Welcome to CHP conversations podcast series produced by the BC College of Health Professions. This series includes conversations with faculty, students and alumni who exemplify our mission to create influential leaders and help you. Hello and welcome to CHP conversations. My name is Mallory bucket with the College of Health Professions Dean's office. Our topic today is understanding health policy. And we're talking to our guest, Dr. Paige Powell. Dr. Powell is an Associate Professor of Health Administration and the MHA and MSH2 Program Director in the VCU College of Health Professions and noted health policy experts. She's been teaching for over 20 years in courses such as health economics, health policy and healthcare systems, health care quality and outcomes management, and interdisciplinary approaches to solving community health issues. Welcome, Dr. Paige Powell. Thank you for being here with us. Thank you so much for inviting me, Mallory. Absolutely. So first off, tell us a little bit about yourself. Where are you from and where did you grow up? Sure. Well, I actually grew up a little bit all over. I was born in Alabama and live there for the first seven years of my life, lived in Virginia Beach for awhile, moved around quite a bit growing up. My parents now live in North Carolina, so that's sort of home even though though I never actually resided there. And part of what brought me to Virginia. Awesome. And they're not far from here. Just neighbors, just a couple of hours away. That's wonderful. That's right. So as I said, we're talking about health policy. Can you tell us what is this and why is it so important? Yeah, absolutely. So health policy just mainly is focusing on the types of government interventions and regulations that impact the health care sector. Whether it can be at the state level, local level, federal level. Really, the government has a very large role to play in health care in the decisions that they make impact everyone's lives. Not just those who are on Medicare or Medicaid, but, but really all of us. And so to me, it's important that people have an understanding of just how pervasive, I guess it is, that how these regulations impact their daily lives? Oh, for sure. And that's one thing I will talk about that a little bit more about why it's so important to me because it's surprising how many folks probably just don't have even the fundamental knowledge of it, which hopefully we can try to fix that and starting to have more of these conversations. But can you tell us what led you to your interests in health policy and administration? Sure. So trying to think My father was used in the pharmaceutical industry when I was growing up. And so he was in sales and had a lot of friends who were doctors. Of course, as a child I thought, well, I want to be a Dr. turns out science was it my strongest suit? But I always loved all types of policy in high school. And even junior high did things with debate and student congress and other stuff where we will be talking about different types of policy. And so it was really just sort of a combination of that interest in policy and the interest in health care. That once I found out there was an actual major in it, it was really exciting to me. And it's like, Oh yes, this is what I want to do. So I think a lot of us come to health care management and come to health care policy. Thinking that we would take other paths in the healthcare landscape. And then realizing maybe that that's not what we're are where our inclination lies. And it was definitely that way for me. But once I started learning about the health care system, it was at the same time as President Clinton's initiative for health care reform. And so it was a really exciting time to be studying and learning about health policy and really getting a deeper dive and what some of the nation's problems are. Different ways that policy can, or maybe you can't helped to alleviate those problems. Yeah. So many different facets of it. And that leads me to my next question for you, given that health policy can address different components of health care. And we talked about, it is important for people to gain a better understanding. What are some ways that we can try to help our general public, the communities, be able to have that understanding. Well, I think the largest way that we can help communities to have a better understanding of health policy is to help guide them to resources and try to be as, as unbiased as possible. In terms of letting people read information, maybe answer questions for them, but allow them to make their own decisions ultimately about what's best for them and their families. I think that there are a lot of wonderful resources out there that people don't necessarily know about that are available on the Internet, their consumer advocacy groups, there's the Kaiser Family Foundation that compiles a lot of information about health and care and health insurance and other things. The public health sector has taken a little bit of a knock the last few years. And so I think it's important that we show that the information that we're provided is really grounded in research and grounded and things that not just that is grounded in science, but to really try to explain it in a way that people who aren't so wrapped up in this world are wrapped up in health care. Can understand a little bit better. And that's part of what I tried to do is boil down those major points into explanations that everybody can relate to. Absolutely, because we talked about making those decisions and being educated. So important and how can you do that unless you have that understanding of it? So we talk about health policy and there's different parts from public health, global health, mental health, to personal health care to name a few. The goal ultimately is to provide access to care for all these different populations. Can you speak to that a little bit and how, what are you seeing in terms of the trends? And are there specific populations that may have certain challenges as compared to other folks? Absolutely. So one of the issues that we have both in the Richmond area as well as across the country or major disparities when it comes to both health care access as well as treatment and quality. And so people who maybe ethnic, racial minorities are LGBTQ or lower-income, aren't necessarily getting the same resources as those who are in majority populations. Even if they are getting in the same resources, they may not have the same outcomes. Disparities both in terms of health as well as health care access. And that's something that I'm really passionate about. And trying to improve equity and to try to improve access to traditionally more marginalized populations. Because at least getting people in the door is a good first step to trying to eliminate some of those disparities. And the great thing that we are, we are fortunate in this day and age that we've got resources where now people have access, like you talked about a couple of minutes ago, access to things, not just from seeing folks in person but websites, the Internet. Are there any particular resources that you find helpful for folks in different populations? Things that people can access at their fingertips literally to help them. A good question that I hadn't really thought about before. There is a wealth of information that's out there and part of it is trying to determine what's good information. And there are offices within the Centers for Disease Control, the National Institutes of Health and others that are dedicated to looking at health disparities. There's a group called the Patient-Centered Outcomes Research Institute, PCORI, that does a lot with different types of disparities and trying to address disparities. And it's work is really designed around. I'm trying to have the patient be an integral part of the care team. And really taking the patient and family members perspectives into play when it comes to making decisions about health care and improving healthcare quality. And some of their resources may be geared a little more toward a lay audience, more so than, than some of the government sites that you might find. Kaiser Family Foundation that I mentioned earlier also does a very good job of sort of laying things out pretty simply. And ways that people who are non-health care practitioners can understand. And I think a lot of times that's the key is, you know, losing some of the jargon and really trying to draw comparisons to things that are outside of health care to help people understand the implications of the different regulations and policies that the government enacts. And I started having conversations once the Affordable Care Act was passed with friends and others who would be like, Well, I heard this on the news. What's the real thing or what do you think about this? And I would talk to them a little bit about things that the law entailed and really try to explain it in a way that Even though it's a very, very complicated law, sheriff's or a boy that boiled it down to the essentials. And that's what I feel like my job as a teacher is for my students as well as for other people in the community. Sure. It's great to see that there's a way that we can encourage people to ask questions because a lot of times people might shy away from things because they might be intimidated or not really be aware of something. But it's that I think that approach is super helpful. Now, tied to that a little bit, do consumers have the ability to help shape health policy? Absolutely. I think consumers can shape health policy and a lot of different ways. So the most important initially or maybe one area that's going to gain quite a bit of traction is of course, contacting your congressmen and senators, whether it's at the state or the federal level when there's something that you're interested in. And I call goes a lot further than an e-mail, then goes a lot further than a letter. Our representatives want to hear what the public are thinking. But in general, consumers are very diffuse group and haven't traditionally had a lot of power in the policy making process. But one of the ways to leverage consumer power is by developing sort of interest groups around either certain diseases or certain topics or certain areas. So one of the best examples of that is breast cancer research and survivors and family members of breast cancer. Patients have done a wonderful job in terms of influencing policy in the United States. Whether it's the amount of funding that the National Institutes of Health receives for breast cancer research through the Susan G Komen Foundation and their walks and the different things that they do. Other ways of. Most states have laws that require insurance companies cover breast cancer coverage and things like that. And so it's one example of a group of consumers, doctors, and others that have rallied together around a disease and have power in numbers that way. So it's a lot harder when you're talking about general access to care or that type of thing. But there are ways that consumers can, can come together, usually around a more narrow interests. Yeah, Those are great examples because we're so familiar with those causes. Having you celebrate breast cancer awareness month, everyone knows. October, I have a little one who six-and-a-half, and she recognizes the pink ribbon. She says Mommy breast cancer awareness. So starting them at a young age is also key. I'm happy to hear that. And not having thought in that frame of mind, how effective that is for a lay person like myself. So I believe it really is important to make people aware of some of these issues, especially when they're younger and like the little ribbons for breast cancer, for MS, for other things that really are one way to show everybody that this is something that we all should be concerned about right now. Granted, we don't can't be involved in every every movement that there is a sure. And so some of it, I think the benefit of rallying around a narrower areas that you're able to impact more specific policies that way. And really get a group of people together that are all passionate about the same things. You don't necessarily have a lot of competing interests. And then that helps to leverage that into votes and other things that we need to be successful in terms of advocating for health policy. That is such an excellent example. So glad you brought that up and it works. Just thinking about like the young ones, it really doesn't work. I mean, it's so realistic it makes sense because for someone to come in and say, well, you can't, you can't just say, oh, I'm going to change everything about what you know and have a general topic starting specifically with something that is of interest to you or you're passionate about. That makes complete sense. So thank you for that. I don't want to tell people they can't change the world. Well, and I'm sure anyone could do it if they put their mind to it. But having that, managing expectations and believing in something is definitely a start for someone who really doesn't think that they could make a difference. So that is excellent. I love that piece of it. So Dr. Powell, as health care educator, what do you believe are some ways to ensure effective implementation of health policy? I think the, the ability of educators lives and in our expertise or our credibility that comes from that expertise. And so I think it's a matter of when we are advocates that we try to be as clear as possible about what the science is behind our advocacy or views, right? I think that we definitely should use that power. That we have if you want to call it power, but, or at least that ability to try to influence policy. But again, it's part of being transparent and Sure. Yeah. I think also sometimes admitting that we don't know everything when it comes to things e.g. like COVID, public health experts were learning day by day and contradicted themselves at different points because we learned new things and the communication of that and the understanding that, yes, we may be experts, but we still don't know everything. I was still learning things. I think we need to show that kind of humility that says, you can trust us because we're going to tell you what we know and what we don't know. So I see that partly as my role as well as as a health policy researcher, as somebody who may advocate for certain policies is to, to be able to say, I don't necessarily know everything there is to be able to talk to you about what I do know. And so that's another thing, at least me personally, I'm very conscious about the types of things that I will comment on, onto news or talk about or those types of things because I don't want to be presenting myself as an expert for something. If it's if I haven't done the research and if it's not something that I'm as familiar with in terms of implementing health policy. Part of the way that we learn is from things that have occurred in the past. And so it's really helpful to look at health policies that have come before and what are the intended consequences? What are the unintended consequences? What types of things did we learn from that? And also what can we learn from, say, other countries or other states? What are others doing that is worked. Then that allows us to do better research in the future on policies that maybe you're being proposed but haven't been implemented yet to say, well, okay, well maybe we need to watch out for this unintended consequence. What something else that we can add to the legislation or to the regulation, maybe to try to limit those unintended consequences. How can we amplify our message? How can we make the policy more, even more effective in terms of the implementation process? So the researcher's role I think plays into not just implementation, advocacy those areas, but, but also in trying to learn from the past and do better in the future as a result of what we've learned from the past. And again, drawing that parallel with things that we do in life, learning from what did and did not work in the past. That all make sense. I should probably take a class of yours because maybe I'll feel that I can actually understand because of the way you explain it, it makes so much more sense. And I'll be honest, you know, being an adult and a decision-maker in my household, usually a female takes a prominent role in health care decision-making. I tend to get intimidated because I don't necessarily understand. But now I'm seeing just in these few minutes that I probably just didn't allow myself to open up the possibility of learning because I'm looking at it from a different lens. So thank you. And there's different lenses. I appreciate that. Sometimes I think and a lot of fields we can become very insular and we don't necessarily think about what are the people that are outside that maybe aren't steeped in this world. What are their questions, what are their concerns? And so to me, I feel like it's helpful to hear from others who are outside of the health policy realm to try to learn what's important to them, what concerns are absolutely well as to clear up some of the confusion about different policies, we all know there's a wealth of information that's out there, especially on the Internet. Some of it's good. It's not good as it can be very difficult to try to determine what that information is that really is factual important and helps to inform people without misleading them exactly. And it goes back to your earlier points about the importance of educating our publics. Because the last thing that any consumer should be doing is making those types of decisions when they don't have all the information or where they're typically wearing, you're a healthcare situation if it's not, even if it's voluntary, some type of voluntary surgery, there's a lot of stress that's involved. So I'm glad that you're really opening my eyes and mind to knowing that I can learn about these things and not necessarily have to be an expert about it. Just be more aware and embrace the things that are. Impactful to my life. And so I think that will resonate with a lot of folks who are listening to this. I appreciate it. Yeah, absolutely. So can we talk about your research? And I'm going to hope I can get this right. Let's see. Your research focuses on building capacity for patient and family caregivers to work as a team with researchers and providers to improve the care of African-American cancer patients. So first off, tell us a little bit about the research which I can tell by looking at the smile. And I know you guys can't hear that out there listening, but I can tell that Dr. Powell was very passionate about this. Tell us about that and talk about any specific life experiences or pointing or education that drew you into focusing on this? Well, I came to looking specifically at cancer disparities with African-Americans when I was living in Memphis, Tennessee. And there was a newspaper article that showed that black women with breast cancer had four times the mortality rate of white women. And to me that was just a shocking statistic and exploring the matter a little further, we realized that it wasn't just breast cancer, but it was all major cancers where the mortality rates for African-Americans were a lot higher than they were for white. Me, personally, my grandmother died at age 60 from colon cancer and it was because she didn't go to the Dr. she my mom was the first person in her family to go to college, so they weren't very educated, didn't know a lot about health care and my grandmother didn't have things checked out until it was too late. Yeah. And so that gave me a passion for looking at cancer and then just realizing how large the disparities were was something that I thought I wanted to be a part of solving that problem. But I mentioned the Procore, the Patient-Centered Outcomes Research Institute before. And part of what I really love about that organization and about this way of thinking and looking at health care is that it's not somebody coming in to save a group or a community. This is really trying to learn from communities about what their needs are and have them find the solution. Through my research and my expertise, I can help them to find the solution. But ultimately, it's, it's coming from the ground up. More so than a top-down approach. And that's what our work in Memphis did. We developed a team of patients and family caregivers with a couple of providers, nurses, social workers, and focus support group areas. A couple of ministers as well that came together and developed focus group questions and things like that surrounding the researcher and patient and the Dr. and patient relationships and cancer care. And so these were all African-American patients and family members and other community members. And they really guided the development of the questions. The training that we ended up developing as part of this award for researchers and patients. And we found that a lot of the barriers for cancer care with African-American patients had memphis was related to more interpersonal aspects of care. They didn't feel respected, they didn't trust their doctors. There were a number of things that they believed were either discriminatory or I'm just that their doctors didn't necessarily understand why they didn't have the cultural competence really to understand the things that were of concern to the African American patients and the interventions that we developed in the programs that we've developed are really designed around improving trust, improving communication, showing that respect to communities and to people as individuals for what their concerns are, what their needs are, because those are different. No two patients are alike. And really trying to get both researchers and providers to see that. We've got to let the patient be a primary member of that care team. Yeah, absolutely. And when you talk about that, we've got we talk about things like bedside manner and empathy and knowing that it's great if a person has a skill to do something to heal. But a big part of that also is that connection and understanding of where they're coming from, what their experiences are, what they're going through. Because I do believe and I'm learning myself that that plays such a huge part in if that part is missing, that could make a huge impact on how they go about their care. And then just the entire I guess the patient experience as a whole. So how important that is? Well, once you've lost a patient's trust, you can regain it, or at least it's very, very difficult to amend that relationship. And patients do have a lot to do with their own outcomes. Yeah, medical care, it's estimated only contributes ten to 20% of our outcomes. There are things like genetics and lifestyle and environment that also play a role. And part of that is related to our mental health, related to how we see ourselves. It's related to our family, some board and our community support, many of which are things that the Dr. themselves can address. Sure. We're getting better at looking at these things that we call social determinants of health, of the role that housing or transportation or food or environment and others play in our health and our health care. Providers really need to learn to listen to the patients because they're the experts on themselves, or listen to the patient's family members because they have experiences that they know about that the doctors don't necessarily that can inform that care delivery. Now, I'm not saying that providers need to do everything that the patient asks of them. Of course, they're experts in their own fields and have that, but it's more of a give-and-take and learning how to listen to patients and families to try to improve the care process for everyone. And then that should in turn improve our outcomes and make us healthier as a result. Absolutely such a critical part of it all. So we've talked about you being an educator. I do want to hear a little bit more about this because it's so important. Can you talk about some of your most rewarding experiences? I'm sure there are many. But what stands out to you is that having been an educator for this time in your career? Yeah. For me, it's all about seeing where the students end up, you know, 51020 years down the line. And knowing that I played a small role, maybe in what they're doing for themselves or their communities. I think back to students that I've taught over the years that I'm still in touch with. And they'll they'll text me or email me if they get a new job or, you know, tell me about other exciting things that are going on in their lives. That personal connection to me that's the most rewarding. I think. I've had students who have won national awards, students who have done well in these competitions that we attend. Students who have earned incredible scholarships and have other opportunities, and students who are making very real differences in people's lives now. And so it's really hard for me to point to just one moment and say, This is why I do it there. Sure, there's 20 years of moments that, that are about why great day enjoy this. And it really is about seeing people grow and succeed. Yeah, Thank you for sharing that. And is there anything you hope that students will take away from time spent either interacting with you or in your programming, your classes. I hope that they, they see that I care, that I care about them as people as well as students for me personally. But I also hope that they take away that they can impact change. And it may be as part of a larger voice. But what they should be doing with their careers is trying to make patients lives better. And there are a lot of different ways to go about it. But ultimately as healthcare managers, as health policy analysts, whatever the role may be, the goal is to make your humanity better. Improve health care, improve the system. Advocate for policies that help people try to make hospitals and doctors offices and other care providers the best that they can be. Because ultimately, we're caring for people and we're relying on a workforce of people all take care. That's our community. And so to me, that sort of touch of understanding where they're coming from or even them seeing where I'm coming from on issues I think is really important to me. And I talk a lot about my parents health issues, even so about health issues I've had in the classroom because I want them to see that everybody is impacted by absolutely right, by health policy in one way or another. So I hope that I'm making it more accessible. And the way that I teach and the things that I teach them. Dr. Powell, we thank you so much for taking part in this conversation with me. I thoroughly enjoyed this. And I really do believe that a lot of everything that you said is going to resonate with our audiences. Thank you for being a part of CHP conversations. Thank you so much, Mallory for inviting me. It was pleasure.