Health disparities drive everything from school absenteeism to loneliness, say experts

When Jason Farley was growing up in rural Alabama as a young gay man, he faced a lot of prejudice.

“Everything I heard was like I was going to wake up one day and God was going to smite me with AIDS,” he said.

This kind of stigma later inspired Farley, now a nurse practitioner and director of the Center for Infectious Disease and Nursing Innovation at Johns Hopkins University, to research one of the most vulnerable populations in the LGBTQ+ community.

“That drove a big passion in my life to address the health inequities that occurred throughout the care cascade for people living with or at risk of getting HIV,” Farley said Wednesday in a panel at the Milken Institute’s Future of Health Summit. He and other panelists were gathered to discuss solutions to “generations upon generations of systemic inequities” that have harmed the health of marginalized communities, as Kara Odom Walker, the executive vice president and chief population health officer for Nemours Children’s Health, explained.

Housing policies like redlining, for example, continue to disproportionately impact Black communities. Kimberly Driggins, the executive director of Washington Housing Conservancy, helps people in the D.C. region find affordable housing, particularly in high-opportunity neighborhoods where there’s already access to healthy food, transportation, and schools.

“Housing is health care. Safe, affordable housing is paramount to keeping people healthy,” she said.

In Washington, D.C., Walker and her colleagues have partnered with the local school district to address school absenteeism and its underlying health disparities. “The number one reason that kids are absent from school are health-related reasons. It’s asthma, dental care, and mental health issues,” she said. If a child is absent for more than three days of school, their pediatrician now gets notified.

Building relationships between schools and the health care system will provide greater opportunities to uncover the health issues that put children out of school and find solutions, Walker said. “[Pediatricians] will say, ‘Let’s make sure that they actually have a second pair of glasses in the classroom so that the student can overcome some of the challenges in learning reading, or have a second inhaler in the school nurse’s office so their asthma is better controlled and they’re not missing days of school,’” she explained.

Rebuilding trust in communities, especially BIPOC communities that have been historically marginalized, is a key step in carrying out a successful health intervention, Farley told the panel moderator, STAT’s Nicholas St. Fleur.

During the peak of the coronavirus pandemic, Farley and his team noticed that multiple communities in Baltimore did not have a nearby pharmacy that had vaccine availability. To get more people vaccinated, they partnered with a syringe support program that serves a vulnerable population of substance users, he said, to create a vaccine clinic. The key, he said, was teaming up with community organizations “to provide that service based on where the patients were going to be, not asking them to come seek health care to receive the intervention we had to offer,” said Farley.

In nearby Washington, D.C., Driggins and her team are working to address another pandemic: loneliness. “The community fabric is so important for being connected and I think that we lost some of that, especially during Covid,” she said. Many residents live alone, she said, and bilingual community health workers help connect them with neighbors.

“I would love to see a time where health care is coming to places like the Washington Housing Conservancy, and serving and treating people where they live,” said Driggins. “So if we can encourage more partnerships that provide direct access to health care, I think the better off will be we know that prevention is key.”

Juliet Choi, the president and chief executive officer of the Asian & Pacific Islander American Health Forum, also emphasized the importance of policies that will dismantle structural racism and advance health equity. For example, President Biden signed a racial equity executive order on his very first day in office. Holding leaders accountable is a key step to driving change towards equitable policies, Choi said.

“We need the right set of elected leaders, leaders in government, who have the commitment, who will really commit to health equity,” she said. “We need community voices and we need all systems to integrate with one another. Every vote matters.”