Tired of health disparities hand wringing, I was almost reluctant to attend the "Community Health and Disparity: Moving Beyond Description" breakout at the National Health Policy Conference. I wasn't sure if I could take another session of attempting to validate the "merit" of health disparities research or the "impossibility" of a health disparities solution.
What better way to assemble all the people of color at one conference than to hold the typical standing room only session and discuss the 'minority
Loren Robinson, MD, is a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania's Perelman School of Medicine, and a Fellow at Penn's Leonard Davis Institute of Health Economics (LDI).
problem'? I expected the obligatory bland head nod to "Unequal Treatment" or cursory tip of the hat to Clayton and Byrd's "An American Health Dilemma". My assumptions could not have been more wrong. The speakers were not here for business as usual.
Moderated by Darrell Gaskin of Johns Hopkins' Bloomberg School of Public Health, this session identified and supported health disparities solutions that were supported with hard data and sustainable answers.
Residential segregation Gaskin discussed the impact of residential segregation on health, highlighting cartographic modeling data from multiple urban centers that showed nearly identical patterns of racial separation and health disparity. Cartographic modeling has its roots at Penn in the work of C. Dana Tomlin. Penn's Cartographic Modeling Lab investigators compare social determinants of health, health outcomes, and geographic presence or place. This mapping technology allows researchers to further expand upon a concept identified by Gaskin as the "Nexus of Race, Poverty, and Place".
Following Gaskin's brief opening, Brian Smedley led off with a discussion of his work in creating Place Matters. Smedley is the Vice President and Director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, DC. Place Matters, highlighted in the recent report of the
RWJF Commission to Build a Healthier America, is based upon the premise that that "it takes a village," and harnesses the existing resources of local communities to address the social determinants of health.
Broad collaborations Ultimately, it will be the collaboration between community members, the academy, public and private entities, ACOs, hospitals, clinics, city and local governments, housing, public works, etc. -- all of these sectors coming together to propose solutions that will address health disparities. The solutions cannot and will not be limited to the suggestions of those in white coats or wielding stethoscopes.
Lastly, and of particular interest, Smedley discussed the utility of health impact assessments (HIA), which act as a vehicle to communicate issues of health to federal, state and local policy-makers. HIAs are how we translate research and practice to policy, and move the health disparities research and action agenda forward.
Jeff Brenner, well-known community organizer, MacArthur Genius Award Winner, and founder of the renowned Camden Coalition offered insight into community organizing as an answer to health disparity. He highlighted that organizing in the community can force academic medical centers to be more accountable to underserved communities.
Academic medical centers Adding this caveat, Brenner cautioned that academic medical centers will never be at the center of the fight to end health disparities as they are essentially profiting off them and contributing to them on a daily basis. Innovation, he argues, is impossible when you have income disparity among physicians to the tune of hundreds of thousands of dollars, and the driver of salary inflation is overuse and over-ordering of medical tests, procedures, and operations. Overuse, Brenner points out, is also a form of health and healthcare disparity.
M. Chris Gibbons of Bloomberg's School of Public Health, Urban Health Institute closed the session by offering further suggestions about how to move the field of health disparities research and intervention forward. He identified eHealth and technology solutions as innovative ways health disparities can be both documented and addressed. Gibbons also discussed the importance of community consultation, involvement, and engagement in any community-based intervention to address health disparities. It is important to conduct "asset mapping" in addition to "needs assessment," he said, as there may be multiple resources already existing in a community. "Don't go in and try to re-invent the wheel" especially when the community may already have all the wheels it needs.
This session was a refreshing departure from normal. The health services research and policy communities can look forward to more "walking the walk" from these three innovators in health disparities research and action. Health disparity is not just a 'minority problem'; it's everyone's problem, and a threat to universal health justice.
Drs. Gaskin, Smedley, Brenner, and Gibbons delivered on an airtight agenda of health equity research, health justice solutions, and placed a call for action with the audience, a call that this writer has enthusiastically accepted.
