Ongoing health disparities could have catastrophic consequences. U-M Public Health and Nursing leaders are working to prevent them.
By Eric Gallippo | Art by Kara Fields
For many people, the new year marks a time of reflection and renewed focus on their own health and personal well-being. But for a large number of Americans, that’s much easier said than done. Major barriers to quality health care caused by racism, sexism, location, and socioeconomic status prevail, despite decades of research and warnings about the consequences.
The result? “Poorer health outcomes for individuals, significant health disparities for communities, social and economic ramifications for families, challenges in care delivery, and financial challenges for health care systems and insurers,” said F. DuBois Bowman, dean of the School of Public Health and Roderick Joseph Little Collegiate Professor of Biostatistics.
School of Nursing Dean Patricia Hurn echoes those sentiments.
“It’s one of the biggest issues of our time, and if we don’t turn it in a different direction, then the results are going to be potentially catastrophic,” Hurn said.
The challenges are many and complex. But the University of Michigan is dedicated to making a difference by bringing together efforts across campus—and private philanthropy—to not only treat life-threatening diseases, but root out the conditions that make so many people more susceptible to them.
“We’ve got the talent, we’ve got the structures, we’ve got the connections, and we’ve got the supporters, so there’s every reason to take this on,” Hurn said. “It’s a huge, important problem for the future, and we have all the necessary ingredients to make a difference for the country and for the world.”
‘If we’re not trusted, communities won’t engage’
The United States’ health outcomes are among the lowest—with the exception of cancer—for rich countries in a wide range of areas. To improve on this, Hurn said a new paradigm is needed.
“Wouldn’t it be an amazing world if we started to shift our focus away from strictly dealing with care and started dealing with prevention and health maintenance in a very different way than we do today?” she said.
Effective preventative care requires relationships with patients, which can take time, especially after years of living with a system many can’t afford or that hasn’t served them well. Acknowledging biases and what the health system has missed—and still is missing—as a result of them is another part of the equation.
“If we’re not trusted, then the communities won’t engage,” Hurn said. “If you are being disenfranchised from the health care system, or if you are unable to afford it, you are certainly not going to spend time worrying about prevention.”
The social toll
Moving to a prevention model of care means focusing on where people live, work, play, and spend time—the social determinants of health. And disparities among these factors for Black, Latino/Hispanic, Asian American, and Indigenous communities have taken a toll.
As examples, Bowman cited the following:
- Black individuals have double the death rate from avoidable heart disease and stroke compared to white individuals and other racial/ethnic groups.
- In geographic areas with less racial diversity and more income inequity, we see shorter life expectancy, higher rates of obesity, and higher rates of frequent mental distress.
- Premature death from all causes is much higher for Black individuals compared to all other racial/ethnic groups and white individuals.
- In Detroit, where the population is 84% Black, 39.5% of adults have high blood pressure, 8.2% have coronary heart disease (double the national average), and 4.5% have had a stroke—all statistics that are higher than the national average.
To help address these inequalities, the School of Public Health announced two, large-scale initiatives last year: a $25 million Bank of America-funded collaborative effort to improve health outcomes for historically marginalized communities in 11 cities across the U.S., and Public Health IDEAS for Building Health Equity.
For the first initiative, U-M researchers and staff are working with the American Heart Association, American Cancer Society, and American Diabetes Association to focus on the leading causes of death in communities of color, while also improving health outcomes more broadly, including maternal health, mental wellness, and nutrition.
U-M’s involvement is led by Minal Patel, associate professor of health behavior and health education, who said it’s the kind of collaborative effort needed to bring health management out of a vacuum and address the social element along with disease management.
“These leading health agencies are being brought together for the first time to really partner around prevention and more effective management and policy advancement to mitigate adverse outcomes of chronic diseases, especially in marginalized communities,” Patel said.
Bringing together partners like these in a timely way underscores the value of private support.
The Public Health IDEAS for Building Health Equity initiative is co-led by Enrique Neblett, professor of health behavior and health education, who works with the Detroit Community-Academic Urban Research Center to build relationships between academics and community partners.
“We really want community partners to be part of the initiative,” Neblett said. “One of the visions I have is to not only have academics and researchers involved in these conversations, but also to bring in folks who are in Detroit to find out what ideas are most important to the community from a health equity perspective.”
‘A different kind of nurse’
At Nursing, Hurn said the school is “all-in” when it comes to advancing wellness for all, from researchers already working to remove barriers to hiring new health equity scholars.
The school announced a new endowed professorship last October, created by a gift from longtime Nursing supporters Mike (MBA ’79) and Nancy (BS ’75, MBA ’79) McLelland. The McLelland Endowed Professorship will support a faculty member whose research is focused on health equity.
The McLellands were inspired to make their gift by Hurn’s vision for the future of nursing at Michigan and by Nancy’s involvement with Community Volunteers in Medicine, where she serves on the board of directors. Based near their home in the Philadelphia area, the organization works to provide free medical and dental care to people without insurance.
“Just being involved with that, I see in our own community what the need is, and where the inequities are in health care and people’s access to adequate health care,” Nancy said.
And going forward, from their first days in the program, nursing students will be exposed to the scholarship of health equity and learning what that means in health care, Hurn said.
Building a better framework
After studying disparities in hospital treatment and outcomes following COVID treatment, Sheria Robinson-Lane has been on the radar of government health agencies and public servants looking for insights on how to better support communities.
Last October, she was contacted by the Centers for Medicare & Medicaid Services about improving equitable health care delivery within long-term care. To do this, Robinson-Lane, an assistant professor of systems, population, and leadership at the School of Nursing, said equity has to be a formal priority with real benchmarks—not a side conversation that gets picked up and put back down.
“These sorts of equity and equitable decisions have to be built into the framework of organizations,” Robinson-Lane said. “It has to be part of the basic mission and vision of an organization, and it has to have the same standing as any other quality initiative.”