Health Justice For All

As one of the nation’s leading health care executives, Dean has consistently used his platform to advocate for health equity. He played a pivotal role in the passage of the Affordable Care Act (ACA), working with President Barack Obama and congressional leaders. One of Dean’s proudest accomplishments as a leading Black executive is CommonSpirit’s partnership with Morehouse School of Medicine, investing $100 million over a decade to increase the number of Black doctors.

Born in Alabama and raised in Muskegon, Michigan, Dean is the secondoldest in a family with nine children. His father was a foundry worker and his mother a homemaker. At times, the family was on welfare and, growing up, he and his brothers and sisters had little or no access to basic health care or other resources. It’s these experiences that have guided Dean’s career and shaped him into the man he is today.

On a recent afternoon, I caught up with Dean for a wide-ranging chat about his formative childhood, living a mission-driven life and the innovative future of health care in America.

Meet Lloyd Dean.

Your entire career, you have been an advocate for improved health care and better access. How did your personal experiences influence your advocacy and career?

Sometimes we underestimate how our childhood — where we grew up, how we grew up — really impacts our path in life. I came from a family of nine kids. My parents migrated from the South, like a lot of African Americans. And my grandparents also did because people of color could get jobs [in the North], particularly working in the heyday of the auto industry. My grandfather worked in the factory that made parts for the auto industry and my dad, when he got out of the service, did the same. The community I grew up in was a community of African Americans. And it was out in the country, so we had no public resources. We had no health infrastructure.

Tough times.

When the factories were shut down, we would go on welfare. Eleven people in a three-bedroom house. And in factories, they didn’t offer any kind of benefits. I was bused to an upper-middle-class school, seven miles into a whole different community, so I saw the contrast. Basic things like going to a dentist and preventive medicine, those kinds of things just didn’t exist. The remedy for everything was castor oil. So I saw my mother and father suffer. I got to know kids there and I’d hear them [say], “Oh, I got to go to the dentist today,” “I got to go get these different shots.” And it stuck with me that their lives and their grandparents’ lives were so different. My grandfather died of prostate cancer because no one went to a doctor. If you got a burn, my grandmother would put butter on it. If I got a toothache, my father would cut this piece of cloth, soak it in whisky, make you bite down on it and then pull your teeth himself with pliers.

Ouch!

And I only say that to get to the specifics of your question. I knew I didn’t want my brothers and sisters — because I was the second to the oldest — to experience what I experienced. And I was just so frustrated that other kids seemed to be healthy and their parents healthier, but in my community they weren’t. So that really is what got me into health care. I’ve only had two professions in my life, Janet. One was education. When I was bused to the school, there were no teachers of color. And so I said, “Well, why is that?” Because in sports, I’d see other schools and coaches of color, so that’s what influenced my desire. And I said, “If God gives me the strength and the availability to go to college, I’m going to try to do good with that opportunity.”

I understand you did a stint as a news anchor.

Oh, I did, and you’ve done your homework. Growing up really poor, I became a dreamer. One day I was watching TV and I said, “I like what that guy does.” And this was back in the day, so I made this tape and I sent it to ABC. I did four segments never thinking I’d get a call, and I got a call to do it. I was teaching at the time. And I said, “Well, what segment would you like me to do?” And they said, “The 4 a.m. news.” So I’d have to get in the car, drive, do the news, prepare the news, do the timing, all of the enunciation, all of the pronunciations, write my segment and do that for 10 minutes of news and then go back and be in the classroom at 7:30 to teach.

That didn’t last long, did it?

It lasted about six months and I loved it, but the wear and tear of it, and in the winter in Michigan. And I didn’t want to be late for my class because I have this fixation with being on time.

You talk a lot about health equity and health justice. Can you define those terms and tell me the difference?

I’ll start with justice. My premise is that health care is a right. It is not something that should be driven by economic capability or where you live or anything like that. And to me that is an issue of justice and of fairness.

The equity piece of it gets at the what. When I think about health equity, I’m thinking about the resources available in a community should be available for all. And the quality of care should be equal and equitable regardless of who you are, gender-wise, race-wise and your economic means. We saw during this pandemic the impact of the lack of equity and the lack of justice. We saw that certain communities and certain ethnicities were disproportionately impacted because there wasn’t a just and fair opportunity to enter the system. Care was not equal or balanced. We saw the impact of the haves and the have-nots. So that’s how I distinguish. Justice to me is a moral proposition around fairness and equal access. Equity is making sure that when we talk about and define health care in products and services, that they are available at a quality that is equal from community A to community B.

You’re so right, the pandemic shone a bright white spotlight on the disparity to access depending on where you lived, your economic status and a variety of other metrics. Do you think, as a result of incresed awareness, we are any closer to universal health care in this country?

It’s a great question and a timely question, because we’ve been talking about health injustices for a long, long time in our country. But to your point, what the pandemic did was really lifted the veil on this. And it also caused people to pause and for the first time say, “What happens to my neighbor and their health directly impacts me.” Because one thing about a pandemic or a virus is that it does not get data on economic status. It does not see ethnicity.

It doesn’t discriminate in any way.

Right. It is the great equalizer. So with what we’ve gone through around social justice, couple that with the pandemic, I do think that consciousness has been raised. As we sit here today, a million people in the United States lost their lives. And when you begin to dissect the profile, the demographics of that million, it’s skewed to the poor and vulnerable, but not by much. This is going to sound kind of strange, but if there’s any positive that comes out of a pandemic, it is a realization that to ensure the health status of a community, all of its community members must be on a path to being healthy.

Let’s talk about one of the biggest health care reforms in the history of this country, Obamacare, or the ACA. Thirty-five million Americans benefit from the ACA, yet another 31 million remain uninsured. How can we build upon this progress?

You just zeroed in on the raging debate that still exists in this country. President Obama and the Obama administration took a bold move to say we have to come up with a plan, as the wealthiest nation on this planet, to ensure that all members of society have basic access to care. If there was ever a proof point on that, we’re living through it now — a pandemic. I think when you set the politics aside, it doesn’t have to all be funded by the government. I do think there’s a responsibility for the individual, if they can contribute to their health. I think there’s a responsibility for employers, communities, but I also think there’s a state responsibility and a federal responsibility and we all benefit. So I am a proponent — have always been and I don’t apologize — for some type of universal health care. But if I have the means, I should contribute to that. In the nation, we should ensure that whether you have the means or not, we end up with stronger communities, healthier communities, better lives, more efficient ways of receiving our care if there is a basic capability for all.

The price of health care is also a hindrance, particularly preventative care, even with insurance. How do we address the cost issue?

I say this all the time. We, as one of the largest providers in the country, bear some accountability and some responsibility. But our whole health care system and how we pay for health care lends itself to a need for reform. I will start with access. One of the most expensive ways of getting care is … through our emergency care. That is one factor in the cost.

When you look at our medicines, our costs are some of the highest in the world. Now, the question is why? So I think this has to be addressed.

And I don’t want to keep going back to the virus, but we learned that things we thought historically had to be done in our most costly settings — in hospitals and on hospital campuses — we know can be done virtually. And we need to invest in access to preventive care, behavioral health and mental health services.

I would put an umbrella over [everything] I listed and say we have to use the technology that is available in other sectors and apply it to health care, like AI and data. Our [smartphones] are becoming as powerful as some of IBM’s first computers. How many people in this country do you think do not have access to some kind of [smartphone]? It’s a low percentage. And when I think about some of the corporations that are entering into new [areas] — AWS (Amazon Web Services), Google, Apple — I think we’re going to see all of that begin to affect utilization of care when people access the system.

What are some of the most exciting medical innovations that are coming down the pike?

One of the most exciting things on the cusp of being scaled up is precision medicine. If both you and I have asthma, and we go to a physician, we’re likely to be treated exactly the same. But one of the things that we know is that there’s no two like cases of asthma. Some of the symptoms are the same. How we use your medical data and when we use it, again, around prevention and around treatment, around DNA, all of those things I’m really excited about.

And I’m excited about some of the new prosthetics. Think about a knee replacement today versus a knee replacement even a decade ago. The technology, the compositions of the pieces of the knee structure, are so different and long-lasting and sustainable. And some of the new developments around pharmaceutical innovations are just going to change our lives. There are studies going on now that there are agents that, at least in some of the study groups, have dropped the percentage of people who are having heart attacks by 80 percent.

You talk about a tool that you use at CommonSpirit Health, which is neither new nor necessarily innovative, that helps in healing and that’s human kindness.

Oh, absolutely. And there is a science behind that. We did some work with Stanford University, and Oxford has done some work, to show that how we treat each other as human beings, particularly how we treat others in their most vulnerable time, is a major factor to how they recover. [And] it’s free. Health care is still one human reaching out to another. Even with all the technologies, it is still driven by human beings.

You are one of the most respected and influential leaders in health care in the country. What makes you a good leader and what advice do you give to aspiring leaders?

I tell people that number one — and it sounds so basic — you have to understand that leadership is a gift. It is something that you earn, but it is a gift. I learned early in my career by watching and reading and making some mistakes, that the greatest success a leader can have, and the greatest evaluation of their success, is not what they do individually, but their ability to get things done through others. To be successful you need to be consistent. You need to learn to listen. You need to understand that you are one spoke in the wheel, but you are not the wheel. And you have to hold yourself accountable.

So what’s next for you, Lloyd?

Oh, now there’s the million-dollar question. I will tell you, I am in a discerning mode about that. My wife and I can spend more time together. And she always cautions me, not too much time! But I do want to spend more time with my grandkids and with my kids. I want to continue to contribute to society. And I want to share [what I’ve learned] … to ensure we talk about fairness and justice for women and health and health care, fairness and justice and opportunities for people of color in health care.

Inactivity is always a challenge for me. I’ve worked since I was 10. Because at 10, all the boys in the house had to get some kind of job and we had to start paying rent. If I earned $5, my dad would get $1.50 of it. I can’t think of a time in my life where I wasn’t thinking about what I was supposed to be doing or would be doing. And the last thing is, retirement is a word that makes me nervous because the things that I’m passionate about, I don’t know if I can ever retire from those.

This interview has been edited and condensed for clarity.