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Can the United States Achieve Health Care Equity?

Db4_6306As part of the Perelman School of Medicine’s 250th anniversary celebration, last week’s Dr. Martin Luther King, Jr. Health Equity Symposium treated a packed auditorium to a group of health disparity and policy experts who addressed the question, “Health Equity: A Dream or Achievable Goal?”

The day featured a keynote talk by David Satcher, MD, PhD, director of the Satcher Health Leadership Institute at Morehouse School of Medicine, followed by an expert panel from the Perelman School of Medicine and other areas who addressed the health of women, the LGBT community, children, veteran, immigrant, and other populations and the role the Affordable Care Act plays in care for these individuals.

“This panel offers a biopsy of the talent, and deep thinking we have at the University of Pennsylvania, and the opportunity to interact across different schools,” said J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine.

Introducing the keynote speaker was Eve Higginbotham, SM, MD, vice dean of Inclusion and Diversity at the Perelman School of Medicine, who hopes this will be the “first in a series of symposia where we challenge ourselves with seemingly unanswerable questions.”

Invoking the words of Martin Luther King Jr., Higginbotham said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Higginbotham added that these words are a “poignant reminder that we as members of the first medical school in the United States have an important obligation to society to foster a culture of health.”  

Satcher’s influence on medicine in the United States is profound and long-lasting, and evidenced his preparedness to guide attendees on how to foster this culture of health.

In addition to countless honors and a role as former director of the CDC, Satcher served simultaneously as surgeon general of the United States, and assistant secretary for health (where he led development of Healthy People 2010, where the goal of eliminating health disparities was first outlined by the federal government). Satcher was also a member of the WHO Commission on Social Determinants of Health, which looked at conditions in which people live that impact health.

The keynote address focused on the importance of leadership in what Satcher referred to as the “relay race towards health equity.”

“There has been a lot of passing the baton of leadership here at this institution,” said Satcher. “Because that baton has been passed so well, so smoothly, this institution continues to grow. We have to continue to pass the baton; it’s our responsibility.”

After highlighting anti-smoking efforts and other positive stories of advancing health equity in the United States, Satcher did not gloss over a sad story that dramatically defied that effort, as well as today’s standards in medical ethics.

In Tuskegee, Alabama in 1932, the Public Health Service initiated a study of 400 black men diagnosed with syphilis but not treated, while giving them the impression they would be treated, despite the availability of penicillin and other options. In 1959, the study was transferred to the CDC. The trajectory of their disease was studied until the study was discontinued in 1972.

The study is a painful reminder of the prevailing belief in eugenics and that some lives are worth more than others during decades of that research in the United States.

In May 1997, as part of the CDC, Satcher led a commission that issued a report on the study. In a call with then President Clinton, the president agreed that a public apology on behalf of the nation should be issued to the 10 living study participants. That event, followed by the establishment of a bioethics center at Tuskegee, new requirements for those performing human research, and new mandates that the community be involved in research that affects them, has helped in moving beyond past mistakes and towards health equity.

Still, problems in research extend today, Satcher explained, reaffirming the need for efforts to be relevant to the populations they are aimed at helping.

“It’s very hard sometimes to get the people most affected by problems,” said Satcher, “Like Alzheimer’s, for example, it’s hard to get blacks to participate in studies that are critical. We have a trust gap, but we also have a participation gap and we must work to bridge those gaps.”

Hosting a symposium on Martin Luther King, Jr.’s birthday was an appropriate time to refocus these goals.

“Martin Luther King Jr. had the ability to educate, motivate, and mobilize,” said Satcher. “If we are going to solve a lot of these problems, we need to increasingly figure out how to mobilize people around change behavior – he had the ability in his area to do that better than anyone I have ever met.”

See slideshow of event photos below:



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