What 40 Years on the Front Lines of Health Equity Taught This Doctor About Trust, Respect, and Needless Suffering

Dr. George Rust sat down with me to share four decades of experience fighting for health equity—from the rural dirt roads of Groveland, Florida, to the chaos of Cook County Hospital in Chicago, to the halls of Morehouse School of Medicine.

And what he revealed about the state of healthcare in America? It's something every one of us needs to hear.

You Don't Walk Into Communities With Trust—You Have to Earn It

One of the most striking moments in our conversation was when Dr. Rust described what he calls "trust adjacency."

Picture this: He's treating Mrs. Sanchez for diabetes. She nods and smiles when he recommends a new medication. He assumes she'll take it. She walks out to the front desk and asks Carolina, the receptionist, "He wants me to take another pill. I don't like taking medicines. What do you think?"

If Carolina trusted Dr. Rust, Mrs. Sanchez might give that blue pill a try.

Dr. Rust told me, "You don't come into communities carrying trust with you. You have to earn it. And much of the time I was trust adjacent."

This hit me hard. How many of us in healthcare assume we come with built-in credibility? How many times do we miss the cultural bridges—the Carolinas—who actually hold the real influence in our patients' healthcare decisions?

The Home Visit That Changed Everything

When Dr. Rust worked in Groveland—a two-stoplight Florida town with unpaved roads on the Black side of town—he did something most doctors would never consider.

After discharging patients from the hospital, he'd visit their homes within a week.

He'd walk down that dirt road, enter their house, and see their reality. Not the sanitized version, patients present in the clinic. The actual strengths, the resilience, and yes, the challenges.

"It made me much better at not giving stupid advice to people," he told me.

How often do we prescribe solutions that sound perfect in a medical textbook but are completely impossible given someone's lived reality?

83,000 Lives: The Cost We Refuse to Count

Here's a statistic that should haunt every healthcare professional and policymaker in America:

If we eliminated the Black-white gap in health outcomes, we could save 83,000 lives every single year.

Let that sink in. 83,000 families who wouldn't lose a parent, grandparent, sibling, or child—if we just achieved equality.

In Atlanta alone, Dr. Rust found that closing the premature death gap would save 43,000 person-years of life annually in the Black community. That's 43,000 grandmother-years. 43,000 wisdom-years are lost every single year.

This isn't about a lack of medical knowledge. We know how to treat high blood pressure, diabetes, and cancer. This is about what Dr. Rust calls "needless suffering"—the title of his powerful new book, Healing in a Changing America: Doctoring a Nation of Needless Suffering.

"Please, Sir, May I Have Some Healthcare?"

Dr. Rust shared a story that perfectly captures our broken system.

A young farmworker got his hand caught in machinery. His tendon was torn. Without surgery, his finger would never work again. The local hand surgeon demanded $500 up front just to be seen.

Dr. Rust's colleague spent three to four hours making phone calls, begging specialists to see this person. Finally, one of their medical school alumni agreed to help.

He called it "tin cup medicine."

Meanwhile, that young man's livelihood—his ability to work, to provide for his family—hung in the balance while doctors played gatekeeper based on ability to pay.

The "Lou Sullivan Name Tag" Story: A Master Class in Respect

One story from our conversation perfectly illustrates the subtle ways disrespect shows up in healthcare and professional settings.

Dr. Rust and his colleagues from Morehouse School of Medicine—including Dr. Louis Sullivan, the institution's founding president—attended a meeting at a local hospital seeking affiliation.

The hospital had prepared name tags in advance. Dr. Sullivan read "Lou." Dr. Rust read "George." Everyone was on a first-name basis.

The hospital CEO thought he was being egalitarian, breaking down hierarchies. What he didn't understand was that in minority settings, you elevate everyone through respect—you don't bring everyone down to first names.

Dr. Sullivan put on that "Lou" name tag. The mask went up. And that affiliation agreement never materialized.

After the meeting, one of Dr. Rust's colleagues spontaneously shared a story from his childhood—how his mother rushed him to the hospital during an asthma attack, entered through the main entrance, only to be redirected by their own doctor to the "colored entrance."

"Why did he suddenly tell me that story?" Dr. Rust wondered. The answer became clear: he'd been triggered by the disrespect felt in that meeting. Decades-old wounds reopened by something as simple as a name tag.

Navigating Public Health in Florida During COVID: When Ideology Trumps Evidence

Dr. Rust's experience on the front lines during COVID reveals where we are as a country right now.

Early in the pandemic, things were different. President Trump led Operation Warp Speed. Governor DeSantis sent teams to nursing homes. Dr. Rust and his team vaccinated a thousand people a day.

Then it polarized. Hard.

Dr. Rust watched as "ideology began to dominate over competence and over facts."

He described it as "me all versus we all"—the tension between individual autonomy and community responsibility that has always existed in public health, but has now reached a breaking point.

When a measles case appeared in Tallahassee, Dr. Rust went to the home, examined the patient, and confirmed it was measles. Another unvaccinated person in the household had been exposed and worked a public-facing job. There was a 90% chance they'd develop measles.

The epidemiology was clear: quarantine was necessary to prevent an outbreak.

But suddenly, leadership started saying things like, "We can't really use the word quarantine," and "We can't make him not go to work."

Dr. Rust had to work behind the scenes, writing letters to excuse the person from work. As he put it: "Would you rather deal with having somebody not go to work for a couple of , weeks? Or would you rather be explaining to the public why you let a measles outbreak happen?"

Public health worked. But it shouldn't have been that hard.

Lessons for the Next Generation

Dr. Rust wrote his book as "a manual for my younger self"—the things he wishes he'd known starting.

Here's what he wants young clinicians and public health professionals to know:

1. Perseverance Matters The tide comes in and the tide goes out. During the Reagan administration, he worked on farmworker health, knowing change would be slow. But he showed up anyway, because people would suffer more without him.

2. You Can't Do This Alone.on He wanted to be the "doctor for the poor" who single-handedly changed communities. He learned quickly: you need a team, a coalition, partnerships with the community.

3. Self-Care Isn't Optional.. He talked about "peeling back layers of the onion" and finding racist thoughts or biases he thought he'd already addressed. Be compassionate with yourself. Growth requires honesty, and honesty requires self-compassion.

4. Respect Is Everything.. It's not about shallow first-name intimacy. It's about demonstrating genuine respect first. In his clinic, nurses weren't called by first names—they were "Ms. Cobb" instead of "Barbara." That small shift communicated volumes.

5. Ask Naive Questions.. Dr. Rust said that as someone new to a community, "there's probably some deeper stuff here that I'm not going to hear about for a little while. I have to really be open and ask naive questions."

Don't be afraid to say, "I don't know. Help me understand."

"We Have Already Won"

Near the end of our conversation, Dr. Rust quoted Desmond Tutu during apartheid in South Africa—a time when there was no earthly reason to be optimistic:

"We have already won. They have done their worst to us,. and we have already won."

Dr. Rust believes we can apply this same vision to health equity. Not blind optimism, but a commitment to a future we know is possible.

He pointed out that some communities already have less disparities. A few have achieved equity in specific health outcomes. It can be done.

Nelson Mandela said, "It seems impossible until it's done."

We're in the hard labor of birthing a multicultural, pluralistic democracy. Some people want to keep prolonging that labor, pulling us backward to some imagined 1950s America that never really existed.

But if we can just get through this—if we can commit to the work—the "wonderfulness on the other side" is waiting for us.

What Now?

This conversation reminded me why I started The Healthy Project. Because these stories need to be told. Because health equity isn't just a nice idea—it's life and death for 83,000 people every single year.

Dr. Rust's book, Healing in a Changing America: Doctoring a Nation of Needless Suffering, is out now. If this newsletter resonated with you at all, I encourage you to pick up a copy. [Amazon] [Johns Hopkins Press ]