Race, economics and medical care focus of conference

Questions of race, socioeconomics and varying levels of medical care were on the minds of more than 300 registered attendees at the fourth annual Texas Conference on Health Disparities, “Targeting Health Disparities Through Prevention.”

Hosted by the Texas Center for Health Disparities and the UNT Health Science Center, the two-day conference brought together guest lecturers from around the country. Dr. Scott Ransom, president of the Health Science Center, captured the conferenceÂ’s theme by asking those present not to focus on whether there is a problem.

“We know there’s a problem,” Ransom said. “But how do we solve these problems?”

Michael Smith, professor and chairman of the Department of Integrative Physiology in the Health Science CenterÂ’s School of Health Professions, served as conference chair this year and said prevention also would be a major theme this year.

“The thread of health disparities pervades the entire health care system,” he said.

Two keynote speakers, Fernando Torres-Gil and Lovell Jones, focused on the future of health care in this nation as it relates to minorities. Torres-Gil, who gave the keynote address on the opening day of the conference, May 28, looked at Latino baby boomers and how aging will change the face of America.

Not only are Americans aging, but the country is becoming increasingly diverse, and minorities may not be in the minority much longer, Torres-Gil said, citing demographics in states like Texas and California, where Torres-Gil is associate dean of academic affairs at the School of Public Affairs at the University of California, Los Angeles and director for the Center for Policy Research on Aging.

Latinos generally live longer than whites or blacks, Torres-Gil said, and yet they also have lower median earnings, are less likely to have health insurance and are less likely to have savings.

“Latinos are least able, financially, to live longer,” he said.

Making up for cumulative disadvantages and disparities, lifetimes of hardships and stresses, is going to be difficult but will benefit other aging adults, though, he said.

“It’s about redefining a policy for the aging of this country and the changing minorities,” he said.

Torres-Gil said there is a moral obligation to take a part in changing the country for the better if we’re a part of it. The same question of morals was raised by Jones, professor in the Department of Health Disparities Research and the Department of Biochemistry and Molecular Biology at the University of Texas M.D. Anderson Cancer Center. Jones gave the keynote lecture May 29 and noted that disparities — like the difference in infant mortality between blacks and whites — have been noticed for decades, if not 100 years or more, and yet nothing tangible has happened to fix it on a large scale.

“The times for niceties are over,” Jones said, saying that trust, respect, communication, partnership, flexibility and knowledge need to be key to everything in health care to move it forward.

Sufficient funding, representing the targeted population and using standards to measure progress are just some of the things that need to be kept in mind to tackle health disparities in a meaningful way, instead of just redefining the problem, he said.

“I know we have problems with this, but sometimes we have to accept the fact that our thought process just doesn’t make sense,” he said.

Prevention strategies in medicine

The first session included copious amounts of data showing the disparities in various sectors of the health care world from all three of its guest speakers. Dr. Ileana Piña, a heart researcher and professor of medicine at the Case Western Reserve University, pointed out the vast differences in care that minorities receive for chronic heart disease. Women also are vastly unrepresented in heart trials, despite heart disease still being the No. 1 killer of women.

Part of the problem, Piña said, is that women and minorities are going to see physicians who do not participate in clinical trials, so it’s integral to capture those doctors and patients to get more data and improve care.

“We have got to do something to bring those docs into research mode. . . . The model of the patient and the provider in the chronic disease model is gone,” she said.

Dr. Roberti Treviño, a private practice physician in San Antonio, founded the nonprofit Social & Health Research Center, which runs the Bienestar school-based diabetes prevention program. Children go through four critical stages of growth that shape their eating habits and the physiology of their fat cells, Treviño said, and through the program he instituted in San Antonio public schools, minority children have been making lifestyle changes. Disparities, he noted, are not necessarily race based, but are often due to socioeconomic issues, which sometimes align themselves with race.

“Race and ethnicity has little to do with this,” Trevino said. “Living in poverty has a lot to do with this.”

Misconceptions abound about health — and health disparities — said Dr. Ralph Anderson, chairman of the Health Science CenterÂ’s Department of Obstetrics and Gynecology, and itÂ’s important to realize that “perception is reality.” Anderson spoke about the concerns regarding the vaccine for human papillomavirus, or HPV. Not only does the vaccine prevent against most types of cervical cancer (other cases of the disease are caused by other strains of HPV not included in the vaccine), but it prevents other cancers as well and has a very low rate of even mild complications.

Despite that, many minority women — who are more likely to get cervical cancer and die of it — are wary of the vaccine due to lack of communication or cultural history or other factors and won’t get it.

“We do have a vaccine that is probably one of the most effective vaccines against very debilitating diseases that we’ve ever manufactured,” he said.

Prevention strategies in the community

The second session of the conference, which took place May 29, looked at how research can do a better job of defining a problem and then work with the people in a community to find solutions.

Sherrie Wallington, who at the time of the conference was a postdoctoral fellow at the Harvard School of Public Health and the Dana Farber Cancer Institute but accepted a faculty appointment with Georgetown University, explained how community-based participatory research (CBPR) will be vital to the fight against health disparities.

CBPR, which involves the community in every stage of research, the dissemination of information and solutions, and support into the future, has already been touched upon in part in the past, Wallington said. She gave some background information about MassCONECT, which made mammograms available to uninsured or underinsured women in Massachusetts and made use of various community leaders.

“As academics, we should not assume we know what’s best for a community,” Wallington said.

Elleen Yancey, director of the Morehouse School of Medicine Prevention Research Center, provided information from her own work regarding HIV and AIDS in black populations around Atlanta. Community leaders were involved in gathering data about the problem, which has been increasing as African-American women are the fastest-growing group of new infections. Not only was information gathered, but her program also organized educational seminars.

“There is no one-size-fits-all in CBPR,” Yancey said, and added that for many years this type of research was seen as not scientifically rigorous enough, there are an increasing number of reputed peer-reviewed journals accepting papers based on these methods.

Avelardo Valdez, a professor at the Graduate College of Social Work at the University of Houston and director of the Office for Drug and Social Policy Research, gave examples of some research done on a community level that focused on substance abuse in U.S. Hispanics. Genes, physiologic factors, personalities and traits, psychosocial and family histories, neighborhoods and society all play a part in the fact that Hispanics have higher rates of drug and alcohol abuse than whites and blacks, Valdez said.

Historically, this wasnÂ’t the case, Valdez said, until changing urban landscapes and laws made drugs like heroin more common in minority neighborhoods and targeted them for punishment. He noted certain peculiarities in data that are still unexplained, though, such as the incidence of disease compared to intravenous drug use.

“We really should have even higher rates of AIDS among Hispanics than we do,” he said.

Exercise is medicine:

Communicating the message

Robert Carter III, a alumnus of the Health Science Center who is now deputy director for Technology of Medical Systems in the Office of the Assistant of the Army for Acquisition, Logistics, and Technology at the Pentagon, started the final session, which focused on something that is beneficial to everyone, regardless of race, gender, socioeconomic status or any other defining factor.

“Exercise is the best medicine around,” Carter said. “We’ve known this for decades, we’ve known this for centuries, we’ve known this for millennia.”

And while starting moderate exercise, like walking, has a profound effect on people who are otherwise getting no physical activity, itÂ’s hard to sell exercise because there are no big companies behind it, Carter said. If a pill gave all the benefits of exercise, it would be aggressively marketed and it would be guaranteed to reach every citizen, he said. Instead, less than half of physicians are even talking about exercise with their patients, he said.

Andrea Kriska, a physical activity epidemiologist and associate professor in the University of Pittsburgh Graduate School of Public HealthÂ’s Department of Epidemiology, pointed out the problem of inactivity isnÂ’t isolated to any one group. Instead, it affects kids and adults of all classes and races, although white socioeconomically advantaged people did more voluntary physical activity.

Programs in communities and schools definitely help with behavior, she said, but the key factor is getting permanent changes.

“This isn’t just about making these improvements,” Kriska said. “It’s about making improvements that can be sustained.”

One issue regarding physical activity is that even exercise professionals have negative perceptions of obese or overweight people, said Tinker Murray, professor in the Health, Physical Education and Recreation Department at Texas State University. These professionals are supposed to lead the way in promoting physical activity, and yet that group is flawed, he said.

“We already have disparities walking out the door,” he said.

Murray, a former high school and college runner, has worked on changing habits in schools and discussed the challenges that come with such programs, such as getting equipment, funding, work incorporated into lesson plans, teacher training, administrative support and more. It may be appealing to focus on a captive audience, like students, but promotion of exercise needs to be throughout all levels of a community, Murray said.

Deborah Young, professor and chair of the Department of Epidemiology and Statistics and affiliate faculty in the Department of Kinesiology at the University of Maryland School of Public Health, discussed physical activity interventions for adolescent girls and noted that there was a decline in activity after programs were complete. This reiterates how difficult it is to find solutions that stick, Young said, and part of that is because more teachers, parents and adults in the community need to use positive reinforcement regarding exercise.

“You would think that it would be easy for a PE teacher to acknowledge enjoyment among their kids,” Young said.