It has been more than 30 years since the Heckler report(www.cms.gov) offered comprehensive documentation of health disparities in the United States based on race. Yet blacks continue to suffer much higher rates of maternal and infant mortality than their white peers, and significantly higher death rates from heart disease.
"It's a lack of paying attention to the contributors to health disparities that has led to our failure to improve outcomes," said Denise Rodgers, M.D., vice chancellor for interprofessional programs at Rutgers University Biomedical and Health Sciences. "Isn't improving outcomes why we're in this business in the first place?"
Rodgers, who has long been a champion of the underserved,(www.njhealthykids.org) is working to eliminate health disparities and improve outcomes in her community as co-director of the Believe in a Healthy Newark(believeinahealthynewark.org) initiative, which is funded by the Robert Wood Johnson Foundation through a grant from New Jersey Health Initiatives. The initiative has three specific areas of focus in the South and West wards of Newark, N.J.: adverse childhood experiences, food and fitness, and healthy homes.
"As we identify problem areas, we will provide resources to the people who need them," Rodgers said.
According to the CDC,(www.ahrq.gov) 60 percent of factors impacting premature death stem from a combination of social, environmental and behavioral factors, compared to just 10 percent and 30 percent of factors that are related to clinical care and genetics, respectively.
Eighty percent of the students in the two wards are eligible for free lunch and breakfast programs, so the Believe in a Healthy Newark initiative has an impact team evaluating the quality and availability of food in public schools, and will make recommendations based on its findings.
Rodgers said the initiative also wants to implement widespread screening for food insecurity.
"We hope that over time, all people will answer, 'Yes,' to the question, 'Do you have enough to eat?'" she said.
That same impact team also is mapping parks and crime in the city and studying how safety affects people's use of outdoor spaces. The team's long-term goal is to work with residents to make the parks safer and increase utilization.
A second team is working to improve rates of screening for childhood lead exposure and to raise awareness of the availability of abatement programs for lead paint in homes. The same team also is developing parent education information related to asthma.
A third team is working to increase awareness among teachers about adverse childhood experiences and to educate health care professionals about its impact, which may include behavioral problems, higher risk for unsafe sex practices and substance abuse, and shortened life expectancy.
The work is all vital, Rodgers said. "As a country, we seem not to be willing to do the things necessary to ensure that our poorest and most vulnerable people have the same length and quality of life."