Across the country, local and state leaders are declaring racism a public health crisis or emergency. These declarations are an important first step to advancing racial equity and justice and must be followed by allocation of resources and strategic action, according to the American Public Health Association.
In Georgia, only two governments have adopted this declaration: DeKalb County and the city of South Fulton. Many researchers, policy makers and city governments are looking for engaging ways to educate Georgians on this health crisis.
Dr. Jimmie Smith, administrator at the Macon-Bibb County Health Department and a former Mercer University professor, and Erin Lepp, clinical associate professor and coordinator of community engagement and service learning in the physician assistant studies program in the College of Health Professions, decided to use the Office of Diversity and Inclusion’s “Mercer Mondays” podcast to speak to our Mercerians.
Cultural competency in health care
In collaboration with Dr. Smith, “Mercer Mondays” developed a podcast series to focus on cultural competency in health care. Since National Public Health Week is celebrated April 4-8, the health department wanted to address two critical topics in health care: cultural competency and racism.
Dr. Smith particularly wanted to expand the topic to have a conversation around cultural competency in health care from the perspective of physicians in pediatrics, family medicine, obstetrics and gynecology, dentistry and public health.
In addition to Dr. Smith and myself, panelists include:
- Dr. Monique Davis-Smith, Atrium Health Navicent family medicine residency director
- Dr. Yameika Head, Atrium Health Navicent pediatric residency director
- Dr. Felisha Kitchen, Atrium Health Navicent obstetrics/gynecology residency director and OB-GYN chair
- Dr. Tarem Hendricks, public health dentist in Houston and Bibb counties
Disparities in women’s health
In addition to the series with the Macon-Bibb County Health Department, I had the pleasure of interviewing four soon-to-be graduates of the Mercer University College of Health Professions‘ physician assistant studies combined degree program option. This group of scholars wanted to use the “Mercer Mondays” podcast as a way to address health disparities in Georgia and social determinants of health.
In the first episode, we had an amazing conversation exploring disparities in women’s health with Rose Benavente and Kiesha Johnson. Rose graduated from Emory University with high honors in dance and movement studies. Kiesha earned her undergraduate degree from the University of Florida and her Master of Public Administration in 2012.
Rose’s research topic was “Maternal Health Disparities: Hypertension During Pregnancy as a Public Health Approach to Reducing Mortality.” Maternal mortality is defined as the deaths due to complications from pregnancy or childbirth. Georgia has one of the highest rates of maternal mortality, and rural women in Georgia have significantly higher maternal mortality rate than those who live in metropolitan areas.
Rural Black women have double the maternal mortality rate of rural white women, according to research conducted by Dr. Jacob Warren, Rufus Harris Endowed Chair and director of the Center for Rural Health and Health Disparities, a National Institutes of Health Center of Excellence within the Mercer School of Medicine. Dr. Warren’s research has also established that no rural county in Georgia has a maternal-fetal specialist — a doctor who helps care for pregnant patients who are having complications or high-risk pregnancies.
Keisha took a different approach to women’s health issues and focused on reducing the burden of human immunodeficiency virus, or HIV, infection in Black women. She developed F.R.E.S.H. — Free Relevant Education Supporting Health — a four-session group-level behavioral intervention designed to increase condom use among Black women. To note, Black women continue to be disproportionately impacted by HIV, accounting for nearly 60% of new HIV infections in U.S. women despite making up less than 15% of the female population.
Keisha’s research noted that biological markers, such as HIV testing, and assessments were used to determine the successful implementation and application of the intervention. On March 31, Keisha presented her first HIV research/F.R.E.S.H. session to several community educators, leaders and therapists at The Southern Center for Choice Theory in Pleasant Hill with founders Gloria Cisse and Andrea Cooke, a Mercer alumna.
Health inequities and social determinants
In the second episode, we explored health inequities and social determinants of health with Camille Pillay Warrick and Behetrin Mohammed. Camille is a 2011 graduate of the University of Georgia, where she earned a Bachelor of Science degree. Behetrin is a 2015 graduate of Georgia Tech, where she earned a Bachelor of Science in psychology.
Camille’s research sought ways that physician assistants could incorporate screening for food insecurity into their clinical practice as well as action items that could increase partnerships with communities to address food insecurities as a social determinant of health.
The U.S. Department of Agriculture defines food insecurity as a condition of limited access to nutritious foods that are necessary for an active and healthy lifestyle. As of 2020, the USDA estimates that 38.3 million people living in the U.S. are food insecure. This includes 6.1 million children.
Camille’s senior seminar project revealed that minority populations suffer greater racial disparities in food insecurity when compared to their white, non-Hispanic counterparts. For example, the rate of food insecurity in the white, non-Hispanic population is 7.1% versus 17.2% for Hispanics and almost 22% for non-Hispanic Black people. That is three times the rate as compared to white people.
It also noted that almost 19% of the state of Georgia, or about 2 million people, including 500,000 children, live in areas that lack access to affordable fruits, vegetables, whole grains, dairy products and other foods that make up the full range of a healthy diet. We call those areas food deserts.
In a discussion with Behetrin, she highlighted the impact of health disparities on chronic obstructive pulmonary disease, or COPD, outcomes.
In the United States, COPD is the fourth leading cause of death. There are an estimated 14.8 million individuals living with the diagnosis but just as importantly, an additional 12 million individuals are still undiagnosed. Communities within the lowest socio-economic status are 14 times more likely to have a respiratory disease such as asthma, tuberculosis and lung cancer.
The World Health Organization has established that risk factors such as environmental and occupational hazards affect minority groups and low socio-economic status communities disproportionately. One major cause of this is the historic gentrification and redlining — the discriminatory practice of denying a loan or services to certain areas of a community because of its racial characteristics — of Black, indigenous, Hispanic and other minority neighborhoods. That has displaced these communities into areas with poorer land quality, less access to healthy foods and voter disenfranchisement.
Even when controlling for factors of social determinants of health, research shows socio-economic status disproportionately impacts certain communities. Black and Hispanic individuals, even those with high education levels, had higher exposures to secondhand smoke and were more likely to engage in tobacco or alcohol consumption, possibly explaining the higher incidence of COPD in these populations.
In closing, after several episodes of critical discussion from various experts in public health in higher education, health departments and practitioners, it can be determined that the one of the major indicators of quality of life, mortality, morbidity and life expectancy is race and ethnicity. It is just as important as the other social determinants of health such as education, neighborhood and physical environment, education, food, community and social context, and the health care system.
Research data was provided by Erin Lepp, Kiesha Johnson, Rose Benavente, Behetrin Mohammed and Camille Warrick.