Health Policy$ense

Health Equity Symposium Features Fiery Carmona

Penn Faculty Panel Confronts Barriers to Inclusion and Diversity

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Richard Carmona, MD, MPH, the 17th U.S. Surgeon General, called for greater efforts to reduce inequities in health.

Penn’s Second Annual Martin Luther King, Jr. Health Equity Symposium drew attention to the importance of inclusion and diversity in medical education and research on both a national and local level.  A panel of Penn faculty, including several LDI Senior Fellows, directly confronted the barriers to inclusion at Penn, and Dr. Richard Carmona, 17th Surgeon General of the United States, shared a detailed account of his rise from an impoverished Hispanic family in Harlem, New York to the prestigious post as the “doctor for the nation” in the Bush administration.

Dr. Eve J. Higginbotham, Vice Dean for Inclusion and Diversity, introduced the panel, and Dr. Jerry Johnson, Chief of Geriatric Medicine and Director of the Center of Excellence for Diversity in Health Education and Research moderated the group. Each panelist gave her perspective on the importance of diversity, barriers to progress, and possible solutions.

  • Dr. Tiffani J. Johnson from the Children’s Hospital of Philadelphia explained how the “leaky pipeline” prevents underrepresented minority students from advancing through the ranks of medical school to residency to junior and tenured faculty. Part of the issue, she said, is our implicit bias against racial minorities that lies “below the surface, but may influence behavior.” While racial bias is well-documented in the business and academic worlds, Johnson shared evidence that pro-white and anti-black racial bias exists among physicians for both adult and pediatric patients. She suggested that implicit racial bias could be mitigated through “positive black priming” and increasing interactions between people of different races.
  • Dr. Jaya Aysola from the Perelman School of Medicine discussed the factors contributing to a culture of inclusion (and lack of inclusion) at Penn Medicine. Her research has found significant variation in experience according to gender, ethnicity, and sexual orientation. In particular, women, LGBTQ, black, Hispanic, and multi-ethnic individuals perceive a lower “cultural competence” at Penn. Aysola called for identifying and improving factors within Penn’s organizational system and culture.

  • Dr. C. Neill Epperson from the Penn Center for Research on Sex and Gender in Health challenged the audience to think about diversity and inclusion among medical and health services researchers. She shared data indicating that low institutional support, low values alignment, low inclusion and low self-efficacy made people more likely to leave their institution – and that underrepresented minorities experience these issues at high rates. To address the barriers faced by younger researchers, she pointed to solutions such as on-site daycare and more progressive parental leave policies.
  • Dr. Shreya Kangovi, founding executive director of the Penn Center for Community Health Workers explained how the community health worker model can improve access and quality of care, improve patient activation and mental health, and reduce readmissions. The Penn CHW center delivers care to 1,500 patients per year and has advised more than 500 organizations who also want to develop a program. Kangovi related a story that captured the value of using CHWs as preceptors for medical students in low-resource environments: “30-year old, no family, uninsured and taking street Xanax. You automatically think: difficult patient. We walked in and [CHW] was like oh my god, your hair is so cute! The patient got this big smile on her face and started talking to us. My whole impression of her just changed.”

In his closing remarks, Dr. Richard H. Carmona talked about his journey from a poor Hispanic family in Harlem, New York to the U.S. Surgeon General position in the Bush administration from 2002-2006. His tenure is notable for his landmark report on the harms of secondhand smoke and his subsequent criticism of the Bush administration for suppressing his public communications related to stem cell research, contraception and climate change.

Dr. Carmona delivered a passionate call for greater efforts to reduce inequities in health. After recounting “sobering” statistics about health inequities between blacks and whites—including how black women are 2.5 times more likely to die during pregnancy—he discussed how racial inequities pervaded every aspect of his agenda as Surgeon General. During his term, he grew to believe that the issue was one that we could neither ignore nor escape from.

“Martin Luther King recognized these injustices and inequities,” said Carmona. “He understood the social determinants of health — how all of these things lead to bad outcomes. When people don’t have access, when they don’t understand, what they can’t make informed decisions on what they need to pursue optimal health and wellness.” Carmona also called out Congress for delaying progress.

 Congress remains divided and fights over this because, ‘Well, we don’t want another welfare program.’ Well, neither do I. I want to empower people. […] If we don’t do something about these disparities, injustices and so on, the disease and economic burden we will leave our children is unsustainable.

Whether you have a heart, or whether you’re just a smart businessman, we have compelling reasons to start interceding aggressively to eradicate these disparities.

The audience responded with a standing ovation at the end of his talk. You can hear a clip here.

The Third Annual Martin Luther King, Jr. Health Equity Symposium will take place on Monday, January 25, 2017 and will feature a keynote address from Dr. Antonia Novello, the fourteenth Surgeon General of the United States, who served from 1990-1993.

 

See related post by Dr. Eve Higginbotham here.