mHealth App

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Systemic Racism is a Cause of Race Disparities

"No one wants health disparities. So, to eliminate them, we need to know what they are and where they came from. In my presentations on health disparities to students, residents, and health care providers, I use 3 definitions of health disparities. My definitions are slightly different from those proposed in the seminal report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, from the National Academy of Medicine (then Institute of Medicine). I like to think that my definitions elicit the information needed to guide change. The first definition focuses on health statistics. When there are different outcomes for different demographic groups for the same disease, that is a disparity. This could be Black vs white, male vs female, or 1 zip code vs another.

Johnson MS. Systemic racism is a cause of health disparities. J Fam Pract. 2021 May;70(4):162-164. doi: 10.12788/jfp.0189. PMID: 34339356.

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Mark S. Johnson, M.D., MPH

Principal Investigator

Howard University Clinical Research Network for Health Equity

African Americans experience significant disparities in chronic disease morbidity and mortality. Of note, eliminating health disparities requires significant improvement in chronic disease management, which is dependent on the provision and utilization of evidence-based preventive care. The provision of high-quality preventive services to the African Americans is hindered by several things including insufficient evidence which is a consequence of underrepresentation of minority populations in clinical research trials. In fact, United States Preventive Services Task Force (USPSTF) recommendation statements often cite underrepresentation of minorities in clinical trials as a research gap and limitation. This affects the development of clinical practice guidelines that meet the needs of minority populations when the epidemiology of a particular disease is different in minority populations. Not only is there an underrepresentation of minorities as study participants but there is equally severe underrepresentation of African Americans as clinical investigators, which is due in part to underrepresentation of African Americans in the clinical research workforce. Addressing these disparities

requires complex systems analysis, development of innovative approaches, generation of scientific evidence, and effective knowledge dissemination. For over 150 years, Howard University has contributed significantly to the African American physician workforce through undergraduate and graduate medical education. In addition, Howard University has advanced minority health through robust research activities and comprehensive patient care to the residents of the District of Columbia and beyond. The adoption of Electronic Medical Record Systems by Howard University Hospital and Howard University Faculty Practice Plan has led to the generation of vast amounts of clinical data about this inner-city urban low-income African American population. To address the challenges, we propose the formation of the Howard University Clinical Research Network (HUCRN) as an addition to the consortium of the RCMI Clinical Research Network for Health Equity (RCMI-CRNHE). This effort will lead to an innovative, productive, and impactful research network for investigation of studies of high importance in minority health and health disparities. The significance of this project is derived from the necessity to study a health disparity affected population, burden of chronic disease, prevalent health disparities, engagement of an underrepresented clinical research workforce. Further we intend to introduce a new application of innovative data science called mHealth. We will develop a mHealth information technology infrastructure, clinical research informatics infrastructure including a clinical data repository, and we will conduct 2 pilot studies to assess the effectiveness of the infrastructure, policies, and processes that have been implemented.

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Multidisciplinary Approach Management Obesity book cover

Towards combating the obesity epidemic

There is an obesity crisis in America. It is also becoming a global problem, with increased prosperity enjoyed by many developing countries. Because of this, many books have been written on this topic. But none presents a nice, concise, multidisciplinary approach to the problem as this book by Dr. Lalita Kaul. Author has been able to convey the basic information in a simple manner, useful for both medical personnel and lay public. The clinical consequences of obesity are profound and far reaching.

Beginning with prevalence in various ethnic groups, successive chapters deal with causes, health risks, and the management of obesity. Chapter 13 summarizes the treatment for quick reference. The appendices contain valuable information including the caloric content of many commonly used foods, nutritional assessment forms, food diary, ways to measure your servings, and behavior modification strategies. The appendix on calories in fast foods is a true eye-opener. Did you know a Big Mac has 570 calories and 35 gm of saturated fat, only beaten by the Burger King Whopper with 640 calories and 41 gm of fat? No wonder they are called the "coronary diet." Finally, there are healthy, delectable low-fat recipes for your daily use, including a variety of delicious Indian recipes.

All chapters are well written, fully researched, and clearly organized with a lot of practical information on how to handle the problem from infancy to old age. The many tables and diagrams are useful adjuncts. And there is an extensive list of references at the end. The chapters dealing with obesity in children are particularly informative since therein lies the root of the problem. Also, there is an ample discussion on the biology of obesity (genes, hormones, metabolic pathways, etc). Bariatric surgery, now gaining momentum in the United States of America, has been given some importance. Book also discusses obesity in getting COVID and vitamin-D deficiency. In short, this book answers some of the questions we always ask, "Why we eat what we eat? What happens to all that we eat?" and "What can we do to end this epidemic?" and more. Overall, this is a very useful handbook for medical students, residents, nurses, practicing physicians, and the lay public.

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