The gap between the rich and the poor is the topic du jour, and the medical world has its own version in the treatment and health outcomes of minorities and women. Two people who understand those inequities more than just about anyone are Kate Walsh
, the chief executive of Boston Medical Center, and Dr. Paula Johnson
, executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital. Both also serve on the Boston Public Health Commission, which Johnson chairs. Here is an
edited transcript of their conversation about their own work and Boston’s health challenges. — Shirley Leung
Walsh: What would you say are the biggest health issues facing the minority community in Boston?
Johnson: There are a number, and they really occur across the life span. For example, black infants are 1.5 to 4 times more likely to die prematurely in the first year of life. If we looked at those likely to die below the age of 74, blacks are twice as likely to die.
Then you look at the disparities in chronic disease. They are pretty significant. Heart disease, stroke, cancer. And there also are a lot of inequities in people being able to make the right choices. That is a very significant health issue for minorities. For example, being able to make healthy food choices, being able to let your children out on the playground and get adequate exercise.
Walsh: At Boston Medical Center, we are trying to address this, too, using the pediatric visit as completely as we can. If you’re worried about your kid going out to play, we have a jump rope clinic. We can teach your kid how to jump rope, and let them take home the jump rope. We keep track, and there’s a competition of who’s the best jump roper. I’m increasingly impressed by the fact that relatively straightforward and simple interventions are as important to improving people’s health outcomes as the state of our facilities.
Walsh: Paula, under your leadership on the Public Health Commission, the focus on data in determining where we need to make public health investments has been something that distinguishes this department from others. We are less reactive and more able to identify an issue in the community and address it with specific programming.
Johnson: That’s so right. Data not only organized by neighborhood but by race, ethnicity, and gender. So we understand rates of heart disease, obesity, cancers, smoking, by very specific measurements. It really helps our outreach and helps for us to know who we target.
Walsh: Can you talk a little about your work on gender — that it’s more than just a chromosome? It’s really eye-opening to me as a woman in health care just how deep these disparities go.
Johnson: What we say: Every cell has its sex, which is that men and women are different biologically. Traditionally we only look at those gender differences when it comes to reproduction. Women have babies, men don’t. At least today that’s the case. But disease expresses itself differently. For example, diabetes is a major problem particularly in the black and the Latino population. If we think about diabetes, there are higher rates in women and actually far worse outcomes. It allows us the opportunity to think about how we prevent these diseases very early on.
Walsh: We’ve worked really hard on disparities in cancer outcomes. BMC through its cancer center has really focused on making sure that, in particular, minority patients have access to clinical trials. Seventeen percent of [our] patients are on a clinical trial; 40 percent of those patients are minorities. Those numbers are much lower in other places.
Johnson: You’re so right in the engagement of clinical trials in making sure that all populations have the most up-to-date care but also understanding what are the biological differences. Why is it that black patients exposed to the same amount of tobacco have a higher rate of lung cancer? You’re looking at this, and we’re looking at this along with Brigham and Women’s, along with the Dana Farber. These are very important questions for us to keep our eye on because we are going to have to focus on the full range of differences. It’s the science, it’s the access to care, and it’s ultimately the environment.
Walsh: Can you give us a little preview for both the commissioners and the public on how you see the Walsh administration is moving on a public health agenda?
Johnson: One is substance abuse. We know that the levels of opiate addictions are really skyrocketing. Mayor Walsh made a policy intervention to make sure first responders could travel and use Narcan [to treat narcotic drug overdose]. That’s very significant. It doesn’t prevent addiction, but we know it saves lives.
There’s going to be a very significant focus on prevention, treatment — and recovery.
And then violence is clearly a very significant problem in our city. It takes the lives of way too many young minorities, particularly men.
The third is increasing focus on health equity. That’s part of what we’ve devoted our lives to. Boston has some really excellent communicators. The need is to really focus on how we use our great resources to close those gaps.
Walsh: I’ve been impressed with the mayor’s direction. He’s been at the BMC very frequently early on in his tenure. His understanding of the challenges people face and his commitment of getting resources to them has been terrific.
At BMC, we’ve developed a lot of expertise in populations that are struggling with addiction, and that kind of research expertise is now being translated into care for patients.
Johnson: We also know that help is not just about the illness. The context in which people live is so important. The mayor’s dedication and focus on affordable housing and on closing the wage gap, those are all critically important issues in promoting health. We don’t think about them as such, but they are.
Johnson: There are a lot of women in health care today. Is our job done?
Walsh: No, I’d say, “why did it take so long?” Literally 70 percent of [the health care workforce] is women, and it’s great there are more women chief executives [of hospitals compared with other industries], but frankly there should be a lot more.
Johnson: There are many more women in academic medicine [than there used to be], but the leadership is still pretty thin. There’s a significant amount of work to do in advancing women in the ranks both in leadership roles and in the ranks of professorship. This is particularly true for people of color. There, we’ve made very little progress.
Walsh: If you look at medical school, or college, or even business school classes, it’s 50/50 men and women. We have to look at what happens when people want to grow their family, how do they continue their careers?
Johnson: The pipeline is not exactly where it needs to be, but when it comes to medical school, it’s filled. We are bursting to get out the other end and up.