As COVID-19 took its toll on the U.S. in 2020, the numbers began to show that not everyone was equally affected by the virus. Data from the CDC and National Center for Health Statistics showed Black and Latinx populations were almost three times more likely to be hospitalized for COVID-19 than white populations, and it was two times more likely that their cases resulted in death.
But COVID-19 only revealed the health disparities that were already rampant in the nation. And, these underlying disparities did not only affect people of color, but also occurred based on other factors such as socioeconomic status, gender, sexual orientation, geography and age.
As the most economically and ethnically diverse university in the nation, the CSU is committed to ensuring all community members are served equally, including access to health care. Here are a few ways campuses are pushing for that access.
A Little Motivation
The Stanislaus Recovery Center (SRC), which provides addiction recovery treatment for patients on Medicaid or Medi-Cal who are often unemployed or unhoused, is the site of a pilot study led by Shrinidhi Subramaniam, Ph.D., assistant professor of psychology at California State University, Stanislaus.
Working together since 2018, Dr. Subramaniam and the SRC team noticed when patients were transferring from residential to outpatient care, their participation in treatment dropped off. To address the issue, Subramaniam, her students and the SRC launched the project—funded by a Research, Scholarships and Creative Activities grant—to study whether monetary incentives, paid on reloadable credit cards, increased patient participation in outpatient services as well as improved abstinence and treatment outcomes.
“I expect the participants in our study to all be in the category of socioeconomic disadvantage, and hopefully the little bit of money that we can give them with the incentives will also encourage them to access other recovery resources through continuing care,” Subramaniam says.
This pilot study is based off research she conducted during her post-doc at the Johns Hopkins School of Medicine on motivational incentives in health care, including encouraging HIV patients to take their medication and chronically unemployed individuals recovering from substance use disorder to abstain from drug use. Another study also looked at the efficacy of incentivizing patients to do other important tasks like sign up for health insurance, complete job training or acquire identification like a Social Security card or ID.
Subramaniam hopes her work can expand to incentivize patients to use other services at SRC, including its existing resources that link clients to training or local job opportunities—with the ultimate goal of setting up her own “therapeutic workplace” where individuals can receive treatment as well as help securing education, employment and housing.
“We have to deal with a lot of stigmas working with this population; both the stigma of addiction and the stigma that comes along with poverty,” Subramaniam says. “So, one of the major goals of my research program is to figure out what it takes to help people with that combination of addiction, unemployment and poverty to get out of their situation to the best of our ability. Of course, there are structural changes that need to be made to help people in that position, but there are also things psychology can do on an individual basis to help people access resources that are available. And incentives are a great way to help motivate people to do those difficult tasks.”
The Next Generation
Named in honor of the unsung medical personnel dubbed heroes during the COVID-19 pandemic, the proposed Regional Healthcare Initiative Health Education, Research, and Clinical Outcomes (HEROs) Institute at San Diego State University would seek to improve health care services and reduce disparities in its community by addressing issues in health education.
“We can’t address access to health care if we don’t address access to health care education,” says Harsimran Baweja, Ph.D., associate professor in exercise and nutritional sciences. “Our idea is to make a grassroots-up change to health care delivery, so that these students who go out now, our alumni, will be the changemakers.”
Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.
Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.
“We will be accelerating the delivery [of health care] from bench to bedside or to the community, because the problem in health care access and delivery is the pace at which it’s given,” Dr. Baweja explains. “We need to reduce the burden on the health care system and reduce the burden on the money that is spent. Our trainees who will go out will know how to run the system more efficiently. We really have to create a better and more efficient work system and workflow.”
Spearheaded by Baweja, María Luisa Zúñiga, Ph.D., campus director of the Joint Doctoral Program in Interdisciplinary Research in Substance Abuse, and other faculty in research and innovation, public health and physical therapy, the HEROs Institute will also consolidate efforts currently occurring separately in the colleges. For example, the NIH-funded Addiction Scientists Strengthened Through Education and Training (ASSET) Program aims to increase the number of Black and Latinx scientists in substance abuse addiction and education, while the California Outreach Challenge, which SDSU participates in, has physical therapy programs compete for the most community service hours. Under the institute, similar programs could be implemented that extend across SDSU’s health care disciplines.
Lastly, professors in the participating programs would imbue students with the values, cultural competence and community understanding that would prepare them to drive health care policy changes in the future.
“If we not just prep students to be ready for whatever is coming in the future, but we guide them with the value system that you have to serve your community before they graduate, then the health care system is going to be better prepared for itself than it was in the past 12 months,” Baweja says. “These are going to be the people who are going to be not only informing the workforce, but will be informing the policies in the future.”
The team is currently seeking public, private and industry partnerships to jumpstart the HEROs Institute, which is part of the SDSU Big Ideas Initiative.
A Health Care Transformation
Building on the campus’s Mi Gente, Nuestra Salud (My People, Our Health) effort, California Polytechnic State University, San Luis Obispo is piloting a new institute that facilitates community-led initiatives to address health equity around the cities of Santa Maria and Guadalupe on California’s Central Coast.
“Our solution is a people’s movement for health ownership,” says Suzanne Phelan, Ph.D., professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “The Mi Gente, Nuestra Salud initiative flips our current system upside down, empowering people—and especially those who are currently minoritized in America—to identify and address their most pressing health concerns. We aim to transform health care into health ownership.”
To meet this goal, the Cal Poly Institute for Community Health Training and Research will largely provide resources that enable existing groups to better serve all members of the community with the help of collaborators from all six of the school’s colleges. These resources will include training in health equity principles, data on the community, funding opportunities and strategies for community partnerships, health advocacy and program evaluation.
“We see this effort as collaborative and, ultimately, community-driven,” says Marilyn Tseng, Ph.D., assistant professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “We see the institute as providing resources that will help the process along; we are only one piece in the complex health ecosystem in Santa Maria. If we can help generate ripples that will produce larger beneficial impacts on community mobilization, health ownership and health equity, we will consider the effort to be completely worthwhile.”
To secure support for the project, the team has already forged partnerships with the city of Santa Maria, nonprofits and University of California, Santa Barbara. It also recently received funding from the California Breast Cancer Research Program to study breast cancer risk disparities in the Latinx and immigrant communities of Santa Maria.
These efforts will also be bolstered by Cal Poly San Luis Obispo’s Women and Infants Mobile Health Unit, which, in addition to supporting local health workers and providing free medical care to uninsured women and infants, will serve as a connection point between the institute and the community.
Finally, the team hopes to introduce health advocacy and ambassadorship training into the classroom, preparing Cal Poly San Luis Obispo students to effectively care and advocate for these communities.
Inspiration for these efforts grew out of a program in Jamkhed, India, called the Jamkhed Comprehensive Rural Health Project (CRHP), aimed at empowering people to address health disparities in their communities by first addressing the social, cultural and economic challenges that exacerbate those inequities.
“All of us conduct research and teach courses in which we confront issues of health inequities rooted in systemwide, structural inequities in access to healthy environments, opportunities and resources,” Dr. Tseng says. “The Jamkhed CRHP has been successful and cost-effective in India, but more importantly, its principles resonated with all of us. We felt that health ownership was something we would like to see here given the stark disparities in health, even in our region.”
