A Model to Reduce Health Disparities

Posted in GUMC Stories

Phyllis Magrab, PhD, has administered many grants, large and small — she is an expert at keeping the parts of studies and centers moving together and efficiently flowing in both vision and outcome. But the five-year, $6.1 million award to her and two other investigators from the National Institutes of Health (NIH), announced this summer to establish the Center of Excellence for Health Disparities in Our Nation’s Capital (CEHD), is, in Magrab’s eyes, special — a seminal achievement for Georgetown University and its medical center.

And that is a lot for Magrab to claim. She has spent 45 years at the university, and as director of the Georgetown University Center for Child and Human Development (GUCCHD), is considered a pioneer in changing systems of care for children and youth with developmental disabilities and other special health care needs.

Ensuring quality of life for the most vulnerable amongst us has always been Magrab’s passion, and to her, the CEHD represents that ethos, a philosophy that embodies Georgetown’s culture.

“The Center is so consistent with the Jesuit values of social justice, community engagement, and service learning,” she says. “It embodies all that I have believed in for so long and has such great potential.”

The CEHD is the first substantive outcome from a university-wide initiative, underway since 2010 and formally launched this year, to bring together Georgetown researchers, faculty, and students across the campus who engage in a wide range of projects that seek to address health disparities — locally, nationally, and globally. The initiative was designed to foster communication and collaboration between these diverse groups, and offer a common thread that could tie these projects together. Magrab and Lucile Adams-Campbell, PhD, were tapped to lead the effort to build this Georgetown health disparities community. Campbell, a co-principle investigator of the CEHD grant, is associate director for minority health and health disparities research at the Georgetown Lombardi Comprehensive Cancer Center.

When Magrab and Adams-Campbell then brought researchers who engage in different aspects of health disparities work into one room in order to form a medical center committee, “there was a kind of collective ‘aha’ moment,” says Magrab. “Health disparities resonated because it was a way of crosscutting through people’s work that they may not have seen before, or thought about before,” she says. “Some researchers were doing environmental health, some were working on women’s health, and others working with District of Columbia residents — and they had never been in the same room discussing their work together. Creating this umbrella concept of health disparities helps us all tackle this problem.”

The interaction quickly led to a joint proposal for a health disparities grant from the NIH by Magrab, Adams-Campbell, and Chelsea Kidwell, MD, professor of neurology and medical director of the Georgetown University Stroke Center. It was funded in the first round. “That was amazing because it was our first time writing a grant together. I think we were successful because we could see the synergy within the grant and the center it created,” Magrab said.

Model for D.C. could be national, international template

The vision of the Center of Excellence is to eliminate or dramatically reduce health disparities in Washington, D.C., with a particular focus on minority populations. The grant is divided into four core areas. Perhaps the most visible core is the one that features two research projects — stroke disparity by Kidwell and breast cancer risk by Adams-Campbell. The District of Columbia has the highest rate of breast cancer deaths in the country, and stroke is the fourth leading cause of death.

The community engagement core is led by Carla Williams, PhD, a clinical psychologist at Howard University. The research training/education core trains individuals in both research and outreach in health care disparities, and is led by Bruno Anthony, PhD, director of research and evaluation for the GUCCHD. Magrab leads the grant’s administrative core.

A significant focus within the administrative core is to ensure the CEHD and its core areas integrate cultural and linguistic competence, says Magrab. Leading that effort is Tawara Goode, MA, assistant professor and director of the National Center for Cultural Competence within the GUCCHD.

Goode defines cultural competence as an organization’s capacity to acknowledge and respond effectively to cultural differences, reflect upon and understand the implications of culture, engage in self-assessment, acquire and institutionalize cultural knowledge and skills, and adapt practice and care to the cultural contexts of the patients, families, and communities served.

Linguistic competence is the capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse groups.

The effort to integrate cultural and linguistic competence is pervasive, says Goode. “For example in the research process, this will include the role of cultural and linguistic competence in question formulation, design, theory development, sampling, outreach to and recruitment of subjects, instrumentation, data collection and analysis, dissemination, and translation efforts.”

The CEHD represents a unique and targeted focus on health disparities in D.C., she says. “There are other universities in the District that conduct health disparities research, but we have an opportunity at Georgetown to provide a cohesive effort across all university programs that may provide a national model to reduce health and health care disparities.”

Magrab believes the center may indeed provide a template for health disparities wherever they exist. “The Georgetown initiative spawned this grant, which is a national center that is very focused on D.C.,” she says. “We hope what we learn from the center will be informative on every level, which will help us look at communities that have similar demographics.”

“We want the opportunity to look at these issues on a much broader scale, and that is why this center offers us such a wonderful opportunity,” Magrab says. “Our work will not end here. We need to influence policies at the regional, national, and global levels that best serve the underserved.”

This is part three in a series of stories about the research funded by the National Institute on Minority Health and Health Disparities (P60) grant awarded to establish the “Center of Excellence for Health Disparities in Our Nation’s Capital.”
(Grant #1P60MD006920-01)

By Renee Twombly, GUMC Communications

(Published Dec. 12, 2012 )