Framing the Health Disparities Problem

This past week, I had the opportunity to attend the National Institute on Minority Health and Health Disparities Grantees Conference. Over 1,000 people attended, all representing different parts of academia and the non-profit world, all coming together to collaborate and present research regarding health disparities. The National Institute on Minority Health and Health Disparities is a branch of the National Institutes of Health. It’s mission is “to lead scientific research to improve minority health and eliminate health disparities.”

What are health disparities, exactly? The Healthy People 2020 initiative defines it in the following terms: “If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.” Health disparities can be seen, for example if we look at something like infant mortality.

Infant mortality rates in the US by race

Since 1980, the US infant mortality rate has dropped from 12.6 deaths/1,000 live births to 6.17. This is okay (though it should be noted that we rank as having the 55^th lowest rate for the wealthiest country on the planet). This rate takes on a new life when we break it down by race. For Non-Hispanic Whites, the infant mortality rate is 5.5 deaths/1,000 live births. For Non-Hispanic Blacks, the rate is 12.8 deaths/1,000 live births. We can see disparities again when we look at childhood obesity rates. At the conference I learned that for the first time, the national child obesity rate seems to be plateauing; yet for white, upper class children, this rate is actually declining, and for Hispanic and Black children, this rate continues to climb rapidly.

It is probably not surprising that health disparities are closely linked to what is termed, “the social determinants of health,” which can include everything from one’s education level to how close one lives to a landfill. It is important to remember that long histories of power inequality have led to many of these social determinants, and therefore, the increased health status of some groups over others.

In the United States, health disparities are certainly a reality. What struck me most at the conference, though, was a question posed at one of the panel discussions. The facilitator asked, “How can we combat health disparities, when the work requires that we give more to those at the bottom, while giving less to those at the top?” Though it caught me a bit off guard, this idea makes sense. Have-nots need more resources and support so that they can “catch up” so to speak, to the Haves. Though similar, this is not exactly Robin Hood logic. The rich wont necessarily be loosing out so that the poor can gain. The way the question was framed insinuated this, and it made me realize that this is exactly how some people think of health equity work. Potential supporters can be turned off to a cause when it seems like they will be deprived of something. We have seen this argument come up again and again with the Affordable Care Act. Saying things like “they’re going to make us ration health care if everyone is covered” or “we will have to wait longer to get appointments” fosters this exact type of thinking. The problem is that we’re framing it all wrong.

We need to highlight that it is important to give those at the bottom more support than we give those at the top, not even because they deserve it, but because they need it and the people at the top do not. A salient example is one from Chile, where everybody is covered for health insurance. Their public insurance option is tailored towards equity as opposed to equality—those who need more support get more support and those who need less support, well, they wont be missing out on any free services, because simply put, they don’t need them. New mothers in the lowest income bracket receive, among other things, free baby carriages. If the health sector were to view patients as equal, they’d give these to the wealthiest mothers, too. The majority of mothers in higher income brackets would probably not take the low-cost baby carriage, if they can and want to buy one of their choosing. Equity, on the other hand, still means that all mothers can and will have baby carriages, but that we should be intentional with how resources are delivered, targeting those most in need.

So, how can we in GlobeMed at Tufts use this idea of framing to combat health disparities with our partner organization, PHASE Nepal? Right now, we are fundraising through our individual giving campaign. So far we have raised almost $4500 for, our project right now, which is hitting an important determinant of health: that of childhood education. PHASE Nepal will take the funds we raise this year and hire a teacher trainer, who will work with currently employed teachers in elementary schools in the communities that PHASE serves. This trainer will help teachers utilize methods to foster creative thinking and problem solving among students of Nepal. He/she will also support child clubs, which operate as extracurricular forums for the children to play, learn, do local development projects such as planting gardens, and talk about child rights. Additionally, we envision the formation of a health curriculum to be taught as supplementary material in the Child Clubs, so that these children can begin to learn about the importance of having a healthy body and mind.

When we think about how to bolster our fundraising efforts, we need to be able to discuss how the situation in Nepal came to exist, and about the power structures that perpetuate such inequalities. When we talk about this stuff, we have to know how to frame it in a way that will help us build support for our chapter, PHASE, and the global health movement at large.

To learn more about PHASE’s work, please visit http://phasenepal.org/

To donate to our project, please visit https://www.globalgiving.org/projects/child-health-education-program-in-nepal/

Rachel Weinstock is a senior majoring in Anthropology and Community Health. She is a member of the policy team.

A Vital Lesson: How Volunteer Empowerment Will Help Us Survive

Tonight, I attended Partners In Health Volunteer Night, at their Boston office. Jon Shaffer, the Community Engagement Coordinator at PIH and a friend of GlobeMed at Tufts, was running it. He made sure we were all full of crusty pizza (a definite motif at practically every global health meeting I’ve been to for some reason) and that all 30 of us introduced ourselves, and then he started in on a general presentation about the work PIH does. I was really impressed and pleased at the variety of volunteers there; I was sitting across the table from a soon-to-be-Harvard-Med-School-Student, across the room were Haitian-American women and their teenage sons, behind us a woman who worked at a financial firm. One question sat in my mind: How does PIH draw all of these people in? Not only to volunteer, but to donate (as our task for the night was to call and thank donors from every corner of the country)? What lessons can I learn, and can GlobeMed at Tufts learn moving forward in their third year, when member engagement is really going to be put to the test?

A few things really struck me as the key pieces to engaging us as volunteers. The whole night began with information. We learned about Partners In Health’s basic mantra, a little bit about the then and now, and then we got a special presentation on monitoring and evaluation methods that the data team at PIH use to improve their systems and interventions (Side note: I’ll see if I can grab that presentation, it might be really good for explaining to our data team and our chapter how we can help Nyaya use data). Right off, the volunteers were engaged because they were empowered with a little knowledge. Next, we were given our instructions on how to call and thank donors, which were very specific. We were told what an asset to PIH we were, since they don’t have nearly enough staff to call and thank all of the donors. As volunteers, we help ensure that monetary support for PIH will continue, and all of the great work out in Haiti, and Rwanda, and Malawi, and Russia, and Peru will continue. We went to our phones, we did our jobs. Finally, we came back together and shared stories about our most interesting phone conversations before leaving. So, with all of this, I tried to think about what, exactly, kept me engaged the whole night?

Volunteer Empowerment. We talk often in the world of global health equity about patient empowerment and community empowerment, but it’s important not to forget about keeping up a sense of agency for volunteers. Didn’t we all get involved in the fight to end health care inequity because we felt like we could do something about it? This sense can easily get lost, when there seem to be a million other people in your organization, doing a million different, seemingly unrelated things. I think we lost this a bit in the past year at our chapter. So here’s the bits I pulled from how PIH keeps their volunteers engaged and empowered.

1. Empower with knowledge. By teaching our chapter members about big global health issues (here is where GHU already does some work) and specific things about Nyaya and Nepal (something that I hope will be added to the weekly meetings), we will give our chapter members some authority, some agency, so they can be excited to get their work done. It would be the most beneficial to do this at the beginning of each meeting. Knowledge is (em)power(ment).
2. Empower with specific roles. Each chapter member should have a specific job that they do. If this means giving them a title, do it. If this means giving them a printed out sheet of directions on how to complete a task, do it. This one is going out to the EBoard especially. Work with your team to assign very specific jobs to everyone.
3. Empower with solidarity. Remind everyone, every week, that the work we are doing is important, and that every member with his/her specific job is vital to the functioning of the chapter, and immensely helpful to our friends at Nyaya and their patients.
4. Empower with work. Actually DO what you and your team set out to do. Everyone is responsible for making sure everyone else is contributing, so don’t be afraid to ask your fellow member about their project, and encourage them along. Sometimes organizing events or writing grants or planning lessons is hard, but we all committed our time and effort early on, so lets actually focus the energy of our commitment into our tasks.
5. Empower with community. This part, I think, also has gotten overlooked at our chapter the last 2 years. We all get stressed out from time to time, we all have a funny story we want to share with everyone some days. We need to find time, either at meetings or outside of them, to connect and just be humans around other humans tied by a common love and drive. If we care about our fellow chapter members, then we will care more about seeing everyone succeed individually and as a group.

I’m definitely missing out on what will undoubtedly be an excellent fall semester for our chapter, and I look forward to coming back and diving into more great projects with all of my friends at GlobeMed.

Rachel

Opening Night: Summit 2013

The night began with a great dinner, and ended with an even more elaborate feast of discussion.

After gobbling some cheesy lasagna, it was time for the meaty part of the night. First up was the opening keynote speaker, Northwestern University President, Morton Schapiro. Next, we watched How to Survive a Plague, a documentary on AIDS activism in the US in the 80’s and 90’s. Finally, there was a panel discussion with Amirah Sequeira, the National Coordinator of the Student Global AIDS Campaign and Peter Staley, a founding member of the Treatment Action Group and leading subject of the preceeding documentary.

President Schapiro’s speech struck me as a particularly effective way to launch this year’s Summit. He spoke frankly about our generation’s power to enact change, and his generation’s failures in addressing fundamental global issues. Today’s American youth has been described as a generation of cynicism; we were children when planes struck the Twin Towers, barely boasting double-digit ages while the US began two wars in the Middle East, and teens when the worst economic recession since the 1930’s hit. Schapiro argued that our experience with these negative global and domestic issues transform us to act, but that we cannot act alone. The 300 of us Globemedders sitting there needed something to bring back to our chapters, to our schools, to our communities. We need data.

If we can tell people about global health issues in a way that incorporates the facts, the staggering numbers associated with epidemics and poverty the world over, that we would force people out of complacency. The numbers don’t lie, and I think as a chapter, Tufts has a lot to offer. We have data, we can get those numbers, and we can convince our chapter members and our fellow Tufts students to care, to feel connected, to get upset and take action.

Schapiro also spoke about what makes an effective leader in the world of development:

1. Have empathy. Experience someone else’s perspective. Open yourself up to listening to the people you are trying to help.
2. Have humility. Schapiro said one of his biggest regrets as a young economist years ago was have the hubris to tell government officials in African countries how to run things. It ended up hurting more than helping. We are not smarter, we are not better than those we are trying to help. “But for the grace of God,” as Schapiro put it, we are not in their place.
3. Hold yourself accountable. This is where the data comes in. Have facts, have ways to monitor what you do, and if what you’re doing isn’t working, change. Prove that you are being a positive and effective agent.

Schapiro ended with a joke about the incompetency of his generation, and how his faith in youth relied on the fact that he knew we couldn’t mess up as badly. We all laughed, and in that room of 300, we all somehow felt the electricity of our potential. We will do more than ‘not mess up as badly’ as our predecessors.

Rachel Weinstock ’15