Population Health

Storytelling Through Narrative Medicine: Measuring the Lived-Experiences of Black Women’s Reproductive Health

Storytelling Through Narrative Medicine: Measuring the Lived-Experiences of Black Women’s Reproductive Health
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Shameka Poetry Thomas, Ph.D.
Postdoctoral Fellow
NIH Intramural Research Program
Health Disparities Unit
Social and Behavioral Research Branch
National Human Genome Research Institute

Dr. Shameka Poetry Thomas

Dr. Shameka Poetry Thomas

My grandmother was a traditional healer and a medicine-woman in Georgia’s rural South. Although I grew up in Miami’s Opa-Locka (a small urban neighborhood tucked between Miami-Gardens and the cusp of Hialeah / Little Havana), I spent most summers near middle Georgia’s farmland, listening to my grandmother. I observed how grandmother, who did not have a Ph.D., gathered Black women in circles. She described the process of listening to Black women’s pregnancies, births, and wellness experiences as “chitchatting and holding space.

Learning how to ‘hold space’ is what draws me to narrative medicine. My first dose of learning how to conduct narrative medicine, I suppose, came from my grandmother. This methodology (before I knew it was such) was simply understood as the process of sitting in kitchens and beauty salons in the South—just listening. During childhood, I was merely curious about how Black women described their pregnancies, births, and reproductive health—from their side of the story. Thus, when it came to reproductive health, my grandmother taught me a powerful tool: how to “hold space” for people’s narratives. Continue reading “Storytelling Through Narrative Medicine: Measuring the Lived-Experiences of Black Women’s Reproductive Health”

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All Health is Local: Measuring the Burden of Disease by U.S. County, Race/Ethnicity, and Socioeconomic Status

All Health Is Local
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Ali H. Mokdad, Ph.D.
Chief Strategy Officer, Population Health

Professor, Health Metrics Sciences
Institute for Health Metrics and Evaluation
University of Washington, Seattle

Ali Mokdad, Ph.D.

Ali Mokdad, Ph.D.

Despite greater public awareness about the social determinants of health, health inequities in the United States remain severe. Reducing disparities in health outcomes are a persistent challenge for policymakers, public health officials, and medical professionals. Due in part to these gaps, the U.S. underperforms against other industrialized countries in key health metrics, such as overall and healthy life expectancy. The reasons that the U.S. lags behind its peers are manifold. Most importantly, however, are the health discrepancies by geographic location, race/ethnicity, and socioeconomic status (SES). Understanding and reducing disparities among those most affected must be of central interest to policymakers to ensure that every person in the U.S. can lead a healthy life. A dearth of sufficient evidence on local health patterns produced from high-quality scientific research weakens our ability to understand the problem and design interventions. A particularly pressing need is for comprehensive and comparable examination of health outcomes for individuals in the U.S. by race/ethnicity and SES at the local level. Continue reading “All Health is Local: Measuring the Burden of Disease by U.S. County, Race/Ethnicity, and Socioeconomic Status”

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National Minority Mental Health Month: Reflections and Resources

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stock image of minorities in counseling circleMental illness does not discriminate, and more than 40 million Americans experience them each year regardless of race, ethnicity, gender identity, or socioeconomic status. July is National Minority Mental Health Month—a time to raise awareness about the unique psychological struggles that people from racial and ethnic minority communities face.

For National Minority Mental Health Month, NIMHD is sharing reflections and resources about the challenges, stigma, and access to mental health providers minorities often experience. We encourage you to educate yourself, your families, and your communities about mental health and emotional wellbeing. Continue reading “National Minority Mental Health Month: Reflections and Resources”

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Don’t Forget the Good: Reflections from LGBTQ+ Youth Before and During COVID-19

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Dr. Jeremy Goldbach

Photo of Dr. Jeremy Goldbach

By Jeremy T. Goldbach, Ph.D., LMSW
Associate Professor
Chair, USC Social Behavioral Institutional Review Board
Director, Center for LGBT Health Equity
Pronouns: He/Him
University of Southern California
Suzanne Dworak-Peck School of Social Work

I remember it like yesterday. I stepped into the small, cramped meeting room of a local LGBTQ drop-in center. The room served triple duty as a social milieu, computer lab, and meeting room. Posters and homemade art covered the walls, displayed proudly everywhere the eye could see like wallpaper, almost demanding inspiration and hope from passive onlookers. The warm room, paired with the anxiety that no title or position can ever seem to overcome, made my hands clammy. I had arrived seeking feedback on an intervention we had been developing for nearly a decade. Bracing myself for the brutal honesty only found in adolescence, I opened the floor. “So, what do you think?” Continue reading “Don’t Forget the Good: Reflections from LGBTQ+ Youth Before and During COVID-19”

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Addiction Should Be Treated, Not Penalized

Addiction Should Be Treated, Not Penalized
Addiction Should Be Treated, Not Penalized

NOTE:  NIMHD Insights is reposting this op-ed piece with permission from the Health Affairs Blog. It is written by the Director of NIH’s National Institute on Drug Abuse (NIDA), Dr. Nora D. Volkow, and is available in Spanish on the NIDA website.

By Nora D. Volkow, M.D.
Director of the National Institute on Drug Abuse

Photo of Dr. Nora Volkow

Dr. Nora D. Volkow

The COVID-19 pandemic has highlighted the large racial health disparities in the United States. Black Americans have experienced worse outcomes during the pandemic, continue to die at a greater rate than White Americans, and also suffer disproportionately from a wide range of other acute and chronic illnesses. These disparities are particularly stark in the field of substance use and substance use disorders, where entrenched punitive approaches have exacerbated stigma and made it hard to implement appropriate medical care. Abundant data show that Black people and other communities of color have been disproportionately harmed by decades of addressing drug use as a crime rather than as a matter of public health.

We have known for decades that addiction is a medical condition—a treatable brain disorder—not a character flaw or a form of social deviance. Yet, despite the overwhelming evidence supporting that position, drug addiction continues to be criminalized. The U.S. must take a public health approach to drug addiction now, in the interest of both population well-being and health equity. Continue reading “Addiction Should Be Treated, Not Penalized”

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Other Impacts of COVID-19: Anti-Asian Hate

#stopasianhate

By Gilbert C. Gee, Ph.D.
Professor, Department of Community Health Sciences
UCLA Fielding School of Public Health
University of California, Los Angeles

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Dr. Gilbert C. Ge

The rise of COVID-19 coincided with a rise in reports about anti-Asian hate incidents in the U.S. and around the world in 2020. Analyses of social media data showed a massive 17,000% increase in negative sentiment against Asians that correlated with our former president’s infamous use of the phrase “China virus” in March of 2020, which directly contradicted calls by public health officials to use neutral terms such as “COVID-19.” 1 Other research confirms these trends2. Continue reading “Other Impacts of COVID-19: Anti-Asian Hate”

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In Search of Equity: Rethinking Race and Racism in Science and Medicine

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Black History Month  

In Search of Equity: Rethinking Race and Racism in Science and Medicine

By L. Ebony Boulware, M.D., M.P.H.
Chief, Division of General Internal Medicine, Department of Medicine
Director, Duke Clinical and Translational Science Institute
Duke University School of Medicine

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Dr. L. Ebony Boulware

Recent events compel us to reckon, yet again, with the ongoing legacy of systemic racism in the U.S. The merciless murders of George Floyd, Ahmaud Arbery, Breonna Taylor, and countless other Black individuals through police violence reflect an epidemic of brutality that manifests ongoing and profound racially mediated structural social inequities in the U.S. Compounding this, the recent higher COVID-19 death rates among Black and Hispanic communities have made it clear that race-based structural inequities are directly tied to poor health and further threaten the lives of Black and other minoritized individuals.1 These intersecting realities have brought many in the fields of science and medicine to consider how race and racism are harmfully operationalized through many aspects of our collective experiences. Continue reading “In Search of Equity: Rethinking Race and Racism in Science and Medicine”

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Amplifying the Voice of Native Hawaiian and Pacific Islander Communities Amid the COVID-19 Crisis

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Photo of Dr. Joseph Keawe‘aimoku Kaholokula

Dr. Joseph Keawe‘aimoku Kaholokula

Joseph Keawe‘aimoku Kaholokula, Ph.D.
Professor and Chair
Department of Native Hawaiian Health
John A. Burns School of Medicine
University of Hawai‘i at Mānoa

The coronavirus disease 2019 (COVID-19) pandemic has spotlighted the health inequities of Native Hawaiians and Pacific Islanders (NHPI) and provided the podium from which to amplify their voices.

Historically, the voices of NHPI were drowned out by other numerically larger health-disparate racial/ethnic groups in the U.S. Their unique health concerns are often overlooked because their data has been aggregated—grouped together—with those of Asian Americans, an arbitrary practice that has done a disservice to both groups.1 NHPI know that resources follow the data, which is why they have been voicing their support for disaggregating—separating out—the data for NHPI and Asian Americans for decades, but to little avail.

Along comes COVID-19 to amplify their voices as to why data disaggregation is important. Continue reading “Amplifying the Voice of Native Hawaiian and Pacific Islander Communities Amid the COVID-19 Crisis”

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NIMHD Investigator Forums on the Impact of COVID-19 on Research Communities

NIMHD Co-authors - COVID-19 PI Forum

Jennifer Alvidrez, Ph.D.
Rick Berzon, Dr.P.H., P.A.
Dorothy Castille, Ph.D.
Nancy L. Jones, Ph.D., M.A.
CDR Nadra Tyus, Dr.P.H., M.P.H.
Division of Scientific Programs

The impact of the COVID-19 outbreak has strained daily life for people living in the United States, affecting nearly every sector including biomedical research. The disruption has also disproportionally affected the lives and livelihoods of populations that experience health disparities, which are also the populations that NIMHD’s research addresses.

To provide an opportunity to better understand the impact of COVID-19 on researchers and research funded by the institute, NIMHD hosted four COVID-19 NIMHD Investigator Forums this summer. NIMHD staff who hosted the events were Drs. Jennifer Alvidrez, Rick Berzon, Dorothy Castille, Nancy Jones and Nadra Tyus.  We knew that the COVID-19 pandemic created many challenges for our research community and learned of the creative strategies they developed to navigate these challenges using their extensive connections with health disparity communities.  We structured the forum to hear directly from NIMHD Principal Investigators (PIs) about their observations and thoughts in three areas:

1) Impact of COVID-19 on the communities where research is conducted
2) Strategies to modify recruitment, data collection, and/or intervention protocols
3) Understanding and addressing the impact of the pandemic on study outcomes. Continue reading “NIMHD Investigator Forums on the Impact of COVID-19 on Research Communities”

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National Minority Mental Health Awareness Month Blog Series

July Is the Best Month to Start a
New Year of Working on Mental Health

Harold W. Neighbors, Ph.D.
Division of Intramural Research
National Institute on Minority Health and Health Disparities

Dr. Harold W. Neighbors

Dr. Harold W. Neighbors

When I started graduate school in the mid-1970s, I had just one seemingly simple research question. I wanted to know: “Who had the higher rate of mental illness, Black or White Americans?” I remember the puzzled looks from fellow students, as most of them already knew the answer – “Blacks of course!” Their reasoning made good sense – life was harder for Blacks in the United States, and a life spent fighting against racial discrimination can lead to emotional damage.

So, I began my investigation, uncovering layer after layer of complexity surrounding what I thought was a simple question. My motivations were both professional and personal. Personally, like many families, Black and White, mine had revealed a few semi-private stories about “bad nerves” (the preferred language of emotional distress used to describe mental health problems) that were offered for consumption in the smallest of morsels. And even though my curiosity was never quite satisfied, I instinctively knew not to push for too many details. Professionally, there was my first “big” assignment as a graduate research assistant on a new, innovative study, the “National Survey of Black Americans”1. I wrote my dissertation on one aspect of the subject: help-seeking behavior for mental health problems, using data from the National Survey of Black Americans. My dissertation research told me that Black Americans need to stop, look, listen, and most importantly, tell the truth about our feelings. The key to sound mental health is what people of color decide to do about profound sadness, feelings of helplessness resulting from attacks on our self-esteem, and hopelessness due to unjust institutional impediments that erode aspirations for achieving one’s best life2. My investigation revealed that when feelings become unbearably painful, they are symptoms. Once you are symptomatic, you need to get help. It is just that simple; and difficult; and complicated. Continue reading “National Minority Mental Health Awareness Month Blog Series”

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