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HMSS doctoral student wins AcademyHealth's op-ed contest

Carmen Mitchell, doctoral student in the Department of Health Management & Systems Sciences, was selected as the winner of the AcademyHealth Disparities Interest Group’s first student op-ed contest. These editorial submissions were on any health disparities topic with a focus on specific causes or consequences of disparities and/or solutions with the most potential to reduce disparities.

As the winner, Carmen received free registration for the AcademyHealth 2019 Annual Research Meeting, a certificate of recognition, and her op-ed was published on the Health Affairs Blog and shared with interest group meeting attendees.

Chris Johnson, PhD, Chair, Department of Health Management and Systems Sciences, said, “Carmen is the epitome of a model PhD student and this is quite an honor within our health services research profession. We’re proud of her accomplishment and believe she is a great representation of the school and our department.”

Carmen discovered the contest while browsing through social media. She said, “I actually found out about the contest from Twitter (academic Twitter is the best!) and even though I didn’t have a topic in mind, I immediately knew I wanted to try to go for it, especially since just a few weeks beforehand I had gotten my first-ever op-ed submission published on Inside Higher Ed.”

Health disparities is a focus of Carmen’s and something she feels very passionate about. She explained that through her own experience with disparities, whether through research, the classroom, or just talking to people, she finds that sometimes the conversation can stay surface-level.

“If people don’t have a deeper understanding of the root causes of health that go beyond some of the high level factors (like income), and it can especially be tricky to talk about ways where our own societal systems are actually contributing to those problems (whether intentionally designed to or not). I think if we can have more of those discussions, it can help us move forward in research, policy and intervention designs.”

Carmen was shocked to learn she won and honored to have her op-ed published in Health Affairs while representing SPHIS and HMSS. She added, “While I am very honored, I know these are not new ideas and I’m very grateful to all the scholars—both inside and outside of public health—who have been uplifting these ideas for a long time. Most importantly though, I just hope it can help push the conversation forward a little more.”

The June 2-4, 2019 conference was her first time attending the Disparities Interest Group Session. She looked forward to meeting scholars in the field, including the committee that oversaw the contest as well as learn about the latest developments in the field.

Carmen would like to thank her advisor, Dr. Liza Creel, and Dr. Lauren Freeman, philosophy professor, and Christopher Fleming, Health Affairs Blog Editor, for reviewing and providing feedback on her submission.

Read her editorial on the Health Affairs Blog or below.

To Address Disparities, HSR Students Must Understand Inequity, Not Just Inequality

Carmen Mitchell

I’ll never forget a moment early in my PhD program when, in the midst of a class discussion, I brought up recently published studies showing that black women suffer from higher rates of infant mortality compared to white women, even when controlling for income and education. I vividly remember the pause and facial reaction of my (white male) classmate.

“Really?!”

“Really.”

Too often, research and discussions around health disparities become centered around socioeconomic status; “disparity” becomes a proxy for “poor.” In some ways, this is understandable: socioeconomic status is inextricably linked to health status, and affordable access to care is a major concern in our field and relatively easy to measure.

However, as a black woman, I have heard older family members express their desire to deal with medical problems on their own -- and even die -- before they would be willing to trust a medical provider, because of the systemic racism and mistreatment experienced by our community at the hands of the medical establishment. That’s not an affordable access problem.

Truly foundational to the successful study of health disparities is understanding both inequality, the uneven distribution of resources, and inequity, avoidable differences in care caused by the marginalization or mistreatment of specific groups. Most students can conceptualize the former but many have a very limited understanding of the latter. Health services research is interdisciplinary at its core, which means students arrive in graduate programs with a wide variety of educational backgrounds. While students with degrees in people-centered fields such as sociology, anthropology and psychology often (but not always!) arrive with a strong understanding of the language and frameworks around inequity, students from quantitative-focused fields such as statistics, mathematics and economics may find themselves with less exposure to the topic of systemic inequity. This divergence becomes even more acute when comparing students who identify with a group that has been traditionally marginalized to students who do not.

Many (though not all) health services research doctoral programs integrate population disparities of some kind into the core curriculum, and indeed my own program recently reformed the curriculum to include such a class. However, the learning experiences in inequity and health disparities that most significantly reframed my thinking were opportunities I pursued on my own: participating in my university’s LGBT health certificate program and taking a course outside of my program, on Gender, Race and Culture, taught by a philosophy professor. These experiences, which heavily inform my research, helped me go beyond the statistics of disparities and better conceptualize how unequal systems-including those outside health care-reinforce disparities, which can’t be fixed neatly through initiatives like expanding insurance.

Those of us who understand inequity know that ‘health disparities’ isn’t its own separate category -- it underlies every part of systems research and interventions. We can’t improve the mental health of LGBT youth without understanding the social conditions that lead to those problems. We can’t recommend meaningful policies to address polluted neighborhoods without knowing that the biggest predictor of exposure to pollution is race, not income, and without understanding how policies like redlining created this marginalization.

And can we really talk about combating opioid addiction if we don’t understand the history of criminalizing black and brown drug users? Can we help African-American communities if we aren’t acknowledging that yes, racism itself is the problem?

One good example of the sort of research needed: In 2018, a study was published on the effects of police killings of unarmed black victims on the mental health in African-American communities. When I spoke to Dr. Jacob Bor, an epidemiologist and the lead author on the study (who is not black) and asked him why he had decided to do the study, he spoke about how heightened media focus on shootings of unarmed black people over the past several years had been partially responsible for leading him to the topic. I was happy to hear of Bor’s concern for this problem, but at the same time health services research needs to be proactive, not just reactive, in investigating the causes and effects of inequity.

Instead of just providing a surface-level of understanding of health disparities and differences in health outcomes as they relate to race, gender, sexual orientation, etc., health services research programs would do well to incorporate serious study of inequity as a foundational curricular requirement. As a field, we are well positioned to change the research narrative around health disparities and engage with more complex questions, as Dr. Bor’s study does. But first, we all need to be on the same page.

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