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Reaching Out For Change

Reaching Out for Change

An actuary uses his skills and develops some new ones to put a face on racial disparities in this hometown
By Glenda Maki

Those of us plugging away at our daily tasks in offices and cubicles often don't get to see the effect of our work on the public or in the community. This is the story of one actuary who has done just that–taken his skills and passion to the community to bring awareness to racial disparities in infant mortality.

Racial disparities and infant mortality make the news periodically, but most stories' numbers and statistics do little to put a face on the issue. To increase awareness, Jim Toole, FSA, MAAA, decided to take action.

Toole began writing and speaking on the topic, and he also did something unusual for an actuary –he created an art exhibit titled, "Dispassionate Discourse: Examining Racial Disparities."

Why an art show? "I wanted to get the people who create art to be more socially aware," he says. "And I wanted to hook them up with patrons and raise their awareness as well. The whole reason for the show was to create a dialogue." The vision for the exhibit was to ask artists to capture through their chosen medium an aspect of existing disparities and communicate it to the public in a way that words cannot. This unique way of increasing awareness in the community also would create a sense of urgency that these issues need to be addressed, rather than accepted.

Nationally known artists including Sheila Pree Bright from Atlanta, Linda Hesh from Washington DC, San Pedro de Burque from Albuquerque McArthur Freeman from Durham and Andrea Ellen Reed of San Francisco took part, as well as many local and regional artists. "Although it wasn't a major show, it was very interesting," Toole says. He was involved, right down to combing through the images submitted by prospective artists. In the jury process, some of the artists would ask which works of art he recommended they submit. As he did so, he recalls thinking, "I'm an actuary. You're asking me?"

Toole became aware of disparities in health outcomes when he, formerly a life actuary, purchased MBA Actuaries, Inc., a practice in Winston-Salem, N.C., that centers on both life and health. He decided to emphasize the health business of the practice, but in doing so found he needed to learn more about the topic.

He turned to a mentor for guidance on the technical aspects of the field and reached out to experts who recommended readings and activities he could do to learn more about the health practice. One of these readings was the Pulitzer Prize-winning book, The Social Transformation of American Medicine, and another was the policy journal Health Affairs.

Through his research, Toole was awakened to racial disparities in health outcomes in his hometown. He also learned more about something few of us think about: the field of public health and its role in society. He views public health as the foundation of community health, and today we credit advancements such as immunizations, the elimination of lead in paint, the dangers of asbestos and the benefits of not smoking to the work of public health officials.

Public health is the base of a health pyramid that creates the conditions for people to be healthy, he says, adding that "Doctors treat individuals. Public health programs treat the health of communities." He says that public health spending accounts for only 1–2 cents of the health care dollar, yet according to the CDC as much as 80 percent of the longevity gains in the United States can be attributed to public health interventions.

He likens actuarial work with populations and statistics to the efforts of those in the public health field, noting that actuaries have "so much more in common with public health officials than with doctors." He recommends working with public health officials to create communities in which people understand the components of good health. Eating well and exercising, for example, drive down the cost of health care.

Toole found that he had been thinking about health on global and national levels, but hadn't connected these ideas to his community. Then, he heard the director of the Winston-Salem public health department speak about the disparities in health outcomes at a Rotary Club meeting he was attending, and "the bells went off," he says.

This conversation was the piece of the puzzle he was looking for. After speaking with him, Toole became involved with the Winston-Salem Infant Mortality Reduction Committee. The group meets regularly to discuss community issues, working with non-profit organizations and doctors' groups to implement strategies. Other activities include writing letters to the editor and speaking at an awards ceremony with Senator Richard Burr. When the Michael Moore movie "Sicko" came to Winston-Salem, he organized a community forum to discuss the issues raised in the movie. "Health is in the air. People want to talk about it," he says. "Over 400 people attended the county Health Summit in 2007 versus just 250 in 2005."

What can the average actuary do to get involved in his or her community? Toole says almost anything. Most communities have 10–20 task forces, and "every single one of those task forces could use an actuary." These task forces might address issues such as asthma, obesity, diabetes or aging. "You name an issue that you see in the paper today, and there's probably a public health task force dealing with it," he adds. "In your community you have more impact on health policy than most people in Washington. I'm a big believer in thinking globally, acting locally."

"Our profession has so much to gain from learning about real problems in our communities. If you look at our mission statement, our mission is to look out for the interests of the public first and the member second."

He adds, "You don't have to be an expert in health to get involved. You do have to care. We have such a robust skill set that if you give us a set of numbers, we can tell you what we see in them, and that adds value. Believe me. These committees are numbers-poor. You can be a life or pension actuary and make a difference. I promise."

Glenda Maki is grassroots program manager at the Society of Actuaries.