While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
A few decades ago, a middle-aged man arrived at a hospital in Missouri with a septic infection. He lingered in the hospital for months before passing away. One day, Demetrius Chapman, a Robert Wood Johnson Foundation (RWJF) nursing scholar who was working at the hospital at the time, decided to add up how much it had cost to keep the man alive. At $1,500 a day, the hospital bed fees alone surpassed $135,000—and that figure didn’t include additional expenses such as surgery, anesthesia, medication and the use of durable medical equipment.
The simple math added up to an epiphany for Chapman, MPH, MSN, who grew up “dirt poor” in rural Missouri. That kind of money could have worked miracles for the barefoot, hungry children he grew up with in the Ozarks. He asked himself, “How can the health care system find so much money to prolong the end of one man’s life when it cannot seem to find resources to help countless children and families in desperate need of care?” And he wondered what he could do about it.
Chapman soon found an answer. As a public health nurse, he came to realize, he could help exponentially more people at a fraction of the cost to the health care system than he could as a critical-care nurse. He would earn less in his paycheck, he figured, but would gain much more satisfaction in his life by focusing on prevention and helping people stay out of the hospital.
Doing more with less has been a guiding principle for Chapman ever since he left his childhood home where he had lived with his mentally ill mother and an abusive step-father. Chapman’s biological father was a homeless alcoholic who had drifted from the family. He describes his “people” as “the kind of poor that most of America pretends doesn’t exist in the greatest nation in the world, the kind where the favorite child is the one who can steal the most from the grocery store. Their lives are continuously hard and mostly unrewarding, with only hope to sustain their efforts.”
Today, Demetrius Chapman is an award-winning and highly educated nurse who is working to get a doctorate degree in nursing through the RWJF Nursing and Health Policy Collaborative at the University of New Mexico. The program prepares nurses to meet health policy challenges, particularly those facing vulnerable populations. He says it is his roots that have motivated him to help the poor, the marginalized, and the oppressed.
A Long Journey
The journey has been a long and arduous one. On Chapman’s 17th birthday, he moved out of his violent home to live with a high school friend. He went on to earn his high school diploma and became a nurse’s aide, one of very few jobs open to him at the time. Despite its low pay, the job turned out to be a good one: In addition to health insurance coverage, he had access to partial tuition reimbursement, which he used to earn an associate’s degree in nursing. He became a nurse and loved it from the start. “I joke that I became a nurse by accident but I stayed one on purpose,” he says.
Chapman went on to earn a bachelor’s degree in nursing and two master’s degrees—one in nursing science and one in public health—and then took a nearly 50 percent pay cut to become a public health nurse in East St. Louis, a city rife with poverty, crime and poor health. “I grew up so poor I didn’t mind,” he says.
During this period, he managed a child lead poisoning prevention program that received a national best-practices award and drew attention from the governor, who tapped him to lead a safe housing advisory council. He also worked with sex workers, high-risk infants and other marginalized groups. “Man, did I love it,” he says. “Every single day. It wasn’t about treating sick people; it was about keeping people healthy. I was improving people’s lives. Before it had just been about keeping people alive.” This, he says, was more rewarding.
The job was not without its frustrations, though. Many of his clients fell into the black hole of the nation’s health care system. As working poor, they earned too much to qualify for Medicaid coverage but, because they held low-wage jobs, they couldn’t afford insurance on their own. He could help them, but they couldn’t afford or access primary care.
Chapman thought he could circumvent this problem on an American Indian reservation, where all residents are entitled to federally provided health coverage. He was commissioned as a lieutenant in the U.S. Public Health Service, sold his house, and moved to Arizona. “I wanted to be as useful as possible,” he says. “I was more driven to make a difference than I was to stay and work in one place forever. With every move, I thought I could do more good.”
For the next four years, Chapman worked as a public health nurse and HIV/AIDS program manager treating American Indians, who are disproportionately affected by the disease because they have little access to health care services and because their culture can make them reluctant to seek treatment. As a result, American Indians are often diagnosed in the later—and more lethal—stages of the disease.
A senior nurse specialist, Chapman was responsible for HIV/AIDS patients in the Navajo region in Arizona, Utah and New Mexico, an area the size of West Virginia. It was an overwhelming task, he says. The region is enormous, the patients are countless and the social stigma around the disease runs deep. “I encounter patients who refuse to take medicine just because they don’t want someone in the household to discover it, even though they know full well it will significantly shorten their life.”
The only way to adequately address the problem is with comprehensive policy change, he concluded. And he aims to achieve just that. Chapman is starting his dissertation through the RWJF Nursing and Health Policy Collaborative at the University of New Mexico while working part-time at a nearby hospital to support his growing family, which includes three boys adopted out of the foster care system.
When he graduates, Chapman hopes to conduct research for the federal government that can be used to influence policies affecting health care for people with HIV/AIDS. He also wants to study ways to improve the health of children in foster care. “I really feel strongly that some of our policies regarding foster children aren’t in their best interests, and in some ways our system hurts them,” he says.
Wherever he lands, one thing will be certain: Demetrius Chapman will be doing the most he possibly can to help our nation’s most vulnerable people. He can’t imagine doing anything less.
RWJF examines the types of competitive foods - foods and beverages schools offer outside of meal programs - available in our nation's school...
Progress and lessons learned from two programs that seek to advance the impact digital games can have on health.
Joint Commission Resources in Oak Brook Ill., oversaw development and testing of an online course and support materials to improve communica...
The rapid rise of antibiotic resistance can be tracked using ResistanceMap, an online tool that visually highlights regions of the country w...
Report examines, compares and contrasts Massachusetts and Utah health insurance exchanges.
Report examines issues states will face as they integrate Medicaid into the exchange.
This poll shows most Americans believe the quality of U.S. health care is average at best. More than half of American adults surveyed barely...
Want to improve health? Start with where we live, work, learn and play.
Health care reform may create incentives to spur the growth in HDHPs and CDHPs, a move that might help hold costs down?at least for a time.
The authors suggest repairing the health care system by realigning provider incentives, increasing the availability of information with whic...
While the ACA is aimed primarily at improving individual health by increasing access to health insurance, it also contains a number of provi...