Rahn: Academic Health Centers Vital in Addressing Disparities
Dec. 3, 2012 | The nation’s academic health centers like the University of Arkansas for Medical Sciences (UAMS) are positioned as primary assets for addressing the problem of health care disparities, said UAMS Chancellor Dan Rahn, M.D.
UAMS Chancellor Dan Rahn, M.D., addresses
the Sixth Annual National Conference
on Health Disparities.
Gail C. Christopher, an executive with the W.K. Kellogg Foundation, joined Rahn on a panel discussion about social determinants
of health disparities.
Speaking at the Sixth Annual National Conference on Health Disparities, being held in Little Rock Nov. 28-Dec. 1, Rahn said success will require shifting from a model that focuses on medical care to one concentrating more on prevention and factors that influence disease and health problems.
Rahn appeared on a panel addressing the impact of social determinants — such as race, income, education and environment — on disparities in health and health outcomes. He pointed to Arkansas as “big enough and small enough” to be a microcosm of health disparities as well as a perfect testing ground for strategies to address them.
He pointed to overlapping similarities across a succession of slides showing health risks by county in Arkansas. The unhealthiest parts of the state tend to coincide with the Delta region in the east and south east, which is poorer and has a higher minority population than the rest of the state.
Life expectancy is nearly 80 years for someone living in Benton County in northwest Arkansas — home to Walmart and a whiter, more educated population. Five-and-a-half hours away in Phillips County in east Arkansas, life expectancy is shortened by a decade. The infant mortality rate is higher, too.
“Factors that influence health in this state are more based on social determinants than biology,” Rahn said.
Academic health centers are the greatest asset in the nation for health, Rahn said, by virtue of their confluence of education, medical care and research. While social determinants are seen as problems to address by academic medical centers, historically the focus has been more on training new health care professionals and conducting research, he said.
Truly engaging in eliminating the barriers to better health likely requires flipping the concentration of resources more toward disease prevention and strategies that reducing social determinants of health. It is a call to action for academic health centers, Rahn said.
Joining Rahn on the panel were David E. Rivers, Ph.D., public information and community outreach director for the Medical University of South Carolina; Lisa F. Garcia, an administrator in compliance for the U.S. Environmental Protection Agency; Brian Smedley, Ph.D., vice president and director of the Health Policy Institute of the Joint Center for Political and Economic Studies; Gail C. Christopher, an executive with the W.K. Kellogg Foundation; and Kurt C. Organista, Ph.D., professor in the School of Social Welfare at the University of California-Berkeley.
Smedley shared similar maps that showed the geography of health care disparities in New Orleans and Albuquerque, N.M. Lower life expectancy and high rates of health problems coincided with higher minority population and higher poverty rates. “Your zip code is more important than your genetic code,” Smedley said.
Smedley called for “place-based” strategies from public/private partnerships that improve communities to policy changes. He pointed to an incentive in California that encouraged farmers markets in communities that lacked a convenient grocery store. In other places, land use and zoning policy changes are intended to reduce the concentration of health risks.
African-Americans are still more likely to live in a census tract without a grocery store but also have a higher concentration of fast food restaurants, liquor stores and convenience stores, he said.
Still, the nation has made progress, he said, in identifying social determinants, researching the impact of place on health, promoting strategies to correct the problems and sharing with other communities. “But there’s still a lot to be done.”
Christopher echoed the concerns of other panel members about race, geography and other social determinants. She distilled her concerns and the grip of health disparities into three targets to conquer: poverty, obesity and racism.
“We hear talk in the news of the fiscal cliff but the intractable problem of childhood poverty is a cliff we’re already going over,” she said, exhorting efforts at job creation and paying a living wage.
Obesity was once a disease of the rich, she said. The easy availability of sugar and sugary substances like fructose pushed the problem of obesity to the poor through cheap and unhealthy sugar-laden foods.
Racism still persists, she said, despite a civil war and the civil rights movement in the United States. She attributed it to a persistent mythology — “a belief in a hierarchy based on physical characteristics.”
“Until we challenge the fundamental fallacy that we are not fundamentally the same, then segregation will persist and poverty will persist,” she said.