UAMS and Its Community
Billy Thomas, MD, MPH
UAMS Vice Chancellor for
Diversity and Inclusion
Professor, College of Medicine
By Billy Thomas, MD, MPH
UAMS Vice Chancellor for Diversity and Inclusion
Professor, College of Medicine
According to the 2010 census, the U.S. population is now greater than 312 million (a 9.7% increase over the past decade) with individuals under 18 representing the most diverse and rapidly growing segment of the population, about 24%. It is predicted that by 2020, no racial or ethnic group will comprise a majority; already, minorities make up about 46% of the under-18 population and about half of all births.
Minorities now make up 30% of the U.S. population with individuals of Hispanic or Latino origin the largest segment, 16.2%. As the population grows, this young, diverse group of mostly underserved minority individuals will continue to struggle with an educational system that in many cases lacks the infrastructure to support their unique needs.
It has been well documented that educational level, socioeconomic status and health status are all directly linked, are key components of our social structure, and play a major role in how we progress as a society. In 2005, the mortality rate for U.S. adults, ages 25-69, with some education beyond high school was 206/100,000. For those with only a high school education, the rate more than doubled, and tripled for those with less than a high school education.
In Arkansas, high school graduation rates are high, with 82% of individuals over age 25 earning a diploma. However, only 19% of those over 25 have a bachelor’s degree (compared to 28% nationally). In addition 18% of Arkansans live below the federal poverty level.
Part of the mission of any academic health center, in this case the University of Arkansas for Medical Sciences, is to engage in and to become part of the social network that exists within the surrounding community – engaged beyond the role of primary and specialized health care services; engaged beyond just brick and mortar; and engaged to the point of having bidirectional conversations with the community resulting in the development of partnerships and programs that are specific to the needs of the community, defined either geographically or as subpopulations.
In short, part of the responsibility of UAMS is to identify those factors (social determinants of health) that negatively influence health within communities and to educate the health care workforce, communities, and policymakers about the direct, and in most cases very negative, impact these factors have on overall health, quality of life, and life expectancy.
Academic health centers are obligated to not only support but in fact energize the communities in which they are located. This includes investing in those individuals that make up the community – their human capital, for the health of a community is its most important asset. One of our primary goals must be the very visible movement of services into surrounding neighborhoods. A first and essential step will include the development of partnerships within designated communities formalized through the integration of multidisciplinary health care workforce teams within the community. The primary purpose will be to foster educational exchanges with the community that lend themselves to community ownership and engagement.
UAMS is bordered by neighborhoods that in many cases do not provide the type of environment or infrastructure necessary for children and young adults to thrive. In many areas, high school and college graduation rates are at or below the state rates. This results in high unemployment and high levels of stress, both of which are primary contributors to poor health and worsening health disparities. Although race and ethnicity still play a very prominent role in determining health, it is becoming more evident that factors such as education, income, socioeconomic level, access to health care and living conditions play a direct and distinct role in both individual and population health.
An obvious example is obesity, which is caused by multiple factors while treatment is primarily through diet and exercise. Many individuals live in neighborhoods that don’t have parks or sidewalks so movement in those neighborhoods is limited and is some cases not safe. In addition the diets in many neighborhoods are dictated by the food supply from local supermarkets many of which have inadequate stocks of fresh and healthier foods. Forty-five percent of all obese children, ages 10-17, in the U.S. live at or below the poverty line and many reside in neighborhoods in which the built environment is not supportive of a healthier life style.
Perhaps the most powerful determinant of health over the life course is educational attainment. How far we go in school will largely determine our income, the neighborhoods in which we live, and our access to health care, information, and other resources critical for good health.
The prevalence of stroke and diabetes in high school dropouts could decline by 50% if they had the same prevalence as college graduates; for coronary heart disease, the decline would be 40%.
Improving educational quality and attainment in fact may prove to be a “dollar-smart” strategy for reducing health care costs. For example, an analysis by Muennig and Woolf indicates that smaller classroom sizes could result in significant reductions in Medicaid and Medicare enrollments with a net savings in overall societal costs.
An academic health center cannot solve all of the ills of society, but in this case it is our responsibility to shine a light on the most powerful determinants of health, morbidity, and life expectancy and apply our diverse expertise to finding efficacious and cost-effective solutions. Part of our mission must be to serve the community and improve the conditions of daily living in a fashion that is tangible and beneficial to all. We must ALL be able to connect the dots leading to both improved health and reduced economic burden on the health care system.
1. Frey W. America Reaches Its Demographic Tipping Point. Brookings Institution. August 29, 2011. http://www.brookings.edu/opinions/2011/0826_census_race_frey.aspx
2. The Blue Ridge Academic Health Group. The Role of Academic Health Centers in Addressing the Social Determinants of Health. Boone M, Molter J. Report 14, January 2010.
3. World Health Organization: Commission on Social Determinants of Health. Closing the Gap in a Generation. Healthy Equity through Action on the Social Determinants of Health.
3. Woolf SH, Dekker MM, Byrne FR, Miller WD. Citizen-Centered Health Promotion: Building Collaborations to Facilitate Healthy Living. American Journal of Preventive Medicine. 2011;40(1S1):S38–S47.4. Muenning P, Woolf SH. Health and Economic Benefits of Reducing the Number of Students per Classroom in US Primary Schools. American Journal of Public Health. 2007;97(11):2020-2027.
5. Woolf SH. Future Health Consequences of the Current Decline in US Household Income. JAMA. 2007;298(16):1931-1933.