Scientific retreat tackles tough issues of health disparities, racism

With shock still hanging in the air Nov. 9 about the presidential election, Camara Jones, M.D., Ph.D, took the stage as the keynote speaker saying it was time, more than ever with the uncertainty created by a change in leadership, for a frank discussion on racism. 

The Health Disparities Retreat held at the Medical University of South Carolina was sponsored by MUSC’s South Carolina Clinical & Translational Research Institute, which receives funding from the National Institutes of Health’s National Center for Advancing Translational Sciences. The retreat attracted a record crowd of more than 200 participants.

Audience members knew they would be hearing about health disparities, which is the difference in the incidence and prevalence of health status of different groups of people, and the latest MUSC research aimed at addressing it.

What many weren’t expecting was how Jones, immediate past president of the American Public Health Association, would put them on the spot as she has done in her talks around the country in her efforts to foster a nationwide dialogue on racism.

After just a few minutes of general comments, she paused.

“We’ll stop right here to have a conversation,” she said, letting an awkward silence fill the room. For Jones, it was a teachable moment showing that if real change comes in addressing health care disparities and inequities, it will only happen with open, honest discussions that get to the root causes.

A queen of allegories, Jones led the audience through three different stories to illustrate the challenges in addressing these issues. The stories, including The Gardener’s Tale, offer new frameworks for discussion. They serve as a tool, which she encourages others to adopt as well, in developing strategies for eliminating racism in health care and in the workplace.  

“We have a narrow focus on the individual,” she said of America’s approach to health care. “We have a disease care system, not a health care system.”

Jones, using a cliff analogy, flashed up a slide showing an ambulance waiting at the bottom for people who have “fallen off.” She then described other ways, represented in her drawing with a safety net halfway down the cliff and a fence at the top of the cliff, that could improve survival. Even better, the people could be pulled away from the edge. Each of these scenarios relates to policy and structural changes that would address health disparity interventions. 

Resources currently are mostly focused on urgent care services represented by the ambulance in the cliff analogy, she said. “We spend an inordinate amount on health care versus social programs aimed at prevention. It is a travesty.”

The analogy gets even more complex if a 3-D component is added that incorporates what’s causing the disparity in the first place, she said. Racism saps energy from our entire society and prevents lasting, effective change, she said. When she shares her allegories, she notices people have the language and framework necessary to have critical discussions that lead to insights about biases and create an urgency for change.

Several attendees at points during her talk shared their stories and experiences of racism, including how racism has impacted the quality of health care. Jones thanked them for adding to the discussion. “Many people are in denial that it continues to exist today and that it has a profound impact on the health of our nation. We need to name it and label it as racism.”

She defined health equity as the assurance of conditions for optimal health for all people. “Health disparities will be eliminated when health equity is addressed,” she said. “I used to be all about the structure, but I’m all about values now. We have to challenge values.”

When health care providers and researchers get together to recognize and address where inequities may exist, it can be uncomfortable at first. It’s one reason she uses her stories as focal points. “It’s not a scary thing to label racism. It’s an empowering thing.”

MUSC Health Disparities Research

Carolyn Jenkins, DrPH, RN, and other MUSC researchers also spoke at the daylong retreat. Jenkins said it’s critical to look at what is producing healthy and unhealthy communities. “Place matters. Where we live matters,” she said, showing national statistics about poverty and the lack of health insurance. 

Small hospitals throughout the state are closing, which increases health risks for vulnerable populations in rural areas. “Where do all these folks go for care? Education and unemployment also are issues.”

Beyond issues of health equity, there are areas of noted disparities in the prevalence of diseases. The U.S. Office of Minority Health has set priority areas, which include cancer, HIV, infant mortality, heart disease and stroke, she said.

Cardiovascular disease was the leading cause of death in the state in 2014 and the leading cause of death for African-American women. Jenkins, who specializes in diabetes research, said South Carolina ranks seventh in the nation in adults with diabetes. African-Americans have a higher prevalence rate than whites where an estimated 1 in 6 African-Americans have the condition. In 2014, three people died each day from diabetes. 

Jenkins summarized important steps MUSC has taken to address health disparities, including establishing the Center for Health Disparities Research in 2005 and launching the Hollings Cancer Center Disparities Program. Listing 20 of the more than 200 ongoing research studies at MUSC related to health disparities, Jenkins said it’s important to keep advancing progress in this area.   

Researchers at the retreat who presented highlights of their work included:

• Paula Ramos, Ph.D.: “Enrichment of Immune Pathways in Genes Under Geographically Restricted Adaptation in the Gullah African America Population of South Carolina”
• David Turner, Ph.D.: “Sugar-Derived Metabolites – Biological Links between Ancestry, Lifestyle and Cancer Disparity”
• Carol Wagner, M.D.: “Vitamin D status during Pregnancy – A Decade of Health Disparities Continues”
• Dana Burshell, coordinator of the Community Engagement Program with SCTR Institute: “Locally-Employed Study Staff Improved Study Recruitment and Retention”
• Georges Nahhas, Ph.D.: “Implementing an Automated Quitline Referral in a Large Academic Emergency Department”
• Colleen Bauza, M.P.H. student: “Recruiting Diverse Populations to a Study Assessing Perceptions of Breast Cancer Genetics Research”
• John Luque, Ph.D.: “Survey of Latina Immigrant Women of Recency of Cervical Cancer Screening in the Lowcountry"

SCTR retreat director and dean emeritus of the College of Graduate Studies Perry Halushka, M.D., Ph.D., called the event a success. “We were pleased that this SCTR-sponsored scientific retreat on health disparities was organized by faculty from Clemson, USC, MUSC and individuals from the community, and that the attendees were from the three institutions and the community. This was an excellent demonstration of SCTR’s statewide reach and its fostering research into diseases that are prevalent in South Carolina.”