← New Books Network
New Books Network
Daniel Skinner et al., "The City and the Hospital: The Paradox of Medically Overserved Communities" (U Chicago Press, 2023)
00:43:20
Loading summary
Transcript84 lines
- [00:01]
Laura Stark
When it comes to gifting, everyone on your list deserves something special. Luckily, Marshall's buyers travel far and wide, hustling for great deals and amazing gifts so you don't have to. That means your mom gets that cashmere sweater, your best friend, that Italian leather bag, your co workers unwrap their favorite beauty brands, and your nephews the coolest new toys. Go ahead. A price is this good, you can grab something for yourself too. Marshalls, we get the deals, you gift the good stuff. Shop now@marshalls.com or find a store near you. Coca Cola for the big, for the small, the short and the tall. Peacemakers, Risk takers for the optimists, pessimists for long distance love for introverts and extroverts, the thinkers and the doers for old friends and new Coca Cola for everyone. Pick up some Coca Cola at a store near you. Every holiday shopper's got a list. But Ross shoppers? You've got a mission like a gift run that turns into a disco, snow globe, throw pillows and PJs for the whole family, dog included. At Ross, holiday magic isn't about spending more, it's about giving more for less. Ross, work your magic.
- [01:16]
Podcast Host
Welcome to the New Books Network.
- [01:20]
Laura Stark
This is Laura Stark at Vanderbilt University. The new book the City and the Hospital is a remarkable collection collaborative project. I had the great pleasure of talking to John Wynn, Professor Jonathan Wynn, who is one of the three co authors on this project. At the core the book is looking at this paradox which is that the people, the residents who live closest to hospitals, actually tend to have poor health outcomes despite the fact that they're living in these near these anchor institutions in communities, these places of he and allegedly well being. I hope you enjoy this conversation. It is a good one for theory nerds and policy wonks and everyone in between. I had the great pleasure of having this conversation along with students in the course American Medicine and the World. You'll hear their voices as well in this conversation and we hope you enjoy we're delighted to be talking today to Professor Jonathan Wynn. John Wynn, who's at University of Massachus and one of the co authors of a fantastic new book, the City and the the Paradox of Medically Overserved Communities. And this was co authored with two other scholars and it's specifically looking at the issue of why it is that hospitals which are thought to be considered to be the sites of wellness and healing are tend to be located places where the communities near them actually are quite unhealthy by all.
- [03:11]
Conventional metrics this is the puzzle that you were.
- [03:16]
Set out to figure out. You look at three case studies in particular three hospitals, Hartford, Connecticut, Cleveland, Ohio, and then Aurora, Colorado. And the book has more than 200 interviews that you were based on with those three sites.
- [03:35]
And before we get too far along though, I wanted to give you a chance to introduce your colleagues sort of by telling us a little bit about them and how those relationships came about. So to actually lead us in this direction, I wonder, Maddie, whether you could jump in with your group's question. Absolutely. Throughout your writing process, how did your collaboration with authors of different disciplines shape your perspective?
- [04:10]
Professor Jonathan Wynn
Well, thank you for the question, Mattie, and thank you all for having me. And my colleagues would love to have been here, so they send their regards as well. So thank you. Thank you very much to them. It actually started with Daniel Skinner and I being friends from graduate school. We both were in the cafes, sitting there talking and hanging out and, and actually played music together in Brooklyn. And we, we know each other from these kinds of worlds and we kept in touch after graduate school and we were sitting together and aft well, after graduate school, after my first book, my second book, which also are about culture and, and place and communities and we started to think what would it. What would, what would a project look like for the both of us to work together? With my expertise and his expertise, me coming from a place and qualitative background and Daniel coming from a theory and medical policy background.
- [05:18]
We very quickly started thinking about hospitals. What is the story about hospitals? How can we think about that? It wasn't a puzzle searching for an answer and bringing these people together. It actually came about coming together and searching for a puzzle, which I think is sometimes the case. Sometimes we have a puzzle. We want to see a social problem. When we attack that problem and find people to kind of join us on that quest in co authorship and complement each other's work. But really it was the complement of each other's work that then was in the search of a puzzle. And so part of the way through, Daniel had a colleague join him at Ohio University, Berkeley, Franz and she was started to join the project as a part of it too to help support us as we were going through. And so it kind of progressed. I don't think, I don't know, Professor Stark, if that's what's conventional or not, but it does. Maybe it was a slightly unconventional kind of initial plan.
- [06:28]
Laura Stark
No, it actually sounds unconventional, at least in itself. Admission so the fact that people say actually it wasn't something that was all that.
- [06:39]
Necessarily empirically driven from the outset. But it also sounds like the kind of collaboration that makes the most productive work because you know that you operate together and you think in ways that really chime nicely. And so your, your work today has been about all kinds of things. I'm not necessarily in the medical soc area and we talking previously about your side hustle as a bass player as well. And you've done a lot of work around music and music festivals in particular. So I actually wonder whether you could actually make a case for listeners kind of at the top of the interview for actually the relevance of a space based approach to studying hospitals and health in particular. And you make this case a bit early on in the book when you talk about the notion that things are becoming increasingly placeless, and especially if we think about telehealth and the idea of a lot of health access happening in the cloud or in a virtual realm. What's the case that you would make for a place and space based study?
- [08:00]
Professor Jonathan Wynn
Well, you stole my answer a little bit, but yeah, I. In the prelude. That's great. When I was a, when I was writing my dissertation, I was interested in place and culture and cities. I moved to New York City and I was fascinated with New York. I'd always wanted to live there and the chance to study New York was great. And I struggled for about a year afterwards thinking about what I was going to, what I was going to study. And I thought about different, different ways of approaching place. And after the September 11 attacks, I started getting really interested in tourism, about how were using public spaces to kind of take histories, make meanings of them for themselves and for, you know, others to, to tell stories. And so I was really, I got interested in walking tours, not tours on a bus that just kind of circle through and they've got the same script, but somebody who studies a neighborhood and studies that culture and studies that place and those buildings, and if that group that's with them is interested in, you know, radical left politics, that they would turn this way and go, oh, that makes me think of going two blocks. And so I got really interested in the idea of the way that culture works in place, that cities and in general cities produce a lot of excess stuff and they produce different stories, food, culture, all these sorts of things, music. And there's this kind of collective, what sociologists would call collective effervescence of living in cities and groups of people kind of rubbing up against each other and producing new things. And so I think throughout all of my projects there's Always this relationship between stories, history, culture, and the neighborhoods that they're in. And so while it does seem strange for me to be interested in something like hospitals, after, if you look at all these different works and being somebody who plays music and likes tourism. But I am a complete sucker for how communities are different. When I go to a neighborhood or a new city, I want to know what the thing is. I will eat the thing. I will eat anything that any place has. I want to know what the. What the thing is in these different places. And talking with people. So there's this old professor, Howie Becker, and he would. He was sitting in a bar, and he was talking to somebody, one of his students, and he looked out the window and he. He saw the bar, and he. He was. I'm looking at a picture of Howie right now that I keep in front of me, and he. He says, I'll be right back. And he runs across the street and runs into the alley to talk to somebody because he saw two people go down that alley. I am interested in place. I am interested in people. I want to run down that alley and talk to somebody. When we're starting to think about hospitals, I obviously was interested in the particularities of those communities and their particular relationships to those hospitals and those institutions, which, for the most part, may be exactly the same on the inside of the walls, but how they relate to the communities outside of the walls may differ. And what those histories of those hospitals and institutions are shapes those relationships that they have with their particular communities. And so I think that there's a really clear line between my thread through all of my work, and I was really grateful that I could have health policy people who could really talk about that.
- [11:20]
The complete richness that allows this book to be helpful to a class like yours and some listeners like you, because I will say that it was a new. It was a new adventure for me to be looking at health policy. And I am sure that most of you know a lot more than I do about some public health and policy stuff. So. Yeah.
- [11:44]
Laura Stark
Yeah. And for the theory nerds who might be listening, it was also really great to have your reflection on W.E. dubois as well, in the Philadelphia Negro and that sort of the urban studies kind of direction from. From a theoretical angle as well. One of the pieces that we spent a lot of time with in this class was actually Phelan and Link and the idea of fundamental cause theory, which, for. For sociology of medicine, it's kind of like it's an oldie but goody in that it is Talking about how the things that actually cause immediate poor health are actually quite.
- [12:32]
Disparate from that in terms of the social networks, the relationships to power, and especially socioeconomic disparities and disadvantage.
- [12:48]
What we take to be the punchline of the book is that one of the things that cities create, at least cities with hospitals, sees your really great phrasing. There's something extra that cities create is actually they create.
- [13:03]
Poor health or at least underserved communities in the areas of hospitals.
- [13:12]
But unlike Phelan and Link in one direction of fundamental cause type thinking and the idea of distal causes is that that literature I take to really dwell on class a lot and class disparities and the advantage that comes from higher socioeconomic status. You're adding into that serious strong consideration and attention to race, which is of course patterned with class. But you especially show that in the division between the folks that you are interviewing who are hospital professionals who tend to be white, and members of the communities which tend to be communities of color, that this really shaped the formation stories as you write about in chapter two, that affected then the possibilities for what the hospital could do to engage communities and vice versa. So on this note, I want to actually ask Paulina to jump into the conversation. Yeah. So on the topic of those formation stories, which ones were very memorable from residents that didn't make it into the chapter, chapter two, but shifted how you understood trust, belonging and access in these communities?
- [14:32]
Professor Jonathan Wynn
Can you say it again? So those stories, those females and stories, how did they shape the kind of flagging trust and access? What is the direct causal language?
- [14:44]
Laura Stark
Which ones didn't make it into the book?
- [14:46]
Professor Jonathan Wynn
Oh, which ones didn't make it?
- [14:47]
Laura Stark
Oh, that's out to you. And how these community members didn't have trust or access in the community?
- [14:54]
Professor Jonathan Wynn
Paulina, Any book. I quote Martin Scorsese in my first book, which is that there's no finished movie, only abandoned ones. And there's no finished book, there's no finished study, only abandoned ones. And you're right, there's just so many stories in this that are just on the outskirts or referenced that couldn't possibly make the book itself. And really.
- [15:21]
You know, increasingly you all should know, like we wanted to do a book because the book length manuscript allows us to tell more stories than in a way that an article format couldn't. Right. At the same time that politics, the economics of book production are such that books have to be shorter and shorter. And so I think that there's only so much that we could really put into the book itself. Now, that said.
- [15:47]
I honestly think we nailed it. Like, it comes to this. Like, we brought in, like, some really good stories, and there were some. And there were. We. We brought up the stories that really, we heard over and over and over again. Right. And so it was not the case that we picked one that just was the most resonant. We picked the stories that actually, you know, came up in our. In our neighborhoods and our communities repeatedly. And so I think when thinking about, you know, we're talking about race, and I think. I think Professor Stark is exactly right. But one of the things that I really wanted to force was culture and history. And so culture and history, just as informative as race. They're racialized. I think culture and history are kind of racialized institutions in some way. They are local.
- [16:35]
They come up and often in opposition to the organizations, the anchor institutions that are around them. And so I think they're always keyed, to use Goffman's term of keying, which. Which I think does have a musical, you know, kind of metaphor to it. And. And I think for all those reasons, I think the ones that we. That. That came out were ones that we heard over and over again, and it was pretty. Pretty dramatic. So what was left on the outside of the four corners of the project? There are a few, but I actually thought that we did a pretty good job. It's a little bit of a cheat of an answer.
- [17:11]
But it's, you know, I think it's also true.
- [17:15]
Laura Stark
Yeah. And you brought Goffman into the conversation, so that's always good. Who doesn't love that?
- [17:22]
So I do want to ask Vic to kind of. To follow up on this, because we were chatting a lot about how one actually goes about synthesizing a community perspective without homogenizing the community, which is exactly what you want to be kind of of breaking down in the book as well, sort of showing pattern differences without homogenizing or stereotyping. So basically making a case for collective memory. And that actually really factors in the possibilities that are available to institutions. So, Vic, I'm going to let you take it away.
- [18:03]
Professor Jonathan Wynn
How did you decide whose stories would represent an entire community's perspective? I mean. Oh, you didn't hear? I was. I paused my mic, but I let out a deep sigh. I mean, that's a great question. Right. And so especially as, you know, kind of racialized, white, you know, researchers and entering into these communities, that's, I think, was really at the forefront of nearly every conversation that we had. And so I think one thing that we, we were really careful about, and I think it actually goes back to the initial description of the book. We were interested in the puzzle. We weren't interested in the.
- [18:45]
A story that we preconceived. We wanted to know how to best tell this story without.
- [18:53]
Having our own prejudices against us. You know, kind of. This was not a pro hospital book. This was not an entirely anti hospital book. In some ways, we really tried to set our own biases as, and really allow ourselves to be open to what the communities were saying and talking to us about. And so it was the selection of cases and stories that allowed us to not have confirmation bias, which I think often happens with a lot of research in sociology. They know that there's a problem and then they figure out what there was. And I have graduate student after graduate student coming into my office complaining that people are just not. Not saying the things that they want to want to say. I said, well, I think one of the problems is that you have an idea of what you want people to say. And people are tricky like that because they have minds and they have experiences. And so.
- [19:52]
I think that that approach of being very, very open and what that did was allow us to hear the same stories over and over again and really get saturated in all of the stories. And, and there were certainly some that we, that we weren't able to tell, you know, like business owners maybe or something like that. And I think in some way it was small business owners could have been one. One chunk of the story around the community, how the small business owners, there's, there's little references to them, but especially the stories of like the restaurant being invited into the food court in Denver. That was, that was a, that was one of those stories. But we really wanted to kind of, we did try really hard to do that. And I think that one of the things that, that also to cycle back earlier is about the embrace of the W.E.B. du Bois approach to research, where you really do kind of have a strong connection to history and the history of the particular communities that are there when we're doing qualitative data work as well. And so that kind of theory history research and qualitative research research cycle of having more of an iterative process allowed us to really hone in on some of that and also to check our own biases. I'll say just to just say quickly.
- [21:11]
We probably would have had a more successful book if we came out pro hospital or anti hospital. But it's universally disliked, I think, because.
- [21:24]
Some hospital folks, the American Hospital association didn't like it. But we thought we were being, you know, kind of, you know, impartial and we thought that actually we, it was a missed opportunity for book sales and you know, but that's, that's, you know, that's, that's, that is what it is.
- [21:45]
Podcast Host
The holidays have a way of sneaking up on you and I can tell you they snuck up on me. This year I have people coming and I need to buy those people gifts. Or as I say, I just didn't have everything I need. So what I did did is I went to Wayfair. From bedding to linens to decor for every room in the house, Wayfair is your one stop shop. Last minute guest prep. Wayfair has you covered. You can refresh bedding and throw pillows and accent chairs for way less. That's what I did. Pretty much all the bedding in my house is threadbare. So I decided to replace it. I went to Wayfair and I ordered some new sheets and pillowcases and I got a comforter which was really cool. I ordered it, the price was great, the shipping was free. It arrived and now I am ready for the hordes to descend upon me. And it's not just bedding, of course. You can get linens and towels and things for the kids room, kitchen essentials, things for your living room and of course they have holiday gifts. So get your last minute hosting essentials gifts for all your loved ones and decor to celebrate the holidays. For way less. Head to Wayfair.com right now to shop all things home. That's W A Y-F-A-I R.com Wayfair Every style, every home.
- [22:58]
Professor Jonathan Wynn
And Doug, here we have the Limu Emu in its natural habitat helping people.
- [23:03]
Podcast Host
Customize their car insurance and save hundreds with Liberty Mutual.
- [23:09]
Professor Jonathan Wynn
Fascinating.
- [23:10]
Podcast Host
It's accompanied by his natural ally, Doug.
- [23:13]
Laura Stark
Limu is that guy with the binoculars. Others watching us cut the camera, they see us.
- [23:17]
Professor Jonathan Wynn
Only pay for what you need@libertymutual.com Liberty Liberty Liberty. Liberty Savings Fairy underwritten by Liberty Mutual Insurance Company affiliates excludes Massachusetts.
- [23:27]
Laura Stark
Yeah, no, it's, it's really interesting to think about the process of research as a process of learning itself. So the idea that actually if you, if you find that your, your interviewees aren't telling you what you, what you want to be hearing, that it's actually forgetting that learning element of the research process itself. So although you didn't have a take pro hospital or anti hospital with the book going into it.
- [24:00]
I actually, I wonder whether you had a take on the concept of community benefit. That as a legal term, and particularly how it was framed out in the Affordable Care act, as well as in earlier laws as well, which you write about, like the.
- [24:25]
Emergency Care and Labor act that requires that hospitals provide some sort of treatment to communities or for people who come into the error, if they are hospitals that accept Medicaid, and then also even earlier, the Civil Rights Act. So thinking about this official legal designation of having to have a community benefit, I wonder if you had a take on that going in, if you had a suspicion or maybe if you do now.
- [25:00]
Professor Jonathan Wynn
I mean, sure, probably my colleagues had more suspicion and more of a critical eye to how. How hospitals are able to claim community benefit without with doing minimal amounts of work. There's certainly plenty of horror stories in. In the public health world of. Of hospitals claiming all sorts of things, because there's a lot of looseness when it comes to what you can claim as being community benefit, including, you know, a hospital saying that it's entire med school because it occasionally will take care of some. Some people in the community, that that entire enterprise as a part of their. They count as community health. And so one of the policy recommendations that we have at the end is this to tighten up the language when it comes to what exactly is community health. And I think that was. My colleagues were the ones who were really.
- [25:54]
Interested in that. And so when they raised that, I think that was an excellent point. The one group that was really interested was the loan kind of index. So the loan communities really were the people who were saying that we should be really interrogating. They're very much on this idea of what is community benefit. And coming up with their alternative rankings of hospitals based on racial equity is kind of something that I think is incredibly important. We really try and elevate.
- [26:28]
That narrative in this book. And that was one of the. So while hospitals and communities were. Were disappointed a little bit in that, the Loan Institute actually was. Really embraced this project, which I really grateful for. We want to give enough of that information in their analysis and ranking of these specific hospitals, but also talk about it in general. And so we did have to reach out to them and get their blessing because we were almost at the point where we were like sharing too much of their information. And we wanted to make sure that we were kind of doing the right thing by them as well. And so they actually to kind of broadcast this work a little bit for which we're grateful. So if anyone's interested in the community benefit and that I mean the loan Institute is really where it's at.
- [27:13]
Laura Stark
Yeah, that's great. And I really appreciate you raising up that case as well. And alternative rankings, they're so subversive. I really love them. And thinking just giving a shout out to sociologists as well. I'm thinking of. Wendy Espeland and colleagues work on university and law school in particular ranking systems and how if you just tweak the rankings and the reactions that institutions have to ranking structures, it really changes how the world works. It's remarkable.
- [27:45]
Professor Jonathan Wynn
Yeah. And I think this is a mirror image, I think of universities. So I mean I think we could also be looking at universities as urban institutions that have, have because of their tax free status, have or should be compelled to do more and beyond just pilot programs, payments in lieu of taxes instead of just paying in occasionally when they want to. Because a place like, again like Hartford, there's a, there's a data point that just kind of blows my mind that over half of the property doesn't have, isn't taxable property because it's either a state government institution, an educational facility or a health facility. And what that means is that the city is actually pretty poor. It's always verging, teetering on bankruptcy. And so while the hospitals, we're thinking about the community benefit when it comes to health, I don't know. And if there is, I could be wrong. But the same kind of alternative ranking when it comes to universities. What is the expectation of these universities to do good by their communities? We could very easily do the same project and thinking about the same thing from public safety to outreach and wall, you know, the physicality of the walls and.
- [28:59]
The capturing of.
- [29:02]
Property. Right. And so I think.
- [29:06]
It is about hospitals mostly, but it is also about just anchor institutions and what we should be expecting from cities, the anchor institutions that we have left in our cities.
- [29:15]
Laura Stark
Yeah, that's so great. And Larry wanted to follow up on this point about the ways in which, which community is defined both in residents own terms and also in policy terms as well. Larry, I'll let you hop in.
- [29:32]
Professor Jonathan Wynn
The book mentions medical administrators viewing research and education as sufficient community contributions. What creates disconnect between institutional self perception and lived community realities? These are such great questions. That's the kind of question I want to ask a hospital administrator. You know, like what's your definition of a community? How do you, how do you figure it out? Right. And so you know, for them they were very strategic about how they defined community. And there was the example in Cleveland is just amazing. To me, the focus on Fairfax county in a particular population that they saw as being one that they could actually help and move the needle on while literally turning their back on the huff in the more African American community that we focused on, on interviewing folks. Folks, right. And so their definitions of community were highly strategic. My definitions of community were.
- [30:25]
I very early on was interested in this kind of Chicago school ecological model where you have a. This is terrorism, but you know, essentially concentric circles, you know, kind of around. Around it. Boy, that's, that's really bad. But you just. And so what I did was I plotted the hospital on a map and then I, and I looked at the census tracts that were, you know, directly around them. And so what I was trying to do was not to try and bias our estimations of health of the, the, you know, health poor community by the hospital zone metrics, but just by geography. Like you, you were. Whether it's, whether it's 1 mile east or 1 mile west, you're still 1 mile away from a hospital. Hospital. Right. And so what I was trying to do is really, you know, kind of force the, force the conversation and really allow us to have a bigger conversation about what they meant. What, what. And not take what they say is their community, which is like maybe for example, in Cleveland, Fairfax over Huff, but instead looking at the more geographic thing. And there's, there's. There's maybe some, some faults in that and maybe it's overcorrecting in some way. But I think, I think it was a. That was my argument.
- [31:43]
That was my argument.
- [31:46]
Laura Stark
Yeah, it's great. And actually, since we are talking from Nashville, so much of this resonates with the experience in our city as well, because of the very strong and enduring history of segregation. Vanderbilt Medical is just one of the. The university based medical schools in the area, but we also have Meharry Medical School as well, which is a really esteemed historically black medical school as well. And a lot of the arguments around the neighborhood and how it plays out with these different institutions with a different set of priorities really, really resonates with the situation that we're. That we see in Nashville. So thinking about these moments and places in which hospital administrators and health professionals actually engage with people who are residents of the area. So folks who actually have, I mean, the statistics you give on the health outcomes of people who live really nearby hospitals, it's truly stunning, like how, how much disparity there is. So you develop this notion of contact zone from Mary Louise Pratt in particular. And so I wonder I'm actually going to hand this over to Isabella on behalf of her group to ask a little bit more about contact zones and the ways in which.
- [33:27]
Communities and professionals come into contact. Yeah. So contact zones highlight major economic and demographic gaps between hospitals and the communities around them. How does this tension complicate the claim that hospitals function as true anchor institutions?
- [33:42]
Professor Jonathan Wynn
I mean, hopefully successfully. You know.
- [33:47]
That was my point. You know, I think, I think forcing a conversation with, this conversation with contact zones was to try and, you know, kind of force the hand when it comes to having more engagement that the contact zone tends to be the, the ED and not, you know, kind of in any kind of other contact zone where these satellite, you know, kind of facilities that we, that we kind of flagged a few in a few different ways instead of bringing people in and we know, you know, kind of with full awareness that you can't just have, you know, kind of random community members just, just walking through kind of ors. But at the same time, how is it that we can expect to have hospitals do more? And really, I think one of the things that we wanted to engage with was there's a thread about how hospitals even unintentionally are undermining the contact zones of communities by. And we have this example in Hartford of, of a, a funeral home that was a, you know, kind of a central, you know, kind of community place for, for, for folks and Latino community. And how when they bought that property, which was to kind of grab particular, you know, kind of kind of property, they're actually like erasing community zones as well or contact zones as well. And so I, I think I, I probably could have underscored that actually a bit more.
- [35:20]
In the book. I say I because actually, like, I'm thrilled you guys are bringing up the things that I, that I was really hot on. So I really appreciate that. Those are, those are. I say I. But you know, there was. We in this too.
- [35:31]
Laura Stark
Yeah. I mean, one of the things that we especially appreciated about the book was the way in which you're able to write about the formal quote, unquote, unquote community benefit.
- [35:46]
Initiatives of the hospital. So things like the bilocal hire local, the farmer's market on a medical campus, these kinds of things.
- [35:58]
Showing that the implication is that this would be a good thing to actually have contact between communities and hospitals. And at the same time there's things like actual physical barriers that are erected and also there's pretty strong policing and security around hospital areas. So the way. And the trickle down effects of the ways in which gentrification, which you write about really nicely in the book happens as well. And displacement, which is definitely something that's happened with the Vanderbilt Medical School as well to kind of capitalize and colonize on local land. So kind of bending you out.
- [36:43]
To maybe think through or ventriloquize your colleagues as co authors of the book, the folks who are doing a lot of the policy thinking professionally around this. We actually wanted to ask you about this the last chapter of the book. So chapter six in which you make a few policy recommendations and a lot of them have to do with.
- [37:10]
Community investment by hospitals being really focused on things that we would consider distal causes or neighborhood effect things not necessarily opening your doors more easily in the ER things that aren't necessarily obviously directly health related for acute events. I wanted to ask, ask Alexis to take this up. How can hospitals shift implicit development strategies to make care more equitable for uninsured or underinsured patients?
- [37:48]
Professor Jonathan Wynn
This is also well scripted. You guys are great. So yeah.
- [37:53]
I think. I don't know.
- [37:57]
I'll say once since you mentioned is the public safety piece as far as that's kind of one of the contact points. I'll say towards the end of the book as we're doing all the interviews we kind of thought that we'd finished up. We took a look back, we stepped back and we said what is the story? What are the stories that are missing? What is the piece that we're really going to be scared of if we, if we don't include it and, and regretful. And I really started focusing in. On public safety and how public safety serves as a, as a branch of the like the most kind of out the most. The most obvious public facing part of it. If not. If you don't include advertising that. Where, where there's a in between spaces of the streets and how much the public safety works in tandem with urban policing which we know, you know, kind of. I don't think it's a surprise to anyone here is a racialized institution as well. And so that I think is one of the hardest pieces of community.
- [38:58]
Engagement that we didn't. We really were going to be regretful if we didn't include it. And so we did start. We did a bunch of. And we stopped the writing of the book to then re. Engage in doing some data collection because we thought that that was really one of the biggest pieces of the. Of how hospitals really do community engagement and community development.
- [39:22]
In. In a. In a. As a less obvious. A less obvious Arm of community engagement and development. I'll say that.
- [39:32]
Laura Stark
Yeah, yeah. It actually reminds me that one of the issue that you're raising around advertisement as well, and how hospitals are able to appropriate a lot of the sort of the language and the notion, the concept of community in their own sort of symbolic gesturing and really getting a lot of prestige about this. And it reminds me that one of the most striking advertisements I've ever seen for any product actually, was for a hospital. And it was in the local. It was in the airport.
- [40:08]
So it kind of speaks to. Speaks to the audience that's being the clients that are trying to. Yeah, yeah.
- [40:16]
Professor Jonathan Wynn
Medical tourism. Right. I mean, you. That's. It's not, you know, it's people coming in. People, you know, I mean, so, you know, the Cleveland airport as. As just as many languages as they possibly can fit. And it's not because Cleveland is a international community. It is because people are flying into the clinic. And so that is. Yeah, absolutely, part of a. Part of the story. That's great that you picked up on that.
- [40:40]
Laura Stark
Yeah, yeah. No, and I feel like this idea of medical tourism that you write about in the book also speaks to exactly the point that it's the folks who live around the hospitals who are actually being treated least by it. It's people who are coming in through medical tourism and through other methods that are actually the people who are the clients, the patients in the hospitals. I will flag. I feel like you're underselling yourself a little bit in this last chapter. Is that you also.
- [41:12]
Per the audience of listeners here, you write, I think, really important things about medical education and the ways in which community health should be integrated into medical education as well. So I have to give you a virtual pat on the back for that one as well.
- [41:26]
Professor Jonathan Wynn
Well, almost no hospital. Like, we should be going in and talking to, you know, people. I don't. I don't get it. Like, I think they don't want us. I don't know why med schools are not interviewing us and bringing us in. So, I mean, I. I'm confused. I think that this is. This. This should be mandatory reading. I think at least that's what we sold to the University of Chicago back in the day. We said, like, look, the med schools should be. We should be assigning this book. Book. I still feel that way.
- [41:55]
Laura Stark
Yeah, for sure. No, I'm definitely. I've told my. My medical school friend friends about it. And actually, I consider that in academic worlds really, like, hot off the press because it was just published like. Like a year and a half ago. So it's. It's pretty new, I think. I think that you're. You're picking up steam.
- [42:14]
But thinking of your. Your medical health and well being, I will say, say, given that you had started the interview by saying that you take your task to be. When you go to a new city to find out what's new, what's the thing, like, what's really special about this place, and knowing that you spent quality time on your previous book project in Nashville, we're really glad that you survived hot chicken and eating the thing that is the Nashville thing, which is hot chicken, which I've never done and I hope never to because I know I.
- [42:47]
Professor Jonathan Wynn
Would meet in threes. That's the thing. Meat and threes. So many threes. I. There's so many choices for those threes. That's the thing. That's. That. That, for me is the thing. Yeah, that's the meat. Hot chicken's the easy part. The temperature's the. It's. It's not the. It's not the heat. It's the quantity.
- [43:05]
That's the hard thing.
- [43:06]
Laura Stark
Yeah. Point well taken. Yeah. I. You can sign me up for macaroni and cheese with a meat and three any day. So, Professor Nguyen, thank you so much for your time. We really, really appreciate it. I hope our paths cross again soon.
- [43:18]
Professor Jonathan Wynn
Thank you so much for having me.
- [43:32]
Laura Stark
Join Vanguard for a moment of meditation. Take a deep breath. Picture yourself reaching your financial goals. Feel that freedom. Visit vanguard.com investinginyou to learn more. All investing is subject to risk.