Dec 27 2013
Comments

A Remedy for What Ails the Urban City

By Santa J. Ono and Greer Glazer

Santa J. Ono, PhD, is president of the University of Cincinnati. Greer Glazer, PhD, is dean and Schmidlapp professor of nursing at the University of Cincinnati College of Nursing, and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This piece first appeared in the Cincinnati Enquirer; it is reprinted with permission from the newspaper.

file

The children of poor Cincinnati neighborhoods are 88 times more likely to require hospitalization to treat asthma than their peers across town. That’s an urban health disparity born of unequal access to the kind of consistent, attentive, high-quality health care that renders asthma a controllable condition.

In academic medicine, we chart the credentials of our staff and the test scores of our students. We tout the wizardry of the medical technology we bring to bear on exotic maladies. But too often we lose sight of the fact that the ultimate test of an academic medical center isn’t what’s inside the building, it’s what’s outside. If we are improving the health of the communities we serve, then we are truly succeeding.

By that score, we are falling short.

Collectively, the nation’s medical, nursing, allied health and pharmaceutical schools are not meeting the needs of 30 million urban-dwelling Americans who live in medically underserved neighborhoods. We are—quite simply—not producing enough health care professionals committed to serving the underserved. What’s more, even where care is physically available, too often a cultural disconnection between the provider and the patient limits the efficacy of the treatment.

The phrase “urban health disparity” is a dry, wonkish phrase for this problem. A more compelling name is Kyle Willis—the 24-year-old Amelia father who died for want of antibiotics to treat a toothache. It doesn’t take more than one death to establish the imperative to act—but, of course, there are more. A report from the New York City Department of Health and Mental Hygiene estimates that more than 50,000 deaths each year could be avoided if we simply made preventive health services more widely available in America’s cities.

We can do better than this. Indeed, we must.

Today, the University of Cincinnati is one of five academic medical centers taking part in a National Institutes of Health-funded effort of the Coalition of Urban Serving Universities and the Association of Public and Land-Grant Universities, “Urban Universities for HEALTH Learning Collaborative,” to reduce urban health disparities by asking new questions and redefining what we value.

We know that the health care professionals who affect the most lives—who save the most lives—are the ones willing to serve the underserved. Yet, we could do more to promote this reality in our admissions and training programs in the health sciences.

Now, we find ourselves asking what would happen if instead of reflexively choosing the student who looks good on paper, we chose the student who could do the most good. A holistic admissions standard is not a surrender to marginal talents, it is instead a long-overdue recognition that talent can transcend conventional rubrics of evaluation.

In our nursing program we have students who would not have been admitted in the past who are today among our very top performers in the classroom and in clinical work. These are students who didn’t have the advantage of ACT prep courses, but who do have the knowledge and sensitivities—and what’s more, the inclination—to serve the neighborhoods that need our graduates the most.

We know that students who speak the same language—literally and figuratively—are better able to make the diagnosis and then understand and help overcome cultural obstacles that might keep a patient from pursuing proper treatment. Now we are developing measures of cultural competence to help us understand what it takes not only to provide the prescription but to see that it’s followed.

More than any single innovation, we are committed to following the sum of the evidence. From our initial contact with a student applicant to the eventual health outcomes of our patients and our community, we will relentlessly track what we do. And, we will share what we learn so that we are not all inventing the same wheel at the same time in every urban university in America.

No child should be 88 times more likely to be sick because he or she comes from a poor neighborhood. Yet, ignoring the urban health disparity is a common response. A medical school that lowers the incidence of asthma hospitalizations—or for that matter heart attack and stroke deaths—in the city it serves gets precisely zero ranking points from U.S. News and World Report for its triumphs. We need policy-makers, prospective students, the public at large, and our peer institutions to see the bigger picture and to work with us. Because collaborating in the quest for health equity—to prevent the preventable—is the best medicine.

Tags: Asthma, Barriers to care: financial, Children (0-5 years), Children (6-10 years), Disparities, Human Capital, Medically underserved areas, Nurses, Nursing, Shortage of medical or nursing personnel, Voices from the Field