December 1, 2014

Ensuring equal access for all

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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.”

Dr. Richard Andrews (left) professor of environmental sciences and engineering, was a panelist at a Minority Health Conference in the 1980s.

Dr. Richard Andrews (left) professor of environmental sciences and engineering, was a panelist at a Minority Health Conference in the 1980s.

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.

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.

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

Profile: Vic Schoenbach

For nearly 35 years, Victor Schoenbach, PhD, associate professor of epidemiology at the Gillings School, has worked — often behind the scenes — to keep the issue of health disparities in the spotlight.

Dr. Vic Schoenbach in the 1970s.

Dr. Vic Schoenbach in the 1970s.

It was therefore no surprise that, when accepting the University’s inaugural Martin Luther King Jr. Unsung Hero Award in January 2014, he deflected praise onto his students and colleagues in the Minority Student Caucus and the National Health Equity Research Webcasts.

“This award is shared by all of us, and I thank them for enabling me to play a part,” he said.

Schoenbach has been at UNC since 1972, first as a master’s student, then as doctoral student and postdoctoral fellow in psychosocial epidemiology. He joined the public health faculty in 1980.

Since 1991, he has advised the planning committee for the student-led annual Minority Health Conference, a project of the School’s Minority Student Caucus. He also is devoted to preserving the history of the Caucus by collecting and curating materials with colleagues at the UNC Health Sciences Library.

Dr. Vic Schoenbach, today.

Dr. Vic Schoenbach, today.

A long-time champion of research and programming to address health disparities, Schoenbach leads the UNC Minority Health Project. The Project aims to expand awareness and strengthen relationships between groups whose members focus on eliminating disparities. Previously, Schoenbach led the UNC Lineberger Minority Cancer Control Research Program.

Despite his vast experience studying the complexities of society, economics and health policy, he sums up the problem rather simply.

“Poor health for anyone is a problem for everyone,” he says.

—Elizabeth Witherspoon

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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.