the health disparities podcast

There are numerous social and structural vectors for disease that are not often discussed in medical school. So, Dr. David Ansell says he had a lot to learn once he became a physician.

Ansell, author of “The Death Gap: How Inequality Kills,” writes about the stark disparities in access to treatment and outcomes for patients in the U.S. healthcare system.

“We always talk about inequities. We have frank inequities, but we have gross inequalities,” Ansell says. “The care isn’t equal… And if we could get to equal, then we can take on the inequity.”

One of the most glaring examples is life expectancy; a person’s zip code can be a strong predictor for their life expectancy due to social and structural determinants of health, including structural racism and economic deprivation, he says.

“If you live in The Loop in Chicago, you can live to be 85 and if it were a country, it’d be ranked first in the world,” Ansell says. “But if you live in Garfield Park, three stops down the Blue Line from Rush, life expectancy post-Covid is 66.”

In this conversation, which was first published in 2023 for the Health Disparities podcast, Dr. Ansell speaks with Movement Is Life’s Dr. Carla Harwell about the importance of addressing systemic racism and inequality in the healthcare system.

Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

The transcript from today’s episode has been lightly edited for clarity.

Dr. David Ansell: But even if you get beyond unconscious bias, it’s the systematic ways in which racism and other forms of exclusion actually are harming minoritized populations today, tomorrow, and the day after tomorrow. And it is time for us as a profession, as institutions to really think just like we thought about patient safety, how do we prevent harm from occurring in the environment? How do we take anti-racist actions within our organizations, across our organizations to reduce these giant disparities?

Jerry Fennell: You’re listening to the Health Disparities Podcast from Movement is Life – featuring conversations about health disparities with people who are working to eliminate them. I’m producer Jerry Fennell.

There are numerous social and structural vectors for disease that are not always discussed in medical school. So Dr. David Ansell says he had a lot to learn once he became a physician.

Ansell, author of “The Death Gap,” writes about the stark disparities in access to treatment and outcomes for patients that reveal startling and systemic inequities in the U.S. healthcare system.

In this conversation — which was first published in 2023 for the Health Disparities podcast, Dr. Ansell speaks with Movement Is Life’s Dr. Charla Harwell.

Dr. Charla Harwell: David Anselll’s book, the Death Gap, “How Inequality Kills,” was first published in 2017. In a foreword for the book updated in 2020, Chicago Mayor Lori Lightfoot wrote, and I quote, “Three years before the Covid-19 crisis, Dr. David Ansell published, “The Death Gap,” brilliantly synthesizing what he experienced in decades of practicing medicine in two utterly different medical worlds that were mere blocks apart. What makes this book so compelling is that rather than focusing exclusively on data and statistics, Dr. Ansell makes these gruesome numbers real. He tells the story of the disparities through the real-life experiences of patients with whom he had deep committed relationships. And for this year’s summit, Dr. Ansell joins us to talk about, “Closing America’s Death Gap Solutions for Leaders”. So, I am excited to welcome you to the podcast for this discussion.

Dr. David Ansell: Thank you for having me here and I’m so pleased to be here at Movement Is Life once again.

Dr. Carla Harwell: So, let’s dive into our discussion today. In your talk you explore the multifaceted factors contributing to the alarming disparities in health outcomes across different communities in the United States. Could you share what some of those factors are with our listeners?

Dr. David Ansell: What I’m going to talk about is how these conditions have arisen that have led to unequal outcomes between populations, neighborhoods, families, very, very different experiences. And I’m going to also not just talk about it, but I’m going to talk about what potential solutions are. So, while it’s tips for leaders or lessons for leaders, at the end of this, I’m going to ask the question or pose the question or make the statement, how can hospitals heal? What can we do given everything that we’ve experienced for some of us over decades of work, but I think for most of America during and since the Covid Pandemic, how can hospitals contribute to not retelling the same story but actually taking action?

Dr. Carla Harwell: And we’ve seen so many hospitals closing in areas where patients depend on that. That’s their lifeline. We have these security, these safety net hospitals that are closing and I’m sure that that has a horrific impact on the continued disparities that we see in this country.

Dr. David Ansell: Yes, I mean, one of my observations, I came to Chicago 45 years ago.
I’m a general internist, I’m a primary care physician and I’ve had a very interesting career, and I don’t regret one moment of it. It’s been a joy and a gift to take care of patients even to this day. But my observation in Chicago as I moved from Cook County Hospital, that storied public hospital in Chicago where I spent 17 years and I was at the end, head of general internal medicine to Mount Sinai Chicago, Sinai Health System. And I spent 10 years as chief of medicine and I got recruited to Rush literally down the street to be his first inaugural chief medical officer, but my patients came with me. I still have patients from my internship, not many. I’m very old by now and so are they. But it was an eye- opening diagnostic test on what was wrong with the healthcare system. And when I got to rush, it was a little bit like I landed on a different planet and I and people inside of Rush couldn’t understand the experience. In all those years of observation of my patients, there was something about the diseases that they had that seemed to be beyond my ability to treat them. And there was something about the mechanisms of disease that I learned in medical school that seemed not to apply and that led me to write, “The Death Gap”. And I talk about this experience of being one street, two worlds because there were two worlds of health and healthcare, but there’s two worlds of healthcare financing as well. It was the same doctor, and they were the same patients, but the institutions and how they were financed and the struggles that they either had or didn’t have was another aspect that I don’t think people saw. And that had to do with healthcare financing, how institutions are resourced and things that were of now suddenly available to me at Rush, were unavailable, out of reach or just beyond reach at Cook County and Sinai. And it could make you cry.

Dr. Carla Harwell: Yes. And I definitely can relate as a primary care physician in Cleveland, Ohio, the zip code where my health center is located, the life expectancy there is 68 years old and literally just four miles away it’s 82. And so, the patient population that I serve is definitely a different patient population that lives just four miles away. Yet the access to care for both of those different zip codes is the same. So, I ask myself what’s going on here?

Dr. David Ansell: Exactly. And that’s what I asked myself. As a white physician from Upstate New York whose parents were immigrants, at some point in time I realized that what I had learned in medical school about disease causation was incorrect and I needed to find a language to describe what happened. So, I want to take your analogy. I’m going to do a four-mile analogy in Chicago. I’m going to present it in my talk, but if you live in The Loop in Chicago, you can live to be 85 and if it were a country, it’d be ranked first in the world, think Japan or Monaco. But if you live in Garfield Park, three stops down the Blue Line from Rush, life expectancy post-Covid, 66. Now, if you think about what that means, very similar to where you practice, if Garfield Park were a county, it’d be the lowest life expectancy county in the United States, think Pine Ridge, Sioux Nation. Now, The Loop, we’re right halfway between The Loop in Garfield Park. You go two miles in one direction and it’s like the Upper Eastside of New York and in two miles in the other direction and it’s like Sioux Nation. What does that mean for the way we need to think about the public health messaging, the care we provide and what people need to thrive that’s different because, and so that’s when I got to Rush after that experience, say something is going on here. And so, I want to just talk about what is going on. I give the analogy about malaria because malaria is caused by a parasite, but you can’t eradicate it unless you eradicate the female anopheles mosquito. Now it’s not any mosquito and it’s not all insects. You’ve got to address this one factor; the female Anopheles mosquito and any malaria eradication program has a mosquito protection or elimination as part of it. Well, I came to realize that the social conditions under which people lived worked in play, now we call them the social determinants of health. I call them the social and structural determinants of health, including structural racism and economic deprivation. This is what I told our board in 2016 when I presented that map that I described were factors for disease that I was never taught in medical school. And that if we’re going to think about the things we have to do, we are going to have to take those factors on and eradicate them just like we would mosquitoes. It became important to me as a white physician, as the inaugural chief medical officer at Rush in front of our board presenting that was our community health needs assessment for the first time publicly. I said to them, we can be the highest quality hospital in the United States. We’re a US News & World Report honor roll hospital, very high quality. I was responsible for that quality. We could put a clinic on every corner, and we would not get to that death gap and if people were dying of common diseases in these neighborhoods, but we needed to rethink our position, but not only our position, our responsibility, and our accountability for what we’ve allowed to happen in this neighborhood outside our doors.

Dr. Carla Harwell: So, tell us about the reception you have received for your book.

Dr. David Ansell: Well, it was kind of interesting. It came out right after former President Donald Trump was elected. I think it didn’t really hit home until Covid. For me it was, I’m working with these very lovely people, and they were fantastic clinicians and I’ve worked actually with great clinicians everywhere I’ve worked. The doctors weren’t the issue nor were the patients the issue. It was the way that we thought about the problems were the issue. And so, I think it took a while for people to really clue into this idea. I call it how inequality kills. We always talk about inequities. We have frank inequities, but we have gross inequalities. And if we could get to equal, then we can take on the inequity because the care isn’t equal.

Dr. Carla Harwell: That’s true.

Dr. David Ansell: I’ll give you an example. This is good for an orthopedic conference. So, I was Chair of General Internal Medicine at Cook County, Chair of Medicine at Mount Sinai Hospital, and in those 30 years, maybe one patient or two got a joint replacement. Whereas I got to Rush, which is Mecca for orthopedics, one of the Meccas for orthopedics in the Midwest. You limp inside into the front door. Three weeks later you can get your joint replacement. When you drive across the west side, I’m sure it’s like this in Cleveland, you watch people walking. There’s a lot of very visible physical disability, where in my town of Oak Park, the first western suburb or in The Loop you don’t see that. And as of my experience as a doctor, we had trauma surgeons. We didn’t have joint replacement surgeons. So, there’s an interesting example. The other example I give you as a chief medical officer, I was confronted one day with undocumented people demonstrating at our hospital seeking kidney transplants. And I realized that in my 30 years at Cook County and Mount Sinai, zero of my patients and none of the patients of my colleagues, zero ever got a lifesaving transplant. And yet the organs that went cross town, they followed the El tracks in the opposite direction, came from the black and brown bodies in the ICUs and nobody thought it was a problem. And I realized there was a connection because as being a chief medical officer and having to be responsible for quality and safety, we always say that no one comes to the hospital thinking they’re going to harm patients. People are not coming to intentionally provide bad care. And just like in the same vein, people are not coming to the hospital thinking that the care they’re providing could be perpetuating racism.

Dr. Carla Harwell: That unconscious bias that we hear so much about.

Dr. David Ansell: Unconscious bias, but actual the way the institutions actually work, who gets, you mentioned access. So, we look at access to care as being a problem with the patient not having access. It’s the problem of the institutions.

Dr. Carla Harwell: Yes, there’s your systemic racism.

Dr. David Ansell: Exactly. So unconscious bias is one thing, and it is so pervasive and spoiler alert, I’m going to do a little thing today about it. You’ll see it. It’s so pervasive we can’t help ourselves. But even if you get beyond unconscious bias, it’s the systematic ways in which racism and other forms of exclusion actually are harming minoritized populations today, tomorrow, and the day after tomorrow.
And it is time for us as a profession, as institutions, to really think just like we thought about patient safety, how do we prevent harm from occurring in the environment? How do we take anti-racist actions within our organizations, across our organizations to reduce these giant disparities that have existed in the United States for 400, 450 years, 400 years? And we’ve got to now stop describing the problem, stop talking about it and holding ourselves collectively responsible for fixing them.

Dr. Carla Harwell: I’m biased, but I think your book should be mandatory reading, for everyone in the United States of America. But can you give us some idea of what kinds of people are reading your book?

Dr. David Ansell: Well, I know, well, first of all, my mother read it before she died. If you put it under your pillow, it’s a sleep aid. It’ll help you sleep. I know at a number of medical schools they are giving it the first year students. I think the, I call it the collision that occurred, the crash that occurred when Covid-19 came to the United States and crashed into the preexisting pandemic of social inequity, including racism, economic deprivation. They’re not the only thing, we have to center on racism because that’s been at the top of the list, racial inequities, the gaps between black people and in this country, American Indian and indigenous and other populations, white people have been, these gaps are pervasive, been here forever, had the center on it. But people didn’t realize it didn’t become visible until the first the bodies were counted from Covid and in Chicago for example, because we knew this was going to happen, those of us who’ve done this work, you and your primary care, we knew who was going to get sick first and who was going to die. But the visual, visceral impact of Covid was a shock to a lot of people in this country. I talk about it in the Death Gap. So, it should be read. But the point is, in Chicago, of the first hundred deaths, 72 were black people. And Mayor Lightfoot, who ran on this idea of investing in the south and west sides of the city, the traditional black and Latinx neighborhoods, said it took my breath away and she didn’t know what to do. And they called us, actually they called West Side United, which is a racial health equity collaborative we put together to try to take on the death gap on the west side of the city and asked us what we should do. And we said to her, the hospital response, more ICUs, more ventilators, more masks, more hand gel was necessary. We needed a hospital response, but we needed to have a community response that was as powerful or more powerful. Now, that was true prior to Covid, but it was very true in the midst

of the pandemic that the public health messaging that we were giving, social isolate don’t go to work, was a meaningless piece of advice. So, the Death Gap should be widely read, but more than read, we’ve got to, like I said before, that we know the things that we have to do as a country. We’ve just got not to find ourselves in the same situation that we found ourselves during Covid.

Dr. Carla Harwell: Yes, Covid uncovered so much. And I actually found it to be almost comical in the sense that what supposedly it uncovered always existed. It just wasn’t being addressed. It was being overlooked. It was like that tip of the iceberg that you can see what’s up under the water.

Dr. David Ansell: If you wanted to see it. If it was the tip of the iceberg, it’d be one thing. It’s a giant mountainous Mount Everest.

Dr. Carla Harwell: I agree.

Dr. David Ansell: Okay. It’s one thing if it’s underwater, you can excuse someone for maybe not knowing about it.

Dr. Carla Harwell: Absolutely.

Dr. David Ansell: These are mountains that they are preexisting conditions. And WEB Du Bois wrote about it in the Philadelphia Negro, 1896. In 1906 or somewhere around there at a conference in London, he said the problem of the 20th Century is the problem of the color line.

Dr. Carla Harwell: The color line, absolutely. Well, a perfect segue to my next question. What do you think is on the horizon in 2024 in terms of the work that you are doing to address disparities?

Dr. David Ansell: Well, I’m going to say some good news that came out of it. First of all, I’ve sort of told you my personal story and it took me all of those years to finally say, I’m not going to be a chief medical officer anymore. I’m going to focus my time on the real problem, what I wasn’t taught in medical school, but as a giant mountain. And I never spoke about it as a white man. I never spoke about it in the boardroom. So, I had to overcome, and I had to sort of do my own root cause analysis like why didn’t I? And at the end of the day, you don’t want anyone to be offended. You want to want this. I don’t want to be this, that and the other. But at the end of the day, if there’s a mountain out there or call it a giant pit, whatever you want to call it, it’s got to be spoken about. So, it took me, that was 2015, 2014, and then it took me quitting my job and saying, if we don’t take responsibility and accountability for this life expectancy gap as an organization, number one in quality in the country. And we said, that’s not enough. And I convinced our board at that point in time to go on this journey and we didn’t know

where to begin to go. But it really required a rethinking not only of root cause, but of solutions.

Dr. Carla Harwell: And what are some examples of solutions that we need to get behind?

Dr. David Ansell: Well, I want to just talk about what happened after Covid. We had conversations with CMS, we had conversations with the Joint Commission. There are now for the first time in American history, some regulations. Now, I don’t think there are enough, but it’s at least something we can organize ourselves around. That said, health inequities are a patient safety problem. Joint commission requires healthcare organizations to have leaders of health equity and organize around look at your outcomes by race, ethnicity, language and other things. So, there are things we can do. I was telling about Mayor Lightfoot in the first a hundred deaths and calling us up this racial health collaborative called West Side United we created in Chicago to address the life expectancy gap between The Loop and the West Side. And we went in. And so, West Side United co-led the city’s racial equity rapid response team for the city that had, and we said at the end of the conversation, you can’t just have a public health response, you can’t just have providers. You need the community voice around the table guiding the community response. And we built that. And then George Floyd was murdered. So, I’m going to give you the days. April 5th was when the first stats came out of a hundred deaths, 72 black. May 25th was when George Floyd was murdered in front of all of our eyes. And that was the moment of the two pandemics crashing, right? The world went up and the community around this table where I was co-chairing the provider group of the racial equity rapid response team, and we had the community around that and we had a moment of silence with our meeting. And then, we decided we needed to go further. We were going to make a public statement and we did. And it got published Juneteenth in the Chicago Tribune and the Chicago Sun Times, and we got every healthcare organization in Chicago to sign onto it. It’s undeniable, racism is a public health crisis. So, it wasn’t just me after I think I named racism in front of our board. I was 60 something years old after witnessing all of this, after growing up in a family where my parent’s whole families were wiped out in the Holocaust, victims of racism, mass incarceration, took me then. Now the whole city was saying it, but it was not enough to say it. These are the seven things that we commit to. That statement went around the country, but we took it one step further. We created and supported by the Commonwealth Fund a racial equity and healthcare progress report that a hospital can take. I hope we can convince; we’re trying to get Cleveland to take it. It’s a national scorecard, racial equity and healthcare progress report that looks at how well a health system is performing across four domains. Our organization, including our leadership, our board makeup, our policies, our procedures, our patients, our people, meaning our employees and our community. Because those four domains are the domains that a healthcare organization have impact on. And you can take this report card

scorecard and you can get a score and it’ll show you anonymously and confidentially where you are compared to other healthcare organizations in the United States, but not just that it’s action oriented. What can you do? And it’s different than the American Hospital Association framework because this one centers on anti-racism. This scorecard centers on anti-racism is different than Lown Institute or US News & World Report that gives you a score but doesn’t make you improve anything. This is a scorecard on improvement. And it came out before CMS and the Joint Commission made their guidelines, but it a hundred percent aligns with the intention of CMS. It’s meant to be taken and then reported up through your leadership and your board. And then just like we did with quality and safety, just like we did with central line infections and falls in the hospital, it obligates us to put together a charter that says, how are we going to take anti-racist action in our healthcare organization? It’s been done. This has been taken. We took it to the Illinois Health and Hospital Association. It is in it’s third year of being completed in Illinois. Not all the hospitals, but I want to say half the hospitals in the state have taken it three years in a row. And when we take it and you do improvement, we see improvements. So, enough talk, it’s time to take action.

Dr. Carla Harwell: Time to take action.

Dr. David Ansell: But we’ve got to take action nationally. We’ve got to take it. All of our organizations, none of us are going to the hospital or our clinics thinking we’re causing harm to patients or that we’re racist in any way. But the difference between this and patient safety is there wasn’t an anti-patient safety national movement.

Dr. Carla Harwell: Wow.

Dr. David Ansell: The Heritage Institute, many states have passed laws that says to talk about racial gaps is divisive and we can’t hurt the feelings of white people who may not have had anything to do with this or anyone. And so, we can’t use the words diversity, equity, and inclusion. So, there is this anti woke movement that’s trying to now oppose the potential for advancing the longevity, the role that healthcare can play in improving the lifespans of our most historically marginalized populations. And so, we have to take the report card and the scorecard, get institutions to it, but we also have to be publicly spokespersons since against these sorts of historic injustices.

Dr. Carla Harwell: Wow. Just like I said, your book needs to be a mandatory read this scorecard on improvement. What a beginning, what a great beginning.

Dr. David Ansell: I think the goal is we can make it better. I was there at the beginning of the quality movement as a chief medical officer, and I had to wrap my head around what it means and say, if you don’t inspect it, you can’t expect it.

Dr. Carla Harwell: Wow. Say that again.

Dr. David Ansell: If you don’t inspect it, you can’t expect it. If you don’t pay it attention, you can’t move forward with intention. And if you think about so I’m looking at this co- linearity between the quality movement, the safety movement and the equity movement. (The) Quality movement was improve our outcomes. The safety movement was improve our outcomes but don’t cause harm along the way. So, for the orthopedic crowd, it’s great. I got my knee replaced, but then I got an infection is to reduce those sorts of things. And the equity piece of this is we want to improve quality and safety for everybody. And if you think about the way we measure quality and safety, we use averages, we use medians. But to look at equity, we’ve got to look at who is not performing so well around the margins. It requires you to look at data in a different way. And race is a social construct. It’s a ridiculous idea of what’s a race and what’s not a race. And so, even it’s a crude measure of somebody’s circumstances more than anything else. But we have to get better ways of measurement of understanding. But the idea here is if you take an average, you’re taking in on average those who are doing much, much better versus those who are doing much worse. And that’s what equity means is we’ve got to look at our data in a different way. We’ve got to ask questions. Let me give you a real example. Now, imagine you go shopping to, you go out shopping and you go to a store and one out of every four times when you go to the store, you have an awful experience. Would you go back to that store? I think not.

Dr. Carla Harwell: I think not.

Dr. David Ansell: But the Commonwealth Fund interviewed and if this is done over and over again so we can keep doing it until we get better, this is the insanity test. Keep asking the same question, getting the same result and not doing anything about it. But they’ve asked black, Hispanic, and white elderly, not elderly because I’m old, people in their older adults about your experiences in healthcare in the last year and whether you’ve had an experience that you felt discriminated against you because of your background and makeup. And one in four black people, one in four Hispanics said yes. And it’s 2% for whites. So, if you are a white hospital administrator and you’re thinking about your institution, you have never thought for one minute that your institution is, we treat everybody the same. All insects matter, right? Back to the female anopheles mosquito thing. All mosquitoes matter. We treat all of our insects the same. Do you know what I mean? But imagine if you began in your Press Ganey surveys of your patient just to ask about perceived discrimination, and then if you found it, wouldn’t you try to

improve it? So, if we don’t inspect it, we can’t expect it. If we don’t pay attention to it, we can’t have the intention to improve it. Now, you may not like the word racism, so we don’t have to use it, but none of us are expecting that when patients come into our institution, they’re not going to be treated, get the treatment that they deserve. And if they have the perception that something went wrong, that’s their experience. We’ve got to then change their experience, not their perceptions.

Dr. Carla Harwell: So very right. So very right. Dr. Ansell, I understand you’re writing a new book. Can you tell us about it?

Dr. David Ansell: Yes. I’m reminded of my publisher when I wrote my first book and he said to me, do you know how you make a million dollars in the publishing industry?
And I said, no, I don’t. How do you make a million dollars? He said, start with 2 million. So, I’m writing another book, and it is tentatively called, “Crash: When Epidemics Collide.” And it’s the story Covid coming to Chicago and a little bit of the story of how I got to be in this position to be really dedicating the last parts of my career now to fighting racism and health inequities. So how did that evolution and Covid is coming to Chicago, and because my hospital had taken on anti- racism and health equity as a strategy, how we were preparing for this situation, which we knew was going to be this one global pandemic crashing to the existing, often invisible to some people pandemic of social inequity. And I’m calling it, “Crash: When Epidemics Collide,” because when there’s this little silence before the crash, and then when the crash happens it’s explosive and using the moment when George Floyd was murdered, as the time where we saw the social upheaval and even the potential and opportunity in the United States for racial reckoning. It wasn’t just black people demonstrating it was white people. It was not just in the United States, it was around the world. Black Lives Matter, Black Lives Matter. We put it on our billboard, Black Lives Matter period. And it tells the story of all the conflict and the tension around that. So that’s part of, in the third story, it is about this lowest life expectancy neighborhood of Garfield Park that when we were entering in to think about how would we take on, as a healthcare organization, not just quality, not just safety, but equity. We took, went to meet in Malcolm X Junior College in January 2017, and I sat at a table with a minister, pastor Marshall Hatch, Sr., of the largest church in West Garfield Park. And when you saw that life expectancy that I described before, he said, the Bible says the last shall be first. And I was so moved. I asked to meet with him two weeks later. And it’s the story in this book about what happened the fall of Garfield Park. It was the neighborhood where Martin Luther King came in 1966, went up in flames when he was assassinated in 1968, and has had no investments since then. And Pastor Hatch, myself, many others went out to the community and asked what they wanted and they didn’t want a health center.
They wanted a wellness village. And through the pandemic we met, first of all, he lost his sister, his best friend, many people in his church. A lot of tragedy, life

expectancy dropped in that neighborhood. The only grocery store left the neighborhood. I mean, one blow after another. But we never gave up on this idea that the community deserved to have a wellness village. Every neighborhood does. And we applied for the Chicago Prize, which is a once in a lifetime capital prize for the best project in the city, competing against 37 other projects. We were the underdog. South side is the Black Metropolis, the west side is the toe headed stepchild to the south side. We were not that well organized. We won the Chicago Prize, and this wellness village is being built. So, the book is about hope and it’s about the tragedy. The tragedy of not seeing what’s visible, the tragedy of what happened during Covid, how one could have responded, how we responded, how if all healthcare institutions responded the way that we did the country would’ve been better, but also as the story of hope, how a community took their situation rather than bring their hands and cries and said, no, we’re going to be the masters of our destiny. And Rush is going along for the ride. So that’s my book.

Dr. Carla Harwell: Fantastic. Can’t wait to read it. Dr. David Ansell: Thank you.
Dr. Carla Harwell: Well, that brings us to the end of another episode of the Health Disparities Podcast. Thanks to my special, special, special guest today, Dr. David Ansell.

Dr. David Ansell: Thank you for having me.

Dr. Carla Harwell: And thanks to all of our listeners for joining us on America’s leading health equity podcast. Until next time, be safe and be well.