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'Culture of good health' is essential to medical equity

This article first appeared in the St. Louis Beacon, March 22, 2012 - The absence of a "culture of good health" is one key issue that society must confront to reverse medical inequities among minorities, a Harvard professor said Wednesday during a conference at Saint Louis University.

David R. Williams, a faculty member at the Harvard School of Public Health, discussed the impact of discrimination, habits and education on health outcomes during his speech at a conference co-hosted by Saint Louis University's School of Public Health and School of Law.

Williams stressed that health inequities should be regarded as a social problem rather than one affecting certain groups. He cited numerous studies showing that blacks and other minorities tend to be sicker and receive less care than whites. He also said health quality wasn't helped if minorities also are less educated and face other adverse social and economic conditions.

"People worried about where their next meal is coming from or where they are going to sleep tonight can't think about quitting smoking or getting exercise," he said in an interview. "So your basic economic and social needs must be taken care of before you can focus on improving your health."

The answer, he says, is "to build a culture of good health. It isn't created in the doctor's office. It isn't the task of the county health department or the hospital. It's created in our homes, our work places, our churches, our schools, places where we spend most of our time. Everything we can do in all of those places could enhance good health."

Williams acknowledged that some minority communities already are making health a priority. Examples are fitness programs like those at the Monsanto YWCA on the north side as well as a growing number of exercise and wellness program sponsored by churches and social organizations. These are occurring not just in some black communities but in Latino and American Indian neighborhoods around the country, he said.

"But the question is: Can we take it to scale? We need to make it the norm as opposed to the exception."

He added that good health isn't just a minority issue since Americans in general are losing ground on health matters in relation to some other countries.

"We're less than 6 percent of the world's population consuming one half of its medical resources, and we have the worst health outcomes among major industrialized countries," Williams says. "It's not just that African Americans and other minorities are doing poorly in terms of health. All Americans could be doing better. So this is a problem that we all need to work together to address."

But Williams and other panelists acknowledged the impact of race on health issues. Dr. Lisa A. Cooper, a professor at Johns Hopkins University, said her program that focused on disparities in cardiovascular health continued to use varied approaches to enlightening health professionals about minority patients as a way of addressing health disparities. She didn't think care providers were indifferent since most entered the field because they wanted to promote wellness for patients.

"So we know that people don't really intentionally want to not deliver the care that patients need," she said. "They want to think they are doing the right thing based on what they've learned."

Still, she says stress and experiences from training are among factors that can adversely affect the quality of care doctors provide to some patients.

"It takes something to actually wake them up from that," she says, noting that focusing on the statistics about the disparities can help but says more needs to be done to "create awareness."

Examples at Hopkins, she says, have included using stories and personalizing experiences of patients so that providers can "see where they possibly could be going wrong."

The focus, she says, must be on finding ways "to appeal not just to the minds of those professionals but to their hearts." The matter is complicated because "the whole issue of race in America is very emotionally charged" so the conversation can't only be about race.

The goal, she says, must be about getting providers to "feel what it might be like to be on the other end of that treatment. What if (the patient) were someone you know, someone in your family. Get (providers) to connect on individual human levels with (the patient)."

Although panelists tended to praise the Affordable Care Act, some like Sidney Watson were concerned that the legislation could perpetuate a two-tiered health system. A Saint Louis University professor, who was also a panelist, Watson said the reform law, though welcome, meant that "we will still have Medicaid for the poorest Americans and that higher income Americans will have private insurance. That continues the challenge of making sure that both of those insurance programs work for the people they serve. We don't want to end up with Medicaid being second class."

Other panelists were Alvin Starks, a program officer at W.K. Kellogg Foundation; and Keith Elder, an associate professor at the Saint Louis University School of Public Health.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.