In Pennsylvania and across the country, Black Americans experience health disparities. Health disparities are disproportionate health conditions and inequalities that exist among all ages in a certain population, including chronic conditions, access to care, preventive screenings, and mental health.
But health disparities are preventable, and UPMC is committed to creating health education and programming that combats these issues. Our goal is to partner with community members and train health care providers to ensure that everyone has access to healthier lifestyles.
The first step to preventing health disparities starts with identifying and understanding them. Health disparities can result among Black patients from multiple factors, including but not limited to:
Individual and behavioral factors
Inadequate access to health care
Educational inequalities
Environmental threats
Poverty
Read below to learn more about health disparities and what UPMC is doing to ensure equity in health care.
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string(9451) "Steven Evans, MD, FACS, is a general surgeon and surgical oncologist with UPMC Hillman Cancer Center. Dr. Evans serves on the Shadyside Hospital Foundation board and is past vice president of the Gateway Medical Society, which represents Allegheny County's Black physicians. He is an advocate for the elimination of cancer disparities among Black women. Dr. Evans is the co-investigator for the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) study and founder of Pittsburgh's first African American cancer caregivers support group. Recently, Dr. Evans was appointed as the director of the Division of Community Engagement in the Division of Surgery at the University of Pittsburgh School of Medicine.
What has been your path to a medical career?
In 1920, Black Americans represented only 2% of medical students in our country. Today, 100 years later, that number has only grown to 6.2%, even though Black Americans represent 13% of our total population in the United States. When I graduated from George Washington Medical School, I was one of just two Black Americans in a class of 155 students.
In my final year of medical school, I had an internship at the National Cancer Institute's Center for Cancer Research. One of my patients was a Black woman who needed a very serious and rare operation. She saw the long hours we were putting in for her and said to me, “Dr. Evans, I want you to know that I appreciate all you're doing. Even if this surgery doesn't give me a longer life, I want to thank you." I immediately knew then that I wanted to become a surgeon and focus on cancer. Her words ultimately led me to complete a surgical residency at UPMC and a cancer fellowship at the National Cancer Institute.
What kinds of disparities have you experienced as a doctor?
In 1994, shortly after finishing my training, I joined one of the largest private general surgery practices in Pittsburgh. Its leaders were committed to building a diverse medical team of different races, ethnicities, and faiths. Ironically, I shared the same last name as another member of the practice.
Some patients would call for an appointment and say, “I don't want the Black Dr. Evans — I want only the white Dr. Evans." When the office manager asked me how to handle those requests, I told her she did the right thing by coming to me. I've dealt with my racial identity from the day I was born, so who better to help our patients understand and develop a relationship with me — than me? I knew we needed to make it clear to patients that every member of the practice — including me — was equally prepared. We all had the same rigorous training and passed the same surgical boards. That became an important statement of equity that helped everyone realize that the color of my skin had nothing to do with my medical skills.
How would you describe racial disparities in health care today?
Health care disparities should not be looked at as a genetic construct. Socioeconomic access to health care — shaped by factors like being poor or uninsured — are the greater determinants that all come under that umbrella of racial disparities in health care in general and, to a certain degree, in cancer care specifically.
What I'm challenging everyone to do in this conversation about health disparities is to look and listen and become more inquisitive and sensitive about that conversation.
From your vantage point as a surgical oncologist, what challenges do Black women in particular face in terms of health disparities?
Studies show that Black women die from breast cancer at a higher rate than their white counterparts. Doctors also know colon cancer is the second leading cause of death among Black women, and Black men are at a much higher risk for colon and prostate cancers.
My wife, Cynthia, an African American woman and doctor, succumbed to colon cancer in 2015 when she was just 56 — so I personally understand that cancer has no regard for a person's socioeconomic status or skin color. That's why it's vital for all Black Americans to know that help is available. That's especially important now, in the midst of this pandemic.
The importance of screenings and early cancer detection is a critical message that we must share over and over again with Pittsburgh's Black community. In the medical community, we have to advance Pennsylvania as a state where uninsured women can get their mammograms, colonoscopies, and cervical cancer screenings done for free.
How are you personally working to help address these issues?
I first had to allow myself to be vulnerable enough to speak out on these issues as someone who has personally experienced great losses due to cancer. In addition to losing my wife, my mother died of breast cancer, and my sister was diagnosed with breast cancer in her 50s.
During COVID-19, Zoom and Facebook have given me a much broader platform to communicate with Pittsburgh's Black community about the risks of cancer. I've worked closely with groups like our Black sorority, the Deltas, and with people of influence like Jasiri X (a Pittsburgh activist and rapper) to connect with women of color of all ages on social media.
I've also learned professionally that opportunities happen when I ask questions about a problem or gap in resources. When I do, people usually respond, “Why didn't I see that?" My response is that's not a sign of insensitivity — you just don't live in my space. You're not a Black man. You weren't a caregiver for a wife struggling with cancer. You weren't trying to raise three children at the same time. So, when I asked why there wasn't a cancer caregivers support group for Black Americans in our community, leadership and donors responded with solutions to make it happen.
My form of advocacy is to be that clarion call — to acknowledge that racial disparities exist, but that doesn't have to be how the story ends. At UPMC, we need to tell the members of Pittsburgh's Black community that we are here to care for them in an exceptional, first-class way, no matter their race, socioeconomic background, or insurance status.
What can community members do to help?
As individuals and as a medical system, we all have opportunities to grow when it comes to issues like race. Patients and communities of color want to know that we see them — that they are not marginalized just because they are poor or because they are different. If their trust isn't with us, we cannot move forward in making recommendations about their health.
That kind of trust takes time, but Pittsburgh is a city of bridges. I feel that our greatest asset is the ability to build bridges between communities of color and civic leaders, community leaders, church leaders, and policymakers. We must work together to build a plan that seeks to eliminate racial disparities in health care — and specifically in cancer outcomes. We must all come together with a common goal, pooling our resources so we are not diminishing the power and effectiveness of our voice. If the medical and health-related schools of the University of Pittsburgh work together with UPMC Hillman Cancer Center and all of UPMC, I am confident that we can find a way to strengthen the bonds that are necessary to heal the wounds, bridge the gap, and change how the story ends. To that end, I was just appointed director of the Division of Community Engagement in the Division of Surgery at the University of Pittsburgh School of Medicine. In that new role, I look forward to creating partnerships that will ultimately make a difference.
Do you have hope?
With all that I have gone through, how can I not have hope? It's the hope that keeps me going! And that's what I want to pass on to my patients who are suffering from any type of cancer. My goal is to not only to care for them surgically but to provide them with all the support they need to thrive, not just survive. That's means chemotherapy, radiation, support groups, and more.
Some people are upset by the protests going on now in our society, but protest has been integral to our history. It's how America became America, starting with the American Revolution. We are no less than the sum of our parts. All of our hues, our colors, and backgrounds make America unique. Martin Luther King, Jr., one of my greatest inspirations, said “Injustice anywhere is a threat to justice everywhere." So, we must continue to speak truth to justice through our protests and our actions.
You're known for singing with your patients before surgery. What's your inspiration for doing so?
I've been singing since I was five years old. When I come up with a song, it's one that's really intentional — an expression of my spirit at that moment. During these uncertain times, especially when I pray, I sing knowing that we're not alone on this journey. I call on the song by Kari Jobe, “I Am Not Alone." I thank God for my privilege of being where I am today. I don't want to be anywhere that I can't be all of me — and that's both a surgeon and a spiritual person. I want to be in a place where I can have the freedom and liberty to be me. And I feel I have found that place."
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Dr. Steven Evans, MD, is an advocate for the elimination of cancer disparities among Black American women.Read More
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string(6693) "Austin A. Davis was the first Black American outside of the city of Pittsburgh to win an elected state office in southwestern Pennsylvania. A native of McKeesport, Pa , Rep. Davis captured 74% of the vote to lead the 35th district of the Pennsylvania House of Representatives in a January 2018 special election. He holds seats on the House Appropriations, Insurance, and Consumer Affairs committees and serves as a deputy Democratic whip. His district includes three of the region's most racially diverse and economically challenged communities: Clairton, Duquesne, and McKeesport.What led to your career in politics?
Growing up, I was always interested in government. But it wasn't until high school that I started thinking about government as a solution. I was concerned about the violence I saw happening in McKeesport, particularly among young people. I decided to go to a city council meeting.
I discovered that only one person on council looked like me, despite the city's significant minority population. And its members weren't even my parents' age — they were my grandparents' age. I felt government needed to be more representative of all the people they were serving.
I approached then-Mayor Jim Brewster (now a state senator) with an idea for a youth advisory council, and he graciously allowed me to get involved. Our advisory council took on a number of community projects. We got involved in raising awareness about youth violence and cleaning up different neighborhoods.
What racial and health care disparities concern you most?
I was a student in the McKeesport Area School District, which was and still is predominantly Black American. Then and to this day, it's severely under-resourced. Compounding that problem is the fact that many of its children live in poverty. In fact, 50% of all the kids in McKeesport, Duquesne, and Clairton live in poverty. If you're looking for equity and racial issues, look no farther than the Mon Valley.
Food insecurity is a major deterrent to good health in our region. The city of McKeesport has five grocery stores, but Clairton has none, and there's no prospect of one moving in. Duquesne has one grocery store, and it's on the verge of closing. There once was a time when people lived, worked, and shopped all in the same community. But our world has changed. The resources we need to adapt — like affordable and dependable transportation — have not kept up with the people who need them the most.
How has COVID-19 affected the communities you serve?
Spring 2020 really changed the world — and southwestern Pennsylvania. In January, my legislative agenda focused on a massive transportation bill to create more revenue for regional mass transit.
But when the coronavirus hit, we just threw the bill out the window. It didn't make sense to try to raise revenue when unemployment rates jumped from 4% to 12% in literally one month.
I've always been able to learn firsthand what people are really struggling with through the calls that come into my office. During COVID-19, the huge concern initially wasn't unemployment: it was health care. Many of the communities that I represent already had significant health disparities before COVID-19 arrived, including barriers to health care access. COVID-19 only magnified those issues. How can we ensure that folks are getting tested? How can people even get transportation to the medical centers to get tested?
Local colleagues and I banded together to try to find answers. We reached out to all the health care providers in the region, including UPMC, UPMC McKeesport Hospital, and the UPMC Latterman Family Health Center. Their collective response was and continues to be terrific.
You've probably seen recent reports that say this virus seems to be hitting Black Americans and other people of color harder than other populations. My fellow House representatives Jake Wheatley and Summer Lee and I worked to create a COVID-19 health equity task force. We've met regularly with Dr. Rachel Levine, Pennsylvania's secretary of health, and Dr. Debra Bogen, director of the Allegheny County Health Department. We pushed very hard to expand testing to our federally qualified health centers in the region because we know that in low-income communities, those centers are often the first line of defense for health care needs. It's no accident that I located my office next to a federally qualified health center.
But it's hard to both lead people and adapt to the moment, especially when that moment is a time none of us have ever lived through. There's no one with first-hand experience in a better way to do things. While some will disagree, I think Pennsylvania is doing significantly better than other places. Although we still have to be vigilant, we have made strides.
Is there one particular issue in terms of racial disparities that troubles you most?
There's no one specific thing, but I will say tackling this problem has to be a collective effort. It's not a matter of one person or one organization addressing the issue. It has to be a partnership. The health care community needs to address disparities and biases within their systems. Those of us in government need to make sure that we are ensuring access for people living in marginalized communities. That means transportation, making health care affordable, and making sure we are adequately funding public health services.
I'll share a personal example. Studies show that Black Americans tend to do better if they're treated by diverse doctors. When I was elected to the House, I had to change insurance companies. It took me two years to find a new doctor I was comfortable with. If I found that process difficult, imagine how hard it is for a community member who can't tap into the same resources that I can.
There's no silver bullet to fix the challenges of racism in medicine and health disparities in our communities. But if we all continue working in our respective spaces to address the issues within our wheelhouses, we will see success.
Health disparities are preventable and disproportionate health conditions that exist among all ages in a certain population. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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Austin A. Davis was the first Black person outside the city of Pittsburgh to win an elected state office in southwestern Pennsylvania.Read More
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string(8096) "Hyagriv Simhan, MD, MS, is executive vice chair of obstetrical services at UPMC Magee-Womens Hospital and director of clinical innovation for UPMC women's health services. His pioneering research on premature births — funded by the Magee-Womens Research Institute and the National Institute of Child Health and Human Development — has received national recognition. Dr. Simhan also is a leader in promoting increased safety and health care quality for pregnant women.What Led You to Specialize in Maternal Fetal Medicine?
I've wanted to be a doctor since I was a child. My intent was to do heart transplants, so as a medical student at Boston University, I did some research in that area. I was pretty confident that's what I wanted to do. But during a rotation at Boston City Hospital, I found myself drawn to obstetrics and gynecology.
As a resident, I started focusing on complicated obstetrics and how to optimize the health of both mother and baby. That path led me to maternal fetal medicine (MFM) and the knowledge gaps that exist in the health needs of both mother and child. I came to UPMC for an MFM fellowship 22 years ago and have been specializing in that area since then.
In your research, you identified that premature births among Black women are nearly double that of whites and Hispanics, and that premature Black babies die at a significantly higher rate than other racial groups. What are some of the contributing factors to those statistics?
There are many disparities contributing to health outcomes in addition to race, and that's certainly true in pregnancy. Researchers have explored how biology, environment, health, and disease affect fetuses as they develop — and how they affect pregnant women both during and after pregnancy.
We also know there are many social factors that contribute to the health of a mother and child, such as access to care and the quality of the health care experience. Patient engagement with a system of care can vary by many factors, and race is one of them.
Only about 20% of all health care outcomes are actually the direct consequence of health care interventions. The other 80% are related to other things, like the safety of the neighborhoods we live in, the availability of healthy foods to eat, and the opportunity for leisure time and physical activity.
It's said that our ZIP code is a greater predictor of our health and wellbeing than our genetic code. But in recognizing that social determinants contribute to adverse health outcomes, it's also important to understand we have the ability to improve. We don't get to change our genetics. But as a society, we do get to influence our structures and policies. We can become more fair in assuring good access to care.
How is your research and clinical work helping to address racial disparities in health care?
At UPMC Magee, we're very cognizant of the fact that there are health disparities for Black Americans and other racial groups here in Pittsburgh and throughout the country. From both a research perspective and in our role as clinical leaders, we're committed to contributing to the conversation and to improving these circumstances.
For example, women with high blood pressure during and after pregnancy have a much greater risk of dying after delivery. Black women have a higher incidence of hypertension during and after pregnancy.
We've developed an innovative virtual program to monitor and manage postpartum hypertension. The program identifies women who are at risk and connects them to better health care through educational resources and risk assessment. We're helping them to be informed and supporting their adherence to prenatal care. We're also linking them to ongoing preventive care with the goal of minimizing the harm of hypertension across the course of their lives. While helping to improve health for all women postpartum, programs like this also help narrow disparity.
What is the role of health care systems in addressing racial disparities?
So much of what happens in the health care environment is affected by what we do outside of it. Outreach services and engagement with community stakeholders cannot be an afterthought. They're essential to maximize and optimize health care outcomes. We as a health care system need to own that.
We can begin by giving an effective voice to those individuals and communities who have not been heard before. Just as importantly, those of us in health care need to be a receptive audience. We need to listen and make sure that we actually understand the problem and hear the voices of those most affected by these problems. We can't function in a vacuum, developing interventions or coming up with answers without a collaborative effort.
And we must do our part to address our unconscious bias as care providers. We need to better understand what women of color expect from their pregnancy and birth experience. That will enable us to narrow disparities, engage populations, and enhance trust.
How are you working to build trust among women of color?
We are constantly working to engage patients, enhance cultural competency, and maximize health literacy. For example, studies show that doulas can play a vital part in ensuring that a patient's voice is heard, care adherence is maximized, and that the patient's perspective and wishes are followed. At UPMC Magee, we are working to integrate doula professionals into our health care teams. When a woman “clicks" with her doula — a laywoman specially trained in childbirth — that relationship provides invaluable advocacy, education, and support before, during, and after delivery. It's a tangible way for us to improve the lives of women during pregnancy and in the postpartum period to help them form a closer, more trusting bond with their entire health care team.
How has COVID-19 impacted your work?
It's safe to say that no aspect of American life has been untouched by COVID-19. But compared to many other health care fields, obstetrics marches on. During COVID-19, our business of delivering babies has remained consistent.
From the very start of COVID-19, we worked hard to find ways to use virtual technologies to protect our moms and babies, and our staff. Fortunately, we're part of a system that's been on the cutting edge of using telemedicine for some time. We were able to adapt very quickly, completing more than 6,000 virtual prenatal visits interspersed with face-to-face visits.
Telemedicine essentially allows us to bring our care to a patient's home. It improves the patient experience by maintaining a high degree of communication with the provider using a lower resource footprint. Delivering that kind of care makes it easier for the patient on countless levels.
Are you hopeful for the future?
I've recognized the gravity of racial disparities for a long time. What I see that gives me hope is the degree of attention it's now getting across a broad swath of society. My hope is that this broad range of support brings immediacy and action to these problems. Problems of racial disparities and differences in women's health outcomes didn't happen overnight, and they likely won't be resolved in 2020. But the current sense of urgency is creating a real momentum that has me feeling positive about the future.
Health disparities are preventable and disproportionate health conditions that exist among all ages in certain populations. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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Hyagriv Simhan, MD, MS, is executive vice chair of obstetrical services at UPMC Magee-Womens Hospital and director of clinical innovation for UPMC women’s health services.Read More
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string(9699) "Tracey Conti, MD, is executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine and program director of the UPMC McKeesport Family Medicine Residency, which features Latterman Family Health Center in McKeesport as its clinical site. She also is president of the Pennsylvania Academy of Family Physicians. Dr. Conti's interests include health disparities and health care delivery to underserved communities, medical education, and women's health issues.
What Inspired You to Become a Doctor?
As far back as I can remember, I wanted to be a doctor. My mother worked in the West Penn Hospital laundry. She'd point to the hospital across the street and say, “Remember — that's where you want to be." She was raised by her grandparents on a working farm in South Carolina, and my dad was a Vietnam veteran. Both really valued learning, but neither had the opportunity to advance their education. They always encouraged me, saying, “You have the ability and all the love in the world to do what you want to do."
Why Did You Decide to Specialize in Family Medicine?
When I was in college, my parents adopted my brother. His mother had a substance use disorder, and he was prenatally exposed to the substance. That experience was formative: I realized that I wanted to take care of these mothers when they were pregnant — and then take care of their kids. I just didn't know how I could combine those interests into a career.
As a medical student at Temple University in Philadelphia, I discovered family medicine through the school's family medicine interest group. When I learned that family doctors care for patients from birth to death, I knew that's what I wanted to do.
As a third-year medical student, I did a rotation in family medicine at the University of Maryland School of Medicine in Baltimore. My first day there, the chair of the Family Medicine Department called me to say, “There's a delivery — let's go!" I went from a delivery in the morning to caring for pediatric patients in the afternoon. I realized nothing could be closer to my vision of being a doctor than family medicine. I went on to do my residency training in family medicine there.
When Did You First See Health Disparities in Medicine?
My medical studies had a huge impact on me because both institutions have a focus on inner city populations. That's where I've always wanted to serve. My goal was to blend family medicine with the community aspects of being a family doctor.
One of my favorite things as a resident was seeing patients in their homes. You learn so much about people and the barriers they face when you get outside the four walls of your office. How can we as doctors possibly understand what our patients are going through if we never see the road they have to travel? I've always tried to remember that and really try to walk in my patients' shoes.
For example, if you've never had to rely on buses to get around, you may not think of public transit as a barrier to health. You don't know the stress of having to take little children with you to an appointment because you don't have access to childcare — or arriving late to the doctor's through no fault of your own because the bus was late, only to be told you missed the appointment.
Access to medical care may be even harder today here in Pittsburgh because budget cuts mean there are fewer buses running in many communities. Here at Latterman Family Health Center in McKeesport, the bus stop in front of our building was suddenly eliminated. Patients had to walk to our offices from another stop several blocks away until we advocated for it to be reinstated. It was just another barrier our patients had to face to get to care.
What Are Some of the Critical Issues That Need to be Addressed?
You can't talk about health disparities without also talking about racism in medicine. Until now, that's been a subject no one really wanted to discuss, but it's an underlying issue we must understand.
This is a deep, multigenerational issue in the Black community. More than 100 years ago, the speculum was created by a gynecologist who did experimental surgeries on enslaved Black women. In my parents' lifetime, the Tuskegee research study followed the lives of Black men with syphilis without ever giving them a diagnosis or treatment. The Black community's mistrust of medicine has its roots in these and many other acts of racism.
That past can't be ignored if we want to establish trust. And, unless we earn the trust of our diverse communities, the gap in health care will continue. Nowhere is that more evident than during COVID-19.
What's Been The Impact of COVID-19 in The Black Community?
Black Americans are getting sicker and dying from the coronavirus at much higher rates than other populations. My own dad was infected this spring and is thankfully doing well, but it's been a long and frustrating recovery. Now, as researchers work toward developing a vaccine, there's talk on Facebook, Twitter, and even in churches that the COVID-19 vaccine will be just another experiment on Black people. In recent years, I've also seen a growing antivaccination sentiment among young Black mothers. It's a trust issue. We have to constantly work on rebuilding the trust between doctors and patients to break down the barriers that affect health care.
Why is The Doctor-Patient Relationship so Important?
The bond between patient and doctor is central to the quality of care. That relationship takes time to develop and build rapport. I worry about the pressure that many doctors face today to complete a patient visit in just 15 minutes. The emphasis on productivity can erode that relationship.
One of the core tenets of family medicine is continuity of care. It's so important for family doctors to be able to see their patients over time. When I first came to Pittsburgh I was still doing deliveries, so I specifically practice in a residency clinic today because I still want to see those pregnant moms! I love caring for patients who are with child, then caring for them and their children as the kids grow up. That relationship with the family is central to building trust.
How Can Medical Education Help Address Health Disparities?
Our family medicine residency at Latterman Family Health Center emphasizes the importance of knowing and responding to the needs of our community. You can't do that if you stay inside your office, so we work hard to have a relationship with the entire McKeesport community.
Our family medicine residents attend community provider meetings so they can get to know other service organizations and better understand community needs. They've created a community advisory committee to encourage conversations on a neighborhood level. That effort has led to a mentoring program at the local high school, funded with help from the Beckwith Institute of UPMC, that's designed to introduce students to the many career paths available in health care. Food insecurity also is a major concern for many of our patients, so we partner with the Greater Pittsburgh Community Food Bank and 412 Food Rescue to offer thrive boxes at our office.
We have to be aware of the social determinants of health so we can break down those barriers to care. If we can't help our patients with basic needs for living, how can we care for them in our offices? It's very fulfilling to me to work in an environment where we're teaching new family medicine doctors how to do this in a way that is community-oriented, then see them take this approach to medicine into other communities around the country.
I'm also very excited and encouraged by the partnerships that are developing between UPMC and local communities on health disparities. There's a new openness among all parties to talking about disparities and how we got here.
How Can Partnerships Bring About Change?
I was installed as president of the Pennsylvania Academy of Family Physicians just as the pandemic hit. In that role, I quickly learned how much politics impacts what happens on a community level during a time like this. I don't think the average person knows how influential it can be to talk with local leaders.
Health doesn't just happen in a doctor's office. If we're going to address a health crisis like asthma, for example, we need to look at issues like poor housing and air quality. That means getting county and state support. It's critical to know and interact with the key players politically because that is how decisions are made. Health equity must have a diversity inclusion component. We can do everything that we want on a microlevel in our offices, but unless we also influence policy, we really won't see change.
I am seeing open and honest discussions happening in medicine like never before. In my own role as a family doctor at UPMC, I feel like it's my duty to keep pushing the envelope and keep trying to make it better for the people who come after me.
Health disparities are preventable and disproportionate health conditions that exist among all ages in a certain population. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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string(190) "Tracey Conti, MD, is executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, and an advocate for the elimination of health disparities. "
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Tracey Conti, MD, is executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, and an advocate for the elimination of health disparities.Read More
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string(8195) "Utibe Essien, MD, MPH, is an assistant professor of medicine at the University of Pittsburgh School of Medicine. As a physician researcher, his work focuses on racial/ethnic health disparities in cardiovascular disease care and on social determinants of health such as food insecurity and housing instability. In 2020, he co-authored a study with Yale researchers that attracted national attention to racial and ethnic disparities in the reporting and prevalence of COVID-19 deaths.
What Inspired You to Become a Doctor?
My story begins in Nigeria, where my parents were born. After my father completed medical school and residency in Nigeria, my mother, around seven months pregnant with me, decided to come to the United States to advance her education. Not long after arriving in New York, she visited her new obstetrician for a routine visit. She was told she had preeclampsia — very high blood pressure — and needed an emergency Cesarean section. My birth reflects many of the same health disparities Black mothers face today: they're more likely to develop preeclampsia, have C-sections, and give birth to premature babies.
After obtaining his necessary travel paperwork, my father later joined us in New York and ultimately set up his own primary care practice, after years of U.S. medical licensing exams and retraining in Internal Medicine residency. The summer before I went to college, I worked with him there and saw the incredible bond he shared with patients. Even the kids he treated would bring their report cards to him, saying, “Look, Doc — see how good I did in school." I realized that was the kind of personal impact I wanted to make in a community. He's the main reason I'm in this profession.
When Did You First Become Aware of Health Disparities in Medicine?
When I was a medical student at Albert Einstein College of Medicine in the Bronx, it seemed like whatever the class topic — from genetics to kidney or heart disease — Black Americans had higher health risks. But there was never any context behind the statistics. It was just accepted as, “it is what it is." I started wondering: Why is this the case — and how can we fix it?
After medical school, I did a residency in internal medicine at Massachusetts General Hospital in Boston. My clinic in Chelsea served a largely Central American immigrant population. I quickly realized that the problems my patients faced outside the clinic were having a greater impact on their lives than whether I put them on the right blood thinner or cholesterol medicine. Did they have a job? Were they worried about being deported? Could they afford the medicines I prescribed?
I had no training in what we now call social determinants of health. I went on for a master's in public health so I could better understand the root causes of my patients' health issues.
Is Pittsburgh Seeing Any Specific Health Disparities That are Greater Than The Rest of The Country?
I personally haven't done any research specific to Pittsburgh. But the city of Pittsburgh's Gender Equity Commission report released last fall showed that Black women in Pittsburgh have some of the poorest health outcomes in the country — particularly those related to pregnancy and post-pregnancy. Black infant mortality also is unfortunately quite high in our community.
This subject is now part of the national conversation around health disparities. Maternal health boards are being formed to more deeply and thoughtfully understand why pregnant Black women — even those with a college education — are dying at five times the rate of pregnant white women.
It's a statistic that relates to why and how racism can influence health. Increasingly, data suggests that racism, both physiological and psychological, influences access to care. We must begin to ask if there are differences in prenatal and postpartum visits based on one's race.
What Drives Your Research Work in Health Disparities?
I look at health disparities as three distinct buckets: the patient, the provider, and the system. Each area needs to be better understood from both a clinical and social perspective.
Right now, I'm working to understand why patients with the most common heart rhythm disorder — atrial fibrillation — receive different care based on their race. Is it because of their clinical condition or their social condition?
How Was Your Research in Health Disparities Impacted by COVID-19?
I don't think anyone in health care could foresee just how quickly and how impactfully COVID-19 would affect communities of color. But as data started trickling in, the disparities became clear. Black, Hispanic, and Native Americans are infected, hospitalized, and dying at higher rates from COVID-19 than the rest of the country.
I became involved this spring in a nationwide COVID-19 study with a team of researchers at Yale. We used publicly available data to look at three things: the racial differences in testing for COVID-19, the reporting of race and ethnicity data, and the actual mortality rates. Our initial data in April 2020 showed that Black patients were three and a half times more likely to die from COVID-19.
At that time, only 28 states were reporting race and ethnicity data. Nearly six weeks into the pandemic, we didn't have any such data on 22 states. How does that lack of information impact the medical response and distribution of resources for those communities?
Another striking observation — something that relates specifically to our state — was the wide variation we saw in the completeness of data. Pennsylvania was missing 40% of data related to race and ethnicity in its reports. Ten years ago, the Affordable Care Act mandated the collection of race, ethnicity, and language data. But here we are, a decade later, still calling for clear and complete data in these areas.
How Can Social Media Help Drive Awareness?
I've always used social media to promote and share research data as it related to what's going on in the world. But when the COVID-19 crisis hit, I felt it was important to highlight the racial disparities emerging in medicine. I began talking about why all of us — especially those of us in the health system — need to begin prioritizing health equity.
When George Floyd died, my social media presence took a new direction. I was a second year resident when Eric Gardner was killed minutes from where I grew up in New York City. Back then, I deeply felt the silence of no one talking about what happened — including myself. There weren't open conversations like we're having right now with virtual town halls supporting the Black Lives Matter movement and discussions about what it means to treat racism as a public health issue.
It's been a game-changer to now talk openly about racism. I'm not unique in any way, but hopefully telling my story helps to put a face to the problem. If you can imagine what I feel hearing a siren behind me while out on a run, I hope that you can imagine how that feeling is shared by 40 million other people in our country who look like me.
How can medical training make a difference in addressing racial disparities and racism in medicine?
Racism is embedded in our nation's history. We've come a long way, but we still have far to go. It's important to recognize that racism isn't just individualized. It's not just the bad egg who called me a racist word. It's the policies, procedures, and systems that are in place that actually perpetuate racist ideas and beliefs.
Health disparities are preventable and disproportionate health conditions that exist among all ages in a certain population. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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Utibe Essien, MD, MPH, is a physician-researcher who focuses on racial/ethnic health disparities in cardiovascular disease care and social determinants of health, such as food insecurity and housing instability.Read More
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string(10141) "Lyn Robertson, DrPH, MSN, BSN, Associate Director for Health Equity and Community Outreach and Engagement, UPMC Hillman Cancer Center discusses efforts underway to connect uninsured and underinsured people with free cancer screenings.
Read The Full Podcast Transcript
- This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
- Connecting people in the community to important health screenings. Welcome to the UPMC HealthBeat podcast. I'm Tonia Caruso, and joining us right now is Dr. Lyn Robertson. She is the associate director for Health Equity and Community Outreach and Engagement with UPMC Hillman Cancer Center. Doctor, thanks so much for joining us.
- You're welcome. I'm glad to be here.
- So let's begin by telling me what the goal of this work really is.
- The goal of prevention and early detection and actually being out in the community is to reach those individuals who otherwise either hesitate or don't get screened for the recommended cancer screenings. We do it through education and also facilitating actual screenings. I'm actually, and my team, are in communities throughout the 29-county catchment area of UPMC Hillman Cancer Center, and we work with the various facilities, UPMC facilities, in those counties, and we also work with various agencies, institutions, etc., that are within those counties and like to work with us in regards to education and screening of populations out there.
- And let's talk in general about the importance of screening, and what do we know about screening as it relates to outcomes?
- Screening is very important because the earlier we can detect cancer, the better chance we have of treating it, putting the person into remission, and having them go on to live a quality of life or their normal lifespan. So it's very, very important with cancer that you detect it early.
- And so, talk to me more about the program and just how exactly it works. Who do you connect with in the community, and are there certain groups you find need more conversation about this?
- It's a great question. I connect with communities, and I think that connect is very, very important because in connecting with communities, we don't go out there and tell the community what they need. We go out there and sort of learn about the community, work with key leaders in the community, which may be some of our local politicians, it may be school districts, it may be senior high-rises or senior community centers, it may be the Y, it may be libraries. It may be "Johnny on the street" who happens to have heard a lecture that I gave somewhere or one of my team did and they want to know more, and they want us to reach other groups like the PTA or Grandmothers for Pearls, or some organizations that are out there that may volunteer in communities, but also have people that they know need to learn about their health, need to learn about what screenings they need to be doing, and also to get them done.
- And so, doctor, can you give us a sense of what are the types of screenings that you help connect the community to?
- Certainly. I'd be happy to. We connect the community with breast cancer screening, cervical cancer screening, skin cancer screening, colorectal cancer screening, low-dose CT screening for those that are eligible for early lung cancer detection, and also prostate cancer screening if the individual's at high risk.
- Can you talk briefly about how this takes place? How do you connect them to these programs?
- We connect them to these programs by, first of all, talking to the individual on a one-to-one, determining their age and their risk and whether or not they've been screened before, and then from there, we ask them if they'd like to be screened, and if they indeed say they do, then what we do is work with setting up an appointment. It depends upon the type of screening. If it's a breast cancer screening, then we would, in most instances because I work with uninsured or underinsured individuals, I would obtain a mammography voucher, schedule their mammogram, and then talk to them about any barriers or anything that may stand in the way of them getting to their appointment. Maybe they don't have transportation and they need assistance with that. Other types of screening we can do, sometimes, right on site, if the facility where I'm at has en exam room. Or, we also have a Prevention and Early Detection suite in the ground level of the Hillman Cancer Center, and we can actually make the appointment there with one of our nurse practitioners.
- And beyond the idea of someone being uninsured or underinsured, are there other reasons people tell you that they don't want to be screened?
- Yes. Some of it's fear, fear of the unknown -- they're afraid that something might be found. Sometimes it's myths, or stories that they've heard, or experiences they've had. "I had Great Aunt Sally, and she was diagnosed with breast cancer and never got out of bed again and died." Or, "I've heard that if you go and you get a mammogram, that's a lot of radiation, and I don't want to be exposed to that radiation." So there are a lot of myths out there in the community, so sometimes it takes more time than you can imagine to actually work with an individual and get them in to be screened. Many of the individuals that are out there in the community don't have medical homes. So that's something else we really try to do. We try to plug them into what we call, we call them medical homes, but it's actually a medical provider. And it may be a free clinic, a federally qualified health clinic, or we may help them to get coverage so that they can choose the provider of their choice. However, that's easier said than done in many instances because individuals that don't get screened usually aren't screened or don't have health care providers for reasons. And a lot of those barriers, we have to work with them on so that we can get them plugged into medical systems.
- But you're always willing to take on new partners, as well?
- Always. And individuals can call on their own. They can just call our main number and say, "I think I need a mammogram," "I'm not sure I need a mammogram," or, "Maybe I need a gyno exam or a colorectal cancer screening." The main number to call is 412-647-1809. We will get back to them and assess their risk over the telephone and then get them set up for whatever's needed. And I think what people need to realize that despite what's going on with the pandemic, screening is very, very safe here at UPMC. We take all precautions that are necessary, and individuals can feel very comfortable coming in and having whatever screening they need done.
- A lot of this is community outreach. Is this still, are you still able to do this in the time of COVID?
- We are because we've been out there for a number of years. I know myself, I think I really worked to develop the program about 10 years ago or better. And so, being out there that long, we've made enough community-based connections that once the initial fear of the pandemic sort of settled down, I reached out to all of our collaborators, and we developed virtual ways to stay in contact, and many of the clinics, the free clinics or the federally qualified health clinics, and even some doctors that are out there and run into patients that are uninsured or underinsured, just either pick up the phone and call, or they send me an email and say, "These people need this, this, and this," and we facilitate it.
- Any idea of how many people you have helped and how many people who have gone through screenings thanks to your program?
- Thousands. I could honestly tell you on an average year, we have one-to-one interaction with somewhere between 5,000 and 7,000 individuals. Over the years, I mean, on any given year, I'm just trying to reflect back, we probably do between 250 to 300 free mammograms. That's not including colorectal screenings, the low-dose CT, the prostate screenings that we may do, or the cervical cancer screenings.
- You are so passionate about this work, and tell me why that is.
- I'm passionate about this work, and really, it's because I really strongly believe that the only way we're going to conquer this disease is by early detection and prevention, as well as our research. It's important that we meet people where they are, that we're in the community and we talk to them, learn about them, and realize that what I may know, they may not know. So by educating them and sometimes guiding them and helping to direct them, then they too can get the kind of services they need, and hopefully, be diagnosed early, or hopefully, get a clean bill of health and not get diagnosed at all. I generally tell people because I hear it a lot: "I'm very afraid to get screened because what if there's something there?" And I say to them, you're letting fear stand in the way, and we all are afraid when it comes to being screened. But in reality, if you get screened and everything's fine, you can let go of that fear. And if you get screened and there's something there, knowing at least allows that fear in many instances to be a little less, and we can work with you and start to help you down the road of the treatment you need, etc. But the unknown, the fear never leaves, and so you're just in a constant state of fear. So I try to work with people on getting rid of that fear, and let's do something about it.
- Well, doctor, some great information. We thank you so much for coming in and spending time with us today. We appreciate it.
- And thank you.
- I'm Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat
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Lyn Robertson, DrPH, MSN, BSN, discusses efforts underway to connect uninsured and underinsured people with free cancer screenings.Read More
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string(5227) "The COVID-19 pandemic has caused millions of infections and hundreds of thousands of deaths worldwide since late 2019.
The disease, caused by novel coronavirus SARS-CoV-2, has spread across the United States.
Although anyone can get COVID-19, some people are more at risk. And in the United States, that includes racial and ethnic minorities.
The Risk of COVID-19 in Racial and Ethnic Minorities
According to the Centers for Disease Control and Prevention (CDC), members of some racial and ethnic minority groups are more at risk of severe illness or death during public health crises.
According to CDC data, racial and ethnic minorities are more at risk of infection or severe illness from COVID-19. The hospitalization and death rates are higher in those groups than in non-Hispanic whites.
Non-Hispanic Native Americans or Alaska Natives are five times more at risk of hospitalization than non-Hispanic whites.
Black Non-Hispanic people are five times more at risk of hospitalization than non-Hispanic whites.
Hispanic or Latino people are four times more at risk of hospitalization than non-Hispanic whites.
According to APM Research Lab, Black Americans had the highest mortality rate: more than double that of white Americans.
Why Are Minorities More at Risk of COVID-19?
Several factors may play a role in why some racial and ethnic minorities are more at risk of being affected by COVID-19.
Existing medical conditions: Black Americans and other racial minority groups are more likely to suffer from chronic medical conditions than non-Hispanic whites, according to the CDC. People with underlying conditions like heart disease, lung disease, or diabetes are more at risk of COVID-19.
Job status: Members of racial and ethnic minority groups are more likely to hold jobs deemed as "essential services." The risk of infection may be greater in jobs like health care, meat-packing plants, grocery stores, and factories. Many people had to keep working in those industries for economic reasons. Many others may lack paid sick leave.
Economic status: People in minority communities earn less on average than non-Hispanic whites, have higher joblessness rates, and on average have less education and saved income. This may affect where they live and work, which in turn can affect health outcomes.
Less access to health care: Racial and ethnic minorities may have less access to health care. They are more likely to be uninsured or underinsured and may not live closely to a health care facility. This puts them more at risk of getting the care they need to prevent or treat health conditions.
Living conditions: People in racial and ethnic minority groups are more likely to live in densely populated locations or multi-generational homes. Some minority groups are more likely to be over-represented in jails, detention centers, prison centers, and homeless shelters. They may live further from essential services such as grocery stores and medical facilities and may be more likely to use public transportation. These factors all can increase the risk of COVID-19 spread.
Systemic racism: Inequality in living and working conditions and in society at large can make it more difficult for people in racial and ethnic minority groups to get proper care.
How Can We Help People in Minority Communities Amid COVID-19?
The CDC recommends health authorities, community groups, and health care providers work together to address the health care disparities in minority communities. This includes providing accurate information, reaching out to communities to address inequalities, and providing better access to health care.
“UPMC is committed to providing quality care for everyone, regardless of race or ethnic minority," says Graham Snyder, MD, medical director of Infection Prevention and Hospital Epidemiology at UPMC.
As the COVID-19 pandemic continues in the U.S., prevention methods remain crucial. Ways to limit the risk of COVID-19 spread include:
Social distancing: Avoiding large crowds and close contact (6 feet or closer) with others
Wearing cloth face coverings when out in public
Washing hands frequently with soap and water
Cleaning and sanitizing commonly touched surfaces
Monitoring your health and seeking care if you experience COVID-19 symptoms like fever, cough, or shortness of breath
UPMC's Center for Engagement and Inclusion strives to bring equity in health care to the diverse communities we serve. Visit UPMC.com for more information.
For more information on UPMC's COVID-19 efforts, visit UPMC.com/COVID19."
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string(205) "According to the Centers for Disease Control and Prevention (CDC), members of some racial and ethnic minority groups are more at risk of severe illness or death during public health crises.
According to the Centers for Disease Control and Prevention (CDC), members of some racial and ethnic minority groups are more at risk of severe illness or death during public health crises.Read More
Have you heard of health disparities? A health disparity is a preventable difference in health status between groups of people. Many factors, like race, ethnicity, gender, age, and economic status can cause these differences, along with lack of health coverage, access to quality health care, or education.
Health disparities can impact a person's cancer diagnosis and treatment. Some Americans are more likely than others to have certain kinds of cancer, less likely to get cancer screenings, and more likely to die from the disease. These are all examples of cancer health disparities.
Take this quiz to test your knowledge and learn important facts about cancer disparities from the National Cancer Institute.
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Share the quiz to show your results !
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Quiz: Test Your Knowledge of Cancer Health Disparities
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"
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string(230) "Health disparities can impact a person’s cancer diagnosis and treatment. Some Americans are more likely than others to have certain kinds of cancer, less likely to get cancer screenings, and more likely to die from the disease. "
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Health disparities can impact a person’s cancer diagnosis and treatment. Some Americans are more likely than others to have certain kinds of cancer, less likely to get cancer screenings, and more likely to die from the disease.Start Quiz
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string(6086) "Breast cancer is the most common type of cancer among women in the United States, according to the National Cancer Institute (NCI).
In fact, breast cancer rates have been slowly increasing since 2004, with an estimated 266,120 new cases of the disease in 2018. While there is some good news, as the NCI reports that that overall breast cancer death rates are decreasing, not all breast cancer realities are created equal – particularly not for Black women. For the first time, Black women have been added to the list of groups considered "high risk" for breast cancer, according to the American College of Radiology.
Breast Cancer Disparity
Breast cancer outcomes vary by race and ethnicity — and the disparities in Black women are startling:
Black women in the United States are about 1% less likely to be diagnosed with breast cancer than white women but 40 percent more likely to die from the disease.
They are more likely than white women to develop breast cancer before age 40.
Black women are more likely to be diagnosed with more advanced-stage cancer than white women.
They are nearly twice as likely to be diagnosed with triple-negative breast cancer, an especially lethal form of the disease.
One of the best ways to address these outcomes is early detection.
"UPMC Hillman Cancer Center and UPMC Magee-Womens Hospital are joining forces to change the story," said Steven Evans, MD, surgical oncologist at UPMC Hillman Cancer Center. "We want to change the story. The outcomes. Women will live longer once diagnosed with breast cancer. And how is that going to be made possible? That's going to be made possible because we are going to empower them with education
Why Early Detection Matters
Early detection through routine breast cancer screening remains the single most important preventative measure for women, regardless of race or ethnicity. The earlier the breast cancer diagnosis, the higher the chances of long-term survival. Women whose cancer is contained within the breast (stage 1, or localized breast cancer) have a 99 percent five-year survival rate.
Mammograms are the first screening option for most women, improving their chances of early detection. In this type of screening, a series of breast x-rays are taken to look for cancer. Knowing what to expect during a mammogram may help ease your mind if you're wondering how they work and what happens during the test.
When Should You Get a Mammogram?
For women at average risk of breast cancer, our health experts recommend getting an annual mammogram, starting at age 40. This early breast cancer screening protocol has been shown to save the most lives from breast cancer.
Since Black women are more likely to develop breast cancer before age 40, they may want to get screened earlier. As with any medical advice, talk to your doctor about the benefits and risks of screening.
“We are committed to eradicating breast cancer disparities right here at home in Pittsburgh,” says LaJuana Fuller, Director of Women’s Imaging at Magee-Womens Hospital of UPMC. “But we need you to help us. If you have not or you know someone who has not had her annual screening, let’s get that done. I am here to answer your questions and make those connections to get the mammogram taken care of. I am available at (412) 641-5837.”
Breast Density and Breast Cancer Risks
Women with dense breasts have a higher risk of breast cancer. On a regular mammogram, dense breast tissue appears white, making it more difficult to spot cancerous tumors early, if at all.
Breast density has nothing to do with the size or shape of your breasts. Studies have found that Black women have higher breast density on average than white women, which can contribute to more difficult detection of breast cancer.
In 2014, Pennsylvania passed the Breast Density Notification Act, requiring women to be notified of their breast density on their mammogram report. Be sure to read your mammogram report once you receive it from your doctor. If you have questions about your breast density, ask your doctor whether additional screening makes sense for you. Other screening options may include 3D mammography, ultrasound, or magnetic resonance imaging (MRI) of one or both breasts.
Women at high risk may benefit from more intensive screening and should consider making an appointment with the Magee-Womens High-Risk Breast Cancer Program.
Call 1-800-649-4077 to schedule a mammogram at any of our conveniently located Magee-Womens Imaging or Womancare Centers.
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For the first time, Black women have been added to the list of groups considered “high risk” for breast cancer, according to the American College of Radiology.Read More
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string(4922) "Pregnancy and childbirth can be an exciting time for mothers, but it also can be a difficult one.
Physical changes and challenges can occur for expectant and new mothers, but so can mental health challenges. Between 20-25 percent of mothers suffer from perinatal mood and anxiety disorders (PMADs), according to the National Perinatal Association.
Black mothers may face even more challenges. They are more at risk of PMADs but are less likely to receive treatment.
UPMC Magee-Womens Behavioral Health Services, in conjunction with UPMC Western Psychiatric Hospital, offers treatment for a variety of mental health conditions women may face during pregnancy or after birth. Call 412-641-1238 for more information.
Mental Health Challenges for Mothers
Perinatal mood and anxiety disorders can occur during pregnancy and up to a year post-birth.
Common PMADs include depression during pregnancy, anxiety, post-traumatic stress disorder, and postpartum depression.
Postpartum depression is the most common, affecting about 1 out of 8 mothers in the United States. Although many mothers get "the baby blues," postpartum depression is a serious condition that lasts much longer. Feelings of emptiness and a lack of connection to their baby can last for weeks or months.
Symptoms of postpartum depression include:
Crying more often
Feeling angry
Withdrawing from others
Feeling numb, empty, or not connected to your baby
Worrying about hurting your baby
Feeling guilty about not being a good mother, or doubting your ability to be a good mother
Mental Health Challenges for Black Mothers
While mothers of any race can face mental health challenges during pregnancy and after childbirth, women of color are especially vulnerable.
Black mothers are much more likely than white mothers to suffer from PMADs like postpartum depression, according to a 2019 study in Archives of Women's Mental Health.
Close to 40% of Black mothers will suffer from postpartum depression. That's more than double the rate for the general population.
Factors like socioeconomic status and systemic racism play a role in why women of color are more likely to suffer from PMADs. Risk factors include:
Lack of access to high-quality medical care
Higher risk of pregnancy and childbirth complications: Black mothers are four times more at risk of maternal mortality than white mothers.
Lack of social support
Gaps in medical insurance
Financial barriers, including lack of paid time off from work
Unsafe neighborhoods
Increased stress
Exposure to trauma
Maternal Mental Health Treatment
While Black mothers are more likely to suffer from PMADs, they also are less likely to receive treatment. According to a report in Psychiatric Services, Black women were less likely than white women to initiate or continue treatment for postpartum depression.
Many different factors may play a role in why Black mothers don't begin or continue treatment:
Lack of access to quality health care
Distrust in health care system
Lack of diversity in health care
Less screening for mental health conditions in women of color
Mental stigma
Lack of insurance
Finances
Getting treatment for mental health conditions during pregnancy and after birth is important. Without treatment, mothers are more at risk for issues like substance abuse, birth complications, pregnancy-related death, and suicide. PMADs may also cause problems with the baby, including problems with behavioral and cognitive development.
Treatment can include medications, therapy, or a mixture of both. Doctors should consider whether a mother is breastfeeding when prescribing antidepressants, most of which are considered safe to use in lactation.
If you are pregnant or recently gave birth and are suffering from a mental burden, help is available at UPMC. Call UPMC Magee-Womens Behavioral Health Services at 412-641-1238 for more information or to schedule an appointment.
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Pregnancy and childbirth can be an exciting time for mothers, but it also can be a difficult one. Black mothers may face even more challenges.Read More
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string(4072) "Following closely behind glaucoma and macular degeneration, diabetic retinopathy is one of the leading causes of blindness in the United States.
In the earliest stage of the disease, blood vessels in the retina may become swollen and leak fluid and small amounts of blood into the eye. As the diabetic retinopathy progresses, blood vessels begin to block the blood supply to the retina. Often there are no symptoms of diabetic retinopathy or the symptoms are minor.
Proliferative Retinopathy
In the most advanced stage of diabetic retinopathy, signals are sent to the body to grow more blood vessels in an attempt to restore the blood supply. These new blood vessels are fragile and abnormal. The walls of these new blood vessels are thin and fragile and as a result do not supply the retina with proper blood flow. These thin blood cells may begin to leak blood, which results in severe vision loss and blindness.
Macular Edema
At any stage of the disease, macular edema can occur. When this happens, fluid leaks into the macula, the small area at the center of your retina. The macula is the section of your retina that is responsible for sharp vision. With the addition of fluid, the macula becomes swollen and ultimately blurs vision.
Diabetic Retinopathy Symptoms
Like most conditions of the eye, significant vision changes and blindness don't typically occur until the more advanced stages. When symptoms of diabetic retinopathy do begin to appear, the first symptom is usually blurred vision, but sometimes spots of blood may also be visible. Your sight may temporarily improve if the spots disappear; however it is common for them to recur. Once the disease has progressed to the later stages and bleeding is occurring, you will begin to see spots of blood in your visual field. Additionally, if and when, macular edema occurs your vision will become blurry.
Diabetic Retinopathy Risk Factors
Diabetic retinopathy is a diabetic eye condition that commonly affects individuals with both Type 1 and Type 2 diabetes. Likelihood of developing the disease increases the longer you have diabetes. It is estimated by the National Eye Institute that approximately 45 percent of individuals with diabetes have some stage of diabetic retinopathy. In addition to diabetes, individuals who are Hispanic or Black American have an increased risk of developing the condition. Other risk factors for diabetic retinopathy include:
For more information on diabetic retinopathy, or to schedule an eye exam, please call the UPMC Eye Center at 412-647-2200.
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Black and Hispanic people have an increased risk of developing the condition.Read More
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string(7891) "Updated Feb. 27, 2021
The Food and Drug Administration issued Emergency Use Authorization in December 2020 for two COVID-19 vaccines. Pfizer-BioNTech developed one vaccine, and Moderna developed the other.
A third vaccine, developed by Johnson & Johnson, received an EUA in February 2021. Other vaccines are in development.
Vaccine distribution began in December with frontline health care workers and residents and staff of long-term care facilities. It has expanded to people age 65 and older and people with underlying health conditions, based on availability. The hope is that vaccines will become more available to the general public as we approach the summer.
Data from clinical trials reported that the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines are safe and effective with minimal side effects.
But some are still skeptical of the COVID-19 vaccine for a variety of reasons. Many Americans are indicating they are unwilling to get the vaccine.
Black Americans are showing particular uncertainty about getting the COVID-19 vaccine. According to studies, they are less likely than many other Americans to get vaccinated when the vaccine is available to them.
Black Americans and other minority groups are at higher risk of COVID-19, with health disparities a major reason. Getting the vaccine is crucial for stopping the spread of COVID-19 and putting an end to the pandemic.
Tracey Conti, MD, executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, discusses the impact of health disparities on minority communities and what that means for COVID-19 vaccination efforts.
The Effect of COVID-19 on Minorities
Minority populations in the United States are at higher risk of COVID-19 infection and complications compared to white Americans.
Data from the Centers for Disease Control and Prevention show:
Black Americans are 1.4 times more likely to be infected, 3.7 times more likely to be hospitalized, and 2.8 times more likely to die from COVID-19 than white Americans
American Indian or Alaska Native, non-Hispanic Americans are 1.8 times more likely to be infected, 4 times more likely to be hospitalized, and 2.6 times more likely to die than white Americans
Asian-Americans are 1.2 times more likely to be hospitalized and 1.1 times more likely to die from COVID-19 than white Americans
Hispanic or Latino Americans are 1.7 times more likely to be infected, 4.1 times more likely to be hospitalized, and 2.8 times more likely to die than white Americans
Minorities may be at higher risk for COVID-19 for a variety of reasons. But health disparities are a primary factor.
Health disparities are preventable and disproportionate health conditions and inequalities that exist among all ages in a certain population.
Disparities can come from many factors, including access to health care, living environment, and physical environment. These disparities magnify other health issues and risks.
"(COVID-19) has really highlighted health disparities and brought the issue to the current conversation," Dr. Conti says. "I think this is always in the community, but just not really talked about. Now, I think there's a more open conversation because people see that Black and Brown communities were being affected more and dying more."
How Do Minorities View the COVID-19 Vaccine?
Recent polls show Black Americans have skepticism about the COVID-19 vaccine.
A December poll from the Kaiser Family Foundation reported 35% of Black American adults said they probably or definitely would not get the vaccine (compared to 26% of white adults). A Pew Research poll in December reported only 42% of Black Americans said they would get the vaccine (compared to 61% of white adults).
Dr. Conti says factors like health disparities, systemic racism, and past incidents like the Tuskegee experiment have caused many Black Americans to distrust the health care system. Skepticism in the COVID-19 vaccine is an example of that mistrust.
Misinformation and politicization about the vaccine also may be playing a role, Dr. Conti adds."We need to have a good way of addressing the mistrust and talking about it."
Addressing Minority Mistrust in the COVID-19 Vaccine
With the increased risk of COVID-19 in minority communities, it is important to fight people's skepticism of the vaccine. Community leaders, health care professionals, and elected officials can help in several ways:
Be good examples: It's important for leaders — especially if they're minorities themselves — to share facts about the COVID-19 vaccine, including why they are getting the vaccine when it's available.
Be transparent: Explaining the vaccine process — including the speed of its development, its benefits, and potential side effects — can help address concerns. It is also important to explain why the vaccine is so important for minority communities. "We want to make the process as transparent as possible," Dr. Conti says.
Personalize the message: Leaders should recognize different people may have different reasons for skepticism. "It's targeting that message," Dr. Conti says. "Making sure that we are addressing their specific concerns and not just doing something superficial."
Make the message consistent: Community, health care, and government leaders should have a consistent message about why the vaccine is important. Conflicting responses can cause more uncertainty. The message also should be consistently reinforced. "There has to be a recognition that you're not going to be able to convince everybody with just one conversation," Dr. Conti says.
Provide equal access: Access to COVID-19 care and COVID-19 vaccines should be equal to people in all communities. “Leaders should advocate for equal vaccine access, the same way they advocated for COVID-19 testing," Dr. Conti says.
Making sure people have the right information and equal access could go a long way in addressing the concerns minority communities have about COVID-19 and the vaccine.
"Knowledge is power," Dr. Conti says. "When you start educating people and educating them in a way that they're understanding it, and breaking down how we came to the vaccine, why were they able to get this vaccine quickly … I believe in educating as much as possible, for people to have the information to make a good, informed decision."
The UPMC Center for Engagement and Inclusion advocates for health equity in all communities. Read more on how UPMC promotes health equity.
For COVID-19 updates from UPMC, visit UPMC.com/COVID19."
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string(264) "Tracey Conti, MD, executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, discusses the impact of health disparities on minority communities and what that means for COVID-19 vaccination efforts.
Tracey Conti, MD, executive vice chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine, discusses the impact of health disparities on minority communities and what that means for COVID-19 vaccination efforts.Read More
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string(7040) "Updated Feb. 27, 2021
In December 2020, the Food and Drug Administration (FDA) issued emergency use authorization for two new vaccines to protect against COVID-19. One vaccine is from Pfizer/BioNTech, and the other is from Moderna. On Feb. 27, 2021, a vaccine developed by Johnson & Johnson/Janssen also received EUA.
Pennsylvania and the Centers for Disease Control and Prevention (CDC) set guidelines for distributing the vaccines. UPMC is distributing the vaccine following these guidelines. In the coming months, the distribution will expand to the general public.
As the vaccine distribution happens, it's critical to ensure no disparities in who receives the vaccine.
Many Black Americans and underserved communities continue to face health disparities. These disparities can affect their access to the COVID-19 vaccine. Vaccination is critical to stop the spread of COVID-19 and prevent the occurrence of severe illness and death.
How do health disparities affect minority communities, and what does that mean for COVID-19 vaccination efforts?
What Are Health Disparities?
Health disparities are preventable and disproportionate health conditions and inequalities among all ages in a certain population.
In certain populations, health disparities can happen for a variety of reasons, such as:
Individual and behavioral factors
Inadequate access to health care
Education inequalities
Environmental threats
Poverty
“When you don't have good grocery stores or access to exercise facilities, of course, there's going to be a disparity there just because of someone's zip code. That is unacceptable," says Tracey Conti, MD, executive vice chair, Department of Family Medicine, University of Pittsburgh School of Medicine.
Health disparities can range from conditions like heart disease to hypertension and can cause more vulnerability to COVID-19.
How Has COVID-19 Affected Black Americans?
The CDC reports that, compared to white Americans, Black Americans are:
1.4 times more likely to be infected by COVID-19
3.7 times more likely to be hospitalized from COVID-19
2.8 times more likely to die from COVID-19
Black Americans are more vulnerable to COVID-19 for several reasons.
1. Black Americans are more likely to be exposed to COVID-19.
Black Americans are more likely to be exposed to COVID-19 because of factors including:
Occupation
Transportation methods
Neighborhoods
Historical and structural racism
"It goes back to structural racism," Dr. Conti says. "It goes back to how people lived in certain communities. Structural racism has a lot to do with the health of communities."
Structural racism is a combination of public policies, institutional practices, social forces, ideologies, and processes that generate and perpetuate inequities among races.
One example of systemic racism: The "redlining" system that banks and the real estate industry once leveraged, using red ink to outline the neighborhoods where people of color lived. Granting loans to those inside the red lines was considered risky, so banks were less likely to offer loans or investments.
2. Underlying health conditions and health disparities
The elderly and those with underlying health conditions are at the highest risk of severe COVID-19.
Black Americans are more likely to get hypertension, diabetes, and heart disease than other American populations. This puts them at risk for severe COVID-19.
3. Access to health care and distrust in health care systems
Inequalities in health care access make it challenging for many Black Americans to get both adequate health care and preventive care.
Lack of preventive care can result in more hospitalizations, worsened chronic conditions, and undiagnosed illnesses.
In addition, Black Americans may have a deep-rooted distrust in health care systems due to historical events like the unethical Tuskegee experiment.
"(COVID-19) has really highlighted the impact of health disparities and brought it to the current conversation," Dr. Conti says. "I think this is always in the community, but just not really talked about. Now, I think there's a more open conversation because people see that Black and Brown communities are being affected more and dying more."
Why COVID-19 Vaccination Is so Important for Black Americans
Since Black Americans are more vulnerable to COVID-19, it's important to help make sure these communities get the vaccine when able.
Dr. Conti says Black Americans may be hesitant to get the COVID-19 vaccine for many reasons. This includes the speedy development of the vaccines, along with general distrust in health care systems.
"Every person might have a different reason for being skeptical," she says.
Dr. Conti stresses it is important for community, health care, and government leaders to have a consistent message about why the vaccine is important. The message also has to be regularly reinforced.
"There has to be a recognition that you're not going to be able to convince everybody with just one conversation," Dr. Conti says. "We have to build relationships, and it takes time to develop trust. It can't just be a one and done."
Dr. Conti advises that it's important for leaders — especially if they're minorities themselves — to share facts about the COVID-19 vaccine. This includes getting the vaccine when it's available.
"Leaders should advocate for equal vaccine access, the same way they advocated for COVID-19 testing," she says.
How Can Health Disparities Be Addressed?
While health disparities may be difficult to address, especially during a pandemic, they are preventable. There are many things the community and elected officials can do to help, beginning with education.
"Knowledge is power," Dr. Conti says. "When you start educating people and educating them in a way that they're understanding it, and breaking down how we came to the vaccine, why were they able to get this vaccine quickly ... I believe in educating people as much as possible, so they have the information to make a good, informed decisions."
UPMC is working with community organizations and leaders at every level. We are developing health education, programming, and services to ensure equity in health care and the well-being of all people.
Learn more at UPMC.com/HealthDisparities."
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string(279) "Many Black Americans and underserved communities continue to face health disparities. These disparities can affect their access to the COVID-19 vaccine. Vaccination is critical to stop the spread of COVID-19 and prevent the occurrence of severe illness and death.
Many Black Americans and underserved communities continue to face health disparities. These disparities can affect their access to the COVID-19 vaccine. Vaccination is critical to stop the spread of COVID-19 and prevent the occurrence of severe illness and death.Read More
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In my final year of medical school, I had an internship at the National Cancer Institute's Center for Cancer Research. One of my patients was a Black woman who needed a very serious and rare operation. She saw the long hours we were putting in for her and said to me, “Dr. Evans, I want you to know that I appreciate all you're doing. Even if this surgery doesn't give me a longer life, I want to thank you." I immediately knew then that I wanted to become a surgeon and focus on cancer. Her words ultimately led me to complete a surgical residency at UPMC and a cancer fellowship at the National Cancer Institute.
What led to your career in politics?
Growing up, I was always interested in government. But it wasn't until high school that I started thinking about government as a solution. I was concerned about the violence I saw happening in McKeesport, particularly among young people. I decided to go to a city council meeting.
I discovered that only one person on council looked like me, despite the city's significant minority population. And its members weren't even my parents' age — they were my grandparents' age. I felt government needed to be more representative of all the people they were serving.
I approached then-Mayor Jim Brewster (now a state senator) with an idea for a youth advisory council, and he graciously allowed me to get involved. Our advisory council took on a number of community projects. We got involved in raising awareness about youth violence and cleaning up different neighborhoods.
What racial and health care disparities concern you most?
I was a student in the McKeesport Area School District, which was and still is predominantly Black American. Then and to this day, it's severely under-resourced. Compounding that problem is the fact that many of its children live in poverty. In fact, 50% of all the kids in McKeesport, Duquesne, and Clairton live in poverty. If you're looking for equity and racial issues, look no farther than the Mon Valley.
Food insecurity is a major deterrent to good health in our region. The city of McKeesport has five grocery stores, but Clairton has none, and there's no prospect of one moving in. Duquesne has one grocery store, and it's on the verge of closing. There once was a time when people lived, worked, and shopped all in the same community. But our world has changed. The resources we need to adapt — like affordable and dependable transportation — have not kept up with the people who need them the most.
How has COVID-19 affected the communities you serve?
Spring 2020 really changed the world — and southwestern Pennsylvania. In January, my legislative agenda focused on a massive transportation bill to create more revenue for regional mass transit.
But when the coronavirus hit, we just threw the bill out the window. It didn't make sense to try to raise revenue when unemployment rates jumped from 4% to 12% in literally one month.
I've always been able to learn firsthand what people are really struggling with through the calls that come into my office. During COVID-19, the huge concern initially wasn't unemployment: it was health care. Many of the communities that I represent already had significant health disparities before COVID-19 arrived, including barriers to health care access. COVID-19 only magnified those issues. How can we ensure that folks are getting tested? How can people even get transportation to the medical centers to get tested?
Local colleagues and I banded together to try to find answers. We reached out to all the health care providers in the region, including UPMC, UPMC McKeesport Hospital, and the UPMC Latterman Family Health Center. Their collective response was and continues to be terrific.
You've probably seen recent reports that say this virus seems to be hitting Black Americans and other people of color harder than other populations. My fellow House representatives Jake Wheatley and Summer Lee and I worked to create a COVID-19 health equity task force. We've met regularly with Dr. Rachel Levine, Pennsylvania's secretary of health, and Dr. Debra Bogen, director of the Allegheny County Health Department. We pushed very hard to expand testing to our federally qualified health centers in the region because we know that in low-income communities, those centers are often the first line of defense for health care needs. It's no accident that I located my office next to a federally qualified health center.
But it's hard to both lead people and adapt to the moment, especially when that moment is a time none of us have ever lived through. There's no one with first-hand experience in a better way to do things. While some will disagree, I think Pennsylvania is doing significantly better than other places. Although we still have to be vigilant, we have made strides.
Is there one particular issue in terms of racial disparities that troubles you most?
There's no one specific thing, but I will say tackling this problem has to be a collective effort. It's not a matter of one person or one organization addressing the issue. It has to be a partnership. The health care community needs to address disparities and biases within their systems. Those of us in government need to make sure that we are ensuring access for people living in marginalized communities. That means transportation, making health care affordable, and making sure we are adequately funding public health services.
I'll share a personal example. Studies show that Black Americans tend to do better if they're treated by diverse doctors. When I was elected to the House, I had to change insurance companies. It took me two years to find a new doctor I was comfortable with. If I found that process difficult, imagine how hard it is for a community member who can't tap into the same resources that I can.
There's no silver bullet to fix the challenges of racism in medicine and health disparities in our communities. But if we all continue working in our respective spaces to address the issues within our wheelhouses, we will see success.
Health disparities are preventable and disproportionate health conditions that exist among all ages in a certain population. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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string(135) "Austin A. Davis was the first Black person outside the city of Pittsburgh to win an elected state office in southwestern Pennsylvania. "
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What Led You to Specialize in Maternal Fetal Medicine?
I've wanted to be a doctor since I was a child. My intent was to do heart transplants, so as a medical student at Boston University, I did some research in that area. I was pretty confident that's what I wanted to do. But during a rotation at Boston City Hospital, I found myself drawn to obstetrics and gynecology.
As a resident, I started focusing on complicated obstetrics and how to optimize the health of both mother and baby. That path led me to maternal fetal medicine (MFM) and the knowledge gaps that exist in the health needs of both mother and child. I came to UPMC for an MFM fellowship 22 years ago and have been specializing in that area since then.
In your research, you identified that premature births among Black women are nearly double that of whites and Hispanics, and that premature Black babies die at a significantly higher rate than other racial groups. What are some of the contributing factors to those statistics?
There are many disparities contributing to health outcomes in addition to race, and that's certainly true in pregnancy. Researchers have explored how biology, environment, health, and disease affect fetuses as they develop — and how they affect pregnant women both during and after pregnancy.
We also know there are many social factors that contribute to the health of a mother and child, such as access to care and the quality of the health care experience. Patient engagement with a system of care can vary by many factors, and race is one of them.
Only about 20% of all health care outcomes are actually the direct consequence of health care interventions. The other 80% are related to other things, like the safety of the neighborhoods we live in, the availability of healthy foods to eat, and the opportunity for leisure time and physical activity.
It's said that our ZIP code is a greater predictor of our health and wellbeing than our genetic code. But in recognizing that social determinants contribute to adverse health outcomes, it's also important to understand we have the ability to improve. We don't get to change our genetics. But as a society, we do get to influence our structures and policies. We can become more fair in assuring good access to care.
How is your research and clinical work helping to address racial disparities in health care?
At UPMC Magee, we're very cognizant of the fact that there are health disparities for Black Americans and other racial groups here in Pittsburgh and throughout the country. From both a research perspective and in our role as clinical leaders, we're committed to contributing to the conversation and to improving these circumstances.
For example, women with high blood pressure during and after pregnancy have a much greater risk of dying after delivery. Black women have a higher incidence of hypertension during and after pregnancy.
We've developed an innovative virtual program to monitor and manage postpartum hypertension. The program identifies women who are at risk and connects them to better health care through educational resources and risk assessment. We're helping them to be informed and supporting their adherence to prenatal care. We're also linking them to ongoing preventive care with the goal of minimizing the harm of hypertension across the course of their lives. While helping to improve health for all women postpartum, programs like this also help narrow disparity.
What is the role of health care systems in addressing racial disparities?
So much of what happens in the health care environment is affected by what we do outside of it. Outreach services and engagement with community stakeholders cannot be an afterthought. They're essential to maximize and optimize health care outcomes. We as a health care system need to own that.
We can begin by giving an effective voice to those individuals and communities who have not been heard before. Just as importantly, those of us in health care need to be a receptive audience. We need to listen and make sure that we actually understand the problem and hear the voices of those most affected by these problems. We can't function in a vacuum, developing interventions or coming up with answers without a collaborative effort.
And we must do our part to address our unconscious bias as care providers. We need to better understand what women of color expect from their pregnancy and birth experience. That will enable us to narrow disparities, engage populations, and enhance trust.
How are you working to build trust among women of color?
We are constantly working to engage patients, enhance cultural competency, and maximize health literacy. For example, studies show that doulas can play a vital part in ensuring that a patient's voice is heard, care adherence is maximized, and that the patient's perspective and wishes are followed. At UPMC Magee, we are working to integrate doula professionals into our health care teams. When a woman “clicks" with her doula — a laywoman specially trained in childbirth — that relationship provides invaluable advocacy, education, and support before, during, and after delivery. It's a tangible way for us to improve the lives of women during pregnancy and in the postpartum period to help them form a closer, more trusting bond with their entire health care team.
How has COVID-19 impacted your work?
It's safe to say that no aspect of American life has been untouched by COVID-19. But compared to many other health care fields, obstetrics marches on. During COVID-19, our business of delivering babies has remained consistent.
From the very start of COVID-19, we worked hard to find ways to use virtual technologies to protect our moms and babies, and our staff. Fortunately, we're part of a system that's been on the cutting edge of using telemedicine for some time. We were able to adapt very quickly, completing more than 6,000 virtual prenatal visits interspersed with face-to-face visits.
Telemedicine essentially allows us to bring our care to a patient's home. It improves the patient experience by maintaining a high degree of communication with the provider using a lower resource footprint. Delivering that kind of care makes it easier for the patient on countless levels.
Are you hopeful for the future?
I've recognized the gravity of racial disparities for a long time. What I see that gives me hope is the degree of attention it's now getting across a broad swath of society. My hope is that this broad range of support brings immediacy and action to these problems. Problems of racial disparities and differences in women's health outcomes didn't happen overnight, and they likely won't be resolved in 2020. But the current sense of urgency is creating a real momentum that has me feeling positive about the future.
Health disparities are preventable and disproportionate health conditions that exist among all ages in certain populations. The first step to prevent health disparities is by learning about them. UPMC is committed to driving health education and programming, partnering with our community, and training health care providers to ensure all individuals and families have the opportunity to live healthier lifestyles."
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string(174) "Hyagriv Simhan, MD, MS, is executive vice chair of obstetrical services at UPMC Magee-Womens Hospital and director of clinical innovation for UPMC women’s health services. "
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string(150) "Women face mental health challenges during pregnancy and after birth, and Black mothers may be at greater risk. Learn more about this topic from UPMC."
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string(142) "Pregnancy and childbirth can be an exciting time for mothers, but it also can be a difficult one. Black mothers may face even more challenges."
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