Experts Discuss the Path Toward Overcoming Racial Health Disparities

News

Racial and ethnic minorities are disproportionately affected by virtually every major disease of our time, and this gap has only been exacerbated by COVID-19. This year, the NYSCF Conference featured a panel discussion entitled, “Overcoming Racial Health Disparities with a New Model of Biomedical Research” that explored how we can all work together to overcome racial health disparities and ensure that all communities benefit from biomedical breakthroughs.

“The reality is that not everyone is benefiting from the breakthroughs we are discussing at this conference, or that are happening in our field,” noted Raeka Aiyar, PhD, NYSCF Associate Vice President of Scientific Outreach and moderator of the discussion. “A black woman is 22% more likely to die from heart disease than a white woman, and 71% more likely to die from cervical cancer. 67% of Puerto Rican children do not respond to the drugs used in asthma inhalers. This is all being exacerbated by the pandemic: If they had died of COVID-19 at the same actual rate as White Americans, about 20,800 Black, 10,900 Latino, 700 Indigenous, and 80 Pacific Islander Americans would still be alive.”

“Health equity means giving people what they need, when they need it, to reach their optimal level of health,” explained Valerie Montgomery Rice, MD, FACOG, President and Dean of Morehouse School of Medicine. 

“It sounds like a simple concept, but achieving it is actually quite a challenge,” added Monica Webb Hooper, PhD, Deputy Director of National Institute on Minority Health and Health Disparities at the National Institutes of Health. “It requires a major shift, or even a dismantling of the way systems have been set up. We have to factor in historical and contemporary injustices. Operationally, what it looks like is something that you don’t usually see.”

So how do we move toward health equity at all stages of the scientific and healthcare process? For those conducting disease research, diversity of samples in the lab as well as diversity of patients in clinical trials is of critical importance for ensuring that findings do not just apply to one group.

“[At NYSCF], we always felt it was essential to represent all ethnicities, genders, and ages in our research,” noted NYSCF CEO Susan L. Solomon, JD. “Stem cells present an unprecedented window to basically create, if you will, avatars of all of us. We built the NYSCF Global Stem Cell Array, our robotic system for creating stem cells, with this in mind and are now planning to recruit and collect several thousand diverse patient samples to add to our ethnic diversity biobank so that we can realize the full potential of stem cell research.”

“One of the things that population genetics has told us is that when you include diverse people in your study, you can end up with outcomes which are better in terms of revealing mechanisms of disease and the particular susceptibilities of people,” added John Greally, DMed, PhD, FACMG, of the Albert Einstein College of Medicine.

However, genetics is just one piece of the puzzle, as highlighted with the COVID-19 pandemic, providing all populations with equal access to quality care is a major hurdle that must be overcome. Dr. Greally sees patients in the Bronx, and he understands that high death rates in his community are largely due to socioeconomic and structural issues that pose barriers to care.

“The counterbalance [to genetic studies] is what we’ve seen with the pandemic: one in every 350 people in the Bronx has died of COVID-19. We’re not sure exactly why, but we know the overwhelming issues involve socioeconomics, health disparities, and racism…For example, we hear stories of families not seeking care because they were afraid ICE would pick them up on their way to the hospital.”

Dr. Montgomery Rice stressed that even once a vaccine is approved, we must ensure that it is safe and effective for everyone in our diverse community and that everyone can receive it.

“There are two ways you can measure the effectiveness of a vaccine: one is that you give the injection to someone and it produces the antibodies, and they may be immune for a period of time,” she said. “But the other measure of effectiveness involves uptake of the vaccine among those persons who are at greatest risk of the disease. And if we do not do that second one, we will just have a nice vaccine that sits on the shelf, and we will not have eliminated the risk associated with this disease.”

“We have to spend a lot of effort ensuring that we are making the public comfortable,” she continued. “They are not going to come to our nice, shiny buildings. We have to be in mobile vans. We have to go to the community centers. We have to step out of our comfort zone to meet people where they are.”

Moving forward, the panelists stressed the importance of collaboration to enact widespread change.

“This has to be an all-hands effort,” remarked Dr. Webb Hooper. “We must have stakeholders at all levels and all disciplines across organizations contributing to get this work done. I think that all too often, a grassroots organization who are on the ground doing this work daily and have keen insights into community needs are often not included, or if they are included, they’re not equitably included. Equitable engagement with affected communities is a cornerstone of the efforts that will address disparities and move us towards justice.”

The group also recognized the importance of seeding the pipeline for diverse researchers, clinicians, and administrators who will recognize the severity of health disparities and advocate for better practices.

“When you have diverse persons in the room and people who are able to really participate in understanding others’ circumstances – even if they have not lived them, because they have made themselves aware – that is when we get the rich solutions. That is when we get the solutions that are going to be inclusive of others,” said Dr. Montgomery Rice.

There is a lot of work ahead to reach equity, and getting there will be an ongoing effort.

“We’ve been faced with the deadly consequences of systemic racism in many ways this year, and that is not something we are going to solve today,” expressed Dr. Aiyar. “What we wanted to do is start a discourse with this community about how we can make sure it stops affecting our research, so that we can protect all the lives that science is meant to serve.”

Watch the full discussion below.