Cleveland Clinic alumni Gregory Hall, MD, MBA (IM’94) and Charles Modlin, MD, MBA, (U/RT’96), Founder and Director of the Minority Men’s Health Center of Cleveland Clinic’s Glickman Urological Institute and Executive Director of Minority Health for Cleveland Clinic, have served together on the Ohio Commission on Minority Health. Independently, they focus on healthcare disparities and the health concerns of the African American community.
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Cleveland Clinic alumnus Gregory L. Hall, MD (IM’94) explores healthcare disparities and evidence-based strategies to improve clinical care of African Americans in a new CME web series, “Bridging the Gap: Conversations with Dr. Hall.” The monthly Pri-Med series attracts a primary care audience from across the country.
An expert in African American healthcare, Dr. Hall is an associate professor of integrative medical sciences and internal medicine at Northeast Ohio Medical University. He also is an assistant clinical professor in medicine at Case Western Reserve University School of Medicine and director of the National Institute for African American Health, where his colleagues include fellow alumnus Mark Spears, MD (IM’94).
Establishing trust is essential in addressing healthcare disparities, Dr. Hall says. “Forty-four percent of African Americans don’t trust medical providers regardless of race. They don’t trust medications or vaccinations. Trust in government also has taken a dive. I’m worried about that, especially during a pandemic.”
The coronavirus pandemic has raised awareness of disparities in accessing healthcare and the specific medical needs of African American patients, Dr. Hall says. “It has revealed what’s already there, the underlying chronic illnesses that African Americans always have had, including hypertension and diabetes, as well as our ability to be screened in a pandemic. All the confusion surrounding the pandemic is making these trust issues worse.”
Dr. Hall is board president of the Cuyahoga County Board of Health and was vice chair for 10 years prior to that. “I became president just when the pandemic started,” he says. “Patients are now under a lot more stress, and they have symptoms including anxiety, depression, insomnia, increased blood pressure. It’s a hard time.”
A desire to reach a wide audience of healthcare practitioners led to his book, Patient-Centered Clinical Care for African Americans: A Concise, Evidence-Based Guide to Important Differences and Better Outcomes, published in November 2019. “I thought that African American outcomes were bad enough that they deserved their own book,” he says. “I happen to have a patient population of 85 percent African Americans, so I needed to know best practices for that population.”
Many health conditions of African Americans are related to smoking, poor diet and obesity, as well as living with the stress of discrimination in jobs and housing that deprives them of opportunities and services and limits access to healthy food and healthcare.
“Everything was set up to give us what we have now,” he says. “We have to first recognize that this is happening. I can’t fix racism and oppression, but I can give the people who have medical practices with African Americans a book of research-confirmed best practices.”
The web series with Pri-Med, a leading medical education provider, followed the book’s publication. “I thought it would bring interest to the subject of the clinical treatment of African Americans, and I had learned so much just through writing my book that I wanted to share,” he says.
Each chapter of Dr. Hall’s book lends itself to a CME discussion, he says. “It’s been fun. At first, I was nervous, but not now because I’ve been doing this from my home office since July. People who respond to it are shocked and say, ‘Why haven’t I heard this?’ It’s great to spread this information and get people excited about having it all in one place and not being preached at or having a finger wagged at them. Let’s just learn.”
In 2020, the American Medical Association declared racism a public health threat and said a “proactive approach to prevent, or identify and eliminate, racism is crucial.” It referenced studies showing that historically marginalized populations in the country “have shorter lifespans, greater physical and mental illness burden, earlier onset and aggressive progression of disease, higher maternal and infant mortality, and less access to health care.”
Photo taken prior to March 2020.
Tackling these issues requires that “once and for all, healthcare leaders, policy makers, elected officials and community leaders must acknowledge that these disparities exist,” says Charles Modlin, MD, MBA (U/RT’96), a kidney transplant surgeon, Founder and Director of the Minority Men’s Health Center of Cleveland Clinic’s Glickman Urological Institute and Executive Director of Minority Health at Cleveland Clinic.
“We can’t just point a finger at an individual and say, ‘Change your behavior’ when there is public health data that shows where you live determines life expectancy,” he says. “If you live in Hough [a midtown Cleveland neighborhood] rather than Pepper Pike [an east-side Cleveland suburb], for example, there is a 23-year difference in your life expectancy.”
Dr. Modlin, who heads the yearly Minority Men’s Health Fair that launched in 2003 and has served over 35,000 men, has been leading the effort to establish multicultural health programs within institutes across Cleveland Clinic. “These are a shining example of what we can do now to address disparities in the specialties in which we have expertise,” he says.
Outreach is important, he says, “We have to work to improve health literacy, thereby enhancing and empowering the communities’ abilities to make better informed healthy decisions, and we must closely listen to the needs and concerns of people and communities of color. This will help build trusting relationships and is essential in encouraging the community to be more willing to absorb the information and understand the value of health screenings for the early detection and prevention of disease.”
Recently, Cleveland Clinic awarded a Caregiver Catalyst Grant to support Lerner College of Medicine students’ FRESH Fairfax project in which the students offer residents of Cleveland’s Fairfax neighborhood health screenings and personalized education on food and lifestyle choices. Residents also are connected with support programs for sustaining their long-term health. “I applaud Cleveland Clinic and the medical students for coming up with a program to better engage the community,” Dr. Modlin says.
For over two decades, Dr. Modlin has treated patients affected by healthcare disparities. “I can ascertain the underlying contributing causes, the social determinants of health, depending on where patients live, their poverty and lack of access to quality healthcare,” he says. “They may not have adequate transportation to medical appointments, and they may live or work in unhealthy, unsafe, or toxic environments. They may have behaviors including smoking, drinking, and sedentary lifestyles, all of which to contribute to a higher burden of disease, health disparities and lower life expectancies.”
Heredity predisposition to certain diseases in many situations also contributes to the disparate health outcomes experienced by people of color, he says, including in prostate and colorectal cancer, hypertension and diabetes. “Minorities have higher rates of chronic, pre-existing healthcare conditions that lower the immune system and thus also make them more susceptible to COVID-19, influenza and other infections, as well as cancer. People of color, especially African Americans, have a higher morbidity and mortality with COVID-19. Once infected with the COVID-19 virus, in many situations, the immune systems in minorities mounts a hyper-reactive response, which causes greater tissue destruction in their lungs, kidneys and other organs. They have a higher incidence of ventilator use and higher death rates.”
In addition to heightened vulnerability to certain diseases, in many situations African Americans have historically faced, and still face, healthcare discrimination based on race. For example, he says, research shows that African Americans who are in sickle cell disease crisis and go to hospital emergency rooms because of pain often are falsely viewed as “drug-seeking.” This misperception also affects them when they have bone fractures and leads to their receiving smaller doses of pain medication than other patients do.
Dr. Modlin, who served on the Ohio Commission on Minority Health and Gov. Mike DeWine’s COVID-19 Minority Health Strike Force, says “the COVID pandemic has actually unmasked the existence of health disparities. Now, the general public, policy makers, healthcare leaders and many others who maybe didn’t understand the overall impact that health disparities has on minority populations, and even tried to downplay it, can see that racism, itself, is a social determinant of health. It can lead to chronic stress and hormonal changes that manifest in physical problems including hypertension and kidney damage, and there’s also some suggestion it can cause cardiomyopathy.”
Cleveland Clinic is a leader in identifying and addressing healthcare disparities, Dr. Modlin says, including in research. Recently, Cleveland Clinic established a biorepository, and Dr. Modlin is heading outreach efforts to obtain samples from the African American community.
“We are encouraging the community to become more aware and also encouraging researchers to address healthcare disparities,” he says. “We promised the community that we’d do that.”
Including messaging by Black physicians could help convince more African Americans to participate in medical research studies, he says. “Less than 5 percent of NIH studies actually include African Americans. It relates to a lack of trust. We need to encourage them to participate in trials, screenings, and follow recommendations. Better trust will result in better compliance.”
Dr. Modlin also would like to raise Cleveland Clinic alumni’s awareness of healthcare disparities, “whether they currently are practicing or are retired,” he says. “I welcome their contacting me about what Cleveland Clinic is doing and helping them to implement similar programs, including in their individual practices.”
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