Health Disparities: Exposing a Paradox in the Nation’s Capital

Posted in GUMC Stories

The nation’s capital is a paradox. The D.C. metropolitan area is home to four of the nation’s wealthiest counties, according to recent census data, and yet the District leads the country in chronic killers such as cancer, heart disease, obesity and diabetes. 

Health disparities are rampant — in this city, variables such as race, socioeconomic status and even neighborhood are strong predictors of health status. Disparities in care are also prevalent, including limited access to health care and quality care for vulnerable populations such as minorities, women, children, immigrants, the elderly and people with disabilities. 

Building on Georgetown University’s Initiative to Reduce Health Disparities, launched in April 2012, Georgetown University Medical Center (GUMC) convened a panel of experts to explore the topic of “Health Disparities: A Global Problem in our Nation’s Capitol.”

The event, held Oct. 7, was part of GUMC’s highly successful Doctors Speak Out quarterly series.  

Moderated by local news personality Andrea Roane, morning co-anchor of 9News Now and breast cancer advocate, the panel featured three Georgetown experts: Lucile Adams-Campbell, PhD, associate director for minority health and health disparities research, associate dean for community health and outreach, and professor of oncology; Carole Roan Gresenz, PhD, Bette Jacobs Endowed Professor at Georgetown’s School of Nursing & Health Studies; and Phyllis Magrab, PhD, professor of pediatrics and director of Georgetown’s Center for Child and Human Development

All Policy is Health Policy

The panelists uniformly agreed that health disparities cannot be reduced to one demographic group, policy or variable. To the contrary, all policy — whether related to transportation or education or economic development — must be viewed through a health policy lens.  

A neighborhood’s access to healthful foods in the local grocery store, for example, has a direct impact on a community’s health. Whether streets are safe for children to walk home from school will determine the amount of physical activity they get. 

“We call these the social determinants of health — these can include the availability of grocery stores, fast food, walkable streets, schools and the environment. All are important when we think about health outcomes,” Gresenz said. “When there are policy decisions being made in these domains, we need to think about the implications for health policy.”

Adams-Campbell underscored the importance of biological factors, noting for example that ovarian cancer disproportionately affects Caucasian women, and that triple-negative breast cancer claims more Black women’s lives than anyone else. 

But Adams-Campbell, a renowned epidemiologist who last year opened a new Office of Minority Health and Health Disparities Research in Southeast D.C. as part of Georgetown Lombardi Comprehensive Cancer Center, also stressed that the issue of access — or lack thereof — is key to understanding health disparities.  

“Access is huge. We need to export the good science we are doing here on campus to the community,” she said.  “There is a myth that people are not interested in participating in clinical trials or research projects. My feeling is that people will be included if you invite them in and if they can get there.”

Prioritizing Prevention 

Another community-based arm of Georgetown Lombardi overseen by Adams-Campbell, Capital Breast Care Center (new window), is also in Southeast D.C. and provides free breast and cervical screening for women who cannot afford to pay. And the Hoya Clinic, located in the former DC General Hospital, also seeks to remove barriers to access. Run by Georgtown medical students, the after-hours clinic provides free health care to the homeless, underserved and uninsured populations. 

The importance of this type of preventative care must be recognized by the policymakers in the region and in the country, Magrab said. However, merely making the services available does not go far enough, she added. 

“The Affordable Care Act leads us on a new trajectory as a country thinking about how to prevent disease. But having the services exist is not enough; we have to think about how the services are culturally or linguistically appropriate as well,” Magrab said. 

The Human Perspective

The panelists agreed that finding innovative ways to address health disparities is essential from an economic standpoint — ensuring wellness, rather than just responding to acute illness just makes good economic sense from a policy standpoint. 

But it is the human perspective that really drives them to do their work at Georgetown, each concluded. 

“Georgetown is a Jesuit institution with a very deeply ingrained notion of social justice. It is that spirit of social justice that is our higher reason for addressing these issues,” Magrab said. 

Regular attendees of Doctors Speak Out have formed a community-funding organization called Partners in Research. To learn more about this group and the cutting-edge biomedical research the Partners are supporting, click here.

By Lauren Wolkoff, GUMC Communications

(Published October 15, 2013)