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Prioritizing Health Disparities in Medical Education to Improve Care

Report of the NY Academy of Sciences



Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
— Martin Luther King, Jr.

An African American born in 2009 can expect to live approximately five years less than a Caucasian born the same year. A young girl is three times less likely to be obese if at least one of her parents has a Bachelor's degree. A patient living in Massachusetts has access to over twice as many physicians as a patient in Mississippi. These are just some of the health disparities identified by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention in a 2011 report.

Examples of health disparities facing Americans today. (Image courtesy of Claire Pomeroy)

In October, 2012, medical students, faculty, educators, and administrators met at the New York Academy of Sciences to discuss how medical schools and academic institutions can minimize health disparities—differences in health outcomes between groups that often reflect social inequalities—and promote health equality.

The concept of health disparity has evolved over time. As Fitzhugh Mullan of The George Washington University recounted, in the 1960s and during the Civil Rights movement the idea was primarily associated with racism and segregation in medicine; gradually, it has become broader and now encompasses both unequal access to medical care and imbalanced health outcomes for various racial, ethnic, and minority populations. This concept entered academic discourse after it was highlighted in the Institute of Medicine's 2002 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Mullan argued that this report helped to legitimize the concept in the academic world and encouraged professionals from various fields of expertise, such as medicine, education, engineering, and policy, to begin to work together to eliminate disparities.

What can medical schools, in particular, do to address health disparities? To answer this, we must first define the role of medical schools. At the simplest level, a medical school exists to train future physicians. However, as the speakers described, that responsibility encompasses more than just teaching students about the newest treatments for disease. As Mullan asserted, in choosing who has the opportunity to become a physician and what to teach, medical schools are inherently selecting for and determining which values will prevail in the medical field. Most medical schools have a mission statement that includes a reference to the "three-legged" stool of medical education: patient care, education, and research. Claire Pomeroy, dean of the School of Medicine at the University of California, Davis, asserted that academic medical centers also have a responsibility to ensure that healthcare and services are available to everyone. To achieve this, she and others stressed the need to add a fourth leg—social mission—to address health disparities.

If medical schools are to accept the responsibility of addressing health disparities, how should they do so? How can social mission be incorporated as a primary goal? According to Mullan, a commitment to social mission would include mainstreaming diversity, assessing graduates' goals and career development, advancing access to care, and raising awareness of health disparities. Two main strategies were discussed throughout the conference, which can broadly be described as "reaching out" to the community to align university resources with community needs and "reaching in" to promote diversity within the university and to increase the participation of underrepresented minorities within the medical field.

Several new initiatives aiming to transform medical school curricula to include a stronger focus on health disparities equip students to better serve an increasingly diverse patient population and encourage them to "reach out" to communities. Arthur Kaufman from the University of New Mexico described the need for medical schools to address social determinants of health, such as education, lifestyle, and access to affordable housing and transportation, and underlined efforts to do so at the University of New Mexico. Joseph Betancourt from Massachusetts General Hospital and the Disparities Solutions Center emphasized the importance of cultural-competence training, highlighting Harvard Medical School's initiative to equip students and physicians with tools to care for a diverse population. Mitchell Lunn from Brigham and Women's Hospital and Harvard Medical School followed up with specific steps medical schools can take to ensure that physicians are prepared to care for lesbian, gay, bisexual, and transgender (LGBT) patients. Claire Pomeroy from the University of California, Davis described initiatives at the university to address social determinants of health and to provide cultural-competence training. Finally, Fritz François from New York University School of Medicine provided an overview of the school's curricula, highlighting how molecular epidemiology is being used to address health disparities.

Others spoke about how medical schools must "reach in" to support a diverse workforce. Marc Nivet from the Association of American Medical Colleges underscored how diversity within the student body, the faculty, and the workforce is essential to eliminating health disparities, while Claire Pomeroy highlighted programs at the University of California, Davis to promote diversity and inter-professional teams. Mekbib Gemeda from New York University Langone Medical Center described the challenges involved in maintaining underrepresented minorities in academic medicine, and Estela Estapé from the University of Puerto Rico, Medical Sciences Campus discussed a new postdoctoral Master's degree program in clinical and translational research that provides training in health disparities and works to increase the number of Hispanics and women in the field.

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