Meet
Dr. Kristene Tadese & Dr. Bryn Fahalee
Meet Dr. Kristene Tadese and Dr. Bryn Fahalee our partners from the Leadership for Health Equity Pathway at Brigham and Women’s Hospital.
The Leadership for Health Equity Pathway (LHEP) at Brigham and Women’s Hospital (BWH) is a two-week curriculum that trains physician leaders to confront social and structural disparities toward achieving health equity in the U.S.
Vital CxNs partnered with LHEP to create a bridge between academic medical systems with community health efforts. Through this partnership we developed a series of “Community Convenings” bringing together a group of cross-sector stakeholders—including community-based organizations, city government, health systems—to brainstorm community health ecosystem improvements.
We sat down with two of LHEP physicians, Dr. Kristene Tadese, a BWH Resident, and Dr. Bryn Falahee, a BWH Clinical Fellow in Obesity Medicine, to hear about their personal journeys and experiences with health equity and the community health ecosystem.
We need the dreamers and the idealists and the people that are really pushing for new policies and lobbying and trying to move financial incentives.
What does health equity mean to you?
Kristene: Health equity for us means looking at [structural barriers] that determine a person’s health and working to create an environment where health is accessible to everyone. There’s so much beyond the strictly medical [factors] that influences health outcomes. Health equity involves addressing these non-medical factors, like how redlining and segregation have led to certain communities having worse access to health centers, specialists, pharmacies, grocery stores, and green spaces.
Bryn: I think another important piece [...] is taking these big, beautiful, and sometimes sad concepts that Kristene mentioned and asking: even if we can't change everything in a big way, what are the small things we can do today, right in front of this patient? How can we help them feel more connected to the medical community or more in control of their own care? [Health equity] is about being mindful of the context each patient comes from and finding ways to incorporate that into their treatment.
What are some memorable experiences you’ve had through LHEP? How does LHEP prepare residents to address systemic inequities in healthcare?
Bryn: Our trip to Jackson, Mississippi was definitely the most memorable experience for me. [Learning about] the overlap between health and civil rights and the Community Health Center movement…
Kristene: [The LHEP trip to Mississippi] demonstrated how different landscapes in health can look like. In Massachusetts, for example, even though the system isn’t perfect, there are a lot of systems in place. Our lower-income patients can access healthcare through MassHealth’s expansive Medicaid system. But in Mississippi, where Medicaid hasn’t been expanded, it means something very different to counsel a patient about heart failure. The medications they have access to, and their ability to pay, are entirely different, which directly impacts their care. We also saw a lot of food deserts in Mississippi, which makes it difficult for patients to adhere to dietary recommendations. It showed how powerful context is.
Bryn: LHEP does a good job of getting us into spaces that we would not otherwise be in, especially as [ivory tower] Harvard-Brigham physicians.
It's important to talk through the lens of, re-imaging infrastructure with a focus away from these big institutions—while understanding that a lot of the priority of American healthcare is going to be at these big institutions.
What challenges do you face in promoting health equity within the healthcare system?
Kristene: [In the hospital] incentives just aren't aligned well [...] there are certain metrics and certain pressures that clinicians face. [We] don't live in a system that compensates a hospital or clinic for addressing those things. A lot of times, even when it comes to, like, seeing a gap in outcomes, or wanting to partner with the community, the question arises, ‘Okay, well, where's the money gonna come from for that?' And not just for a month [or] to do a pilot, but long-term. No one—a hospital and a clinic are not compensating them for that.
Bryn: We need a spectrum of people. We need the dreamers and the idealists and the people that are really pushing for new policies and lobbying and trying to move financial incentives. And then we need the people on the other side of the spectrum, like me. We can't all be pushing for big things and change. Some of us are really happy doing that individual one-on-one work and still trying to make an impact.
How does LHEP interface with Vital CxNs?
Bryn: It's really great to partner with Vital CxNs, an organization [...] building bridges between the academic medical system and community. [That’s] how we developed Community Convenings: [bringing together] people from all different facets of health in the community—food security , healthy movement, community safety, meditation-based [services], hospitals, and community health centers. There haven't been many chances for that group of people to sit down with community members. It's important to talk through the lens of, re-imaging infrastructure with a focus away from these big institutions—while understanding that a lot of the priority of American healthcare is going to be at these big institutions. How can we reimagine, as a group, a way that we can better interact with everybody at that table and kind of build a better system altogether?
Our goal is to create an accessible space where people feel empowered to advocate for their health and equipped with the knowledge to make healthier choices.
Kristene, could you tell me about Walk With a Doc and the story behind its start at Brigham?
Kristene: "Walk with a Doc" promotes health education and physical activity in a relaxed, community-driven environment. [Partnering] with Vital CxNs, a trusted community organization that works with health hubs in Boston, we wanted to create a space where community members could easily connect with medical professionals, ask questions, and engage in physical activities. We piloted weekly events, each focusing on relevant health topics like heart health, pain management, mobility, mental health, and nutrition. We’ve invited experts, including cardiologists, nutritionists, and physical therapists, to join us and provide valuable guidance. Our goal is to create an accessible space where people feel empowered to advocate for their health and equipped with the knowledge to make healthier choices. We’re excited to see this idea come to life.
Written by Shwe Win (November 2024)