Last week, Tamara shared insights from her experience conducting nutrition education in Birmingham City schools with the Minority Health Research Center, and reflected on how health disparities affect children. She also spoke to a few similarities between her volunteer work and her experience as Senior Health Advisor at Pack Health, helping members work through barriers that prevent them from living their best lives. In Part 2 of this #PackChat, Tamara shares deeper insights on the social determinants of health and the health disparities she’s witnessed in the South.
Time to read: 5 minutes
INTERVIEWER: So looking at the Southeastern region, we [Alabama] generally have poor health outcomes compared to other states. Why do you think that is?
TAMARA: That’s a great question. There are a few factors that play a role in the health outcomes of Southern regions. I think one of those things is the number of primary care providers. Nationwide, there is a shortage of primary care physicians, but in the South, it’s pretty substantial. Additionally, coverage is a huge issue. Alabama and a few other Southern States did not extend Medicaid coverage. Unfortunately, a lot of people are suffering from that. And if I don’t have health insurance, I won’t probably go see my health care provider. Therefore, I probably will not get the care that I need to manage my chronic condition. Lack of coverage doesn’t necessarily stop people from using the Emergency Room, but it makes it harder to practice the preventative measures that may keep me out of the hospital.
Also, there’s a degree to which unhealthy lifestyle choices are culturally ingrained in the Southern identity. Stereotypically speaking, you come to the South and you’ll get your sweet tea, fried chicken, and buttermilk cornbread. If you’re eating it every day, that isn’t the best nutritional choice. But, that’s what people have grown up on, so they don’t perceive it to be unhealthy.
I think the perception of what’s considered to be healthy plays a big role – and not just with food, but exercise as well. If you look at other regions that have better health outcomes, they have more walking spaces. They have more green space. The landscape is more likely to encourage physical activity, whether it’s through bike routes or sidewalks or dog parks.
INTERVIEWER: I want to focus in on your point about physical space. Last week, you had mentioned the safety and structural factors that impact how kids play outside. Can you explain this a little more?
TAMARA: For sure. If you feel safe outside, you’re more able and willing to go outside and get some physical activity in. Those different factors can sometimes impact a person’s ability to practice more positive health behaviors.
I think the biggest thing I see with kids here is that a lot of the time, they don’t have a place to play or be active. Many kids live in an environment that may not be safe to go outside and play. Some may have a safe neighborhood, but they live around a lot of traffic, so it’s still not technically safe. That’s why we focus on teaching them things to do inside until the kids and their parents have the opportunity to go to the park.
Additionally, structural factors and the built environment also impact nutrition. One thing to note is that grocery stores cater to the neighborhood. A good example of this: if people don’t know what avocados are, they won’t buy them. So then, why would a grocery store stock avocados? In most low income neighborhoods, the grocery store is also likely to be a discount grocery store. It will generally just have the bare essentials and affordable options, like frozen premade foods. Produce isn’t as fresh in those stores, so people will have to do what they can with the resources that are available.
INTERVIEWER: You’ve talked about working through barriers, like access to food, with your members at Pack Health. How do the barriers that adults are experiencing impact their household?
TAMARA: Yeah, at Pack Health we’re essentially coaching the parents. One of the most common barriers I hear is related to time and the perception of ability. I hear parents express barriers such as, “I don’t want to cook something special for myself – and just because I’m eating healthy, my kids aren’t going to eat the healthier foods,” or, “I’m ready to make a healthy change, but I know my kids and my spouse are used to eating a certain way.” They feel that in order to be healthy, they have to double their cooking to make themselves healthier options. But the funny thing is when you ask kids what they eat; do you know what they say? They say they eat what their parents put in front of them.
Ultimately, it is the parent who will decide what foods they’re going to bring into the house. If you continue to expose a child to healthier options, the child can ask for those healthier options. If access to healthier foods is an issue, as your Health Advisor, I can help you make a plan to make healthier choices with the resources you have.
INTERVIEWER: That’s all so true. So as you’re dealing with these issues both at work and in your volunteering, I’m curious: what do you think our role at Pack Health is in eliminating health disparities?
TAMARA: I think Pack Health plays a very unique role in eliminating health disparities because we engage people from all walks of life. We find out what is preventing an individual from living their best life, and go from there. Whether you have platinum insurance and found us through your employer, or no health insurance and accessed us through a grant, we’re providing the same personalized support. We’re asking about your barriers. We’re asking, what are the steps that you willing to take to reach your goals? And what do you think that you’re able and capable of doing to get there?
INTERVIEWER: Can you provide an example?
TAMARA: Sure. Say I have a member with a goal to manage their blood sugar. One of the things that the member needs to do is actually take the medications their doctor has prescribed. And very frequently, that’s not happening. As their Health Advisor, I’ll ask them what barriers are preventing them from taking their medications. If the member tells me they can’t afford them, we can work together to track down an assistance option and get them their insulin so they can start managing their blood sugar. If their insulin depresses them – for some members, it’s like a reminder that they’re sick, I can help them start thinking about it like a vitamin. Or if they’re concerned about side effects, I can coach the member on how to talk to their doctor about the questions they have. And if they don’t have a doctor, we will find a doctor or specialist that can help the member get the care they need.
INTERVIEWER: That’s huge and probably such a relief for the member. At Pack Health, what other resources are available for individuals who are low income?
TAMARA: We are a digital health coaching company, but we also know that all of our members may not have access to a computer or a cell phone. If they do have a cell phone, they may have limited minutes. As your Health Adviser, my job is to go through all that red tape that’s normally been a barrier for you and help you get the resources you need. Whether that’s mailing them to you or whatever the method needs to be, I’m going to find a way to make it happen. That’s what I’m here for.
We’re building that bridge of health equitya and working to get people on the same playing field. For example, I can have two members: one with a lot of money and another with lower financial resources. They’re both coming to the door with uncontrolled diabetes. Regardless of their differences, our goal is to make sure that both of those individuals get the care that they need and to improve health outcomes moving forward.
INTERVIEWER: That really puts things in perspective. What would you say is the most rewarding part of your role at Pack Health?
TAMARA: Having an impact on increasing someone’s life span is huge to me. No story is the same. Even though the behavior modification techniques are similar, the outcomes for each person are vastly different. Everyone has a story, everyone has their vision and everyone has the different barriers that may prevent them or slow them down reaching their goal. But, everyone has the ability to make a difference.
I think that that’s one thing that makes Pack Health different. We believe that you have what it takes. We know that you have what it takes. Your journey is not your neighbor’s journey. Your journey is your journey. Once you understand that, believe that, and know that [your Health Advisor] is not here to judge you or make you feel bad about anything, we get to help you figure out how to get you to be the best version of you that you want to be.
INTERVIEWER: Your perspective on barriers and health disparities, as a Health Advisor has been so insightful, but I want to come full circle and take us back to your volunteer work at the Minority Health Research Center. If someone wanted to get involved, what would that look like?
TAMARA: Providing financial assistance is always a great way to support a community program, because they don’t run themselves. We would love to expand to more schools and reach more kids, but it costs money to buy the supplies, like food for recipes and exercise resources. That’s a big challenge that we face in terms of keeping the programs sustainable. To donate, you can go to the Minority Health Research Center website. The Center is sponsored through UAB.
Finally, some of our biggest challenges stem from the ability to get more people on board. People aren’t as aware of the health disparities that exist in our own community. Most of us know some about nutrition and exercise, and their benefits, but I don’t think everyone’s as aware of the trajectory of how the two can impact your health behaviors and overall health. Health behaviors are developed in childhood and they follow you into adulthood. The sooner we increase more awareness about that, the closer we can get to eliminating health disparities.