Health Policy$ense

Novello Inspires Action at 2017 Penn Health Equity Symposium

‘No time for apathy or complacency’

Penn’s third annual Martin Luther King Jr. Health Equity Symposium featured a keynote address by Antonia Novello, 14th Surgeon General of the United States, who had a hopeful, yet challenging message: “Had Martin Luther King been here today, he would see that we are doing much better, but he would he would still be fighting. He would feel pride, disappointment, sadness, and he would be appalled that blacks and whites are still segregated.”

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Keynote speaker Antonia Novello served as U.S. Surgeon General from 1990 to 1993.

Dr. Eve Higginbotham, Vice Dean for Inclusion and Diversity, and director of the Perelman School of Medicine’s Office of Inclusion and Diversity, began by acknowledging the uncertain future of the ACA and the possibility that the health disparities we see now could worsen. She noted, when introducing the theme for the symposium in honor of Dr. King: “In times of uncertainty, we must remain true to our moral compass, and reflect on our role as virtuous servant leaders.”  She introduced Dr. Novello as one of those leaders.

Dr. Novello, who served as Surgeon General from 1990 to 1993, and New York State Health Commissioner from 1999 to 2006, noted the progress in the past 50 years around promoting inclusion and diversity within the American health care system, even as she said that Dr. King would not be satisfied. Citing persistent racial discrimination and a growing socioeconomic gap, she again quoted Dr. King: “This is no time for apathy or complacency. This is a time for vigorous and positive action.”

She urged her audience to face these challenges head-on in their work as she outlined an agenda of protecting programs and innovating around education; expanding health coverage to people now in the “coverage gap”; creating a more ethnically and racially diverse police force to promote justice; stronger enforcement of fair housing laws; making jobs and job training more available; and reforming the criminal justice system to be more humane and fair. She likened the efforts needed to the five-year Marshall Plan, which reconstructed post World War II Europe. “If we can reconstruct Europe, I don’t see why we can’t reconstruct inner city communities.”

She ended with a quote from the historian Yehuda Bauer about three commandments beyond the first ten: “Thou shalt not be a victim, thou shalt not be a perpetrator, but, above all, thou shalt not be a bystander.”

A panel of Penn faculty responded to Dr. Novello, and brought their own perspectives to these persistent societal problems.

Dr. Kevin Jenkins, the Vice-Provost's Postdoctoral Fellow in the School of Social Policy & Practice, compared health disparities to a bad game of musical chairs where “every time the music stops, people of color, those from vulnerable societies and communities, are left standing.” Instead of trying to add more chairs, i.e., more policies, more research, as many argue, his solution is to “change the DJ.” He introduced the concept of a “win-when,” of searching for a “win” when situations present challenges, such as when funding gets cut. Dr. Jenkins explained that we focus too often on the “win-win” situation, rather than looking for “the win, when things aren’t on our side. I can’t change the numbers, but hopefully I can change the narrative.”

Dr. Jaya Aysola, Assistant Professor of Medicine and Pediatrics, and Associate Dean of Graduate Medical Education, discussed how to pursue and understand inclusion within our health care institutions. Inclusion, as she defined it, involves a shared sense of belonging and purpose. Quoting Andres Tapia, she said: “Diversity is about the mix of people you have, and inclusion is about making that mix work.” Dr. Aysola discussed Penn’s quantitative and qualitative research studying its own level of inclusion. She highlighted qualitative findings that reveal reasons that women and minority groups ranked institutional cultural competency lower than average, and proposed initiatives to address these factors:

Dr. Lisa Lewis, Associate Professor of Nursing and Assistant Dean for Diversity and Inclusivity, discussed her thoughts on what Dr. King would say about the state of health disparities and health research today. She focused on the ongoing underrepresentation of minority populations in clinical research, which threatens the internal and external validity of evidence. Further, she said that health disparities would likely persist because we lack data. She urged the audience to critically examine how we fail to recruit some populations who experience the most persistent disparities, and to consider more targeted ways to involve minorities in research. These ways include more proactive recruitment strategies, culturally tailored study materials, recruiting outside the health system, and collaborating with community leaders. She challenged the audience to share study findings and share data ownership with communities, and to use these strategies even if they had not done so before. She quoted Dr. King about the urgency of the task: “The time is always right to do what is right.”

The Symposium included the perspectives of an important health profession—dentistry—that is often omitted from discussions around health equity. Dr. Denis Kinane, Dean of Penn’s School of Dental Medicine, noted the importance for all health schools, including dentistry, to come together around this issue, as he introduced the final speaker, Dr. Caswell Evans, Associate Dean for Prevention and Public Health Sciences at the University of Illinois at Chicago, College of Dentistry.

Dr. Evans opened with a concept he stresses to his trainees—that social justice demands action from dentists because they are, first and foremost, health professionals with expertise in oral health. As such,  “we must think beyond that instance that is immediately before us…[and] think about the patient, the family, the community, and in some regards, think about the nation.”

Disparities in oral health stem from severe inequities in access to dental care, he said, such that, “the most in need receive the least care.” He noted that the programs providing access to dental care to vulnerable populations—Medicaid, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), and the Children’s Health Insurance Program (CHIP)—face substantial threats to their funding.  If the objective is to achieve equity in access to care, Dr. Caswell said, “traditional systems that have led to disparities and lack of equity are not sufficient to solve the problem…[and] additional action must be taken.”

He used the example of dental therapists as one way to extend dental services to vulnerable populations. Dental therapists emerged in Alaska a decade ago as a solution to workforce shortages leading to disparities in access. A number of states have followed this model, and now nearly 30 states are considering the use of these mid-level practitioners. Although they are not trained at the level of the dentist, they are certified to deliver a variety of services important to oral health, including prevention and screening. Dr. Evans concluded with an emphasis on the common vision health professionals need to protect the current programs under threat, to ensure that the benefits offered by the current health system continue, and to find new ways to achieve health equity.

The entire symposium can be viewed here. Looking ahead, the fourth annual Martin Luther King Jr. Health Equity Symposium will be held on January 24, 2018 and will feature a keynote by Dr. Howard Koh.