November 19, 2018, 10:42 am David Mitchell – Before Karen Isaacs, M.D., M.P.H., went to medical school, she earned her master's degree in public health. Education "etched in my brain" the idea that an individual's health is influenced by many factors other than encounters within the health care system, she said.
"Coming from that training, it's hard to let go of," Isaacs said. "Though sometimes vital, the one-on-one patient-physician interaction in clinic is a small piece of what contributes to health. I've reached the point now where I keep circling back to that idea from public health and wonder how else we can make an impact on people's health and well-being."
Isaacs, a clinical assistant professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill, organized and implemented a health equity curriculum this summer at the New Hanover Regional Medical Center family medicine residency program in Wilmington, N.C. The longitudinal program, supported by an Area Health Education Centers grant, includes four large-group didactic sessions, as well as individual learning tasks embedded into various resident rotations throughout the academic year. Resident input was the impetus for the initiative, and a primary driver was to create a better understanding and utilization of cultural humility in the program.
For the past six years, Isaacs split her time between the residency program and a community-based nonprofit that cares for underserved teens and young adults. This year, she started devoting 100 percent of her time to the residency.
"Seeing the disparities in the community was eye-opening," she said. "I felt like it was something I didn't want to lose touch with after coming to an academic role full time. I wanted to stay abreast of local community dynamics and also continue exploring with residents about different types of vulnerable populations facing disparities."
While Isaacs was launching the residency's health equity curriculum, the AAFP posted a notice that the Academy and Family Medicine for America's Health were seeking their inaugural class of health equity fellows. Isaacs was chosen to participate, along with Michelle Quiogue, M.D., of Bakersfield, Calif., and Paul Ravenna, M.D., of Chicago.
"The timing and opportunity were a perfect fit for me to gain more experience in health equity as I try to teach and lead residents on this issue," Isaacs said.
Isaacs' yearlong fellowship project will involve creating standardized work for clinic-based screening and community referrals for social determinants of health, as well as investigating the role of local lay health workers or navigators for those referral linkages.
As Isaacs alluded to above, social determinants of health include factors that affect health beyond health care settings, such as transportation, food and housing security, and interpersonal safety, among many others.
Isaacs is also drawn to understanding health through the lens of the socioecologic model, a concept of nested levels of interrelated factors that can affect health outcomes, but that also can be targets for health promotion and other solutions -- including at the individual, interpersonal, community, organizational and policy levels.
"There's a lot of untapped leverage for health justice that doctors don't realize we have in our voices and what we advocate for," she said. "I'm interested to see how more doctors will get involved in the future."