cc
And it's a real privilege for me >> Thank you.
I wanted to tell you before I accepted the invitation to come
to the University of Wisconsin, I had to reflect on what all my
Badger connections were.
few. And actually, I have quite a
from the University of Wisconsin Two of my brothers have degrees
And again, as I reflected on here in Madison.
significant impact in my nurse leaders that have had a
connections to Wisconsin. dMary was my dissertationd
advisor, and she has a degree from here.
And also Norma, a dean at the University of Pennsylvania had a
profound effect on my career. It's also a privilege to be here
at the Vivian Littlefield lectureship, because we did in
fact have an opportunity to work
of the National Advisory Council together when she was president
Practice, which oversees most of for Nursing Education and
of nursing. I was absolutely young in my
career. She was very welcoming, and
certainly made an impact in the very areas that we're talking
about.
leadership, along with Marla Because it was under her
report, of which I was chair at, Salmon that we commissioned a
the nursing workforce. to take a look at diversity in
think, badly in need of That's stiupdating.ication, I
But I think that was done in the
We've all lost track of time. So at any rate, it's a wonderful
privilege for me to be here.
Ann Arbor. *I do bring you greetings from
I have to tell you that usually I have a picture of our stadium,
the Big House, but we're not
at the Big House these days. feeling too big
So I thought this would be ( laughter )
So this morning, what I'm going* to talk about is health
disparities.
also some innovations. And again, some challenges and
some definitions of health I want to start out by giving
causes of disparities, talk about some of our challenges in
addressing disparities, and again, show you some exemplars
that I think give me hope in
directions. *First of all, when we take aht
look at health disparities, there are several terminologies
that get mixed up, from health
to health inequalities. ineThere are some very subtley,
differences about these definitions that have
reflections in terms of policy
health disparities. and Simply, a disparityving
is a difference.
It's when two quantities are not It's an inequality.
A health disparity is defined as equal, as you can see here.
difference in environment, a chain of events signified by a
quality of care, and also health access to, utilization of, and
Or, a health outcome that deserves scrutiny.
Currently, we have made policy*
And this definition or who was decisions.
population was defined by our consideredgovernment. disparity
Specifically, here, the National
those that experience differences in health statuses
in access are racial and ethnic minorities, rural populations,
as well as socioeconomic status.
efforts to reduce disparities, Again, when we talk about
groups of populations that we're these currently are the three
Health and equality is based on* observed differences and
reflects differences in opportunity, treatment or
status. For example, women live longer
than men. Migrant workers die younger than
stock brokers.
lung cancer than non-smokers. Poor mothers are more likely to
have lower-birthweight infants
And undocumented workers than non-poor women.
healthcare. encouThese are facts.rs to
These are simple differences. This is the health inequality.
When we're talking about health* inequities, though, we're
looking at differences in healthcare which are unnecessary
and unavoidable, but more importantly, unfair and unjust.
So given the example of health
ourselves, again, based on inequalities, we have to ask
differences, should migrant workers die younger than stock
brokers?
have higher rates of lung Is it accepcancer?hat smokers
Is it acceptable that poor
infants? mothers have lower birthweight
access to healthcare. SI'm not sure we've come to anve
agreement about all these.
are inequalities. We dBut are all inequalitieses*
inequities? That's the question that we need
to answer.
considering, are all health And thdisparities unfair?ased on
Is it fair that someone is
And which health disparities are taller than you?
Is there some level of disparity fair?
consider acceptable? that we can work with, that we
judgments, we have to go back to *When we make these ethical
determinants of health look at, what are actually been
There are biological disparities.
There's health damaging behavior determinants.
perhaps cigarette smoking. that's freely chosen, such as
behavior, of which we engage in because there's limited choice.
For example, one of my
encounter she had with a poor colwoman around diabetes an
management. My colleague, who's a nurse
practitioner, was saying, you know, you need to eat five a
day.
vegetables. And these are the types of foods
you need. She was telling her all this and
the woman said to her, "Honey,
that I have to spend on Igroceries, and you tell me how
I'm supposed to do that." So again, the choices she
made, maybe not freely chosen,
There's also exposure to but because of limited choice.
And again, inadequate access to and essential services for other
healthcare services.
provide you an overview of some of these social determinants of
health, again, that play a big
We know from the big body of impact in terms of health.
status, regardless of how litmeasured, by education, byic
income, by wealth, predicts variations in health.
We also know that the link
but they are distinct. between SES and race are linked,
is when we take a look at infant Again, the best example of that
the differences in social moeconomic status between low at
birthweight infants in white and
At the poor level, the low SES black populations.
Yet, when African American status, disparities exist.
comparable to white women, their women, who have higher incomes,
low birthweight are as bad as diswhite women at the lowerof
socioeconomic status. There's another dynamic that's
going on. Linked, but distinct.
Education and income have been*
mortality, acute and chronic linked with infant and adult
diseases. infAnd we know that healthous
practices are patterned by SES. Again, persons with low SES are
less likely to reduce high risk behavior or initiate new
health-enhancing practices. Why is this?
Perhaps again, it's limited choices that are available.
We also know, again, trying to*
environmental kinds of figure out how these
associate themselves with mental conditions really work to
or with cancer, or with some health disparities for example,
a clear link. oBut again, as we're looking ate
different science approaches, we're seeing that again, chronic
environmental stress that's brought on by these conditions
may be an important pathway that
*There's another effect of socioeconomic status, and that's
community socioeconomic context.
environmental hazards, we know Again, when we're talking about
worse pollution. lower SES communities often have
less healthy housing, work Lower SES communities often have
consumer outlets, and greater exposures to toxins such as lead
paint, asbestos and infestation.
Pennsylvania for a while, and I *I wdid work in the Latinof
community.
where there was a very high I wenminority population,hia,
predominantly a Puerto Rican
We did a lot of work in the poschools..
The conditions were horrid, but what really struck me was that
we couldn't drink water.
couldn't drink water from the drinking fountains because of
the lead pipes. *Another issue, and my
colleague, David Williams says
racial disparities is racial and this is the fundamental cause of
He said this is a fundamental cause of health disparities that
leads to highly segregated
of education, severely restricts schools, which impacts quality
income levels of communities, and isolates people from role
models with stable employment and limits social network.
*Again, you can see by these graphs here, how segregated as a
society we are. And there's not been that much
difference between 1980 and 2000, between the segregation of
blacks and whites.
segregated from most of the other racial ethnic populations,
as well.
problematic, again, when we're So again, it gets to be
*Another one is educational looking at disparity issues.
U.S. Schools are structured that students routinely receive
dramatically unequal learning opportunities, based on the race
and social status is simply not recognized.
We were talking last night about
I think in some Milwaukee schools, it's abotu 50%.
It's not just Milwaukee schools.
It's Detroit schools. IIt's inner city schools..
Again, we know the critical links between education and
health, and education and future
Again, this is an area that absolutely needs to be addressed
and considered. *So again, when we think about
health disparities, and we think
we think about the role of about what determinants are, and
And this is said well by my colleague James Jackson at
Michigan, that says that if you live under very stressful
conditions, you have to work
health. Sometimes the strategies you use
to cope become harmful in themselves.
You have to use what's available
And the three resources that are to you.
residents in African American neighborhoods: liquor stores,y
fast food outlets and illegal subtances, are potentially
harmful.
at an individual level, without Sconsidering context, becomese
problematic.
divided no longer by the formal, *And our world continues to be
but by a tragic faultline between those who can benefit
from those opportunities and
them. tAgain, we're talking about
disparities worldwide, but our
that fault and what that country is a microcosm of what
*One of the things that I'll bring to your attention is that
there is a PBS special that's coming out that's called,
"Unnatural Causes." And in there, a number of
noted scientists are going to be
determinants in health, and racial ethnic disparities, and
talking about issues like infant
disease, and a number of mortality, cardiovascular
at this context. different issues to take a look
people are looking at is that maybe we need to start reframing
our advice from, "Don't smoke.
If you can't cut down. If you can, stop.
the five a day." Eat a balanced meal,
And if you can, stop. If you can't, try not to be poor
for too long, because it's
Live near a good supermarket and detrimental to your health.
*In the city of Detroit and affordable fresh produce stores.
there are no major grocery neighborhoods where I work,
There are, again, fast food outlets, mom and pop stores.
So we know that it's easier to
buy a banana. buy*Again, another example.is to
Make sure you stay physically active and exercise at least
three times a week. And be safe on the roads.
Maybe that's not an issue here
parks. in Madison, where you're full of
because people don't live in But again, it's problematic,
there's good sidewalks, and again, where the environments
are safe. Again, relying on public
transportation, which in most major cities, is not adequate.
I'm going to swith now to again* talking about the emphasis on
racial and ethnic disparities,
priority in our country, and which we've indicated is a high
I'll talk a little bit about certainly in policy areas.
The main reason it's such an those.
ethnic disparities are still issue is because racial and
Most minority populations, persistant.
some Asian populations have higher mortality in general, and
in age-specific conditions, as
conditions. And over the 50 years, these are
unchanged, and in many
For example, we have not made a* dent in the whole issue of
infant mortality among African
The whole issue related to American women.
skyrocketing in African American HIV/AIDS is absolutely
Again, I think there are many incidences, both in cancer and
mental health, that have similar
So we're not making a dent in sthat.s.
We can talk about it from it's a
piece. human rights, it's a humanity
people who contribute widely to But agaour work force.mportant
I was driving in to the airport* yesterday, and listening to the
whole debate of the Jena 6. There was an African American
caller who was talking about the
And what he said was that over situation.
African American. 7And what he said was you can't
tell me that African American men are any more violent, are
predisposed to crime more than
So there is an issue, again, in terms of what is equality,
again, what is justice and
So again, it brings light that moving that forward.
play into these disparities. there are many conditions that
initiatives. *We've had a number of policy
black and minority health was in The secretary's task force on
And again, that has been the 1985.
action, for more data, for more spring bresearch.a lot of
It's a priority in terms of Healthy People 2000 and 2010,
which says we're working to eliminate these disparities in
healthcare. The National Institute for
Health, since the 1985 report,
racial and ethnic groups in has made research.o include
Not only include them, but
The Department of Health and mandate that they be included.
Minority Health, again, a number Human Services Office of
And the Institute of Medicine, of different initiatives.
unequal treatment that with their landmark study on
the bias in healthcare against documented over and over, again,
*So again, we have a lot of racial and ethnic populations.
we have a lot of nice policies policy initiatives, or let's say
There has been a shift in this written in paper.
really, what the focus is and how we might be able to go about
that. So we have nice paper.
We have enough framework. But we don't have a lot of
action going in there, or at
been able to make a measurable least not enough action that has
This is the quote from Healthy difference.
for an elimination of health People 2010, again, which calls
that population, again, by disparities among segments of
education or income, disability, gender, race or ethnicity,
orientation. geographic location or sexual
enough with trying to figure out *So do you feel challenged
particular issue? hoI'm going to bring a coupleis
more. If we're going to be looking at*
elimination of disparities, we
fundamental causes. And one of those would be the
elimination of discrimination.
civil rights maven says that, "Covert discrimination is thea
problem.
Unless we acknowledge that It's more difficult than overt.
eliminate it. If people define racism only as
certain attitudes, then the solutions they will seek are
ways of changing these
If racism is seen as pervasive, fundamental and systemic, then
the solutions sought will be
character." So maybe as a result of some
of the policy initiatives, maybe
treatment, at least we have an as a result of unequal
Again, we can look at our attitudes and think about how we
might have encounters with
and how we think about our care. patients at different levels,
is not enough. *But what we're saying is this
of racism are institutional. Many of the fundamental causes
many years that we don't even recognize why they came and what
kind of issues we're dealing
My favorite example that I like* to use is the GRE exams.
How many of you love to take GRE
And what we know, what the exams?
is that even the testers will scienacknowledge that theyexams
discriminate against women and
Those groups of folks are going to have lower GRE scores.
But yet, nursing schools hang onto to that as if it's a
fundamental predictor of
Yet, we have not done the work, either, to determine that in
itself will lead to success in
Some people are taking a look at graduate schools.
eliminated that, or put that that and some people have
But again, that is a fundamental into consideration.
The whole issue of ACT and ACT piece.
After Brown v. scores came up, when?
And it was a way to keep black The Board of Education.
institutions. peopleThat's fundamental. higher
No one questions that.
to deal with this is, again, do *we really have a shared vision
of what's unfair and where it is
Again, part of that happens because our perceptions of
racial and ethnic inequities
There are two huge news stories that, again, I think are raising
conversations about some of these inequities.
One of them is O.J. How many think O.J. did it
this time?
But more importantly, what's going on with the Jena 6?
And again, the whole discussion about did these six African
American students, was justice
It's causing a lot of debate. seI'm going to share with you,.
again, some different perspectives that we have.
*This one has to do with Katrina.
This was a survey done that asked, "What would've been the
government's response if most of
The majority of blacks said that it absolutely would've been
faster. What whites said is that it
would've been the same. Perspectives on Katrina.
What were personal reactions to the disaster.
And again, you can see that Katrina has had more of an
impact on African Americans who felt depressed, felt angry and
had a close friend or relative
Again, not as signficant in terms of perceptions of white
persons.
person's own experiences with *racism and discrimination.
Again, a survey, have you ever
healthcare, 35% of the African had experience with racism in
absolutely. AmericaAnd whites, 15%.os said
Never had an experience.
How many of you have ever had an *And I would ask you.
been treated unfairly? experience where you felt you've
that have gone up. There's not a whole lot of hands
But what this is saying is that realities are different.
This may not be your reality, but you have to acknowledge that
this certainly is other people's
Perception is reality. reality.
Do you feel that racial minorities have equal job
opportunities as whites?
whites think absolutely, whereas Again, what you see is that most
think less likely. African Americans and Hispanics
our proposal too, Thwhich eliminated minority orad
affirmative action preferences
debate. in Again, should students behuge
admitted by merit, or should
considered. Again, what we see is that
whites think it should be merit only, where again, blacks,
primarily and high among Latinos
consideration. think that it should be a
affirmative programs for racial Do yominorities?oppose
Again, African Americans and
to the majority of the white Latinos favor that, as opposed
And again, part of it is population.
we made links, or have we made determined when people say have
disparities or in moving these progress in eliminating
Many people say we don't need it things forward.
at a particular time, but we anymore, and that we needed it
Again, different perceptions. *Here we take a look at issues
between immgrants and non-immigrants.
And again, huge debates.
going in this whole immigration sentiment, in terms of how it is
that we treat people, documented
countries. or undocumented from other
the U.S. because of hard work, Again, an immigrant strengthens
working than others. immingrants are more hard
immigrants say yes, they are, as Again, higher percentage of
non-immigrant. opposed to those who are
concerned that immigrants are Whetaking jobs away, that there
government isn't tough on immigration, and that the
government should spend more to prevent illegal immigration.
So again, these are important challenges, the perceptions is
an important piece. *Other challenges, if you
haven't had enough, include the lack of diversity in the
healthcare work force, the lack of data and research,
and the limited science in health disparities.
Our profession, whether we're looking at nursing, medicine or
dentistry, do not reflect the composition of the population.
In nursing, I always say it's 2%
It's been that way for 15 or 20 Lyears..
And I don't think in my lifetime
more than that. It is more than just Latinos or
African Americans not wanting to
There are other issues, again, be nurses.
Certainly, the diversity work tforce report that we did many.
years ago highlights some of the
admission, in terms of issues, both in terms of
being prepared in cultural recruitment, in terms of faculty
diversity of the faculty, are all important systemic barriers
that need to be addressed.
colleagues think that well, gee, I think some of our nursing
some of our professions. we're doing really better than
And nothing to be proud of here. But it's, you know, bad is bad.
bears attention is the whole *Another issue that I think
base for addressing health issue of what is our research
I'm a researcher, so our course, disparities.
about. it's an area that I'm concerned
of how we look about that in Again, concerned about in terms
A few years ago, two or three years ago, I edited a volume of
the Annual Review of Nursing
And contributors were racial Research.
And Sandra had a very important etchapter there on cancer..
Crosscuttingly, again, taking a* look at all the chapters that
were done in cancer prevention
health discrimination in our and treatment, in terms of
looking at care of the elderly, and looking at care of children
with disabilities, this is what we found.
There were important subtantive areas that had not been
extensively studied.
several things that came out in Sandra's chapter, and I hope
you're not going to be talking
steal your thunder. But important areas that had not
been studied was end of life
populations. care in racial and ethnic
prostate cancer in terms of treatment was another area that
had not been addressed. Lung cancer, although it's the
leading cancer killer, there are
do that. very few studies to be able to
about ten years ago, I was When I did one on children maybe
two studies on sickle cell astounded that there was maybe
conditions faced by African anemiaAmerican children.common
So how is it that we're going to
research base. build practice when we have no
having-- It's not an issue only of
found that there were important *In areas that have not beene
extensively studied.
the issue of discrimination. For example, nobody looked at
barriers to healthcare. Given the study done by the
Institute of Medicine on equal
nursing studies that took a look treatment, there were very few
or treatment by nurses in at thhealthcare settings.ation
Most of the research that had been done had been done in
England.
at that issue. So why are we not taking a look
are all-loving, all-caring, Do wedon't discriminate.s who
No one has asked the question.
think, given all the stuff But there's no way that we can
that's not going to affect that's been around us, that
patients. Given that you're in a setting
where there is not diversity in your classroom, and maybe not in
your clinical experience. There isn't any reason to think
that you could have a shared
with that particular plan. perspective of what's going on
research on all racial and We found that there was limited*
The majority of work had been done with African American..
There was less related to Latinos, and even less related
to certain Asian groups, and
For example, even the work done with Latinos, the majority of
the work was done with Mexican
Ricans, who again, when you take Americans, and not with Puerto
differences between populations, a look at the gradient and
health disparties than any other Puerto Ricans experience worse
*There's certainly a need for Latino subgroup.
for more expansive contacts. intervention studies and a need
determinants of disparities, Again, given all the
practice, maybe other reasons, we're limited, maybe by our
We have a very limited view of but we're limited by taking--
view of persons. environments, a very limited
research is HIV prevention. In my area, we know that there's
an increasing incidence of HIV
But again, a few studies and a among Latino youth.
have been conducted with this group, there were no effective
interventions tested or developed with the population,
despite 25 years of the HIV/AIDS
No evidence-based practice. No way to address cultural
issues related to Latinos.
It's my curriculum. I'm happy to talk to you about
that. But again, we need more than
one.
We need to have one for youth. One is not enough.
interventions for women. But there are still no
among that population, so we Again, incidences are increasing
We need researchers. need people.
particular issue. We Again, these are certainhat
populations that, again, need to
In talking, Sandra and I were having this discussion before.
You all have great challenges ahead of you in terms of the
research. We've addressed a lot of the
easy questions. I'm not going to say they were
easy, because they were very
well. hBut you have a base, then, ofas
which you can ask questions,
difficult, and a lot more thchallenging, and require ae
different perspective.
notch, to move the science up a notch, to start looking at these
populations that are hard to
As a reviewer, I get tired of hearing that we're going to do
this on a white population
then we'll be able to apply it first, and once it's successful,
But it doesn't work that way. to dDifferent context.ns.
Different reasons.
in need, it's again, our monies are a little bit displaced, Is
believe.
the great divide, both in terms of practice and also in terms of*
research. There's an historical mistrust
in communities, in racial ethnic
researchers, and also between cominstitutions.ween
I remember when I was at one
position. I said I wanted to be able toa
talk to some community members, because my research is
community-based.
problem, we're a very prestigious university.a
We give a lot, the community
All we have to do is tell them loves us.
the doors will be open to you. we're from XYZ university and
leaders. So I met with some community
in HIV prevention. I said, you know, I'm interested
interested in, something that Is this syou support?t you're
They said to me, yes, you know, we're invested in you.
We want you to be successful. It's an important area.
We want you to work with us.
I said, okay. They said don't tell anybody
you're from XYZ university, or
( laughter ) the doors will be closed to you.
There's an incongruence of the* So differences in perception.
of how we work with communities. methods of our research in terms
We can't come up with an answer because we don't know enough
yet.
or actually it was pregnancy When I started working on HIV,
I would start doing work, and pthey asked what they could do.,
I said I don't know enough yet, you know, I'll let you know in
seven to ten years. They had no use for me.
And I could see that it's like I
shifting to look at joint nintervention research.d
While it may not be the total answer, and while it may be a
way to find the answer, again,
area. itAt least you're trying to doar
something.
issues right now. Much of our research happens in
hospital settings.
at more community settings and We need to be adept at working
communities. working in partnerships with
I do experimental studies. *We love to control things.
over different things, but I like to have lots of control
clinical settings or community that's not always possible in
Again, we're trying to settings.
only for science, but it's also important for the diffusion that
we design interventions that
over. I was at a CDC meeting, and we*
had a meeting with researchers
agenda on their sexual in communities looking at CDC's
And a community member said, you reproductive programs.
talk to us before they develop know, I wish researchers would
He said he wanted to use these interventions.
But the only evidence-based intervention that you have for
homeless is a 17-week session intervention, that's over an
hour long that requires a health
that. pHe said that's not going too
work, and he could tell from the
So again, if what we're creating onset it wasn't going to work.
the end users, we're missing isn't going to have utility to
*Finally, there are a limited great opportunities.
white, Latino, or others, who are willing to conduct research
with racial and ethnic minority populations.
So we have work to do to be able
address some of the issues. toI'm not that old, but I amto
worried about the next
after me. And I want people to be engaged
in that type of research. I know many of you as students,
as faculty, are interested in that.
We would welcome you, I'm sure, to many of our programs of
research. We need people to take the
baton.
depressed, let me just tell you that there are some innovations
and I think some strategies that
think some things to consider. that I think are useful, and I
realize, if you didn't get this, First of all, it's important to
These issues have been rampant. We're not going to be able to.
fix them with one research
research. There are no quick fixes.f
This is going to take a concentrated effort of a number
of persons to be able to work on
I think we need to be taking a* these.
versus behavior change only. look at population initiatives
have to take a look at what it And it means, I believe, that we
research, and think about the policy implications, so it can
have a greater impact.
seatbelts, water fluoridation and teenage driving, have
probably done a lot more to reduce car mortality and dental
caries than any "let me show you
intervention. *We also need to be looking atof
interconnections among
diseases and populations. Again, one area that I think
about is that whole issue of
prevention, and cervical cancer prevention, specifically among
youth.
pregnant, they get HIV, and they When you think about it, they
way, sexual behavior. But people talk about thesee
things in silos, not recognizing
you know, maybe the HPV vaccine is an opportunity for me to talk
to my child about sex and about HIV prevention and pregnancy
prevention. But these groups of folks aren't
talking across. So what you get would be so much
more powerful, for example, to
education versus what it is that lobby for comprehensive sex
So again, being able to work we currently have.
I mean, these are diseases that are related.
Cardiovascular disease and
related. diabetes, for example, are also
same, but people aren't talking and are looking at replicating.e
So there has to be a better synergy.
*Finally, I also think we need to be taking a look at levels of
intervention. And I think this is what we're
talking about, how it's getting to be complex.
We have some interventions, and I'll say mine for example, HIV
prevention with Latinos, that gets at the general population
of HIV among Latinos. But then there are other
subpopulations that need more extenstive type interventions,
because that alone is not going to catch them.
So we have to, again, that's I
and targeting those populations that need additional resources.
*I believe the best health policy is good social policy
approaches. And that means education, that
means housing and neighborhoods,
It means, I believe, for you all and that also means employment.
we have to move out of the here and for you as faculty that
move out of the health settings claand go into communities.to
We need to see where our
We need to understand what those patients are coming from.
That's only going to improve our realities are.
*As I said before, we need to practice.
implications of our research. If what we're doing is not going
to improve policy, if it doesn't
what's going on in practice setting, then I think we really
need to question why it is we're
doing. doing what it is that we're
about all it is. It's a great paper, but that's
and again, we're getting a lot *I think promising approaches,
at transdisciplinary work, support from the NIH, is looking
sustainable partnerships, and looking at the development of
infrastructures.
discussed today, and that Manycontribute to healtht we
disparities, again, don't reside
and nursing science. only with the nursing
We need demographers. We need educators, again, to be
able to work together, to be
situations. *I think again, in schools, in
areas that we're working with,
sustainable partnerships between we need to look at building
populations. communities and between
individual faculty member has to There's no reason that each
We do it among our schools, too. find a population.
and a school of social work, and We're a school of public health,
It's the same community, and a school of education.
there. nobody knows that anybody is
groups. ThAgain, how much richer oure
educational experience would be,
our efforts would be if we were how muable to coalesce.its of
Again, the development of infrastructures, again, making
sure that faculty are rewarded, that students are rewarded for
doing the type of hard work that
*Just to mention, I was on a transdisciplinary initiative
looking at the issues of infant mortality.
It was a very interesting exercise in how it is that we
might be able to work together. It was difficult, a lot
of different times, because we
perspectives and again, ways certainly have different
approaching particular efforts. tWe tried to do this in
combination or conjunction with communities, but we even had a
different perspective on who
The physician who was PI of the group thought community meant
community providers.
input from community, that was So when I talked about getting
When I said it needs to be his community.
they really can't help us define pregnant women, he said, well,
be. whAnd that was just contrary.uld
But the discussions were hot, and they were heated.
And I think that we were able to
science proposals. at least develop some good
that we had was between one of I think the most innovative one
social worker, who was looking our researchers and also our
access, and how that related to at foopre-term labor.nd food
So we got some very creative
I do believe that at the end of the day, we had some things to
teach our colleagues about
We had these discussions about* approaches, about whatever.
cause of disparities is racial people who say, well, the major
And I'd say, well, I understand that, but I can't do anything
about that. I can move, but that's about the
only thing that I can do. So, you know, I understand that
a client encounter isn't going
issue. to solve the whole disparities
It's an opportunity for nurses. But It's an opportunity for me.
physicians. So let's figure out what we can
do in that encounter to be able to move forward.
But again, not easy questions.
examplars. *I'm going to give you some
at least move on this particular Again, of how we've been able to
And the one that I have had the opportunity to work in, and have
certainly learned a great deal
Initiative, Urban Research from, is our Detroit URC
It was established in 1995, so Center.
time. Initially brought together byg
CDC funding.
been very successful in getting NIH money, in getting other CDC
monies, and getting university
foundations monies to support the work of again, these diverse
schools in their university, as well as two communities in
Detroit, one predominantly
primarily Latino. This is a community-based
participatory action research group that again, works well
with communities. *We have a set of guiding
principles. We say that our research is
conducted with mutual respect,
each other brings to the table, and having open communication.
I will tell you, we have open and loud communication.
*Our principles, as we look at ways in which we can enhance the
capacity of everybody, not just the community-based
participants, but researchers as
We do, again, a lot of team well, building.ocess.
Our principle is that the community is involved as
appropriate in all phases of the
It's enlightening to, when I was research.
study, and I was talking about a talking about an intervention
an equal control group, and one of the community members raised
an issue about the control
I thought he was going to say, group.
group when you know that this geeintervention is effective.ol
He was concerned that that
was going to be too effective, control intervention that I had
of the effectiveness of the and woulintervention.e results
So I though, oh, my gosh, how very wonderful.
*Again, we work at at striking collaborations among our schools
and among communities.
segregated. So this process has allowed very
different partnerships, again,
Detroit. between these two communities in
and disseminating findings that Agaagain, reside not only incing
journals, but again, through
Our successes, very important.* community forums.
researcher, would say that we Mosthave good science.s a
That we have an infrastructure
We have an infrastructure that to reduce health disparities.
We have students involved in all supports education and research.
We certainly have had new partnerships among our members.
And the approaches have been
But the last exemplar I'm going* to mention to you is one that
I've been involved in for the past ten years.
And that is the National
Nursing Associations. This is a group of all these
ethnic minority associations, the Black Nurses, Hispanic
Nurses, Asian Pacific Islander
Association, and also the Native Nurses, Philipine Nurses
together and as we looked at our American Association, came
we're doing, we said we can do a history and what it is that
can do in our separate silos. lotSo we formed a coalition.n we
We've been in existence for ten years.
We're celebrating our anniversary on Capitol Hill.
*One of the tangible fruits of our labor is a $2.5 million
grant that we received from the National Institute for
General Medical Sciences to help
nurse researchers. prepare the pipeline of minority
nurses that are here, who are I thinking about research as ay
career, to visit our Web site,
who's been an important advisory to talk to myself or Sandra,
about coming to a conference member in this grant, to think
We will pay for your way to go. Next year it's going to be in
San Diego.
Mexico. ThBut it's an incredibleew
opportunity to see other ethnic nurse scientists that are
working, and who are absolutely willing to support you on your
journey.
you with some nuggets of wisdom So in from the Motor City.eave*
Coming together is a beginning. Keeping together is progress.
Working together is success.
working relationships with you I'll look forward to successful
Thank you very all.
much.