Who you are, what you look like, where you came from, and where you live in the U.S. all have a profound effect on your health and wellbeing. Today, public health professionals are seeking to better understand how issues such as race and culture impact health. One such professional is Alisa Lincoln, professor and director at Northeastern University’s Institute on Urban Health Research and Practice.
At the Institute for Health Equity and Social Justice Research, Lincoln works with interdisciplinary teams of students and faculty to conduct community-partnered research aimed at increasing our understanding of racial and ethnic disparities in health as well as strategies to reduce them.
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“Efforts to promote health equity must include attention to a wide range of factors, similar to how it has been framed for understanding early childhood development, from neurons to neighborhoods,” Lincoln explains. “To be successful, these efforts will require innovative collaborations among people with expertise across a range of disciplines, including medicine and other health professionals, biology, health services and policy researchers, the social sciences, and others, along with active efforts to partner with the communities most impacted by unequal access to individual and community-level resources needed to promote and sustain health. Public health provides a framework for such integrated approaches. Until we address the systematic structural racial inequalities in access to housing, education, employment, and justice, we cannot expect efforts to promote health equity to succeed.”
“There are terrible disparities in everything from the quality of nutrition of the mother to access to prenatal care and safe births to early childhood development, as well as educational and work-related opportunities,” explains Jean McGuire, professor of practice for Northeastern University’s Department of Health Science.
“These all play a role in how we enter the world, how we live in the world, and how we leave the world.”
Racism and Health Inequities
“There is a growing body of research to connect racism to poor health outcomes,” says Neil Maniar, professor of practice and director of the Master of Public Health program at Northeastern University. “There are many ways that race and ethnicity are connected to health. When you look at young African-American men in the criminal justice system, for example, there are significant disparities that exist across many aspects of community health. But beyond that, it is the exposure to racism itself that has a very profound biological impact on the body.”
McGuire concurs. “Weathering the long-term impacts of racism creates stress that translates into metabolic disorders. As people experience degradation and isolation, this imprints itself on the body. This is not going to be solved simply by giving people better health care.”
Some public health professionals are now working on health disparities more broadly, examining issues ranging from whether a community has access to stable, affordable housing to how quickly police respond to calls in the neighborhood. All of these are relevant to thinking about population health. Public health professionals don’t just look at disparities associated with race, ethnicity or class; they look at the structural aspects of those risk. They research and try to find answers to what political, economic, and cultural structures are in place that create or reinforce disparities that result in poor health.
Public health professionals are tackling health disparities from a myriad of fronts. McGuire’s work, for example, explores whether financing changes in healthcare can drive improvements in equity. “The daily experience of racism underlies a lot of health risks, as well as healthcare access and outcomes,” she explains. “Going upstream and addressing social determinants of health can improve the quality of people’s lives as well as healthcare costs and outcomes.”
Culture and Healthcare
Another area that public health professionals often examine when looking at health disparities is how culture impacts one’s health. “Our culture informs so much, from how we value healthcare, to what we’re looking for in a relationship with a healthcare provider, to our willingness to comply with a treatment regimen,” McGuire explains. “There are so many experiences of identity that shape our cultural lens and our economic and healthcare opportunities.”
Carmel Salhi understands these issues well through his research work into how Iraqi and Somali refugees and immigrants in Massachusetts access healthcare systems and the challenges they face.
“One major barrier is navigating a complex new healthcare system,” explains Salhi, assistant professor for the Department of Health Sciences at Northeastern University. “There are many other cultural barriers, however, such as how you interact with a doctor. One issue that comes up often with Iraqi refugees is that they speak about mental health in a different way than a doctor might expect. For example, symptoms of depression might be expressed outwardly, such as through irritability, instead of sadness.”
There is now increasing attention in the public health field on developing responsive and resilient health systems that can help address these nuances to foster greater health equity.
“Oftentimes we think of how we can improve healthcare access for a particular race or ethnicity, rather than how we build systems that are more responsive generally,” Salhi says. “A resilient healthcare system is one that is able to respond to the impact disasters or emerging crises, such as in cases of refugee resettlements. A resilient system can respond to new populations and the many facets that impact healthcare. Further, while refugees might be resettled in areas where rents are affordable, if they don’t have access to appropriate health systems or are in an area where they have no personal connections, that can bring its own challenges.”
A Move Toward Cultural Humility
Until recently, cultural differences in a variety of ethnic groups were addressed through factual knowledge about their cultures and societies. Cultural memos or reports were intended to help one be a more competent healthcare provider.
“The challenge is that this is a very simplified version of anyone’s culture,” explains Salhi. “This cultural competence approach is not a sustainable model to help support people from many different backgrounds. Newer models such as cultural humility teach the provider ways to be open to other people’s identities and to understand the patient-provider relationship differently. For example, in thinking about culture in healthcare delivery, we need to understand power and how it influences communication. This will affect the way that patient interacts with their provider and vise versa.”
There are innumerable ways that public health professionals can work to break down barriers to healthcare and help improve people’s lives. To learn more about how you can help address health disparities with a career in public health, download our guide below.