the world and save millions of lives all around the world, just because of what happened to her.
I think those are the core things. Hopefully, we can do our role to help facilitate and support the creation of a multicultural, multidisciplinary pipeline of healthcare professionals who look like the people that they’re serving in the community.”
SK: In your last answer you spoke a bit about the distrust that exists in the Black community towards the health care system. How is your organization bridging the gap between the health care system and the Black community?
RS: “We really want to provide more health and wellness education, so that ultimately, what we accomplish is help people to do some of the basic, simple things that they can do to either prevent diseases from happening more effectively, or more effectively manage their current health conditions, should they have one, and definitely prevent disease progression from happening. And so at the end of all of this, what we hope will happen and aspire to do is really garner patient empowerment so that when people are seeking health care, they can advocate for themselves. So there’s self advocacy — they will be able to understand how to better engage in a conversation with their health care providers, they will understand what their rights are as a patient and how to navigate within the system of care, and to ask the right questions, and what questions do you need to ask when you’re seeking health care, especially if you’re presented with a devastating diagnosis of some health condition. We really, at the end of the day, want to empower people to engage in self-care and self-advocacy because that is, for me, an important part of driving change.
Improving the health literacy of providers [is important] too. So how do we do our part to help improve more cultural humility and cultural competency at the provider level? Health literacy works on both sides of that relationship. I think that it’s a process, because we’re really talking about driving culture change and how health care is delivered. I think it sounds simple, but it’s not simple to make happen because you’re talking about redesigning the whole health care system, which is already inefficient to begin with. So I think that if we are to bring in a personalized medicine approach to primary care, that we will begin to see some changes in the health and well being of all people.
And then also coupled with that, how do we help providers become more culturally astute, aware and competent? How do we hold people accountable for making improper decisions, or judgmental decisions that have an impact? I’m not talking about malpractice. We know a lot of times decisions get made about certain people just because of who they are, what they look like, where they live, what country they’re from. So we need to really work to eliminate those biases, and educate people, so that they are aware that everybody’s a human being. They just have different life experiences and come from different places. But at the end of the day, we’re all human beings that have the right to be treated as humans in a humane way. And not discounted because of who we are, where we look, what we look like or what country we may come from.”
SK: The past year has been especially traumatic for the Black community. How is the California Black Health Network working to destigmatize behavioral and mental health?
RS: “We are working in three counties in Northern California to address mental health disparities. So we’re working in Alameda County, and Sacramento County, and also San Joaquin, to address a variety of things related to mental health disparities. So for example, in San Joaquin, we’re going to be focusing on youth and how violence has impacted the community there. In Sacramento, we’re going to be looking at policing and how policing has impacted the black community and providing, you know, some tools and resources and interventions for people there. In Alameda County, it was really more about reinventing mental health for the black community, and what that really looks like, and making mental health not so much of a taboo in the black community. But being more open minded about mental health and how important that is to our overall health and well being.”
SK: What gives you hope going into the next few years?
RS: “That’s a great question. I think like, there’s always the calm after the storm, right? And we’ve been in this storm for the last year, and COVID is not going away anytime soon. But I call it the perfect storm of opportunity, because I think out of that perfect storm right now we see a lot of the inequities. So because of COVID and everything that was happening last summer everything was in our face. What people had been talking about, but certain pockets of individuals, did not necessarily believe it or didn’t take it seriously. But now it was in everybody’s face, it was undeniably so.
I think I’m hopeful. And it gives me hope that we’re having these conversations that people weren’t comfortable about having, or didn’t want to talk about before COVID. And now we are talking about racism as a public health crisis. Talking about the racial, or implicit bias that happens within the healthcare system when certain people are seeking care. Talking about racism as a part of our institutional fabric, and within this country in our history. So, that gives me hope that we have to go through this, this shift and this change, and on the other side of it, you know, we will be in a different place, for sure. And, hopefully, there’s more compassion for that.”
This interview has been edited for clarity and length.