Ten years have passed since the water crisis in Flint, Michigan, noted Khalid OsmanPhD, assistant professor of civil and environmental engineering. He said one way to achieve equity in the design and management of water infrastructure is to help key stakeholders – community members – understand what is in their water by sharing data with them. Government officials may believe that the public cannot contribute to decision-making processes regarding water and sanitation infrastructure because they do not understand it, Osman said. “But the reality is they interact with their water on a daily basis. They interact with their sanitation systems on a daily basis. And they have a deep understanding of it. We just don’t evaluate it in… our decision-making processes. `
Stéphane LubyMD, Professor of Medicine Lucy Becker whose research focuses on health in middle- and low-income countries like Bangladesh, said academia has done a good job defining environmental problems and inequalities, but “we have paid much less attention to solutions. research-oriented research. He cited advances in solar cells, which he said are 400 times cheaper today than when they were first developed, as a good example of solutions-based research. Likewise, he cited developments in battery technology as helping the government’s efforts to move away from fossil fuels. “There are enormous ways to create a better environment and a healthier world,” he said.
A collaboration for racial equity
Omar Lateef, DO, has made implementing solutions to health inequities a hallmark of his leadership as president and CEO of Rush University Medical Center in Chicago.
Health systems must become deeply involved in the communities they serve to reduce health disparities, he said. “You can’t show up, have a form filled out for a grant and disappear three years later,” he said. “You want to connect with the community. You have to go all out and build trust, build relationships.
This is the type of effort Lateef led at Rush. Even before taking the helm of the medical center in 2019, he engaged in major efforts as chief medical officer to implement a holistic, equity-based health care system by building partnerships with local businesses and community leaders.
The goal was to reduce life expectancy gaps between Chicago’s wealthiest neighborhoods, such as Streeterville, home to the city’s famous shopping district, and areas like Near West Side. If you were born in Streeterville, you can expect to live an average of 15 to 17 years longer than if you were born on the Near West Side, Lateef said.
Lateef and his colleagues adopted a plan to improve the health of the community by hiring locally, investing locally, purchasing supplies from local businesses, and providing local volunteers. “If in everything we do as a health care institution we seek to improve the community as a whole, we will improve the social determinants of health,” he said. “This means that if you hire locally, create jobs and provide financial stability to your community, you will save lives. … We have to resort to companies anyway. Why not finance our own neighborhoods? »
Rush has since partnered with five other health systems to create an anchor network called West Side United, which Lateef said has become “a national model for how a community could come together and address inequities.”
Improving healthcare and outcomes
Public health insurance works, but it’s not enough, said Alice AdamsPhD, professor of health policy and epidemiology and population health, speaking as a member of a panel on addressing health disparities. “Patients are still faced with expenses beyond their means,” Adams said. “They have access to it, but they don’t have the means. » Health systems must be prepared to monitor and address these gaps as “proactive health systems focused on affordability,” she said.
Lisa ChamberlainMD, PhD, professor of pediatrics, said universal preschool is a key tool for reducing health disparities. As a doctor who has cared for children for more than two decades, Chamberlain said she observed that many of the 5-year-olds she examined during well-child visits were not ready for kindergarten, even if their parents were responsible and hardworking. .
Chamberlain began consulting with researchers at the Stanford School of Education to develop interventions that could help children better prepare for kindergarten. She noted that studies begun in the early 1970s found that children randomized to “high-quality preschool now have higher rates of high school graduation, higher incomes and lower heart attack rates.”
“It’s a lifelong investment that begins in those powerful 0-5 years,” she added. “I really believe that as a community – if we start doing transdisciplinary work and coming up with innovative solutions-based research that can help change these trajectories – there are incredible opportunities.” »
Michelle WilliamsScD, a professor of epidemiology and population health, who moderated the panel, said she found it surprising that the social and political will to create equitable health care had not come together “when we intuitively know that we all prosper if we don’t leave people behind. In preparing for the symposium, Williams said she thought about the work of Toni Morrison. The origin of the others and how people tend to “other” their fellow human beings who are poor, homeless, or intellectually disabled. “Our tendency to do this othering dampens our chance to galvanize social and political will to expand interventions,” she said.
Maisha WinnPhD, professor of learning excellence at the Graduate School of Education, said finding common ground is critical. “That doesn’t mean everyone agrees on the solution,” Winn said. “It doesn’t even mean that everyone is in the same place. But fundamentally, if you can start from a common ground and decide on the process to follow to get there, you will be more likely to succeed in getting a policy.
She said otherness is a way for people to simplify complex problems. Reflecting on the assassination of UnitedHealthcare CEO Brian Thompson in December, she said she was horrified to hear people justify the killing and claim that insurance companies are the enemy and that “now can -maybe they will listen.”
“I think, ‘Oh, my God, you don’t understand how complex this is,’” Winn said. “If every insurance company decided, ‘I’m going to cover everything that’s out there,’ that wouldn’t solve the problem because it’s much more complicated than that.”
It’s vital to educate people about the social determinants of health as well as why the health care ecosystem has grown the way it has, she said. “We get what we pay for. We get what we put in.