Health Policy$ense

Koh Promotes Partnerships at Penn 2018 Health Equity Symposium

Collaborating across public and private sectors

At Penn’s fourth annual Martin Luther King, Jr., Health Equity Symposium, keynote speaker Howard Koh, MD, MPH, former Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS), shared a motivating quote by Dr. King: “Life’s most persistent and urgent question is, ‘What are you doing for others?’”

J. Larry Jameson, MD, PhD, Dean of Penn’s Perelman School of Medicine, opened the symposium by discussing the legacy of Dr. King, “a great example of how one person, with vision and leadership, can change the course of history in an important way.” Dr. Jameson said that Dr. King “would be disappointed that we still have such a wide gap in health care disparities,” noting also that “poverty and education are the heart of the challenge.”

Eve J. Higginbotham, SM, MD, Penn’s Vice Dean of the Office of Inclusion and Diversity, set the stage for the day with Dr. King’s well-known quote, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” She encouraged the participants to ask themselves, “How should we incorporate this information [from the symposium] in our research, educational initiatives, and in our service to our patients?” Because 70% of factors contributing to health are modifiable, she said, “We cannot succeed in population health without addressing all the determinants of health.” She then introduced Dr. Koh, described as someone who “cares most for those in society counted least and put last.”

Dr. Koh is the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard, and served as 14th Assistant Secretary for Health from 2009 to 2014, as well as Commissioner of Public Health in Massachusetts from 1997 to 2003. Dr. Koh shared one his favorite Dr. King quotes: “I choose to give my life for those who have been left out of the sunlight of opportunity.” Dr. Koh marveled at the last phrase and its relevance for his work: “Some of us have that sunlight of opportunity in terms of our health, and many of us do not. Why and why not? That’s part of the reason we are here today.” 

Dr. Koh talked about the goals of Healthy People 2020, which he led during his tenure at HHS, and shared insight from his research with the National Academy of Medicine on health care disparities. He called attention to the troubling data that are “triggering discussions about future strategies for health and health care”—for example, life expectancy in the U.S. has decreased two years in a row for the first time since 1993. He underscored the need to “collaborate and build…nontraditional partnerships and make the social-determinants-of-health approach move forward.”

“Health is too important to be left to health professionals alone,” Dr. Koh declared, and cited specific examples of “nontraditional partnerships” that have shown promise to reduce health care disparities: “housing as health” and “fair housing” initiatives; early childhood interventions that address education, poverty, and health; and partnerships with faith-based groups. He also spoke about the potential to reduce disparities by engaging businesses in health.

He concluded, “When [Dr. King] says, ‘injustice anywhere is a threat to justice everywhere,’ I know that behind that theme is also a plea for health equity and making better attempts to have all people achieve their highest attainable standard of health.”

In the panel that followed, three members from the Penn community shared insight from their own work that uses novel methods and nontraditional partnerships to tackle health care disparities.

Brenda Curtis, PhD, MSPH, Assistant Professor of Psychology in Psychiatry at the Hospital of the University of Pennsylvania, is using social media to overcome the time and resource limitations of conventional substance use disorder treatment and improve retention of patients in treatment. Dr. Curtis and colleagues found in a recent study that together, traditional measures of addiction severity and social media language were better predictors of relapse, than they were separately. As a source of real-time data on relapse risk, digital health platforms may allow for the creation of “just in time adaptive interventions.” Her future work will include developing a smartphone social media recovery app and a personalized feedback tool for patients on their health profiles.

Sara Jacoby, PhD, MPH, MSN, Assistant Professor in the Department of Family and Community Health in the School of Nursing, shed light on the historical antecedents of urban firearm violence, and pointed to novel approaches to injury prevention that focus on the built environment. She cited the example of Philadelphia, where there is one firearm injury or death every six hours, and injuries are five times more likely to occur among black residents than white residents. In a recent study, Dr. Jacoby and colleagues found that “urban spaces deemed unworthy of investment by virtue of the race, ethnicities, and poverty of their residents from a century ago have greater incidence of firearm violence today.” The insight that “urban firearm violence is a disease of places as well as people,” has led to place-based interventions. For example, work to “clean and green vacant lots” has resulted in decreased injuries in the surrounding areas.

Imran Cronk, Penn alumnus and Co-Founder of Ride Health, emphasized the need to address transportation barriers that cause more than 3.5 million patients a year to miss or delay care. His company, Ride Health, is a web platform for providers to facilitate on-demand, non-emergency medical transportation for patients; it has shown promise to improve patient adherence and reduce provider costs. Mr. Cronk noted, “There is a large amount of public funding available, but it takes innovation in the private sector to fine-tune the delivery model of the service.” He discussed possible solutions to transportation barriers, which include empowering providers and forging public/private partnerships—for example, in identifying high-risk high utilizers of health care who live in transportation deserts.

Dr. Higginbotham concluded the symposium with a quote by Dr. King: “Unarmed truth and unconditional love will have the final word in reality.” She added, “We’ve heard people talk about love these days, but…it’s got to be an authentic driver for all of us, as we move the needle on health equity.”

A video recording of the entire symposium is available here. The fifth annual Martin Luther King, Jr., Health Equity Symposium will be on January 23, 2019, and feature keynote speaker Dr. Jonathan Woodson.