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The World Health Organization defines a maternal death as the death of a woman during pregnancy or within the first 6 weeks of the end of pregnancy “from any cause related to or aggravated by the pregnancy or its management,” including a condition that developed before or during pregnancy and was worsened by the physiologic effects of pregnancy. According to Joan Stephenson, PhD, maternal deaths have been increasing in the US since 2000, according to a 2020 report from The Commonwealth Fund. That report also noted that the US maternal mortality rate is double or more the rates of 10 other high-income countries.

As a student at Santa Clara High School, I benefit from learning from peers’ culturally diverse backgrounds as over 50% of my classmates are Hispanic or Filipino. This enriched ethnic environment allows opportunities to learn about different cultural traditions. However, during COVID, I learned more about how many of my classmates suffered specific health disparities attributed to the pandemic. 

Such disparities occur, even though the Santa Clara County Public Health Department Bay Area community works to improve access to care across the extended Bay Area, demonstrated by a new community board, the Race and Health Disparities Community Board, to tackle issues that help create these disparities and identify gaps in our existing healthcare systems and public health programs that leave some community members behind. According to California’s state government Covid-19 tracking, Latino people account for 45.7% of all Covid-19 cases while accounting for less than 39% of the population. When compared to other races such as white people, who account for 25.2% of the confirmed cases but make up more than a third of California’s population. We can clearly see the disproportionate impact the pandemic had on the Latino population of Santa Clara county. It is important to take steps to curb these inequalities and provide people of all races with opportunities to take care of their health and themselves. 

Moreover, my research reveals the diverse efforts the Santa Clara Public Health Department undertakes to conduct specialized health assessments for different racial and ethnic groups, including its Asian and Pacific Islander health assessment that revealed the stark differences between and within certain groups, such as Santa Clara’s Vietnamese community’s overall health and healthcare. Research shows that access is different than the health status and outcomes of South Asian members of the extended community.

I also learned that health disparities occur beyond the Bay Area, as measured by differences in incidence, mortality, burden of disease, and other adverse health conditions. While disparities are often interpreted to reflect differences between racial or ethnic groups, disparities can exist across different groups, including gender, sexual orientation, age, disability socioeconomic status, and geographic location, factors that may shape an individuals’ ability to achieve optimal health.

References:

Mitchelle Pitcher “New Santa Clara County board aims to address racial disparities in health care” 21 Feb 2021 Mercury News.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the US; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington DC: National Academies Press (US); 2017 Jan 11 at: https://www.ncbi.nlm.nih.gov/books/NBK425844/.

https://covid19.ca.gov/state-dashboard/

In the United States, the most watched sport by a large margin is American football. Although the game may be enjoyable to watch and generates 1.8 billion dollars a year, playing the game itself is dangerous. In a new study by Dr. Zachary Kerr, a professor at the UNC Injury Prevention Research Center, found that the number of concussions experienced by high school football players increased exponentially per year. This phenomenon is prevalent amongst college and professional football athletes as well. There is a plethora of injuries that a football player can suffer, but about 10 percent of these are concussions.

With COVID driving a rise in mental health issues affecting students, I explored the effect of school-based wellness centers on high school students and discussed how and why they should be implemented in low-income communities if not already offered.

According to a study by Stacy Hodgkinson PhD, living in poor or low-income households is linked to poor health and an increased risk for mental health problems in both children and adults that can persist across their life spans. Despite this noted need for mental health services, children and families living in poverty are least likely to access high-quality mental health care (Hodgkinson et. al, 2017). Compared to people living in middle or high-income communities, students living in low-income communities are inherently disadvantaged due to a lack of mental health resources, which may result in them developing major psychological issues, such as generalized anxiety disorder or major depressive disorder (MDD). Furthermore, some researchers have found that a fear of stigma is a fundamental cause of health inequalities, demonstrated by poverty stigma is associated with poor mental health among lower income groups (Knifton & Inglis, 2020). Though students in low-income communities are more prone to developing mental health related issues as they develop, they may not choose to seek out care due to its lack of affordability, accessibility, and the overall stigma they attach to such care. 

While these individuals are at a significant disadvantage, school-based wellness centers can serve as an adequate solution to this. Saratoga High School, a public school located in the Bay Area of California, provides a wellness center as a place where students can take short breaks during class, connect with their strengths, and receive mental health support (Saratoga High, n.d.). Such centers, located within high schools, could eliminate issues of accessibility and affordability of mental health resources as they would be available on-demand for all students. Additionally, the stigma surrounding receiving mental health among lower-income students could be reduced, as students see peers utilizing wellness centers services and may feel comfortable using such services themselves.

In all, I believe wellness centers should be implemented in lower-income high schools. Teenage mental health is an incredibly important issue, which should not be ignored, and the growing value of wellness centers can help nullify this issue to some extent.

References

Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving Mental Health Access for Low- Income Children and Families in the Primary Care Setting. Pediatrics, 139(1), e20151175. https://doi.org/10.1542/peds.2015-1175

Knifton, L., & Inglis, G. (2020). Poverty and mental health: policy, practice and research implications. BJPsych bulletin, 44(5), 193–196. https://doi.org/10.1192/bjb.2020.78

Wellness center. Wellness Center. (n.d.). Retrieved June 14, 2022, from https://www.saratogahigh.org/student_life/wellness_center#:~:text=The%20Wellness%20Center%20is %20a,%2D%20receive%20mental%20health%20suppor

During COVID, I noticed family, friends, and members of my extended community in Minnesota find it difficult to handle the strain of COVID-driven social distancing. While I reached out to undertake some service remotely, my work with East Side Elders whereby I help brighten seniors’ days by creating printable coloring books that seniors use to help relieve their stress and reduce isolation has heightened my awareness of some health disparities affecting seniors in our community. 

My research of seniors’ health disparities revealed that disparities occur relating to health access, quality, and sometimes, outcomes. Recognizing that unconscious bias can affect some health systems, improved training to help caretakers develop cultural competence. Nevertheless, addressing health disparities in long-term care, eldercare lags behind and as our senior population increases, this problem is becoming more severe. My research also revealed that religious and cultural differences, mistrust of physicians or medical systems, and poor communication contribute to disparities in end-of-life and palliative care. 

Recognizing the need to improve care, the National Institute of Aging (NIA) has developed an initiative, Goal F, to analyze seniors’ health-related factors — disease burden, diagnosis, response to treatment, quality of life, health behaviors, and access to care among population groups.  As a result, NIA is working to develop some solutions to address health disparities relating to aging, including research on seniors afflicted with Alzheimer’s which is more prevalent among African Americans and Hispanics than other ethnic groups. Also, while women live longer than men, they are more likely to develop osteoporosis or depression. Moreover, social environmental factors such as residential segregation, discrimination, immigration, retirement, education, income, and wealth can impact seniors’ health and well-being. 

Moving forward, various medical organizations continue to work individually and collectively with physicians and medical systems to improve quality care with improved access. In the meantime, consider getting involved with a senior care location near you or reach out and be a compassionate listener for a lonely senior in your community.

References:

Curran, Kathy. “Health Equity – Reducing Disparities in Eldercare.” Journal of the Catholic Health Association of the United States July-August 2019.

National Institute of Aging. Health Disparities and Aging | NIA Goal F. Available at https://www.nia.nih.gov/…/goal-health-disparities-adults.

Figure 1. Old Man looking out a window. Adapted from “Depression in Older Adults,” by Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D., 2021, October, helpguide.org.

With November 20 being the Transgender Day of Remembrance, the American Heart Association (AHA) is drawing attention to unique factors affecting transgender health and related healthcare disparities and poor access to care for transgender people. AHA finds that there are higher levels of heart disease among transgender and gender diverse people that are linked to stresses of experiencing discrimination and poorer health outcomes linked to lack of equitable access for care, as well as transgenders’ higher levels of smoking and obesity. BU Prof. Carl Streed MD., MPH, leads research at the Center for Transgender Medicine and Surgery at Boston Medical Center. Dr. Streed asserts more training is needed for clinicians and healthcare professionals to ensure gender diverse and transgender people feel safe and welcome in healthcare settings, as well as careful screening and management of cardiovascular issues and risk factors. Also, the Accreditation Review Commission for accrediting Physician Assistants now must undertake LGBT curricular content, including learning how to protect sexual orientation and gender identity information in electronic health records and information that allows broader examination in research and public health efforts of the cardiovascular health of LGBT adults. Interestingly, the AHA is expanding its heart-related research to also study brain health and also, tracks how heart disease uniquely affects the LBGTQ+ population. Transgender and gender diverse populations also face unique psychological stressors, including gender non-affirmation, discrimination, concealment of gender identity and violence based on gender identity. These factors contribute to higher levels of stress, which can negatively affect heart health. Also, transgender and gender diverse people who are also part of historically excluded racial or ethnic groups experience multiple layers of stress, such as lower income levels or limited access to to healthcare. References American Heart Association. “Health disparities and equitable access to health care persist with transgender adults” online 17 Nov 2021. American Heart Association. “Gender-affirming hormone therapy may increase risk of high blood pressure” Accreditation Review Commission. Education for the Physician Assistant (ARC-PA), available at http://www.arc-pa.org/wp-content/uploads/2019/04/ARC-PA-Logo-color.jpg.

While trying to develop a basic understanding of applying Big Data, artificial intelligence (AI) and machine learning (ML), I also am exploring how these novel tools can be used to better understand the social determinants of health, with a goal to reduce health disparities. Through my research I am learning how the National Academies of Sciences, Engineering, and Medicine is working with the National Cancer Institute’s Center for Biomedical Informatics and Information Technology to help develop and implement digital capabilities (biomedical informatics, scientific management information systems and computing resources) to identify and help resolve some health disparities.74, 74);” In researching efforts being undertaken by the National Cancer Institute (NCI) I am learning how health disparities are a critical community issue, with lack of equal access to services for all diseases and disorders threaten public health. NCI is working to narrow the gap between individuals who need treatment and individuals who receive treatment to identify underserved populations that can be included in clinical trials for cancer research. This effort will hopefully generate more accurate data to help all people afflicted with cancer.  Additionally, by increasing the size and diversity of clinical trials, scientists will be better able to identify barriers to care, including mistrust, stigma, transportation, or technology such as lack of internet access. As a budding data scientist, I am always interested in exploring different forums to learn how to collect quality data from multiple sources. Also, by linking quality data with demographic information, we can learn more about why some populations are at greater risk for disease and if health disparities increase such risks. Interestingly, the National Association of Engineers Grand Challenges include three medical-related challenges and goals that in turn relate to advancing the field of precision medicine care based on genetics and clinical characteristics. It is exciting to learn how AI and ML models may propel improved platforms to reduce health disparities. Yet, researchers and data scientists, individually and collectively, recognize that in order to use these new tools effectively, such data must be recognized that it “can carry bias [if’ participants are selected that don’t represent a diverse population … If an algorithm is too narrow or too broad it can unintentionally lead to false conclusions].” Moving forward, to improve data for identifying and solving health disparities, data users need to determine whether there are any within the data that could inappropriately impact the model itself, handle missing values, and be conservative to not over-filter data. As a future student majoring in computer science with interest in data science, AI & ML, I am committed to vet diverse ethical challenges and social impacts of modern technologies and how emerging tools are appropriately used to address current and emerging challenges.

References:

Chen, I.Y., Joshi, S. & Ghassemi, M. Treating health disparities with artificial intelligence. Nat Med 26, 16–17 (2020). https://doi.org/10.1038/s41591-019-0649-2

National Academies of Sciences, Engineering, and Medicine 2020. Applying Big Data to Address the Social Determinants of Health in Oncology: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25835.

          There is a history of racist segregation systems implemented in Portland, Oregon . When Oregon became a state in 1859, the constitution stated, “No free negro or mulatto not residing in this state at the time of the adoption of this constitution, shall come, reside or be within this state or hold any real estate, or make any contracts, or maintain any suit therein. …”. Yet, African Americans came to Oregon anyway to pursue a better life. Before the 1960s, Portland, Oregon implemented a redlining system, which was the practice of outlining areas with large African American populations in red ink on maps. These redlined areas were deemed invaluable, or of less worth than areas which were inhabited by white citizens. The Portland Government enforced this practice so that African Americans would suffer lower levels of investment than their white counterparts and be able to only reside in those redlined areas. The gentrification and redlining of Portland rests on a history of economic injustice perpetrated by white figures who had control.

           We see evidence of this originating in 1948, when a flood destroyed Vanport. When this flood hit Oregon, white residents had the option to move while black residents did not. They had the option between leaving Oregon entirely or moving to the Albina district of northeast Portland, the only place at that time where they could reside. They could only reside in Albina due to redlining. Redlining had massive effects on minority communities in the way that banks were loath to provide loans for property inside the red line, claiming the loans were too high risk or were for sums too low to be worth the bank’s effort. The code of ethics of the National Association of Real Estate Boards as well as the Federal Housing Authority(FHA) forbade realtors and bankers from selling or giving loans to African Americans for properties in white neighborhoods as they believed that it would be detrimental to property values. The FHA rated the significance of neighborhoods using maps using a letter scale. All white inhabited neighborhoods received an “A”  while other neighborhoods having Blacks received a “D”. As a result of redlined communities being worth less, landlords often let the property fall, and the health of African Americans as well as other minority groups suffered. From these laws being enforced, minority groups could not afford proper healthcare and lived in undesirable areas where there was heavy pollution and construction. These groups were breathing in toxins that were bad for their health and had no chance in changing this scenario. 

           The issue of gentrification and redlining is slowly being solved. In 1968, the civil rights movement led to the Fair Housing Act which addressed racial discrimination in housing and in 1977, the Community Reinvestment Act was issued to address these racial problems. Even with these Acts passed though, the issue of gentrification still occurs today. If you look at the demographic of homeless in Oregon, African Americans make up above 40% of the homeless population. We are progressing in our way for health equity towards all in Portland, but we still have a lot of work to do.

                                        Work Cited

“History of Racist Planning in Portland.” Portland.gov
        https://www.portland.gov/bps/planning/history-racist-planning-portland.

Johnson, Katharine, and Katharine Johnson (kjohnson@pps.net) teaches at Irvington Elementary School in Portland.
        “‘Why Is This the Only Place in Portland I See Black People?”.” “Why Is This the Only Place in Portland
        I See Black People?,” Rethinking Schools , 24 July 2020, https://rethinkingschools.org/articles/why-is-this-
        the-only-place-in-portland-i-see-black-people-teaching-young-children-about-redlining-4/.

“Racial Inequalities in Homelessness, by the Numbers.” Racial Inequalities in Homelessness, by the Numbers,
        National Alliance to End Homelessness, 16 Oct. 2020,
        https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/. 

As a US Air Force Civil Air Patrol cadet, I periodically volunteer at veteran events. Recently, I became aware that New York has the fifth-largest veteran population in the US (840,000+ veterans), of which 7% are women at 50% are over age 65, and the majority of veterans in New York prefer to receive their health care from outside of the VA.

When researching this issue further, I learned that as our veterans are a vulnerable and growing population, the National Academies of Sciences, Engineering, and Medicine; Health’s Board on Population Health and Public Health is now focusing on several efforts to promote health equity for our military members and our veterans who often experience chronic trauma from their service as well as socioeconomic disadvantages post-deployment that influence their physical and mental well-being – conditions resulting in healthcare disparities.

Several factors contribute to veterans’ poor health and mortality, including higher rates of suicide, homelessness, and mental health issues.  The VA recently examined suicide rates among VA-enrolled veterans from all states (in 2014) and found VA-enrolled veterans account for approximately 18% of suicide deaths among US adults, with higher suicide risk noted among younger veterans (57% higher than rate among active-duty military personnel). Likewise, mental illnesses, including PTSD, depression, substance abuse, and sexual trauma, are more prevalent among the veteran population.

Per the National Health and Resilience in Veterans Study (2013), disparities related to access to and use of healthcare and prevalence of chronic diseases are also present in the veteran population. A review of studies examining racial and ethnic health care disparities in the VA found that relative to white veterans, African American veterans experience lower levels of arthritis and cardiovascular disease management, lower levels of surgery related to cancer and cardiovascular disease, and lower quality of diabetes-related care. Similarly, veteran homelessness is a staggering issue affecting veteran health.

References:

NYS Health-produced snapshot, see New York State Health Foundation at nyshealthfoundation.org.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425844/.

The COVID-19 pandemic has focused the spotlight on many disparities in America, with higher rates of infections and deaths among lower-income populations and communities of color. Infection and mortality rate are not the only disparities apparent in America though. There are many differences in end-of-life care that patients receive based on ethnicity, race, social status, and economic status. While efforts to increase equality should focus on mortality prevention, policymakers and clinicians should also seek to eradicate inequities in end-of-life care. 

End-of-life care takes on many forms depending on socioeconomic class and race. Medicare and Medicaid are the two biggest corporations in end-of-life care for low-income populations. Hospice and palliative care are frequently unavailable to American Indians and Alaska Natives for a variety of reasons. Poverty and geographic isolation are major factors in indigenous communities’ limited access to end-of-life care services, which mirrors greater inequities among rural patients of all races. Many tribal health institutions are also unable to meet the numerous Medicare and Medicaid standards for hospice treatment, leaving patients to rely on outside hospice programs that are typically oblivious to tribe culture and norms about end-of-life care.

Most alarming, research shows that disparities in access to hospice and palliative care result in negative outcomes for lower-income populations and racial/ethnic minorities with serious advanced illnesses. Another factor contributing to this pattern is that hospice and palliative care has traditionally focused on cancer, whereas other illnesses, such as end-stage kidney disease, which has significantly higher rates among racial minorities, can cause symptoms as severe as cancer, but patients with these illnesses are less likely to receive key elements of high-quality end-of-life care.

What can be done? First and foremost, financial access to health-care services must be enhanced. States should eliminate prescription drug caps that prevent proper end-of-life symptom management, and Congress should designate hospice as an essential service required in state Medicaid systems. A road to affordable coverage for undocumented immigrants is also necessary to ensure that they have access to meaningful health care throughout their lives. Second, unlike Medicare, Medicaid’s long-term care function opens up the possibility of extending access to inpatient hospice, a place that provides superior family-reported end-of-life care than hospitals and nursing homes. Because of its long-term care component, Medicaid might possibly assist hospice usage to a higher extent than other programs, given that lack of proper help at home is a key obstacle for many families contemplating hospice. Third, initiatives to make hospice and palliative care more accessible in underprivileged institutions and communities are crucial. The quick deployment of telemedicine during the COVID-19 epidemic indicates a new approach for sending palliative care professionals to rural locations.