Dr. Courtney Jordan Baechler
Appearances
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
Do you agree with all that? I do, but I don't, well, I don't want to miss Clarence's question. No, no, no, you go ahead. I can follow up. Okay. I just, I was, what I was going to say is, yes, Jim summarized the data perfectly.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And a couple of things that I would just add on to is number one, when we look at that data, the disparities within it of who's doing decent living with chronic disease and who's doing poorly and dying more prematurely definitely disproportionately impacts the black and brown people. Number one, that's a huge issue. It's particularly a really big issue in Minnesota.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
We have some of the largest disparities based on our overall fairly great outcomes for white people. We do not see the same for our black and brown population. So that's a big issue. And then the other thing that I would just emphasize as somebody who is seeing people on the clinical side, People don't feel well.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
So even though for a couple of decades, our life expectancy had been improving for folks with chronic disease, that we had been managing cardiovascular and diabetes better, people do not have a high quality of life with these coexisting diseases. And this is this, as you're talking about this inflection point of We're off the rails.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
We have got to do more upstream primary and secondary prevention on. And that is what the community has been asking for loud and clear. Yes, no one wants to die from heart attack, stroke or diabetes complications. But in between, they don't want to feel like they're walking through, you know, a cloud their whole life because they're on drugs.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
15 medications to manage this disease process, which is what it is for a lot of people who have these three conditions. So we have a lot of work to do to actually, again, respond to what people are asking for versus responding to the disease process. Those are two different things. And I think challenging as someone who was trained in a Western medicine.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
That's not what we learned to do in medical school. So we got a lot of change that has to happen.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And if I can just say one more thing to that, Jim, and to answer your question, Clarence, one of my favorite systems that I have seen within the U.S. is in Alaska, NUCCA or the South Central Foundation, which is a federally qualified clinic for decades, or I should say federally qualified clinics.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
received dollars from DC, you know, over to Alaska dictating how healthcare should be done there, as you would expect all the challenges that we face largely around cardiovascular disease. stroke and diabetes.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And a few decades ago, they decided to actually listen to what the community said, because while the healthcare system was saying, we need better diabetes control, we need better blood pressure control, we need all, you know, all these different metrics, the community said, what we want help with is domestic violence.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And you can, you know, keep saying all this, but this is actually the number one thing impacting us, And as soon as the health systems and, you know, largely collectively changed to listen and respond, then the community, there was different trust, there was different partnerships and relationships responded collectively to how best to they could engage around diabetes, heart disease, and stroke.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And now they have lower ER rates. They have better control of these diseases. They have all sorts of metrics that we consistently look at financially and otherwise of who's using what. But it was a different model. And took totally reversing how things were done, because I think on the clinical side, it was so hard for people to get to, well, is that our lane?
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I mean, the number of times I hear that, is that our place to be in? You know, we're not going to fix homelessness, Courtney, you know, that's not, we treat cardiovascular disease, but it turns out, right, as everyone on this call knows, that
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
that to the individual experiencing this, that's what is, of course, most important to them, or whatever the case is, is that social need, and certainly as it relates to these healthy behaviors that we're talking about, all the time, you can't, right? We can't expect people to do any of this if these basic needs are not met. You're right.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I guess I would just say that it just makes me so excited because this is something that I can share with any audience, right? Sometimes I feel like when I bring things from the health side of things, the health system side of things, I have to justify or decode when I'm with
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
community facing and then vice versa if I come up with things on more with non-profits and different community facing folks I have to explain them to the clinical side so somebody who lives in both worlds I love that this is very unified and it's you know just to some of the other points that you brought up Clarence it's this could be any disease process yes we are talking about
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
cardiovascular stroke and diabetes, but we're talking about whole person. We are recognizing that people don't like having to see all these different specialists and kind of, well, how does that impact my mental health? How does that impact this? And so I just, I'm super proud of the work that we've done. I feel like it really is a great framework to move forward in
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
in getting to these outcomes and that I hope resonates with a lot of people. But like Jim said, we don't think we're perfect. And we are interested in wanting to adapt and change as people see fit if we miss the mark.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I would just emphasize that the number one thing people with diabetes die from or suffer with in between then is cardiovascular disease and stroke complications. It's so connected.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And in fact, from a research perspective right now, what we're seeing with all these new super expensive drugs that are coming out, these GLP-1 inhibitors that were initially created to manage diabetes, and we're talking about Ozempic semi-glutide will go be all those guys initially created to manage blood sugar. Turns out that they had weight loss implications.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And now, Oh, what did they just get an FDA approval for cardiac prevention? So it is so interconnected that basically all the trials that we do on the clinical side. Now we look at, the SLP ones that we use in heart failure have diabetes implications in terms of improving because it's just, it's such an interconnected process. And in fact, from an epi perspective, the next sort of biggest proposed
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
issue that we're going to have as a country is diabetes actually overtaking cardiovascular disease, which again, isn't surprising, like we just said, because in this case, it usually comes first, and then cardiovascular disease comes second with what we're dealing with now, with our culture of obesity and poor nutrition and poor exercise and poor sleep and high stress.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And now I can't help, but yeah, I can't help, but just add one more thing for our, for your listeners too, is that the number one thing I hear from people when we want to start a statin drug, which, you know, is the number one drug that we prescribe in this country, not as cardiologists, but as anybody is, oh, I've heard that they cause diabetes, statin drugs in trials and
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
they showed people who are on statins got diabetes six months earlier. And for Gemini and anybody who's an epidemiologist, that is what we call true, true and unrelated because people are usually walking around with, diabetes for quite some time before we actually diagnose it.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And so it's totally not causally related to these drugs and speaks more to what we are saying in that these conditions, diabetes and cardiovascular disease for the individual that is living with them coincide often together. And so it really takes a more holistic look at how we prevent it, treat it effectively and prevent deaths.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
Yeah. The only thing I would add to that is, can we, excuse me, be patient and wait? Because again, there are a lot of examples that have shown that if you respond to what community is actually asking for, we can get to this place. But so far, we've been impatient and wanting to our needs, our clinical needs met first and just met resistance.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
So I think this is really, I think it's a critical piece that we give this time and are open to some of, quote, the softer metrics that might actually be more important than some of, quote, the hard metrics that we've done.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I think your point is a good one, Erin. And we certainly did our very best in making this plan to be engaging with community. Obviously, the ones that we engage with were people who wanted to engage to what you're saying. But the Department of Health and the leadership team that helped create this had lots of
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
various connections that way that we tried to use as much as possible to engage with people and different sectors that historically have not been involved. And I think part of our thinking that way is that we sort of just continue to build that tree with broader roots as we change who is involved and look at different ways, easier ways for people to engage in terms of
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
how we access virtually in person, you know, all the different things that that's not how it's always been in the past. So I think like everything else, the proof will be in the pudding, right? And the final product in the sense of, I'm sure there are some people who are kind of cautiously watching from afar to see, well, let me see how that works with that group. And if that goes well, then
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
we would be willing to, et cetera. But open to people's feedback. And Jim, anything else that you would add there?
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
Yeah. Yeah. Well, it's fun to hear, you know, just like Jim saying your intro into all of this, because I realized that Jim and I actually started at the same time in terms of my involvement with the Stroke and Prevention Committee was 2007. So I remember you getting introduced. It was either my first or second meeting and how excited I was that you were joining. Now, just to put this in context.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I was in the middle of my epidemiology and cardiology fellowship. So I think my mind had not been completely corrupted by medicine yet. So I did choose during my intern year to go get my public health training because I realized how broken I felt the system was.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
But what I would say is at that time, I had just come back from Finland where I got to see the North Corelia Project and the way that they had, from a country level, improved cardiovascular disease mortality by 85% over 25 years. So I knew it was possible. And I am 100% being honest with you that the one thing that gave me the most excitement and optimism was
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
was the statewide committee where we came together around prevention of heart disease and stroke because as a clinician that rotated through five different of the leading hospitals in the Twin Cities, you realized how disjointed and fragmented it was for the human being, the community, everyone, and largely who we were and were not seeing and what stage we were and were not seeing them. So
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I just think the infrastructure that the Department of Health and both you, Stan, and Clarence has been a part of all of this, and Jim leading now, that for me, it's been a really exciting to know that we've had this infrastructure in place, that despite funding changing, we still have continued it. And now I'm the most excited I've ever been with what the 2035 plan looks like, because it looks...
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
very different than the plans have looked in the past because of whose voices and thoughts have been involved, which was nobody's fault. But it's just exciting to see where we've evolved and the direction we're heading.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I would say in the conversations that we've had so far, absolutely to the point that we have to cut people from talking about where they see potential partnerships or ways that they'd like to use this framework and these goals to implement change. So I think that there is a lot of enthusiasm of how we can do things differently.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
And again, I think in part because of the, as I think we'll talk about, the goals and the outcomes are different. It doesn't mean that they won't Our goal, right, is that they lead to these other things that we've been measuring for a long time.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
But rather than talking about an optimal vascular score to a community member, which isn't really right, how most people wake up and think, there's things about investing in partnerships with the community, you know, in community. improving and changing and diversifying who is a part of healthcare, making access easier.
Health Chatter
2035 Minnesota Cardiovascular and Diabetes Health State Plan
I mean, all these things that people say, yeah, I waited an hour on a 15 minute lunch break yesterday to try to get into my primary care and ultimately just sat on hold the whole time, you know, well, there you go. Like that's not gonna, that's not gonna work. But when they hear things that resonate with them, there's interest.