Eliminating Health Disparities -- Ensuring Equal Access for All

October 1, 2014

Since establishing  the first department of public health education in the U.S. to serve all people in a southern state during the Jim Crow era UNC’s public health school continues leading research, service and teaching to address health disparities.

A hallmark of that work has been an unrelenting focus on working with minority students, faculty members and communities in the study and development of programs that help equalize access to health care and information for underserved groups.

“You can’t address public health without addressing health disparities,” says Victor Schoenbach, PhD, associate professor of epidemiology and current director of the UNC Minority Health Project. “The School grew out of that awareness.”

In the 1940s, for example, when segregation laws barred black students from enrolling at UNC, School leaders, particularly health education professor and chair Dr. Lucy Morgan, developed a joint public health education program at what was then the North Carolina College for Negroes (now N.C. Central University).  The School also established a health education program focused on the needs of American Indians.

In the 1950s, Dean Edward McGavran, frustrated that the epidemiology department was not as engaged as it might be, hired Dr. John Cassel, with Public Health Service funding, to lead a new chronic disease section in the department. Cassel, an émigré from South Africa and a strong anti-apartheid advocate, was soon joined by Drs. Sidney Kark and Guy Steuart.

Kark left after one year to work at the World Health Organization, but Cassel and Steuart were appointed as chairs of epidemiology and health education, respectively. Their leadership brought a fresh perspective and a new focus on the social causes of disease.

Dr. Sidney Kark spent a year in
UNC’s epidemiology department. In 1959,
he and his wife, Dr. Emily Kark, permanently
emigrated to Israel, where they developed a Master of Public Health program for physicians at Hebrew University’s Hadassah Medical School.

Michel Ibrahim, MD, future dean of the School, came to UNC to study biostatistics in 1960, but quickly transferred to epidemiology because of his admiration for Cassel.

“Cassel advanced the theory that social and psychological factors affect people’s health,” Ibrahim says. “He was concerned with cultural values, societal values and stress and how they related to illness.”

The 1960s brought political upheaval to UNC. The School’s faculty and staff members and students participated in protests against injustice and inequality, and their research explored health disparities that clearly resulted from poverty and racism. More black students were being educated at the School, and many went on to become national public health leaders. In 1964, William A. Darity and Edward V. Ellis were the first minority students to earn doctoral degrees from the School.

When a group of students formed the Minority Student Caucus and took their concerns to Dean Fred Mayes in 1971, Mayes appointed William T. Small, MSPH, to increase minority student enrollment. Small’s influence spanned more than 25 years, during which the Caucus organized the first Minority Health Conference in 1977. The conference continues as an annual event. Now in its 36th year, it is the longest-running student-led health conference and has served as a model for such conferences at other public health schools. In 1999, then-dean William Roper, MD, MPH, named the event’s keynote lecture to honor Small’s contributions.

Through a strategic planning process in the 1990s and a grant from GlaxoSmithKline, School faculty members helped develop the UNC Program on Ethnicity, Culture and Health Outcomes (ECHO), an effort to foster research collaborations between academicians and communities, train scholars to address health disparities and develop resources. Anissa Vines, PhD, research assistant professor of epidemiology, co-directs ECHO’s Carolina Community Network to Reduce Cancer Disparities and Community Research Core. The network addresses disparities in prostate cancer among African-American men. More recently, the group has studied malignancies related to HIV, a first for UNC, according to Vines.

Jack Geiger and Count Gibson at Tufts University received federal funds to establish the first U.S. community health centers. Gibson headed the center at Columbia Point in Boston. Geiger hired John Hatch as community health action director, and together, they led the center in Mound Bayou, Miss. Hatch eventually earned a Doctor of Public Health degree at UNC and joined the public health faculty.

In the early 1990s, Diane Rowley, MD, MPH, who joined the Gillings School in 2008 as Professor of the Practice of maternal and child health, worked with colleagues at the Centers for Disease Control and Prevention to develop a conceptual framework for research on health disparities that affect women and infants. That framework considers disease and health in the context of a social environment influenced by social behavior and cultural, historical, political and economic forces. Rowley continues this work with Vijaya Hogan, DrPH, clinical associate professor of maternal and child health, who leads projects in Philadelphia and Jackson, Miss., that train and empower minority women as advocates.

“When you do planning around health disparities, you have to include people who are affected by those problems,” Hogan says.

Geni Eng, DrPH, professor of health behavior, has been a vital leader in community-based participatory research since her days in the Peace Corps and as a doctoral student at UNC. For the last decade, she has worked with the Greensboro Health Disparities Collaborative (GHDC), an academic-community coalition. Funded by the National Cancer Institute, Eng and colleagues have launched Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) to test the effectiveness of reorganizing cancer care to optimize quality and narrow treatment disparities between white and African-American patients with breast and lung cancers. If their approach is effective, it could lead to better care for minority patients, and, indeed, for all patients.  (Read more at tinyurl.com/eng-cph-2013.)

Meanwhile, graduate students and professionals also can earn an Interdisciplinary Certificate in Health Disparities through a program that spans economics, sociology, psychology and anthropology.

Thanks to people in the Gillings School today and those who have come before, there has been great progress in addressing health disparities. Still, there is work left to do.

A new epidemiology professor carrying on the legacy is Allison Aiello, PhD, who joined the faculty in 2014. She is founder and principal of Aiello Research Group (aielloresearchgroup.org).

“Our research group is dedicated to uncovering how social determinants and exposure to stress influence the biological pathways of health within minority populations,” Aiello says. “I am excited to join the Gillings School and its cadre of top-notch faculty members who are dedicated to addressing health equity issues.”

—Elizabeth Witherspoon

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph.