Health disparities in the news

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M. Roy Wilson: Lessons from Detroit on racial disparity and St. Louis coronavirus deaths

President M. Roy Wilson wrote an opinion piece about the coronavirus disproportionately killing African Americans. “As of Tuesday, there were 3,407 coronavirus-related deaths in Michigan, with 1,622 in one county alone. That county, Wayne County, is home to Detroit, a city populated 80% by African Americans. By comparison, St. Louis city and county account for 175 of Missouri’s 274 deaths. African Americans are disproportionately represented among the victims. Fortunately, both the number of new cases and hospitalizations have reached their peaks in Detroit, and we are now on the downward side of the curve. Yet, few in Detroit have not been personally impacted by the tragic toll of death among friends and family. I believe that there are lessons to be learned from Detroit’s experience that can help mitigate the death toll in St. Louis’ African American community.”
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Race disparities amid infectious diseases aren't new. It's time we took action | Opinion

Wayne State President M. Roy Wilson wrote an op-ed about race disparities amid infectious diseases and the need to take action. The Centers for Disease Control and Prevention (CDC) recently published data on hospitalizations for COVID-19 across 14 states from March 1-30 in its Morbidity and Mortality Weekly Report. It documented that African Americans accounted for 33% of the hospitalizations but only 18% of the total population in the 14 states. Many states have reported an even starker reality. African-Americans accounted for 40% of COVID-19 deaths in Michigan and 43% in Illinois despite making up only 14% of the population in both states. Such disparities in disease outcome by race are unacceptable, but not surprising. Health disparities by race/ethnicity have existed for a long time in our country.” Wilson continued: “I urge that we focus now on what can be done to narrow this racial disparity in outcomes for COVID-19, starting with a more effective communication effort targeted toward African-American communities.”
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‘We need help’: Coronavirus ‘devastating’ black cities in outstate Michigan

One month since Michigan’s first case of coronavirus, the pandemic is taking a far heavier toll on African-American communities statewide, from metro Detroit to Ypsilanti and Flint to Lansing. Nationwide, African Americans in cities such as Chicago, New Orleans and Milwaukee have been infected at greater rates, while the Associated Press reported this week that African Americans comprised 42 percent of the nation’s deaths where demographic data were made public, some 3,300 of 13,000. “I'm not surprised and in fact I would say that it's expected,” said Dr. M. Roy Wilson, an ophthalmologist and president of Wayne State University. I'm somewhat surprised that people are surprised.” Wilson, who worked on strategic planning on minority health and health disparities at the National Institutes for Health, said poverty and lower levels of education have left more minorities exposed to the virus through jobs that can’t be done from home. African Americans also are more likely to have a harder time with the virus because of underlying health conditions, Wilson said. Wilson said those underlying conditions create a quicker sequence, or cadence, from “morbidity to mortality.”
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Isolating together is challenging – and relationship stresses can affect biological functioning

As the COVID-19 pandemic moves into high gear in Michigan, thousands of frontline hospital workers are facing increasing stress, fatigue and frustration going into the second month of the public health crisis that is projected to kill more than 2,000 in the state over the next several weeks. The COVID-19 pandemic has exposed flaws and vulnerabilities in how government responds to pandemics and how hospitals staff, supply and deliver health care to populations they serve. Some medical experts fear once the current emergency is over, political leaders and hospital executives will go back to bickering over holding down budget deficits and rising health care costs instead of focusing on real solutions. They say permanent changes in health care delivery and financing should be made because future killer outbreaks should be expected. "Inertia is a powerful force. (After a crisis is over), people tend to step back to their baseline position," said Mark Schweitzer, M.D., incoming dean of the Wayne State University School of Medicine. "I hope we learn from this and change." Teena Chopra, M.D., DMC's corporate director of epidemiology, said COVID-19 has exposed Detroit's broken public health system and fragile health care infrastructure. She said high incidence of chronic disease, poverty, low literacy rates and lack of trust in the medical system of many inner-city residents contributes to the high numbers of cases and hospitalizations in Detroit. "We will see even worse than what we are seeing today (last Thursday). We haven't peaked yet. We are going to see a lot of cases; we are going to see a lot more deaths. We are on the exponential phase of the epidemic curve," said Chopra, who also is a professor at Wayne State University School of Medicine.
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Black communities hit harder by coronavirus in Michigan, not just Detroit

Residents of Michigan communities with large African-American populations are disproportionately sickened and killed by the coronavirus, according to a Bridge Magazine analysis of public health data. Detroit, which is 79 percent African American, has 7 percent of Michigan’s population but 26 percent of the state’s infections and 25 percent of its deaths. The outbreak so far is centered in southeast Michigan, as Wayne, Oakland and Macomb have 80 percent of the state’s 9,334 cases as of Wednesday. Bridge’s analysis of public records shows: In suburban Wayne County, communities with the largest black populations — Highland Park, Redford Township, Ecorse, River Rouge and Romulus — have roughly double the rate of infection as the county. In Oakland County, infection rates are highest in majority-black Southfield and suburbs with higher-than-average black populations: Lathrup Village, West Bloomfield and Farmington Hills. In Macomb County, nearly 35 percent of all infections were among African Americans, who comprise less than 15 percent of the county’s population. County maps show the most cases are in southern Macomb including Warren, Eastpointe and Roseville, all of which have a higher percentage of African-American residents. Matthew Seeger, a communications professor at Wayne State University who has worked with the U.S. Centers for Disease Control and Prevention, said public health officials must tailor messages to different audiences by using different media. He said Whitmer, Duggan and Evans have done an “exceptional job” so far.
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Packing ethics into medical students’ global health trips

Medical trainees want to help in less-resourced countries. But short-term programs can misread local needs, overburden hosts, and send students into situations they're not prepared to handle. Here’s how leaders are ensuring ethical, effective experiences. Programs that want to provide effective, ethical experiences should avoid veering toward "volun-tourism," experts say. Instead, they should build solid, respectful partnerships with local communities. Some call this “fair trade education,” borrowing from the “fair trade” concept that promotes equity between producers, who are often from lower-income places, and consumers in higher-income nations. To make sure it was achieving this and other goals, Wayne State University School of Medicine paused its student-run global health trips a few months ago. Until then, the school’s World Health Student Organization would raise funds, buy medicines, and travel to sites in less-resourced countries. “The students would create pop-up clinics” and organize trips with the help of U.S. nongovernmental organizations, explains Ijeoma Opara, MD, who codirects Wayne State’s new interdisciplinary Global Health Alliance (GHA). “It was students’ responsibility to arrange faculty to accompany them on travel as well as faculty in the host country to provide oversight.” Now, though, the school is working on extensive changes. “We want to focus on structured, competency-based learning experiences as well as on developing strong, long-term, bidirectional relationships with faculty leadership in host countries,” says Opara. “Hosts should be fully engaged in program design and defining intended outcomes. Only they really know their resources, their needs, and their capacity." At Wayne State, predeparture trainings include lessons in the history, language, and culture of destinations, combined with modules from the University of Minnesota’s Global Ambassadors for Patient Safety program. Students’ failure to understand local values can inadvertently cause problems for both patients and providers, notes Kristiana Kaufmann, M.D., who codirects the school’s GHA program with Opara.
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Wayne State University launches new Office of Women’s Health

Wayne State University launched its new Office of Women’s Health, a comprehensive approach to improve the health of women overall, through a deep dive into medical research affecting more than half the population of Michigan and the nation, a segment often unintentionally overlooked in research. The Office of Women’s Health marked its official debut with an inaugural symposium Dec. 3 at the university’s McGregor Conference Center that brought together more than 130 researchers from across the university, community and grassroots partnering organizations, and a keynote address from Janine Clayton, M.D. Clayton, the National Institutes of Health’s associate director for Research on Women’s Health and director of the NIH Office of Research on Women’s Health, delivered the address, “Putting Women at Center Stage in Biomedical Research,” the very purpose of the new WSU office. “We have the resources and a wonderful research culture at the university,” WSU President M. Roy Wilson told the attendees. “That, coupled with our concentration on health equity, means we can come together with a focused effort on women’s health.
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Mom’s immune system and microbiome may help predict premature birth

Roughly 10 percent of children worldwide — an estimated 15 million babies — are born prematurely, or before 37 weeks gestation, each year. In developed countries, surviving an early birth has become more likely, thanks to the availability of intensive medical care. More than 98 percent of U.S. preemies survive infancy, according to a study published in the American Journal of Obstetrics and Gynecology in 2016, though as many as 44 percent of the youngest preemies don’t make it. Survival is least likely in nations with the fewest resources. Worldwide, complications associated with preterm birth are the leading cause of death in children younger than 5 years old. Some of the signs of inflammation linked to preterm birth differ from those found during full-term birth, says Nardhy Gomez-Lopez, a reproductive immunologist at Wayne State University. For example, in 2017, she and colleagues reported in the American Journal of Reproductive Immunology that some proteins involved in inflammation, called cytokines, were present at higher than normal levels in amniotic fluid from a subset of women who delivered preterm. The earlier the women delivered their babies, the higher the cytokine levels. Infections, which are present in at least a quarter of preterm births, could be the cause, but inflammation and cytokine levels were also elevated when no infection was found. Part of the problem with developing a predictive test is that preterm labor isn’t just one condition. Thirty years ago, preterm labor was viewed simply as regular labor that happened early, says perinatologist Roberto Romero at Wayne State, who directs the perinatology research branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Although scientists now recognize that the biology of preterm labor is distinct, they still have to grapple with the reality that it varies depending on the underlying cause. Wayne State and NICHD recently released gene activity data from the whole blood of 150 Detroit women, 71 of whom delivered preterm, and encouraged researchers to use the data to find predictors of preterm labor, as part of a crowdsourcing collaboration called the DREAM challenge. The challenge is expected to be completed in January 2020. “We are at the beginning of an exciting period,” says Romero at Wayne State. The field is now equipped to start studying preterm birth as a collection of several different syndromes and seek out treatments to address each one, he says.
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Why are uterine cancer rates rising so drastically in black women?

According to a December 2018 report from the CDC, the number of new uterine cancer diagnoses increased an average of 0.7 percent per year between 1999 and 2015, resulting in an overall 12 percent rise. Rates of endometrial cancer, specifically, jumped 4.5 percent per year on average. The uterine cancer mortality rate increased 1.1 percent per year on average between 1999 and 2016, amounting to a 21 percent leap overall. What’s more, the burden of uterine cancer is greatest for black women, and the disparity is increasing with time. While that same CDC report found that non-Hispanic white and black women had similar incidences of uterine cancer (about 27 cases out of 100,000 people), black women were more likely to be diagnosed with uterine sarcoma, the most aggressive form of uterine cancer, than women of other races, and also more likely to be diagnosed at a later stage than women of other races. Teasing apart the potential reasons behind this disparity is a complex task. The puzzle pieces start to come together when you look at some of the major risk factors for developing uterine cancer. Let’s start with endometrial cancer risk factors. “We do know that obesity is one risk factor,” Michele L. Cote, Ph.D., a professor of Oncology at Wayne State University and associate center director of Cancer Research Career Enhancement, tells SELF. This is because it’s a health condition that can increase the amount of estrogen in your body. Another endometrial cancer risk factor revolves around children. “The more children you have, the lower your risk,” Cote says. Pregnancy increases your output of progesterone, so you might benefit from its protective effects against this cancer. But people are generally having fewer kids these days, Cote explains, including black women. “Unfortunately, we don’t have a lot of research data yet on why black women are more likely to have a more aggressive form of uterine cancer,” Cote says.
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Medical students take to the streets to give free care to Detroit's homeless

Armed with care packages, clothes and clinical supplies, medical students in Detroit are learning outside the classroom. They are putting their knowledge and boots to the pavement, providing free health care to the city's homeless. Each week, students under the supervision of a registered physician or nurse practitioner get on their bikes and look for those in need. Programs such as Michigan State University's Detroit Street Care, Wayne State University's Street Medicine Detroit and the University of Michigan's Wolverine Street Medicine work together to treat as many of the city's homeless as possible. Jedidiah Bell, a fourth-year med student at Wayne State University and president of Street Medicine Detroit, says seeing issues from lack of health care access in his home country of Zimbabwe made him want to participate. "When I moved to the states for university and medical school, I saw the similar things [lack of access] with the homeless population," said Bell. "When I saw street medicine, I appreciated the model of how can we take medical care to the street and build up trust to bridge the gap between the homeless and the medical world." While the programs provide a vital service to the community, Bell says the real-world experience teaches students things the classroom or clinic can't. "It teaches medical students to hone-in on, not just medical conditions of patients, but to be able to sit down and form relationships and discuss other things that might be contributing to [patients'] health but might not come up during a traditional medical encounter." Bell says there's a widespread belief that the "students take away more from people on the streets than they take away from us." Anneliese Petersen, a second-year medical student at Wayne State University and volunteer with Street Medicine Detroit, says the experience also shows upcoming medical professionals another side of health -- the social determinants. "Things that are not strictly medical-based but have a strong impact on health and well-being. Income, access to health care, access to medication, being able to eat well, sleep well, to be able to relax and not be under chronic stress."
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AG's office: Make Your Date didn't pay staff to raise funds

The state Attorney General's Office has found that a nonprofit for a program linked to Mayor Mike Duggan did not compensate staff or contractors to raise money nor did it take in enough funds to require state registration. Attorney General Dana Nessel's Charitable Trust division delved into the fundraising practices of the nonprofit Make Your Date, Inc. The single-page finding issued Tuesday by the Attorney General's Office notes that "it appears this organization does not compensate staff or independent contractors for services related to fundraising." "Additionally, this organization does not solicit or receive contributions in excess of $25,000 in a 12-month period," the letter notes, adding that based on the finding and state laws for charities, registration under the Charitable Organizations and Solicitations Act was not required. Wayne State University noted in a Thursday statement that the attorney general office's analysis included interviews and inspection of documents and "confirmed that its registration exemption status was proper. The attorney general confirmed that the separate nonprofit had not spent or received in excess of $25,000 in a 12-month period," the university's statement reads. "In fact, it spent or received no money." Wayne State on Thursday said that the report reaffirms that the university is the only entity operating the program. "Wayne State is proud of Make Your Date, which a recent study has shown has reduced preterm birth among the program’s clients by up to 37%," the university wrote. "Wayne State University will continue to execute and expand the Make Your Date Program to further reduce preterm birth and improve pregnancy outcomes for women and children in the City of Detroit and beyond."
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Wayne State University pediatrician and professor helps develop policy recognizing racism as a health factor

A Wayne State University pediatrician played a critical role in developing a national policy statement that recognizes for the first time the impact racism has on the health of American children and teens. Lynn Smitherman, M.D., FAAP, assistant professor of WSU Pediatrics, is a member of the American Academy of Pediatrics’ Task Force Addressing Bias and Discrimination. The task force’s work contributed to the policy statement, “The Impact of Racism on Child and Adolescent Health,” issued by the AAP on July 30. The statement is a call for action by the nation’s pediatricians to reduce the impact of racism and improve the health of American children. The AAP believes that racism has a significant impact on children’s health. The academy says that pediatricians must play a part in improving the health condition of children through listening to families, creating “culturally safe medical homes” and by becoming advocates for social justice in their communities. “Eliminating discrimination, racism and bias in the care of our most valuable resource, our children, is a basic tenet to any civil society. Participating in the AAP’s Task Force on Addressing Bias and Discrimination in the care of children was one of the many highlights of my professional career,” said Smitherman, who also chairs the National Medical Association’s Pediatric Section and is the vice chair of Medical Education for the WSU Department of Pediatrics. “Any activity to bring people together and heal the divides of this country are critically important to the well-being and health of the society in general. I was very proud that the AAP took this important position and that I, as a WSU faculty member, was able to contribute.”
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Wayne State/Henry Ford Health System Lead $4 Million Detroit-Based NIH HEAL Initiative

The National Institutes of Health launched the “Helping to End Addiction Long-term Initiative” in April 2018 to improve prevention and treatment strategies for opioid misuse and addiction and to enhance pain management. This initiative aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose, and achieve long-term recovery from opioid addiction. A team of researchers led by Wayne State University this week received one of 375 grant awards across 41 states made by the National Institutes of Health in fiscal year 2019 to apply scientific solutions to reverse the national opioid crisis. This $4 million award, “Dual-orexin antagonism as a mechanism for improving sleep and drug abstinence in opioid use disorder,” will bring together a research team from Wayne State University and Henry Ford Health System to investigate a rigorous treatment method that may offer a new therapeutic approach to reduce opioid addiction relapse. According to Mark Greenwald, Ph.D., principal investigator on Wayne State’s grant and professor and associate chair of research and director of the Substance Abuse Research Division in the Wayne State School of Medicine’s Department of Psychiatry and Behavioral Neurosciences, insomnia is common in opioid addictions and is a major predictor of potential relapse. Current medications to treat insomnia have limited results on relapse and may produce unwanted side effects. “There are FDA-approved medications for treatment of insomnia, but there is an unmet need for alternatives, especially to aid in preventing opioid addiction relapses,” said Greenwald. “The Orexin (OX) system plays a key role in sleep and substance use, and offers promise as a potential alternative to other medications currently used to treat insomnia.
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$3.1 million NIH grant to improve quality of life for African American cancer survivors

African Americans have the lowest survival rate of any racial or ethnic group in the United States for most cancers – a problem that is magnified in southeast Michigan. These differences are often due to socioeconomic disparities that result in unequal access to medical care, health insurance, healthy food and more. African Americans who survive cancer also have the shortest survival of any racial/ethnic group in the United States for most cancers, according to the American Cancer Society. A team of researchers from Wayne State University and the Barbara Ann Karmanos Cancer Institute are investigating the combined role that community, interpersonal and individual influences have on the health-related quality of life for African American cancer survivors, and how those influences create racial health disparities between African Americans and white survivors. The team includes Felicity W.K. Harper, Ph.D., associate professor of oncology in the Wayne State School of Medicine and the Karmanos Cancer Institute; Malcolm P. Cutchin, Ph.D., professor in the Institute of Gerontology and the Department of Health Care Sciences in Wayne State’s Eugene Applebaum College of Pharmacy and Health Sciences; and Hayley Thompson, Ph.D., professor of oncology in the School of Medicine and associate center director for community outreach and engagement at Karmanos. The study, “ARISE: African American Resilience in Surviving Cancer,” is a five-year, $3.1 million project funded by the National Cancer Institute of the National Institutes of Health that aims to identify targets of change and inform the development of interventions to address causes of poorer health-related quality of life experienced by African American cancer survivors.
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Make Your Date Detroit delivers results

Detroit has one of the worst (highest) preterm birth and infant mortality rates in the country, equal to that of some third world countries. With a preterm birth rate of 14.5 percent, Detroit earned an “F” among major U.S. cities for premature births according to the 2018 Premature Birth Report Card from the March of Dimes, the nation’s leading maternal and infant health nonprofit organization. Research has shown that disparities such as racial inequity, poverty, stress, food insecurity, lack of education, and limited access to transportation or health care can contribute to poor health outcomes for mothers and babies. In efforts to quell this epidemic, the city of Detroit has welcomed several initiatives geared towards reducing the city’s infant mortality rate. One such initiative is the Make Your Date Detroit program. Make Your Date Detroit is a Wayne State University organization that is fighting to turn the tide against premature births in Detroit. “African American infants are at a 50 percent greater risk of preterm birth compared to white infants. As a result, African American infants are now more than twice as likely to die as white infants,” says Marisa Rodriquez, director of strategic operations of the Office of Women’s Health at Wayne State University. “African American women are three to four times more likely to die in pregnancy than white mothers. Hispanic mothers and infants are also at greater risk when compared to white women. There are tests and treatments that exist to reduce preterm birth, but many pregnant women do not have access to them. Our program works to make these lifesaving approaches available. What our program and others provide is important in the fight to reduce the very substantial racial and ethnic health disparities that are seen in pregnancy.” Rodriquez says that the Make Your Date program has already begun saving infant lives in a short period. “Make Your Date has been so successful that participating mothers are 37 percent less likely to deliver at under 32 weeks and 28 percent are less likely to deliver at under 34 weeks,” she said. “In a city with such high rates of preterm birth and infant mortality, these results are remarkable. We are very proud that women are delivering healthy babies as a result of this program.”  
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Wayne State looks to ‘reboot’ urban pediatrics program

Wayne State University has created a new practice plan called Wayne Pediatrics, according to Dr. Herman Gray, chair of the new Wayne Pediatrics department. Gray says the department is taking advantage of this opportunity to reimagine how care is delivered to children and their families in an urban setting. As part of that effort, Wayne Pediatrics has created the Urban Children’s Health Collaborative, an initiative to connect urban kids with better health care. Gray also talked about the wider health care disparities that exist, both in Detroit and around the country. “Certainly, poverty and racism are pretty much universally acknowledged as the foundational components of societal disparities,” says Gray. “We believe that being minimized, being disrespected, being uncertain of your place in society induces toxic stress.”
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Michigan doctors reach out to LGBTQ community to narrow health disparities

Roughly 1 in 6 LBGTQ people nationwide report being discriminated against when visiting a doctor or health clinic, while 1 in 5 say they’ve avoided health care because of discrimination fears, according to a 2017 survey of  lesbian, gay, bisexual, transgender, and queer adults. That, in turn, deepens health disparities over a lifetime as patients skip screenings and get less help for chronic conditions and poor health habits, according to an overview of health research by the U.S. Office of Disease Prevention and Health Promotion. From public health clinics to large hospital systems, Michigan’s health care industry is reaching out to close such disparities, from updating forms to accommodate genders beyond “male and female” to adding LGBTQ-specific services. Among the most tangible efforts is the Corktown Health Center in Detroit, which opened in 2017 as Michigan’s first nonprofit health center with a focus on LGBTQ patients. It’s also one of only a few dozen such centers nationwide. As vice chair of education at Wayne State University’s Department of Internal Medicine, which helped establish Corktown Health Center,  Dr. Diane Levine is helping Wayne State’s medical school incorporate coursework, clinical teaching, and even residency slots at Corktown so that medical students today are more aware of the needs of LGBTQ patients tomorrow. The curriculum will mean that new medical students will go from “about two hours” of focus on LGBTQ health in the classroom, to about two dozen hours, she said. Among her presentations, she said, is the genderbread person, to prompt discussion on the interplay of the mind, heart, and reproductive organs. Understanding these basics, she said, is a first step in understanding a patient, she said. “And that,” she said, “is really Doctoring 101.”