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SUNY Downstate Medical Center

Brooklyn Health Disparities Center

Spotlight On…

Awards

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Dr. Ruth Browne

Ruth C. Browne, ScD, MPH, MPP, Co-Director of BHDC and chief executive officer of the Arthur Ashe Institute for Urban Health, was awarded the 2013 Lewis and Jack Rudin Prize for Medicine and Health, at the New York Academy of Medicine, December 11, 2013. As part of her presentation, Dr. Browne commented, "I want to acknowledge the Institute's 20 year academic partner, SUNY Downstate Medical Center. Together we have built a national model for universities in partnership with communities."



New Collaborations

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Dr. Daniel Cukor

Dr. Daniel Cukor was appointed Research Scientist for the Center in the Fall of 2013. Dr. Cukor is also an Associate Professor in the Department of Psychiatry and Behavioral Science at SUNY Downstate Medical Center and is SUNY Downstate's Networks of Excellence Presidential Scholar.

Dr. Cukor received his Ph.D. in Clinical Health Psychology from Ferkauf Graduate School/Albert Einstein College of Medicine at Yeshiva University (2002). He did a post-doctoral fellowship in cognitive behavioral therapy treatment and research at Downstate Medical Center. He has authored many articles and reviews in the field of behavioral medicine and sought after speaker in the field of psychonephrology. He was recently appointed as SUNY Downstate's Networks of Excellence Presidential Scholar.

Research Interests:

His current research interests are well aligned with those of the Center and are focused on behavioral medicine and affective disorders, as well as adherence to medical prescriptions. The bulk of his research has focused on the complex relationship between depression and end stage renal disease. He has received grant support for his research from Downstate Medical Center, the American Psychological Association and the National Institutes of Diabetes and Digestive and Kidney Diseases and Mental Health.


Community Partners

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Maha Attieh
Health Program Manager, & NY State of Health IPA / Navigator
The Arab-American Family Support Center

Question: How have you and The Arab-American Family Support Center (AAFSC) been involved with the roll out of the Affordable Healthcare Act (ACA)?

First, I think it is a great time to talk about ACA to bring awareness and to get ready for the next enrollment period. I also want to say it's great to partner and work with Arthur Ashe Institute and the Brooklyn Health Disparities Center's wonderful professional staff and volunteers that are involved in the work we do. We have greatly appreciated being part of great coalition and committee.

The Affordable Care Act (ACA), also known as (OBAMA Care), is simply a Health insurance program for people who don't have health insurance in United States, (sad to say it is not for undocumented immigrant groups). Some of the states adopted the program on the state level while other states went for Federal level involvement. New York has a state controlled program called NEWYORKSTATEOF HEALTH (NYSofHealth).

It's very important for people to know that, by law, you must have health insurance or you will pay a penalty when you file for taxes. There are different programs and plans that you can be enrolled in depending on income and family size. Programs include Medicaid and Child Health Program, private plans, employer plans or Qualified Health Plan (QHP/Obama Care plan). You can choose the level of monthly premium you can afford (plus extra expenses like deductibles and co-payments).

The Arab American Family Support Center, a not for profit organization, was the only Arab American Agency (CBO) granted the opportunity to become a Navigator site for the NYSofHealth. In September, I was trained and certified as an in person assistor and Navigator to help the clients from every community especially the Arabic speaking to apply for health insurance.

The first enrollment period was from October 1st 2013- to March 31st 2014. We did not know what to expect or the number of people that would show up for enrollment. As "word of mouth" information spread about our ACA services, responses were high and our office was packed, but we survived. As a result, 600 clients have health insurance for 2014 in NYC & Long Island (only 50 people on QHP the rest on Medicaid program). Of the 351 applications, 281 were completed with assistance in the Arabic Language).

In April I had the chance to attend The Asian & Pacific Islander American Health Forum (APIAHF) ACA conference in California representing our state lead agency The Coalition for Asian American Children and Families ( CACF) and I was able to speak on behalf of every immigrant community about challenges and strategies that might be used to help them.

Other services we provide at the heath program include access to health care for our community clients with providers who speak their language, workshops on areas of health disparities like Breast Cancer, Colon Cancer, Drug overdose and more, for other programs and services at our agency please check our web site at www.aafscny.org

The next ACA enrollment period will be November 15, 2014 - February 15, 2015. We encourage everyone who is not already insured to seek further information about ACA.


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Joan Peters, Executive Director BCID
Brooklyn Center for Independence of the Disabled

Joan Peters presented on the issues associated with being a disabled person who is also a member of a racial and/or ethnic minority group at BHDC's November 2013 Journal Club meeting. Her presentation led to innovations in training SUNY Downstate Medical Center students.

Peters highlighted health disparities as a major issue among people with disabilities. Nationally, adults with disabilities report fair or poor health more frequently than Hispanics or blacks. Obesity is higher among people with disabilities, as are diabetes, stroke, and coronary heart disease. Peters commented, "Being Deaf shouldn't intrinsically put you at a higher risk of heart attack." Women with mobility impairments have a much lower adjusted odds ratio of pap smears than other women. Being in a wheelchair affected the diagnosis of and treatment decisions for women with early-state breast cancer.

Disability Prevalence in New York City

According to the 2008 American Community Survey (ACS), 10.4% of New York City residents, or 889,219 people, have a disability. 1 The percentage is marginally higher in Brooklyn, where 10.8% of borough residents, or 269,060 people, have a disability. About 30% of New York City's disabled population lives in Brooklyn.

Since 1965, BCID's mission has been to empower people with disabilities by improving the quality of their lives and advocating for equal access to society for people with disabilities. "We are pleased that BHDC has been so receptive to working with BCID. Minorities with disabilities face enormous disparities compared to minorities who do not have disabilities. Addressing disability issues is key to improving health outcomes in minorities overall."

Articles on health disparities in people with disabilities:
  • Article: Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497651/
  • Newacheck, Paul W., Yun-Yi Hung, and Kara K. Wright. "Racial and ethnic disparities in access to care for children with special health care needs." Ambulatory Pediatrics 2.4 (2002): 247-254.
  • Ouellette-Kuntz, H. (2005), Understanding Health Disparities and Inequities Faced by Individuals with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities, 18: 113-121. doi: 10.1111/j.1468-3148.2005.00240.x
  • Gary, Faye A. "Stigma: Barrier to mental health care among ethnic minorities." Issues in Mental Health Nursing 26.10 (2005): 979-999.

1 Center for Independence of the Disabled, New York, "Disability Matters: Unequal Treatment and the Status of People with Disabilities in New York City and New York State (July 26, 2011)


New Training Core Leadership

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Dr. Michael Joseph

Dr. Michael Joseph was appointed as the new Director of the BHDC Training Core in the summer of 2013. Dr. Joseph, recipient of the 2013 Chancellor's Awards for Excellence in Teaching, has participated in training efforts of BHDC, most recently providing a workshop teaching community based organizations how to analyze research data. He also provides supervision to staff engaged in the community based research conducted by BHDC.

As vice chair and assistant professor of epidemiology and biostatistics in the School of Public Health; he played a key role in the transition of the Graduate Program in Public Health to full School status and is known for creating a learning environment where excellence is expected.

He consistently receives high praise in student evaluations of his teaching and takes great personal interest in his students' success: each semester devoting time to tutoring students who find epidemiology and biostatistics challenging. Dr. Joseph has a knack for explaining difficult concepts in a simplified, yet exhaustive fashion; for this reason, his course at the Annual Meeting of the American Public Health Association, Biostatistics for Non-Statisticians, is widely popular.

He is also active in local pipeline programs, such as the PRISM Program at Medgar Evers Preparatory High School, which seek to inspire underrepresented young people to pursue health careers. Dr. Joseph also has vast international teaching experience in epidemiology and biostatistics, and has provided training in Zimbabwe, South Africa, Estonia, and Ukraine.


Sharing Our Knowledge

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Dr. Moro Salifu

Dr. Salifu presented on the topic of "Health Disparities in Renal Diseases" at the January 11, 2014 Health Disparities in African Americans conference of the Association of Haitian Physicians Abroad (AMHE) and the AMHE Foundation. Among his take away points, Dr. Salifu commented, "Bridging gaps in access to care and improving socio-economics are essential to addressing the disparities in renal diseases."



Ongoing Research

Drs. Cukor and Salifu, along with other investigators at Downstate and 2 other New York hospitals are currently analyzing the data from a study they did on kidney transplant medication adherence.

Strict adherence to anti-rejection medication is a key factor in maintaining the health of a donated kidney, yet many people have difficulties taking their medication exactly as prescribed. The current study interviewed over 300 ethnically diverse transplant patients, from across New York City, about their medication adherence and what types of problems prevent them from taking their medication. While, by and large, most patients reported taking their medication as prescribed, there were some interesting differences across the sample. Patients who reported more concerns about the safety of the medication and less conviction about the need to take the medication, not surprisingly, took their medication less frequently. What was also true was these folks identified more barriers to getting their meds, being more forgetful and feeling more depressed, anxious and generally worse than people who believed the medications were safe and necessary. While we are still analyzing the data, the need to study people's perspectives and belief systems seems to be fundamental to understanding why they do anything, or in particular take their immunosuppressant medication.

Links to articles on health disparities in kidney transplantation:

  • Epstein, Arnold M., et al. "Racial disparities in access to renal transplantation—clinically appropriate or due to underuse or overuse?." New England Journal of Medicine 343.21 (2000): 1537-1544.
  • Smedley, Brian D., Adrienne Y. Stith, and Alan R. Nelson, eds. Unequal treatment: confronting racial and ethnic disparities in health care (with CD). National Academies Press, 2009.
  • Young, Carlton J., and Robert S. Gaston. "Renal transplantation in black Americans." New England Journal of Medicine 343.21 (2000): 1545-1552.
  • Powe, Neil R. "To have and have not: Health and health care disparities in chronic kidney disease." Kidney international 64.2 (2003): 763-772


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