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Podcast: Racism as a public health issue
As the world continues to find solutions to the COVID-19 pandemic, society is confronting another pandemic: racism. Racism is embedded and woven into the historical fabric of the nation and finds itself throughout health care. From forced, unconsenting sterilization of Black women in the early 1900's (and among women in ICE detention in 2020) to segregated medical treatment by race and ethnicity, it is time for us to reckon with our history and work toward the structural changes necessary toward health equity. As health professionals and members of the health professionals training institutions, we must explore and embrace the difficult yet necessary work that is required of us to achieve health equity. This edition of the BFA newsletter will focus on the mission driven work being done to advance our work in dismantling structural racism and advancing racial justice in health professions education.
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Over the last few months, we have all seen the worsening of health disparities. While these disparities are being brought to light because of COVID, the systems-level and structural inequities far preceded the pandemic. The need for collective work to re-align our training institutions to meet the needs of society, toward a more just and equitable healthcare system for all, is an utmost priority. In this social mission COVID newsletter, during both Asian and Pacific Islander American Heritage and Mental Health Awareness Month and National Nurses Week, we seek to feature inspiring responses to the inequities, vitriol, and fear surrounding COVID and to ensure that we continually advance social mission for the betterment of our communities.
The Beyond Flexner Alliance also wants to take this opportunity to highlight valuable resources for the emotional and spiritual health of all of our colleagues who are working in these unprecedented times. It has been a humbling experience for all of us, and we send our sincerest condolences to each and every one of you who has lost family or friends. May we continue to grow stronger as a social mission community and get through this together.
“We cannot become what we want by remaining what we are.” - Octavia Butler
Native American Heritage Month Health Equity Newsletter
This month, our newsletter focuses on the often neglected population of 5.2 million Native Americans in the United States in honor of Native American Heritage Month. This sizeable population suffers from staggering health disparities compared with the US general population. Native Americans die 5.5 years earlier than the average American. Compared to white Americans, Native Americans suffer nearly twice the rate of diabetes, COPD, obesity, and liver disease and are 60% more likely to suffer from depression and twice as likely to attempt suicide.
With a diverse array of challenges driving these disparities from lack of health insurance coverage to geographic isolation, there are a number of innovative programs that have sought to overcome the barriers to achieving health equity in Native American populations. This month we highlight the important work of research to illuminate these disparities, programs that address them, and individuals who champion health equity among Native Americans.
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Between #MeToo & #TimesUp, the last year has been a high water mark for the awareness of the challenges faced by women in our society. In honor of Women’s Heritage month, the Beyond Flexner Alliance brings you a newsletter this month highlighting the amazing and diverse work being done on gender inequities across health professions; work often being done by women in academia to highlight the trials they face in their training and the tribulations their patients face in achieving health equity. We encourage you to explore the full breadth of leading content we are highlighting this month from an academic study of bias faced by female dental students to a new WHO strategy to address gender inequity and even a media plea for more women to participate in clinical trials. There is a lot of ground to cover, but we hope to have a curated a few highlights for members of the Beyond Flexner Alliance to stay on the leading edge of work in gender health equity.
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To commemorate Black History Month, this newsletter focuses on the health equity efforts concerning the 46.8 million black people, the largest racial minority group in the United states. The health disparities among Black Americans are stark and disproportionate. For example, compared to non-Hispanic whites, African Americans are eight times as likely to be diagnosed with HIV and nine times as likely to die from it. Black women are three to four times as likely as Whites to die from pregnancy-related deaths and are about 1.5-3 times more likely to die from stroke, asthma, breast cancer, cervical cancer, and prostate cancer. Teaching students about the social determinants of these health disparities alone is inadequate. Rather, as Sharma et al. argue, educators and society at large must adopt a justice and equity lens to transform the deeper, historical origins of systematic exclusion and discrimination.
We invite you to read about the research that is improving our understanding of the epidemiology of the health inequities among our black community and the incredible work that some groups are doing to lessen the detrimental effects of over a century of local, state, and federal policies on the health of our black population. We hope that the research and articles in this newsletter will inspire and inform the work that you continue to do to train our next generation of health equity and social mission driven health professionals.
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BFA will begin celebrating several heritage months through themed newsletters to illuminate the current interprofessional efforts to improve the care for our diverse populations! We begin our celebration with the National Hispanic/Latinx* Heritage Month.
The National Hispanic/Latinx Heritage Month, which is observed from Sept. 15-Oct. 15, is a time to appreciate the culture of our Hispanic/Latinx (H/L) population. This group is the largest and fastest growing ethnic minority group in our nation. According to the 2015 U.S. Census Bureau, this group makes up 17.6% (56.5 million people) of the total U.S. population and is expected to grow to 28.6% by 2060. However, as of 2014, only 7.7 percent of all healthcare practitioners and technicians were H/L (U.S. Department of Labor, 2015).
With this degree of population growth, there are staggering health disparities that demand collaborative and comprehensive efforts. One recognized approach to addressing health disparities is to increase the number of H/L in health professions able to provide culturally competent care and increase access to care. Organizations, such as the National Association of Hispanic Nurses (NAHN), recognize that reducing current health disparities will require an increase in H/L representation. This article discusses NAHN’s recent efforts to increase H/L nurses and urges healthcare leaders to also take action.
We understand that populations such as the H/L community are incredibly diverse. Below we have showcased a small sampling of the varying H/L experiences as it relates to health equity. We look forward to kick-starting the conversation and appreciate everyone’s on-going contributions to improving health equity and health professions education!
*Latinx: While most pre-existing research uses the term 'Latino,' we use the term Latinx as a gender-inclusive alternative. The H/L ethnic group is defined by the U.S. Census Bureau (2016) as those from “Spain, Mexico, and the Spanish-speaking nations of Central America, South America, and the Caribbean.”
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Brittany Seymour, Assistant Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine, and Carlos Faerron, of the Intra-American Center for Global Health, developed a one week field course in Costa Rica that allows dental students to learn from and with dental students from the University of Costa Rica, and to obtain perspectives on oral health from migrant workers, urban residents, and indigenous people in the country. The course seeks to develop sustainable partnerships that will benefit communities and learners for years to come. Additional information about the course is available here or in this video.
It has been a few weeks since our Beyond Flexner Conference and we are thrilled about all of the exciting ideas that were shared and the collaborations that are being forged nationally and internationally!
This newsletter is to highlight some of the exciting opportunities ahead of us and we look forward to your ongoing engagement and innovation in the field of health equity and social mission promotion in health professions education.
Host the Next Beyond Flexner ConferenceIs your school interested in being the host of the next Beyond Flexner conference? The next conference should be in mid-to-late September 2019. We will soon be forming our Site Selection Committee and sending out an official invitation for schools that might be interested in hosting. In the meantime, if your school is interested or if you have a recommendation of another school that you think would be a good site, we’d like to hear from you. Please contact Leigh Anne Butler at firstname.lastname@example.org with your suggestions.
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Challenges to delivering oral health care have garnered more attention recently, notably in a front page story in the Washington Post entitled "The Painful Truth About Teeth”. This article highlights the continuing divide between Americans who can afford dental coverage and those who cannot. It also provides insight into a major inequity in health care – the challenge of providing oral health care to the country.
A recent opinion piece by R. Bruce Donoff “It’s time to break down the wall between dentistry and medicine” illustrates the division in the two disciplines. "We cannot drill, fill, and extract our way to better oral and overall health. We need a fundamentally different approach, one that accentuates disease prevention and health management using a multidisciplinary, integrated, and patient-centric approach to overall health. And that means breaking down the wall between dentistry and medicine." To break down this barrier, the Harvard School of Dental Medicine created “The Initiative to Integrate Oral Health and Medicine.” Other institutions have also realized the importance of integrated dental health and primary care. Donoff further notes that, "While inter-professional education has met with some success, inter-professional practice remains elusive.”
Fitzhugh Mullan’s JAMA Viewpoint published this week is an essential document for the Beyond Flexner Alliance. It details why and how the Beyond Flexner movement has grown and why it is critical for health professions educators, leaders, learners, and community-based allies to join the BFA and move social mission to the top of the concerns and commitments of the health professions education community in the United States and elsewhere.
In May of 2012, 200 educators, policy makers, students, and community members met in Tulsa, Oklahoma in a conference entitled Beyond Flexner: The Social Mission of Medical Education. The previous two years had seen a growing discussion about the chronically weak focus on the social determinants of health in most medical schools and teaching hospitals. Fueled by a determination to provide more universal care and equipped with ever increasing documentation of disparities in health between rich and poor, urban and rural, insured and uninsured, etc., the participants in what is now called “Beyond Flexner 2012” wanted to see the educational system leading the movement for social mission by teaching it and practicing it.