A core theme that emerged from this year’s minority health policy conference at HMS was the concept of the “medical home” and the role it can play in reducing health disparities. A medical home is an approach to primary care that facilitates partnerships between the patient and his or her care team and family.

Sponsored by the Office for Diversity and Community Partnership under the direction of Dean Joan Reede, the annual meeting provides a glimpse into the future of minority healthcare policy and health disparities research. The sessions feature practicum presentations by fellows from the Commonwealth Fund/Harvard University Minority Health Policy Fellowship, the California Endowment Scholars in Health Policy program and the Joseph L. Henry Oral Health Program. This year’s meeting, on May 6, covered a range of topics that examined why some patients experience barriers to care or health disparities, and what might be done to remedy these problems.

Raising Standards

Jaya Aysola, a Commonwealth Fund/Harvard University fellow and pediatrician in New Orleans, presented her recommendations to enhance the cultural effectiveness component of the 2011 revision of the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home standards, which assess a practice’s ability to function as a medical home. Aysola became interested in the project after serving as medical director of a clinic recognized by the NCQA standards. Though surveys at such clinics have shown that patients experience fewer barriers to care and less anxiety about costs, Aysola said, she still wonderedwhether the NCQA model was enough to serve the vulnerable populations she was seeing.

She did a side-by-side comparison of existing cultural effectiveness standards to see which components fit best into the medical home evaluation process, then used these standards to evaluate existing medical home programs. She found significant regional variability, particularly when it came to collecting patient data important to providing culturally effective care. Aysola presented her insights to the NCQA, which she said were being reviewed at the time of the meeting and which she hopes will inform the organization’s upcoming revision of their standards.

The Community Foundation

Another presenter to discuss the idea of a medical home was Commonwealth Fund/Harvard University alumnus Ricardo Custodio. He presented the “10 Commandments” of creating a successful medical home, based on his experience as director of the Waianae Coast Comprehensive Health Center in Hawaii.

“Just because you are poor does not mean you deserve poor care in poor facilities by poorly trained doctors,” he said. His clinic is the only healthcare facility in the area. Many of the patients are poor and native Hawaiian and present with problems typical of such populations, like obesity and diabetes.

Custodio stressed the idea that the foundation of a medical home is the community. Because the Waianae community is so remote, it is important that the patient does not have to move to receive care, he said. The clinic integrates primary care with specialty care, dental and urgent care, but they also provide a gym for children and adults and even a traditional healing center. He also stressed that a clinic can strengthen a community by doing more than handing out pills. His clinic is the largest employer in the area, and 80 percent of the employees live in the clinic’s service area. They also provide educational programs for high school and medical school students and healthcare professionals.

Ad Power

During his keynote address at the meeting, Ichiro Kawachi, chair of the HSPH Department of Society, Human Development, and Health, discussed a modern-day paradox: why are Americans so unhealthy when we are so obsessed with health? Studies have shown that Americans are more concerned about nutrition than other cultures, and yet we have some of the highest obesity rates in the world.

“I think the puzzle of American health needs to be reframed if we are going to make progress,” said Kawachi. Rather than being a sign of laziness or lack of willpower, “American obesity is actually an amazing tribute to the stunning success of the private sector of the food and advertising industry, which has succeeded in making us overweight in spite of Americans’ overarching concern with food and nutrition.”

Kawachi argued that public health professionals do not have the tools to beat the competition—the food industry—at its own game. Current theories in behavior modification do not work when it comes to choices about food because they assume that people make reasoned, deliberate decisions, when in reality many food choices are made impulsively. Most public health messages, however, appeal to our rational side. To illustrate this point, he compared a dry, preachy CDC message about exercise to an advertisement from a gym that promised increased vigor and sex appeal. To make the message more effective, said Kawachi, public health professionals need to take cues from people who stand to make money by getting us to change our behaviors.

The day’s events also included the sixth annual Junior Investigators’ Health Disparities Poster Session and the inaugural Reede Scholars Health Equity Symposium, with presentations by alums from the minority health policy fellowships.