While America's overall health is looking up, not everyone has shared equally in the good news. Millions, including many minority and low-income individuals of all ages, remain on the outskirts of the health care system, resulting in significant and often untreated acute and chronic illnesses. Consider: African-American men experience AIDS at 7.4 times the rate of white men; diabetes and high blood pressure are more common among Korean Americans than among their white counterparts; and, compared with white women, twice as many African-American new mothers and 2.5 times as many Hispanic women received late or no prenatal care. These inequities extend beyond access to care; they are implicated in the process and even in the outcomes of care.
Working and learning in urban East Baltimore, the faculty and students of the Johns Hopkins University School of Nursing (JHUSON) have been battling to reduce and, ultimately, eliminate disparities in health care access and outcomes through its programs of community-based research, clinical care, and health education. The faculty works to translate its new research knowledge into best practices in community care, often focusing on underserved populations. In fact, the School of Nursing's renowned community health programwith its center of activity in urban, underserved, and predominantly low-income areas of Baltimore and around the worldis ranked second in the nation. Its approach is grounded in core nursing and public health values, prevention and early intervention, an approach increasingly valued by leaders in health reform and health care economics today.
Patient Voices Lend New Perspectives on Reducing Disparities
The value of listening to what patients have to say cannot be overstated, particularly when it comes to reducing health disparities. "Health disparities research enables us to learn just what can be done to change that equation, providing the tools we can use to improve both our nursing education and community-based care to reduce health disparities," says Fannie Gaston-Johansson, PhD, RN, FAAN, Director of the Center on Health Disparities Research, now in its seventh year at the School of Nursing (SON). "Weve found that sometimes, it can be simply a matter of really hearing patients, sharing information in meaningful ways and engaging them as active participants in their health care." Gaston-Johansson's research, conducted with Phyllis Mason, MS, RN and others at the Johns Hopkins University Schools of Nursing and Medicine, suggests that avenues to reducing health disparities include attending to such issues as empowering prospective patients to make informed choices of health provider, valuing patients' time, engaging patients as part of the health care team, improving provider communications and cultural competence, integrating potential alternative service delivery models, and creating opportunities for patient evaluation of care. "Many of these findingsand findings from other ongoing research here at the Center on Health Disparities Researchcan, and are, being translated almost directly into our nursing education and practice," noted Gaston-Johansson. "After all, nurses are most often at the front door of diagnosis and on the front lines of treatment."
Cultivating Community Roots Gives Research Staying Power to Reduce Disparities
According to a growing number of SON faculty researchers, a unique research methodology, called community-based participatory health research (CBPR), can help reduce health disparities, build community heath knowledge, and leave behind a positive health legacy in its wake. According to SON Professor Miyong Kim, PhD, RN, FAAN, who directs the Korean American Health Research Initiative, rather than conducting research on a community as in traditional research practice, CBPR is conducted with the community. In that way, research targets and explores identified community needs, building both structures and results that can be left behind and sustained in ongoing community-based health programs. This community-involved research requires intensive groundwork to engage community-based organizations, key stakeholders, and groups like churches and neighborhood organizations, not only to help recruit subjects, but also to play a direct role in the design and conduct of the research. Moreover, the community is connected to the outcomes of the research, often becoming involved in getting the word out about the research and promoting the use of its findings. Kim notes, "Unlike traditional 'helicopter' research, where a team comes in, gathers data and leaves, in community-based participatory research, the community not only knows about the research results, but it also gains ongoing benefits."
One of the benefits is a reduction in health disparities. While Kim's work focuses on community interventions to reduce disparities in the prevention, diagnosis and treatment of diabetes and high blood pressure in the Korean-American population, additional SON faculty researchers are engaged in work focused on other populations that remain at risk due to ongoing health care inequities. Professor and Associate Dean for Research Jerilyn K. Allen RN, ScD, FAAN, has focused her community-based partnership model on improving heart health among urban-dwelling minority and other underserved populations. In contrast, Lori A. Edwards, MPH, BSN, APRN, BC, has built her disparity-busting research upward from a community base. Her focus has been on identifying ways to improve child health in underserved communities by building and testing unique programs to develop a cadre of lay health workers including the unique "Amazing Grandmothers Project." Allen observes "Without a doubt, nurses are uniquely positioned to conduct community-based participatory research; our unique skill set includes holistic approaches and a person-centered focus, both critical to this special research methodology."
Good Nursing for Neighbors in Need
The reduction of health disparities is a focus at the SONnot only in research, but also in nursing education and clinical practice, most notably through the long-standing, award-winning Community Outreach program, directed by Patty W. Wilson, MS, RN. In operation for more than a decade, the program annually places more than 150 student nurses as community nurse volunteers in over 40 local agencies that provide extensive health-related services to the most underserved people in Baltimore, among them schools, churches, homeless shelters, domestic violence shelters, and health clinics. All serve the needs of diverse, often underserved populations through innovative and multidisciplinary approaches designed by Hopkins faculty, researchers, and clinicians. Critically, these approaches engage the residents of Baltimore neighborhoods and address the vital health care needs of a broad and deep urban population. The SON manages a number of community clinics, serving a broad population from older adults to elementary students to victims of intimate partner abuse. Partnerships with community-based organizations promote nursing care to Baltimore's Hispanic community, individuals with HIV/AIDS, families who are experiencing homelessness, among others. According to Wilson, "Students are able to take what they have learned in lecture and see firsthand the struggles of low-income families. This opportunity will stay with them and change their perspective of the delivery of health care whether it be in the hospital setting or in the community."