Dr. Creshelle Nash is Arkansas Blue Cross and Blue Shield’s medical director for Health Equity and Public Programs. In this article, she discusses how her premature birth prepared her at an early age to address health disparities especially in Arkansas.
Diversity, equity, inclusion, social justice, and health equity have been a part of my life since I entered the world.
I was born to Bobby Joe and Geraldine, a young, poor couple in Miller County, Arkansas, in 1968, the same year Dr. King was killed. Hospitals had mostly been desegregated. I was a premature baby, weighing only 3 pounds 2 ounces—so tiny—and I stayed in the neonatal intensive care unit (NICU) for months. My grandmother would cup her palms next to each other and say, “This is how big you were.”
Statistics for babies my weight showed there was about a 50/50 chance of surviving, and if I did, I could have a multitude of problems, including learning disabilities. I not only survived but have had the opportunity to thrive and flourish. “To whom much is given, much will be required” is a line from the Bible instilled in me by my parents, and it is in my core to this day.
My parents had the opportunity to get an education, have food and housing and the things needed for health, including healthcare, and to continually seek more and better opportunities. We always had many books. My parents taught us to cherish those books and encouraged us to read. We had a family dinner every night, which opened with, “What did you learn today?” That question started many conversations about the world we lived in.
Dad had a vinyl album (yes, a record!) of live speeches by Dr. King that he played all the time. My brother and I would grumble about how often he played that record, but I now appreciate why he did it. While I didn’t understand all the words at the time, I felt the importance of what he was saying through his feelings, passion, the cadence of delivery that many Baptist preachers use to this day, and the audiences’ responses.
A curious teenager, I remember finding and reading a report on my dad’s bookshelf about health and infant mortality. That prompted me to look up the mortality rate for births in Miller County where I was born. It was really bad—worse than some third-world countries at that time! That was a sentinel moment for me to pursue healthcare as a profession. As a child, my parents recall me looking for a “doctor doll,” saying I wanted to be a doctor when I grew up.
In school, I always felt like I didn’t belong — an “other.” I wore a brace on my left leg because of a limp caused by a tight heel cord. I remember walking down the hallway in that special shoe with the metal pieces that came up the sides of my leg to my knee and the kids looking at me differently. Also, when you are a person of color and given rare opportunities to excel (which I did), that was also considered unusual.
I got through school as “the smart kid.” I attended medical school, where I saw how people were treated differently in healthcare — students of color, patients of color, doctors of color, everybody. It was like an undercurrent, everywhere, and I didn’t have words to put on it until I started to study it as a profession. Now I understand it to be race based bias, both implicit (or explicit as video cameras have shown) and systemic. Those biases result in health inequity, and healthcare disparities between people of color and white people. I understand, too, that race is but one attribute subject to bias. People face bias based on age, gender, the presence of a disability, and many other factors.
Social justice and healthcare
During my primary care residency program at George Washington University in Washington, D.C., I served at a free clinic where I met a woman who had a mass in her breast. Despite my best efforts, I could not get her quick access to care. That ignited something in me. This injustice in access to needed critical care, my observations of differences in how people of color are treated in the medical institution, the messages from those Martin Luther King speeches—they all culminated in my convictions that there had to be a better way, an equitable way, for ALL people to get quality health care, and that I can play a role in influencing how people get care. I was seeing people as patients one on one, but I wanted to help on a larger level to tackle the upstream issues that lead to bias, inequities, and disparities. This led me to policy work where I have studied, taught, and acted to identify and shed light on the root causes of bias, inequity, and disparities; and learned that access to quality health care is only a part of the picture, and that the health of individuals and communities is highly impacted by other factors such as economic stability, safe neighborhoods, education, access to nutritious foods, and others. Suddenly, I saw a connection between my father’s passion for policy and community development, my mother’s passion for service and my passion for healthcare.
Being at Arkansas Blue Cross has helped me understand how influential health payers can be in driving health equity efforts. I am very impressed and proud that Arkansas Blue Cross made the commitment to stay on the Exchange and to stay with the Medicaid expansion when other companies throughout the nation were pulling out. I’m proud and humbled to have the opportunity to work toward creating a health equity framework. I am always asking: Who are we missing? Are we addressing health inequities or are we making them worse? What barriers do we need to remove to ensure everyone receives quality healthcare and has a fair opportunity to be healthy?
Why health equity is important
Social justice is core to creating Health Equity and improving health equity is core to creating social justice. Systematic disadvantage by race, or any other factor, creates inequity that deprives individuals, families, and communities of not only health, but education, economic stability, and quality of life. The impacts can span generations and impacts us all. The health care system has been a part of the problem, and it can also be a part of the solution.
My life experiences created in me a drive for inclusiveness. I root for the underdog and want to ensure everyone receives quality healthcare, especially people who feel like they are “other.” I’d been talking for a long time in our community about the connection between social justice and healthcare. The death of George Floyd really illustrated that understanding. And the COVID-19 pandemic showed how far we have yet to go to achieve health equity. The same power and forces that lead to judicial, criminal justice, educational, economic, and environmental inequities have been illustrated during the COVID-19 pandemic. Our current conditions bring urgency that we act on the opportunity and do something different to get something different.
I’m reminded of a quote from Dr. King, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”
We, at Arkansas Blue Cross Blue Shield, are a part of the solution. We are committed to improving access to affordable, quality healthcare, and improving the health of individual communities throughout our state with an intentional focus on Health Equity. We are collaborating with many partners across the state of Arkansas, to address the root causes of inequity and find innovative ways to provide quality health care to all Arkansans.