From ATLANTA Medicine, 2013, Care for the Underserved, Vol. 84, No. 2
By Rachel Harris, M.D., MPH, Elizabeth Ofili, M.D., FACC, David Satcher, M.D., Ph.D., and Rachel Harris, M.D., MPH
The Determinants of Health are the “range of personal, social, economic, and environmental factors that influence health status” and involve the interaction between policy making, social factors, health services, individual behavior and biology/genetics.(1) The World Health Organization, Centers for Disease Control and Prevention, Department of Health and Human Services, as well as numerous state and local level agencies have led the way in redefining care of healthy populations to include social factors that address inequities and the physical conditions in the environment in which people are born, live, learn, play, work and age.(2,3)
The 2011 National Healthcare Quality Report by the Agency for Healthcare Research and Quality (AHRQ) found overall health care quality has improved for the general population between the years of 2002 to 2008, . howeverHowever, of the 250 health care measures tracked, there are persistent challenges in access to health care among racial and ethnic minorities, with 50% percent showing no improvement in this population as well as 40% percent of the core measures in this group declining.(4)
The Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine (MSM) was established in 2006 to develop a diverse group of public health leaders, foster and support leadership strategies, and influence policies toward the reduction and ultimate elimination of disparities in health. Led by David Satcher, M.D., Ph.D., and a team of dedicated faculty and staff, the Institute has several programs, including which includes the Center of Excellence for Sexual Health; Community Voices: Healthcare for the Underserved; the Division of Behavioral Health; the Division of Health Policy; and the Division of Health Promotion and Disease Prevention.
The role of SHLI/MSM in caring for the underserved is a pivotal one, not simply from the individual provider-patient standpoint, but also from the national and local perspective of health care leadership and policy. In keeping with the mission to reduce and ultimately eliminate disparities in health, the formula for continued success is by focusing on neglected diseases and underserved populations, while giving priority to health promotion and disease prevention.
In examining underserved populations, there are several factors which that contribute to the inequities that preponderate. Those individuals with inadequate access to health care providers who meet their needs, low socioeconomic status, lack of insurance or affordable access to medical care, and limited English proficiency and health literacy have the most health disparities, with ethnic and racial minority groups frequently found among this population.(4)
The SHLI/MSM will implement a regional approach to address persistent health inequities by leading a Health Policy Transdisciplinary Collaborative Center (TCC) for Health Disparities Research, with the unifying theme of a comprehensive and meaningful approach to the development, advancement and implementation of health policy that harnesses the power of collaboration to bolster innovation, cost reduction and health equity. This recent award by the National Institute on Minority Health and Health Disparities (NIMHD) has been an honor and great achievement by the faculty, researchers and community at large. The TCC will focus on collaborations in the Health and Human Services’ (HHS) region IV, which encompasses Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
The SHLI/MSM TCC and its partners will address social inequities that affect child outcomes, mental health, health and health outcomes in vulnerable and high-risk populations, as well as continued implementation of health information technology “meaningful use” in through academic/community partnerships.
Actions to reduce health disparities must start before birth and continue through the life span to reduce inequities due to socioeconomic status or disparate opportunities that deprive a fair and healthy start for all children. Evidence has shown a strong association between poverty and health disparities, including mental health, education and child outcomes.(5) Additional evidence from neuroscience and early childhood development research has shown that early childhood, particularly a child’s first five years, lays the foundation necessary for the complex skills they will need as adults to become successfully employed, lawful, cooperative and productive.(6)
Although there is demonstrable evidence showing that even when policies are in place, written policies alone do not adequately address health inequities until they are supported with effective local delivery systems and community participatory action. Thus, to effectively reduce and ultimately eliminate disparities, the SHLI/MSM TCC will engage nine states’ members of the Centers for Disease Control and Prevention’s Racial and Ethnic Health Disparities Action Institute (REHDAI) to evaluate the extent to which the outcomes of quality parenting impacts healthy child development, and how state and local policies ensure that every child receives quality parenting and early child development through supportive programs and public service delivery systems with community participation in decision-making.
Mental Health and Health Outcomes
Addressing the multi-faceted health and mental health needs of the U.S. population is a complex issue that warrants attention from policymakers, clinicians, researchers, scientists and public health professionals that can offer unique perspectives and strategies to support efforts for greater well-being among individuals.
With growing diversity concerning different ethnicities, nationalities and sexual orientation, and with significant changes in the constellation of the myriad of risk factors that can influence health and health outcomes, it is imperative that we delineate strategic health policies, focused community-based programs, and innovative research that include an examination of evidence-based models that can improve individuals’ longevity and quality of life. These issues have particular relevance for vulnerable and high-risk populations, including veterans, ex-offenders, uninsured, homeless individuals, lesbian, gay, bi-sexual and transgender individuals (LGBT), and racial/ethnic minorities.
There are several key pieces of federal legislation passed by Congress that were designed to have positive health and behavioral health implications for underserved populations, including the Mental Health Parity Act (1996), Second Chance Act (2008), Mental Health Parity and Addiction Equity Act (2008), and the Patient Protection and Affordable Care Act (2010). Although collectively, these health policies support the promotion of better access and utilization of health and behavioral healthcare services, the extent to which policies related to these legislative mandates are implemented remains questionable, and health disparities continue to plague our communities. The SHLI/TCC will implement strategies that integrate mental health in primary care practice settings. Through novel culturally-centered approaches targeted to ethnically and culturally diverse adults, the goals of reducing health and mental health disparities, improving health equity, and enhancing the quality of life for individuals, families, and communities will be accomplished.
Health Information Technology
Using shared learning to enhance academic/community partnerships by leveraging Health Information Technology (HIT) is crucial in developing, informing, and implementing public policies that impact health disparities relative to healthcare quality improvement. The use of shared information in underserved or understudied populations has been successfully implemented in a multi-institutional, multidisciplinary collaboratory model with a focus on key diseases and health conditions which that disproportionately and adversely exist among racial and ethnic minorities.(7)
This model of information sharing has helped in professional validation, transdisciplinary integration, and improved communication/interventions and as a result has had policy implications and improved health outcomes.(8) Key areas for quality improvement measures include insurance delivery and payment system reforms, health promotion and disease prevention, appropriate data collection and reporting, and comparative effectiveness research based on the health equity agenda of the Affordable Care Act.
The SHLI currently has two SHLI health policy training programs: SHLI Health Policy Leadership Fellowship Program for postdoctoral professionals and the SHLI Community Health Leadership Program for community leaders and students.
Since its inception, the SHLI Health Policy Leadership Fellowship 10-month program for postdoctoral professionals has 13 alumni and five current fellows, with numerous additional previous summer program and workshop attendees. It is the goal of the fellowship program to develop a diverse group of health leaders who “care enough, know enough, do enough, and are persistent enough” to help realize global health equity.
The Community Health Leadership Program (CHLP) is a 12-session program focused on developing community health leaders with an interactive and community-based curriculum. An important part of the CHLP curriculum is its community-based research and practicum component. The community participants and MSM MPH students partner in developing community projects that must be relevant to community needs, show evidence of sustainability and impact health disparities.
Through a coordinated effort to identify health policy leaders’ training needs for developing, implementing, and changing policies to address disparities in health, the SHLI will continue to work on the behalf of millions of Americans who are affected daily by disparate health challenges and outcomes.
Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative that is shared by the Satcher Health Leadership Institute. The SHLI/MSM TCC proposes transformative health policy goals that will positively impact and sustain health equity across this regional transdisciplinary collaborative.
The ultimate goal of the SHLI is emerging as the preeminent, national health policy center focused on innovation, cost reduction and health equity, emerging as the ‘collaborator of choice’ in leading-edge health policy research focused on health equity, training the next generation of leaders in health policy research, and expanding the diversity of the health policy workforce. SHLI TCC and its partners across HHS Region IV, will significantly impact the health outcomes of participating communities through policy development and implementation.
For more information, visit the Satcher Health Leadership Institute
Rachel Harris, M.D., MPH. joined the faculty of Morehouse School of Medicine, Section of Cardiology as an Assistant Professor in July 2011 and as Staff Cardiologist at the Atlanta VA Women’s Center of Excellence East Point Outpatient Clinic in September 2012. She enjoys teaching and also serves as one of the Morehouse School of Medicine Internal Medicine Residency Associate Program Directors. Dr. Harris is Board Certified in Cardiovascular Diseases, Internal Medicine, Nuclear Cardiology and Echocardiography. She serves as the Echocardiography Lab Co-Director at Grady Memorial Hospital in Atlanta, GA.
David Satcher, M.D., Ph.D, is Director of The Satcher Health Leadership Institute which was established in 2006 at the Morehouse School of Medicine in Atlanta, Georgia. Dr. Satcher was sworn in as the 16th Surgeon General of the United States in 1998 and served until 2002. He also served as the 10th Assistant Secretary for Health in the Department of Health and Human Services making him only the second person in history to have held both positions simultaneously. His tenure of public service also includes serving as Director of the Centers for Disease Control and Prevention (CDC). He was the first person to have served as Director of the CDC and then Surgeon General of the United States. Dr. Satcher has held top leadership positions at the Charles R. Drew University for Medicine and Science, Meharry Medical College, and the Morehouse School of Medicine.
Elizabeth O. Ofili, M.D., MPH, FACC, is a Professor of Medicine, and Chief of Cardiology, at Morehouse School of Medicine. She also serves as the Associate Dean of Clinical Research, and Director of the Clinical Research Center. Dr. Ofili is known for her expertise in the field of cardiovascular medicine and health disparities with a focus on translating discoveries to benefit patients through community engagement. She has been continuously funded by the National Institutes of Health (NIH) since 1994; Dr. Ofili is the national PI of the WARFARIN study, which was recently approved by the Center for Medicare and Medicaid (CMS) as the first large scale randomized clinical trial to evaluate gene identification ability to predict patient response and improve safety when dosing warfarin, the world’s leading anti-blood clotting drug. A passionate advocate for the inclusion of minorities in biomedical research, she has helped to raise over $150 million in research funds, to support research infrastructure and training at Morehouse School of Medicine.
1. Department of Health and Human Services (US) Healthy People 2020 Framework [cited 2013 Feb]. Available from: URL: http://www.healthypeople.gov/hp2020.
2. World Health Organization. Report from the Commission on Social Determinants of Health. Geneva: WHO; 2008. [cited 2013 Feb]. Closing the gap in a generation: health equity through action on the social determinants of health. Also available from: URL:http://www.who.int/social_determinants/thecommission/finalreport/en/index.html.
3. Satcher, D. Include a Social Determinants of Health Approach to Reduce Health Inequities. Public Health Rep. 2010; 125(Suppl 4): 6–7.
4. U.S. Department of Health and Human Services Agency for Healthcare Research and Quality National Healthcare Quality Report 2011.. AHRQ Publication No. 12-0005. March 2012. [cited 2013 Feb]. Available from: URL: www.ahrq.gov/qual/qrdr11.htm
5. Briggs-Gowan MJ, Carter AS, et al. Are Infant-Toddler Social-Emotional and Behavioral Problems Transient? J Am Acad Child Adolesc Psychiatry. 2006 Jul;45(7):849-58.
6. National Scientific Counsel on the Developing Child. The Science of Early Childhoon Developmentt: Closing the Gap Between What We Know and What We Do. Center on the Developing Child at Harvard University;2007. [cited 2013 Feb] Also available from: URL: http://www.developingchild.harvard.edu
7. Fleming E, Perkins J, Easa D, et al. Addressing Health Disparities through Multi-institutional, Multidisciplinary Collaboratories. Ethn Dis. 2008 Spring; 18(2 Suppl 2): S2–161-7.
8. Massie LC et al. Measuring collaboration and transdisciplinary integration in team science. Am J Prev Med 2008;35(2S):S151–S160