As the daughter of the legendary physician Charles Drew, it comes as no surprise that Sylvia Drew Ivie has been deeply involved in issues of equal access to health care for most of her career. But now, the former head of the groundbreaking T.H.E. Clinic is taking her expertise into the political arena.

Last month, the onetime civil rights attorney was named chief of staff to Los Angeles County Supervisor Mark Ridley-Thomas, a post in which she is expected to play a key role in shaping the supervisor’s plan to reopen King-Harbor Hospital near Watts. In an exclusive interview, Ivie shared with The Wave her thoughts about health issues in South L.A., what can be done to reverse disparities in care and how she plans to use her position to help the supervisor meet his health care goals.

What does your new job as chief of staff entail?
I am responsible for assisting the supervisor in managing his staff, which when he’s finished filling all of the positions that are available, could be as large as 45 people. It’s really about making sure that all of our people who are in headquarters and in our five district offices are organized in a way that we interface effectively with the Board of Supervisors’ activities, which are administrative and legislative in nature, taking care of the unincorporated areas of L.A.

In your experience, what health disparities are the most persistent in urban neighborhoods, particularly South L.A.?
South L.A. has more chronic diseases in almost every category than any other district. We have more poverty, more people who are uninsured, more teenage pregnancy, more diabetes, more cardiovascular disease, more cancer, more asthma, more strokes. So, it’s a picture of tremendous difference in the rate of disease that you find among people in our population compared to other populations.

What would you attribute the health disparities to?
There are two factors. In one broad way of thinking, there are things which are not within the control of the population and there are things that are in the control of the population. … If you live where the air is bad, where the transportation is limited, where you have no grocery stores with fresh fruits and vegetables, where there is a great deal of violence, all of these factors are external to the individual and where you have more quantity of those negative environmental influences you also have more disease. So, efforts to address health disparities have to take a broad definition of health, they can’t just say ‘well if we got everybody insurance then disparities would go away.’ No they wouldn’t. It would certainly help get people access to care and insurance matters a great deal but we also have to address getting more grocery stores, we also have to address violence, we also have to address broken homes and family support for children. The number of kids in foster homes in South L.A. is just enormous.

What can people do themselves to counteract external factors that lead to health disparities?
We as individuals can also protect our health more aggressively with decisions we make about what we eat and decisions about who we eat with because when you eat with other people it has a beneficial effect. Also, determining the portion size of what we’re eating, [placing] emphasis on eating fruits and vegetables, particularly green, leafy vegetables. All of these things, we have some control over; of course, cost is a factor. So, if you’re a person struggling to make that dollar stretch, it’s hard to go out and get all of the good food that you may have otherwise bought for yourself and your family.

Beyond poor eating habits, what else can contribute to poor health?
Well, if you live in neighborhood where there is a great deal of crime you’re not going to say ‘let me go out and take a run,’ because you’re afraid that you may be injured or shot by a drive-by shooting. So, you’re pretty much confined to your residence because of crime outside your door. That’s a tremendous problem. Getting more help from law enforcement to control violence in the neighborhood would help us decrease disparities in health.

Several studies including the South L.A. Health Equity Scorecard, recently published by the Community Health Councils in collaboration with the Coalition for Health and Justice, have found that South L.A. has an abundance of fast food restaurants and a limited number of grocery stores — especially those that carry fresh fruits and vegetables — compared to other parts of the county, why is that?
There are fast food restaurants in all neighborhoods in L.A. — you have them in Beverly Hills, in Culver City, they’re everywhere. But the difference is that they have a counter-balancing availability of other kinds of restaurants. We [South L.A.] don’t have [a proportionate number of] sit down restaurants. … The restaurants haven’t come in, the grocery stores for the most part have not come in and they cite crime, they cite costs and they cite people not having the same discretionary money to spend on groceries as in other neighborhoods. We’re sort of redlined by the business industry and that redlining really hurts us.

How then do we bring healthy food options to South L.A.?
The planning departments have to work and sit down with the restaurant industry and say ‘what incentives could we provide you to come into low-income areas in South L.A.? What tax breaks could we possibly look at? What do you need to make it financially viable for you to do that and get it started?’ It has to be a problem that government agencies say that this is our problem to solve because the individual resident can not solve this problem. The individual resident can not go knock on the door of the president of Ralphs [Supermarket] and say ‘Please reopen the Ralphs that you’ve closed in recent years in South L.A.,’ but Ralphs is dependent on the cooperation of the city of Los Angeles. ... Superior Market is doing just fine. There is money to be made, the government just has to make that case. They can get that data and share it with the Ralphs or Albertsons or Vons and say ‘hey, it’s in your business’ interest to locate here. These people spend a lot of money feeding their families just as they do in any other district.’

What impact would you say the closure of Martin Luther King Jr.,-Harbor Hospital has had on neighboring health facilities?
What happens when you have a hospital serving more than a million people and the emergency room is closed? You’re subject to not only not getting the care that you need but you might also die if you can’t get to the next emergency room. The next emergency room might be so crowded that you can’t be seen for very long periods of time. So, our loss of that facility has really been a hardship that compounds the health status. [There] is poor health status plus ever diminishing access to care. ... It’s quite urgent to restore services there and to make sure that the other hospitals and clinics in South L.A. are functional and have the capacity to absorb the population and the needs they present.

Health care overall has changed. Patients often are shipped from doctor to doctor, wait lengthy periods to get appointment just to be observed and diagnosed within 10 minutes and do not receive additional tests and screenings. This has led to misdiagnoses and a lack of quality care. Can you expand on this?
If you have Medi-Cal insurance, fewer and fewer physicians, especially specialists are willing to take Medi-Cal patients because the state keeps cutting back on the Medi-Cal reimbursement program. So, they say “I can’t make enough money” … An HMO is supposed to have access to all the specialty services but HMO leadership says to the doctors ‘Don’t order extra tests if you can help it. It will help us all make more profit.’ So, the doctors say ‘I don’t think you need an MRI at this time.’

How do we get physicians to care more about their patient than a paycheck?
There is a lot of deterioration on all sides and the doctors, if  we look at their side, are discouraged and many doctors are coming out of medical service because they say all they get to do now is fill out paper work and they didn’t go into medicine to fill out paper work, they went because they want people to get better. So, they’re unhappy too...

You have an extensive background in health care. Will you be assisting the supervisor in that area as well?
He is very interested in health being a priority for his administration. So, it’s not accidental that I have a health background but we are also hiring a health deputy and other health experts who will make up a health team. In his office we will have a team of people working on a variety of health issues.

Will the health team be focused on reopening Martin Luther King Jr.-Harbor Hospital?
Absolutely. They will be working on King very seriously.

When did you get involved in health care?
I’ve been involved for over 30 years. I started out as a civil rights lawyer in the 60s and I was doing school segregation, housing segregation, employment discrimination, jury discrimination, but ... someone called me from North Carolina and said ‘I’ve got a health case.’ So, I went down and tried the case with him. What I found out was that there was no data being kept on health care access. So, there were hospitals built with federal money all over the country under something called the Hill Burton Act but they were segregated and the way they kept them segregated was in order to get into a hospital you had to have a physician who would admit you. They didn’t give any African-Americans physicians admitting privileges; therefore, there were no African-American patients. My first case involved an African-American man who was shot and was treated in the emergency room. His wife begged them to keep him overnight and they refused because they didn’t admit Black patients and he died three days later of an aneurysm to his brain which was already in evidence at the time he was being treated in the emergency room. That energized me around health. I was director of the Office of Civil Rights in the Department of Health and Human Services and I was able to get a change in the data keeping so that hospitals that were receiving Medicare and Medicaid funds had to report the patients they were seeing by race and ethnicity. That way we could see who was only admitting one race to their hospital. I was very happy that we were able to make that change.