From the onset of the COVID-19 pandemic, it quickly became clear that Black Americans were being disproportionately affected by the virus. By April 2020, rates of infection and death in predominantly Black counties were already three and six times higher, respectively, than rates in largely white counties, a report in JAMA showed. And up through June 2020, Black Americans accounted for 21.8 percent of confirmed COVID-19 cases in the United States, according to research published in Frontiers in Public Health, though they make up just 13 percent of the U.S. population.
Such stark health disparities are unfortunately nothing new: Black Americans have regularly had higher rates of conditions such as high blood pressure, diabetes, obesity, and cardiovascular disease, which put them at higher risk of complications and death from COVID. The reasons for these underlying conditions are multifold: Socioeconomic factors have limited their access to care, and systemic factors such as racial bias in healthcare, as well as a historically well-founded mistrust of the healthcare system, have been barriers to getting adequate care, including preventive care.
Health literacy — how well a person can obtain, process, and understand the basic health information and services they need to make appropriate health decisions — is another challenge. Health insurance policies can be hard for anyone to digest, for example, but when there are lower levels of health literacy, it can be even more difficult to understand how copays, deductibles, and coinsurance work, or to determine whether a provider is in- or out-of-network, according to research published in Health Literacy Research and Practice. Racial and ethnic minorities are among those most affected by low health literacy, including the 58 percent of African Americans who have basic or below basic health literacy, compared with 28 percent of white Americans. All of this ultimately impacts health outcomes even in a time when the Affordable Care Act has greatly expanded healthcare coverage.
Lisa Fitzpatrick, MD, MPH, an infectious-disease physician and a public health advocate, has been a leader in changing this narrative by providing underserved communities with “trusted, credible, and relatable health information.” Affectionately known as Dr. Lisa in various communities in Washington, DC; Mobile, Alabama; and Baton Rouge, Louisiana, the acclaimed doctor is the founder and CEO of Grapevine Health, a company that uses the power of story, technology, and community to improve health literacy and healthcare among Black and Latinx communities. She began her career in public health as a medical epidemiologist in the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service, where she spent the first 2 of her 10 years at the CDC. During her last two years, she served as Chief of Party for the Global AIDS Program in the Caribbean region, where she implemented the President's Emergency Plan for AIDS Relief (PEPFAR).
In 2013, she started her video and podcast series Dr. Lisa on the Street, in which she talks to people in the community about their common health concerns and questions. This project evolved into Grapevine Health, which she founded in 2019. Dr. Lisa is also a clinical professor and professorial lecturer at the George Washington University School of Medicine and the Milken Institute School of Public Health, and a member of the Aspen Institute Global Leadership Network, which is dedicated to tackling the biggest societal challenges of our time. She was selected as a 2017 Aspen Institute Health Innovator fellow, and in January 2022, she was awarded the esteemed and highly selective (she was one of only five recipients) McNulty Prize Catalyst Fund, an award given to young organizations that are demonstrating the momentum required to effect meaningful change.
Dr. Lisa discussed her groundbreaking health information company and her mission to improve health literacy in underserved communities across the country.
Everyday Health: When did you know that you wanted to become a physician and work in the medical profession?
Lisa Fitzpatrick: By the time I entered high school, I knew that I wanted to work in medicine. All throughout school, I gravitated toward science and found it really interesting, and while in high school, I volunteered at a nursing home and worked at a pharmacy. I eventually applied to medical school. At first, I thought I would be an emergency room doctor, until I spent a few months working in the emergency room and realized that it wasn't for me.
Most of the things that I observed in the ER were not emergencies. Emergency rooms are not at all like what you see on TV. So, I became an infectious-disease doctor after spending some time in Africa working on a research project. When I was in Africa, I decided to pursue a career in public health, so I went to work for the CDC, and I was there for 10 years before going back into clinical medicine and moving to Washington, DC, which is where I launched Dr. Lisa on the Street.
EH: Can you share more about the goal of Dr. Lisa on the Street, and how it was first received?
LF: Dr. Lisa on the Street typically consists of myself and a team of other physicians going into different underserved communities to answer health-related questions and provide health information. We typically pick a corner and set up or partner with an organization already doing something related to public health or health information. Everything is outdoors in the community. So, I'll set up a table with a sign. There's also a whole bunch of doctors who work with me, but I'm the main one who devotes my time to this — everybody else is working full-time. They volunteer, or we pay them to do virtual sessions or come to the streets with us.
Dr. Lisa on the Street was really well received. Even now, people are very receptive. When I was in Mobile, Alabama, and even in Savannah, Georgia, I continued to hear the same comments from Black residents, which were, “It’s so great to see a Black doctor out here in our community. Normally, we don't get to see people like this. Thank you for coming out to talk to us. It’s so much more comfortable with you coming into our community.”
There's usually a large gap between healthcare providers and the community. Even though we're [healthcare providers] serving patients in clinics, it's still very much on our terms. We're asking people to keep appointments, sit in the waiting room, wait for us to give them prescriptions, tell them to come back, and give them instructions. And that's as far as the relationship goes for a variety of reasons. So, I think the way we [doctors] are perceived is that we’re very standoffish: We don't have time, and we don't really care about them [patients]. So when I show up and tell community members that I want to hear their frustrations and ask them about their concerns — not only about their own health but also about the healthcare system — people really appreciate that. We taped a woman for a video that I posted on my YouTube and Instagram page who shared that this was the first time she’s seen a doctor physically come into the community. So, it's really powerful.
EH: I can imagine the barriers and existing stigma you help deconstruct by going into the communities and working one-on-one with community members in a personal way, and how that ultimately helps build trust. Digging a little deeper into the services you offer, can you share what led you to start Grapevine Health as a larger umbrella over Dr. Lisa on the Street?
LF: I started thinking about helping to improve community health literacy many years ago. When I was in the CDC, I was on a community panel for 100 Black men of Atlanta, and after that panel, this man walked up to me — he must’ve been in his fifties or sixties — and he asked me, “How does someone like me access someone like you on a regular basis?” At that moment, I realized there are probably millions of people out there like him who don't understand their health, their medications, or how to speak to doctors.
Grapevine Health; Everyday Health
That's what led me to think about how I could create a resource to help improve access, not just to me personally, but also to help Black people in underserved communities better navigate the health system overall and better understand how to take care of themselves. So, it’s evolved over the years from Dr. Lisa on the Street to Grapevine Health, which is now a for-profit company. Our goal is to work with health systems and insurance companies to really take over their health communication, particularly with underserved communities.
EH: I know you provide both in-person and virtual services to patients. Is most of your on-the-ground work done in DC, and can you talk a little bit more about the kind of work that you do with community members, both on the ground and virtually?
LF: Most of the on-the-ground work that I have done has been in DC because that's where I'm based and where I have the largest footprint. But we've been to several communities. We've been to places like Detroit, Michigan; Philly; Newark, New Jersey; Mobile, Alabama; Savannah, Georgia; and Baton Rouge, Louisiana. We are really focused on building a national brand for trusted health information. We're going to different cities because we get a lot of the same questions in every city. It really shows how universal the need for credible health information is and how much people from all over crave access to trusted health information from someone who looks like me and my colleagues.
EH: Let’s talk a little about your virtual work.
LF: Sure. My virtual work includes Ask the Doctor sessions. When the vaccines first became available, I documented my experience in the clinical trial, and some people — mainly organization leaders — started reaching out to me to talk to their staff because they didn’t want to get vaccinated. These conversations further confirmed that there are a lot of people in the community who also didn't have access to someone like me to answer health-related questions about the vaccine and otherwise. So, we started these Ask the Doctor sessions, and we would have five or six doctors who would rotate and be available for the community to call into a Zoom to get their questions answered.
But we're scaling that back. We are now turning our attention to private organizations rather than the general public, because I think people have vaccine information fatigue right now. They're not talking about the pandemic. Most people have either been vaccinated or are not planning on getting vaccinated.
So, we've been trying to find the people who still need trusted health information to help them make a decision or answer questions about misinformation. I think we find those people through trusted partners rather than just having these general sessions and hoping people find out about it because that's not a very good strategy for us. I think it's really important to try to work with folks who are already doing work in the community and who have already built trust with communities.
EH: Grapevine Health has a podcast as well. Can you share a bit about how you use the podcast to share health information?
LF: I started the podcast because I feel that we make a lot of decisions in healthcare, and we don't really incorporate the patient or community voice. So, I set out on a mission to talk directly to people, rather than experts, about our [the Black community’s] experiences. I wanted patients and community members to talk about their experiences. That's what the podcast is all about. Overall, Grapevine Health is really about elevating humanity and community voice and educating people in the process.
EH: Are your podcast and the Ask the Doctor chats intended only for the local DC community?
LF: Absolutely not. We want Grapevine Health to be a brand for trusted health information in the Black and brown communities. Because people like you and me, we have a lot of resources, we can find people we know who work in the health sector. A lot of people who wander into the emergency department don't have a soul to call. We need to make sure they have resources available to them so they know where they can go if they are confused about something or if they need help. I’ll give you an example. I was on the street sometime last year, and this lady walked over to me and asked for my help. She asked me to read her discharge papers because she had just gotten discharged from the hospital, but was still feeling sick and didn't know what to do.
She ran into me on the street, and here I am, a stranger, and she’s saying, “Help me. I just got out of the hospital, and I don’t understand what to do now.” That's disgraceful. So, how do we create resources for people like her across the country and particularly in the South, where there's a huge deficit in healthcare access? A lot of these states have not expanded Medicaid and people are just making do, or they're just not getting care at all.
EH: Through your virtual efforts, do you have a way of assessing your reach in terms of your audience base and the kind of impact or footprint that you’re making in other parts of the country?
LF: We have a Google number [where people can] text or leave a voicemail [for free]. People from all over will call us from time to time. We have reached people even outside the United States, from the Caribbean and the UK. In fact, many of our YouTube followers are from the UK. But mostly, we get that information from social media: Instagram, Facebook, and YouTube. Part of Grapevine’s focus is to have credible and experienced messengers deliver trusted health information to underrepresented communities.
EH: Can you talk a bit about how you find the right messengers and who they are?
LF: Well, what I’ve found is that a lot of the Black doctors who work with us grew up in meager circumstances. So, I think a lot of this is lived experiences that translate to effective communication. Dr. Fabián [Sandoval] is our doctor who speaks Spanish. He's very effective because he does research and keeps his finger on the pulse of health education and health issues that are impacting Black and brown communities. He has a TV show called Tu Salud Tu Familia (Your Health Your Family) on Telemundo, and he's very relatable to the Hispanic community.
I pick these doctors myself if I've heard them communicating complex information to the public, or if I brought them out on the street with me or maybe observed them in a lecture or something. They all have a passion for plain speak and helping the community understand health information. But they also generally either have spent most of their careers working with underserved communities, or they're from those communities themselves.
EH: What have been your biggest challenges and successes since you founded Grapevine Health?
LF: Some of the challenges have included marketing and consistently getting in front of the right audiences through social media. Identifying trust-based funders who are willing to partner but let us lead implementation of solutions based on our experiences and what the community has taught us has also been difficult. But some of my successes have been demonstrating how and why the messenger matters. We have delivered tailored messages and video content to Black and brown audiences and know our interventions have increased vaccine uptake in vaccine-hesitant folks by up to 35 percent. We now want to shift our focus to chronic health conditions that will assist in improving long-standing health outcomes.
EH: Speaking of the messenger, with the pandemic, it seems that trusting the messenger has been more important now than ever for underserved communities. I know you recently wrote an article for Forbes about the need for health providers to deliver medical information to patients in a nuanced way that is tailored specifically to their background and to their needs in order to help them better understand the how and the why of medicine. Essentially, the importance of what you just referred to as “plain speak.” Can you expand a little more on that and give an example of what this means and how you've been able to do this personally?
LF: I give lectures a lot about how we [medical providers] can better communicate health information to patients. I think the main thing is, we have to be creative about how we demonstrate that we're listening. In the clinic, a patient will be very attuned to whether or not you're paying attention to them or listening to them. There was a study done that showed doctors spend way more time talking than patients, which needs to be flipped. So, just being aware of that and having a spirit of openness when you approach people is really important, because they can sense that. If you ask them questions, do you let them talk?
I've asked people to help us understand how they decide if they can trust a healthcare provider. So many of them say, “Well, this doctor listens.” One lady said, “Well, my doctor, she's always in a rush. I feel like I can't ask questions because I don't want to bother her, and she's in such a hurry, and I can tell she's in a hurry because she'll move toward the door and put her hand on the door.” So, subtle things like this signal to patients that what we [doctors] have to do is more important than listening to them. The other thing is, we have to listen for cues and different things that we take for granted.
For example, I interviewed a gentleman about why he used the emergency room. I talked to him for over an hour before I figured out he couldn't read. So think about how illiterate people get lost in the health system. Do you know how many portals you have to log into, how many forms you have to fill out to be seen, or to get a follow-up appointment? How frustrating it is if you can't read and no one even recognizes it because you've become so adept at hiding your reading ability? You get lost in the system. But we can pick up on things like that when we listen and ask the right questions.
I was also doing an outreach event, and I asked this man to sign up for our newsletter, and he asked me to do it for him. So, I looked at him and asked if he was okay and then asked if he had trouble reading, and he indicated he did. If we [medical providers] ask, they will tell us, but they're not going to always volunteer that information. So those are just a few examples. But there are many others. We just have to slow down, listen, and get information from people and let them feel like we're there because of them, not the other way around.
EH: Based on your interactions and some of the feedback you’ve received from your patients and people in the community, what should white healthcare providers keep in mind on how to be the most effective when working with members of the Black community?
LF: Pay attention to body language and the subtle, nonverbal cues we may be sending people. Oftentimes, people feel rushed when we [doctors] are talking to them, and we may not be listening intently. They will sense this, and it impacts trust. We all have biases about the poor and underserved, and some have not been in their shoes. Take time to understand their challenges and why it might be difficult for them to adhere to instructions. Recognize when there is a need to improvise and be creative in developing a treatment or follow-up plan. As for engagement in the community, simply show up consistently and listen rather than fly in and fly out or believe you have the answers or understand based on what you’ve heard or seen in the media.
EH: What are your hopes and dreams going forward?
LF: I hope for Grapevine Health to become the go-to source for trusted, relatable, and science-driven health information for underserved Black and Hispanic communities.