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Disparity in Medicine: A Reflection by a Minority Physician and Neonatologist

The following manuscript was submitted to the February 2017 Social Medicine Themed Writing Contest.

Is it possible to imagine a world where health disparities didn’t exist? A society where people of all cultures, races, and backgrounds live the same healthy lives as their majority counterparts, practice preventive medicine, and take reasonable precautions against illness and disease.

As a child. I remember being the only African-American student in my advanced classes and becoming aware of the disparities — social, economic, health — that plagued my community. I often questioned why these disparities exist, what resources were available, and what I could do to make a positive difference. As I matriculated through school and medical training, I experienced firsthand the lack of diversity in the medical profession, which may indirectly relate to the lack of effective strategies for adequately addressing these disparities. I was one of only eight African-American students in my medical school class of 214, and now I am a part of the less than four percent of African-American physicians in this country. My personal and professional experiences have further invigorated my passionate interest in public health and to explore effective strategies to reduce health disparities for minority populations in the United States.

In 2005, I had my first real-life introduction to health disparities while living in New Orleans pursuing my undergraduate degree at Xavier University of Louisiana — Hurricane Katrina. I was in my sophomore year of college and had a front row seat to the destruction and devastation that the hurricane had on the city, the community and the country. The public health response to the crisis was sluggish as the residents of the city, the majority of whom were African-American, had been unable to evacuate and were forced to stay and suffer the horrific aftermath of infection, death, and mental illness caused by Hurricane Katrina. In the weeks and months following the hurricane, I listened to numerous stories from survivors and came to realize that the hardships they faced were not solely due to poverty, but the many other factors commonly associated with poverty, that caused such devastating circumstances after the storm. My experiences following the hurricane sharpened my academic lens and ignited an already existing passion to identify societal determinants that create health disparities in this country and find ways to positively influence change.

In medical school. my interest in public health disparities among minorities materialized into a research project. I was able to establish a medical-legal partnership at one of the clinics in downtown Milwaukee, Wisconsin, where I learned about the concept of social determinants of health — access to health care, socioeconomic status, race, education, public benefits — and how they affect the health of populations differently. The pediatric population at the downtown clinic was predominantly from lower socioeconomic groups. The fundamental objective of this program was to radically change health care delivery for vulnerable children by establishing systemic advocacy between lawyers and medical teams to help deal with social determinants that exacerbate health problems for children and families. Before being fully able to participate in the program, I did a literature review to understand the need for a medical-legal partnership in Milwaukee. It was during this process that I found myself delving deep into the overall effects that poverty and classism have on children’s overall health — physical, mental, emotional — in this country. It saddened me to read how the social determinants of health and the existing disparities within the system, established by public policy and societal norms, start their damaging effects so early in childhood. These children, who once wore the unseen tag, “handle with care,” now carried the societal labels — “most likely to be obese” or “most likely to develop hypertension, diabetes, or asthma” — further limiting their ability to be active and productive members of society. I appreciate that there is still much work to be done to ensure that all children, irrespective of their class, social or economic status, receive their deserved right to live healthy lives and have access to resources that will optimize their ability to lead successful lives in this country.

Now as a neonatology fellow, I find that I am most interested in how the care infants and families receive in the NICU can positively affect one or more of the social determinants of health and thereby help to reduce the health disparities within minority communities. My current research project is specific to the low breastfeeding rates among African-American women when compared to other races in the United States. This research is important because low breastfeeding rates have been strongly linked to infant mortality rates. There are many studies that identify that breastfeeding rates are low among African American women. Studies, however, have yet to determine why the rates are so low amongst this population. Many promising theories have been identified that include, but are not limited to: legislative policy, birth characteristics, socioeconomic status, beliefs, social networks, or community. To date, however, the literature is limited in specifying how the social determinants of health relate to disparities in the care that is provided in the neonatal intensive care unit. I hope to be able to answer the more important question — why? Only when the causes of the disparities are identified can the resources be established in the community and across the country to effectively and appropriately address and reduce the disparity of breastfeeding rates for African-American infants.

As an African-American female physician, I have a unique platform that allows me to touch the lives of families in a very dynamic way. In the future, I hope to be significantly involved in research related to understanding and reducing health disparities in minority populations, and in the development and implementation of national and/or international resources that lessen these disparities. This commitment to the research of health disparities, will enrich the impact I have in the lives of the families I interact with daily; in addition to managing the critically acute phase of their lives, I will also be a catalyst for change in the areas of specific health disparities that plague vulnerable and diverse communities.

Image creditMy Blue Girl by Bill Keaggy licensed under CC BY-NC-SA 2.0.

Danisha McCall, MD (1 Posts)

Fellow Physician Contributing Writer

University of California, Irvine School of Medicine

I am a 31-year-old Cali girl born in Santa Ana. I have studied throughout the country, but there is no place like home.