If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Not so long ago, there was a chain of movie stores called Blockbuster. I suspect Blockbuster’s executives thought they were in the video cassette and DVD rental business, but they weren’t. They were in the “I want to watch a movie” business—the failure to understand that distinction is why you don’t see Blockbuster stores or a Blockbuster streaming service.
Health systems are at a similar precipice. We are not solely in the “diagnose and treat” business of medicine. We are in the “I want to feel good and healthy” business of health.
The vast majority of health happens outside the hospital or clinic. It happens in the community and at home. As healthcare and research leaders, it is our responsibility to embed in our communities and partner with them to find ways to create solutions that advance health.
Now, I consider myself a lucky guy. In my administration role at MedStar Health and MedStar Health Research Institute, I get to work at the crossroads of academics and real-world medicine. My colleagues are brilliant clinicians who confront medical and societal challenges and insightful researchers who are at the forefront of creating new knowledge.
That’s pretty exciting stuff. But if we can’t apply that understanding to advance the health of our communities and neighbors, we have lost our focus. Our work goes beyond medicine. Our work must advance health.
Distributed care delivery networks have arisen through the consolidation and accumulation of hospitals due to business necessity, not necessarily community health priorities. As the dominant provider of healthcare in the U.S., health systems like ours have a responsibility to ask some foundational questions:
- Why are we really here?
- What business are we really in?
- How can we advance health equitably?
We can’t do that with medicine alone. We need deep community partnerships, we need collaborative research, we need to be in and a part of our communities, and we need to be always looking ahead.
Advancing equity throughout our work.
The last couple of years have been a real eye opener for a lot of people, especially people experiencing tremendous privilege. Acknowledgment of inherent bias in medicine is not new to our clinicians and researchers, but for a lot of leaders, there has been a more earnest effort to understand the true scope of disparities in care.
This isn’t an excuse. It’s a call to action.
- The average life expectancy among Black people in the U.S. is four years lower than for white people.
- People in historically minoritized communities have higher rates of disease than whites for chronic conditions including diabetes, hypertension, obesity, asthma, heart disease, cancer, and more.
- LGBTQ+ people have higher rates of breast cancer, HPV infection, and related cancers and are less likely to have a regular healthcare provider.
- People with disabilities represent more than 27% of the United States adult population, making them the single largest minority group. Yet, they are profoundly underrepresented in the biomedical and behavioral research workforce and face discrimination, bias, and lack of accommodations, in additional to increased health needs.
It is imperative that every healthcare and research interaction is viewed through the lens of health equity. We established the MedStar Center for Health Equity Research to make it clear that this work is a priority. Our scientific director, Karey M. Sutton, Ph.D., is more than an investigator. She’s an educator and an enabler, working with scientists to understand and prioritize equity throughout our research portfolio.
For example, we’re working to reduce barriers to participation in research by patients from historically minoritized communities. From historical trauma to challenges with time away from work, there are multiple reasons why patients might not enroll in a trial that offers early access to advanced treatments. To solve this, we’re building partnerships with people who hesitate to be part of research to find out what’s holding them back and how our health system can effect positive change.
Health research in, with, and for the community.
Research is the creation of new knowledge, shining a light into the dark corners and revealing opportunities to do more good.
For instance, one of our most important initiatives is the D.C. Safe Babies Safe Moms Program. This research and community health collaboration arose from one incredibly important question: How can we, in the capital of the richest country in the world, have some of the worst child and maternal health outcomes?
To identify and understand the gaps that result in preventable tragedies such as maternal and infant mortality, we illuminate unasked questions through research collaborations with clinicians, community partners, and patients—all equal partners in our work to create new solutions in how we best care for birthing individuals and their babies.
At MedStar Health, we possess a unique opportunity to leverage community engagement to benefit many patients through real-world research. We serve a broad array of patients over a large geographic area, so we gather an integrated data set from rural, suburban, and urban patients who are ethnically and economically diverse. This true-to-life microcosm of U.S. healthcare allows Medstar Health Research Institute scholars to ask, and answer, questions that lead to impactful discoveries. Discoveries that are then generalizable to all corners of our community and not isolated to a privileged few.
I believe that the future of academic medicine looks beyond the hospital walls to answer questions that truly make a difference and improves the well-being of all people in our communities.
Measuring success and looking ahead.
Rather than experts standing at the hub of a wheel, extending spokes into our community, we’re building bridges to connect and partner with our neighbors. MedStar Health’s focus on integrating clinical and research expertise allows us to become a flatter, more equitable organization, distributing care through all types of environments. MHRI’s research touches all aspects of our work and extends into our communities where health is lived.
This is a uniquely effective model, especially here in our region. And it presents a new challenge: When you’re tackling big problems, it’s hard to know if you’re having a real impact.
For example, the ultimate success metric of our Safe Babies Safe Moms Program is a reduction in maternal and infant mortality in Washington, D.C. But we know there are lots of factors that influence those statistics.
Rather than solely comparing mortality data, we also measure contextual statistics that can help us understand our holistic impact, such as the annual numbers of preterm babies, newborns with low birthweight, and mothers who experience bleeding complications.
Over time, we will move to broader measures of health outcomes, working disease by disease, challenge by challenge, community by community.
I’m reminded of an old adage that seems more apt the longer I’m in this line of work: In the end, it’s not only the years in your life that count, it’s the life in your years. While age span is important, health span is paramount to living a fulfilling life If we can add more life to the years of the individual members of our community regardless of their background or economic circumstances, then we have truly accomplished something worth doing, and doing together.