Karen Appold

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Obesity and diabetes disproportionately affect Latinos in the United States, a group that comprises 18.4% of the population, or approximately 60.5 million people. Latinos are 1.2 times more likely to be obese than non-Latino Whites, according to HHS Office of Minority Health. 

Almost 4 out of 5 (78.8%) Hispanic women are overweight or obese compared with 64% of non-Latino White women. Latinos are twice as likely to have type 2 diabetes (17%) than Whites (8%), according to the CDC. The average adult in the United States has a 40% chance of developing type 2 diabetes, but Latino adults have a greater than 50% chance. Furthermore, Latinos are more likely to develop diabetes at a younger age than the average American and therefore are exposed to its negative effects longer.

Although the interplay genetics and environment certainly plays some causative role, social determinants of health are a leading — and modifiable— factor in the complicated, web of factors and influences that affect the health of Latinos in the U.S.

Consider these statistics from a 2019 report by the HHS Office of Minority Health:

Latinos have the highest uninsured rates of any racial or ethnic group within the United States; 50.1% of Latinos had private insurance coverage compared with 74.7% of non-Latino Whites.

Among full-time, year-round workers, the average Hispanic median household income was $55,658 compared with $71,644 for non-Latino White households.

The unemployment rate for Latinos was 5.1% compared with 3.7% for non-Latino Whites.

“Obesity results from an imbalance of calorie consumption and inadequate physical activity, which is persistent among Latinos,” says Anabell Castro Thompson, M.S.N., APRN, ANPC, FAAN, FAANP, senior vice president of health equity at Equality Health in Phoenix. “Furthermore, as with many other health issues affecting the Latino community, this problem is exacerbated by the inaccessibility and unaffordability of healthcare.”

People who lack adequate health insurance often don’t have a primary care provider, so they are less likely to get continuity of care and help with prescription adherence, Castro Thompson says. They also are less likely to seek preventive services and may instead obtain care in expensive emergency room settings.

Franz Monroy, M.D., M.P.H., M.S., associate medical director of family medicine at Intermountain Healthcare in Salt Lake City, believes the high cost of healthy foods and easy access to less expensive, high-calorie fast food options contribute to less-than-ideal food choices for some Latinos. “When finances are tight and time is short, it takes less time and money to purchase fast food from a restaurant than it (does) to buy fruits and vegetables and prepare meals at home,” he says. Additionally, many cultural factors contribute to obesity. For example, some Latino families — especially those who have experienced food insecurities in the past — may see being overweight as an indicator of being in good health and having a higher socioeconomic standing. “Some Latino families think that a fat baby is a healthy baby,” Monroy says. “Children are often encouraged to eat their entire meal even if they’re full, a practice that can lead to overeating as an adult.”

To reduce incidence rates and costs associated with obesity among Latinos, providers need to adopt a team-based holistic care approach that accounts for medical, behavioral and cultural factors, as well as social and economic needs.

“Some Latinos live in areas of high poverty and food deserts and lack access to adequate or stable housing, transportation and good-paying jobs,” Castro Thompson says. “Providers need to be aware of these potential challenges and screen patients for information related to their social determinants of health. Then they should connect patients to community resources that can address any issues they have. Strong connections between providers and community-based organizations are essential because patients spend most of their time in their communities rather than engaging directly with the healthcare system.”

Based on his experience with his patients, Monroy says Latinos’ lower incomes and decreased access to healthcare contribute to their higher rates of diabetes. A lack of access to healthcare makes it less likely that patients will be seen for preventive visits. That can mean they may not be screened for diabetes and other conditions that are potentially preventable — or at least more easily managed at earlier stage.

“Very few Latino patients make a point to have a preventive visit,” Monroy says. “For some, it’s understandable that they don’t want to leave work if they don’t have a specific concern, which could potentially mean a loss of income and subsequent economic burden. Others don’t want to miss work for fear of losing their jobs. But by not getting seen, I can’t screen people for diabetes, discuss what (makes up) a healthy diet, or review the importance of exercise and weight loss, all of which aid in diabetes prevention.”

As with obesity, diet and lifestyle also are major contributors higher diabetes rates in Latinos. Some traditional Latino foods and ingredients, such as flour tortillas, refried beans, lard, fatty cuts of meat, cheese and cream, are high in fats and calories. There can be cultural pressures to overeat, specifically in the setting of family gatherings and celebrations. “There is typically a negative association (with) declining food, which is often seen as being rude or not culturally acceptable. Generally, (fewer) leisure time activities are exercise focused,” Monroy notes.

Castro Thompson believes that reducing incidence rates and costs associated with diabetes in the Latino community requires improvements in affordability, accessibility and equity. “Accessibility needs to be expanded beyond medical care and should include prompt access to behavioral health needs and making connections to socioeconomic needs,” she says.

Patient education, whether written or spoken, should be in the correct language and at the right literacy level, which is critical to helping Latino patients better manage diabetes, Castro Thompson says. Providers should also assess patients for social determinants of health and connect them to community resources that can assist with access to healthy foods, housing insecurity, and even with paying for utilities, which is important because insulin, used to manage diabetes, requires refrigeration.

Finally, it’s important to build providers’ cultural competence so they can understand how cultural preferences and beliefs play a role in diabetes medication adherence and preventive care. Patients with diabetes need healthcare services to help them avoid complications such as diabetic retinopathy, neuropathy and amputations, Castro Thompson says.

Karen Appold is a medical writer in the Lehigh Valley region of Pennsylvania.

Articles

Diabetes and obesity rates are high among Latinos. To lower them, providers and payers need to understand cultural factors and barriers to healthcare.

Improving Latino Health

Editor’s note: Samagh left her position at Optum Health in September.

Sonia Samagh, M.D., M.B.A., partner, Stealth Venture Fund, former vice president, The Center for Digital Health and Innovation, Optum Health

I was raised in San Diego. I earned an MBA from Stanford University and an M.D. from UCSF School of Medicine, and I currently practice as a hospital medicine physician.

I’m a founding member and vice president of The Center for Digital Health (CDH) and Innovation at Optum Health. For the past 10 years, I have worked at healthcare organizations, leading medical groups through value-based care transformation and serving in corporate strategy, operations and venture roles. I have led and implemented digital health strategy and innovation efforts across Optum, including digital health product development, corporate partnerships and clinical redesign for virtual care delivery.

Who has had the greatest influence on your life?

My parents. Watching them overcome incredible odds to both migrate to this country and overcome health issues has been a huge inspiration in lessons on perseverance, grit and tenacity. The value system they instilled in me makes me want to live an authentic and fulfilled life with service to others, human-centered compassion and a hope to change the world.

Why did you pursue a career in healthcare?

As an internal medicine physician, I see the effects of the healthcare system on patients and providers. I also see the amazing advancements made in technology and innovation. There is such potential for the ways that we can care for one another and create a health system where feeling better is a result of many ways that we interact with our bodies, minds and each other.

I believe physicians need a seat at the table to design our system of health and ensure that the system we create treats the whole person. I also believe that there is a chasm between what I am able to accomplish as a physician with my patients and what is possible with technology and innovation. My goal in healthcare is to close that gap.

Which career accomplishment has given you the greatest satisfaction?

When COVID-19 resulted in a rapid need to transition our 10,000 providers onto scalable, national telemedicine and remote patient monitoring systems, I founded and led Optum’s Digital Response Team (DRT). The DRT served as the foundation for our Optum Center for Digital Health and Innovation and consisted of 115 teammates rapidly deploying telehealth solutions and remote patient monitoring nationwide. We came together across our enterprise to support the infrastructure for rapid, coordinated, digital health scale, including launching a digital health support call center, local implementation teams and a digital nurse monitoring center. As a result, the DRT added more than 15,000 providers onto video visit platforms in eight weeks, completing more than 1.3 million virtual visits in 2020.

What has your organization’s role been in the rollout of COVID-19 vaccines?

Here are a just few examples of what Optum, along with its parent company UnitedHealth Group, has done to support the rollout of COVID-19 vaccines. We have worked with public health officials in California, Texas, North Carolina and Florida to set up community-based vaccination clinics. Through our care practices, community-based pharmacies and health services operations, Optum administered COVID-19 vaccines to patients, employees and other community members. And we created a COVID-19 vaccine resource locator to help people find vaccine eligibility and vaccination providers.

What would be the best way to reduce healthcare inequities in the U.S.?

To advance health equity, Optum Health is focused on delivering personalized care based on an individual’s needs, promoting equity and diversity in the health workforce, improving the health of underserved communities, and leveraging data and emerging analytics to monitor and address disparities in care.

Name a book or article that everyone in healthcare should read.

“Change by Design” by Tim Brown provides an introduction to the concept of design thinking and how it can transform organizations and inspire innovation. Design thinking’s tools and clear process steps help teams break free of human tendencies that can get in the way of innovation. I studied the elements of design thinking at Stanford Graduate School of Business and believe embracing the ethos of design thinking can truly help transform healthcare.

Samagh is one of 13 up-and-coming health leaders featured in this annual Managed Healthcare Executive series.

Emerging Health Leaders: Sonia Samagh of Stealth Venture

Andrew Toy, M.S., president, chief technology officer and board member at Clover Health in Nashville, Tennessee

I was born and raised in Hong Kong and came to the United States to study computer science at Stanford University in 1996. Following my role as vice president of mobile applications at Morgan Stanley and then running mobile content for MTV, I co-founded Divide, a company focused on creating a split between work and personal data on mobile devices. At the time, as iPhone and Android devices were gaining popularity, it was common for folks to bring two devices to work — a work-assigned BlackBerry and a smartphone for personal use. We created Divide to fix the two-phone problem, and four years later Divide was acquired by Google for $120 million.

After serving as a director of Google’s Android enterprise group, I saw the potential to both grow a great business and truly help people at Clover Health. I became chief technology officer in 2018. I helped create its breakthrough clinical support platform, the Clover Assistant. In February 2019, I was appointed president of Clover and also joined the board.

My parents, who have always encouraged me to take the path less trodden. They are Australian-Chinese immigrants who raised me in a British school system in Hong Kong and encouraged me to pursue excellence by attending a university in the U.S. They taught me that talent and opportunity are distributed and that you should always push yourself to chase them wherever they are.

After I sold my last startup, I wanted to do something mission-oriented and build a great business. Healthcare seemed incredibly interesting and ripe for innovation but, as a technologist, I also saw it as a difficult task to create a business that could drive real change.

Then I met Clover’s CEO Vivek Garipalli, who’s been the most influential person in my healthcare journey. I’ve learned so much from him, and I’ll never forget when he took a chance on me and said, “In a year, you’ll be the technologist (who) knows the most about how healthcare actually works.” I think that was a prescient observation because, in a short time, we’ve combined technology innovation with a deep understanding of how the wheels of healthcare actually turn to create real change.

My time at Divide has by far been my most satisfying accomplishment to date. Divide technology is built into every Android device in the world.

That said, I fully expect Clover to be the most satisfying career journey I’ll go on — but only after we truly make momentous progress on our goal to fundamentally transform healthcare and make it more equitable. Our mission is to “improve every life,” and we’re only just getting started.

During the height of the pandemic in 2020, we prioritized supporting members who had the highest risk for mortality and morbidity to shelter in place in their homes in a number of ways: integrating vaccine supply information into our website with insight into local distribution programs, helping members quickly enroll in a mail-order pharmacy program, building technology to support virtual/telehealth visits (in just three weeks) within the Clover Assistant, delivering programmed iPads to members without access to a video-enabled device via our Video on Wheels program to support virtual/telehealth visits.

Free internet access for every home in the U.S. would go a long way toward reducing healthcare inequities. The pandemic highlighted just how intertwined internet access and health and wellness are as telehealth took off.

“StrengthsFinder 2.0” by Tom Rath is about understanding how to value people who are good at what you aren’t and leaning on their strengths to augment your weaknesses. Diverse opinions and strengths are key to a strong team and company.

Toy is one of 13 up-and-coming health leaders featured in this annual Managed Healthcare Executive series.



Emerging Health Leaders: Andrew Toy, M.S., of Clover Health

Evie Powell, Ph.D., virtual reality architect at Proprio, a med-tech company in Seattle

I grew up in Charlotte, North Carolina. I earned an M.Sc./B.S. in computer science and a Ph.D. in information technology, all from the University of North Carolina at Charlotte.

I am a games researcher and developer specializing in immersive interactions and prototype design. I integrate game design and UX (user experience) design to create meaningful experiences that help people learn, play, teach and work differently. In 2014, I founded Verge of Brilliance, an independent experimental games studio in Seattle, and I was a program manager at Microsoft on natural user interfaces and the Kinect technology at Xbox. At Proprio, I evaluate how we can create technology that supports surgeons in the operating room, and I am designing a suite of tools to help empower them to perform optimally.

Leadership highlights include leading external teams that won several hackathon awards, including Seattle VR 2018 Hackathon’s Best in Audio and 2016’s Best Technical Achievement.

I also co-led a successful Mobile Future Forward demonstration in which my team showed the possibilities of blending technology and the operating room through remote multiuser collaborative surgery by connecting a remote surgeon to an in-person practicing surgeon.

Everybody needs a champion who believes in you, challenges you and encourages you to pursue your goals. For me, that is Tiffany Barnes, Ph.D., my Ph.D. adviser and a professor at North Carolina State University.

I’ve always been interested in technology and its impact on communities. When I was introduced to Proprio, I recalled reading the book “Ender’s Game” by Orson Scott Card and was excited about the possibilities of blending immersive technology with real-world scenarios. Although the story features a more dystopian view of technology and society, I could envision how intentionally designed technology could fundamentally change how important tasks are presented in a way to promote focus and performance. For example, by creating calm design through intentional data management and distillation, we can reduce anxiety, minimize overstimulating environments (like an operating room) and distill complex tasks for improved focus, well-being and results.

Proprio has given me the greatest satisfaction in my career so far. I’ve been a lead, hiring manager, researcher, designer and prototype. Proprio has a team of engineers who empower surgeons to think differently about how they can improve the medical industry and who are passionate about making a positive impact on our community.

We have established a remote, safe working environment. The company provides transparency regarding vaccination rates and social distancing.

To reduce inequities in healthcare, we must recognize and reduce inequities in technological development. The concept of universal design is particularly important, as we need to design systems by a group that represents the people they are built for in order to ensure that quality of care is high for all patients and quality of experience is high for all surgeons.

“Homo Ludens” by Johan Huizinga is a book that focuses on the study of play in everything from law to language to other key aspects of culture. This book influenced a lot of the ways that I view how technology can blend into core aspects of our lives and how we can use early technology to assess which technologies and concepts will successfully permeate day-to-day life in the future.

Evie Powell is one of 13 up-and-coming health leaders featured in this annual Managed Healthcare Executive series.


Emerging Health Leaders: Evie Powell, Ph.D., of Proprio

Michael Palantoni, vice president of platform services at Athenahealth in Watertown, Massachusetts

I grew up outside of New York City and graduated from Johns Hopkins University with a concentration in systems engineering. Prior to my current role at Athenahealth, I was a management consultant at Deloitte Consulting, where I specialized in healthcare and technology.

Some of my formative leadership experiences at Athenahealth have been leading our patient engagement teams and running the Athenahealth Marketplace (app store) business. These have been great opportunities to learn from consumer-focused executives and to have front-row seats to the explosive growth of the health-tech ecosystem over the past five years.

At Deloitte, I worked on the firm’s response to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which involved building models for how meaningful use requirements and funding would impact the industry. This was my introduction into healthcare technology strategy.

On a personal level, definitely my wife. We’ve been together since we were 19, and she has been my consultant for virtually every major decision of my adult life. She’s incredibly mission driven and really grounds me. From a pure career perspective, I was fortunate to work with a unique group of senior people at Deloitte who showed me what could be possible with technology in healthcare at an early career stage. That influenced me to consider how I could best use technology in the healthcare space.

My mom battled and ultimately passed away from cancer and its complications during the four years I was in high school. During those years, I struggled to find an outlet for processing this and ended up channeling it into my education at college, my career and my purpose.

I became very focused on healthcare and medicine. I shadowed staff in various medical areas at a hospital and worked on a project to evaluate provider-to-provider communication in a new hospitalist program. I believe they gave me this project as an internal experiment. Ultimately, I discovered I really enjoyed this type of “systems thinking” work as an outlet for both my purpose and strengths.

I built a platform services business that enables others to innovate in healthcare quickly and effectively. This involved starting with a business plan, selling it to initial customers and then leading the product team to grow its capabilities. Seeing it launch as a mainstream part of our business has been an incredible journey.

I can’t think of anything more rewarding than enabling others’ innovation in healthcare delivery and patient experiences.

Over the past year, Athenahealth has built a significant number of COVID-19 vaccine workflows in real time to help provider organizations create and administer vaccine delivery programs.

I don’t think there’s a single best way. If you look at the challenges the healthcare industry is facing in addressing inequalities and access to care, they are multifactorial. There must be a layered approach that looks at everything from social determinants of health to local healthcare access levels to addressing clinical biases.

“The Square and the Tower: Networks and Power, From the Freemasons to Facebook”by Niall Ferguson is a great primer on network theory and strategies. A key insight in the book is how people and organizations that are connected to more things are generally more resilient and influential in times of change. For example, a supply chain with only one supplier is more likely to be very brittle and might create risks for that company during a crisis like COVID-19. In healthcare, there are many implications for how providers build referral networks and how their design impacts access, quality and costs for patients.

Michael Palantoni is one of 13 up-and-coming health leaders featured in this annual Managed Healthcare Executive series.



Emerging Health Leaders: Michael Palantoni of Athenahealth

Shantanu Nundy, M.D., MBA, chief medical officer at Accolade in Plymouth Meeting, Pennsylvania

I was born in Canada but largely grew up in the Washington, D.C., metro area. I earned a B.S. from Massachusetts Institute of Technology (MIT), an M.D. from Johns Hopkins University and an MBA from the University of Chicago Booth School of Business. I completed my medical residency and fellowship in health disparities at the University of Chicago.

Previously, I served as a senior health specialist at the World Bank Group in its Health, Nutrition and Population Global Practice, where we advised developing countries across Africa, Asia and South America on health system innovation and technology. I served as the director of The Human Diagnosis Project, which we successfully built into the world’s largest open medical project spanning 80 countries. Prior to that, I was managing director for clinical innovation at Evolent Health, where we launched value-based care models and accountable care organizations around the country.

Who has had the largest influence on your life?

My mom. When I was in middle school, she was diagnosed with type 2 diabetes, which she struggled to manage for many years. Whenever I think about building innovative solutions for healthcare, I think about whether it would work for her.

When I was a college freshman, I taught English in a small village in India where my aunt ran a school and anti-poverty program. The first day I stood in front of the classroom, I was taken aback by the students’ health. Most had runny noses and many had open sores. I couldn’t understand how anyone could learn while sick.

The next week I found a local doctor who, to my delight, agreed to come to the school and examine all of the children for free. He prescribed preventive medications and supplements for many of them. Over the next three years, with support from MIT, we built a school-based clinic and public health program that still exists today, 20 years later.

The experience was exhilarating. It cemented my desire to serve individual patients as a physician and to scale access to high-quality healthcare as an entrepreneur.

I’m most proud of creating multiple new organizations and solutions from scratch and taking them to a point where they demonstrate clinical impact and have a pathway to sustainability. Healthcare is in urgent need of reinvention.

Accolade provides personalized advocacy and healthcare services to more than 8 million working Americans and families through their employers. As a trusted partner to employers and families, we have sent evidence-based communications and email campaigns on the vaccine, hosted dozens of expert webinars, and directly provided nurse education and navigation on COVID-19 and the vaccine to Americans nationwide.

Healthcare needs to meet people where they are physically and emotionally. Many vulnerable health populations either don’t have access to care or don’t trust their care options. To reduce healthcare inequities, healthcare needs to become distributed. Care needs to start at home and in the community at places such as churches and barbershops to meet
patients where they are and in contexts they trust.

I just published a book with McGraw Hill on where healthcare needs to go, post-pandemic, titled, “Care After COVID: What the Pandemic Revealed About What Is Broken in Healthcare and How to Reinvent It.”

Shantanu Nundy is one of 13 up-and-coming health leaders featured in this annual Managed Healthcare Executive series.

