FROM THE PRESIDENT by Aneeta Bhatia, MD, MBA, FFARCS, FASE
Leading for Health Equity
By the time a patient reached my operating room, most of what determined their health had already happened. It happened in the zip code they grew up in, the quality of the school down the street, whether the bus route reached a grocery store selling fresh produce or whether a parent could take a day off work without losing a paycheck to bring a child to a well visit.
Health researchers have a name for this, the social determinants of health: the conditions in which people are born, live, learn, work and age. And by the most widely cited modeling of population health outcomes, from the County Health Rankings framework built by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, clinical care of the kind we deliver accounts for only about a fifth of what determines how long and how well someone lives. The other four-fifths are social, economic, behavioral and environmental factors that we physicians cannot prescribe our way out of.
That statistic should unsettle every physician who reads it, because it means our hardest-won clinical skill only ever gets to act on a fraction of the problem. As physicians, we are trained to treat what walks through the door. But physician leadership asks something more of us: to look upstream, to understand why the same conditions keep walking through that door, and to use our voice and our position to change the conditions themselves. That is the charge of this issue’ s theme and during my time as President of the Greater Louisville Medical Society.
Partnership as a Clinical Skill
Health equity is not built by any one organization alone. It is built in partnership with public health departments, faith communities, nonprofits and neighborhood leaders who already have the trust that no health clinic can manufacture overnight.
I see it at the community events organized by GLMS at Smoketown, and now firsthand through our work supporting Kentucky and Indiana Physicians of Indian Origin( KIAPI) partnership with the Hindu Temple of Kentucky, to bring a free community health fair to our city. What strikes me about this initiative is not just the free screenings or the education it will provide, but the model it represents: a faith community opening its doors, physicians bringing their expertise and a shared commitment to reaching people where they already gather. Through the GLMS Foundation, we will support this work with grant funding, because meaningful community health infrastructure does not happen on goodwill alone; it requires resources, and it requires physicians willing to advocate for those resources.
This is what I mean when I say physician leadership is about shaping conditions, not just delivering care. A screening at a temple health fair may catch an undiagnosed case of hypertension in someone who would never have scheduled a primary care visit. That is a life changed not by a prescription pad, but by a partnership.
When the Map of Our City Tells a Health Story
I think often of the Have a Heart Clinic, our city’ s only stand-alone cardiovascular clinic dedicated entirely to the uninsured and underinsured. Since 2008, a team built largely on volunteer physicians has offered full cardiac evaluation and treatment to patients who would otherwise have nowhere to turn. As a cardiac anesthesiologist, I recognize the weight of what that clinic represents: patients who would have gone undiagnosed until a catastrophic event are instead being followed, treated and kept alive through a model built entirely on the belief that a person’ s ability to pay should never determine whether their heart disease is caught in time.
I think, too, of what has finally arrived at 28th and Broadway. For more than 150 years, Louisville’ s West End had no hospital of its own. City health equity data has shown a life expectancy gap of well over a decade between the West End and the rest of Louisville, driven by elevated rates of heart disease, stroke and cancer concentrated in the same zip codes that lacked nearby emergency and specialty care. That local pattern mirrors what a landmark national study found: economists Raj Chetty of Stanford and David Cutler of Harvard, analyzing 1.4 billion tax and mortality records for their Health Inequality Project, documented a 10- to 15-year life expectancy gap between the richest and poorest Americans. What their data made clear is that this gap is not fixed. It varies enormously by geography, and it narrows most in places with stronger local investment, not simply better hospitals. Some American cities have all but closed the gap; others, with comparable poverty rates, have not. The difference is what the community around a patient chooses to build.
The opening of Norton West Louisville Hospital happened because health leaders were willing to say plainly that a zip code should not determine a lifespan, and then acted on it.
What connects the Have a Heart Clinic and the West End hospital is the same principle: meeting people where the data says they are being failed. That is physician leadership in its most literal form.
Beyond the Individual Fish
There is a concept from health equity research that I find myself returning to often: when a stream turns up full of dead fish, the problem is rarely in any one fish, it’ s in the water. A 2023 research agenda published in Health Services Research,
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