Medical Students Learn Firsthand About Inner-City Health Disparities

Medical disparities — variations in the incidence of common diseases among different populations due to social, not medical, factors — are a fact of life in the United States.

But while medical students learn such disparities exist, their education typically does not explore why.

Called “Health in the Neighborhood,” the new course aims to educate students about why disparities develop and how people are affected by them.

“It’s amazing to learn of the distrust and ambivalence some people feel toward health care providers,” says Linda F. Pessar, MD, director of the Jacobs School’s Center for Medical Humanities and a teacher and founder of the course.

“If you want to learn about the source of that ambivalence and distrust, to discuss what health care providers can do to improve that, you need to go in without your white coat.”

By bringing students into the community to meet with members of Hopewell Baptist Church in Buffalo and by pairing medical students with families in the neighborhood, they will become familiar with life in the Martin Luther King Jr. Park community as well as the realities of medical disparities and how they affect individuals.

“Health in the Neighborhood” is an outgrowth of a week-long community immersion program launched in 2015, in which medical students visit several inner-city neighborhoods. It was a resounding wake-up call for both teachers and students.

“What shook us all was to walk the streets of intense poverty and to hear the degree of distrust,” says Pessar, professor emerita of psychiatry.

“When you meet people from the congregation, you get slapped in the face with their distrust. Most of us physicians think we are doing good. The intensity of the distrust and misinformation was shocking.”

For two years, Pessar developed the new course curriculum with Henry Louis Taylor Jr., PhD, professor of urban and regional planning in the School of Architecture and Planning; David A. Milling, MD, senior associate dean for student and academic affairs at the Jacobs School; and community partners Kinzer M. Pointer, pastor of the Agape Baptist Church and Dennis Lee Jr., pastor of the Hopewell Baptist Church.

Among the course’s goals are to get students to begin understanding:

• how structural racism results from policies that have created segregated, substandard living conditions
• how physicians’ lack of knowledge of black culture creates lack of rapport
• how and why widespread bias, both implicit and explicit, persists among health care workers
• how health care delivery to these communities can be improved

Students learn, for example, how structurally racist policies have created neighborhoods in Buffalo that lack access to healthy food, better schools and health care and where environmental toxins and the lack of green space contribute to higher asthma rates and a higher incidence of lead poisoning.

A lack of understanding also permeates much of the physician workforce, Pessar says.

“A single mother working two jobs and raising children on her own knows she’s obese, but for the physician to tell her, ‘eat healthy,’ may be well-intentioned, but it’s shaming.”

Those realizations are part of the change in perspective that students are already experiencing.

“Medicine is a field that is supposed to be filled with compassion and desire to help others,” says first-year medical student Aberlee Milliron. “But how can that be if wait times for whites vs. African-Americans in the emergency room are different? Just being aware that these differences do exist will help us become better physicians overall and help us treat our patients to the best of our abilities.”

Through the connections with the families that participate, students are expected to become familiar with the limitations of the neighborhood. For example, there may be no supermarket in easy walking distance, and most people don’t have cars while food stores that are nearby may have high prices and a limited selection of healthy food.

“The aim is to ignite a process that teaches incoming medical students about black lives in the hopes that this knowledge and information will inform their growth and development as physicians,” says Taylor, who also directs UB’s Center for Urban Studies.  

Taylor adds that the participation of the two churches and their congregations was crucial.

“This course could not be done without the enthusiastic support of the community, including the ministers who are co-teaching it,” he says.

“Both the level of cooperation and the openness of the residents have been the most surprising. They have embraced the students and faculty members and the conversations have been intimate and honest,” Taylor adds. “They have become cultural guides who are carrying the students into their lives and community.”

“Usually, in medical school, you have world-renowned doctors and scientists at the front of the classroom,” notes Karole Collier, a first-year student taking the class. “This course shifts the paradigm: It puts community leaders and the people who will be our patients at the front of the room.”

Pastor Pointer’s involvement with the course and with the Jacobs School’s Center for Medical Humanities derives from what he sees in his congregation, his family and among his neighbors.

“I got tired of burying people at 55,” he says, noting that members of his community are dying at that age while the average life expectancy of a white woman in the U.S. in 2015 was 79.

“I have impressed on my colleagues as pastors that we have a huge influence and we need to use it to improve these outcomes,” Pointer adds. “You see how many years of productivity we are losing as a nation. We’ve got to turn that around and fix what ails our health system.”

Pointer has another goal in working with the Jacobs School.

He hopes that through this program, he can begin to convince Jacobs School students to stay and practice not just in Western New York, which suffers from a physician shortage, but to convince them to start their careers in areas like the Martin Luther King Jr. Park neighborhood, where the shortages are far more profound.

Collier, for one, is listening.

“It is incredibly uplifting for this course to happen during my first year in medical school,” she says. “It has changed my trajectory completely about how I feel about staying in Buffalo and about the promise of what the school is really hoping to do in the community here.”

The introduction of the new course coincides with the move of the Jacobs School back to its historic roots in downtown Buffalo.

While medical disparities present a tremendous challenge, Pointer notes that a key part of the course is focusing on something as ordinary as sitting down to eat together.

“In America and around the world, food is the great equalizer,” he explains. “We sit at the table and we break bread together. If our equality is only that we’re hungry and need to eat, well, that’s a start.”