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The pandemic highlighted inequities in health care for historically disadvantaged groups. See what we’re doing to address the imbalance in social determinants of health.
Everyone, regardless of social position, education or income, deserves the opportunity to attain full health potential. But many people, in particular Black, Latinx, Indigenous and people of color, continue to face barriers that result in a direct and negative impact on their health. These barriers reflect historic social and economic inequality and structural racism in our country, according to the National Academy of Medicine (NAM).
Across the nation, COVID-19 has taken a greater toll on Black and Latinx communities, exposing and deepening pre-existing racial health inequities. A study by researchers at the University of Illinois and DePaul University, published in January 2021 in the journal JAMA Network Open, found that a higher Black or Hispanic composition and a higher level of economic inequality are each associated with higher COVID-19 incidence and mortality. High levels of income inequality may harm population health irrespective of racial/ethnic composition, suggests the study, whose authors urge more research into identifying the structural drivers of racial/ethnic gaps. “Such work is vitally important,” they write, “for shifting the narrative from one that places explanatory power on race to one that recognizes the centrality of racism in shaping health.”
“ Communities can play a powerful role in changing the conditions for health.” 2017 NAM report on health inequity in the United States
Uché Blackstock, MD, founder and CEO of Advancing Health Equity, calls COVID’s disparate impact on Black and brown communities, which have long carried high chronic burdens of disease, “a crisis on top of a crisis.”
In a 2020 Ethics Talk podcast of the AMA Journal of Ethics, Dr. Blackstock, a former associate professor of emergency medicine at the New York University School of Medicine, said most clinicians in the U.S. healthcare system are not attuned to the social determinants of health, which play an outsized role in health outcomes.
PROMOTING HEALTH EQUITY COULD AFFORD CONSIDERABLE ECONOMIC, NATIONAL SECURITY, SOCIAL AND OTHER BENEFITS. YET RECENT RESEARCH DEMONSTRATES THAT WORSENING SOCIAL, ECONOMIC AND ENVIRONMENTAL FACTORS ARE AFFECTING THE PUBLIC’S HEALTH IN SERIOUS WAYS THAT COMPROMISE OPPORTUNITY FOR ALL. Source: “Communities in Action: Pathways to Health Equity,” National Academy of Medicine’s Culture of Health Program, consensus report, 2017
“I think what we need to realize is that our one-on-one interaction with our patients is so much more than just this interpersonal relationship,” Dr. Blackstock said. “We really need to think about: What are the individual resources of this patient in terms of educational level, income, wealth? What are their neighborhood resources in terms of housing, food choices, public safety? What are their opportunity structures? Is there a lack of jobs? How does the criminal injustice system play a part? We really need to be more proactive about how our interventions influence those social determinants.”
NAM’s Culture of Health Program is working to identify strategies to create and sustain conditions that support equitable good health for all, including a model for communities to promote health equity at the local level.
“Communities can play a powerful role in changing the conditions for health,” states a 2017 NAM report on health equity in the United States. “Their actions need a nurturing environment, supported and facilitated by public and private sector policies, resources and partnerships.”
RFU is a trusted partner and resource for health equity through numerous community-based health, education and workforce pathway initiatives. Our planned program in epidemiology will include community-based participatory research aimed at identifying, eliminating and preventing health disparities. We’re working with Lake Forest College, Northwestern Medicine and the College of Lake County to build and sustain a robust regional health professions workforce pipeline from middle school to postgraduate employment for underserved students seeking STEM careers. That pipeline, which will also feed into our new College of Nursing, will add diversity to our healthcare systems and improve the social determinants of health in our communities.
We are committed to educating health and biomedical professionals who will advance health equity in every community in which they practice; who recognize systemic racism as a threat to public health; and who are committed to expunging racism from our system of care.
A multiyear initiative to create the future of learning at RFU is underway. Guided by the Future of Learning Council, the self-study of the university’s academic environment is a change process involving the input of a broad swath of administrators, faculty, staff and student representation.
“We’re moving academic learning forward and embracing it as a value that we hold as a larger community of practice — of health sciences, education, practice and research,” said Moreen Carvan, EdD, vice president for academic and faculty affairs. “On a visceral level, we have been reminded that we are people who create the system that helps to address the kind of crisis that COVID-19 created.”
“The pandemic has been transformative in the way we deliver education and how we operate, how we all function,” said council member and immediate past Faculty Senate President Carl White, PhD. “It’s a really good time to take a bit of reflection on how that’s going to shape what we do going forward. It’s not a top-down process. It has to emerge from everyone’s perspective.”
The systematic redesign of RFU’s academic portfolio and learning environment to meet anticipated and emerging needs in the interprofessional education of health and biomedical professionals was named a top strategic priority in 2019.
“ What we really want and need is a system that works for all.” Dr. Moreen Carvan
“We certainly knew before the pandemic that the timing was right for more creative and innovative approaches to teaching and learning,” said RFU Provost Nancy L. Parsley, DPM, MHPE. “But the pandemic helped accelerate our timeline, and it sharpened our focus on the systemic health and social inequities that create terrible unequal burdens of disease. That focus has really intensified, and it is a critical part of defining the future of learning at RFU.”
The initiative is a space for innovation and rethinking. Equity is a primary purpose and goal. A restructured curriculum will address the social determinants of health and the root causes of chronic diseases responsible for 70% of all U.S. deaths.
CONCEPTS OF EQUITY, SOCIAL JUSTICE, DIVERSITY, INCLUSION AND CULTURAL HUMILITY AND SENSITIVITY CANNOT BE TAUGHT AND ABSORBED IN A SINGLE COURSE; THEY MUST BE THREADED THROUGHOUT THE ENTIRE CURRICULUM. Source: “Incorporating an Equity Agenda into Health Professions Education and Training to Build a More Representative Workforce,” Journal of Midwifery and Women’s Health, January 2020
“What we really want and need is a system that works for all,” Dr. Carvan said. “We’re focused on creating an equitable, diverse, inclusive and engaged culture of learning.”
All RFU colleges and schools are incorporating changes across curricula focused on the social determinants of health, health disparities and inequities in health care. Coursework in population health and lifestyle medicine, an evidence-based approach to healthy behaviors and the prevention and treatment of chronic illness, will be added or expanded across programs.
“We need to prepare our students for a different way of being, a different way of practicing, a different way of delivering health care,” Dr. Parsley said. “It’s not just the knowledge related to healthcare inequities. It’s the understanding, the sensitivity, the compassion those inequities demand.”
TOP THREE TRENDS IN HEALTH PROFESSIONS EDUCATIONSource: “The future of health professions education: Emerging trends in the United States,” FASEB BioAdvances, Aug. 17, 2020
- INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE.
- LONGITUDINAL INTEGRATED CLINICAL EDUCATION THAT IS MORE PATIENT, COMMUNITY AND CHRONIC DISEASE ORIENTED.
- EDUCATION IN THE SOCIAL DETERMINANTS OF HEALTH AND THE SOCIAL AND HUMANISTIC MISSIONS OF THE HEALTH PROFESSIONS.
Training that reflects RFU’s commitment to diversity, equity and inclusion and community advocacy continues to emerge as a significant priority.
“Our faculty is embracing the opportunity to learn more and teach more about how healthcare inequities come into play — not only in the classroom but in the clinical environment — and how our graduates will deliver care in the future,” Dr. Parsley said.
“Everything we teach must be evidence-based,” said Dr. Carl White, an associate professor and researcher in the Center for Cancer Cell Biology, Immunology and Infection. “We want to make sure that we are accurately evaluating the problems and gaps in health care and effectively covering these gaps in our curriculum. The prize will be a more equitable delivery of care.”