An illustration of people of different colors wearing face masks that cover their mouths and noses

Undoing injustice

Fighting health disparities takes a community

By Caroline Kettlewell

This spring, headlines in the U.S. blared a grim statistic: Thanks to the COVID-19 pandemic, average life expectancy in the country had declined by a full year. Not only that, the report from the U.S. Centers for Disease Control and Prevention revealed a more troubling story of inequality in the pandemic’s toll. For Black, indigenous and Latinx Americans, the projected life expectancy decline was far worse than for white Americans — for Black men, it was a full three years.

That the burden of illness and death has been borne unequally across America, however, came as no surprise for Virginia Commonwealth University experts working in the field of health disparities.

The CDC defines health disparities as “preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” Identifying and eradicating these disparities is a monumental challenge, but VCU is committed to the effort. “At its most fundamental, health disparities contribute to a significant difference in quality of life and actual premature mortality,” says Peter Buckley, M.D., dean of the VCU School of Medicine and executive vice president for medical affairs at VCU Health. “That is anathema to health care and to our aspirations to advance the health of the nation and the health of the commonwealth.”

Unequal at birth

A range of groups and individuals suffer these disparities — the elderly, the disabled, racial and ethnic minorities, immigrants, members of the LGBTQ community and those living in underserved rural communities. And a closely related factor, known as “social determinants of health,” influences who’s most likely to suffer most. Income, education level, health insurance coverage, geographical location and transportation access all factor in. But other things, less easily measured — health literacy or living through years of discriminatory housing and education policies — also contribute. The complex interconnection among these varied determinants is evident in the fact that the neighborhood where you are born can set the course of your health for life. In census tracts only a few miles apart in the U.S., life expectancy can differ by as much as 30 years.

“What we see across the board is that these social determinants, regardless of whether you live in the inner city or a rural community, are shaping health outcomes,” says Marcie Wright, Ph.D., administrative director and director of research support services for VCU’s Center on Health Disparities. “If we desire to improve health disparities, we must focus on addressing social determinants.”

The power of partnership

VCU established the Center on Health Disparities in 2005, with the mission of reducing health disparities through research, education and community engagement. It’s the last part of that equation, Wright says, that truly drives the center’s work. “We cannot address health disparities without engaging the community,” she says.

Alisa Brewer, the center’s director of community engagement and outreach, describes a collaborative process that is an ever-evolving effort to meet community needs. One example is the center’s MATCH (Mobilizing Assets to Transform Community Health) program, which matches researchers at the university with needs voiced by the communities to which the center is connected. One success: a National Institutes of Health grant-funded research project addressing preterm birth, which Black women experience at a rate nearly 50% greater than white women. Working with partners including residents of Richmond Housing Authority communities, the Preterm Birth Prevention Project developed workshops, online courses and other educational materials focused on increasing general health literacy along with awareness about preterm birth risks and preventions.

Sandra Smith, who works at Richmond’s Office of Community Wealth Building, says that having access to health and other experts at VCU “has been a pivotal part in what I do with the public. I can always reach out to those in my circle at VCU and get the answer, or get somebody to talk to a group of people and put that seal on ‘what Ms. Sandee just said.’”

Another ongoing project, Log On for Health, empowers people to be their own sources of expertise. Brewer and Dana Ladd, Ph.D. (Ph.D.’16/M), the health and wellness librarian for VCU’s Health Sciences Library, partnered with the city’s East End library branch to offer health and technology literacy workshops. When the COVID-19 pandemic ended in-person workshops, the team pivoted to digital presentations accessible online or by audio phone link.

Arming against the 'infodemic'

The VCU Medical Center Health and Wellness Library is located on the ground floor of the VCU Health Gateway Building, and Ladd’s role there mirrors what she brings to the Log On for Health presentations: serving patients, family members and the community — “anyone who has a consumer health question”— by helping them find “reliable, consumer-level health information in a language they can understand,” Ladd says. While the pandemic closed on-site operations, the library’s information services remain available by email and phone as well as through health and wellness programming via Zoom and community outreach. “What we’re trying to do is reduce the health literacy burden on patients and community members and provide them with the skills they can use to make good health care decisions,” Ladd says.

Nothing has so dramatically emphasized the importance of those skills as the coronavirus pandemic, which Ladd says has been dubbed an “infodemic” for the flood of information, misinformation and dangerously misleading disinformation it has generated. With potential life-and-death consequences for acting on the right or the wrong information, “it has been even more important for people to be able to look at that information and be able to evaluate it critically and decide if it’s information they can trust.” In her outreach, she has worked not only to arm people with the knowledge of what resources they can turn to for reliable information but also to combat the spread of misinformation, particularly on social media, by encouraging them to “critically evaluate and know the accuracy of information before they act on it or share it.”

A trusted resource

The pandemic has also highlighted how trust, or lack thereof, reduces or exacerbates health disparities.

Robert Winn, M.D., was appointed director of VCU’s Massey Cancer Center in December 2019. As the only Black director leading one of the nation’s 71 federally designated cancer centers at the time, Winn came to VCU with two interconnected dreams, he says: to eradicate cancer and to eradicate health disparities.

To achieve either requires addressing both, he says. It’s no coincidence that the communities bearing the highest burden of health disparities in general — including Black, indigenous, Latinx and rural Americans, and those living in poverty — also experience the highest rates of cancer incidence and mortality. And the health care community has only recently begun a difficult reckoning with its implicit and explicit biases and institutional barriers and how these have contributed to inequality.

Massey serves 16 of the commonwealth’s majority-minority communities and 18 of the 26 localities in the state with the highest incidence of cancer rates among Black Virginians, as well as overall cancer incidence and mortality rates that are among the highest in the state. Since assuming his position at VCU, and with the robust support of VCU leadership, he says, Winn has emphasized Massey’s focus on disparities while also working directly to create a new level of connection between the cancer center and underserved communities.

One initiative was October’s 25 for 25: Health Equity and Justice education and fundraising campaign. Over a 25-day period, Massey promoted daily facts, links and resources on disparities while raising more than $100,000 to support cancer health disparities research.

Another is a soon-to-be-launched community seed grant program funded by Massey.

Winn’s personal commitment is “to be much more consistent about reaching out to the community, being much more visible and much more accessible,” he says, as well as “to bring more voices from the community into the cancer center, with fewer middlemen between the community and the cancer center director.”

But the COVID-19 pandemic put an unexpected spin on that commitment. With the realization that coronavirus — and cancer — misinformation and dis-information were putting people’s lives at immediate risk, Massey board member Rudene Mercer Haynes brought together Winn and the pastor of Richmond’s Fifth Street Baptist Church, the Rev. F. Todd Gray, to launch a webcast called Facts & Faith Fridays. “The goal was really simple,” Winn says. “It was to bring internal experts and external experts together every Friday from 3 to 4 p.m. to inform faith leaders about COVID and cancer and other important issues.”

Winn and Gray both say that lives were saved by creating a direct link between experts conveying clear, accurate information about the virus and trusted faith leaders who shared that information with their communities. And the reach of the initiative has far exceeded the original vision: More than 10,000 people tuned in when one of the most well-known public health voices of the pandemic, Anthony Fauci, M.D., director of the U.S. National Institute of Allergy and Infectious Diseases, was the invited speaker.

Both Gray and Winn believe that Facts & Faith Fridays, and its benefits, will endure long beyond the pandemic. “One of the benefits of Facts & Faith Fridays is that we have a representative of the medical community that we can talk with directly,” Gray says, “engendering a relationship of trust.”

Winn agrees. “It has been clear to all of us that having a regular source of trusted information is probably one of the best tools for the community and for the cancer center to really get good, solid, usable information that will have impacts on all our communities.”

A new focus on an old problem

More than a year into the pandemic, experts agree that lessons learned, connections made and collaborations fostered have been positive outcomes. “We have people working together who never would have worked together before,” points out Winn. Another unexpected plus, he adds, is that the necessary turn to digital platforms “meant we were able to engage more people, inform more people, take care of more people.”

There is a concern, however. What if this new awareness of the uneven toll of the virus, and the spotlight it shone on health disparities, fades when life becomes more normal?

“One would hope that even when COVID is over, there will be continued interest in ensuring all people have access to health care,” Wright says. “But we will have to change our approach to include an intentionality on social determinants. Specifically, we should consider key factors like access to health care, education, food deserts, opportunities for employment, living wages — all things that impact health. A silver bullet doesn’t exist. It will take collaboration from all stakeholders to make meaningful progress.” 

– Caroline Kettlewell is a contributing writer for the alumni magazine.