By Jonathan Waller
The past decade as seen a groundswell of research on equity and inclusion in health care and public health policy, shedding light on issues of structural inequality, racism, and bias.
Through its Health Equity Advancement Lab (HEAL) Penn Medicine’s Center for Health Equity Advancement (CHEA) aims to tackle these challenges, working with diverse groups of health care leaders, clinical teams, community partners, and research fellows to leverage scientific observation into actionable strategies for change. Their scope of work includes the way we teach, develop, and administer medical care.
Jaya Aysola, MD, MPH, executive director of CHEA and an associate professor of Medicine at the Perelman School of Medicine, who long observed a disconnect between the research done in the field, the conversations happening in health care leadership circles, and the actual care being administered in the clinic and in underserved communities.
The program also presents unique opportunities for up-and-coming scientists with a commitment to tackling health care disparities to access mentorship, resources, and support to build their own networks of like-minded collaborators. HEAL’s goal is to foster and advance scientists who reflect populations historically underrepresented in medicine and give a platform for their scientific contributions.
Examining how we think about health care through the lens of society and diverse cultures
Michelle Munyikwa, MD, PhD
Michelle Munyikwa, MD, PhD, is one of those up-and-coming scientists. A resident physician in Internal Medicine and Pediatrics at Penn and Children’s Hospital of Philadelphia, Munyikwa approaches her work with an eye toward the intersections of medicine and social justice. Prior to completing her joint MD/PhD program in anthropology at the Perelman School of Medicine, Munyikwa’s research interests centered on understanding the relationships between political economy, history, and practices of care. It was through this work that she first connected with Aysola and her colleagues in CHEA as mentors and collaborators.
As a research fellow in the HEAL program, Munyikwa has been involved in a number of initiatives, including a critical analysis of preclinical medical curricula, which cast light on the historically misguided use of race in medical education and advocated for a more comprehensive understanding of human diversity.
This work, including a perspective piece in the New England Journal of Medicine that Munyikwa co-authored with Aysola and other collaborators, has shaped how race is perceived in medical practices and medical school curricula nationwide.
She was also an integral collaborator in developing Penn Medicine’s Social Needs Response Team (SNRT), an interdisciplinary initiative addressing the socio-economic challenges faced by underserved patient populations, particularly challenges that were exacerbated during the COVID-19 pandemic.
“We would call patients and pose questions related to food insecurity, housing insecurity, and other struggles their communities were encountering. This really helped us to get a full picture of what these patients were up against,” Munyikwa said. “For instance, we advised a patient who tested COVID-positive about social distancing precautions, but realized, ‘Well, they can’t quarantine from their family because they live with 12 people in a two-bedroom house.’”
The team was set up to help patients in these situations find community resources—such as temporary housing in this patient’s case. Today, the social needs response team continues to expand to connect patients to resources for social needs after they are discharged from Penn Medicine hospitals.
Now in her residency, Munyikwa continues to advocate for equitable health care practices on behalf of both children and adults. She says her clinical work has also provided a more nuanced lens into the societal perceptions and cultural biases that influence pediatric and family medicine.
A medical student’s lessons learned about community engagement
In 2022, CHEA sponsored Tyler Lian’s attendance to the annual meeting of the Society of General Internal Medicine, where he presented a poster on the FAST project
Tyler Lian, a third-year student at PSOM, began his journey in medicine with a deep interest in understanding the intersection of health care and social systems. This led him to enroll in a course on Race, Health, and Social Systems, taught by Aysola. Growing from this initial connection, Lian continued to engage with the center on several impactful projects.
One of these projects, developed by Aysola and CHEA program coordinator Ana Bonilla-Martinez, CHES, focused on the development and evaluation of Food Access Support Technology (FAST), a centralized digital platform designed to connect health systems, community-based organizations (CBOs), and small businesses in Philadelphia to optimize food delivery to underserved populations throughout the region. Using FAST, hospitals and CBOs can place food requests on behalf of neighbors in need, which are reviewed and referred to eligible CBOs and small businesses, who then fulfill the requests with food boxes delivered right to an individual or family’s home.
Between March 2021 and July 2022, FAST facilitated the delivery of more that 250 boxes to food-insecure households across 51 postal codes, demonstrating an effective model for streamlining service delivery and resource-sharing between health care systems and community partners.
“One of my key take-aways from working on this project is that for too long, research and program development has been siloed within large academic institutions. While intentions may be well-placed, this top-down model can often be redundant with efforts that already exist in the surrounding communities of big hospital systems like Penn,” Lian observed. “But through significant community input, health care organizations can better understand the gaps that exist in service delivery, more effectively support community-based organizations, and arrive at solutions that benefit everyone.”
The FAST project has given him a greater appreciation for a holistic approach to patient care and fueled his passion for addressing disparities in health care service delivery. As an outcome of Lian’s work on FAST, HEAL sponsored his attendance to an annual meeting of the Society of General Internal Medicine, where he presented his work to an international community of leading academic general internists.
Looking ahead, Lian’s goal is clear: to continue his efforts towards aligning clinical practices and research work with the genuine demands of the community. He envisions a future where health care professionals work hand-in-hand with the communities they serve, reflecting his commitment to a more inclusive, responsive, and community-driven healthcare approach.
Amplifying underrepresented voices to heal communities and improve health care delivery
HEAL continues to conceptualize and launch programs to advance health equity in care delivery, workforce advancement, and social needs, working with 16+ research fellows from groups traditionally underrepresented in medicine of varying professional levels, ranging from students, to early-career professionals, to professors at PSOM. All HEAL fellows work together to utilize their unique perspectives to toward their common goal of reimagining health care systems that serve all of us. For example, in addition to community-focused projects like the SNRT and FAST, HEAL fellows have worked with Aysola to help evaluate disparities in health care services, such as emergency department throughput times, and lend their unique perspectives to such complex issues.
“The last thing you want to do to improve upon health care disparities or health inequalities is to have the same players in the room trying to solve problems that, perhaps, a lack of diversity has caused,” Aysola said. “To make real progress, you need to uplift underrepresented individuals and communities by giving them the space and opportunities to make a real difference.”