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Race vs. Place

Christopher Myers

Race vs. Place (continued)

While those findings might suggest medical interventions including genetic screening targeting African Americans, Coresh notes that a tremendous amount of kidney disease might still be related to neighborhood factors that interest LaVeist. These include lack of access to health care that could control hypertension and blood glucose levels. In fact, when it comes to diabetic-related kidney disease, Coresh says  epidemiologic studies suggest that nearly all of the excess risk is accounted for by conditions directly related to how people live, and not their genes.

“I think it’s absolutely true that environment and particularly the impact of poverty and access to care are very important to study,” says Coresh of LaVeist’s work, adding that these environmental issues could also trigger disease among both the genetically susceptible and the general population.

LaVeist’s message and methodologies are being carried forth by the many colleagues he’s mentored. Some, such as Thorpe, note that LaVeist’s research dovetails with the past work of another Hopkins researcher, Marsha Lillie-Blanton, DrPH ’88, MHS ’82. In 1993, Lillie-Blanton found that crack cocaine, while far more available in poor African-American communities, was actually used almost equally, on a percentage basis, by blacks and whites within those blighted borders. So much for the common perception that crack was solely an African-American issue.

For EHDIC team members, their research is not just a single study but a prototype for similar efforts and a model for giving back to the communities being surveyed.

Given the growing pool of data, Sara Bleich says that focusing on race as the reason people suffer health disparities is, from a programmatic viewpoint, a nonstarter. “Maybe the difference we observe between blacks and whites regarding, say, hypertension, isn’t a race story but where they live. What that implies is something hugely different for public policy,” Bleich says. She notes that even if disparities turn out to have both biological and environmental components, it may make more sense to focus time and money on the latter. “You can’t make someone who is black into someone white. But you can modify environments. It’s very difficult to do, obviously, but EHDIC and similar studies create policy levers that didn’t exist before that are actually viable,” she says.

Tiffany Gary-Webb, who is now an associate professor at Columbia University researching the social determinants behind diabetes, said she was stunned by the data and its potential implications.
“I made Tom look at the data every-which-way because I had never seen a study where there was no disparity in diabetes between whites and African Americans. It goes to show that if you get people living in similar environments, they’ll have some of the same problems,” she says.

LaVeist isn’t shy about his hopes for EHDIC. He sees it as a prototype for similar studies in other integrated census tracts around the country, and not just in the results they generate. One component of the work is dedicated to giving back to the communities being surveyed, the opposite of parachuting into a community, collecting data and disappearing.

The EHDIC team, for example, published The Southwest Baltimore Community Health Report and mailed it to every active address in the community. EHDIC also helped establish a community center for health and wellness where, LaVeist says, “the programs don’t take a race approach. They take a community approach.”

To address gangs, drugs, smoking and health care issues raised in the EHDIC report, the Faith Center for Community Wellness and Advancement has become a one-stop shop, running everything from smoking cessation and heart-healthy programs to a makeshift gymnasium—all under one small roof. One afternoon this spring, while teenagers pound weights upstairs, 53-year-old Cecelia Battaglia talks about how the Faith Center’s programs were helping her and her family. Battaglia, who has a weakened heart from a childhood bout with rheumatic fever, says that despite being familiar with her condition, she learned “things I never knew before,” such as the need for regular exercise versus the occasional long walk. She’s also visited the Center’s farmers market to buy fresh produce, something not often seen in her neighborhood. “It was great. The kids were just going up and buying it and eating it,” Battaglia says. “When’s the last time you saw a kid buy a tangerine and eat it?”

LaVeist’s team will head next to Prince George’s County, Maryland, which has an annual median income of $86,000. They intend to compare health disparities between upper-income African Americans and whites. LaVeist wants to see whether his findings from lower-income areas hold, or if there are health stressors particular to African Americans who achieve the conventional notion of success, and whether they perceive their environment in the same manner as their white neighbors.
Ultimately, LaVeist hopes to use his meticulously collected scientific data to influence the decision-makers, be they on hospital boards or Capitol Hill.

“This is all about policy,” he says. “I’ve got this policy paper in my head that I want to write, but I don’t want to write it until I’ve done enough of these studies that the evidence is so overwhelming that it becomes difficult to debate. But eventually they’ll be a book or a series of policy papers that say, when it comes to health disparities, we have to look at social factors.”

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