How To Address Social Determinants Of Health In Marginalized Communities

Advancing Science Through Programming

Founding Dean and CEO of the Kaiser Permanente Bernard J. Tyson School of Medicine, Dr. Mark Schuster, with Ogilvy’s Ritesh Patel at JPM 2020 Innovation Pop-Up

Of the total number of therapists in the US, only 4% are African American, while 38% of the US population is a racial/ethnic minority.

As Rina Raphael reports in Fast Company article, consumers from marginalized communities want to be treated by therapists who share their background. If they aren’t receiving the care, then the stigmatization perpetuates. Raphael states:

For minorities already marginalized in other sectors, it can feel extra cruel when such a gap looms when it comes to their therapy needs. In addition, groups such as African Americans harbor long-standing suspicions of mental health institutions, which have proven biased against their needs in the past. As such, only one in three African Americans who needs mental healthcare actually receives it, according to the American Psychiatric Association.

Telehealth applications are one way consumers can get the necessary treatment tailored to their race, gender, culture, religion, or class. For instance, Ayana is an online therapy for marginalized & intersectional communities. Then there is Henry Health, a digital community providing culturally sensitive teletherapy to black men “so they can show up whole, operate with joy, and live with power.” Entrepreneurs have built these services because they are close to the pain and don’t want to be reliant on incumbents to figure out that gaps in health disproportionately affect diverse and inclusive audiences. Although entrepreneurial ventures are helping narrow gaps, those best positioned to remedy the problem from an institutional approach might be established enterprises and medical schools.

Ohio-based Molina Healthcare, a Fortune 500 company, just announced the launch of its Social Determinants of Health Innovation Center. According to Molina’s press release, the Innovation Center will expand member engagement and support by developing programs and best practices to address health care access barriers created by social factors.

“As an organization that prides itself on its regional focus and partnerships, Molina looks forward to applying SDOH best practices across our nationwide footprint to benefit all the local communities we serve.” — Dr. Jason Dees, Chief Medical Officer, Molina Healthcare

Another organization testing new models to address social determinants of health is the Kaiser Permanente Bernard J. Tyson School of Medicine. The Kaiser Permanente Bernard J. Tyson School of Medicine is an allopathic medical school associated with the Kaiser Permanente health system and located in Pasadena, California. Kaiser Permanente created the school to train “future physicians in 21st-century medicine.” The school expects to enroll its inaugural class of 48 students in July 2020.

Founding Dean and CEO of the Kaiser Permanente Bernard J. Tyson School of Medicine, Dr. Mark Schuster, recently spoke at our JPM 2020 Pop-Up in a fireside chat about how the school plans to use modern educational techniques and teach non-traditional topics, such as population health, data analytics, student wellness, and patient engagement. Below are some highlights from Dr. Mark Schuster’s chat and how Kaiser Permanente is addressing health disparity in marginalized communities:

• We are first and foremost, a school that focuses on medical education, that is our reason for existence.
• And we have started from scratch, we are building up an entire approach to medical education. That is what we think will be best for our students. That said, we are learning from all the other medical schools around the country, including some that were way before me, and we appreciated the generosity of different schools and sharing what they tried what’s worked, what hasn’t worked. However, we are still starting from square one. We’re not purchasing our material from other schools.
• Our curriculum is fully integrated. We don’t have a biochemistry class first semester or an anatomy class. When you learn about the heart, you’re learning about the physiology, electrophysiology, histology, anatomy, and everything all at once. But you’re also learning about prevention related to cardiovascular disease, and it’s a case-based approach and you diagnose hypertension and the patient and you come up with the treatment. It doesn’t end there. Did you find out if the patient had a copay and be able to build a prescription, or were they going to stretch it out and take a pill every other day? You’re an advocate for your patient.
• It’s our job to understand what’s going on in their settings and coordinate with the patients to take into account what’s going on in the rest of your life.
• Health System Science is a significant part of our curriculum that means the quality of care, access to care, ethics, social determinants, and a whole range of issues that are often taught in a single course elective that are core to the curriculum. And then when you’re out in practice, you have integrated them fully. We similarly higher talented teachers for the clinical faculty. We are selecting for 23,000 permanent positions.
• We’re starting at 48 students per class. We want the students who are passionate about whatever they do and what they want to do in the future. You know, in short, we want students who want to save the world that could be through the lab, working in the health center or innovation.
• We don’t want to destroy anyone. We want students to graduate with the same altruism they had when they got there.
• We want our students to understand health disparities in community health. Some of them may go into all different fields. Some of them may practice in underserved areas, or some may practice in well-off areas, but we want them to understand the diversity of your patients, and the diversity of the way their patients think and what their needs are. But, yes, we hope our students really understand what Bernard Tyson really cared about — what the health of the community is.
• We don’t have lectures; they might have Khan Academy style 15-minute lectures. They will read the case, do exercise tables, and watch some short videos based on whatever the educational technique is that week. They come to the group session, ready to learn together.
• We have an Associate Dean for equity inclusion in diversity. He and his team are working on every single case, so the entire curriculum is through the lens of equity and diversity. Our admissions committee is very conscious, and it’s been trained on the importance of taking into account diversity and ways in which students may have overcome challenges that may not be obvious.

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