Anjana Sreedha

[00:00:00] Speaker A: Welcome back, everyone, to the Tron podcast today. Have a very special guest today, very accomplished woman as well as an accomplished author, Ms. Anjana Shriter. Thank you so much. I really appreciate your time. [00:00:11] Speaker B: Thank you so much for having me, Rashad. Looking forward to our conversation. [00:00:13] Speaker A: Yeah. I'm very honored to have you on here. And, you know, I just want to say, like, with what you've done and as far as when I got a chance to really look up your accomplishments, I watch your video on your website, and you have. You're very well versed in public health, and that's a very strong cornerstone of your background. Please, before we get into that, just give a little bit about your background on how that kind of led you, you know, from. This is what I want to do, and this is how I accomplished it. [00:00:36] Speaker B: Yeah, absolutely. I think for me, it's always been interesting to kind of bring together disparate elements to tell a story. And so for me, I think I got interested in healthcare mostly because of the national debate surrounding the Affordable Care Act. And at the time, there was a lot of pushback against the Affordable Care act, people wanting to repeal and replace it. And that really got me thinking about how intricate and how complicated the American healthcare system is. And I think we all know that sort of tagline. You know, the United States is one of the most economically prosperous countries in the world, but we have some of the worst health outcomes when compared to our peers who are also developed countries. So what I. The reason I wanted to explore this question is because I wanted to understand why this was happening and ultimately what. Whenever you want to understand the why, you have to look back into the past. And I'm somebody who's really passionate and cares a lot about history. And so for me, it was really important to take a look at what are the historical narratives around the United States that I've been fed during school, in the public discourse, et cetera. It's usually a narrative around how the United States is incredibly powerful. It's a global superpower, it saves developing countries through foreign aid and things like that. And it also is a place where anyone can achieve their dreams. But I think it's really important to talk about how that narrative kind of fights against the reality on the ground, which is that because of intentional policymaking, a lot of communities have gotten left behind in terms of being able to pursue the American dream, including affordable and quality health care. And so that's what really led me to write my book, Healthcare of a Thousand Slights, which really documents the history of health disparities among marginalized communities in the United States to really say, let's take a magnifying glass and look really closely at what's not, not only what's happened to these communities over time, but how state and federal governments have treated these communities over time as well. [00:02:28] Speaker A: Well, I think the interesting fact that when you said about, you know, U.S. health care is that our U.S. health care system is really a product of World War II, right, where there were price controls and then they couldn't come to a general consensus because universal health care started with Otto van Bismarck in Germany, you know, and then, so now you get to a. Well, we can't have that system because we, you know, it never really had that, you know, inception from the very beginning, excuse me. And so then it became, well, let's just make it a tangible benefit for employers and then it's non taxable. And so then it became Blue Cross booth healthcare associations. And then it sort of morphed into this patchwork system where it never really became the circa universal system that a lot of countries had implemented hundreds of years prior to. So we've kind of been building on top of the private system, you know. You know, I think everybody can agree, you know, to a degree of what they want to, that the private system when it comes to pharmaceutical research, development, diseases that have been implemented. But you can, you can clearly see that there's some holes in the system. And I'm glad you wrote this book because obviously when you look at how wastes are dumped or whether how quality of air in certain areas there are disparate health outcomes depending on your zip code in this country. [00:03:40] Speaker B: Yeah, no, you're absolutely right. And I appreciate you bringing up sort of the history of health insurance because that's the way through which people are able to access health care services. And what's really interesting to your point about World War II is that obviously the workforce shrunk. Shrunk a big deal because a lot of people were abroad fighting during World War II and health care was sort of offered as an incentive to get employees through the door for a lot of these places. And, and obviously when people came back from war, that process just kind of continued. And what's been really interesting about the universal healthcare debate is that it's not that we haven't had that debate in this country. You're absolutely right that you know, maybe in the very beginning it wasn't very palatable, it wasn't really built on. But what's interesting is that there have been Special interests that have really pushed back against this idea of universal healthcare, even if there was approval at other levels. Most famously, the American Medical association, also known as the ama, was really against the provision of universal healthcare because they were worried about reimbursement and payment for their physicians in terms of providing these services. And so it's really important to track that history because like you said, it's really built upon a. More of a privatized system. And it wasn't until the 1960s when Medicare and Medicaid were really developed. So before that time, if you were. If you were a poor person who was working somewhere that didn't offer health insurance, or if you were an elderly person who was retired and you got sick, you had to figure everything out on your own, which obviously made things super challenging and probably made health outcomes even worse at that time. [00:05:11] Speaker A: Right, right. And so, you know, I think one of the keys that, that sometimes people can overlook and even if you just take like a. Like a drive down, like, any, any road, right? Like, so if you, if you drive and you start looking at where either smokestacks are or where waste is dumped or whether. I mean, I live just outside of Detroit, and as soon as you go over what's called the, the Rouge Bridge and you see, like, where there's. Where the smokestacks are for, for an oil refinery, you can see the neighborhood exactly where this is placed. And you start saying, oh, it's, you know, and then you're like, okay, there's more to it. You know, you can. It's not just a road. It was placed there particularly for a reason as to why that took place. And obviously that's a lot of your research. So what did you find out when you started writing your book? [00:05:54] Speaker B: Yeah, no, that's a great question. So I think a lot of what I found out is exactly what you mentioned. A lot of these sorts of places that were known for having really toxic chemicals, whether they were waste dumps or factories or smokestacks, were intentionally placed in poorer neighborhoods and neighborhoods of color in particular, because those neighborhoods were not considered of value. And I think it's also important to talk about the kinds of investments that are made in those neighborhoods. Even now. Oftentimes people who live in these neighborhoods can't access affordable and healthy groceries. You often see bodegas, liquor stores, fast food restaurants in these neighborhoods in very high numbers. And you're not going to see necessarily a place where you can get spinach or arugula or salmon or something that's more, more Healthy for people. Exactly. Oh, I'm making you hungry. And then the other thing, the other piece of it too, is a lot of the folks in these neighborhoods often can't access green space. And that becomes a challenge as far as exercising is concerned. Right. So you have, in a lot of these communities, chronic conditions like hypertension, obesity tend to reign because not only are people unable to access the right foods, they're also unable to access the ability to exercise outside safely. So that's a lot of what I found. And I think it's also important to talk about how history shapes the ways in which communities gather, in which communities eat, in which communities function. So I'll tell you a particular story, which is that in terms of the Native American community, a lot of them had continually been forced off of the lands that they were on historically by the American government to make room for new immigrants, for other people coming from places like England, etc. And as a result, they were taken and put into what we know now as reservations. And what's really interesting is that reservations are very intentionally selected because they don't have arable land. And this is a huge problem for a community that really prides itself on being close to nature, on being able to hunt and gather and farm in ways that are beneficial for the environment, but also beneficial for the community. So in these reservations, a lot of these people didn't have access to running, clean, running water. They didn't have access to grow their own crops, to hunt effectively, et cetera. And so they were reliant on federal subsidies as far as food goes. And obviously, the kinds of foods that were subsidized were not healthy foods. It was a lot of white flour, processed sugar, that sort of thing. And what's been really interesting is that what's come out of that is this food known as fry bread, that's really common in Native American communities. And all it really is is like fried dough. But it's. It's interesting because it's a sign of resilience of the community. Like, this is what we had to do in order to survive. This is what we had to eat. But it's also a reminder of what's been lost, because this community was previously able to access things like, you know, healthy animals to hunt or crops that they were able to grow. And so it's really interesting to think about, you know, communities have lost historical ways of doing things, and they've also. They've also had to suffer negative health consequences as a result. [00:08:58] Speaker A: Salt. That is correct. And then you Know, I was looking up the history of New York, and you're in New York. Right. So one of the things that I looked at was how the building of New York took place, because I'm always. I'm the history junkie, right? Like, I like to watch the History Channel, like to watch the Discovery Channel, and then I can. And so seriously. So I was like, okay, how are major cities built? And so in. Apparently, from my understanding, there was a builder called Robert Moses who's like the founder of building in New York. And so I've heard that the policies were intentional to put lack of access to certain areas to certain amenities, whether the freeways needed to cut through certain neighborhoods, whether party store, whether stores, what you talked about earlier, or even just access to amenities. So did you find that in your research that there were actual, you know, placement of services for certain areas that made it less desirable for people, quote, unquote, to get trapped in certain areas? [00:09:49] Speaker B: Absolutely. I'm really glad you brought up Robert Moses, because there's a famous book about him called the Power Broker I read pages long. Yeah. And I have. I keep starting it and not finishing it. But the introduction that I've read so far actually talks about the fact that Robert Moses wanted to make a lot of things inaccessible, in particular to black communities living out on Long Island. And so freeways and highways were designed to cut across a lot of these communities. Causing people to move, to leave. Exactly. Yes. And I think the other sort of interesting anecdote that he and his wife would go to the beach and they would count the number of black people on the beach and, like, how many people came on, how many people left, etc. And kind of, you know, realize, like, oh, there's. There's too many coming to this particular beach. We may need to reroute the freeway so that not as many black people have access to the beach. And so even that sounds so simple, but it's also so insidious at the same time. Something like the beach is not necessary to live. It's a nice to have, not a need to have, but even access in. [00:10:49] Speaker A: And out of your own area, in your own zone. [00:10:51] Speaker B: Exactly. [00:10:52] Speaker A: Right. [00:10:52] Speaker B: Yeah. Like, you might actually be like 5 or 10 miles away from the beach, but you might have to drive for 45 minutes because the roads are taking you in all of these ways. And like I mentioned before, and like you pointed out, all of this is incredibly intentional. And so it's really important to talk about that. Intentionality has occurred across the country. Right. I think we tend to think of the, the American south as the place where racism really took root and there are signs of it even today, et cetera. But even quote, unquote, liberal states like New York, New Jersey, the, the Northeast, more broadly speaking, have been in support of policies like this historically which have led to these outcomes now. [00:11:29] Speaker A: Well, so let's do you. And then I think that to, you know, obviously you're more of the health research person than I am, you know, but I can tell you, like, even when you drive around, there's freeways called 75 and 275 in Michigan. And it's funny, when you drive down 75, right, you see the freeways intercross and they're very, very tightly woven. And then you have what's called like a 275 which goes to more suburbs and the freeway exits are very wide off to the side and there's easily like it's, it's, it's a straightaway and it's not cutting through a neighborhood, so to speak. Right. So it's on off, so to speak, as opposed to like this freeway, this bus, this cross. It's, you know, and I understand that anytime you're dealing with a large metropolitan downtown city, by default it's going to have a lot of freeway, you know, congestion and traffic and things of that nature. So, but it's a very complicated issue when, you know, your eyes tell you what your eyes tell you. [00:12:21] Speaker B: So yeah, you're absolutely right. [00:12:22] Speaker A: So how did you. So you started this book and like I said, your confidence are incredible. Right. Like, so I mean, a lot of people don't think about the things that you do. And then you also had a friend also who went to, it's Brian Zhang who went down to some developing countries as well too, to find about disparate health outcomes in what people would call third world countries. And I apologize if that offends anybody. Can you go a little bit deeper into that? [00:12:45] Speaker B: Yeah, absolutely. So I think obviously the biggest difference between the United States and lower income countries is that is lack of access to capital. Right. So I think when you think of the United States, obviously we're on the cutting edge as far as drug innovation, as far as the most advanced treatments that might produce the best outcomes for people, et cetera. But I think the differences in lower income countries is that lack of access, a lot of people struggle to even get to the doctors. A lot of the, the public health infrastructure in these countries is such that everything is out of pocket. There is really no such thing as insurance that can cover any kind of medical visit, right? And so, and obviously you're talking about people who are literally maybe making a dollar a day. And how are those people then going to take that money, take that dollar and stretch it so that they can get seen by a healthcare provider. On the flip side, however, there have been some investments made in lower income countries because they recognize the power of community. And I think that's really important because the United States is also a community driven place. Like, yes, we're incredibly individualistic and everyone's sort of looking out for themselves, but at the same time, beings are meant to function in community. And what lower income countries have done really well, and what my friend Byron had pointed out is they've really invested in developing a community health worker workforce. And what that means is, you know, identifying champions in the community, people who are well respected and training them and educating them on really simple things like diabetes management or prenatal care for pregnant women and things like that, and having those people get basic medical training so that they can go to someone's house, ask them how they're doing, ask them how they're managing their diabetes, do they need help with insulin, do they need help with getting to the doctor's office and making sure that they are equipped to provide those solutions to patients? And so obviously, one of the big advantages there is that it's a member of the community, it's somebody who speaks the language, understands the culture, has the trust of the community, but also has that specific training to assist patients with whatever chronic needs they might have. And what I find fascinating is that in the United States, I think we're actually behind the ball as far as investing in that kind of community health work. As you and I both know, a lot of communities, even in the United States, are suffering from misinformation, from lack of trust in medical establishments, which means that they may not want to get care or may be afraid to get care. And so having a community health worker go into this person's home and explain to them the importance of taking their insulin on time or the importance of providing healthy food to children, et cetera, can actually be really powerful as far as demonstrably improving health outcomes. And so it's interesting because I think as the United States and as a lot of other developed countries do as well, there is often an attitude of condescension and looking down on lower income countries as not being as developed, not having the right access to things, not having capital, et cetera. But on the flip side, they have made These investments with the support of the international development community that I think that developed countries like the United States can definitely learn from. [00:15:45] Speaker A: Well, I think one of the distrusts sometimes that they can develop in the health care system in the United States of America. Like, for example, the Tuskegee Airmen experiment. Right. So this is a situation where specifically people, for the people who don't know this story, they were. They were injected with syphilis and they were just basically given placebos to treat it. And then they just wanted to watch to see what happened, essentially. Right. And so you have a situation where people went blind, people died, and then in 1997, you know, Bill Clinton then said, hey, what. What happened here was shameful. This should never have happened. So you have a situation where there. There's a rooted distrust in the healthcare system because in some instances, people were actually experimented on. You know, there are stats. I think there's. Isn't there a statue of a prominent physician that had. That was experimenting on. On slaves at one point somewhere in New York? If I'm not mistake, I can't remember the gentleman's name. What doctor? [00:16:37] Speaker B: His name was Dr. Marion Sims. I actually talk about him in my book as well, because like you said, he's a really good example of why people don't trust the medical system. [00:16:45] Speaker A: Right. [00:16:46] Speaker B: What's really fortunate is that he made all of these advancements in obstetrics, especially as far as, you know, how to, you know, how to deliver children in complicated medical situations. But all of that was built on the pain and the labor of enslaved women. [00:17:00] Speaker A: Yeah, it was. Yeah. Right, right. [00:17:03] Speaker B: And like you said, like, that statue was up in Central park, like, not in a small, you know, neglected place. It was like front and center in Central park, which is very famous in New York. And eventually the. The history around this person was identified and that statue was eventually taken down. But it took until, like, I think it went down in 2019 or 2020. Like, it took a really long time for people to be like, oh, this is a problem. We should not be venerating this person. [00:17:26] Speaker A: Yeah. And I know that that's a, you know, that's a loaded situation. You know, in defense of statues, I will say that if you, if you. Everybody who has a statue, and I'm not defending anybody's behavior, I promise you, they. They somehow didn't do good things. Right. It's. It's such a, you know, and that's because, you know, you have a beautiful hospital, for example, you have beautiful research, like Henrietta Lacks, for example. Right. And what happened with her cells, Right? So, you know, you have all these pharmaceutical firms that are like, yo, we, we cured these diseases. It's done research. It's like, yeah, but you, you took the woman's cells, right, without her permission. And the family literally never got compensated for seven years. It just happened like five years ago after years of litigation, that the woman's family got compensated through some of the largest pharmaceutical firms in the world. Right. But you have to be willing to go down that wormhole and basically come in with an open mind as to say as to those things, which I'm sure your book does. I'm going to have to read it because I love reading about things like, and it's important that people know that. So, and I apologize if I'm talking too much, but you just got my head just like, man, this is so fascinating. [00:18:27] Speaker B: That's good. That means it's a good conversation. [00:18:29] Speaker A: Where did the baseline of your research start? Because healthcare is so tried Bible, it's so politically charged, it's so personal. How did you actually say, this is where I'm gonna start? [00:18:40] Speaker B: No, that's a great question. I think, to be honest, I started writing around the time that this little disease called Covid was taking off in the United States. And so I actually started writing in January of 2020. You know, the first couple cases had arrived in the United States, but people weren't really too worried about it. And then it started to hit cities in a major way and obviously hit New York City, where I was based at the time, pretty hard in March of 2020, about five years ago. And so during that time, it was really obvious to me and to a lot of others who work in healthcare, like who gets to be safe from this disease and who doesn't. And there's a couple of factors that go into that, right? There's obviously the actual health factors, like people who are immunocompromised, people who have chronic conditions, they were the ones who were most at risk of contracting the disease. But then there's also logistical issues as well, such as if you're a lower income worker who can't afford to work from home or doesn't have the kind of job that they can work from home. If you're a healthcare worker providing patient care, there's no way that you're working from home. And so a lot of these people were definitely more at risk. On the flip side, there was less that a lot of these people could do to protect themselves from the disease. And I think, I think about New York in particular, just because space is a constraint anywhere. But especially in New York, where it's very common for there to be three to four people sharing a room. And a lot of people live their lives like they're just there to sleep, right? They're not really at home to do anything else because there isn't space to. And then all of a sudden, you have a lot of people who may be working outside the home most of the day coming back into the home and not. Not being able to protect themselves and not being able to protect each other. And obviously, this was a bigger issue in multi generational households where you had, you know, elderly grandparents, you know, maybe parents who are working outside the home, small children who may not be eligible for vaccination, et cetera. So it was interesting to me to think about, like, who are the people who can protect themselves and who are the people who can't? There were lots of people who left New York during this time. There were a lot of people who couldn't afford to do that. And so that was kind of my entry point into really thinking about this and sort of thinking about historically. It's not like Covid is the first disease that's hit us in this way. There's been Ebola, there's been influenza. There's been a lot of other epidemics, public health epidemics that we've faced. And who are the people who tend to be most at risk in those situations? And then obviously, the murder of George Floyd in the summer of that year really got me thinking about issues of race and gender and a lot of other quote, unquote, demographic markers that affect people's lived experience and also can affect their health outcomes. So for me, I wanted to tie all of those things together, sort of history and the impact of history on people, the impact of history on health, the impact of health on the future, on people's abilities to build the lives that they want. And I wanted to find a way to bring all of those things together. So that was. Covid was definitely my starting point. But then a lot of other things happened during that year that kind of built on. [00:21:39] Speaker A: Well, I have two things about that. Number one, you were in New York of all that. You know, a place that has, you know, what, 20 million people, you know, just the second or third largest city in the world, and then that 8 million people. [00:21:48] Speaker B: But it's all good. Maybe the larger metro area. [00:21:50] Speaker A: Like the metro. Yeah, I'm talking in generalities. Right. So this is the guy who's been three times, right so, like, all good. [00:21:56] Speaker B: I've never been to Detroit, so you're better than me. [00:21:59] Speaker A: Okay, so this is. Yeah, so, you know, this is the part where your knowledge is going to be a lot better than mine. But, you know what's. When you talk about the spread of diseases, right? And I just found this out. This was so crazy to me. So when people hear about, like the Black Plague, for instance, and people hear about it, you've seen movies about it, and sometimes it's just an antidote. And then I actually found out how it actually started. And I'm sure you know this. It was from the Mongols at the siege of Caffa, right? So it. So it's like an island, you know, between Africa, Greece, Cyprus area. And so they were trying to siege this territory, but it was walled off really well. So then their soldiers were passing away and dying, and so they wanted to get to this territory. And so finally, too much to the detriment of the rest of the world, they started catapulting the dead bodies of their soldiers over the walls. And when the. When the dead bodies got catapulted over the walls, the rest happened. Then people started leaving because there's carcasses in the middle of the street. And then those diseases from those carcasses, when people left by boat, brought that to the rest of the world, right? And so you realize, like, just how quickly something can spread, and that kind of tied in when you said, you know, this is not the world's first major disease, that that has happened. So when you do your research in your book and you're finding out that it's hitting certain communities or certain people are getting disparate health outcomes, that that's not in a short percentage. Like, this didn't just happen in this time. This is because people have had poor outcomes for centuries, decades, et cetera. Right. [00:23:25] Speaker B: Yeah. No, you're absolutely right. I mean, I. What I always kind of go back to, and this might be a silly thing for me to not have realized, but we all learn about the history of segregation in the United States, and we especially learn about it in the context of public places and education. Right. Especially thinking about Gromy Board of Ed. It might have been obvious to others, but was not obvious to me, is that hospitals were also segregated, which meant that if you were. If you were a black person seeking care, only certain ambulances would pick you up and would take you to black hospitals that were often underfunded and understaffed. And so there was a lot of response from, like, black physicians in the community, like, if you need me, here's my cell phone number. I will come with my briefcase, right? Because there was, again, a lack of investment in the medical system for the black community, which meant that they, you know, they could call an ambulance. One may or may not come. If it came, they may not get the care that they need. And obviously, there's been a lot done to remedy that, and we no longer have at least legally, legally segregated hospitals and places where people receive care. But the history of that and what I'm talking about is probably about 100 years old. There's obviously a longer history that has to do with enslavement, lack of access, et cetera. But, like, if we're talking about this more recent history, even that has done a huge number on black people's overall health outcomes. And I think we've all seen the statistics as far as black health in terms of chronic conditions, in terms of maternal health outcomes, in terms of infant health outcomes, etc, and that all comes from a broader history. And again, not just a lack of investment, but an intentional disinvestment in these communities. So I think that's really important to think about. [00:25:04] Speaker A: So while you're in. You know, one of the things I found fascinating about your background was you went to. Maybe I'm wrong. All I saw was New York, Shanghai. Did you actually go to China? [00:25:14] Speaker B: Yes, I studied abroad. [00:25:16] Speaker A: I didn't want to miss that. Okay, tell me what. What was the experience like? You know, going to. To China, that's. That's a big leap. [00:25:23] Speaker B: Yeah, it was a really big leap. I mean, I. So I actually, I minored in Mandarin in college. And part of that experience is Mandarin is, like, very difficult as an English, like, native English speaker. And I speak other languages as well. But, like, Mandarin is unlike anything I've learned. And so it was a very sort of difficult language to get a hold of. And I think being in the country, whatever language you study, when you're in the country where people use that language, you're immersed in it. You're around it all the time. You get better and better each day. And that was kind of my intention around wanting to study away. [00:25:54] Speaker A: There you went knee deep. [00:25:55] Speaker B: And so what'd you say? [00:25:56] Speaker A: You went knee deep. [00:25:57] Speaker B: Yeah, I was. I took a year of Mandarin before going, and I thought I knew Mandarin. And then I got there and I was like, oh, I know nothing. This is great. So it's very humbling. Very humbling experience. But what was also interesting is that when I was there, I did get to Interact a little bit with the healthcare system, not all that much. I had to take a friend to the emergency department because as you might know, and as a lot of people know, the drinking age in the US is 21, but pretty much everywhere else it's 18. [00:26:21] Speaker A: Yeah. [00:26:22] Speaker B: So a lot of people are legally drinking, but that doesn't necessarily mean that they know how to handle their alcohol. So I had to take a friend to the ed and it was a bit of a complicated situation because I, I was still learning Mandarin. Not good enough to be, you know, helpful in an ED situation. So it was me and a Chinese speaking friend who took the friend who wasn't well to the ed. And it was really interesting to see how everything worked because the person who was sick was a Chinese national, they had the national health insurance and so they were processed like very quickly. And I think that was interesting to me because in the US when you think about emergency rooms, you think about wait time, of course. And a lot of people are waiting hours and hours to be seen even though they're in an emergency situation. [00:27:04] Speaker A: Correct. [00:27:04] Speaker B: But when we were there, you know, China's a huge country, it's like 1 billion people. Shanghai is 24 million people. It's three times the size of New York. But we went to this hospital and my friend was seen, seen to almost immediately. And so it was interesting to think about, like, obviously their system is a bit more privatized as well, where like everyone has the option of the standard national health insurance. You can level up and get private health insurance, but there is at least a baseline that everybody is eligible for, which is pretty interesting. And it's interesting too because again, it's a huge country, but they've made it work for them. And the big complaint in the United States is, oh, we have too many people. There's no way we can guarantee a baseline level of insurance. So it was interesting to like briefly interact with the healthcare system there because it was incredibly efficient and it wasn't that expensive. Like this person, they just needed to get saline pumped into their body because they had had way too much alcohol. They ended up paying the equivalent of like 3 or 4 US dollars for their trip to the ED, which again is surprising because in the US you don't really know how much you owe. An ambulance ride in and of itself cost so much, let alone the cost of the actual visit. So it was interesting to make those comparisons as well. [00:28:17] Speaker A: Yeah, price transparency is a, is a. Yes, that's a whole nother. I mean, yeah, you could. They have what's called the Price Master. Like, right. Like when they have their coded book. [00:28:27] Speaker B: Inside the hospitals, there's a legislation put in place, right? Yes. But I feel like even that, like, even that, that effort of price transparency doesn't actually make it transparent because the way that the data, the way that the information is shared is not accessible to the average person. Like, I tried to look into it and I was like, I don't, I don't even know what this means. [00:28:48] Speaker A: Right. [00:28:48] Speaker B: So, like, so much for being accessible. [00:28:50] Speaker A: Yeah. And I've seen like the, like the little charts where they say, like the MRI in this zip code is like $4,000 more than the one that's, you know, 100 miles away. So, you know, it's kind of, it's, it's, it's kind of weird. You know, you go on, you go on Amazon, for example, and the price is right there for you. Right. And it's laid out then you can compare that to even, you know, to a lesser extent, ebay. But then when you ask how much an MRI costs, it's like you, you, you'd have thought you'd ask for the, you know, the secret to Coca Cola back when it first got invented. Right. [00:29:17] Speaker B: Like, right. [00:29:18] Speaker A: How is this hard? This. [00:29:20] Speaker B: Yeah, exactly. [00:29:21] Speaker A: So, and you know, this is just so fascinating to me because when you go about the history of health, you know, and I apologize if I'm going a little bit over time, because that's okay. Questions are very important. Is that these countries that do invest in some of these lower income countries, do you find out that they almost find out they have like a responsibility. Because you'll find out, you know that. And I say this because, you know, we're a global country, right? There's global trade. And if you, if a country has resources that need to be exported for a particular reason, whether they do fruit, vegetables, minerals, etc. Natural resources that the countries that are coming in say, okay, in order to get these things out of your country and make a trade deal, it's best for us to invest in your people and your health outcomes to get the best possible flow of goods out of your country. Did you find that out at all in your research? [00:30:07] Speaker B: So not really. Only because my research was pretty, pretty exclusively focused on domestic health issues. But I think as someone with an international relations background, I can kind of share a little bit more about that. I think about this in the context of the organization usaid, which is really focused on international development in developing countries on behalf of the USAID government. There is Part of it is goodwill, right? Like, part of it is these countries are our political allies and so we want to continue to maintain some level of a them. Another part of it is actually executing against global health outcomes. The United States, at least in the current moment and has historically been one of the largest donors for global health in terms of funding, in terms of actual boots on the ground as far as aid workers and things like that. So part of it is like, oh, we actually do want to help improve these health outcomes. And then the other part of it is probably, to your point, having to do with, you know, how do we make the relationship between our two countries as strong as possible? And I'm sure trade is definitely a part of that. The only sort of insidious flip side to that, because you mentioned minerals and natural resources, is that a lot of lower income countries, they face this issue known as the resource curse, which is they'll often be very, you know, they'll often have a lot of oil or minerals or lots of, you know, iron deposits or something. But those resources are often, often not only exploited by the federal government in that country, but also may be exploited by the governments of other developed countries that are trying to build those relationships. And so we're seeing a lot of sort of pseudo colonialism as far as that goes. It's been interesting to take a look at different countries in Africa where, you know, a country like China, sorry, Niger and France. Exactly, exactly. And I think, like, obviously some of that is the repetition of former historic, like historically colonial relationships, but some of it is new as well. Like, I think China is increasingly becoming a bigger player as far as investments in Africa are concerned. And it's like, oh, we'll take some of your oil, but at the same time we'll help you build a road. [00:32:09] Speaker A: Right. [00:32:09] Speaker B: Which can be a mutually beneficial relationship, but it can also be an extractive relationship if you're not careful. I mean, that can ultimately have outcomes that can ultimately have consequences for the health of people in those places as well. [00:32:21] Speaker A: Well, when you're talking about public health, and I'm going to just shift just slightly here, I thought it was crazy because we're taught you're in New York City and I watched the show 1923. I don't know if you ever seen 1923. You don't seem like you have time to do anything much else like tv. And I mean that respectfully because you're the smart one, I'm the dumb guy asking all the questions. So that's not a diss. To you. But so the show 1923, without getting too down the wormhole of TV, was showing how, you know, woman's from England, she married an American. Now she's trying to make to the US and so they go to Ellis island. And I'm sitting there watching, watching the show with my wife. And you have all these immigrants that are from. In a boat that travel across the ocean, packed really tight together. Then they go to a processing station. Right. And, you know, medical has come a long way, but here they are being processed on this island all grouped together. And you don't know who has tuberculosis. You don't know who has a flu. [00:33:11] Speaker B: Right. [00:33:12] Speaker A: You don't know what that, like, literally. And you're like, women, children, whole nine yards. And I'm sitting there with my wife, and this is just watching a fictitious show based on history. And I'm just like, that's disease central right there. That is disease central. They've been packed onto a boat together, they're getting processed and sitting all this room together, and who knows if you've taken a bath, brushed your teeth, sanitary conditions, et cetera, et cetera. And now you spread that to a congested metropolitan area, and that's where a public health crisis can start. [00:33:37] Speaker B: Yeah. And I think that's part of the reason why New York was such a hotbed during COVID too. It's like, there's just too many. There's just people everywhere. And I think it's interesting because when you leave a place like New York and go someplace else, you're like, oh, not everywhere is this crowded. Like, I know I lived in Washington, D.C. for two years. [00:33:53] Speaker A: Yeah. [00:33:54] Speaker B: And when I was there, I was like, where are the people? Like, I don't see. And I was very concerned. I was like, am I going to get. Is someone going to hurt me? Because I'm the only one on this platform. It's like, no, that's actually more common than we think. But like you said, that has implications for how disease might spread. And it's funny, you bring up the story of like, 1923, as far as Ellis island. Being processed at Ellis island goes, because it reminds me of a scene from the movie Brooklyn, which is about a woman who comes from Ireland and moves to Brooklyn, and she also gets processed in Ellis island, and she's, you know, brand new to moving to a new country. And so this other person, who's like a more seasoned traveler on the boat, tells her, like, oh, don't cough or sneeze in front of the officer. Like, hold it in. Because if you do that, you will get pulled aside and you will get questioned about your health and they won't let you in. And so that was. That's one of, like, the wise words of wisdom that she gets from this seasoned traveler. So even though she might need to cough or sneeze, she, like, holds it all inside so that she doesn't get pulled aside separately. [00:34:53] Speaker A: Right. And then when you start having people from different language backgrounds, different, you know, cultures, and who knows if they could actually go and see the respective doctor in those communities when they start landing and coming over. Right. Because obviously, where there's various different people across the country and there's no guarantee you can go to the same doctor, and maybe those diseases then start going generationally throughout a community, you know, and lead to disparate health outcomes too, as well. [00:35:16] Speaker B: Yeah, absolutely. It's funny that we're talking about TV because I think there's a lot of really great health representation in TV as well. And this example comes from the United Kingdom, but talking about, like, doctors and seeing diseases they might have never seen before. There's a great show called Call the Midwife, and it's about midwives and midwives and nurses who live and take care of patients on the East End of London, which at the time is very poor, very working class in the 1950s. And one of the. One of my favorite episodes has to do with a Ghanaian family that moves to the uk they have just gotten their British citizenship. It's a great time all around. And it turns out that I think that they have two children, the son, the older son, who's like 11 or 12. He. He gets tired very easily, and he has these, like, sharpshooting pains in his legs, and they can't really figure out what's going on. And through a lot of research, their primary physician identifies that this child has sickle cell anemia. And they've never seen that before. And as we know, it's. It's more prevalent among black communities. And so it's not surprising that they didn't know what it is. But it's the first time that this physician has seen it and is now, like, trying to teach himself how to treat it. So it's interesting. To your point, how migration patterns also bring. Exactly. Yeah. Migration patterns bring more diseases. They bring other types of, you know, issue healthcare issues that people are facing into a new place. And then it's incumbent on the new place to make sure that they can effectively take care of everyone and learn about these diseases as well, yeah, and. [00:36:47] Speaker A: That'S a heck of a learning curve. Your first patient who you know from a region that you haven't treated before, and all of a sudden you're like, oh, this is sickle cell. What's the next step? You know, it's. Yeah, it's a terrible disease too, you know? [00:36:57] Speaker B: You know, and it's a disease we're still learning about. Like, I think I remember reading last year, there was an investment made in a drug that was specifically developed to treat sickle cell, but it's incredibly expensive and it's not covered by insurance. And so again, it kind of goes back to the story of when we talk about investment, it's not just investment in communities, it's also investment in the kinds of drugs that are being made. Who are they being made for? Who are they impacting? And so there's. There's been an obvious lack of investment in drugs relating to women's conditions like endometriosis or polycystic ovarian syndrome, but also in terms of diseases that impact non white communities, like sickle cell anemia. That's not to say I'm sure there are very few white folks that have sickle cell anemia, but the majority are black. And it's been interesting to me that it's taken to, like, 20, 23, 2024, actually invest in developing a drug that could actually handle this particular, particular disease. [00:37:47] Speaker A: Yeah, it's. It's, you know, when the cells can, you know, hook inside your bloodstream and cut off oxygen. You know, it's. You just, you know, there's a football player, Brian Clark, who has it. He's very, you know, he's very famous now. He has his own podcast. He can't play. He couldn't play in Denver. He's retired, but he couldn't play in Denver, you know, because of the elevation, because he lost his spleen when he played out there. [00:38:06] Speaker B: Oh, wow. [00:38:07] Speaker A: Yeah, that was about, I want to say, like 202009 or 2008 ish or something like that. Yeah, he played out there, and that's when it flared up and he almost died. [00:38:15] Speaker B: Wow. [00:38:16] Speaker A: It's an absolutely amazing, terrible disease. You know, I would honestly like you have enough information that could probably fill a couple different chapters of a documentary, you know, episodal wise. I could pick your brain probably for days and probably wouldn't get past the first chapter of the book. I do want people to give an opportunity to talk about where can people find you and what's the best way to get your book sure. [00:38:39] Speaker B: So where people can find me. I'm pretty active on LinkedIn, so if you just look me up on, on LinkedIn, I post there quite a bit. I also have my own blog on Substack. It's just my name, anjanashreedhar.substack.com the title of the blog is Healing Healthcare of a Thousand Slates. So I kind of try to go into the specific history of certain diseases of certain topics, what, what's being done to alleviate those diseases or those health disparities, et cetera. And the best way to find my book is at any local bookstore. Also, my book is sold wherever you can find books, Amazon, Barnes and Noble, Nook, etc. [00:39:13] Speaker A: I do know, and I want to, I want to make sure I say this as well too. You're, you're a speaker as well too. So you do speak, you do the speaking, public speak, you do speaking circuits. Who have you spoken to and give speeches to? [00:39:23] Speaker B: Yeah, absolutely. So I've mostly been invited by education, more educational, academic environments. So I've been invited to do talks with public health graduate students in places like the University or, sorry, Penn State as well as nyu. I'm also, I've also been invited to do book clubs with various organizations. And so a lot of my work has tended to be more workshop oriented, but I am building out doing more of a speaking on stage kind of thing as well. [00:39:50] Speaker A: I think you've. Well, based on your accomplishments, I'm sure that's the next step. Right. So, you know, I think. [00:39:55] Speaker B: Thank you. Appreciate that. [00:39:56] Speaker A: Absolutely. And you know, this is love topics like this because one thing about health is it's so personal and you'll do just about anything to get yourself well. Right. You know, we've seen people travel the world, sell their houses and this is, this is not just United States thing, this is anything even in fictitious movies like, you know, Dr. Strange, you know, a guy travels to see a Tibetan monk so that, that way he can heal himself from a, from a debilitating injury, from car accident when his hands were damaged. So, you know, I think everybody can relate to at any point in their life what it's like to not have a positive health outcome from themselves or for their loved one and they want nothing more for them to get better. And so, you know, the work you do and the research that you've done in addition to the disparities is a topic that I think deserves as much attention as possible. And I'm so honored to have you on the show about this topic. It's been a great. [00:40:42] Speaker B: Yeah. Thank you so much for inviting me. It was really fun to talk about this with you and to learn. I got to learn quite a bit, too. Like, I actually didn't know a lot about the history of the Black Plague, for example, so thanks for sharing that with me. [00:40:53] Speaker A: Look up the Siege of Kapha. Like, I'm not going to pretend like, I know how to spell Kapha. [00:40:56] Speaker B: I don't know how to. [00:40:57] Speaker A: Look, I'm gonna butcher it. But I'm sure, like, Google's your friend. All of our friends. Right. And I literally. I was watching, like, the Discovery Channel, and I'm like, that's how that thing started. Are you kidding me? Right. Because you just hear about how many people it wiped out, but you don't really understand, like, where it actually started. Right. [00:41:13] Speaker B: Yeah, exactly. [00:41:14] Speaker A: And so it. But I'm always fascinated, and I think that the Tron podcast is perfectly suited for guests like you. I would love to be able to follow up and have another dialogue with you as well, too. [00:41:24] Speaker B: Absolutely. I would love that as well. [00:41:25] Speaker A: I appreciate you. You take care. Okay. [00:41:27] Speaker B: You too. Thank you. [00:41:28] Speaker A: Thank you. Have a good one. [00:41:29] Speaker B: You, too. Bye.