Dr. Marcella Nunez-Smith Takes Goal at Racial Gaps in Well being Care

Dr. Marcella Nunez-Smith grew up in the United States Virgin Islands and saw firsthand what can happen in a community with limited access to health care. Her father, Moleto “Bishop” Smith Sr., was only in his forties when he suffered a debilitating stroke that left him partially paralyzed and with slurred speech.

The cause was high blood pressure, which could have been treated but was never diagnosed. Without immediate access to advanced treatments, “the stroke was allowed to take its course,” recalled Dr. Nunez-Smith, 45, in a recent interview. Your father never fully recovered.

“He was a champion and a fighter,” she said. “But my memories are of a father who had to live with this daily reminder of how we failed with our health care. I don’t want another little girl to have her father stroke her, which is debilitating and life changing that way. “

Dr. Nunez-Smith, associate professor of internal medicine, public health and management at Yale University, is now approached by President-elect Joseph R. Biden Jr. as the head of a new federal task force dealing with a terrible reality in American medicine : Persistent racial and ethnic differences in access and care that contributed to their father’s disability.

Dr. Nunez-Smith has a far-reaching vision for the job. He plans to target medical resources and aid to vulnerable communities, but also to address the underlying social and economic inequalities that threaten them.

Experts noted that your goals are ambitious.

“For such a long time we have set our sights on achievable goals and tried to say, ‘We probably cannot have fully equitable care. So let’s at least make sure that minority patients take out insurance, or at least make sure there is a health clinic in their community, ”said Dr. Utibe R. Essien, assistant professor of medicine at the University of Pittsburgh Medical School who studies racial differences in cardiovascular disease.

“This is a great opportunity to stretch out and grab what you’ve been imagining for decades, if not centuries,” he said.

Racial health disparities present a major structural challenge in this country, compounded by the raging pandemic. Black, Latin American, and Native American people are infected with the coronavirus and are more likely to be hospitalized with Covid-19 than white Americans. They died almost three times as often from the disease, according to the Centers for Disease Control and Prevention.

“Ensuring that the communities hardest hit by the pandemic have access to safe and effective vaccines remains a priority,” said Dr. Nunez-Smith. “What is needed to ensure equitable recovery, however, is not limited to just health and health care. We need to hold discussions about housing stability, food security and educational equity, as well as ways to economic opportunities and promises. “

Many factors have contributed to higher infection rates and serious illnesses in minority communities. Blacks, Latinos, and Native Americans are more likely than whites to live in overcrowded households and are less likely to be able to work from home. Minority Americans have higher rates of underlying health problems that increase their risk for severe Covid-19, and they often have limited access to medical care. Asian-Americans were less likely to be infected than white Americans, but had slightly higher rates of hospitalizations and deaths.

While almost every American today knows someone affected by Covid-19, in color communities at least a third of people have lost someone close to them. “Think about the individual toll that costs,” said Dr. Nunez-Smith. “These are people’s parents, friends and relatives. We cannot overestimate the disproportionate impact. “

Dr. Nunez-Smith is currently one of three co-chairs on an advisory board that advises the Biden transition team on managing the pandemic. Colleagues describe her as a brilliant scientist with a gift for consensus-building, a sharp contrast to the politically motivated administrative officials who led the response during the Trump era.

“She is a national gem,” said Dr. Harlan Krumholz, Professor of Medicine at the Yale School of Medicine. “This is a person who spends their days thinking about how we can make health care more equitable and what interventions can address these differences.”

At Yale, Dr. Nunez-Smith many hats – practicing internist, scientist, teacher, mentor, and director of several research centers. She heads Yale’s Equity Research and Innovation Center, which she founded, and a National Institutes of Health-funded research collaboration investigating chronic diseases in Puerto Rico, Trinidad and Tobago, Barbados, and the US Virgin Islands.

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She is also involved in community organizations such as the Community Foundation for Greater New Haven and Connecticut Voices for Children. “She’s not sitting in her ivory tower,” said Christina Ciociola, senior vice president of grants and strategy at the foundation.

“She’s on the front line,” said Ms. Ciociola. “She sees patients and she has seen friends and colleagues who have this disease. She lost people to the pandemic. “

Dr. Nunez-Smith’s early interest in medicine was nurtured by her mother, a retired nursing professor, who instilled her commitment to the community, or, as she puts it, “the village.” Her grandmother played a vital role in her life, as did her godfather, a surgeon who still practices in St. Thomas.

Her mother filled the house with medical books. “She said I could read anything I could,” recalled Dr. Nunez-Smith. “I started learning medicine and nursing texts early and was fascinated by the human body and biology.”

Over time, she recognized the importance of health care policies and their implications in countries like the United States, where lower federal payments for services hamper access to care and the quality of health care is limited. (A recent study she co-wrote found that older women in the US with breast cancer waited longer for surgery and radiation and were less likely to be on the cutting edge of technology than their counterparts in other regions of the United States.)

After graduating from high school at the age of 16, Dr. Nunez-Smith graduated from Swarthmore College in Pennsylvania, majoring in biological anthropology and psychology, and received a medical degree from Jefferson Medical College, now called Sidney Kimmel Medical College.

She did an internship at Brigham and Women’s Hospital at Harvard and then a fellowship in the Robert Wood Johnson Foundation’s Clinical Scholars Program, where she also received a Masters in Health Sciences.

Some of her research came from her own experience as a black doctor, she said. She still encounters hospital patients who assume she has come into the room to pick up her tray or empty her trash, despite introducing herself as a doctor with a stethoscope around her neck.

In studies of the attitudes of black patients towards the health system, she found that distrust is widespread. A joint project in May by Dr. Nunez-Smith’s Equity and Research Innovation Center and the NAACP survey of 604 black Americans found that more than half of those polled felt that black people were less likely than whites to get access to coronavirus testing during testing, and that it was scarce they were less likely to be hospitalized if needed. More than half believed that black patients in the hospital are less likely to “do everything to save their lives”.

The survey also found that more than a third of black respondents had lost a job or cut their working hours. Almost a third said they didn’t have enough money to buy groceries and had problems paying rent. Economic pressures keep them to work even when they get sick, said Dr. Nunez-Smith.

“People are very concerned about surprise bills for finding care and this is very different from other countries where cost is not an issue,” she said. “How do we ensure that there are positive incentives to come in, get tested, and get care?”

All of these factors must influence the response to the pandemic, she said. For example, test sites need to be in or near low-income communities – they can’t just be pass-throughs used by people with cars.

Hotel rooms should be made available to people who have no space at home to quarantine or isolate after exposure or a positive test. Workplaces must take the necessary steps to ensure the safety of key workers.

“One size doesn’t fit everyone – you can’t just say, ‘Everyone will stay home and be safe,” she said. “There are people whose work requires them to leave their homes and when we have no news they have, that is our failure. “

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Those who are hesitant to take a Covid vaccine need to rest assured that the vaccines are safe and effective – and that they won’t receive a surprise bill later. You need to be informed in advance of the foreseeable side effects.

Health equity researchers recognized that the task force’s goals will be difficult to achieve, but welcomed the new government’s ambitious focus.

“Yes, it is going to be difficult and we have to take iterative steps,” said Dr. Clyde W. Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine. “But starting is exactly what we should be doing, and given the links between poor health, poor education, poor housing and poverty, an important first step can be economic development in the most vulnerable communities.”

Like many Americans, Dr. Nunez-Smith with the work and responsibility of the community while raising school-age children amid a pandemic. She knows the pressures will increase as she takes on difficult new assignments.

“Everyone needs a village,” she said. “I am grateful to have a great supportive spouse, family members. I had a friend yesterday who dropped off several meals and someone else goes shopping for us. It is our village where we try to protect ourselves. “

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