Photo by Tom Jenz
Dr. Leonard Egede
Dr. Leonard Egede
Dr. Leonard Egede is a professor of medicine and the Inaugural Milwaukee Community Chair in Health Equity Research at the Medical College of Wisconsin. He once said, “The way people live, the neighborhoods that they live in, the environment that they have to interact in, the resources they have available to them, the jobs they have—all of these factors are more powerful than what happens in the doctor’s office.”
I found that remarkably innovative, and I was interested in hearing more about Egede’s holistic approach to medicine. I met him in his office at the vast, glass-front building in Wauwatosa, a sweeping new addition to the Medical College of Wisconsin.
Egede grew up in the central part of Nigeria. His parents worked for the government as education administrators. For high school, he went to a competitive boarding school, the students matriculating from every Nigerian state and diverse background. He told me, “For five years, we all mixed together, and I got comfortable with diversity and cultural differences, students with varying beliefs and attitudes.”
When did you get interested in a career as a doctor of medicine?
From the age of 10, I knew I wanted to be a physician. In high school, I specialized in the sciences, and then I went directly from high school to Medical School, which is how the system works in Nigeria. The program lasts for six years. By the time I was 23, I was a licensed doctor. In Nigeria, schooling is free, but you are required to do a year as an intern and another year working in national service. I was sent to northern Nigeria, a relatively disadvantaged area where people couldn’t get much medical help.
How did you come to live in the United States?
I met my future wife in medical school. She was studying to be a doctor. She had been born in the U.S., and planned to return. She is now a psychiatrist in Milwaukee. I always wanted to settle in America, do research and pursue a career in academics. My future wife came back to the U.S., and I followed. I attended graduate school at Towson State in Maryland, while I took the exams to practice medicine. Right after I passed my exams, both my parents died in a car accident. That was a very difficult time for me, the grieving process. During my residency, I got married.
Through those three years of doing my residency, my goal was to be a teacher and educator. Then, I had the opportunity to do a research fellowship in Charleston, South Carolina at the Medical University of South Carolina. I ended up working in Charleston for 17 years, rose up the ranks from assistant professor to full professor and to an endowed chair.
You were settled in Charleston with a successful career. So how did you end up in Milwaukee?
A recruiter from the Medical College of Wisconsin reached out to me. I ended up taking the job as the chief of the Sivision of General Internal Medicine and also director of the Center for Advancing Population Science where I am now. We moved here in 2017, my wife and two children.
You are currently a tenured professor at the Medical College of Wisconsin. What do you teach?
I teach research skills to medical students and graduate students.
You are the Inaugural Milwaukee Community Chair in Health Equity Research at the Medical College of Wisconsin. What exactly is health equity research?
Health equity is basically health disparity based on the economic, race, and social backgrounds of people. In 2017, I brought in five faculty and staff from South Carolina, and we did surveys and interviews with Milwaukee citizens on key issues like housing, transportation, food security, educational assistance, and health care systems. We covered 10 zip codes with poverty-driven issues. We found large disparities between the inner city and the rest of the city in these areas—segregation, historic redlining, food insecurity, lack of housing and transportation, poverty, care of the elderly and unemployment. These all fall under the category of social risk. We know that a person’s environment contributes to health, where they live, employment, income, and social disadvantages. We are taking the holistic approach. Currently, there are too many government and nonprofit silos covering many of these topics. We’d like to bring the silos together and create a system where an individual is cared for holistically—not just for illness but for how environmental issues affect health. We used these survey results as evidence for research to help change public policy.
Who benefits from your research results in order to take action on the ground? Who uses the data?
The way research works in this country is that it is evidence-based. Take food, for example. If you give disadvantaged people healthy food in boxes versus giving them food vouchers, we test the results, basically whether proving food in stock boxes leads to healthier outcomes. We partner with local, federal and state legislatures, big business, nonprofits, and community organizations to create public policy. The practice of medicine is based on guidelines.
In South Carolina, we tested Telemedicine, namely providing therapy via video conferences, to treat depression. That program worked, and the Veterans Administration now uses telemedicine. With diabetes patients, we did something similar, a series of half hour telephone education sessions. When that worked, insurance companies started approving paying for providing diabetes education via telephone for diabetes patients. In another program, we studied devices that measure blood pressure and glucose on patients. That information was uploaded to a central server. When that kind of home telemonitoring worked, South Carolina adopted the program and now 6,000 patients benefit.
In other words, you are trying to move public policy into a more holistic approach.
Yes. Public policy used to suggest that lack of good housing, food insecurity, depression, or unemployment did not matter that much in health matters. But we proved those conditions did matter. For instance, housing and food do affect diabetes care. And now public policy includes screening for a client’s social environment as part of diabetes care.
From what I understand, your research has focused on a person’s geographic location regarding chronic medical and mental health conditions. You’ve been developing and testing innovative interventions to reduce health disparities related to race/ethnicity and socio-economic status. What have you discovered in your research?
We work with multiple organizations. Hunger Task Force, churches, food pantries, and more. Our research can evaluate how well their programs are working and what components are most effective. These programs need to be communicated to the scientific and the lay communities.
I believe your work has focused on understanding the impact of structural racism, the social determinants of health and social risk on health outcomes. You described these social determinants, and I quote you, “as discrimination, high incarceration rates, high levels of poverty, racial segregation, substance abuse, housing instability, food insecurity, low education retainment, and unemployment.” I assume any of these factors can lead to physical health issues but also mental health problems such as depression and anxiety. Can you expand on the influence of social determinants?
Medicine used to just pay attention to biology, high blood pressure, for instance. But the social environment is just as important, where you were born and how you lived your life. But it is really social risk. For example, if you grew up in poverty like bad housing, food insecurity, and lack of access to healthcare, then poverty becomes a risk for you. Social risk drives poor outcomes. Since about 2010, I’ve been researching the factors of social risk. If it is unhealthy food, financial difficulty, or isolation of the elderly, we figure out the best way to address these social determinants. For example, if you live in poverty but have access to free Medicaid, you can focus on your other social determinants. Seventy percent of bankruptcies are tied to health. If you stay in a hospital for two nights, and you are uninsured, your bill you are responsible for may be $50,000. But if you have health insurance, you may only be responsible for $2,500 after pre negotiated insurance payments.
I understand the end goal of all your research is focusing on the individual’s social determinants.
Take the Milwaukee area economy as a social determinant. If there is a factory in Waukesha paying good wages, but you live in the inner city, it is nearly impossible to get to work by bus. You need a car, and many inner city residents can’t afford cars.
I’ve been covering inner city residents, leaders and social problems for years. I’ve walked the streets, attended events, and gotten to know people. I get the feeling of general angst and even social depression for many. I also see too many people who just don’t look healthy. It saddens me.
I know what you are saying. We try to think about what levers we can pull that have the most effect. Economic empowerment is at the top. Then, comes education. In the Milwaukee public schools, too many high school seniors are reading at the 6th grade level. Not everyone may want to go to college. Many can train to be electricians or carpenters, good paying jobs that lifts them out of poverty. When the factories left Milwaukee many years ago, the good paying jobs went with them. This created the cycle of poverty.
I’ve talked to Black men of advancing age who fondly remember growing up in the urban neighborhoods. Their dads had good jobs, there was little violence, kids could pay in the streets, and they could walk to stores, bars, and restaurants.
That was all in the past. Right now, we have to say, where do we go from here? How do we create a school system that gives students a good chance? If you want to work, how do you get a good job? If you want to own a house, how do you afford it?
Three years ago, there was a fundraising campaign by local philanthropists to raise $5 million to improve racial equity in health through the ThriveOn Collaboration, a partnership between Greater Milwaukee Foundation, the Medical College of Wisconsin and Royal Capital Group. I believe these funds were to be used as a permanent funding source for you to focus on health equity research. How is the ThriveOn Collaboration coming along here in early 2024?
So far, we’ve raised about $2 million, which is placed in an investment account, and my research gets the interest, which is about 5%. Every year, we get from $50,000 to $100,000 to do research. We invest that money in high-risk ideas. Right now, we are studying levels of basic income and how that affects a person’s health. For instance, we are giving $500 a month to 100 people for six months and studying how they used the money and how it impacts health outcomes. 97% used that money to pay utilities. We plan to submit that data to the National Institute of Health to prove that supplemental income helps to provide basic needs and health outcomes.
My next question is kind of off-beat. Richard Wright, the esteemed Black writer of many novels including Native Son, once said, “Goddamnit, look! We live here and they live there. We black and they white. They got things and we ain't. They do things and we can't. It's just like livin' in jail.” I think this statement poetically reflects the health disparity challenges you are up against. Do you agree?
The way I think about it is we need to address the problem of hopelessness with many inner city residents. Hopelessness is detrimental to mental and community health. I recognize the anger from past transgressions, but my work is focused on hope, a better way forward. We must learn from the past to create a brighter future. I am an optimist. I believe the future is bright. I think a lot has changed from the Civil Rights movement in the 1960s. We’ve made progress. To deny that progress is to deny history. However, there is still work to be done.
You were 27, I think, when you moved here from Nigeria. You are now 56. Do you like living in the USA?
I love this country. The U.S. has its problems, but it’s a good country. Sometimes, we get stuck in all the social issues, but we can go from good to great.
