By: Anna Gomberg
The University of Chicago Digestive Diseases Center incorporates work to address health care disparities into its tripartite mission to achieve excellence in research, teaching and patient care in many ways. Several physician-led initiatives focus specifically on the reduction of health care and health care access disparities due to race, gender, geography, socio-economic status, and other factors.
Karen Kim, MD, Professor of Medicine and Vice Provost for Research, Associate Director of the University of Chicago Comprehensive Cancer Center, and Director of the Center for Asian Health Equity (CAHE) focuses on health care disparities among the Asian and African immigrant communities, which makes up a large portion of Chicago’s population, and face health challenges due to socioeconomic, language, cultural and access related barriers.
Dr. Kim explains, “The cultural competency of providers working with the Asian and African immigrant populations can be enhanced to help provide better care to those living with digestive diseases, including the importance of timely screening and prevention for colorectal, gastric and liver cancer, which can save lives.”
CAHE is an academic-community partnership between the University of Chicago and a nonprofit organization, Asian Health Coalition, to focus on research, advocacy/policy, community engagement and training. An important focus of CAHE is to culturally tailor evidence-based interventions and build community capacity to implement these programs among their at-risk communities.
With African Americans dying from colorectal cancer at a rate twice that of any other population and with colon cancer screening rates among the lowest in Asian and Latinx communities, Dr. Kim leads the CDC-funded Colorectal Cancer Control Program for the State of Illinois, and the NCI Beau Biden Moonshot Initiative’s Accelerating Colorectal Cancer Control through Implementation Science research program to improve colorectal Cancer screening among racial/ethnic minority and rural populations across the State of Illinois.
Edwin K. McDonald, IV, MD, Assistant Professor of Medicine, is a trained chef as well as gastroenterologist, and is committed to improving the health of his patients and addressing health care disparities through nutrition education. McDonald became more aware of the social determinants of health in part through his experience of training barbers as health educators at Project Brotherhood, a program addressing the health of African-American men in Chicago. McDonald’s research investigates the way that nutrition influences the health of those living with chronic conditions like inflammatory bowel disease as well as the health outcomes of obesity. McDonald is committed to providing advice to close these gaps, and provides recipes, food safety, and nutrition tips on his website, The Doc’s Kitchen and on Instagram (@thedocskitchen4). McDonald also holds healthy cooking demonstrations in the hospital, mentors high school students interested in medicine, and teaches nutrition to marginalized youth interested in careers in the culinary industry. He has even written a book on digestion for children, called Do You Know Where Food Goes?, with imagery selected to humanize and universalize Black men for children of all backgrounds.
“Obesity and other health care concerns are major factors in wellness for all populations, but minority populations are more likely to be underserved by our health care system. They can be disproportionately affected by health crises, as we have seen with COVID-19. We need to make sure our research and messages effectively close these gaps, to make sure that everyone can learn what they need to know to stay safe and healthy,” explains McDonald.
McDonald has directly addressed the problems of bias in academic medicine in the black lives matter movement in the New England Journal of Medicine, and with colleagues, called for actively working to dismantle the systemic implicit bias, prejudice, racism and stereotyping in patient care, as well as hiring and admission decisions.
“Many studies demonstrate that bias contributes to the persistence of black–white disparities in health care, medical school recruitment, and faculty retention in our own institutions. It is a moral imperative for us to examine our practices to make sure that all our patients, regardless of race, class, or gender, receive the best care, and that our medical center is inclusive,” explains McDonald.
Hepatologists at the Digestive Diseases Center focus on the health disparities found among patients with liver diseases, including Hepatitis C, chronic liver disease, cirrhosis, and fatty liver disease. As Gautham Reddy, MD explains, people living in underserved areas face considerable challenges when attempting to access care.
“Health care for those living in rural or sparsely populated areas can be more limited than health care provided in larger cities—providing access to the resources at a teaching hospital, and building relationships to empower primary care physicians in these areas may help support better health outcomes.” explains Reddy, “Which is important to us all.”
Three recent studies highlight this work. Helen Te, MD; K. Gautham Reddy, MD; Andrew Aronsohn, MD and colleagues determined that educational interventions during training can increase competency and knowledge of hepatology in residents, and that this new expertise in the next generation of physicians helps to meet the public’s growing need for liver specialists, particularly in underserved areas. In a new study published in June 2020, Helen Te, MD; Gautham Reddy, MD; Michael Charlton, MD; Sonali Paul, MD; Anjana Pillai, MD; and John Fung, MD, with colleagues looked at trends for alcoholic hepatitis and liver transplantation, noting that while liver transplantation for patients with severe alcoholic hepatitis has increased dramatically, they find geographic disparities in how often they are performed. In June 2020, Reddy and colleagues published a study highlighting the growing need for and geographic variability in liver specialists.