School spotlight

Experts gather at Pitt Public Health to tackle health equity and disparities.

The United States spends more on health care than any other high-income nation yet ranks last in many disease outcomes—largely because of disparities in terms of income, housing, transportation, environment, and a host of other factors, agreed a distinguished panel of experts from academia, government and public health advocacy who convened at the University of Pittsburgh School of Public Health on Oct. 20. The discussion, presented on the theme of “Forging Advances in Health Equity and Health Disparities Research,” was among a yearlong series of events designed to mark the 75th anniversary of the school.

“We were honored to host this star-studded panel of health equity experts,” said Maureen  Lichtveld, MD, MPH, dean and Jonas Salk Professor in Population Health, who moderated the discussion. “They seamlessly highlighted a path into the future, giving us much to contemplate as we look ahead to the next 75 years.”

Eliseo J. Pérez-Stable, MD, director of the National Institute on Minority Health and Health Disparities (NIMHD), one of the 27 National Institutes of Health (NIH), delivered the event’s keynote address before an audience of nearly 200 attendees.

Other panelists included Peter Kilmarx, MD, acting director of the Fogarty International Center at NIH; F. DuBois Bowman, PhD, dean of the University of Michigan School of Public Health; Georges Benjamin, MD, executive director of the American Public Health Association (APHA); and Leandris Liburd, PhD, MPH, acting director of the Office of Health Equity, U.S. Centers for Disease Control and Prevention (CDC).

“Studies show Pittsburgh is among the worst places in the country in terms of disparities,” said Clyde Wilson Pickett, vice chancellor for equity, diversity and inclusion at the University of Pittsburgh, who offered a local perspective to open the session. “We don’t often recognize how stark those differences are.”

In 2019, Pittsburgh’s Gender Equity Commission reported that the maternal mortality rate among Black women was higher in Pittsburgh than in 97% of similar cities. In addition, the report found that 13 of every 1,000 Black babies die before their first birthday, compared with fewer than 2 per 1,000 white babies.

“We have a responsibility as an institution to step up. Cities around the world are looking to us to make an impact,” said Pickett, calling for action as a moral and economic imperative.

“Promoting health equity cannot happen without reducing disparities,” noted Pérez-Stable, a recognized leader on the science of minority health and health disparities research, adding that the success of the Affordable Care Act of 2010 demonstrated that expanding access to previously uninsured individuals can work. Even so, challenges remain.

For example, as a group, Latinos make up the largest uninsured population, he said. As a result, Latinos (and African Americans) have greater difficulty managing chronic conditions like high blood pressure and diabetes than whites—until they qualify for Medicare coverage. “We also need robust primary care in this country,” added Pérez-Stable.

Research shows that disparities carry economic as well as moral costs, he continued, pointing to a study published in the Journal of the American Medical Association that pegged the economic burden of racial and ethnic health inequities at up to $451 billion. At the same time, costs of education-related health inequities were estimated at up to $978 billion.

The study also found that African Americans, American Indians, Alaska Natives, Native Hawaiian and Pacific Islander populations faced disproportionately higher levels of health disparities in view of their share of the population.

Low income and disadvantaged people may not seek care—or be able to find it—even if they are insured, noted Benjamin. “They don’t have the $20 copay or maybe it’s a bad choice between paying for care and paying for rent or food,” he said. “And we have fewer providers per capita in low-income communities compared to wealthier ones.”

Solutions can be found, the panel agreed—but systemic change must come first.

“Our aging population requires more people with expertise in gerontology and more awareness of ageism,” said Liburd. “We need a multilingual public health workforce that can use emerging tools like AI and machine learning.”

Awareness of diversity, equity, inclusion and accessibility issues continues to grow, but the finish line remains distant, she said, adding “Our work requires global solutions.”

According to Kilmarx, NIH is extending its global reach, awarding some 35% of funding to collaborations that include investigators outside the United States. And the publications resulting from these international projects, in fact, have a higher scientific impact, he said.

“We see Pitt as a key partner in building research capacity around the world,” added Kilmarx.

Partners also may be found outside traditional institutional boundaries, said Bowman, describing a $25 million initiative launched in 2022 to advance health outcomes for Black, Hispanic/Latino, Asian American and Native American communities across the U.S.

“The theme of equity is central to this transdisciplinary effort. We will only be successful in this space if we work closely with and are responsive to the communities whose health we are trying to improve,” said Bowman, explaining that the four-year Collaboration for Equitable Health targets 11 cities and includes the American Diabetes Association, American Heart Association, American Cancer Society and the University of Michigan School of Public Health. “I am grateful to Pitt Public Health for convening this panel and for its longstanding and impactful work on health equity.”

- Michele Dula Baum