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Addressing health care disparities: Speakers advocate for greater inclusion

VCU health sciences schools shared perspectives on diversity, equity and inclusion throughout fall 2020.

Illustration of racially diverse faces Photo: Getty Images

Health care professionals nationally may be inadequately trained to address gaps in health care affecting underserved communities, according to findings published this summer in a JAMA Network Open paper. VCU’s health sciences schools are working to bridge this gap.

In the fall of 2020, VCU’s health sciences schools initiated several inaugural events to increase awareness of the health care needs of diverse populations and increase opportunities for inclusion and equity in the workforce.

Here, VCU experts and guests invited by VCU’s health sciences schools share their insights regarding the events and the topics explored.

Introducing Inclusive Excellence Week

Carlos Smith, D.D.S., M.Div., VCU School of Dentistry’s director of diversity, equity and inclusion and director of ethics curriculum, held a “Why the renewed focus on DEI?” session on Oct. 19 to introduce the School of Dentistry’s first Inclusive Excellence Week. He walked students, faculty, alumni and dentists through the reasons why diversity, equity and inclusion are essential to improve patient outcomes and access to care.

“We are making great progress in myriad areas concerning our reaffirmation to the values of diversity, equity and inclusion,” Smith said, acknowledging that challenges still lie ahead in the field of health care.

“These efforts touch every facet of our educational enterprise: patient care, policies and protocols, enhancing our curriculum for cultural competence and more comprehensive understanding of health disparities and more. This inaugural Inclusive Excellence Week was designed to serve as an exclamation point for all we are doing. It is a schoolwide opportunity to pause together and take notice of our progress and wins but also our challenges and opportunities.”

Oral health disparities and the Latino community

Dina Garcia, Ph.D., M.P.H., assistant professor in the Department of Health Behavior and Policy at the VCU School of Medicine, spoke on “Oral Health Disparities and the Latino Community” during Inclusive Excellence Week. Her presentation addressed the factors that contribute to oral health disparities among Latino populations in the U.S. and the unique ways dentists and health care professionals can address this challenge.

To address oral health disparities in the Latino community in Milwaukee, Garcia set up The Milwaukee Diabetes & Oral Health Gallery, which displayed art based on Garcia’s research findings to encourage better oral health practices and advocate for improved access and dental coverage. Garcia also focused on challenges that can face some members of the Latino community who may have immigrated to the U.S. It’s important for providers to examine how policies can cause worry, stress or fear among immigrant populations, she stated.

“Policies can also indirectly influence health,” Garcia said. “This includes a broader assortment of social policies that influence the availability of socioeconomic resources that are essential to the production of health. This refers to, perhaps, educational attainment, employment, income, housing, and it also includes things like driver’s licenses. This summer, Virginia became the 17th state to give the right to drive to undocumented immigrants, which indirectly can also be linked to health.” This may make it easier for immigrants and the family members of immigrants to make it to an appointment without the need to rely on public transportation, Garcia said.

Impact of systemic racism in medicine

Randy Vince Jr., M.D., who completed his urology residency at VCU Health in 2019, discussed the pervasive inequalities that exist in health outcomes for Black patients and how the medical community can address them. His Grand Rounds presentation, “The Impact of Systemic Racism in Medicine: A Data-Driven Assessment,” to the Department of Surgery in the School of Medicine on Nov. 5, followed a piece he published in July in the Journal of the American Medical Association on “Eradicating Racial Injustice in Medicine - If Not Now, When?” Robert Winn, M.D., director of VCU Massey Cancer Center, moderated a post-lecture Q&A.

“Systemic racism is different from conscious interpersonal racism, and these are complex issues so they require collaboration across many different scientific fields, many fields outside of science and many people of different races,” Vince said. “Addressing systemic racism is beneficial for the way we practice medicine, outcomes of our patients and society as a whole.”

How a 30-year School of Dentistry international partnership benefits Kuwaiti dental students and Arabic-speaking patients

In 1991, the School of Dentistry established a program for high-performing Kuwaiti students to come to VCU for their undergraduate and dental education — a program that continues today. Hani Al Mazeedi, D.D.S., a 1999 graduate, Nassar Mohammed, D.D.S., a 2018 graduate, and Talal Aburezq, a third-year dental student, offered their perspectives on Kuwaiti students’ contributions to the School of Dentistry and how they have helped Arabic-speaking and Muslim patients in Richmond.

Current student Aburezq and recent graduate Mohammed both mentioned in an Oct. 21 “VCU Kuwaiti Connection” event during Inclusive Excellence Week the privilege they had as Arabic speakers to work directly with Arabic-speaking patients in VCU’s clinical rotations and its walk-in dental clinic.

“We were able to see the patients who preferred to be seen by Arabic providers,” Mohammed said. “At that stage, we’d be able to interact with them, and that made them more comfortable to express their needs. Especially when there is a language barrier to express through a third party or through a medium versus you being the provider who can explain all the steps in the procedure right away, they felt way more comfortable.”

Inaugural School of Medicine Diversity, Equity and Inclusion Annual Lecture

Geoffrey Young, Ph.D., who serves as the senior director for student affairs and programs at the Association of American Medical Colleges (AAMC), returned to VCU School of Medicine as the featured speaker at the “Inaugural School of Medicine Diversity Equity and Inclusion Annual Lecture.” Young served as the School of Medicine’s associate dean for student affairs in the mid-2000s before joining the AAMC.

“Leaders and people of America’s teaching hospitals and medical schools really now have the challenge of working to mitigate and ultimately eliminate the factors that drive racial bias and help manage the social determinants of health like housing, food insecurity, access to transportation and health care,” Young said.

Young spoke about the AAMC’s framework for addressing and eliminating racism. The framework includes individual self-reflection on systemic racism and its presentation in the workplace; anti-racism efforts within the AAMC and the academic medical community; and anti-racism efforts within the broader community.

Inclusion — improving care for LGBTIQ+ patients

Steven Crossman, M.D., associate professor in the Department of Family Medicine at the VCU School of Medicine, shared insights on LGBTIQ+ health inequalities during his Inclusive Excellence Week presentation, “Inclusive of All: Improving Care for LGBTIQ+ Patients.”

During his talk, Crossman highlighted the need for humility and sensitivity in this area. As an example, Crossman mentioned an update to his practice’s form for new patients. With the help of two eager medical students, his team used this opportunity to make new patients of all sexualities and gender identities feel more welcome.

“Our current form provides three different places where our patients have the opportunity to talk to us about sex, sexuality and relationship-related issues that may be important to them,” Crossman said. “We ask them on page 1 about pronouns and name used, in addition to legal name and sex for billing purposes. On the demographic page, we’ve expanded to ask about gender, sex assigned at birth, transgender/transsexual status, sexuality and then later in the form, we have a much more expanded sexual history/sexual health questionnaire. We’ve found that some patients do choose to leave this blank. Most fill it out.

“Our clinicians — not unanimously but the vast majority of them — have felt that this form has been an improvement in helping their patients have an opportunity to communicate some sensitive information and in giving them more information that is relevant to health care, whether it’s health promotion, disease prevention, vaccinations. It has been, in general, a very positively received change.”

Grooming and natural hair discrimination in the workplace

To cap off the School of Dentistry’s Inclusive Excellence Week, Drexel University law professor Wendy Greene, J.D., delivered the week’s keynote address, “DEI and Discrimination — Free the Hair: Locking Black Hair to Civil Rights Movements.” Through her legal scholarship and public advocacy, Greene has generated historic civil rights protections for victims of discrimination in workplaces, schools, public accommodations and housing.

In her presentation, Greene discussed grooming code discrimination and civil rights law — specifically that natural hair discrimination is unlawful race discrimination — as well as “#FreeTheHair,” her awareness campaign of the systemic and global discrimination that African descendants face based on their hair.

“Oftentimes when we think about our appearance expectations and policies, we perceive them sometimes as being harmless,” Greene said. “What I have been doing for nearly 15 years is interrogating the ways in which grooming policies and appearance norms really do bring about a very specific and systematic form of inequality as well as infringement upon our personhood. It does so through the means of enacting and enforcing appearance and grooming mandates or expectations that really bear no relationship to one’s qualifications, our competencies, our performance and our ability to learn and should really have no bearing on whether or not we have access to public spaces.”

The keynote speech was held in partnership with the Office of the Senior Vice President of Health Sciences, the schools of medicine, pharmacy and nursing, and the College of Health Professions.

Equity for women in academic medicine

The Department of Internal Medicine hosted Reshma Jagsi, M.D., D.Phil., as the annual Ellis Lecture speaker on Nov. 11. Jagsi presented on “Promoting Equity for Women in Academic Medicine: An Evidence-Based Approach,” discussing the drivers behind women’s persistent under-representation among medical leaders and innovative interventions to address these challenges. Jagsi is deputy chair of the Department of Radiation Oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. Among the many institutional-level solutions based in evidence that she presented for health systems to improve equity for women, Jagsi proposed evidence-based implicit bias training, cultural transformation, transparent and consistent evaluation, promotion and compensation processes, on-site childcare at conferences and facilitation of the use of travel funds for dependent care expenses and time banking.

“We shouldn’t be focused on individual fixes. We’re not fixing women here; we’re fixing systems,” Jagsi said. “We need to have recognition and changes at the institutional level, including mentorship and sponsorship programs. This is not ‘go find yourself a mentor.’ This is ‘we need programs that actually lead to recognition,’ so that individuals who are providing mentorship are providing protected time and effort for the work that they are doing.

“We also need to promote work-life integration. There are a variety of creative ways to do this. And never has this been more salient than in an era where the pandemic has given us a window into people’s home lives.”

How providers can promote health equity through cultural humility

On Oct. 9, Kupiri Ackerman-Barger, Ph.D., R.N., associate dean for health equity, diversity and inclusion and associate clinical professor at University of California Davis’ Betty Irene Moore School of Nursing, spoke about the importance of cultural humility as a framework for promoting health equity.

In her presentation “How nurses can promote health equity through a framework of cultural humility,” Ackerman-Barger said engaging in lifelong learning, addressing power imbalances and building non-paternalistic community partnerships are vital to working toward health equity on both the individual and organizational level.

“[For] non-paternalistic community partnerships, this means that we develop relationships with communities understanding that communities are experts on what their needs are, what their strengths are and what kind of resources they need,” Ackerman-Barger said. “So rather than going to groups of people and saying, ‘We have this funding, and we’re going to do this thing to help your community,’ it’s saying, ‘We have this funding. How can we be of service to you? You lead, and we will support those efforts that you need.’”

Wright Center mentorships

The C. Kenneth and Dianne Wright Center for Clinical and Translational Research expanded a mentorship program over the summer to include students at Virginia State University (VSU), a historically Black university south of Richmond. Working with professors at VSU, the Wright Center virtually connected students and recent graduates of VSU with doctors and scientists working in health research for informal town halls and one-on-one mentorship programs.

“Engaging with someone in the field you want to pursue is vital, especially during that end-of-college, post-college time,” said Patrick Nana-Sinkam, M.D., a pulmonologist at VCU Health and associate director for career development and mentoring at the Wright Center. “Many students simply don’t have someone to ask about what medical school is like, what academic careers are like.”

Additional events

  • Following the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor and others, the College of Health Professions held a community vigil led by Dean Susan Parish and Angela Duncan, Ph.D., associate dean for diversity, inclusion and equity for the College of Health Professions and School of Nursing, on June 3.

  • The School of Nursing hosted a virtual panel discussion Sept. 14 on Nurses’ Role in Social Justice for Black, Indigenous and People of Color (BIPOC). Danny Mallory, a 2015 B.S. in Nursing graduate from VCU School of Nursing, works in the Medical ICU at VCU Health and was among the panelists who shared insight on dispelling myths and stereotypes that often impact patient care. Kevin Harris, interim and inaugural senior associate dean for diversity, equity and inclusion for the School of Medicine, moderated the event.

  • The Department of Family Medicine and Population Health in the School of Medicine held its 10th annual Clancy A. Holland Lecture, “Developing an Anti-Racism Framework for Family Medicine” on Nov. 6. Danielle Jones, M.P.H., who directs the American Academy of Family Physicians’ Center for Diversity and Health Equity, and Tanya Anim, M.D., who serves as core faculty at the Florida State University Family Medicine Residency Program at Lee Health, shared insights from the AAFP on approaches to policy, education, research and clinical practice related to learning and growth for current and future health care providers.

  • The C. Kenneth and Dianne Wright Center for Clinical and Translational Research on Nov. 10 held its “Black Lives, Black Lungs” event for the community, the first in a series of events on health equity. Nana-Sinkam and VCU Massey Cancer Center Director Robert Winn, M.D., urged health care institutions to partner with their communities to better understand the complexities of health disparities in lung disease screening, diagnosis and treatment. They encouraged health professionals to go out into the community to reach people, to engage in topics such as environmental quality and access to health care, and to enroll more members of underrepresented populations in clinical trials.

  • Sheryl Garland, chief of health impact at VCU Health, spoke to fellow health care providers about why health systems must continue to be engaged in addressing social determinants of health during Understanding Health Care Disparities, GME Grand Rounds, on Dec. 2.