Hello and welcome. I'm Dr. Will Ross,
Associate Dean for Diversity and Professor of Medicine here at the
Washington University School of Medicine. I'm here to talk to you about a subject
which you've certainly been exposed to in your time here Washington University
and I think will be quite relevant to your future practice, and that is the
subject of health and health care for disadvantaged communities in the St.
Louis region. What I hope to accomplish in this lecture is an exposure to the
variables that have led to poor health in certain segments of this
population. We will explore the epidemiology of some of the leading health
status indicators in the St. Louis region. And then I want to explore the
unique social political history that led to adverse health status of these
vulnerable populations. We're going to delve a little bit deeper into some some of
the social determinants of health. We'll give you an explanation, definition of
social determinants of health and then I hope at the conclusion, you'll have a
greater appreciation of the relationships between culturally
competent practices and the reduction in health disparities.

Now, I want to take
a look at this picture of three homes in the North St. Louis region. I
take our students on the tour and during the tour, we have an opportunity to get
out and look around. And now, you'll see three homes in various stages of
disrepair. You'll see one, to my left – broken windows, vacant lot – and then you'll see
another one, to my right, that seems to be somewhat improved. Someone purchased a
home and and engaged in some significant improvement. When you assess this
situation, this picture of the homes here, I want you to just use your imagination
and ask, if an individual moved into that home, rehabbed that home, the one on my
right, what would his or her life expectancy be simply by living in this
community? Don't answer that yet. This is just a hypothetical for now.
We'll revisit this. Now, what if the individual moved into this home? Now,
let's go back. This home is in St. Louis City, North St. Louis City,
ZIP code 113. This home is in St. Louis County,
actually Clayton, Missouri, 63105.

What is the difference in life expectancy
between these two homes, separated by no more than two or three miles? There's a
big difference. We want to talk about why some neighborhoods are less healthy than others. What are those social determinants of
health that lead to the difference in health outcomes, and one neighborhood
versus another? Why is it so relevant? Why does ZIP code matter moreso than
one's genetic code? A lot of this data stems from the normal work of Dr.
Michael Marmot who's an epidemiologist in London, who really wrote extensively
about the social determinants of health.

These are the social factors in which we
live, work, and grow that really affect our long-term health, our life expectancy.
We'll see that some homes, some neighborhoods, have been under-resourced
for decades, in a setting of residential segregation. There's a disinvestment in
educational opportunities, a disinvestment in in stable housing, and a
disinvestment in the infrastructure surrounding those neighborhoods. As a
consequence, you have unstable neighborhoods, which lead to unstable
individuals in those neighborhoods. Unstable neighborhoods lead to unhealthy
neighborhoods and unhealthy individuals. And so we can speak and work assiduously
to improve the health of the individual, but we can also work assiduously to improve
the health of the neighborhood, of the community.

Let's focus on how we can do
that. Years ago, an economist at Harvard posited this concept of the "broken
windows theory." This was initially used to promote a certain type of policing
which has been later debunked. We won't go into this issue of this broken
windows policing, but it follows Michael Marmot's view of social
determinants of health. If you remember that first image of those homes in
disrepair, the issue is that simply living in that
community, being exposed to broken windows, being exposed to vacant lots,
can actually lead to adverse health outcomes. And a simple concept – actually going in,
fixing the broken windows, mowing the lawn, painting the walls – can actually
restore a sense of confidence to the residents of that community. They have a
greater sense of empowerment.

They feel better about their neighborhood. They
feel better about themselves. And guess what? Their health indicators improve.
Their health status improves. So a real simple concept, but it follows along the
lines of really well-documented evidence on social determinants of health. Now as
we go on with this discussion, I'm going to introduce a couple of terms. One:
health disparities. Another: health equity. And of course we've already talked about
social determinants of health. Health disparities really relates to a
disproportionate burden of disease borne by a certain group, a certain community, even though they have equal access to health care. So when one can
control access to health care, there still is this disproportionate burden of
disease borne by one group, a minority group, compared to a reference group of
non-minority. So if we look at this slide showing populations with equal access to
health care, on my y-axis you'll see increasing quality of health care and
there is a difference. That's what we define as disparity when we control for the clinical purpose of health care. And that
disparity is based on systems that are unfortunately designed to discriminate
against certain groups of individuals.

So this is the definition of disparities.
Again, the disproportionate burden of disease borne by a particular group, even
when one controls for access to care. Now, there is abundant data
chronicling the extent of disparities that are based on race and ethnicity, and
a lot of that data was promoted in this seminal study, Unequal Treatment,
published by the Institute of Medicine, The National Academies, in 2002. And in
this book, Unequal Treatment – Confronting Racial and Ethnic
Disparities in Health Care, the authors posited that racial and ethnic
disparities in health care in the context of broad historic and social and
economic inequality and there's evidence of persistent racial
and ethnic discrimination in various sectors of American life.

So let's talk a
little more about health equity. I gave the definition of health disparities but my colleagues in Europe prefer to use the term health
equity. And I think they're probably a little bit more on task with that,
because when we speak of health equity, we're stating that every person has the
opportunity to attain his or her full health potential. So, I could provide tickets to a group of kids to go and visit a soccer stadium, but they may not be able to view the stadium because of the difference in their
ableness. However, if I provide opportunities for them to have equal access to
seeing that soccer game, then I'm promoting equity.

attained their potential to witness that soccer game and we want to make sure
that everyone has attained his or her full potential to have the
greatest health possible. Now, let's switch gears and talk about Missouri, and
then we're going to drill down and look more at St. Louis, and then we're going to
talk even more about what's going on at the ZIP code level and the neighborhood
level here in St. Louis. Missouri, like most states in this country, is
witnessing an increase in the Latino population and other populations. This is
a changing demographics of all regions in the United States and we're certainly
not an outlier. What a significant increase in the Hispanic population
between the time period 1995 and 2025. In fact, since 2000,
we've witnessed an 80% increase in the Latino population in St. Louis;
rather in Missouri, mostly in St. Louis. In a similar vein, because the St. Louis
region is designated as an immigrant and refugee resettlement area, we've had
a number of refugees processed here in St. Louis. Starting back from the Balkan war in the early 1990s, we now have over 80,000
Bosnians, but we similarly have a significant number of refugees from
Bhutan, Iraq, from Myanmar, and most recently from Nepal.

These groups are
coming in without access to normal health services, and as a consequence,
they will have a great burden of disease. And this is typically a first generation
phenomenon, but it's a phenomenon that really requires our attention. But
there's another demographic which requires our attention. Remember, I gave
you the definition of health equity. You know, everyone should have the
opportunity to reach his or her fullest health potential. We're seeing that a
unique population not just in Missouri, but the United
States, is not reaching his or her health potential and it is young, low-income
whites. Well, we saw that phenomenon in this past year and unfortunately it wasn't
given the attention necessary and as a consequence, we're seeing
an increased number of deaths due to diseases of despair. I would rather call
these deaths of disparities, due to exposure to heroin and the unfortunate
opioid epidemic. And certainly we've realized that here in St. Louis,
we may be ground zero for the opioid epidemic. And in this graphic you can see
the remarkable increase in white death rates between 2000 and 2014.

While African-
American and Hispanic death rates are certainly higher, proportionately, than
white death rates – that burden, disproportionate burden, that disparity
persists – we're clearly seeing an increase in overall death rates among
whites. And so when we talk about disparities, let's recognize there are
many groups that are not reaching their full health potential. So, why is this happening? There are certain challenges
in Missouri that we should be cognizant of. We have low per-capita rates of
spending for public health. In fact, among the lowest in the country. We have
inadequate access to affordable health care, to affordable housing. We're in the
midst of this opioid epidemic. We're in the midst of this epidemic of violence.
And we have a fraying social safety net among other challenges. Missouri
certainly is not homogeneous in terms of where those challenges reside. If you
look at the the counties in Missouri and actually look at the life expectancy
based on those counties, based on the regions, you'll see within our bootheel,
there's an even lower life expectancy. If we look at Pemiscot County and others,
we're seeing they have the lowest life expectancy.

And so there's a
significant burden of disease borne by that population that we should be
aware of. We're going to talk mostly about what's going on here in St. Louis and
why do we see these health disparities and what can we do to ameliorate these
disparities. So what are the challenges here in St. Louis? We are also not
surprised – unfortunately there's a significant amount of racial animus in
St. Louis. We turn on our news, certainly predating of the the events in
Ferguson in 2014 – we know that we have needs, we have challenges and
fortunately, we've begun to address this. But this is something that led to a
reduced likelihood of one group, African-Americans, being able to receive
the amount of health commensurate with their overall need.

Therefore there's
a disparity there. We don't have the proportioned funding to address
health needs that we see in other areas of the country. We don't have the
coordination. We have substandard information systems and and our urban
core is old, and it's decaying. These all will contribute to impaired health and
access to health. We also are very fragmented. Within the city of St. Louis,
a population of now only perhaps 315,000, we have 28 wards serving that
small population. And in St. Louis County, we have over 90 municipalities
serving a population less than a million. And so we don't have the ability
to really coalesce around a health strategic plan that will address the
health indicators and reduce disparities across our region. And so this is really
a political impediment that we can address in order to improve health
equity. Our safety net system, the healthcare that we that we provide for the
medically indigent – those who are on Medicaid – is certainly also substandard.
We're not a Medicaid expansion state.

We're certainly aware of that. The last public
hospital in St. Louis closed in 1987 – St. Louis Regional Hospital. And we've just
had a history of poor collaboration among hospital systems here. Our primary
and specialty hospital care really takes place in separate locations and there's
a greater need to provide more community-based care. As you can see, our
safety net is indeed frayed. Now let's now talk a bit more about St. Louis and
the demographics. I've put this slide up because I just love the images of what
we have here in wonderful St. Louis. The Climatron, Forest Park and of
course our lovely baseball stadium for the Cardinals. But turn to this image
here. This is not a Rorschach test, this is an actual image from the 2010 U.S.
Census of the St.

Louis region. Just to give you a highlight, give you a
reference, in the middle of this image is a white line – that that white dividing
line is actually the Mississippi River. St. Louis is to my left, Illinois to my right.
Each dot represents 25 individuals. The red dots represent
caucasians; the blue dots represent African-Americans. You can clearly see
there is a distinction here in where those dots are placed, where they reside. And there is a remarkable demarcation in the north of St. Louis, along Delmar
Boulevard. So north of Delmar Boulevard, the region is almost 90,
95% African-American.

South of Delmar Boulevard, the region is
about 80% white. The Delmar Divide is such a such a graphic indicator of
segregation. It's so stark that it actually gained the attention
of investigators from the BBC who were here to conduct the study on the Delmar
Divide. And in the divide, as evidenced here in this graphic, they noted that
north of Delmar it's just pretty remarkable; as you can see the 99%
African-American north of Delmar and 70% white south of Delmar. And you
can see that the disparities and differences in an educational attainment,
in household income, and of course we'll talk about the disparity in in life
expectancy, based solely on racial segregation patterns that have persisted
for decades here in St.

Louis. So, what are those disparities? Let's kind of go
into a little more detail here. The Regional Health Commission in 2003
actually developed a series of geocoded charts to really highlight the depth of
the disparities in the St. Louis region, with regards to race, socioeconomic status, and
a number of health indicators; infant mortality, cancer. And you can see from
this graphic which is really looking at poverty, and the highest rates of poverty
are coded red. You can clearly see the distinction that the significant
amount of poverty is localized north of Delmar Boulevard in North St. Louis.
You'll see a crescent shape of red extending southward
along the Mississippi River that really reflects the new immigrant population
that we alluded to earlier. But for the most part, poverty in St. Louis is a
North Side phenomenon. Within North St.

Louis, there
are several ZIP codes which are even more likely be associated with
adverse outcomes, and these we call critical ZIP codes. I want you to
focus on one in particular, 63113 in North St. Louis – a region
characterized by some of the highest maternal child risks, the highest sexual
risks, some of the worst indicators in terms of life expectancy, and then poor
health care access indicators. Now let's contrast 63113.
If you remember the first graphic that I showed you, three homes in North St. Louis,
they were in neighborhood 63113. The second home I displayed was in ZIP code
63105 in Clayton. Let's look a little carefully at those two ZIP codes. And
what you'll see are two separate and unequal ZIP codes that are separated
by less than 10 miles. And 63113, the individuals are born – live births without
first trimester prenatal care are tenfold higher in North St. Louis 63113 compared to Clayton, Missouri. Low birth weight is three times higher
in 63113 compared to Clayton. Lead poisoning rates, again: three to four
times higher in North St.

Louis compared to Clayton. And in the final analysis, I
posed the question, What is the life expectancy between an individual
born in that home and 63113 versus 63105? And you can see the answer. There's a
remarkable disparity: 66 years life expectancy in 63113, compared to almost
83 years in 63105 Clayton. Just remarkable. We can map perhaps every
health care indicator to St. Louis region and it
coincides – these indicators coincide with the 63113 and other ZIP
codes in North St. Louis. Here we've mapped homicides in 2017 and you can see
graphically where those homicides are mostly occurring in North St. Louis. So
with this being stated, I think we now can understand that our region is
is racially stratified – segmented – and there are remarkable differences in
health care indicators between North St. Louis and the rest of the region. So it
really should come as no surprise that individuals living in these communities
would scream for help under the heavy burden of living with poor
disease, in poor health, over years. And so Ferguson, to me, was not some
epiphenomenon. It was a seminal event that should have been predicted because
Ferguson had less to do with the death of Michael Brown – the African-American
teenager, unarmed teenager, shot by a white officer – and more with the
circumstances in which Michael Brown and so many lived, circumstances are
highlighted by high rates of poverty, high rates of infant mortality, high
rates of unemployment, and and less educational attainment.

And so when you
take those factors, and then when you layer on police brutality, racial
profiling, discrimination in municipal courts, then you can understand why
Ferguson occurred and why Ferguson can occur again in another part of our region.
So how did we get this way? What happened? Let's delve into this in a little more
detail, and I want to give you a brief history of St. Louis. I think you get a
better sense of why we're this way and how can we then find ourselves
out; how can we find a path forward.

St. Louis started as a very wealthy city,
founded by French fur traders. There was significant commerce in the Mississippi
River. And so the city was bustling at the turn of the century. I love this
image of the Eads Bridge connecting St. Louis to East St. Louis, with
remarkable industry, on both sides, and this moving back and forth between St.
Louis and East St. Louis. East St. Louis and that area had a lot more nightlife
and I think that kind of led to a lot more excitement on the east side of
the river, but they were they were still viewed as a region, together. But
something happened. Landowners, the reigning gentry, business leaders,
recognized that their economic interests were not served by subsidizing the
expansion of infrastructure to the to the rural areas – what would would be in
the future, St. Louis County. And so they wanted to keep the the largesse of
spending in St. Louis City proper. And through a very narrow decision in
1876, the city decided to to divorce from the county, and the city actually seceded
from the county.

So Howard Baer, in 1978, concluded that this action was
roughly the equivalent of England giving up the 13 colonies; only the city did it
from choice, whereas Great Britain at least had a good sense of struggle, but
half-heartedly against the separation. So St. Louis was wealthy and the we hear
about the St. Louis World's Fair in 1904. We think, my goodness, it's 2018,
why are we still talking about the St. Louis World's Fair in 1904. It really
was an opportunity to showcase the the wealth, the opulence in this city to
the world. We were proud of that and there were many others, particularly
health professionals, who were proud of the of the enlightenment that was
occurring in St. Louis at the turn of the century. John Green, who was president
of the St. Louis Medical Society stated that if we have these resources in
St. Louis, if we have the spirit of enlightenment, can we not extend this to
a medical enlightenment? Can we then create a hospital system which will
benefit our less fortunate citizens and will this actually provide
instruction in medicine to undergraduate students?
He was really prescient in saying that we can provide a system of care that
will uplift the entire region.

And unfortunately his advocacy was not
realized by those who were structuring the health care system. The first
city hospital, the second city hospital, actually, the first one opened in 1846,
and was struck by cyclone. But the first major city hospital opened in 1906
and unfortunately it opened as a segregated facility. African-American
physicians were not invited to the hospital. They were not extended
privileges and African-American patients were relegated to residing in a back
part of the hospital.

This was a time when Plessy vs. Ferguson was the law of
the land; separate but equal. Now St. Louis still even in the setting of
Plessy vs. Ferguson was a relatively progressive region. St. Louis is mostly
southern. Let's be honest, and there are some southern mores which still are here.
But as you can see by this integrated swimming pool
that there were certain practices that were really tolerated in St. Louis.
However, something changed. And what changed was the remarkable migration of
African-Americans from the deep south between 1915 and 1917. This is what
Isabel Wilkerson wrote extensively in her book, The Warmth of Other Suns. She
chronicled the epic migration of African-Americans seeking greater
economic opportunities after being oppressed in the
South for hundreds of years, moving into communities that
hopefully provide those opportunities. But this was at a time in the middle
of World War I, when our economy was unfortunately doing less well and
families, like this one arriving in Chicago, found
themselves, when they were seeking employment, pitted against
white, low-income workers who found them to be a significant
threat, an economic threat. And St.

Louis, in particular in East St. Louis, this
all reached a head in 1917 when African-American workers were trying to
find jobs at the aluminum ore company in East St. Louis, while white
workers were boycotting. They were striking, seeing the African-American
workers arrive. Unfortunately tensions brewed and they boiled over and
culminated in one of the worst race riots in the history of the United
States, in 1917. You can see on one image whites pulling African Americans out of
a streetcar and on the right side you can see homes, African-American homes, that were
simply burned to the foundations. This was really a horrific time in the history of St.
Louis. Even before then, white landowners had written into law restrictive
covenants which prohibited whites from either renting or or selling homes
to African-Americans. These were written into law in 1916. Although they
were declared unconstitutional by the Supreme Court, frankly, they continued
unabated for decades, well into the 50s and 60s. And after the
East St. Louis riot in 1917, African-Americans fleeing from their homes, for
their safety, and from East St.

Louis, came across the Eads Bridge, looking for refuge. And
they were told that if they want to be in St. Louis, and were not in St. Louis,
they could not live south of Delmar Boulevard. There were just harsh
restrictions. And so this is a map of restrictive covenants shortly after
the East St. Louis riot. And there's a certain phenomenon that hasn't changed
here. Not only were blacks relegated to living north of Delmar Boulevard,
if you were Italian, you had to live in The Hill, and if you were Jewish you had
to live in either Kingsbury or University City, and if you were German you were
pushed uptown, rather up north, near to Baden and Riverview. We're at 2018 and
frankly, some of these housing patterns have not changed. Well here's an image of
an attempt to really explode and just collapse that entrenched
segregation: the collapse of the Pruitt-Igoe housing development in 1972.
Hopefully, this was to be the sign of progress for St.

Louis, as we moved beyond
entrenched segregated housing to providing mixed income housing
across the region. Unfortunately, that did not come to fruition.
The residents of Pruitt-Igoe were similarly pushed further north into
North County suburbs also, and housing patterns remain segregated. Let's
talk now about health care in St. Louis, since we've had that type of history
about, you know, the political, social, and cultural events. So here's a
picture of our hospital, Barnes Hospital, around 1815. And there's this beautiful
structure there in the foreground; two smaller frame houses. These were the
hospitals for Negro patients at the time, African-American patients. This
was to the embarrassment of a lot of the trustees at Barnes Hospital
around that time. And so those facilities were dismantled shortly after
this picture was taken. But frankly, African-Americans still resided in the
basement of Barnes Hospital for care, well into the 1960s. African-Americans
were pushing for their own hospital, not wanting to live in the
basement or not having a place where they can receive equitable health care.
The City (Hospital) Number 2 was, in a short timeframe, woefully inadequate to meet
the the needs of the African-American community.

And so an attorney in St.
Louis, Homer G. Phillips, became the the main advocate for a larger facility
for African-Americans. And he was successful and in winning a
significant award from the US Department of Interior, along with significant bond,
to build up a city hospital for African-Americans. Unfortunately Homer G. Phillips
was assassinated before his vision was actualized by, a mystery still to this
date. But his legacy was the Homer G. Phillips Hospital, which was constructed
in 1937 and was widely heralded as the largest Negro hospital in the world.

was a beautiful sight. It really was the largest Negro hospital in the country, if
not the world. And between the days of operation from 1937 to 1979,
one out of three African-Americans completed their residencies in this
hospital. It really was state-of-the-art in every
respect, in terms of the infrastructure, the training in conjunction with
Washington University, as well as a high-quality care delivered in that
hospital. Toward the 1960s, the city of St. Louis population declined, peaking in
the 1950s and declining, the city was unable to to support two public hospitals, City
Number 1 and City Number 2. The mayor at the time actually charged two
commissions to look into, whether or not, to look into which one of these
two hospitals could actually remain solvent, recognizing that the tax base
was not there to support both. Both commissions agreed that Homer G.
Phillips Hospital was the better hospital in terms of its physical
structure and its overall quality of care. Nonetheless, Homer G. Phillips
Hospital, the predominately African-American hospital, was the one that closed in
1979, under remarkable protest.

It was a dark day in the history of St. Louis and
it's a memory that's really fully carved in the mind of those individuals of
color in this city, to this day. Unfortunately, with that history, we
continue to see a decline in St. Louis City population, from its peak
in the 1950s to current of about 315,000 individuals. The
last public hospital was St. Louis Regional Medical Center. I had the honor
of serving as chief medical officer and seeing that history really allowed
me to be able to speak really candidly, having spoken to the physicians and
nurses who actually lived through those wonderful and tumultuous years of
Homer G. Phillips Hospital. So I've given you the history, and I don't want
anyone to leave here thinking, My goodness, all this all this is poor – woe
unto us.

Some things are beginning to improve. And through the collective
efforts of the St. Louis Regional Health Commission, which was chartered in 2002,
we have seen health indicators improve. The Regional Health Commission actually
began to look at areas in North St. Louis. I mentioned those ZIP codes – 63113
among others – and recognized that we could do a better job of coordinating
care among the federally qualified health centers, and those ZIP codes.
As a consequence of that and the creation of the integrated health
network, we have began to witness some improvements in the health care across
the region, particularly the North Side. As you can see, you know,
in the period of 2000-2010, we saw a 29% reduction in heart disease
mortality. Diabetes mortality fell by a similar rate, as did stroke mortality and
even lead poisoning. However for young people who are less likely to access
care, particularly young African-Americans who are less likely
to access care, that population was unfortunately characterized by the
latter rate, an increase in sexually transmitted infections.

And unfortunately,
an increase in homicides. So what have we shared so far? So far,
we've talked about two communities: one black, one white, separate and unequal.
That was a finding of the Kerner Commission by Otto Kerner in
the 60s after the civil rights riots in Watts in
Detroit. But we can say the same thing about here, our own region, in 2018:
separate but unequal. We have communities of opportunity and we have communities
health disparities, low-income communities, and those communities basically can be stratified, based on the collective number of goods and
services; the social determinants of health that we alluded to earlier. The
access to transportation and grocery stores and financial institutions
and better performing schools will give rise to communities of
opportunity, whereas in distinction, poor-performing schools,
limited public transportation, food deserts associated with our
low-income communities, and thus poor health status, compared to the
communities of opportunity with their excellent health status.

Well we've
also talked about the social determinants of health, that our health
status is really undergirded by access to to affordable homes, living wage jobs,
ability to obtain an education, the ability to live above the poverty line; these are
factors which really are more responsible for overall health than
health care that I can deliver as the clinician, in my office. Lastly, I hope
that this presentation allows us to recognize that these disparities persist
based on social and cultural phenomenon. In this graphic, and 8 out of 10 white
practitioners believe that disparities in how people are treated within a
health care system "rarely" or "never" happen, based on such factors such as English
fluency or racial background.

And when they do acknowledge racial disparities,
physicians will say, Well these disparities occur in the U.S.
health care system, but they don't occur in my hospital or my clinic. And even
more disheartening are these beliefs that persist among U.S. medical
residents and medical students – even now, a quarter of residents
in medical schools will believe that African-Americans have thicker skin than
whites. And there are other false beliefs that are perpetuated in our medical system.
And so, because of all these factors, it's really incumbent upon us to delve deep
into this history; to recognize that in order to understand health disparities
in communities of color, we must get out of our comfort zone. We must get
civically engaged. And we have to have a greater sense of, How do we train
ourselves to mitigate the bias that we all have and to become more aware of
these disparities? How do we incorporate questions on social determinants of
health in our medical histories? And how do we recognize that individuals living
in these certain ZIP codes – North St.

Louis – who live under daily trauma and
high stress, how do we begin to deliver care that asks: "What happened to you?"
rather than, "What's wrong?" How do we deliver trauma-informed care? These are
things that we must do now – we have to do – if we really are sincere about wanting
to reduce disparities and ensure that every St. Louisan has the opportunity to
reach their full health potential. There are opportunities for residents; there
are opportunities for students. And in my final statement, I would say a lot of
this is not based on giving a certain level of understanding about disparities,
rather than giving a certain level of understanding about, How do we treat
people? How do we treat our patients? And I think Francis Peabody had the most
salient statement.

He stated in 1927, "One of the essential qualities of the
clinician is interest in humanity, interest in caring. For the secret of
the care of the patient is caring for the patient." I want us all to care for the
patients in our region, whether those patients are from North St. Louis or
South St. Louis, whether they are from Ladue or whether they're from downtown
St. Louis, whether they're African-American or whether they're
white, or whether they're Muslim or Latino. Now we're all St.

and when we all are really supported around the sense of
caring, about uplifting the entire community, then we will have opportunity
to see all of us reach our health potential. And then we will see the
demise of crippling health disparities. Thank you..



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