Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males. His work seeks to identify sources of individual, cultural, and organizational social capital to promote health behaviors, and health care access and utilization, to advance and improve the health and well-being of African American males. This is part of a series of posts looking at diversity in the health care workforce.

I became a public health professional because I recognized a need to find opportunities and strategies to prevent the chronic diseases I saw silently killing African Americans in the community where I grew up. I vividly recall as a child the whispers surrounding the deaths of community members about cancer, diabetes (or sugar-diabetes, as it is commonly referred to in many communities still today), heart attacks, and strokes. I knew there was stigma and fear, but never heard of programs, interventions, or opportunities to stop these trends.

My interest in addressing these problems led me to pursue summer programs and internships during high school that allowed me to witness amputations of uncontrolled diabetic patients who had a range of clinical and social co-morbid conditions. Many of these amputees were living in poverty, they had Medicare or Medicaid, and the majority happened to be African American. This experience raised the question about prevention: How could I prevent African American men and women from having amputations? I never heard this conversation around prevention in my community. Many people seemed to accept the reality of developing these chronic conditions as a fate that could not be controlled.

I knew there had to be another way.

-- Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966

Nalo Hamilton, PhD, RN, WHNP/ANP-BC, is an assistant professor of nursing at the University of California, Los Angeles School of Nursing; and Cheryl Woods Giscombé, PhD, RN, PMHNP-BC, is an assistant professor in the School of Nursing at the University of North Carolina at Chapel Hill.  Both are Robert Wood Johnson Foundation Nurse Faculty Scholars.

The New Year has begun and for some 2013 marks a time of celebration and progress, while for others it is a time of uncertainty and despair. As we pause to remember the rich contributions of Dr. Martin Luther King, Jr., we should also reflect on how his legacy can be used to eliminate the health care disparities that so disturbingly affect the underserved and underrepresented in our nation today.

The World Health Organization has determined that geographic locale, ethnicity, education, environmental stress, and access to a health care system are social determinants of health and health inequities. These factors are influenced by the disparate distribution of resources, wealth, and power.

In the United States:

• African Americans, Hispanic Americans, and Native Americans have rates of diabetes that far exceed those in non-Hispanic whites.
• African American women are more likely to be diagnosed with advanced stage breast cancer compared to white women and have the highest rate of mortality.
• Native Americans report more alcohol consumption and binge drinking than other racial/ethnic groups.
• Hispanic males age 20 or younger have the highest prevalence of obesity compared to non-Hispanic whites and African Americans.
• African American men and women are more likely to die of cardiovascular disease than non-Hispanic whites.
• Infant mortality occurs in African Americans 1.5 to 3 times more than in other races or ethnicities.

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

The Harold Amos Medical Faculty Development Program
is on the verge of a milestone: it will observe its 30th anniversary this year.  In 2012, the program achieved another notable distinction, as a third alumnus was selected to lead an institute at the National Institutes of Health: Gary Gibbons, MD, (’88) is now director of the National Heart, Lung, and Blood Institute (NHLBI). He joined Griffin Rogers, MD, MACP, (’83) Director of the National Institute of Diabetes and Digestive and Kidney Diseases; and Roderic Pettigrew, MD, PhD, (’83) Director of the National Institute of Biomedical Imaging and Bioengineering.

Formerly known as the Minority Medical Faculty Development Program, the Harold Amos Medical Faculty Development Program (AFMDP) was created to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine or dentistry, and who will encourage and foster the development of succeeding classes of such physicians and dentists. AFMDP offers four-year postdoctoral research awards to historically disadvantaged physicians and dentists who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background.

By Daniel L. Howard, PhD, executive director of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. The Center’s mission is to provide leadership in health policy education, research and reform, while improving the health and health care of underserved communities. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.

This week, I am part of a team that had the honor of being chosen to conduct a presentation on mental health in African American faith-based communities at the 140th Annual Meeting and Exposition for the American Public Health Association (APHA).  This is a significant topic for clinicians, researchers and policy-makers to consider when addressing mental health needs for African American individuals and their communities.

The Surgeon General’s Report Supplement (2001) noted that science can offer effective treatments for most disorders.  However, it noted, “Americans do not share equally in the best that science has to offer.” Numerous others researchers have concluded that publicly provided behavioral health services must be improved for ethnic minorities.

Research has consistently shown that, despite significant prevalence of mental health issues in the United States, most individuals do not seek treatment for these issues. Historically, research has shown that African Americans are even less likely to seek mental health treatment than their Caucasian counterparts. There are several reasons for this that are not exclusive to, but do include, the stigma that surrounds mental health in African American communities, the perceptions of mental health in African American communities, and the limited mental health resources available to address mental health needs in the community.

Despite the indication that the majority of mental health service needs for African Americans are unmet, there has been a strong and consistent response from the African American church to serve as the surrogate for the medical sector. Many published studies have found that African American churches have strong potential to serve as a highly effective gateway for the successful delivery of health intervention. The compatibility between health and wellness and African American churches, and particularly between mental health wellness and African American churches, can be attributed to several factors including the church’s consistent tradition of supporting its members and the inherent emphasis on the healing of psychological ills.

Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado.  Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.

Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?

We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation).  I had learned about hands-only CPR in my medical training.  Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.

But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart.  Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.

Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?

In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health.  After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.

After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?

By Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, MD, MBA

In March 1966, only two years before he would be assassinated, Martin Luther King Jr. uttered what I consider one of his most profound statements.

“Of all the forms of inequality,” he said, “injustice in health care is the most shocking and inhumane.”

The quotation is never far from my mind. It embodies so much of the work we do at the Foundation—to narrow and then eliminate disparities in health care access, to improve the health of all Americans. But especially every January, as the holiday to honor the civil rights leader again comes around, his words seem to resonate even more. And they mix once again with some very personal memories.

I met Dr. King once. I was 7 years old, and he was in Seattle for the first and last time in his life. After speaking to a big crowd downtown, he and a group of ministers and friends went out to dinner and then came to my house. My mother, a native of Atlanta, had known Martin from childhood. His father had married my parents and buried my grandparents. And now he sat in our living room, and I got to say hello. It was a scene, and a moment, you just don’t forget.

Nearly half a century later, I believe Dr. King would be both cautiously hopeful and deeply distressed over our nation’s health and health care. He would support the significant changes under way to improve access and quality in our health care system, but he would not minimize the significant inequities that endure between Whites and other racial and ethnic groups.

He would urge us all to work harder and push farther to bring about justice in health care. And so we shall.