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Profiles in Innovation: Research Downstate
Taken from a feature article in the 2010 issue of Profiles in Innovation.
Same Borough, But Worlds Apart: Research into Inequities in Brooklyn Healthcare
Clinton Brown, MD, Ruth Browne, ScD, MPH
"There's a joke among people whose primary language isn't english," says Humberto Brown, MA, director of health disparities/new constituency development for the Arthur Ashe Institute for Urban Health (aaIUH). "If you tell a medical provider you're not good at english," Mr. Brown quips, "he or she will speak very loudly, as if the volume will solve the communication problem."
The Ashe Institute, which has an office on the Downstate campus, works closely with faculty and staff on programs dedicated to improving the wellbeing of vulnerable urban populations. A study the Institute conducted found many older Latinos didn't access health-care that was available to them because "their issues were talked about at a volume that allowed everybody to hear."
This finding and Mr. Brown's anecdote illustrate one reason why health disparities exist in the United states and in Brooklyn in particular. A recent survey by the Robert Wood Johnson Foundation found that Brooklyn ranked 58th out of 62 New York state counties in terms of health outcomes. Residents of New York City's poorest neighborhoods, including many who live in the areas surrounding Downstate, have life expectancies four years shorter than those in the city's most affluent districts. "In Brooklyn, we see severe disparities in the areas of cardiovascular disease, infant mortality, HIV and AIDs, asthma, and other chronic health conditions," notes Brooklyn's Deputy Borough President Yvonne J. Graham.
To help understand the causes of these disparities and to provide solutions, Downstate, the Arthur Ashe Institute, and the Borough President's Office leveraged their long-term relationships to establish, in 2004, the Brooklyn Health Disparities Center (BHDC). "The BHDC is the place that brings together researchers and advocates who work both within the University and outside of it to pursue common goals," says Center Director Clinton Brown, MD, an associate professor of clinical medicine at Downstate.
Since the Center's founding, its faculty has trained Downstate cardiovascular fellows in health disparities research. It established the Summer Institute Program to Increase Diversity in Cardiovascular Health Disparities Research, which instructs junior scientists from around the country in those same research issues. It developed innovative curricula to train hair stylists to become lay health advocates who can teach their customers about cardiovascular health and disease, and it has built a strong network of community-based organizations that advises the Center on community health issues.
Now, with funding from the NIH's National Center on Minority Health and Health Disparities (NCMHHD), "The BHDC is laying the groundwork for future research and policy recommendations to combat health disparities," says Tracey Wilson, PhD, the Center's research core co-director and associate professor of community health sciences.
To achieve these ends, the Health Disparities Center is enhancing its already existing relationships. "This is really a capacity-building grant," explains Ashe Institute CEO Ruth Browne, SCD, MPH, who is also co-director of the Center. The Center is now designing a curriculum on health disparities research for high school students who participate in the Institute's Health Sciences Academy. "The academy is a program we run here on the Downstate campus," Dr. Browne explains, "where faculty and graduate students teach talented minority students in a three-year, after-school science enrichment program, coupled with an urban public health program." the NCMHHD funding will also enable the Center to place these students in paid summer internships at local community-based organizations "to conduct surveys and needs assessments and to disseminate information," she adds. Also strengthened by this grant is the BHDC's involvement with community-based organizations, such as the Caribbean Women's Health Association, the Arab-American Family Support Center, and the Haitian Centers Council. "These groups really have their fingers on the pulse of their communities," explains Marilyn Fraser White, MD, the BHDC's co-director of community engagement and the AAIUH's Associate Director of Research and Training.
The Center staff has begun training 40 such organizations in community-based participatory research, in which members of the communities affected by conditions or issues under study act as full participants in the research process. "We believe that this community involvement is key to identifying reasons for health disparities," Dr. White says.
To further its policy-change goals, the Center is "teaching community-based organizations how to make recommendations to legislators and other policy makers," says BHDC policy analyst Kweli Henry, MPH.
All of these efforts can lead to the elimination of the health disparities that prevent many in Brooklyn from living long and healthy lives.