May 20, 2020

Covid-19 Shines Light on Existing Healthcare Disparities

A conversation with Udaya Thomas, MSN, MPH, APRN, CYT

African Americans and other people of color throughout the United States are suffering disproportionately from Covid-19. In this interview, Udaya Thomas, MSN, MPH, APRN, CYT, talks about how integrative practitioners can better serve the health needs of underserved populations during this pandemic. Thomas is an integrative primary care nurse practitioner and the board president of Integrative Medicine for the Underserved, a nonprofit organization of multidisciplinary practitioners committed to affordable, accessible integrative healthcare for all.

Approximate listening time: 11 minutes

About the Expert

A. Udaya Thomas

A. Udaya Thomas, MSN, MPH, APRN, CYT, is a board-certified nurse practitioner in primary care and practices integrative medicine in a Safety-Net hospital system for the underserved in Southeast Florida at Memorial Primary Care. She is also pursuing her PhD in nursing at Walden University’s interdisciplinary health track, focusing on the integration of behavioral health in primary care. Udaya is also the board president of the non-profit organization Integrative Medicine for the Underserved (IM4US).

Disclosure: Thomas is partially funded by Grant #5T06SM060559-07 of Substance Abuse Mental Health Service Association (SAMHSA) American Nursing Association (ANA) Minority Fellowship Program (MFP). SAMHSA is a government resource for practitioners and the ANA MFP is currently accepting applications for more minority fellows.


Karolyn Gazella: Today, our topic is serving the healthcare needs of underserved populations. We'll also discuss the fact that African Americans and other people of color are suffering disproportionately from Covid-19. Hello, I'm Karolyn Gazella, your host and the publisher of the Natural Medicine Journal. My guest is integrative primary care nurse practitioner Udaya Thomas. Udaya presently works in a safety net hospital system for the underserved in Southeast Florida at Memorial Primary Care and she is also pursuing her PhD in nursing. Udaya, thank you so much for joining me.

Udaya Thomas: Thanks for having me Karolyn. It's great to be with you and thanks also to my colleague Priscilla Abercrombie, Past President of IM4US for connecting us.

Gazella: Yes, that's great. Yeah. Now before we jump into our topic, tell us a little bit about your present clinical work at Memorial Primary Care.

Thomas: Well, I work as a primary care nurse practitioner in a patient-centered medical home, and actually for the past 5 weeks instead of person care, we've had to go virtual with Covid-19 pandemic, but our administration led us into a quick change and we're doing 100 percent telehealth encounters. Patients can also message me directly to give them access to me whenever they need it.

Gazella: That's great. Now, where does your interest in healthcare disparity spring from?

Thomas: I would say from growing up as a first-generation Indian immigrant in a low-resource rural community, I've always actually been interested in integrative approaches. So I chose nursing and public health as my path to work for the underserved in this country.

Gazella: That's great. So you're the president of Integrative Medicine for the Underserved, also known as IM4US. Tell us a little bit about that organization.

Thomas: IM4US is a nonprofit organization of multidisciplinary practitioners who are committed to affordable, accessible, integrative health for the underserved. IM4US is the only integrative health organization focused solely on the underserved, which makes us fairly unique. We support practitioners that serve underserved populations to outreach, education, research, and advocacy. We also have equity, diversity, and inclusion principles for all the work that we do. And while we typically have an in-person annual conference, due to the coronavirus precautions, we've moved our 10th annual conference to a virtual conference.

Our underserved communities have been specifically affected by the crisis, not only because they're more likely to be susceptible to getting ill, but being out of work for this long really puts them at risk by not having an income, leading to less resources and poor health outcomes.

Gazella: Yeah, and I want to talk about that in a little bit more detail because right now, given the data that we've received presently more African Americans and other people of color throughout the United States are dying of Covid-19 compared to Whites. Now this crisis is really shining a bright light on existing healthcare disparity. So from your perspective, what is the present Covid-19 crisis telling us about this huge healthcare gap that exists in this country?

Thomas: There's so many factors. As Dr. Zwickey mentioned and at the end of your last podcast with her, the coronavirus pandemic has really turned on a loudspeaker to how many disparities there really are. Studies have shown that social determinants of health are responsible for on average 50% of people's health outcomes. For example, The Hill published last week that African Americans are 6 times more likely to die than their white counterparts in Chicago. Yesterday morning, Governor Cuomo commented on CNN, the new rise in Latino cases and deaths in New York. Suffice it to say that comparative to their percentage in the population, minorities are greatly affected and dying at a much higher rate. Current estimates as you might know, are up to 70% areas with concentrated low-income minorities. So is it their racial background or ethnicity that puts them at risk? Well, in the case of coronavirus and most illnesses, actually no.

Rather, it's poor social determinants of health, the lack of employment, safe and stable housing, literacy level, and access to healthy food options that determine health outcomes. These determinants are responsible for most health inequities, as well as lack of access to equitable care. For example, Karolyn, a New York hospital was recently highlighted in the lower-income part of town that is struggling with fewer resources compared to wealthier areas. It's a systemic issue. Because of all the challenges and sometimes trust issues, minorities may delay seeking care too. At IM4US we help practitioners attempt to level the playing field by offering low-cost solutions and increase access to integrative modalities and care and to increase trust. We also provide members opportunities to get involved with educational and policy initiatives to support the underserved.

Gazella: Yeah, I love that about your organization and it's going to be especially interesting for our listeners and readers because they already practice integrative medicine. So the fact that they can take their medicine and now serve the underserved, I think it's really a cool thing. And you know, you mentioned that 70% of deaths that studies showed that even though 70% of the deaths were in African Americans, African Americans only represented 32% of the population. So that is a really big healthcare disparity issue that we have. Now, as you mentioned, it is a systemic issue and it's clear that it needs to be addressed systemically. But what can integrative practitioners do to help ensure that they're not contributing to the problem or perpetuating healthcare disparity issues in their clinical practice?

Thomas: Mm-hmm (affirmative) Great question, Karolyn. While there are many things that practitioners and specifically integrative practitioners can do, but just to mention a few really important things that could make a great impact. One, they can do implicit bias training. This is a free training and it's online and it allows practitioners to find out their own biases as we all have them, whether we work for the underserved or not. Secondly, practices if they don't already have one, can try to secure a legal aid attorney to offer low-income patients legal advice and representation when facing issues like discrimination or eviction for example, and third, they can join our movement. IM4US promotes groups as a way to build trust and increase access to integrative care. In light of the current crisis, we're recommending telehealth groups whether in the time of Covid-19 or not, we can also offer medical group visits via telehealth. It's a great way to connect patients, HIPAA-compliant consent of course together with care team members to increase social connection, reduce loneliness, anxiety and fear that the public is currently living with.

Gazella: Yeah, that's true. What about people who may not have internet access? Does the telehealth visits still work?

Thomas: Great question. Actually we are putting together some continuing education for our upcoming conference and on that specific topic because we want to address access to everybody. I know actually that even when I do telehealth visits just with family members together, hearing multiple voices together and knowing that they're connected to their practitioner and their care team, whether through telephone or through video really makes their spirits lift and a sense of relief that they had contact with you. And you're right, many don't have high internet speed or access to join by video, but making group chats available is also helpful and just knowing someone is on the other line can save a life.

Gazella: Yeah. Like when you mentioned in the very beginning that your patients actually have access to you and they can message you. That's huge. And I would think that that would be a big part of their healing and a part of their care. Now, where can people find more information about IAM4US?

Thomas: Well, we have a website and I'll give you the address. It's

Gazella: Perfect. We'll also put a link to that website on our Natural Medicine Journal site so people can just click over and find access. It's a great organization, lots of resources, and really doing some good work to help underserved populations. So Udaya, thank you so much for joining me today.

Thomas: You're welcome, Karolyn. We've been around for about 12 years, so we're still considered somewhat young, but like I said, we're having our 10th anniversary this year and we're really excited to have more of the community join us.

Gazella: Yeah, absolutely. Well, happy anniversary-

Thomas: Thank you.

Gazella: … and this is a conversation that we're going to keep going. I think it's such an important one. You know we provided some good information, but let's just keep talking about it. I think this is very, very important. I also want to remind listeners that you can find all of our past podcasts at Today I mentioned the ones that I've done with Dr. Zwickey on Covid-19. But we have lots of information at and our podcasts are also available on Pandora, Spotify, iHeartRadio, iTunes, and many other podcast outlets. So thanks for listening everyone and stay safe.

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