10th annual Health Disparities Summer Symposium throws a demographic curve
By James Ponder
Count on the leadership of Loma Linda University's Center for Health Disparities and Molecular Medicine (CHDMM) to stir things up when it comes to hotly debated issues of race and culture.
Take the 10th annual Health Disparities Summer Symposium, which was held on Wednesday, August 4, 2010, for instance. The huge auditorium of the Wong Kerlee International Conference Center was jammed with the latest crop of student summer researchers—talented high school, college and university students handpicked to spend the summer conducting important scientific research—and their parents, friends and academic mentors.
The program started non-controversially enough. After a brief introduction from David Ergheligiu, MA, MBA, project manager for the CHDMM, David L. Taylor, D.Min, professor of religion and relational studies in the LLU School of Religion, offered the first of five official welcomes to the event, and the invocation. Dr. Taylor with a sobering insight: "Without vision, there will be supervision."
The next official welcome came from Daisy De Leon, PhD, co-investigator and core director for the CHDMM. Dr. De Leon called the summer research program "a moment in their lives to explore." Dr. De Leon introduced several public and community health luminaries from the Inland Empire and extended a special welcome to parents of the student researchers.
Lawrence E. Sowers, PhD, chair of the department of basic sciences at the LLU School of Medicine (LLUSM), told the summer researchers, "You represent our future faculty." Then he praised the excellence of the research posters flanking both sides of the auditorium. "The quality of the work on display is on a par with research from any medical university anywhere in the world."
Penelope Duerksen-Hughes, PhD, assistant dean in the department of basic sciences at LLUSM, got a laugh when she acknowledged the obvious: "When I looked at the program, I wondered why we needed five people to welcome you here." Dr. Duerksen-Hughes told the audience she had enjoyed the opportunity to train in a similar program. "I know the difference it can make," she said.
Still nothing provocative! Would Roger Hadley, MD, dean of LLUSM, open with one of his signature urology anecdotes? Not tonight. Instead, the dean stressed the need for physicians to understand the unique cultural backgrounds of each of their patients, and noted he is very proud of Drs. Marino and Daisy De Leon and the entire CHDMM team as well as the diversity of the LLUSM faculty.
In his remarks and introduction of the keynote speaker, CHDMM director Marino De Leon, PhD, informed the audience that, "it would be impossible to overestimate the importance we ascribe to our future students." He then pointed out that Dr. Hayes-Bautista was the keynote speaker at the very first Health Disparities Summer Symposium at LLU in 2001. "We thought it would be a great idea to bring him back tonight," he observed.
Dr. De Leon added that David E. Hayes-Bautista, PhD, is professor of medicine at the UCLA David Geffen School of Medicine, and director of the Center for the Study of Latino Health and Culture, also at UCLA. He noted that Dr. Hayes-Bautista is the author of numerous articles.
Right off the bat, Dr. Hayes-Bautista began to stir the pot. After announcing that the subtitle for his message—titled "Cultural Competence in Medical Research and Education"—should be, "The Next Big Thing: California Demographics," he challenged a long-standing belief with a simple question.
"Remember your fourth-grade history class?" he asked. "Remember who your teacher told you settled California and established Los Angeles? The Spaniards, right? But let's take a look at historic epidemiology by examining the state of diversity the day Los Angeles was founded: September 6, 1781."
Before rolling-out statistics on the demographics of L.A. on its birthday, Dr. Hayes-Bautista informed the audience that the city's official name is El Pueblo de Nuestra Senora la Reina de los Angeles del Rio de Porciuncula. That translates to, "The Village of our Lady the Queen of the Angeles of the Porciuncula River."
When he displayed the numbers on the ethnicity of the founders, it became apparent that Spanish immigrants were only part of the mix. Of the founders, 38 per cent (38%) were Indian, eight percent (8%) were African-American, eight percent (8%) were Asian, eight percent (8%) were European, and 38 per cent (38%) were of mixed racial ancestry. Dr. Hayes-Bautista did not use the sometimes-divisive term "Native Americans," but called them "Indians" instead.
He pointed out that the melange of early Los Angeles served as a catalyst for a bit of cross-cultural medical exchange when Dr. Pedro Prat—a Spanish surgeon who came to California with noted explorer Fr. Junipero Serra—paid a call on a local Indian doctor living in the Tong-Va culture village of Yang-Na to solicit her expertise in treating medical conditions he had not encountered in Europe. The woman taught Dr. Prat about local herbal cures, which he applied to his patients.
At several points in his stimulating presentation, Dr. Hayes-Bautista said, "Diversity is hardwired in California, both in the population and in medicine." At one point, he turned to the summer interns and said, "You are the latest iteration of diversity in medicine in California, and I salute you for that."
After sharing observations about the racial make-up of the miners who flocked to California for the '49er Gold Rush—it was a lot more diverse than is commonly thought—he pointed out that, "almost three-quarters of the babies born in California today are what we used to call minorities." In light of the Latino population boom, he asked a poignant question about the future. "Do we just do what we've always done in medicine?"
The real bombshell of the evening came when Dr. Hayes-Bautista said current models for predicting the relationship between racial and cultural factors and mortality rates don't hold up to statistical analysis.
"You would think," he said, "that because of their lower income levels, lower education levels, and decreased access to health care that Latinos would have higher incidences of heart disease, cancer and stroke than non-Hispanic whites. However, the opposite is true: Latinos have a 30 per cent (30%) lower death rate from heart disease, a 40 per cent (40%) lower death rate from cancer, and a 20 per cent (20%) lower death rate from stroke. In fact, Latinos average 30 per cent (30%) lower on all causes of death except diabetes and homicide than white."
After telling the audience that there has not been one science-based article on the effects of cultural competence education on patient outcomes, Dr. Hayes-Bautista dropped another of his cryptic questions.
"Is it the beans or the tortillas," he asked. "Is it the Latino culture with its emphasis on family and spirituality? I honestly don't know. We need to do a study on the relationship between culture, behavior and health outcomes.
"We need to know what causes the Latino Epidemiological Paradox."
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