Taking a hard look at health disparities
By Jason Kelly, courtesy of the University of Chicago Magazine
Photo by Drew Reynolds
Monica Vela, MD’93, needs to leave soon for a talk she has delivered dozens of times. She knows the information as well as her own life story. If she forgets a detail, the thumb drive clipped to the lanyard around her neck contains her PowerPoint presentation, with data about health care disparities and the Pritzker School of Medicine course she developed on the subject. As the daughter of Mexican immigrants who settled in Chicago’s Pilsen neighborhood, where the family had limited access to medical care, Vela also has a background that adds first-person witness to the problems she describes.
Fluency with the topic and experience as a speaker does not ease Vela’s anxiety. She’s so nervous about addressing Rush University Medical Center’s health policy faculty that she takes a cab instead of driving herself. Rolling down the window on a humid May afternoon, she holds her hair back to let the wind cool her face. “If you’d have told me ten years ago that I’d be talking to groups of hundreds of people,” Vela says, “I’d have run out of the room.” Part of her still feels that urge.
Instead, half an hour later she stands at the podium at Rush’s Field Auditorium, where about 50 people have gathered over sandwiches and cookies to hear her explain Pritzker’s five-year-old health care disparities curriculum. Using informational maps, Vela, who recently became Pritzker’s associate dean for multicultural affairs, offers the basics about the community the University of Chicago Medical Center serves: four of the city’s five poorest neighborhoods, afflicted with a wide range of public-health problems, surround Hyde Park.
A dearth of health care facilities throughout the South Side compounds those problems. Clustered dots represent the density of hospitals and clinics on the North Side; to the south, the dots become sparse—and those facilities are less accessible by public transportation. High premature-birth rates and diabetes mortality characterize the underserved neighborhoods. Many are food deserts, lacking healthy, affordable fare and contributing to the prevalence of obesity.
Since 2006 Pritzker students have learned about these issues at the beginning of medical school, taking the required health care disparities course at the same time as anatomy. They’re encouraged to develop creative solutions, but first the students have to understand the communities and individuals they’re serving—and themselves.
The incoming students, Vela says, envision themselves as postracial and less susceptible than past generations to prejudices that lead to unequal care. She argues otherwise, insisting that doctors must recognize their biases when treating patients with a different cultural background, financial situation, or sexual orientation. Ignored differences can compromise communication and, by extension, a patient’s quality of care.
Cultural differences color perceptions, as one assignment illustrates. Students write the first word that comes to mind when they hear “physician” and then repeat the exercise using “welfare recipient.” They tend to associate physicians with altruism, intelligence, and wealth. White and male also come up often. Welfare recipients bring to mind poverty, ignorance, and helplessness. Many students think of welfare recipients as African American. “Look at how disparate these two groups are when you think of them,” Vela says to the class. “How are you going to be able to walk into the room as a member of this group and treat a member of this group unless you do a lot of reflective exercise?”
That reflection requires recognizing more than racial or socioeconomic differences. “It’s very easy to think along just racial lines,” says third-year medical student Robert Stern, “but the health disparities class tried very hard to recognize the range of different groups that can be affected by these issues.” Sexuality as a barrier to equal care comes up in the course, for example, as well as the challenges of treating patients who do not speak English. Even bilingual students sometimes find that they have “false fluency,” lacking an understanding of language nuances or cultural resistance to certain types of treatments.
From the beginning, students come up with their own ideas about how to deal with the problems. One group had a friend drop them off in the middle of a poor South Side neighborhood. Their mission: to determine how much it costs and how long it takes to reach Cook County Hospital. After two bus rides, with a one-mile walk in between, and $7.50, they arrived almost three hours later. “If you’re feeling sick,” Vela says, “it’s going to take an awful lot to get to County Hospital.”
Some projects that originate as class presentations continue long after the quarter ends, carried on by the organizers—as their intensifying medical-school schedules permit—and younger students interested in the same topics. The Pritzker Mammography Access Partnership, begun in a 2009, still helps uninsured women locate facilities that offer free mammograms. The Comer Food Project provides meals for families who can’t afford food during their children’s stay at the hospital. And middle-school students learn healthy eating habits from the On a Mission for Nutrition team.
To highlight the health challenges inherent in underserved neighborhoods, Vela tells her Rush audience about a boy who was amazed at a piece of fruit; he told the Pritzker students leading the after-school nutrition program that it was the first time he had seen a fresh peach.
An associate professor of medicine, Vela had believed for years that care inequality needed to be addressed in medical school. She often discussed the subject with fellow UChicago internist and professor Marshall Chin, who has done research on health disparities. If she could choose anything she wanted to have the biggest impact, Chin asked her, what would it be? Vela’s answer: establish a health care disparities class. “I knew right away this would be a perfect fit,” Chin says. “She has just the right set of life experiences to be the leader of this course. She knows what it means to be a minority patient or a patient with limited means.”