Marcella Alsan is on a quest to reverse racial disparity in healthcare

In 2005, Marcella Alsan received a master’s degree in public health from Harvard and a medical degree from Loyola University. She soon went to Tijuana, Mexico to teach at an orphanage for a year. She ended up providing physical therapy to a young boy with hydrocephalus, a condition that causes fluid to build up in the brain. They picked him up off the ground, tried to swing his legs and arms, and sang to him. The boy had previously been unable to have a shunt as a baby, which would have helped relieve fluid buildup. As a result, he now suffered from brain damage that left him bedridden.

“The contrast at the border was so incredibly stark,” Alsan told The Daily Beast. “I think it has motivated some of my work on health inequalities.”

Years later, in late 2021, Alsan, now a Harvard public policy professor, was recognized for her timely research on how the legacy of discrimination has perpetuated racial disparities in health care and health outcomes in ways we are only now beginning to see start in the public forum. She was among 25 Americans selected for the highly prestigious MacArthur Fellowship, which awards $625,000 over five years to people to pursue creative endeavors and influential work aimed at “building a fairer, greener… and to build a more peaceful world”.

Alsan’s work today consists of analyzing trends in healthcare through the lens of what she calls “the economics of the oppressed.” It’s quite a unique landing point for someone who used to be a practicing doctor and later transitioned into economics.

After earning her master’s degree from Harvard, Alsan initially hoped to work for MSF, as she “always wanted to help bring healthcare to vulnerable populations,” she recalls. But her field experience prompted her to delve into the economics of healthcare. When she visited Ecuador in 2004, she noticed a shortage of insulin due to cuts in health and education budgets.

“What motivated me [to pursue economics] think about poverty and the root causes of the unequal distribution of diseases and medicines.”

Pursuing her two passions simultaneously, she received her PhD in economics from Harvard in 2012 and received an infectious disease fellowship at Mass General Brigham in 2013. The scholarship specifically aims to educate leaders in the infectious disease field who continue to keep diversity, equity and inclusion at the heart of their careers.

Her research has taken her from simply examining the impact of health care disparities to a more aggressive search for solutions. Black men, for example, have one of the lowest life expectancies of any major demographic in the United States American Economic ReviewAlsan and her research team outline a double-blind study they conducted in Oakland, California, to test a strategy to reverse this disparity.

In Oakland, the team opened a pop-up health clinic, recruited black men from nearby barbershops as patients, and hired 14 doctors, half black and half white. In an 11-week experiment, patients were randomly assigned to each doctor for individual consultations every Saturday. The researchers observed the extent to which patients advocated their own preventive measures, such as checking blood pressure or vaccination against influenza.

The study found that black patients were much more likely to choose any available preventive service, particularly invasive services like blood draws for cholesterol testing, after meeting with a doctor. Alsan also concluded that getting advice from a trusted medical source could potentially add up to 1.5 years to a black male’s life expectancy.

“While I wasn’t completely shocked by the results, I was quite surprised at how clear they were,” Alsan said. Unfortunately, black Americans make up 13 percent of the US population, but only 4 percent of all US physicians.

“We need to improve opportunities for people from non-traditional and low-income backgrounds,” Alsan said. “Medical studies are very expensive. and the application process requires many steps and compulsory courses. We could lower tuition and offer a lot more counseling and coursework for people who may not have been exposed to these careers.”

Alex Ortega, director of the Center for Population Health and Community Impact at Drexel University, praised the 2019 study results. He told The Daily Beast Alsan’s work echoes similar research he’s read about “how care improved when minorities were matched with providers of the same race”.

However, he wants this issue to be addressed beyond simply diversifying the healthcare workforce. “More needs to be done to bring equity to healthcare,” he said, “and we need comprehensive healthcare reform to achieve that.”

Seeing inequality play out in a different area of ​​health research is at the heart of one of Alsan’s next projects. “Historically, black patients have been underrepresented in clinical trials, either compared to the US population or the burden of disease,” Alsan said. In a working paper yet to be circulated, Alsan and a team of others from Stanford and Harvard examined how doctors interpret clinical trials for drugs that vary in the proportion of Black patients enrolled.

They found that the more doctors who enroll black patients in these studies, “the more responsive they are in terms of willingness to prescribe this drug for their patients,” Alsan said.

Visiting a doctor of the same race has a tremendous impact on the healthcare provided to black patients. As Ryan Huerto, a primary care physician and lecturer at the University of Michigan, noted, “There is increasing evidence that physicians and patients of the same race or ethnicity share time spent together, medication adherence, shared decisions, and wait times for treatment improve cholesterol screening, patient understanding of cancer risk, and patient perceptions of treatment decisions.”

Running parallel to this conclusion was another intriguing finding: when black patients were exposed to a drug trial with a more representative proportion of black participants, they viewed the drug more positively than if there were very few black participants. This means they may be less skeptical about how this drug might work for them. When you see yourself represented in healthcare, you don’t feel like you’re looking inside from the outside and wondering if a drug actually works for someone from your background. “Representation in the trial definitely affects how patients perceive a drug’s effectiveness,” Alsan said.

Her other project, details of which are yet to be finalized, will focus on healthcare in US prisons. “I will try to understand the challenges associated with providing health care in our country’s prisons,” she said, “and how we can achieve improved quality of health care there. Because there is not much control over the level of care in these facilities.”

Inmates are often sicker than their age-matched controls, with higher rates of diabetes, high blood pressure, asthma and HIV, Aslan noted. In a 2009 study, around 44 percent of prison inmates reported having or once had cancer, high blood pressure, heart disease, kidney disease, liver disease, or other chronic conditions — compared to 27 percent of the general population. Alsan, along with Harvard law professor Crystal Young, wants to explore how these differences occur and where the role of race and ethnicity lies in the healthcare provided to incarcerated patients.

In the wake of new efforts to reverse racial and wealth disparities in public health, Alsan’s work deserves a particularly bright spotlight. Laura Scholl, senior program officer for grantees at the MacArthur Foundation, told The Daily Beast Alsan was selected for the grant in large part because of her goal to “improve health outcomes for historically marginalized and abused populations. It sharply quantifies the need to diversify the medical profession and shows that diversity in the medical profession is a key component to achieving better health outcomes for people of color.”

But can researchers like Alsan effectively study these differences in healthcare interactions mediated by online video? Alsan’s research aims at the personal relationship between patient and doctor. But the rise of telemedicine, especially in the wake of the COVID-19 pandemic, means more and more people are meeting with their doctors remotely. In a 2021 global consumer survey by digital testing company Applause, 63 percent of respondents who have used telemedicine in the past plan to increase their use of such services even after the pandemic ends.

How does Alsan see the rise of telemedicine and virtual doctor visits? “What keeps me up at night,” she said, “is that early adopters – those who can afford it – will enjoy this exciting technology. The opportunities for justice are profound as telemedicine means reducing the transportation and parking fees a patient may incur.

“But,” she said, “what about those who cannot afford these services? This is becoming an elite service and I hope this is addressed at some point.”

Looking back at early signs that she would be diving into health work that focused on racial and economic differences, Alsan recalled a song her mother used to sing to her as a child: “We were created for ministry, to to take care of each other. We were made to love every sister and brother.”

https://www.thedailybeast.com/marcella-alsan-is-on-a-quest-to-reverse-racial-disparities-in-health-care?source=articles&via=rss Marcella Alsan is on a quest to reverse racial disparity in healthcare

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