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According to World Health Organizations equity can be defined as "the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically." The principles of health equity include insuring equal access, utilization and health outcomes for all populations seeking healthcare. It is important to have a global approach in solving these issues to create healthier communities. The theme of this issues focus on disparities faced by marginalized groups in the United States and abroad. Through creative works, innovative research, and thoughtful commentary, our authors explore challenges faced in achieving health equity and assert their opinions on the theme.
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Equity in Healthcare
Journal of the Student National Medical Association (JSNMA), Volume 22.1
Published by SNMA Publications, 2018.
While every precaution has been taken in the preparation of this book, the publisher assumes no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein.
EQUITY IN HEALTHCARE
First edition. September 2, 2018.
Copyright © 2018 SNMA Publications.
Written by SNMA Publications.
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Also by SNMA Publications
Journal of the Student National Medical Association (JSNMA)
Equity in Healthcare
JSNMA Fall 2017 Addressing Racial Bias in Medicine
Also By SNMA Publications
Equity in Healthcare (Journal of the Student National Medical Association (JSNMA), #22.1)
Letter from the Editor
The Effects of a Nutrition Program in a Homeless Shelter to Promote Health Education in this Community
The Tears in Our Eyes
Culturally Awakened: An Outsider’s View of Healthcare in Nicaragua
A Week of No Limitations and No Disparities: An Inside Perspective of Summer Camp with the Muscular Dystrophy Association
Addressing Cultural Competency in Eliminating Health Care Disparities
A Call to Action
Telemedicine: A Modern-Day Approach to Underserved Medicine
Ally. Accomplice. Advocate. Accomplish.
Reclaiming My Body: How Trans Identity Politics Affect Healthcare
Your Story Matters
Embolization Rates in Pelvic Fractures and Correlation to Postoperative Outcomes
Adolescent Empowerment: Improving the Lives of Teen Parents through Project Parenthood
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Further Reading: JSNMA Fall 2017 Addressing Racial Bias in Medicine
About the Publisher
EDITOR-IN-CHIEF: Comfort Elumogo
SENIOR EDITOR: Jonathan Batson
We, the Publications Committee, are thrilled to present our Fall 2016-2017 issue of the JSNMA – Equity in Healthcare. According to World Health Organizations equity can be defined as “the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.” The principles of health equity include insuring equal access, utilization and health outcomes for all populations seeking healthcare. It is important to have a global approach in solving these issues to create healthier communities. The theme of this issues focus on disparities faced by marginalized groups in the United States and abroad. Through creative works, innovative research, and thoughtful commentary, our authors explore challenges faced in achieving health equity and assert their opinions on the theme.
We hope that you thoroughly enjoy the work of your talented colleagues in this fall issue of the JSNMA! May you be inspired to stop, reflect, and spread awareness to ensure equal access to high quality healthcare for all populations. If journalism peaks your interest, consider becoming a member of the 2016-2017 Publications committee and/or becoming a future JSNMA contributor! In addition to the grand opportunity to be published in the JSNMA, being a part of the Publications Committee offers many great opportunities for professional networking, writing development, creativity, and much more. To inquire further, please email [email protected] or [email protected]
Yours in SNMA,
Case Western Reserve University School of Medicine
Doctorate of Medicine Candidate, 2017
SNMA Publications Committee Co-Chair, 2014-2017
Editor-in-Chief, Journal of the Student National Medical Association
Health and homelessness are intimately interrelated in several ways. Illness is a leading factor of homelessness. Of the 1 million personal bankruptcies in 2007, 62% were caused by medical debt. With this medical debt as a precipitating factor and after a personal safety net is exhausted, the loss of housing, financial uncertainty, poor health, and deficiency of support can result in homelessness. In return, homelessness also exacerbates illness by increasing the risk for communicable disease, malnutrition, and violence related injuries. Maintaining a healthy diet that is tailored to one’s specific needs can be difficult in the setting of a soup kitchen where food is prepared to be filling on a limited budget. The high stress environment of a homeless shelter often leads to overlooked substance abuse and mental health issues. Homelessness additionally complicates the treatment course of many illnesses and thus, the average life expectancy for individuals living in homeless shelters is lower than the general population.
Data collected from the Social and Demographic Research Institute (SADRI) of the University of Massachusetts, Amherst, based on the reports from 16 of the Johnson-Pew Health Care for the Homeless (HCH) projects during their first year of full operation, shows a higher prevalence of chronic disease such as diabetes and hypertension in homeless populations compared to the general population. This data was gathered from homeless people who sought health care from available facilities and demonstrates less treatment compliance among homeless populations in the management of diabetes, which had to be treated inpatient more frequently than in their non-homeless counterparts. In a study done by Schanzer et al., however, they showed that resources of a homeless shelter, such as providing insurance, improved the health status of homeless people.
Global Physicians Network Foundation (GPNF) is a 501(C)(3) nonprofit organization comprised of healthcare professionals. The volunteers of GPNF serve as a health resource for residents of a homeless shelter in Queens, NY and provide health education programs to the people of this shelter to promote positive health outcomes in this underserved community. One such program is further discussed in this article.
Diet and Nutrition Educational Program in a Homeless Shelter
GPNF went into a women and children’s homeless shelter located in Queens, New York to provide the first health education program of a program series for the people of this shelter. A needs assessment was done prior to recognize specific reasons underlying healthcare disparity in this particular shelter. This program was then designed specifically for this shelter and was the first time this shelter was providing health education to its residents. Fifty women and children of all ages participated in the program conducted in May 2016, in which the topic was healthy diet and nutrition. The healthcare professional volunteers provided the participants with a brief presentation on healthy eating and the different food groups. The adult participants were then administered the CDC Prediabetes Screening Test to determine if they had risk factors for high blood sugar. Those with an increased risk were encouraged to ask their primary care physician about being screened for diabetes.
Figure A: An excerpt from the CDC Prediabetes Screening test filled out by an adult participant to assess risk factors for high blood glucose. Participants answered seven questions in order to calculate their risk score.
The participants were taught to calculate their body mass index (BMI) and were counseled on making healthy food choices. Notably, these shelter residents do not have kitchen or stove access, which was taken into account when advising them. The children participants were given worksheets on healthy food choices, which they completed in small group settings.
FIGURE B: “Building My Food Plate for a Healthy Meal Worksheet” showing a healthy food plate drawn by a child participant.
Figure C: An excerpt from the “Some Foods to Choose in each Food Group” worksheet. This worksheet describing the various food groups was filled out by a child participant in a small group activity after listening to a brief lecture on the topic.
Children participants were guided through some yoga exercises to teach them the importance of routine exercise in reducing the risk of developing diabetes, hypertension, and other diseases related to metabolic syndrome. Participants were left with healthy snacks.
Due to the transient nature of homeless shelter residents, the benefit of this structured interactive program to bring change in nutritional competence of the learners was gauged via two survey questionnaires. Participants were given surveys to test their knowledge before and after this educational program to determine what they had learned. Of the adult participants, 100% stated that they felt they were knowledgeable about nutrition and had a good understanding of the topic before the lecture was given. A majority of them stated that they would feel comfortable and prepared to make a healthy plate. After the program and activities, a vast majority of participants stated they had a better understanding of this topic. Actions they learned from this program to improve their health included to “eat more fruits + veggies” and to “exercise.”
Residents of homeless shelters are often subject to circumstances that they are unable to control, which negatively impact their health, such as living in close proximity to others and being unable to prepare their own food. Here, healthcare professionals attempted to educate shelter residents to augment their ability to make healthy diet, nutrition, and lifestyle decisions to positively impact their health. This program can be replicated in other shelter communities, in an attempt to overcome healthcare disparities in underserved populations.
National Health Care for the Homeless Council. Homelessness & Health: What’s the Connection. Nashville (TN): NHCHC; 2011. Retrieved from:
O'Connell, J.J. (Ed.) (2004). The health care of homeless persons: A manual of communicable diseases and common problems in shelters and on the streets. The Boston Health Care for the Homeless Program. Retrieved from
Institute of Medicine (US) Committee on Health Care for Homeless People. Homelessness, Health, and Human Needs. Washington (DC): National Academies Press (US); 1988. 3, Health Problems of Homeless People. Retrieved from:
Schanzer B, Dominguez B, Shrout PE, Caton CLM. Homelessness, Health Status, and Health Care Use. American Journal of Public Health. 2007;97(3):464-469. doi:10.2105/AJPH.2005.076190
The tears in his eyes
Can you see the tears in his eyes? The regret in his voice
Can you hear the regret in his voice? “Don’t leave me, nna m*, don’t leave me”
The above is a lamentation of countless Nigerians who have lost people very dear to them tragically to the poor Nigerian healthcare system.
My question is, “Why?”
It is much easier to blame someone, perhaps the Nigerian government laden with corrupt officials who know how to travel to developed nations with their families for better medical treatment or better yet, the physicians themselves. “Aren’t they so incompetent and selfish? They only care about money. What about a person’s life?” we all say.
But is it really the corrupt Nigerian government or the so called incompetent and greedy physicians who are to blame? As members of the medical profession, we are taught to seek to know the root of a problem. Then and only then, do we have a greater chance of curing a disease or preventing it as opposed to just treating symptoms.
And this is why I believe that the Nigerian problem is one that pertains to love. It is a problem of we not them—whoever them may Who gives birth to the children who become politicians, physicians, lawyers, teachers, and/or leaders? We do. Who has the privilege of teaching them love, integrity and patriotism? We do. Who elects individuals into positions of authority? We do. Who suffers when we fail to imbibe in ourselves and to instill in our children love for our fellow man? Definitely, we do!
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