Physicians cannot heal their patients until they understand their “life circumstances” including poverty, isolation and living in unsafe communities, a nationally recognized health care advocate said at the College of Medicine’s Dr. John C. and Martha Hitt Grand Rounds today.
Claire Pomeroy, president of the Albert and Mary Lasker Foundation, used her own experience to illustrate how the social determinants of health are more powerful drivers to wellness than clinical care.
The infectious-disease expert asked the audience to imagine a 17-year-old girl, living on her own after years in foster care. The teen is working a minimum-wage job and trying to finish high school. She suffers from asthma and gets ill, but doesn’t have the money to afford a decongestant. There’s no one at home to care for her, so she travels across town on a bus to the emergency room where providers give her a prescription for an inhaler she can’t afford.
“That girl was me,” Pomeroy says. “The doctors and nurses were doing their best. But what I really needed was a ride home, healthy food and enough money to pay the bills when I missed work.”
While medicine has advanced greatly with milestones such as vaccines, transplants and human genome sequencing, it has not addressed “unconscionable inequities” in health care, she says.
People living in Harlem have a life expectancy eight years lower than those living in the city’s Upper East Side, just three subway stops away.
She pointed out that in her home city of New York, people living in Harlem have a life expectancy eight years lower than those living in the city’s Upper East Side, just three subway stops away.
A patient’s education, poverty rate, employment, access to healthy foods and ability to live in a safe environment are “more powerful determinants of health” than the clinical care they receive, she says, citing a 2014 report in the Annals of Internal Medicine that reported, “A good job may be the best preventative medicine we can offer.” Other studies have concluded that a patient’s ZIP code is a better determinant of their health than their genetic code.
To solve the problem, Pomeroy urged medical leaders to support more health care spending “up-stream” – in prevention and improving health disparities – rather than spending so much money treating people who are already sick.
She provided several examples. A coalition in Camden, N.J., provides housing vouchers to help improve the health of homeless people and reduce their need to visit hospital emergency rooms for care. A program in the Bronx, New York, has worked to eliminate mold in public housing, thus reducing school absenteeism among asthmatic children. Geisinger Health System in Pennsylvania gives patients prescriptions for healthy foods and sends them to a Fresh Food “Farmacy” at the hospital that is stocked with fresh fruits and vegetables.
“We have to get out of our silos and partner with untraditional partners,” she says, adding, “We have an obligation to move outside the walls of our clinics and hospitals and into the community. Your willingness to do that can save a life.”
Pomeroy became president of the Albert and Mary Lasker Foundation in 2013. The foundation works to increase support for biomedical research by celebrating the power of such research to save and improve human lives. For 74 years, its internationally recognized Lasker Awards have honored medical and scientific leaders whose work made major advances is treating, diagnosing and understanding human disease. The foundation is fueled by founder Mary Lasker’s call to action: “If you think research is expensive, try disease.”
Pomeroy is a nationally recognized advocate for public health and patients, especially those with HIV/AIDS. She earned her undergraduate and M.D. degrees from the University of Michigan and completed her residency and fellowship training in internal medicine and infectious diseases at the University of Minnesota. She was inducted into the National Academy of Medicine in 2011. Pomeroy previously was chief of infectious diseases and associate dean for research and informatics at the University of Kentucky. At UC Davis, she served as executive associate dean and in 2005 was appointed vice chancellor and dean.
The Dr. John C. and Martha Hitt Grand Rounds are made possible by the support of the Edyth Bush Charitable Foundation. The foundation established the event in 2018 to honor the retiring UCF president and first lady.
The Grand Rounds speaker receives a commemorative medal bearing the Hitts’ likeness. Before and after her presentation, Pomeroy met with College of Medicine faculty and students, who are active in caring for Orlando’s medically underserved residents. As she received her medal from Deborah German, UCF vice president for health affairs and the medical school’s founding dean, Pomeroy says she was “deeply inspired by the good work you are doing at UCF.”