History of St. Louis Class Learns about Healthcare

The juniors in the History of St. Louis class met this week for a panel discussion on healthcare. They heard from Necole Cheung, Executive Director of the Christian Hospital Foundation, Dr. Naveen Krishna, a doctor and COVID-19 specialist (and current parent), and Amadou Yattassaye, President of Anthem Blue Cross & Blue Shield (and current parent). The discussion was vibrant and eye-opening.

Carla Federman, JK-12 History Department Chair, led the discussion and kicked things off by asking the guests to comment on the strengths and challenges for the St. Louis region in terms of health and healthcare in general, the pandemic notwithstanding.

Dr. Krishna spoke about how St. Louis is blessed with two large universities – Washington University and St. Louis University – with state-of-the-art equipment and professionals, and multiple community hospitals. We also have a stagnant population which allows us to continue easily caring for the needs of our community versus cities like Dallas and Seattle that have seen a big influx and may struggle to scale up. In regard to challenges, Dr. Krishna pointed out that we have a large 65+ population, many of whom live alone. It can be difficult reaching out to them. The segregation between St. Louis City, St. Louis County, and St. Charles County can also present challenges. “We need to come together and work toward a single goal,” he said.

Cheung agreed with Dr. Krishna in terms of strengths and spoke about how social determinants can cause communities to be unhealthy. “In North County, there are lots of food deserts,” she said. “They don’t have access to healthy foods.” She also talked about how there is a lack of access to care.

“Where we are located is a significant asset,” said Yattassaye. “You can get to 99% of the U.S. ZIP Codes within a day’s drive of St. Louis. We are physically located at the center point and that’s a significant asset.” He also talked about how our weather conditions are mild compared to the coasts, allowing medical professionals to be effective throughout the year. “We are resilient and prepare to overcome challenges,” he said.

Panelists were then queried as to whether there are any unexpected or unforeseen challenges or opportunities that have arisen because of the pandemic.

Yattasaye spoke about how St. Louisans and residents in other communities have embraced the outdoor environment, using parks and recreation to cope with the pandemic. The digital environment has also allowed many to continue working and learning, and maintain connections with others. “People from the coasts are back in St. Louis doing remote schooling. We need technology infrastructure to be robust and available to everyone. We have neighborhoods and communities that still struggle and we have to help them get there because it’s a feature of our world,” he said.

“Nobody saw it coming this bad,” said Dr. Krishna. He spoke about issues with testing and frontline workers at the beginning, and how different CDC guidelines created confusion. Every single patient that comes to the emergency room now is being tested, he said, but a new challenge is the rise in mental health issues due to isolation.

Cheung agreed that the lack of personal protective equipment (PPE) was unexpected and a challenge. She remembered that in the beginning, there were only a few patients and then suddenly there were many. “We weathered the storm and came together as a whole system and were able to assist each other,” she said.

Federman asked the panelists to evaluate how well St. Louis has done compared to other cities, and independently, with pandemic response. All three panelists commented that St. Louis has done well with regard to following evidence-based guidelines and being organized. Cheung spoke about the partnership between her organization and the St. Louis Metropolitan Pandemic Task Force and how that partnership was a position of strength. “We’re still in this so we tell everyone, ‘What we’ve done up to now is good, but we have to continue to maintain that discipline,” said Dr. Krishna. He spoke to the recent news about Pfizer and Moderna vaccines but warned that it will still be a while before they’re distributed and that we need to continue collaborating to get to the finish line faster. “We need patience and resilience,” he said. “We should continue to maintain the element of taking care of other people. We are counting on you to do that.”

Several students asked when things will go back to normal, and will our new normal be what it used to be. Dr. Krishna optimistically projected a return to normal by April or May, but cautioned that we still have to be careful because so much is still unknown. Yattassaye agreed and shared that he’s been reading that the efficacy of the new vaccines is so high that herd immunity may be possible this spring, “where we can put this behind us and have an amazing summer and move on.”

Panelists were then asked to comment on the disparity in terms of low- and high-income areas affected by COVID-19 and healthcare in general. What is being done in low-income areas to help them have access, and how can we solve healthcare disparities?

Yattassaye stressed that innovation and using technology is imperative. “A lot of this community doesn’t have the infrastructure that allows for a facility to be next door, but through digital technology, we see things that haven’t happened before. Access to healthcare should be a right; everyone should have access. Healthcare should not be a barrier but more accessible, and digital [technology] will create more access. We are betting on digital, first, enabled by the power of our physician friends to provide access to the community,” he said.

“The pandemic has paved the way for telemedicine,” agreed Dr. Krishna. He talked about how patients no longer need to drive to a doctor’s office or hospital for treatment of simple health issues. A videoconference call can be enough for a doctor to evaluate and even prescribe medications. “We need to have some kind of education for lower-income populations, such as health fairs for screenings,” he said. Going to patients in their communities would allow medical technicians to detect issues early.

Cheung shared that her organization is investing in hiring more community health workers, who are often trusted members of the communities they serve. Right now they have five community health workers who go right to high-risk patients’ doors to conduct wellness checks and help them navigate the telehealth process. She said a lot of elderly people are embracing the program, and the community health workers are following pandemic practices by remaining socially distanced and wearing appropriate PPE. “I think by providing this service, we are able to provide better access to care for those individuals,” she said.

The panel then discussed the future of health and healthcare in St. Louis and the rest of the country, and how it will continue to change. Yattassaye spoke about predictive analytics helping people make better decisions regarding diet and treatment. “Information will have a huge impact,” he said, and talked about how people can get an EKG from their smartwatches now. People are living longer and doctors and researchers are getting more and more information. “We have to find a way to use technology to help busy doctors have more time with their patients,” he added.

Krishna agreed that investment in telemedicine will help in reducing healthcare costs, and cited other programs like smoking cessation and preventive health along with diagnosing pre-existing conditions for indicators and behaviors that might lead to, for instance, heart disease.

What should students be thinking about today in terms of helping with that innovation?

Yattassaye recommended adopting a business mindset. “Look around you and leverage that to create significant opportunities.” He talked about how organizations like BioSTL, the Danforth Plant Center, and Forest Park Forever, offer opportunities to make an impact. “We are creating lifesaving seeds and plants right here in St. Louis,” he said. “If you have an innovating mindset, and you go away to college, don’t be afraid to come back here and leverage that. The future is in your hands, and we have confidence you can deliver. Be bold.”

Krishna added to Yattassaye’s thoughts about innovation. He said, “No matter what field you get into—medicine, business administration, economics—you can affect healthcare. Try to adopt being a global citizen.” He encouraged students to think about how their work could impact people outside of our community, too. “There is sick and suffering throughout the world,” he said, and working on global issues makes you a better person.

Cheung encouraged students to explore local organizations. “There are all kinds of volunteer opportunities and tours that you can participate in. Some of the organizations or companies like BJC have lots of opportunities for you to learn about different aspects of healthcare. Volunteer, pick up the phone, shadow; there are great ways to learn what’s new.”

The panel all agreed that diet is an important impact on health, and perhaps the most important thing to change about the healthcare system in St. Louis. “What we eat impacts health,” said Yattasseye. “If we could get people to have a more balanced diet, coupled with some healthy habits of light exercising, that would have a long-term impact.” Cheung agreed that access to healthy food and access to care are necessary for good health outcomes. She also mentioned that “transportation is a hindrance to good healthcare for certain populations that struggle with the social determinants of health.” Dr. Krishna said that while healthcare access in St. Louis is adequate right now in terms of patient bed availability, tertiary health care for regions outside of St. Louis might require some expansion. “We are at a good point, but we don’t know what is coming in the future and we need to be well prepared,” he said.

Thank you to all three of our panelists for an informative discussion about health and healthcare in St. Louis today.