A success story of public health
The Atlanta Medical Center Closure Revisited: A White House Adviser Against Inequality in Vaccination Services and Community Health Laws
By February 21, 2021, there was a vaccine shortage at his clinic and he was able to use his political connections to alert the Biden administration. The White House aides were looking for ways to narrow the racial gap in vaccinations when he made the plea for help. “The natural social history of many diseases is that they tend toward inequality, unless you intentionally combat it,” said Dr. Cameron Webb, a pandemic adviser in the Biden administration.
The Trump administration had seemed uninterested in combating those inequities, leaving it up to states. President Biden made closing the gaps one of his top priorities. The White House chief of staff told me the response was built with equity in mind.
During times, the Atlanta Medical Center’s (AMC) downtown hospital, formerly known as Georgia Baptist Hospital, would keep her overnight for monitoring when she was suffering with asthma, diabetes and high blood pressure.
“If you get shot or have an accident or a heart attack at the wrong time of day, it’s a real problem to get from southwest Atlanta to Grady Memorial Hospital in downtown Atlanta,” Rose said. It is an unnecessary struggle.
The decision to close the hospital came as a shock to staff and other people in the city. The newspaper reported the pending closure on August 31.
“Wellstar has operated AMC since 2016, investing more than $350 million in capital improvements and to support sustained operating losses. In the last year, losses have increased due to soaring inflation and decreasing revenue. The pandemic and the intense financial headwinds straining healthcare organizations right now have only made matters worse at AMC,” the nonprofit said in a statement.
The two AMC losses will disproportionately burden Black communities, according to community advocates and health policy experts.
The senior vice president for community health equity at Rush University Medical Center in Chicago told Kaiser Health News in 2020 that it was really criminal to shut down hospitals in Black neighborhoods.
Georgia Republican Gov. Brian Kemp boosted funding to Grady Health in order to “allow Grady to absorb the impact from AMC’s closure and continue providing quality care to new and existing patients.”
In an October open letter to community members, he said that Grady Health would receive more than $130 million in American Rescue Plan funds to add 185 beds to the hospital by the end of 2023.
Nancy Kane, an adjunct professor of management at the Harvard University TH Chan School of Public Health, summarized the precarious state of access to care in Atlanta and beyond the following way.
The residents of these communities rely on hospitals for primary care and other healthcare, and the shutdowns can adversely affect them, sinceWhite and wealthy Americans do not.
Per Wellstar figures cited by the Atlanta Journal-Constitution, of the nearly 4,300 emergency room patients the two AMC locations saw in 2019, north of two-thirds (67.3%) were Black, and more than half (51.5%) were Medicaid and Medicare recipients.
A number of families in south Fulton County have been without a full-service hospital since AMC South closed its emergency center.
The drive from AMC South to Grady could be worse during the peak traffic hours of the day.
Why you have to stay home when you can’t afford it, but you can do it, too: Two years after the closure of the Hahnemann University Hospital
Rose said that Kemp was making a Band-Aid fix on an open wound because his pledge to give more beds at Grady jeopardized the health of residents who lived near shuttered facilities.
“The most obvious consequence is that if you’re in a low-income neighborhood, the distance to care is going to be greater. And if you don’t have a car, that distance can be a big issue,” she said.
Kane said that a number of things are caused by low income and stress. There is higher demand for hospitals in communities of color than there is in other communities. So, it’s a double whammy: You’re sicker, and you have worse access.”
Patients assigned a black doctor were more likely to demand preventative health care services such as flu shots or diabetes screenings when they met in person, according to research by the researchers.
Just two months prior, in June, Philadelphia’s Hahnemann University Hospital, which was the chief teaching hospital affiliated with the Drexel University College of Medicine, announced that it’d be shutting its doors for good.
The nation’s health-care system is described by a professor at the Boston University School of Public Health as “anarchic” over the course of 12 years.
You are hurting people. You’re really hurting people. You’re messing with people’s lives, and you can’t do that. You really can’t do that,” as Phillip Lee, a lifelong DC resident, told the CNN affiliate WUSA in 2019.
Why are tech companies so big? The problem is that the technology sector is too big to fail, and why we can’t afford it, so we don’t
“Declining revenue isn’t an event that comes from Mars. She said that it came from under-investment in the facility. That is part of the problem. It’s not that people say, ‘Let’s not go there anymore.’ It is because they can not get in or the services they need are no longer present in the building and so they choose to go elsewhere.
There are large chains acquiring hospitals in the country. There could be more than 100 hospitals. The office is in St. Louis. The chains have hospitals in a number of states. And the chains no longer have a sense of commitment or loyalty to the local community,” Kane said. If a hospital has lots of Medicaid patients, or not getting enough government support, it will end up being like a poor performer in a portfolio.
In short, because chains aren’t necessarily familiar with the community, they might not have a commitment to it, and state governments aren’t demanding that they pay attention.
The result: Numerous residents will struggle to secure appointments, because metro Atlanta doesn’t have a robust transit system that can get them to other counties.
He told CNN that they were putting profits over people. “We already know that Black people have a lower life expectancy, and suffer from chronic illnesses (at a higher rate). It is going to be difficult for those people to get basic services.
But we could easily repeat the failures of public health if we reproduce the same inequality within the field of technology governance. Commentators often criticize the tech industry’s lack of diversity, but it’s worth noting that America’s would-be institutions of accountability have their own history of exclusion. Many nonprofits say they want to serve marginalized communities. Yet despite being 42 percent of the US population, just 13 percent of nonprofit leaders are Black, Latino, Asian, or Indigenous. While universities celebrate their faculty of color, they don’t make progress in faculty diversity. The year I completed my PhD, I was just one of 24 Latino/a computer science doctorates in the US and Canada, just 1.5 percent of the 1,592 PhDs granted that year. Journalism lags behind other sectors on diversity. Rather than face these facts, many US newsrooms have chosen to block a 50-year program to track and improve newsroom diversity. That’s a precarious perspective to demand information from Big Tech.
In 2019, I started a programme called A Mother’s Heart at the hospital where I work, after observing a high incidence of peripartum cardiomyopathy in Black pregnant people with undiagnosed heart diseases. I set it up to identify people at risk of cardiovascular diseases using grant funding from the New York State Maternity Hospital Quality Improvement Network, multinational manufacturing company Procter and Gamble and TD Charitable Foundation.
I did my residency and fellowship training in Brooklyn, New York, and Newark, New Jersey. I saw how people from the African diaspora who had poor access to health care and lacked insurance had high rates of conditions such as obesity, diabetes, chronic high blood pressure, diabetes, HIV/AIDS and substance-use disorder.
I then worked in West Palm Beach, an affluent urban area in Florida, where I saw a stark difference in how wealthy white women were treated and cared for compared with women in lower socio-economic groups. There seemed to be greater respect for rich white people; they were listened to and offered help, treatment and labour pain relief as soon as needed. But people of colour were labelled harshly because of their social situation. They were stereotyped as lazy, substance-using people and so on, and not listened to.
Black people are more than twice as likely to have underlying conditions such as high blood pressure, diabetes and heart disease that puts them at risk of stillbirths during and after birth. peripartum cardiomyopathy can begin between the last month of pregnant and after delivery, and can be fatal. Black people are also more likely to experience bleeding during pregnancy and premature delivery.
A Mother’s Heart is designed for women from the African diaspora and Latin American countries. We screen pregnant people and include them in the programme if they have a family history of cardiac disease, or if they are overweight. The programme has identified people with cardiac arrhythmia, structural heart defects and other problems. We screen the heart of a fetus in certain cases, and check nutrition, fitness levels, and genetics.
The incidence of cardiovascular deaths in Lincoln has been reduced over the last year due to the programme. For example, there have been no cases of postpartum cardiomyopathy or undiagnosed cardiovascular decompensation, symptoms that indicate that the heart can’t support proper circulation.
We should research the effects of using medical support staff in order to improve Black maternal-health outcomes.
It’s also worth looking at parts of the world that have better maternal-health outcomes and learning from them. In contrast to people in many countries, a lot of people in the United States do not have access to low-cost health care during the postpartum period. Almost half of US births are covered by Medicaid, which provides free or low cost health care for people who can’t afford it. Researchers say that, to catch more medical problems earlier, Medicaid should provide financial cover through at least the ‘fourth trimester’, or the first three months of the baby’s life, and ideally up to a full year after birth. Congress approved an extension to the Medicaid program for one year after birth, as well as 27 states having adopted such plans so far. Each state has different policies on health-insurance coverage for fourth-trimester care, which leaves many people vulnerable.
It is difficult to change the hearts of people, especially when it comes to changing how they think about certain groups. Compensating or disciplining physicians financially for the health outcomes of Black patients could be an excellent way to keep them mindful of how racism and bias lead to poor results.
It happens over the course of the journey to becoming a doctor, according to the man. Exposure to the sciences, science education resources, mentors and role models make it more likely that a child could become a doctor at a young age, but there are disadvantages to such exposure and resources being accessible in the Black community.
And from the research perspective, if you are familiar with a particular set of issues because you are from the same background as the participants, then you can address nuances in your research more readily and build rapport and trust.
Medical School Diversity in States with Discriminating Races and Ethnicities: A Case Study Among Abraham Dill and Samuel Adebagbo
Adebagbo, who was born in Nigeria and grew up in Boston, said that as a child, she often saw tensions between certain aspects of Western medicine and beliefs within Nigerian culture. She wanted to have the expertise to bridge those worlds and help translate medical information, for her loved ones and for herself.
He wanted to go into medicine so he could help resolve that tension and know what it was like.
“I know what to ask for on the patient side if I’m worried about something for myself. Adebagbo said that it was also for his family. If you don’t have a family member in medicine, you have to move in a different style than a Black person that does.
Adebagbo can connect with patients of color in her rotation because of this. She tries to empower them to advocate for themselves in the health system because she knows their encounters with her are brief.
“We can improve our admissions to medical school, make them more holistic, try to remove bias from that, but that’s still not going to solve the problem,” Dill said.
Between 1868 and 1904, seven medical schools were established specifically for Black students. The two remaining schools are Howard University Medical School in Washington and the Meharry Medical School in Nashville.
Smith received his MD in 1837, returned to New York City and went on to become the first Black person to own and operate a pharmacy in the United States, and to be published in US medical journals.
Among Black men, “there were declines in health utilization, increases in medical mistrust and subsequent increases in mortality for about the 10- to 15-year period following the disclosure event,” when the true nature of the study was exposed in 1972, said Dr. Marcella Alsan, an infectious disease physician and professor of public policy at Harvard Kennedy School.
A study published last year in the Annals of Internal Medicine showed that states that ban affirmative action programs affect medical school diversity. There were data on 21 medical schools in eight states that had affirmative action bans. Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington.
The study found that the percentage of enrolled students from underrepresented racial and ethnic groups was on average about 15% in the year before the bans were implemented but fell more than a third by five years after the bans.
Among White students, 2.3% left medical school in the academic years of 2014-15 and 2015-16, compared with 5.2% of Hispanic students, 5.7% of Black students and 11% of American Indian, Alaska Native, Native Hawaiian and Pacific Islander students, the study found.
“Despite the discomfort that may arise on the giver of feedback’s side, it’s necessary for the growth and development of students. You’re hurting that student from becoming a better student on that rotation, not giving them that situational awareness that they need,” she said. “That’s what ends up happening with students of color. No one tells them, and it seems as if it’s a pattern, then by the end of the rotation, it becomes, ‘Well, you’ve made so many mistakes, so we should just dismiss you [for resident trainees] or we can’t give you honors or high pass [for medical students].’ I don’t know
Adebagbo said, “He has been the first site director who has legit listened to me, my experiences navigating third year as a Black woman and tried to understand and put it in perspective – a privilege I’m not afforded often.” “He made making mistakes, growing and learning from them a safe and non-traumatizing experience. Not everyone may understand the depths of what I’m saying, but those who do will understand why I was so grateful for that experience.”
Source: https://www.cnn.com/2023/02/21/health/black-doctors-shortage-us/index.html
Where do I fit? A conversation with Howard: “There’s no place like me, but there is an alternative,” says Dr. Barouch
During those strenuous days at Johns Hopkins University, when all-night study sessions and grueling examinations were the norm, his mind whispered: Where do I fit?
Howard, now a 43-year-old ob/gyn in New Jersey, reflects with pride – and candor – on the day in 2009 when he completed his doctoral degrees, becoming both an MD and a PhD.
The second question is more focused on where a location is than it is on where an existing location is. It helps me answer my question of ‘how do I fit?’ if I show my relationship with existing labels and systems rather than within them. Howard wrote.
He explained that despite the challenges and realities of the field today, he fit wherever and even if he did not like it, he was always shaping his space and resisting assumptions. I finally have an answer for my question, I do not fit, but I am here anyway.
The United States has made “some progress” with diversity in both clinical medicine and research – but diversity in medicine is still not at the point where it needs to be, said Dr. Dan Barouch, a professor at Harvard Medical School and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, who has been an advocate for diversity and inclusion.
One example of broken trust between physicians and Black patients happened in the 1930s, when the US Public Health Service and the Tuskegee Institute launched an unethical study in which researchers let syphilis progress in Black men without treating them for the disease. The study ended in 1972.
Black men and Black women are six to fourteen times as likely to die of HIV than White men and White women are, because of the lack of effective antiretroviral therapies. But Black people with HIV got such therapies significantly later when they saw White providers, compared with Black patients who saw Black providers and White patients who saw White providers in a study published in 2004 in the Journal of General Internal Medicine.
Source: https://www.cnn.com/2023/02/21/health/black-doctors-shortage-us/index.html
Creating a Healthy Digital Environment for the 21st Century: The Impact of Public Health on the U.S. Health Care System and Society
The more the health care workforce reflects the community it serves the more open the patient population is, according to a doctor.
In the Northeast, the South and the Midwest, the diversity of the health care workforce did not match the populations, as evidenced by the number of emergency departments that she has worked in.
The research has shown a difference in how well patients do, how healthy they are, and how long they live. This is one of the most effective places to make a difference in the United States at the moment when social justice is in the forefront.
The tech industry, like public health, has encoded inequality into its systems and institutions. In the past decade, pathbreaking investigations and advocacy in technology policy led by women and people of color have made the world aware of these failures, resulting in a growing movement for technology governance. Industry has responded to the possibility of regulation by putting billions of dollars into tech ethics, hiring vocal critics, and underwriting new fields of study. Scientific funders and private philanthropy have also responded, investing hundreds of millions to support new industry-independent innovators and watchdogs. I’m excited about the growth of these institutions, as a co-cohort of the Coalition for Independent Tech Research.
Through 150 years of public institutions that serve the common good through science, public health has transformed human life. In just a few generations, some of the world’s most complex challenges have become manageable. Millions of people can expect safe childbirth, a water supply that is reliable, and a healthy diet. In the US, people that were born in 2010 or later will live a longer life than people who were born in 1900.
Inspired by the success of public health, leaders in technology and policy have suggested a public health model of digital governance in which technology policy not only detects and remediates past harms of technology on society, but also supports societal well-being and prevents future crises. Public health also offers a roadmap—professions, academic disciplines, public institutions, and networks of engaged community leaders—for building the systems needed for a healthy digital environment.
Algorithms of Oppression: a Black Hole Journey through the Black Mass Era in the 21st Century (with a special emphasis on algorithms of suppression)
Computer scientists had already been studying search engine filters for decades when it came to racism. It took another decade for Noble’s work to reach the mainstream through her book Algorithms of Oppression.
