ISSUE
     
New York, New York! What Can This Great, Diverse City Teach Us About Health Care?
The Importance of Finding the Right Comfort Level:
Lessons Learned From New York's Harlem and Washington Heights Communities
 


Michael P. O'Connor, EdD, MPA




The annual Three Kings Day Parade in Harlem is a long-standing community tradition.




A concert in Lincoln Centerís Damrosch Park draws Ethiopians living in NYC.





By Michael P. O'Connor, EdD, MPA
Executive Associate Dean for
Administration and Finance
NYU College of Dentistry

As someone who has worked in healthcare administration, services, and delivery for nearly 30 years, I have developed a very strong viewpoint on the impact of diversity on access to care. One of the most important lessons I've learned-perhaps the most important lesson-is that patients are most comfortable dealing with healthcare providers they can identify with. Unless this comfort level is achieved, opportunities to improve community health are limited.

Let me give you some examples. In the late 1980s and early 1990s, I was actively involved in establishing the Harlem Prevention Center, a collaborative project of Columbia University's Mailman School of Public Health and the Harlem Hospital Center. Funded by the CDC, the program was designed to focus on alleviating the disproportionate health burden of people living in Harlem. Target areas for disease prevention and health promotion included asthma, addiction, cancer, safe sex practices, nutrition, oral health, teenage pregnancy, tobacco prevention, and smoking cessation.

Despite good intentions on the part of everyone involved, the program was initially met with skepticism by the community. And the reason soon became apparent. People in the community were not embracing the program because they could not relate to the program staff, primarily white doctors from Columbia University, with whom they did not share a common background and life experiences. Simply put, the community did not feel that the program leaders understood their health issues, mores, and culture, or that they could be trusted. Given our nation's history of abuse of minorities in medical research, it's not difficult to understand the community's lack of trust.

Realizing that if the program were to have a chance to succeed, it would have to be staffed by a much more diverse group of clinical professionals, we made a conscious decision to recruit top minority public health leaders/educators from throughout the country to serve as role models and mentors, as well as healthcare providers. With the first recruit, a leading African-American physician who was eager to partner with us, the barriers began to recede. We recruited one of the leading community health educators from the West Coast, and established a senior level, Dean's Office cabinet position (Associate Dean for Community & Minority Affairs) to ensure that the needs of both the Washington Heights and Harlem communities were better understood and addressed. It took nearly two years to achieve the level of diversity among the program's leadership that we desired, but by working to get it right, we ultimately transformed the community's perceptions of the program. To this day, the program continues to operate successfully with funding from the CDC; more importantly, it continues to make a major difference in the health status of Harlem residents.

A few years later, the Mailman School of Public Health partnered with a team of senior administrators at the Police Athletic League to develop a program of health screenings for adolescents in central Harlem. Once again, we faced the challenge of reaching out to the community, and it wasn't until we brought in an African-American physician-a specialist in pediatric and adolescent medicine, who had grown up in Harlem and was a product of the community-that the program took off. As with the Harlem Prevention Center, the lesson learned was that you have to be open, listen, recruit the best talent for the task at hand, and understand what's needed from the local community's point of view.

The establishment of school-based clinics in Washington Heights in the early 1980s provides another example of a program that began to flourish once we staffed it with people who were effective at reaching the adolescent community-in this case, people who spoke Spanish and were of Latino heritage. Today these school-based programs are models of excellence throughout the country.

New York City has the most diverse healthcare workforce in the nation, but we still have a long way to go. We need to become much more creative and assertive in providing opportunities for underrepresented minorities to enter health professions schools. While schools of public health and nursing schools have had somewhat better results in this area, we are not where we need to be.

Medical and dental schools need to begin much, much earlier to reach out to potential students. We need to become more aggressive, more open, and more welcoming than we have been in the past. We need to create pipelines beginning at the junior high school level and continuing through college to provide mentoring opportunities for students with an interest in science-in essence, a support system that will help them to understand and believe that they can become doctors. The greater challenge is to identify "Champions" of the initiative who are willing to take on the status quo and reallocate resources to ensure access and opportunity.

NYUCD's approach to this challenge is guided by the belief that it is better for dental schools to "grow their own"-to identify and nurture existing students to become the faculty of the future-than to compete to recruit the relatively small number of top-ranking minority educators to their faculties. If we are successful, and other schools around the country take up similar initiatives, it could have what Dean Charles Bertolami calls "a hydraulic effect" in increasing diversity in the dental profession. Of course, if you invest in "growing your own," there's always the chance that your investment will be recruited away from you. But that's OK, because it spreads the investment around and, most important, it's the right thing to do.