Using Head and Heart to See and Address Structural Inequalities
Dec. 13, 2018
Step onto the grounds of a plantation in the South. Read the stories, feel the place, and you’ll begin to understand how the lives of enslaved people and their ancestors were affected for generations far beyond emancipation. This is the quintessential history of racial hierarchy and racism in the United States—institutionalized and codified as the law of the land.
Plantations may be defunct, but oppressive and inequitable systems live on. Today we know this as structural inequality: the privilege and inequality that is embedded into our systems, institutions and communities because of the way they were created and are maintained.
A group of fellows from Clinical Scholars, a national leadership development program supported by the Robert Wood Johnson Foundation, recently embarked on an exploration of structural inequalities, one of several special experiences offered to fellows each year. They began as I described above, with a visit to Stagville Plantation in Durham, North Carolina, to ground themselves in the history and lived experience of enslaved people. That was an emotional, powerful and eye-opening experience that sparked deep conversation, and left many people reflecting on how so many details of this painful history have been left out of school curricula and our national narrative.
During the multi-day discussion and training that followed, one especially powerful experience was a “photovoice” project to illustrate fellows’ own stories of structural inequalities in their communities. Through these stories and images we learned about acts of resistance to honor ancestors lost on the Trail of Tears; about the fear and activism of a person married to an undocumented immigrant and living in constant fear for their safety; and how structural inequalities manifest themselves in many communities—our own communities—in many ways. Fellows left this experience with powerful insights on race in America that they are applying in their work and lives.
We will repeat and expand this training around the country—for Clinical Scholars and anyone else who wants to attend—and will post updates at ccphealth.org. Meanwhile here are some questions social workers and other clinicians, community organizations and many others can consider as part of your ongoing journey to create equity and build a Culture of Health.
How is structural inequality being manifested in the situations I am in?
Many clinicians are becoming more aware of the social determinants of health, which are those factors such as access to social and economic opportunities, conditions in the places where people live, and access to healthy options. Those factors affect people’s ability to get to office visits, follow their clinicians’ advice and take care of themselves. Beyond awareness, we need to be very intentional about seeing how our society and institutions create and sustain those factors. Ask, “Why is it that in spite of the quality of care I seek to provide to my patients, they still don’t have good outcomes?” For example, one Clinical Scholars team in Chicago is addressing the challenge of “pharmacy deserts,” a swath of a major U.S. city without access to a pharmacy, and the impact living in those areas has on patients who need to take prescriptions.
How has my discipline, field or institution contributed to structural inequality?
Early research in obstetrics and gynecology in the United States used enslaved women for experimentation. Forced sterilization and other gynecological procedures were used as a tool of oppression. People of color have been denied access to care, to education, and to banking and home ownership. Medical institutions and corporations have purchased land and displaced people. These experiences shape the way our systems continue to function and it’s important that we come to terms with this history. I’m excited about the way academic institutions are beginning to take a close look at themselves and their history with racism, including how they benefited from the slave trade. With your team, explore how people perceive your institution or organization and the history behind that. Are you open and accepting? Do people feel safe coming to you?
How do we dismantle it?
What can you and your team do to address structural inequality? Sometimes it can be hard for clinicians to step back from individual interventions and look at the institutional and systemic issues that affect their patients and their community. But if you ask “what about our clinic/community is making it hard for you to do what you need for your health?” you’ll likely find a place to start. Even a single step like working with the city to keep a bus running later along the route to your clinic can have a significant impact.
How can we engage in partnerships to address the issues of structural inequality?
You don’t have to do this alone, and in fact you’ll likely be more successful if you work in partnership with others. There’s a partnership at the core of the work I’m describing here, one between myself and Giselle Corbie Smith, Co-Director of the Clinical Scholars Program. We’ve known each other for 17 years and have had the opportunity to co-lead projects, submit grants together and much more. Partners can strengthen our work and can help us see things we take for granted or that have become invisible from our own personal context and worldview. Who can you work with in the community, from nonprofits and schools to faith leaders and elected officials, to find and address problems and build new, equitable systems?
It is no small feat to dismantle systems, practices and habits that have become ingrained over generations. But the more your heart and mind are open to seeing the barriers and inequities, the closer we come to solutions together.
Submitted By: Al Richmond, Executive Director, Community-Campus Partnerships for Health
Webinar exploring housing as a lever for health
Nov. 21, 2018
Housing—how it is built, renovated, and maintained—plays a vital role in supporting, or hindering, individual and community health and well-being.
On Thursday, December 13 at 11 a.m. ET, join The Robert Wood Johnson Foundation’s Leadership for Better Health and Research, Evaluation and Learning (REL) programs for a webinar exploring the intersection between housing and health. You’ll hear the latest thinking from a variety of thought leaders who are looking at the issue of housing and health from different angles, and have an opportunity to ask questions.
Adrianne Todman, CEO of the National Organization of Housing and Redevelopment Officials, will moderate a panel of program participants, including:
Steve Barlow, JD, MA, who, along with his teammates in the Interdisciplinary Research Leaders program, is exploring how housing code enforcement interventions in Memphis, Tennessee, can prevent decay of urban areas, and keep communities safe and healthy.
Omolara Uwemedimo, MD, MPH, who, along with her teammates in the Clinical Scholars program, is collaborating with a health system in New York City to incorporate questions about housing into patients’ regular health screenings.
Evidence for Action researcher Bruce Tonn, PhD, who has evaluated how low-income housing units weatherized with “Extreme Energy Makeovers” in Knoxville, Tennessee, have saved energy, reduced environmental impact, and improved residents’ health.
Systems for Action researcher Ricardo Basurto-Dávila, PhD, MSc., who is studying, with his research partner, how providing permanent supportive housing impacts the health of people who have been homeless.
We hope you’ll join us on December 13, 2018, at 11 a.m. ET. Thank you!
Living the Hopkins Mission
Oct. 29, 2018
As a part of the celebration of the 125th anniversary of the Johns Hopkins University School of Medicine, Clinical Scholar Megan Tschudy MD, MPH, and Culture of Health Leader Thomas Cudjoe MD, GER, were selected to serve as two of the 125 “Living the Hopkins Mission” honorees. The honorees were nominated by their peers in the medical school, and selected for their outstanding dedication to the core values of Johns Hopkins University, namely:
- Excellence & Discovery: Be the best. Commit to exceptional quality and service by encouraging curiosity, seeking information, and creating innovative solutions.
- Leadership & Integrity: Be a role model. Inspire others to achieve their best and have the courage to do the right thing.
- Diversity & Inclusion: Be open. Embrace and value different backgrounds, opinions, and experiences.
- Respect & Collegiality: Be kind. Listen to, understand, and embrace others’ unique skills and knowledge.
Read more about both of these leaders below:
Megan Tschudy, MD, MPH:
Megan is an assistant professor of pediatrics in Baltimore. Since joining Johns Hopkins University, Megan has become assistant medical director of the Harriet Lane Clinic, where she has worked to develop new and innovative solutions to eliminate health disparities in pediatric care by integrating school attendance data into clinical care.
In the Clinical Scholars program, Megan and her two partners, Katherine Connor, MD, MSPH, and Katherine Bissett, BA, BSN—also Johns Hopkins health care professionals—aim to work with school-based health centers, primary care providers, insurers, and school districts to design and implement a school-based asthma controller program that will reduce absenteeism and improve outcomes for all kids, regardless of their status or risk factors.
Thomas Cudjoe, MD, GER:
Thomas Cudjoe is a postdoctoral fellow at Johns Hopkins and staple of the Baltimore community, where he serves as a mentor through the Thread: The New Social Fabric program works to fight hunger with Baltimore City Eating Together and leads the Department of Medicine Civic Engagement Initiative.
As a part of the Culture of Health Leaders program, Thomas draws on his medical knowledge, his public health training, and his experiences as a caregiver for his grandparents to develop and disseminate strategies to sustain and improve the well-being of older adults. For Thomas, improving mobility and social engagement are essential to sustaining elders’ physical and mental health, and to ensuring their ability to be the community treasures they truly are.
Advancing Community-Engaged Research
Mar. 1, 2018
The Medical College of Wisconsin (MCW) was recognized as a finalist in the “Community Engagement and Community Service” category for the esteemed Spencer Foreman Award, one of the most prestigious awards given by the American Association of Medical Colleges (AAMC). Each year, two finalists are recognized along with the recipient. Notably, MCW is the only medical school to have been recognized more than once as one of the top three institutions. MCW was the recipient of the inaugural Spencer Foreman Award in 2006.
Dr. Syed Ahmed, MD, MPH, DrPH, is the lead for the Milwaukee Prevention of Opioid Misuse through Peer Training (PROMPT) Clinical Scholars team. Dr. Ahmed and his teammates in the program are using a community-engaged research framework to help prevent opioid-related deaths. The framework emphasizes community stakeholder involvement in all phases of the research, including project/concept development, data collection, and interpretation and dissemination of the results.
“Our Clinical Scholars team is eager to apply community-engaged research methodologies to address the wicked problem of opioid misuse, and it’s an honor to be recognized nationally by AAMC for community engagement,” says Ahmed. “It is my hope that through increased awareness of community-engaged research, more medical students and clinicians will be inspired to learn about community-engaged research and apply this approach in their research.”
Drug overdose is recognized as a leading cause of accidental death in the United States. In Milwaukee County, drug overdose deaths related to opioids increased from 144 deaths in 2012 to 231 deaths in 2015.
Learn more about Dr. Syed Ahmed and the other members of his team by visiting their project page.