By: Christina Hernandez Sherwood
Young Black males face a staggering risk of death by firearm violence—more than 20 times that of their white peers. Black women are nearly three times more likely to die in pregnancy or childbirth than their white counterparts. And people living in majority Black neighborhoods live shorter lives.
Eugenia (Gina) South, MD, MS, the Ralph Muller Presidential Associate Professor of Emergency Medicine in the Perelman School of Medicine, experienced the gun violence crisis firsthand as an emergency department doctor at Penn Presbyterian Medical Center. “In training as a student and then resident, you learn all these things about how to take care of someone’s physical injuries after they have been shot,” she said. “But as a physician taking care of patients in a clinical setting, there is little focus on addressing or understanding why gun violence is such a problem in the first place.”
What can be done to address racial inequities in violence and other health issues?
Eugenia South, MD, MS
South, who now serves as associate vice president for Health Justice at Penn Medicine, realized early in her career that she had more questions than answers about why gun violence, maternal mortality, and other public health scourges ravaged cities like Philadelphia and populations of Black people like herself. “The heartbreak of seeing my community and people who look like me and my family being victims of violence is what drew me to the work I do,” she said. “When I first arrived at Penn in 2010 as a research fellow, I was singularly focused on—why is this happening and what can we do to stop it?”
Her studies with colleagues at Penn and partner institutions looked at geographic and environmental factors related to health, recognizing that disparities in health tend to cluster based on where people live—often in historically racially segregated neighborhoods. They found that greening vacant spaces reduces violent crime and improves mental health, that pregnant people have better cardiovascular outcomes when they live near green space, and that structural repairs to homes of low-income residents were associated with a nearly 22 percent reduction in neighborhood crime.
Meanwhile, other research, such as that of Atheendar Venkataramani, MD, PhD, an associate professor in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine, found that economic disruptions, like the closure of an automotive plant, could have devastating health implications.
The research is clear that the reasons for these disparities are largely unrelated to medicine. Instead, they hinge on structural drivers and social determinants of health, factors such as racism, wealth, and housing that drive racial and economic inequities in health outcomes.
“It becomes very apparent, very quickly, that there’s only so much we can do as health care providers to enable health,” South said. “Health care is incredibly important, but it must be viewed as part of a larger story about how people and communities can be healthy.”
But how can a physician treat a health woe, such as gun violence, when its causes are not medical but instead rooted in deeply ingrained social and historical determinants?
A growing emphasis on health justice at Penn Medicine
The Men of 52K group on the 5200 block of Kingesssing Avenue is a Deeply Rooted partner, operating an urban garden and supporting youth education and activities.
At Penn Medicine, South, along with like-minded colleagues such as Venkataramani, are working at multiple levels to make a difference. For years, they have used their research findings to advocate for transformational policies to help reverse years of disinvestment in segregated Black neighborhoods and increase opportunity for all people harmed by structural inequity. A study now underway, funded with nearly $10 million from the National Institutes of Health (NIH), will add to a growing body of work. In addition, South has focused on community action—leveraging research findings to directly work with communities to advance health, in particular through a major initiative called Deeply Rooted, established in 2022.
South and her team are also building a specific focus within Penn Medicine on structural inequity affecting both staff and patients. A new Health Justice Transformation group within the health system aims to advance equitable access to opportunity and health for all. For example, to better understand how racism occurs in the health system, the team launched the online platform “Lift Every Voice” in 2023. Here, frontline staff can anonymously share experiences and observations of racism in clinical care spaces. Leaders can use the stories to identify themes and trends they can act on at structural and policy levels. One such action: piloting a program in the emergency department to provide Black patients with culturally tailored hair care products, such as satin bonnets and hair bond remover. Another project in early stages is examining how to improve financial well-being and wealth-building for health system employees in low-wage jobs—an effort that is likely to benefit employees who are part of local communities.
These three focus areas—research, community action, and health system transformation—are housed within the newly launched Penn Medicine Center for Health Justice, which South created and leads as executive director.
Front and center in all of these initiatives is a focus on listening and active partnership with the people in neighborhoods impacted by these structural health issues, including hiring staff who have personal roots in these communities. Listening, partnership, and representation are so important because of the structural and historical challenges in this type of community research and action: Research efforts have been complicated by decades of mistrust caused by academics who drop into communities and then leave when they have their data. Despite the documented benefits of tree planting, many people don’t want trees in neighborhoods where street trees were mismanaged in the past. And for these communities most directly impacted by racial and economic health inequities, losing loved ones and neighbors to gun violence and mistreatment within health care systems are ongoing sources of trauma, fear, and fatigue.
“As experts in health, I believe our role as a health care institution goes beyond the provision of excellent clinical care,” South said. “We should marshal all aspects of our expertise to partner with folks inside and outside the institution—including community organizations, policy makers, the business community, and more—to get creative in tackling these fundamental causes of poor health.”
Establishing the Center for Health Justice in 2023 was a key step for Penn Medicine, said Raina Merchant, MD, MSHP, vice president and chief transformation officer and executive director of the Center for Health Care Transformation and Innovation, the umbrella under which South’s center sits. “We’re solidifying that we’re in this for the long haul,” she said. “We’re all-in in our commitment in this space.”
Explore related stories about health justice at Penn Medicine
A large-scale research study of health, wealth, and greening: Combining economic assistance with greening initiatives in a randomized trial, IGNITE aims to show how to reverse the harms of racial injustice in health.
‘We are all Deeply Rooted’: Bringing health justice to action, Deeply Rooted is a community partnership that plants trees, greens vacant lots, and funds grassroots programs.
From the neighborhood: For the Center for Health Justice, hiring people with deep roots of their own in West Philadelphia is key to partnering effectively to support healthier communities.