Meharry looks to close health-care gap

Note: This is the third of a six-part series on Meharry Medical College and the work it is doing to end health disparities.

What will it take to put an end to
health-care disparities?

The answer might come from health-care professionals who are also scholars of political science and economics with a passion for clearing the way for all to have quality medical and dental care.

The Robert Wood Johnson Foundation, a national health-care philanthropy, has invested $18 million to create a breeding ground for health policy experts, and housed the effort in a university historically committed to serving the underserved - Meharry Medical College.

The Robert Wood Johnson Foundation Health Policy Center opened on the campus of Meharry in 2010 and is a partnership between the historically black United Methodist-related college and Vanderbilt University.

One of the first graduates, Dr. Eleanor Fleming, is now an epidemic intelligence service officer at the Centers for Disease Control in Atlanta with her eyes on Washington.

Fleming would like nothing better than to take the issues of access to health care and higher incidences of disease or mortality out of academic circles and into offices where public health policy is being decided.

She graduated from Meharry as a licensed dentist with certification in health policy from the Robert Wood Johnson Foundation Center for Health Policy. She also holds a bachelor, master and doctorate degree in political science from Vanderbilt.

Daniel L. Howard, executive director of the health policy center at Meharry, said like the other scholars in the program, Fleming "had a plan."

All her experiences came together with the health policy certification, he said.

The Robert Wood Foundation Center for Health Policy is an ambitious program with a goal to increase the number of African-American scholars committed to research and public policy that will identify and eliminate health disparities. It is a natural pairing with Meharry's tradition of serving the underserved and researching the root causes of health disparities.

After a nationwide search, Howard was named director in 2010. "Health disparity is a relatively new term. I have always been interested in black-and-white differences in health," he said.

The Meharry center is the first of its kind to focus on educating and recruiting African-Americans. The Robert Wood Johnson Foundation also established a similar center in New Mexico that specializes in health-care disparities among Hispanics and Native Americans.

For the student trained as a medical doctor or a dentist, training in health-care policy has the advantage of not just thinking of one patient but laws or programs that impact many patients, Howard said.

"You are not moving away from treating folks, you are just trying to figure out ways to treat them better that goes beyond the clinical approach. That's the added value that the certificate program brings.

"Good policy comes from good research," Howard added.

Policy mixed with passion

In her role at the CDC, Fleming says she is like a CSI professional looking for the sources of disease.

"EIA officers do the surveillance, assessment and public health work to come up with a solution to any public health issues," she said "My work largely focuses on issues of health equity and social determinants of health (how your race/ethnicity, gender, income, education level, and where you live, work and play affect your health). Most of my attention is on sexually transmitted infections, primarily syphilis, gonorrhea and chlamydia."

Fleming became interested in oral health disparities when she heard Dr. David Satcher, a former surgeon general and Meharry president, talk about children dying from lack of access to dentists. "He talked about people dying from teeth that needed to be extracted and it just haunted me."

After completing her degrees in political science, Fleming started looking for a way to combine that knowledge with her passion for providing suffering people access to quality dental care.

"I enrolled at Meharry, and I thought I would be a community health dentist and I would be working in an underserved community, chair-side seeing patients. But the more that I realized the scope of the problem our nation is facing, to me one dentist in one community is good, but I could do much more being that I understand policy and political science."

Scholars at the Meharry Health Policy Center are encouraged to look at the big picture and see how seemingly unrelated facts are linked, she said.

"So, with my work, I consider whether or not a woman has access to transportation and can afford to take leave from work &ellipsis; how that may affect her seeking treatment for a sexually transmitted infection.

"On the surface, transportation would not matter in a disease outcome. But, in the case of certain communities, especially those with lower incomes, it matters. When I work now, I think about the totality of issues and constantly take an integrated approach to my epidemiologic research," she said.

Different approach

The public health approach is a different perspective from the medical approach, Howard said.

African-American women are more likely to get breast cancer than white women - that's a health disparity, he explained. The data suggests African-Americans get breast cancer at a younger age and in a more serious form.

National guidelines now suggest women older than 40 get their first mammogram.

"Maybe for African-American women, it needs to start at age 30," he said. "That's the health policy - coming up with some intervention based on the data and the research. So it works hand in hand."

While Fleming first dreamed of working "chair-side" with patients, now she is looking at everything through the lens of what she learned at the health policy center.

"In 10 years, I see myself in Washington, D.C., sitting at a table with the surgeon general, members of Congress, the secretary of health and human services, and I am making presentations that will shape our nation's oral health."

It is her goal that every American can receive medical and dental care.

"That is my hope, that somewhere between now and 10 years, I would have won that battle."

Gilbert is a multimedia reporter for the young adult content team at United Methodist Communications, Nashville, Tenn.

News media contact: Kathy L. Gilbert, Nashville, Tenn., (615) 742-5470 or newsdesk@umcom.org.