by Antonio Shallowhorn, MPH Candidate’ 16
It was important for me to work on an Applied Learning Experience (ALE) project that would be rooted in social justice and that would truly impact my partner organization. I knew I wanted to focus my project on men of color, but I did not know in what capacity.
Men of color experience more deaths from heart disease, hypertension, diabetes, stroke, cancer, HIV/AIDS, and other health conditions compared to white men.i,ii,iii,iv In addition, men of color are less likely to receive routine medical procedures and are more likely to experience a lower quality of health services.v This affects healthcare utilization and perceptions of healthcare for this population.vi The premature death of men of color has profound consequences for their families and society. Children without father figures are more likely to use drugs and alcohol and enter into the criminal justice system.ii
I told a classmate about my interests and she suggested that I contact Mr. Albert W. Pless, Jr., the program manager of the Men’s Health League (MHL) at the Cambridge Public Health Department (CPHD). It was the perfect match. The MHL was beginning to look at how their projects could be expanded to address systemic issues and have more of a population health approach.
CPHD is a city department administered by Cambridge Health Alliance (CHA), a regional healthcare delivery system. It operates an array of innovative programs, including the MHL which focuses on improving men’s health and reducing chronic disease disparities. At CPHD, I developed a greater understanding of how medicine, public health, and policy are integrated.
CHA is an organization dedicated to delivering multi-cultural and multi-dimensional care and has made many strides in responding to health disparities. My ALE deliverable was to create a set of recommendations on how CHA could better prepare and support physicians to meet the needs of men of color, with a focus on cultural competency. To gather data, I interviewed CHA providers and the MHL staff, and held a focus group with black men in Cambridge.
Many themes emerged from the interviews. The participants’ responses provided insight on the reciprocal interaction between personal, behavioral, and environmental factors, and their impact on the medical encounter. I collected a lot of information and the hardest part was trying to make sense of it all. As I was coding the data, I began to see how disconnected the men and CHA providers were in their views about the patient experience. For example, physicians mentioned listening, working in groups, and being curious as key components to practicing culturally competent care. However, some men shared that they often felt like they are not valued as patients.
Despite this, I saw a lot of opportunity for more collaboration. I knew that it would take more than a cultural competency training solely targeted to physicians to solve the complex issues. Some of my recommendations included: 1) provide more opportunities for patient-provider partnerships, 2) create avenues for physicians to share best practices, and 3) find ways to connect CHA physicians to the MHL as a resource for reaching men of color and connecting them to social services.
My experience reminded me of the value community organizations and community health centers have in changing the way people think about their health and experience healthcare. We all have a role in ensuring the health of our communities and with that role comes the responsibility to look at issues holistically and ensure that a diverse group of leaders and community members are helping to make decisions.
i Drake, B. F., Keane, T. E., Mosley, C. M., Adams, S. A., Elder, K. T., Modayil, M. V., ... Hebert, J. R. (2006). Prostate cancer disparities in South Carolina: early detection, special programs, and descriptive epidemiology. J S C Med Assoc, 102(7), 241-249.
ii Enyia, O. K., Watkins, Y. J., & Williams, Q. (2014). Am I My Brother’s Keeper? African American Men’s Health Within the Context of Equity and Policy. Am J Mens Health. doi:10.1177/1557988314559242
iii Graham, G., & Gracia, J. N. (2012). Health disparities in boys and men. Am J Public Health, 102 Suppl 2, S167. doi:10.2105/ajph.2011.300607
iv Harper, S., Lynch, J., Burris, S., & Davey Smith, G. (2007). Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003. JAM, 297(11):1224-1232. doi:10.1001/jama.297.11.1224.
v Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc, 94(8), 666. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594273/pdf/jnma00325-0024.pdf
Elder, K., Meret-Hanke, L., Dean, C., Wiltshire, J., Gilbert, K. L., Wang, J., . . . Moore, T. (2015). How do African American men rate their health care? An analysis of the consumer assessment of health plans 2003-2006. Am J Mens Health, 9(3), 178-185. doi:10.1177/155798831453