Developing Insights into Disparities

    • November 1, 2007

The problem: Race and ethnicity affects how patients and their physicians interact and can impact health outcomes. Some minority patients are distrustful of physicians and may be less likely to take prescribed medications. Patients of all races are most comfortable being treated by a physician of the same race.

Grantee background: "I've always been interested in culture and the effect of social interactions on health," says Lisa Cooper, MD, MPH. "I grew up with people from a lot of different backgrounds."

This may be an understatement. Cooper was born in Liberia, attended high school in Switzerland and came to the United States to attend college at Emory University in Atlanta. Her parents immigrated about the same time, and the family's plans to return to Liberia were aborted by political turmoil there.

Since her father had been a general surgeon, the choice of a medical career seemed natural to her. She was drawn to internal medicine—to studying the interaction between patients and physicians, particularly minority patients—and how this affected their treatment.

"I've found that the issues are similar in the United States and the developing world," she says. "During residency training, I felt minority patients were often misunderstood. There's a lot of blaming patients for their problems by health professionals. As a result, patients don't really feel trusting of the system."

For example, in her research on the treatment of depression, backed by a grant in the Robert Wood Johnson Foundation'sHarold Amos Medical Faculty Development Program (AMFDP), Cooper found that African-American patients frequently are more reluctant than other groups to accept medication, fearing that it might be addictive.

There is also, she says, a greater tendency by African-American patients to see depression "more as a spiritual illness." She said patients from minority groups underrepresented in medicine feel more involved in decisions about their care when they are seeing a doctor of their own race. Also, some aspects of communication are better when the doctor and patient are of the same race, but both African-American and White physicians tend to talk more and dominate the conversation when they are with African-American patients.

While the grant freed her up for her research, it also brought her into a network of people who are committed to the development of physicians and researchers from underrepresented minority groups.

"Just bringing me into that network was like bringing me into a big, extended family," she says. "It opened up a huge number of doors for me. A lot of those people are still part of my professional support system."

"Some were other African Americans or Hispanics, some were [Whites] who felt strongly about this," she says. As an example of the latter group, she cites her program mentor, J. Sanford (Sandy) Schwartz, MD, of the University of Pennsylvania. "He was someone from outside my immediate environment whom I knew I could turn to for advice and support," she says.

The MacArthur award presents Cooper with new opportunities to study culture and health in a broad way and to observe people getting health care in other countries. "I would like to travel back to Africa and possibly to a few places in Europe," she says. "Before it would have been out of the question that I could spend a couple of months somewhere learning more about their health care system and trying to identify particular relationship or communication issues in health care that might be important to address there. Now I might be able to do that."

RWJF perspective: The Harold Amos Program is one of RWJF's oldest programs, having started in 1983 as the Minority Medical Faculty Development Program. It was renamed in 2004 to honor the first African American to chair a department at Harvard Medical School and a former director of the program. The program provides four-year postdoctoral research awards to historically disadvantaged physicians who are committed to developing careers in academic medicine.

"One of the assumptions of the program," says J.A. Grisso, MD, MSc, RWJF senior program officer, "is that if you give leadership opportunities to individuals from underrepresented minorities that they, in their career trajectories, are more likely to take on the issues that are particularly important to vulnerable populations. That has been true for the Harold Amos Medical Faculty Development Program. Individuals who could be outstanding scholars and 'geniuses' in any world and for any issue have very often chosen to address these important issues that we care about at RWJF.

"This is a longstanding program that is very forward-thinking," says Grisso. "It has uniquely engaged individuals who do basic science research as well as those who do health services research, policy and sociological research. People who are completely basic science-oriented are now getting trained in epidemiology and public health and then are starting to talk about the social issues as they might affect biological systems. They are asking questions that are unique in my experience with basic science."

Grisso calls Lisa Cooper's winning of a MacArthur award "doubly important" for the Harold Amos Faculty Development Program. "It is extraordinary because it is not just about her genius and about her being a scholar but it is about the issue that she is addressing that is so important—disparities."

Lisa Cooper, MD, MPH

Lisa Cooper, MD, MPH
Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine