Dr. Beverly Gray: Historically, there are so many, so many issues at play. Who has led hospital system historically? Who continues to lead the hospital? Who are the people around the table making big decisions? The demographic of that is changing over time, but it’s slow, it’s a slow process. But I don’t think that means we should give up, I think that means we should continue to have more diverse people around the table who have different backgrounds, different ways of thinking, who understand what it’s like to grow up in poverty. I teach a medical student class called “Cultural Determinants of Health and Health Disparities.” It’s taught in the second year, and we talk about different clinical cases that they’ve encountered where health disparities exist for different groups of people. In one of the classes, in one of our small groups, I asked, “How many of you grew up in a rural area, like a rural part of the world?” And no one. It’s very rare to encounter a student that’s grown up in a small town. I think we care for so many people here, at Duke, and in the North Carolina healthcare system. If you’re at UNC, ECU, or Duke, you’re seeing people from rural areas, and I think often that clinicians don’t necessarily understand what it’s like being in a small town or being a distance from a hospital. Those perspectives are important too, and so that’s why we need people of all different backgrounds and ways to thinking to be able to pose, “Okay, well it may be hard for this person to get to the hospital because they have to drive two hours, they’re coming from this rural area, and you should think about that.” Or just thinking about probably only 10 to 20 percent of actual health outcomes are related to medicine, and the practice of medicine of what we’re able to offer to patients, and the other 80 percent is all the stuff that happens outside of the hospital. What food you’re eating, how safe you feel in your home, are you exercising, do you feel safe to exercise. All these other things. We like to think that with medicine we can make this huge difference, and we can make a difference, and there’s some things acutely, yes, we can save people’s lives. But so much of people’s longevity and their livelihoods, that goes to all of those things that are happening outside the walls of the hospital.