Pre-conference Workshop Aims to Advance Health Equity

Family physicians sat down at the Family Medicine Advancing Health Equity workshop a day before the 2018 AAFP Leadership Conference was held here April 26-28 and discussed important issues of population health.

The goal of the session, hosted by the Family Medicine for America’s Health (FMAHealth) Health Equity team in advance of the AAFP’s combined Annual Chapter Leader Forum and National Conference of Constituency Leaders, is no small task: to prepare participants against injustices caused by health disparities and help them become change agents who lead the way to health equity.

This theme has become a focus of the AAFP with its recent establishment of The EveryONE Project.  

Viviana Martinez-Bianchi, M.D., a member of the FMAHealth Health Equity team, kicked off the workshop by saying that most of the 100 or so attendees in the room became family physicians because of the principle of health equity.

“In our DNA runs the desire to be person-centered, to take care of people of all ages and all life circumstances, to be accountable to our communities, to improve community and population health, to be engaged leaders, to provide continuous, integrated and whole person-oriented care,” she said. “For many of us, family medicine became our vehicle for social justice and health equity.”

Denise Rodgers, M.D., of Newark, N.J., presented the group with the most recent statistical evidence of the health disparities exhibited in the United States, especially between black citizens and all other races.

“We are not talking about (health) equality, we are talking about equity,” she said. “In order to achieve equity, sometimes those who have little have to get more. This is our task; this is our work. If we can go to the moon, we can end health disparities by race, ethnicity and socioeconomic status.”

Following Rodgers’ motivational speech, Jennifer Edgoose, M.D., M.P.H., of Madison, Wis., led attendees in an exercise titled “Beyond Cultural Competency: Power, Privilege and Intersectionality.”

Created by the Safe Zone Project, the Identify Signs 2.0 exercise(thesafezoneproject.com) involved table signs around the conference room with categories including gender, sexual orientation, ethnicity, race, immigration status and religion. Participants were asked a series of questions and then decided which sign best represented their answer.

For example, the first question was “The part of my identity that I am most aware of on a daily basis is…”

For each question, attendees were asked to volunteer to speak about why they chose the sign they did. This elicited emotional and thoughtful responses, which participants were asked not to share outside the room.

During the post-exercise feedback period, multiple participants said they found it difficult to decide how they identified because they hadn’t previously given the question much thought.

The event also included a small-group discussion about where attendees’ medical organizations currently are on a continuum of becoming an anti-racist multicultural institution and what they need to do to improve.

The workshop hosted a three-person panel in which representatives from two local Kansas City patient advocacy groups and the Kansas City Health Department offered their perspectives on partnering to improve health equity.

Panelist Mariana Ramirez is the project director for Juntos at the University of Kansas Medical Center,(juntosks.org) which partners with local underserved Latino communities in Kansas, including recent immigrants, to help eliminate health disparities.

“Being undocumented in this country, especially in these recent years, has been more complicated,” she said. “We would like family physicians to know that some of our community members are experiencing fear and stress, and we want you to be aware of that so we feel safe when we visit you.”

Fellow panelist Hakima Payne is the executive director of Uzazi Village,(www.uzazivillage.org) which was created to decrease maternal and infant health disparities in the urban core of Kansas City, particularly among African-American women.

When asked how the medical community can better serve the African-American community, Payne said a good place to start is with what she described as “culturally congruent care.” For example, she said the local KC Care Clinic(www.kccareclinic.org) uses a community health worker to bridge the gap between the patient and the health care team.

“The (community health worker) advocate who is connecting the community member to the health care system should look like the community member, or share a language, ethnicity or culture with the person being served,” Payne said.

Panelist Rex Archer, M.D., M.P.H., is the director of the Kansas City Health Department,(kcmo.gov) which serves the city’s 480,000 residents.

Archer said family physicians interested in working more closely with their local health departments need to be persistent in communicating with public health officials to make sure that relationship is built through mutual trust.

Ultimately, he said the goal of these relationships in the community should be an actionable, consensus-building community health improvement plan. For Kansas City, the top three issues for that plan are education improvement, violence prevention and economic mobility, he said.

“I have the challenge of an up to 14-year difference in life expectancy in different ZIP codes within my city,” Archer said. “We have an unfortunate, long history of block-busting, redlining practices and racial divides that have challenged and scarred parts of our city. And we still haven’t recovered from that.”

Archer argued that the top 10 leading causes of death in Kansas City aren’t actually causes, but rather symptoms of death.

“The allostatic load or toxic stress that folks are living under messes up their cortisol, norepinephrine and epinephrine, and blood pressure and hemoglobin A1c,” he added.

In their closing thoughts, the panelists offered words of encouragement for the family physicians in attendance.

Ramirez suggested that if family physicians aren’t a part of the communities they serve, they should try to experience the area like their patients do.

“Go where your patients shop; go where they go to the park and buy their food,” she said. “This will be helpful when patients describe the issues they face in their community. Get involved.”

She added that family physicians need to be advocates for all the issues that affect their patients.

“Social determinants of health account for 80 percent of what determines the health of individuals,” Ramirez said. “So, work needs to be done outside the clinic to address these.”

Archer said Kansas City would not have become smoke-free without a family physician advocating to move that policy forward.

“Don’t underestimate what you can do in your community and how you can step forward and lead on different issues,” he said. “Partner with your community and health agency to change the policies in your patients’ community.”

Payne agreed that physician champions are critical in helping communities improve health equity.

“Know that your voice is amplified on a lot of these issues in your community,” she concluded. “Family physicians are in a much stronger position than others to build trust within the community. I encourage each of you to go back to your home communities and throw your authority as family physicians behind your community’s voices.”