Lessons Learned in New Orleans Can Be Shared Across the US, Powell Says

This is the third in a series of interviews on Takeda’s partnership with Xavier University of Louisiana, a multi-year, multi-million dollar investment to create T-REX, the university’s new center for technical research and exchange. T-REX will include health informatics, research findings and interventions to improve health outcomes and well-being.

Xavier University, located in New Orleans, is the nation’s only historically Black and Catholic university. For generations, it has been one of the nation’s leading training grounds for future Black doctors and is known for its School of Pharmacy.

The American Journal of Managed Care® interviewed Lauren Powell, MPA, PhD, vice president, US Health Equity & Community Wellness at Takeda, and Xavier Provost Anne McCall, PhD, about the partnership, and segments from these interview are appearing during the month of July.

Powell previously discussed how the partnership will explore the challenge of lack of trust in the Black community toward medical facilities. A historical factor is Louisiana’s history of segregated medical systems. Starting in the post-reconstruction period, as many Black individuals congregated in New Orleans, the 2-tiered health system emerged: most White patients received care at one of the many private institutions in the city, while Black patients could only receive care at publicly funded Charity Hospital. Even after hospitals desegrated following the creation of Medicare, poor, mostly minority patients continued to travel long distances to seek care at the large hospital known locally as “Big Charity.” Despite the long waits, many trusted the doctors and nurses who cared for them. When the state closed Big Charity after Hurricane Katrina, a system of community clinics was created to provide care closer to patients. But building trust would take longer.

AJMC®: For years, Louisiana had a 2-tiered hospital system, and many of the poorest patients in the New Orleans area were accustomed to traveling long distances for long waits at “Big Charity,” which was shuttered after Hurricane Katrina. How does this legacy affect your work?

Powell:Well, it's an important point and an important part of the context—the society in which we exist. We have to be very honest about the structures that have created the need for health equity. Part of that is very much rooted in racism, and the need [to know] that in racism led [our institutions] to be segregated before they were desegregated. But segregated hospitals—that’s exactly what you're referring to in the history there, and that led to separate and unequal care. It would be unfair for us to step into this partnership and not carry that context of understanding with us. So, one of the first things that we really look forward to [with] Xavier is going in and spending some time on campus. Later on in the summer, we plan to have a partnership kickoff at Xavier, where we're going to spend some time touring the campus; we're going to spend some time getting to know the city of New Orleans and understanding the historical context that has led to the very significant health inequities that the city faces—that the state of Louisiana faces.

One of the reasons why we actually focused on Louisiana is because we understand that in health equity work, what we're ultimately thinking about is how to center the most marginalized in our care. If we had a health care system that centers the most marginalized and made sure that their health outcomes were positive, it would actually work for everyone. So, a rising tide lifts all boats—we took that same approach, if and how we were thinking about our strategy for health equity here at Takeda, we should focus on areas of the country where we know health inequities are the most stark. And if we can start our efforts there, if we can begin our partnerships there—if we can make movement and make an impact there, then we can ultimately help the entire United States. We can take what we've learned from there to help spread that across other communities and across other regions of the country. And so, we fully understood where Louisiana stands in health rankings in the city [and] county health rankings, [from] the Robert Wood Johnson Foundation, and lots of data helps to undergird. We thought very deeply about that. We also thought about the social context of racism and the history that has led to that, and really wanted to think about how can our efforts begin to change some of that and begin to strengthen [this] very vibrant community, this very resilient community.

We think about all the natural disasters and things that have impacted the city of New Orleans in particular, in the state of Louisiana, their health equity efforts that can help undergird and improve even some of those things as well. So, we're just really excited about that. And I'm really excited also to include and incorporate the very important historical context, and [understand] how we pursue this partnership together.

AJMC®: Why is it important for the pharmaceutical industry to invest in partnerships like this one between Takeda and Xavier University of Louisiana?

Powell: It’s a great question. I should start by saying, I am new to pharma. My background is really in public health—[I’m a] former state health official, and so I am very much trained in population health and trained in health disparities and health inequities. And so, I chose to come to pharma because it's a very unique place, right? The pharmaceutical industry has convening power. It has connections in a way that other parts of the health care ecosystem don't exactly have. And I think because of that, there is just so much opportunity here for us to be some be thought leaders and to be leaders in action on how to actually operationalize commitments to health. So often in the funds that we are [putting] into communities or through philanthropic giving efforts, we can be much more targeted with how we use that money with how we use the power and privilege we have, as an industry to create generational change, to create changes and invest in communities and invest in community-based organizations that will actually change the fabric of how people are able to live a healthy life for generations to come. And I think it's just so important.

For this industry, in particular, we're already creating medications and therapeutics that are life- saving. And so, what does it mean for us to think about extending that lens beyond not just the genetic causes of diseases, or the pathogens and viruses that cause disease? But what does it mean for us to think about the social causes of disease as well, and how we can intervene and help? And certainly, the industry can't do everything, but we can at least do something.