Carol Horowitz, MD, MPH, left, and Lynne D. Richardson, MD, directors of the Institute for Health Equity Research, at its inaugural symposium.
As part of its mission to elevate the science of heath equity, the Institute for Health Equity Research (IHER) held its inaugural symposium, one of the first major milestones in a new partnership between IHER and Royalty Pharma, established in 2022, to build an infrastructure to exchange ideas and propel research collaboration.
“We founded IHER to elevate the science of health equity to the same level as other important areas of science that are studied here at the Icahn School of Medicine at Mount Sinai. We are very pleased to partner with Royalty Pharma as we engage other leaders in the field to bring this conversation to the forefront,” says IHER Co-Director Lynne D. Richardson, MD, Professor of Emergency Medicine, and Population Health Science and Policy, Icahn Mount Sinai.
“We designed the symposium to explore two main areas of priority: collecting strong data to transform clinical care and building partnerships for cross-sector engagement,” says IHER Director Carol Horowitz, MD, MPH, Professor, Population Health Science and Policy, and Medicine, and Dean for Gender Equity in Science and Medicine.
The symposium, titled “From Inquiry to Action,” was held Friday, December 1, at Icahn Mount Sinai. The Institute was founded in 2020.
“To help us craft solutions that will really make a difference, we need community-based organizations to help us understand the lived experiences within the community,” says Dr. Horowitz. “We can’t come into a community without understanding the social determinants of health at a local level: Do members of the community have access to nutritious food, do they live in safe housing, how clean is the air? Our institute is looking at all these different influences and working hand-in-hand with people from local communities to develop programs that tangibly improve their health.”
Dr. Horowitz moderated a panel of experts from community-based organizations, academia, and the public sector. The panelists described the challenges and possibilities of community-engaged equity initiatives.
“The use of data, both from health care organizations and from other sectors, is key to addressing structural inequities and achieving health equity,” says Dr. Richardson.
Dr. Richardson moderated a diverse panel that included leaders from health care, payors, and industry who described how cross sector data on health status and health care utilization can be linked to individual data on social risks and needs and to neighborhood data on physical and social exposures that threaten health. The panelists presented examples of how data can be harnessed to inform organizational strategies to promote equity and discussed the considerable challenges of using data in ethical and unbiased ways that do not adversely impact minoritized populations.
Through many voices and viewpoints, a familiar pattern emerged: a sobering story of a broken system that continues to fail its most vulnerable patients.
The keynote speaker, former New York State Health Commissioner, Mary T. Bassett, MD, MPH, FXB Professor of the Practice of Health and Human Rights, Harvard T. H. Chan School of Public Health, described the unequal landscape of medicine over time and across the country. At one point, she reminded the audience that it was only 15 years ago that the American Medical Association, the voice of organized medicine in the United States, acknowledged that it had wrongly allowed, even endorsed, policies that prohibited Black physicians from practicing in hospitals.
“That Black individuals disproportionately suffer from kidney failure is one of many manifestations of unequal care that has its seed in a very long list of inequities,” says Dinushika Mohottige, MD, MPH.
Two members of the IHER faculty presented their research, beginning with Dinushika Mohottige, MD, MPH, Assistant Professor, Population Science and Policy, and Medicine (Nephrology). Dr. Mohottige, who specializes in kidney health equity, led her presentation with a startling statistic: While 13 percent of the U.S. population is Black, Black Americans make up 35 percent of individuals receiving dialysis care.
“That Black individuals disproportionately suffer from kidney failure is one of many manifestations of unequal care that has its seed in a very long list of inequities from underinsurance, limited access to doctors, and a wide spectrum of unequal social determinants working against them. Kidney patients, specifically, also experience the lingering challenges resulting from a race-based algorithm that has been phased out but which previously limited the possibilities for transplantation for Black patients,” says Dr. Mohottige.
Dr. Mohottige has found partners to leverage equity data to reform transplant roadblocks. To address the eGFR algorithm, a race-based correction that had the effect of overestimating a Black patient’s kidney function, she has worked with colleagues to help implement restorative policies to require unbiased, race neutral estimates of kidney health that began in January 2023.
She discussed cascading barriers to transplantation that begin with challenges to transplant referral and evaluation.
“These challenges can include trauma, discrimination, financial or employment instability, mental health or substance abuse, underinsurance, food insecurity or transportation barriers. If you are an individual with any of these challenges, imagine how hard it is to take even the simplest of steps in this long journey,” says Dr. Mohottige. “A fundamental part of change is simply making sure providers know that any of these obstacles can be an impediment, and we know from the data that clinicians are not always aware of these roadblocks. To address this, we are working with multiple partners to build training programs to fill some of the education gaps among providers who treat these vulnerable populations.”
“Faith-based organizations are a natural place to integrate mental health supports,” says Sidney Hankerson, MD, MBA.
Sidney Hankerson, MD, MBA, Associate Professor, Population Health Science Policy, and Psychiatry, and a Mount Sinai Biomedical Laureate, described several initiatives designed to address mental health inequities in New York City. African Americans and Mexican Americans, he told his listeners, have the lowest rates of depression treatment in the United States. Dr. Hankerson is working to address this problem through partnerships he has developed with faith-based organizations throughout the NYC area and Westchester County.
Through the First Corinthians Baptist Church in Central Harlem, he has collaborated with church leadership to develop free mental health care embedded in their HOPE (Healing on Purpose and Evolving) Center. With a new grant from the Mother Cabrini Health Foundation, he is expanding the program by training psychiatry residents at Mount Sinai in the principles of community engagement and supervising residents who provide direct clinical services at the HOPE Center.
Through the TRIUMPH (TRansformIng yoUr Mental health through Prayer and Healing (Triumph Together), he has developed an eight- week training program to teach motivational interviewing in churches in the five boroughs and Westchester. TRIUMPH aims to address racial and gender disparities that affect Blacks and other communities of color by promoting mental health equity, increasing mental health literacy, reducing stigma, and improving access to care for depression, anxiety, prolonged grief, and drug use.
“More people initially seek help for depression from clergy than from psychiatrists. So, faith-based organizations are a natural place to integrate mental health supports,” says Dr. Hankerson.
Through grant funding from the Scarlett Feather Foundation, Dr. Hankerson is now launching “Brothers Connect,” a suicide prevention program aimed at black youth ages 13-19. The program will roll out in YMCA’s across the city to reach boys participating in basketball leagues.
“All of these programs have one thing in common: They are all created as community-based networks of care to reach vulnerable populations where they are,” says Dr. Hankerson. “Our churches and local Y’s are safe havens where we can have the greatest impact. These programs underline how important it is for an institution like Mount Sinai to find partners in the community to reach patients who aren’t likely to walk through our doors and ask for help.”