Home Original Podcast: COVID-19 and Healthcare Disparities in Minority Communities
Podcast: COVID-19 and Healthcare Disparities in Minority Communities

Podcast: COVID-19 and Healthcare Disparities in Minority Communities

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Podcast with Dr. Bjorn Mercer, Program Director, Communication, Philosophy, Religion, World Languages and the Arts, American Public University, and Dr. Ginger Raya, Faculty Member, School of Health Sciences

The COVID-19 pandemic has severely stressed the U.S. healthcare system, with large numbers of patients and not enough healthcare providers, personal protective equipment (PPE), and testing sites. In addition, COVID-19 has highlighted the major healthcare disparities present in minority communities.

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In this podcast, Dr. Bjorn Mercer talks to Health Sciences faculty member Dr. Ginger Raya about her experience as a Hispanic woman living in El Paso, Texas. Learn about issues of diversity in healthcare, how COVID-19 has complicated access to healthcare and the prohibitive cost issues to receiving healthcare. Dr. Raya also talks about ways to address such disparity including the need for people to recognize their own privilege and biases, how to recognize and address microaggressions, and how to improve your emotional intelligence.

Read the Transcript

Dr. Bjorn Mercer: Welcome to the School of Arts and Humanities at American Public University System. My name is Dr. Bjorn Mercer. And today at the Everyday Scholar, we’re talking to Dr. Ginger Raya, adjunct faculty in the School of Health Sciences at American Public University System. And today, we’re talking about chronic disease management and healthcare disparities in minority communities. Welcome, Ginger.

Dr. Ginger Raya: Hi, Bjorn.

Dr. Bjorn Mercer: It’s really great having you, and I’m excited about this conversation. And not to spoil anything, but I’ll just jump into the first question is what are the healthcare challenges in a place like El Paso, Texas?

Dr. Ginger Raya: Well, in El Paso, Texas, we are a border community and we tend to have a lot of uninsured patients. I think if we’re lucky, we have patients who are on Medicaid and Medicare, and then we have a smaller proportion of privately insured patients. So there’s always the issue of insurance coverage and then secondary, there’s also the issue of access to healthcare.

With the physician shortage, the nursing shortage, it is a real issue to sometimes find the care that you need. I think those are the preliminary issues outside of chronic disease management.

Dr. Bjorn Mercer: Thank you. Can you give people some context of where El Paso is and kind of the demographics of El Paso? I think most people have heard of El Paso, but they might not know specifics.

Dr. Ginger Raya: So El Paso is a border community in Texas. We border with the Mexico border and New Mexico. We call it a tri-state area. The population in El Paso is primarily Hispanic.

So I think it’s like 85%, 90% Hispanic. We’re in a Southwest region, so it’s a lovely dry desert area that we’re located in.

Dr. Bjorn Mercer: Thank you for that information. I’m just looking at some stats. In 2017, it says it’s about 82.8% Hispanic, which I think for most people in the U.S., they don’t live in communities that is predominantly Hispanic or any other population that we would typically call a minority, maybe except Brownsville, which is right on the border. So in El Paso, what is it like living in a city that is majority minority?

Dr. Ginger Raya: I think in the Hispanic culture, we have a very strong kind of family community-based kind of sentiment. We’re very close to each other. We’re very connected. We’re a very warm and generally loving society.

I know we have a large military base here, so we do have a lot of, I don’t want to say transitory, but we do have a lot of influx of different types of cultures that are constantly going through the community and adding to its beauty. So I do think that anyone I’ve talked to who’s not from the area absolutely will attest to the fact that it is a very welcoming place and that people easily feel like they fit in here.

Dr. Bjorn Mercer: And I have to completely agree. I was raised in El Paso, so I spent probably ages five until 18 in El Paso.

It was a unique city. I loved growing up in El Paso. It’s one of those places that for some reason, the rest of the country doesn’t quite pay attention to that much.

When El Paso, I think as far as a community and how people live together and just come together as a community, the rest of the country can learn a lot from. This transitions to the second question. Can you describe your experiences traveling around the U.S. coming from El Paso, especially when you travel for say healthcare and finance conferences?

Dr. Ginger Raya: I would say because I was born and raised in El Paso, I’ve spent my entire life here, I didn’t realize that I was Hispanic and that sounds silly to say. But it wasn’t until later in life when we start to travel either with my family, but especially for work and professionally, that’s where I really felt like the experience I had growing up here was that I had been very sheltered from the idea that I was a minority and that I was different because I was part of the majority in El Paso.

I have a healthcare background. I’ve been in healthcare for almost 15 years. Consequently, I have some finance background and I do travel for a credit union, which I’m on the board of directors for. I can tell you that when I go to healthcare conferences, oftentimes I look around and I try to look for people that are like me.

Is it just me that does that? Does everybody do that? But I kind of look around for other Latinos.

I realize that is a broad statement because Latinos come in all colors and it’s not necessarily that I can easily identify them, but I do tend to look around for similarities, for other people that look like me, right? In healthcare, I find that I can find Latinos. It’s not as easy for me to identify with others in a way that I can say they’re like me.

But where I really felt the difference, where I really felt different, was when I travel for financial conferences, the majority of the time, I don’t even default to looking for other Latinos. I’m just generally looking for women. Where are the women at these financial conferences?

The last conference I went to, I think I was lucky if I counted a dozen women in a several hundred member conference. So the majority of them were older white males, generally. So that’s kind of how I’ve felt, like I’ve experienced some differences coming from El Paso and realizing I was a minority.

Dr. Bjorn Mercer: That’s a great observation, very true observation. Growing up in El Paso myself, I am white and I grew up in El Paso. I think that that was an extremely formative and very important experience for me because I grew up the minority as the majority in El Paso.

But then there’s also the conversation you can have of course, of being quite still in El Paso, certain experiences you will and won’t have happened, but just the fact that in a city like El Paso, again, from my respect, everybody basically got along. Everybody was there together.

It’s one of those cultural things that to me was very special and important. I really liked how he talked about traveling around to the rest of the country. I had a similar experience when I went to college, because I just expected the rest of the country to be as diverse and accepting as El Paso.

Then when I went to other cities, especially say in the old Iron Belt, I’ll just describe it that way, I experienced not as accepting as a culture. There’s a few things I would have to follow up on, including that.

First, can you kind of give an idea of the incredible diversity that is in Hispanic culture in the sense that not everybody’s from Mexico, not everybody’s from Guatemala, from Costa Rica, or go to Argentina? And can you explain why it’s important to have more representation, especially in a field like finance where typically, or historically, or for whatever reasons more white males have gone into it and how it would help to have other people that like Hispanic females that go into finance?

Dr. Ginger Raya: So I think as far as diversity, it’s really interesting because again, depending on where you see your ancestral origin coming from, that will very much shape how you identify. I think part of being open and accepting to diversity is that we not try to stereotype or put people in a box and say, “No, you’re Hispanic” or “You’re Latino.”

We have to be open to everybody’s individual backgrounds. That’s interesting because recently, this kind of new terminology arises, I don’t know how recent it is, but the concept of Latinx, where it’s a fluid type of association so that you don’t have to say Latina or Latino, it’s just kind of an all-encompassing thing. It’s important diversity-wise that we’d be open to everyone’s differences, so that’s the first point.

My second point in regards to having more representation I think that we see it everywhere. In healthcare, in finance, in healthcare, for sure, when you have a physician who you associate with as being similar to you, I think your experience is different.

You kind of feel like you’re able to express your concerns a little more easily and that healthcare professional will be able to identify with what you’re speaking to. So I think in healthcare, it’s very important that we continue to have more of a diverse background.

Culturally, I think for Latinos, it’s important for our healthcare professionals to understand what they’re dealing with. When we talk about chronic disease management, I think that’ll be an important place to kind of expand on that concept.

As far as financial conferences, so I’m on the board of directors for a credit union, which is essentially a co-op. So my role on the board of directors is that I do what’s best for credit union members. Part of that is that we do have a diverse board of directors and that it not just be one specific demographic.

We need to have a variety of board members because we make decisions financially and economically that impact the community and our members. It’s so important to have diversity at that point because at that point I can say, “Hey, what about individuals who maybe are not as educated?” or what that does to them in regards to things like credit and applying for loans and thinking about that conceptually in regards to a diverse background.

So I feel like it’s super important that we have diversity in healthcare and in finance because ultimately, we make the best decisions for the majority of people as opposed to just one subset.

Dr. Bjorn Mercer: I really liked how you said that is having that diverse perspective or people helps you make better decisions. It’s one of those things where it’s hard to imagine why people don’t understand that besides for some reason, people can’t quite understand multiple difficult topics at once.

So that brings me up to privilege. When you are say “part of the majority,” if you’re white, say, even in El Paso, you oftentimes don’t have to think about things. What that means is it’s a privilege to just not have to worry. Now, for other minority communities, this sounds simplistic, but why do they have to worry about things?

Dr. Ginger Raya: I’ve had the discussion of privilege with a lot of my peers in healthcare and in finance and what I tell them, especially if they’re not a minority, is that the concept of privilege is that there’s nothing wrong with the fact that you have privilege. But what’s key is that you understand the role that you play because you do have that privilege.

When you think about privilege, it’s not a choice per se, like I wake up one day and say, “Okay. I’m privileged.” It’s something that has been allotted to you. You were born with it either because of the way you look, your socioeconomic background.

There’s nothing wrong with privilege in it of itself, but you need to understand and recognize when you do have it because at that point, you understand why others do not and why they’re not afforded the same opportunities as you, second chances, availability, access. That is the role that privilege has, and it’s important that we recognize when we have it.

Dr. Bjorn Mercer: That’s a really great explanation. I always like to describe it as for me, I recognized my privilege in the sense that I grew up in this country. I grew up in El Paso, so white, typically Finnish, Swedish, Norwegian, kind of put those countries together. That’s kind of what I looked like.

So I’ve been able to walk in and out of restaurants, in and out of department stores and nobody will notice me. So in a sense, that is a privilege because then the cops don’t notice me. There’s no negative attention that is put upon me. That is actually a privilege versus for, say, other populations.

Unfortunately, because of bias, people will be noticed in the wrong ways. There’s many other studies that I wish I could rattle them off, but I can’t where people’s biases when they see, say, a white face versus a different face, they’ll assume more wealth or unfortunately, even more intelligence just because of the biases we have, which come from a culturally imbalanced world. Would you want to add anything to that?

Dr. Ginger Raya: No, I agree with you. I think that growing up in El Paso, I think the one time that I kind of noticed that variance, like if I go into a store, people will frequently speak to me in Spanish and that is not my primary language.

It’s absolutely something that I work on improving every day, but there are times that people just talk to me in Spanish because they assume that I’m primarily a Spanish speaker. So I think that’s what your example kind of reminds me of and I do feel it in some ways.

Dr. Bjorn Mercer: Yeah. It’s one of the challenges of and part of the reason that I was interested is is I originally read your blog post about microaggressions. That’s one of the things that we always have to think about is I think sometimes in general, white folk don’t want to think about or accept the fact that they do have privilege because like you said, they’ve worked hard, their entire lives.

Nobody gave them a check for a million dollars and then suddenly they’re rich, but it’s not about per se working hard, or it’s not about how wealthy or not wealthy you are. It’s about existing in a country where unfortunately, the way you look either gives you some advantages or disadvantages. Is there any way you can think of how your average person can work on these biases to try to help out in some way?

Dr. Ginger Raya: In that blog post about microaggression, I frequently write about the role of emotional intelligence. Essentially, this means that you’re reflecting on a situation, how you’re reacting to things.

Part of being an emotionally intelligent leader is that you also reflect on your privilege, on your bias. And we all have bias. We all have some level of conditioning. It’s part of our culture, whatever it is. We all have some level of bias. So being emotionally intelligent leaders, I think that it’s important that we do recognize that we have bias and/or that we have privilege.

This kind of helps to open up the idea that you’re aware of it; you’re self-aware of it. And at that point, you can reflect on how others are acting or reacting and that you can understand and reflect on why they are having that reaction.

So in that blog post, I talk about the Black Lives Matter movement and about how saying “all lives matter” is a microaggression, and it’s meant to diminish or to make someone else feel inferior and the role that you play as an emotional intelligent leader in understanding how your perspective frames that. So I think calling it out, understanding it, is the first step in understanding your own bias.

Dr. Bjorn Mercer: Let’s jump into the third question. How has COVID-19 complicated access to healthcare? Example, amplified the need for chronic disease management, such as diabetes, obesity, heart disease.

Dr. Ginger Raya: So we definitely know that you are more susceptible to have adverse complications from COVID-19 if you do have those type of chronic disease management issues like diabetes, like obesity, like heart disease. I feel like in a community like mine, that has definitely amplified it.

For example, our free testing for COVID, now they’re doing daily testing at rec centers and they only have 500 tests every day. So you drive around and the line goes for miles and miles of people needing to get access.

When I saw this, my first kind of question was, well, why not just go to your PCP or call your urgent care to see if they have testing? Recently I, myself, was afraid that I had been inadvertently exposed. So I went ahead and called my local urgent care, went in, got ready to get tested and in the period where I was waiting, I heard a patient come in and ask what the cost of the COVID test would be if she didn’t have insurance.

The receptionist told her that it would be about $250 if she wanted to get tested that day without insurance. I was astounded because $250 for someone who doesn’t have insurance, there’s a lot of implications just for that and that’s a lot of money for most people.

So it definitely makes sense why people are opting to get the free test, why they’re waiting instead of getting tested quickly, so that they can try to manage their symptoms, manage any implications of this. Again, if you don’t have insurance and you get a positive test result, what are you going to do if you need care? You’re going to hold off till the last minute because you don’t want to go to the emergency room, or you don’t want to take the hit for the cost of an emergency room or an urgent care.

For most of us who have insurance, that cost is even substantial. It’s $250, $500 to go to the emergency room. Now, imagine if you don’t have insurance. So I think that’s definitely amplified the situation.

Again, there’s not enough tests, I can tell you in my perception, in my community. I feel like if COVID was not front and center right now, there’s so many more issues that we have. There’s such a limited amount of physicians I can imagine in any community, much less in a border community like we have an El Paso. I frequently hear people or patients talking about how they wait all day to be seen by their internal medicine physician.

They’re likely to be there hours, hours in a room full of other patients. They’re lucky if they get a five-, 10-minute face-to-face with a physician. Then at that point, what happens? You get lost in the mix.

I feel very fortunate that I am in healthcare. I’m able to kind of direct my family where they should go if they have problems with the refills, but a lot of people don’t have that. It’s just amplified the situation in my mind to just the fundamental issues that we have with access and not enough access points.

Dr. Bjorn Mercer: There’s a lot to unpack there, and I completely agree. One of the things, obviously the free COVID tests are important, but even, I think yesterday, I saw that there’s an eight-hour wait in El Paso for the free COVID test. Obviously, you need to get tested if you feel like it because if you don’t and you do have it, you’re going to spread it to other people.

That’s only going to tax the healthcare system more. That’s not even talking about post-COVID syndromes and post-COVID complications, which can go on for months and months, which will tax the system even more. Even if when you do have insurance and I’ll say, even my family, when something happens, we’re like, “Okay, how much is this going to cost us?”

Because like you said, $250, $500 is, well, I guess, better than $2,000, but if a family is poor, $200 is a no-go most of the time. So they’re not going to do that.

It reminds me of discussions of higher education when people are like, “Well, it’ll just be $200 for some extra textbooks or something like that.” For poor families, they haven’t budgeted in that $200. So access to higher education could be killed by a $200 bill.

With healthcare, it’s so important because if you get COVID, you could spread it. So even if you’re, say, in your 30s or 40s and you’re asymptomatic and you’re fine, you can spread it to your grandparents and they’re the ones who are truly at risk, or you could spread it to somebody who has healthcare complications and they could be at risk.

Without getting political at all, this is one of the, I would say, great shortcomings of this pandemic is access to testing to ensure that we at least know who has it and where we need to go with that. Is there anything else you’d want to talk about as far as chronic disease management, say, in El Paso that you see?

Dr. Ginger Raya: In El Paso, I think with us culturally, like our food is not necessarily the healthiest a lot of times. When we’re talking about obesity and diabetes, there’s a need for nutritional counseling.

And again, that’s another example of limited access. Even as a healthcare system, you may not have an abundance of nutritional counselors available to help your patients.

It’s such a big problem. It’s such a cyclical problem. I’m sure that our community in that sense, is not greatly different from other communities. But chronic disease management is absolutely an issue here and diabetes, obesity, heart disease is absolutely prevalent. And I feel like that’s making it very complicated in a COVID environment.

Dr. Bjorn Mercer: No, I completely agree. This transitions to our last question. We’re both from El Paso, so what else would you like to add about growing up in El Paso and why it’s such a unique city within the U.S.?

Dr. Ginger Raya: So I’m not proud of it, but I’m a foodie. I have to tell you that in El Paso, we have, again, a wonderful culture, a welcoming community, but we have some of the best food. I think that’s definitely something that helps to make others feel welcomed, that we have that similarity that we can appreciate things like good food.

I also feel like growing up in El Paso definitely gave us access to that tri-state blend of culture and that you do have access to a lot of Mexican influence as far as culture, as far as the food, things like Dia de Muertos, things like that that are very enriching and that anyone can enjoy and value and understand.

Even with our New Mexico neighbors, they also have a very different cultural vibe, definitely Southwest. But there, you see a very different type of Spaniard-type influence. Their food is regionally very different.

I love there’s all these vineyards and all this greenery. And New Mexico is just such a beautiful, lovely place also to be able to take advantage of their culture and be very blended and just a great place to live.

Dr. Bjorn Mercer: I would completely agree. Growing up in El Paso, just the food has been the best. The Hispanic food in El Paso has been the best I’ve ever had in this country. I’ve lived in Arizona for a while, and it doesn’t really compare to El Paso.

New Mexico is also just a great, great state. And Arizona, where I live now, is also interesting, but it’s just not the same as El Paso. When I look at the demographics, I was in Tucson for many years and that’s about 50/50. And I’m in Phoenix, the Phoenix area where it’s about 40% Hispanic, it’s a different experience than living in El Paso.

In Arizona, I’ll just say having certain complications, or I try not to get too political. Having a sheriff like Joel Arpaio for so many years complicated things.

This leads me to my final question. Where is the status of, say, Hispanic political power in the U.S.? Because it seems like in the general U.S. political conversation, there’s more talk about Black people going into political power on the national level emphasizing, say, by Hispanics going into political power, even though the Hispanic population is the second most populous in the country.

Dr. Ginger Raya: I think that’s a great question. As far as civic engagement and civic leadership and the role in growing that interest, I think has been very prevalent, especially in the current political climate. I definitely feel like as a Latina, the focus has been more like, “Hey, we need more women to run for office.”

So I definitely feel like firsthand, I’ve felt the implications of that. I have to tell you that my teenage son was recently selected to participate in the National Hispanic Institute. I wasn’t quite sure what to expect from that experience, but he has come back to us after each of his sessions. He gets ready for something called the great debate, and they talk about social justice and the social implications of not having representation in a political sense for the Latino community.

So I was very taken aback because my son’s a 14-year-old, and he’s talking about social inequity and social injustice. I’ve been very blown away about what that kind of access to knowledge has done for a younger community.

So I’m very proud. I’m very happy that perhaps this political climate has encouraged more of that type of participation, but I’m very excited about what our youth potentially are being exposed to and how living through this political climate, living through all these social injustice movements is framing their perspective. So that leaves me with a lot of hope and a lot of optimism as to what we will continue to see as we, ourselves, age in this community. So I’m excited.

Dr. Bjorn Mercer: That is exciting. It reminds me, and I need to find these stats exactly so I apologize if I say them incorrectly, but since the founding of the U.S. there’s been, I think 11,000 representatives to Congress, House of Reps and Senators. And there’s a stat where like 98% of those people have been white.

So historically, if you look at the country, it’s generally been represented by white folk, even though there’s been plenty of other people in this country. Today, because of the protests and greatly sparked on by the killing of George Floyd, there seems to be a change in the conversation, which is only for the better and the best way to make change is for people to get involved.

That’s so great with your teenage son because political power, even though, or I shouldn’t say political power, political representation is important because it changes the dialogue. Most importantly, locally people oftentimes focus on national elections, but the local elections that’s really where the meat and potatoes are. So it’s so important to get engaged locally.

Dr. Ginger Raya: Bjorn, when I think about the political arena and even what it means to run for something like the local school board, there’s an element of funds that you need to have access to which, in my opinion, keeps a lot of people from running for office. At one point, I was thinking like, “Oh, maybe I should run for the school board.”

The next time, it was up for election and I had reached out to a friend of mine whose husband had run for district attorney just to ask her like, “Well, how much money?” And she’s like, “You need like $8,000 to $10,000 just to start. Plus, you’re going to need to fundraise.”

When you talk about privilege and socioeconomic implications, that’s a lot of money. Do I want to invest $8,000 of my own personal funds and then to possibly lose an election, you know? So that again, I think is a big reason why a lot of people don’t run for office and aren’t more positioned to take over those political roles because of how privilege and socioeconomics plays a role in even getting you through that door and to be set up for success.

Dr. Bjorn Mercer: I completely agree. It’s one of the privileges. Going back to privilege, like you said, political dynasties are dynasties because they have a last name that people recognize.

Oftentimes, rich folk go for a political office because $8,000 to $10,000 is nothing to them. But if you have a family where they’re hesitant to spend $200 on a COVID test or if $200 can crash them out of college, not because they don’t want to.

Because they just don’t have $200, how are they then going to run for office? There’s plenty of examples of people who have worked hard. This is not about working hard.

People whom say are on the lower end of the economic status work hard. They work harder than I can imagine what I work in my office. I type away all day at the computer. That’s working hard, I guess, but it’s not working hard.

Being able to go from poor to rich or to having political power is rare. I would say, unfortunately, the powers that be like to say, “Look, here is an example of this person. They did it.”

Well, sure. But let’s also look at the 80% of all the other people who had that privilege and used that privilege to then get elected. So, Ginger, thank you so much. Any final words today?

Dr. Ginger Raya: No. I just want to thank you very much for having me on the podcast. I really enjoyed speaking about the community and ways in which we can recognize privilege, be emotionally intelligent and help to create a better environment for everybody.

Dr. Bjorn Mercer: Excellent. Thank you, and it’s been absolutely wonderful talking to you today. Today, my guest is Dr. Ginger Raya from the School of Health Sciences at American Public University System. And my name is Dr. Bjorn Mercer, here at the Everyday Scholar.

About the Speakers

Bjorn MercerDr. Bjorn Mercer is a Program Director at American Public University. He holds a bachelor’s degree in music from Missouri State University, a master’s and doctorate in music from the University of Arizona, and an MBA from the University of Phoenix. He writes about culture, leadership, and why the humanities and liberal arts are critical to career success. Dr. Mercer also writes children’s music.

Ginger RayaDr. Ginger Raya is a faculty member at American Public University, teaching graduate-level courses in healthcare administration. She is also a Market Manager of Physician Services Group at HCA, where she specializes in ambulatory operations, as well as acquisition and employment of healthcare providers and their practices. Dr. Raya is an experienced faculty member and a course developer in healthcare administration for over 11 years. She is a certified career coach specializing in helping graduate students find meaningful careers in healthcare and is also certified as a Harvard ManageMentor in Coaching.

Dr. Raya has a bachelor’s degree in organizational communication and a master’s degree in public administration from the University of Texas at El Paso. She also holds a master’s degree in health care administration from Texas Tech University Health Sciences Center. In addition, Dr. Raya holds a Doctor of Education in Organizational Leadership from Argosy University. Her dissertation title was, “The Role of Emotional Intelligence in Reducing At-Risk Behavior in Latinas.”

Dr. Raya was competitively selected and is a graduate of Leadership Texas (Class of 2015) a nonprofit social enterprise that is a nationally recognized, preeminent women’s education organization through Leadership Women, Inc. and was selected to participate in Leadership America, 2021 cohort. Dr. Raya was elected to serve on the current Board of Directors for the American College of Healthcare Executives, Southwest Healthcare Executives Association Chapter. She was also elected to the Board of Directors for one of the largest credit unions in El Paso, Evolve Federal Credit Union (+$300 million). Dr. Raya previously served as Vice Chair of the Board of Directors for KCOS-TV, El Paso’s PBS Station.

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