|
||||||||
|
MINORITY HEALTH POLICY
Talks in Minority Health Policy Aim at Broad Health EqualityBuilding on specific areas of inequality in health care, like pregnancy outcomes, obesity, and child health, presenters at the 2004 annual meeting of HMS programs in minority health policy described a vision of medicine that integrates awareness of health disparities and cultural differences into a broadly informed approach to practice. The two days of presentations, May 5 and 6, featured faculty talks, practicum presentations by fellows and scholars, and a keynote address on each day. The meeting was sponsored by the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy, the California Endowment Scholars in Health Policy at Harvard University, and the HMS Center of Excellence in Minority Health and Health Disparities.Toward Cultural ProficiencyThe opening four practicum presentations on the morning of May 6 began a series of project descriptions by the fellows and scholars in the Commonwealth Fund/Harvard and California Endowment programs. Extrapolating from the talks, commentator Joxel Garcia, deputy director of the Pan American Health Organization, said, "We need to provide quality of care to all people in this country." One direction to take toward this goal, he argued, is that "we should move from cultural competency to being proficient in cultural issues."
Commonwealth Fund/Harvard fellow Claudia Martorell describes data that supported her testimony to state representatives about health disparities among Hispanic residents. (Photo by Steve Gilbert) "Health is the most important economic issue in America," he said, "and more important, health is the most important life issue." In one of the four practicum presentations in the afternoon session, Commonwealth Fund/Harvard fellow Claudia Martorell explained the research that underlay her testimony at an April 16 hearing on health disparities among the state's Hispanic Americans, hosted by the Joint Committee on Health Care of the Massachusetts House of Representatives. For Hispanics in Massachusetts, she said, citing data from the state Department of Health, the HIV death rate is seven times higher than for white non-Hispanics. The Hispanic teen birth rate is 520 percent higher than among whites. Hispanic infant mortality is 32 percent higher than among whites. Hispanics are 185 percent more likely to be uninsured than whites, and Hispanics are 106 percent more likely than whites not to seek care for their maladies. "Puerto Ricans have the highest risk profile among Hispanics," Martorell said. Among her recommendations were extending health insurance to the uninsured; increasing diversity in the health care workforce; standardizing data collection on race, ethnicity, and language; establishing statewide quality standards; and funding translation and other community health services. According to Martorell, these steps ultimately would decrease the health care burden in Massachusetts. Maintaining Community HealthLouis Sullivan, president emeritus of Morehouse School of Medicine and former U.S. Secretary of Health and Human Services, who gave the keynote address on May 5, was followed by Felton Earls, HMS professor of social medicine and HSPH professor of human behavior and development, who gave the keynote on May 6, discussing principles of international child health.Earls heads two large projects, Human Development in Chicago Neighborhoods and, centered in Moshi, Tanzania, the Ecology of HIV/AIDS and Child Mental Health. The central insight of the Chicago project is that children's exposure to violence and participation in risky behaviors is inversely associated with the "collective efficacy" of their social environment. In other words, when a neighborhood has a high level of cohesion and social control, violent incidents and youth risk-taking remain relatively low. In Chicago neighborhoods with high collective efficacy, for example, young people's entry into sexual activity tends to be later. Earls and his colleagues realized that this association might enable them to conduct an experimental study involving HIV/AIDS, whose prevalence rate would be expected to rise among teens with increased teen sex. The researchers chose Moshi as their study site, a small city in a country with an estimated HIV/AIDS prevalence rate of 8 to 10 percent. The team completed a community survey for baseline measurements of collective efficacy and child health status and now are implementing an intervention to increase the community's efficacy. The intervention engages young people in health issues and enlists them as agents of change. Later, the researchers will go back to the Moshi neighborhoods to determine whether the intervention is improving the health of the community and its children. They specifically want to see if their efforts have reduced the stigma associated with HIV/AIDS, which is the most prominent barrier to prevention and treatment. "An intervention that reduces stigma is absolutely essential for everything else that we're trying to do to curb the epidemic," Earls said. "And part of this community efficacy has to be around stigma reduction." As Earls pointed out, the two studies that he is heading connect domestic research with international research by applying discoveries in Chicago to interventions in Moshi. The annual meeting was organized by the office of Joan Reede, HMS dean for diversity and community partnership. --Robert Neal |
