The Health Divide: White House promotes women’s health research, disadvantaged communities left without docs

US program fails to recruit docs to disadvantaged communities

Since 1965, a federal program has offered bonuses, loan repayments, and other benefits to physicians who serve Medicare patients in areas with a shortage of providers. 

But this Health Professional Shortage Area (HPSA) program has largely failed to bring in physicians or save lives, according to a November study in Health Affairs. 

Clinics in HPSAs are crucial to serve Black Americans and other marginalized groups. Many such regions are linked to social factors that impact health, such as race and ethnicity, low education or unemployment, or a rural or sparsely populated nature.

In the new study, researchers from Yale University analyzed data on the density of doctors and death rates of residents in 844 HPSA-designated counties and compared them with similar counties that had sufficient physicians. The study covered a period between 1978 and 2015. 

They reported no changes in mortality rates after a county received the HPSA label. In fact, 73% of counties entering the HPSA program were still short of doctors a decade later.

“Meanwhile, those without shortages continued to amass physicians,” reports Erin Blakemore at The Washington Post. 

One strategy that might help is to recruit other providers, such as nurse practitioners or physician assistants, to underserved areas, the researchers wrote. These providers weren’t included in the study.

Black, Native American and Hispanic physicians are also more likely to practice in HPSA areas — but these ethnicities account for fewer than a quarter of doctors.

First Ladies put spotlight on women’s health

First Lady Jill Biden and the White House Gender Policy Council will lead a new White House Initiative on Women’s Health Research, her husband, President Joe Biden, announced Nov. 13.

“Every woman I know has a story about leaving her doctor’s office with more questions than answers,” Jill Biden said in a White House statement. “There’s just not enough research yet on how to best manage and treat even common women’s health conditions. In 2023, that is unacceptable.”

For example, she noted that heart attack symptoms are different in women than men, so attacks often go unrecognized. 

“These gaps are even greater for communities that have been historically been excluded from research — including women of color and women with disabilities,” Biden told reporters.

She also pointed to a “stunning lack of information” about menopause management.

Right now, the National Institutes of Health spends just 10.8% of its budget researching diseases that affect only or predominantly women, reports Jennifer Gerson at The 19th.

Former California First Lady Maria Shriver, whose meeting with Jill Biden instigated the new program, noted women make up the majority of U.S. residents with Alzheimer’s, multiple sclerosis and other autoimmune conditions, and anxiety and depression. 

The new initiative will make recommendations to advance research on women’s health by late December.

Reflecting on 40 years of health advocacy for Black women

As part of its “Progress, Revisited” series on racial equity and justice for Black Americans, The New York Times highlights an Atlanta event in 1983, when almost 2,000 Black women converged on Spelman College for the First National Conference on Black Women’s Health Issues to discuss how racism and oppression were affecting their health.

Convener Byllye Avery, who organized the event when she became frustrated by the lack of research on Black women’s health, was stunned by the attendance, reports Dara Mathis. The conference inspired Avery and Lillie P. Allen to co-found the National Black Women’s Health Project. 

“Nearly 30 years before the World Health Organization issued a declaration asserting that social determinants like education, income and housing could affect health, the women at the project were talking about the mental and physical effects of oppression on Black women,” Mathis writes.

From humble beginnings in women’s homes and an Atlanta clinic, the group morphed into an advocacy organization called the Black Women’s Health Imperative, with offices on Washington, D.C.’s Pennsylvania Avenue.

Some things have changed in the four decades since Avery was first stymied by limited research findings, Mathis reports. For example, the Black Women’s Health Study has been tracking 59,000 subjects since 1995. 

Tufts University also researches Black women’s health as part of its Center for Black Maternal Health and Reproductive Justice, and other groups support Black women during pregnancy and childbirth. The growing availability of doulas to Black communities doulas has been shown to improve health outcomes for moms and babies, reports Celeste Hamilton Dennis at MindSite News. 

Yet many problems persist. Black women have high rates of hypertension, diabetes, HIV diagnosis and breast cancer death. “And the national mortality rate for Black women remains a national shame,” Mathis writes; it was more than double that for white women in 2021.

“I was scared that maybe my voice wouldn’t be heard, voicing my concerns and just making sure myself and my baby would make it out OK,” dentist and activist Tricia Quartey-Sagaille, now the mother of an active one-year-old, told Morgan Norwood of ABC News New York. But, she emphasized, Black women “do have a voice, and we can advocate for ourselves, and we can help reduce this disparity.”

Gun violence is killing Black youths at record levels

Schools are struggling to prevent gun violence and deal with the tragic aftermath of shootings, report Sabby Robinson, Hannah Natanson and Moriah Balingit in a deeply reported story at The Washington Post. 

Firearm incidents are the leading cause of death for U.S. children, causing more deaths than motor vehicle accidents since 2020. Black children are particularly harmed, as are kids in impoverished communities.

The pandemic further exacerbated the problem, with a record number of children injured or killed by guns  in 2022. 

“Educators often feel they are charged with keeping students alive, not just instructing them,” wrote the Post team. They spent a year reporting at Huguenot High School in Richmond, Virginia, which experienced a rash of violence culminating in a shooting after June’s graduation ceremony.  

The school district has tried a number of measures to combat violence, such as hiring more social workers and encouraging security officers to bond with students. 

It’s also adapted its approach to grief in the wake of violence. For example, after a student is killed, an instructional specialist follows the dead teen’s schedule, sitting in their seat and making themselves available to help grieving classmates and instructors.

But the effectiveness of the trauma-informed approach in improving student well-being and preventing additional shootings remains unclear.

“We don’t have the secret sauce quite yet,” said Angela Ransom Jones, who heads the Richmond district’s trauma team.

From the Center for Health Journalism

• Webinar Nov. 29, 11 a.m.–12 p.m. PT: “The Doctor Won’t See You Now: Combatting Racism in Health Care.” STAT’s Usha Lee McFarling interviews Dr. Lisa Cooper of Johns Hopkins University, whose seminal research on racism and bias has shifted our understanding of health care disparities. Register here!
• The Lori Yearwood Fund for Reporting on Homelessness will provide grants to journalists reporting on the lives and health challenges of people who are unhoused. Donate here!

What we’re reading

• “The Biden administration is slow to act as millions are booted off Medicaid, advocates say,” by Amanda Seitz and Kenya Hunter, AP News
• “Groundbreaking sickle cell fitness program pioneers new way to treat disease,” by Tesfaye Negussie, ABC News
• “Lung cancer survival rates have risen, but data show racial inequality,” by Sabrina Malhi, The Washington Post
• “Underdiagnosed and undertreated, young Black males with ADHD get left behind,” by Claire Sibonney, KFF Health News
• “How abortion bans are undercutting efforts to prevent domestic violence,” by Jennifer Geron and Shefali Luthra, The 19th
• “Your kid is trans. You live in Texas. There are no good options.” By Christina Cauterucci, Slate