• • We must acknowledge the historical trauma and cumulative impact of systemic racism on our mental, physical and spiritual well-being.

• • Shedding light on the realities of what has transpired and who has been disproportionately impacted can transform our ecosystem into one that is truly equitable.

• • Technology that addresses health equity concerns from inception of innovation can help to prevent downstream challenges.

(edited for clarity)

Chris Hemphill: We’ve partnered up with Future of Mental Healthcare to bring a deeper look at conversations about health equity with Jahmal Miller, who is the Chief Administrative Officer at Mercy Medical Group of Common Spirit Health. Just to get it to open up the conversation: I wanted to bring up some some statistics that we’re aware of that we actually commonly share. I’m going to start with Satcher Health Leadership Institute at Morehouse, where they highlighted that between 2016 and 2020, because of lack of mental health coverage, we unnecessarily lost 117,000 lives costing $278 billion. Deloitte also reports that excess spending that is routed back and traced back to health equity results in over $320 billion in asset spending. They’re really doing a good job at putting a cost to how much it costs to have bias within the system.

So Jamal, we’ve got some work to do, and I keep saying it. We can’t solve everything on this podcast, but we can get you started thinking down those those right paths and territories. And Jamal, I wanted to brag on you. As well as being a Chief Administrative Officer, you were also California’s first Health Equity Officer serving under Governor Jerry Brown, and you wrote a book, Equity, Equality and Justice for All. I’m curious about what you hope that the folks watching get out of this conversation.

Jamal Miller: Thank you, Chris. I’m honored to be here with you today and I appreciate it. I try not to brag on myself, but I’m just blessed. And to be able to have a platform like this, to talk about a topic and an issue that I think is the number one issue of our time, we think about the importance of health and racial equity in American society. The topic that you lead with as far as the cost is extremely important for us to explore, the real economic cost, that’s not where the costs started. The costs really started in premature and preventable deaths, uncompromised quality of life, minimized life expectancy. And those are where the real non-economic costs have impacted people from our community for decades and even centuries since the origin of the United States of America. A lot of us are personally familiar with it in that our families; our cousins, uncles, aunts, neighbors have been affected by this for many years. But a lot of those who have power and privilege have had the luxury of us being in their blind spot. So I’ve asked myself rhetorically and literally, how do we center the importance of the presence of inequities in society?

And that’s where we pivot to the economic implications, which I’m grateful that you started off with. If we stay on that trajectory it could cost us annually over $1 trillion. And that doesn’t even take into consideration the indirect costs associated with a lack of productivity, the real domestic and economic security issue of having an unhealthy people here in our country, poor, rural white people, urban, densely populated communities across the country in a very browning and tanning America that are disproportionately impacted by it. So it’s time that we bring out of the blind spot the reality of inequity in our society and the huge fiscal impact that it’s having on us as a whole. I try to encourage leaders in health care to really hone in on what inequity costs your system, what it costs your patients, and the communities that you serve. What does it cost your whole workforce? There’s a very direct impact to the bottom line of these systems. So it’s a moral argument that needs to be made. The ethical imperative as to why we need to do the right thing in seeking social justice, health justice for all people. But just objectively and plainly put, money talks, and oftentimes people literally do not know how adversely impacted our economy is due to disparities and inequities that exist broadly in society, but especially within our health systems.

I am curious about your background and what’s led you to be so persistent in enacting and driving this kind of change?

I’ve been working in health care now for over 25 years and it’s been a pretty consistent journey in getting people to a level of understanding they otherwise would not be concerned about, the importance of health equity and social justice or diversity and inclusion and it’s just a fundamental part of the journey to get there. And when I say there, we talk about health and racial equity in only aspirational ways, but I’m interested in attaining and making it happen. The reality is that you can’t do it alone. It requires allies. It requires coalitions. It requires alliances. It requires the unusual suspects. Even some of them don’t know what their role is. The journey requires education and discourse and conversation to engage people. It’s kind of like evangelism, or ministry or outreach, education and awareness, because not everyone has the same understanding that we have of lived, but also some of us may have gotten the training and academic understanding of what human and civil rights have been, why they’re so essential here in the U.S. and around the world. A lot of us grew up in a way that was core to who we are. And then we get out into this world, in the communities where we live, learn, work, plan and pray. And as diverse as we are, we find out that many of those who are in powerful and privileged spaces, they’ve not had those lived experiences. They’ve been deprived learning about African-American history, which is American history or global history, that informed the transatlantic slave trade and so many components of American history that those who have been in powerful and privileged positions have been very intentional. And it’s documented, the taking out of our stories and inserting a narrative about our racial inferiority to justify why we were treated like savages and brutes, to justify why you would bring men, women, boys and girls, babies from the Western part of the continent to the Americas for the purposes of the economy. So how do you justify that? You justify that by a negative racial narrative about how we are less than human. To make it okay. And now when you’re in positions of schools being built or during that time through now schools being established, hospital systems being established, banking systems being established, all these various systems, institutions, structures that we’re a part of. Now, the origins of that was at a time where those who were in powerful and privileged positions created something that was not necessarily for us. So a lot of people simply don’t know that they’ve been deprived of that.

We’re not going to get to a place of equity overnight. And a fundamental part of us getting there to achieving health equity is education. How do we hardwire that information into school? Because it is American history. It’s a way of humanizing and giving names and purpose to those who literally built this country on our backs with our blood economies. Against our will we were major contributors and builders to this state, but yet we don’t get credit for that. That is what drives me to be that advocate to take the time, even when it’s frustrating. Let me be patient, let me understand my audience, let me understand my key messages so I can engage with them and help them understand that at any given time we can be vulnerable, even with your power and your privilege. A lot of times people have never had to think how we’ve had to think and how we’ve had to lead it. Empathy, humanization and helping people understand that our history is very much so core to our collective improvement as a society, but it’s also core to your bottom line. There’s a strong business case for achieving health equity to do so.

Thank you for that background. It just makes me think that while I did frame up how difficult it is to lead some of these efforts and make some of these changes and deal with the resistance, it’s probably a whole lot more difficult to be silent while watching.

Courage is the word that comes to mind. Sometimes leadership requires that we stand alone. Lean in and have the courage to do the right thing. If you do the right thing, you can never go wrong. So, heart and courage. You know, it’s not the science or the data, but the extent to which we become detached from those attributes or qualities. That’s where we need to reconnect. And I think that’s going to be a key part of our ability to move forward, to really experience, you know, this beloved community that Dr. Martin Luther King so marvelously referenced and documented and talked about. I’m an optimist. I stand on hope. I believe it can still happen.

I really respect the call for finding that courage. Maybe a whole other episode could be about cultivating courage. Part of what you said also makes me wonder. I’m curious about your role. What is a Chief Administrative Officer? What’s under your purview, and how does health equity fit into that?

I’ve been in the Common Spirit Health system for about four years now. And I’ve been Chief Administrative Officer with Mercy Medical Group for two years. Mercy Medical Group is the largest nonacademic medical group in Common Spirit Health. Prior to that I was Assistant Vice President at Common Spirit for Equity and Inclusion. That opportunity to lead our national health equity effort to develop our first ever roadmap for health equity and do that collaboratively with executive leaders across Common Spirit Health. That laid the foundation. After a couple of years into that role, when I was looking at other opportunities within the ministry, it led to the CIO role where we’re closing with our CEO to administer the non-clinical administrative and operational facets of our practice of over 500 physicians in advanced practice providers. And what I actually documented in my book as well, what I really appreciate about this opportunity I was afforded was that Dr. Alan Shaft, our Chief Executive Officer who I report to, saw as a leading strength and asset in my experience, not just in health care administration but also around health equity, social determinants of health, leading California’s Office of Health Equity as an attribute that could be a benefit. I’ve always been appreciative and grateful for him modeling and leading the way as it pertains to leadership and how that is transitioned into my current role. It’s transitioned into a number of ways of opportunities to present and to share and strategize with our hospital partners in the greater Sacramento region.

How does your background influence the decisions and the way the mode of operation that you’re doing today. How do the learnings and experience as California’s first Chief Health Equity Officer translate into the work, the experiences, the stories that you’re talking about that’s happening today?

That was as Malcolm Gladwell would call a true outlier moment. I’m just always grateful for that experience for so many reasons. But, most prominently, why that experience stands out is a mentor of mine that I write about, Grantland Johnson, was California’s first African-American Secretary of Health and Human Services, and he served in the Clinton Administration in the late 1990s. He was one of Sacramento’s first Black City Council members. I connected with him in my senior year at Columbia University. I reached out to him, I cold called him, and we set up some time and we probably talked for about 2-3 hours and he opened up his Rolodex and gave me a number of names. He was key to helping me land my first job in 1998 with Kaiser Permanente. And he mentored me actively over many years. But along the way, he would always say, Hey, you should go on public policy. You should work in health policy. I’m like, no, I’m good working in private sector health care. I’m enjoying it. So fast forward to my second term or tenure with Kaiser Permanente working in a national community benefit office. Another mentor of mine reached out and said, Hey, Jamal, California is now recruiting and looking to have the governor appoint the first ever Health Equity Officer leading California’s Office of Health Equity within the State Department of Public Health. And they’re like, are you interested? I said yes because by then I had learned about like executive appointments or appointments to boards or commissions and how that could be a key career impacting moment and another way to effect change at scale. So that opportunity of learning about it pivoted to the opportunity of me throwing my hat in the ring. One day I get the call to interview. I went in and bombed and walked out thinking God will have sense of humor if they call me back for another interview. And he definitely had a sense of humor because they called me back. Second interview, I felt that I did much better. After an extensive process and delays, I finally got appointed to the role. Being sworn in October 1st of 2013, it was that whole experience where the weight, the gravitas, you know, of the moment and the opportunity just really hit me.

As I settled in, I had over 400 meet and greets within my first year meeting with advocates and consumers, traveling the state, building up our staff to just under 40 representing a very, very dynamic group. We had an advisory board and I was just able to meet so many people who were equally, if not more passionate about achieving health and racial equity in California. And I would always reflect back on Grant when he was there at my Senate confirmation hearing on July 2nd before the Senate Rules Committee, and within a month time, he passed away from complications of diabetes. That was his last public appearance. And the consistent theme from being considered to being appointed, sworn in and confirmed by the Senate, the team, that five year experience, it resonated deeply with me that this is special. So the power of advocacy, the power of public policy, being in such an important executive role and seeing the important role that government plays in our day to day lives is something that still resonates very deeply with me. We did a lot of hard work. It kept me busy. I’m busy now, but that role will always be exceptional and different. It was an awesome responsibility to be in the seat to affect change and to make a difference and to open doors for others, just as opportunities and doors were opened up for you. Do it. Have that courage, have that heart to do it.

When I pivoted back to private sector, to be honest with you, it’s been a struggle, a good, healthy struggle, because you know that cause, that mission, you know, in public service is sometimes hard to replicate in the private sector, even when you’re working for a mission, a nonprofit oriented entity, there’s something a bit more powerful and impactful when we think about systems transformation that working in a government setting of influence that can help inspire.

Who do you see as unsung heroes that we should be keeping an eye out for within this health equity narrative?

An unsung hero that comes to mind for me is Dr. Cheryl Grills of Loyola Marymount University. I met her while I was at the Office of Health Equity. She and her team we brought on to do the statewide evaluation for our California Reducing Disparities Project to demonstrate the value of how investing innovatively in mental health interventions that aren’t necessarily evidence based, but they’re more culturally-based, can grow outside of the mainstream, but yet be very effective. Her team was was sent to us to evaluate these various programs throughout the state that we were investing in. There is some recent work that she has led as a part of California’s task force to evaluate and analyze and ultimately report on why reparations should be afforded to people of the African diaspora in the state of California. And in that role, she put her intellectual genius to work. She demonstrated that heart and that courage to stand up as a black woman speaking truth to power objectively, ensuring that this process was completed in a way in producing a report that would inform what will be a day where we’ll take meaningful regulatory action as it pertains to to reparations and her cause for social justice, for health and racial equity, particularly within our discipline of clinical psychology, has been second to none.

I also admire Mayor Karen Bass from Los Angeles. When I met Mayor Bass, she was Congresswoman Karen Bass representing her district in Los Angeles, and she was a strong advocate at congressional levels for health and racial equity, especially as it pertains to at risk and foster youth. She is someone who provided great guidance and advice to me and who has been on the front lines since our time of being a local leader in L.A. to ascending to be the speaker of the Assembly in California, and then ultimately going to Congress. She is the first African-American woman to lead the city of California and likely the first to lead one of the largest cities in the United States. L.A. is better off having her in that seat.

The last person I’d like to highlight as an unsung hero is my friend Aletha Maybank, the American Medical Association’s first ever Chief Health Equity Officer. She and I met on a health equity research trip to Cuba years ago. She has kicked down doors. She has challenged the status quo with a very progressive, multi-year strategic plan for achieving health and racial equity. And it takes a lot of heart and courage. She’s taken a lot of fire, but yet has had a lot of good support around the country and has really galvanized a different kind of conversation when we think about how health care systems and particularly medicine is starting to embrace and reevaluate and reconsider why health and racial equity is important.

Thank you for sharing multiple stories of incredible people and how they, through their actions, demonstrate that progress is possible. I know that this isn’t a Marvel movie that we’re watching right now, but we’re going to grant you a superpower and that is going to be to be able to change any one aspect of anything about how health care is delivered. If you had the power to focus on just one thing, what would that be?

It would just be a strong dose of the reality of how anti-black racism is baked into medicine and our health care delivery system. That understanding it’s a block right now for people. If you haven’t had a lived experience, even if you spent time educating yourself when you personally have knowledge and understand the weight, the traumatic generational impact that institutionalized racism and discrimination has had against people in this country, especially black and indigenous people, it can’t help but elicit restorative and reparative action to reconcile what was done, how it’s still affecting us today and what we will do in the future to resolve and mitigate that. There are stories around the world where countries that have come to grips with the extreme realities of trauma. I don’t think here we we’ve really gotten there yet because we’re even still having conversations about reparations and other similar restorative acts that must happen to address the impact of anti-black racism. So that would be my superpower, especially in medicine. I think that we share this information to inspire and call people to action. And we have to tell our stories about the realities of what has transpired, who it’s disproportionately impacted and how can we transform this ecosystem into one that is truly equitable.

This has been a very in depth conversation. Where can people reach you? 

At https://jahmalmiller.com/. You can find links to my book there as well, which just came out in May. I’m also on LinkedIn and would love to stay connected to people.

Jahmal, I can’t thank you enough.

Thank you, Chris.