Current Work in Health Equity
Elizabeth Dzeng, PhD, MD, MPH is a hospitalist, sociologist, and ethicist who draws upon sociological, human centered design, and community-based participatory research methodologies to promote health equity in hospital and end-of-life care. Dr. Dzeng’s work focuses on understanding and addressing the impacts of racism on hospital-based care. She is funded by a NIA Beeson award and a Cambia Sojourns Scholar award to understand how structural racism across the life course influences the quality of end-of-life care for older Black adults. Ultimately, this study aims to convene Black community members and hospital leaders to create systems-level interventions to address structural racism in end-of-life care. Dr. Dzeng has also co-led the development, implementation, and eventual evaluation of a health advocate program for Black patients who are hospitalized at UCSF’s hospitalist services. The goal of the program is to improve the quality of care for hospitalized Black patients, which includes both improving care outcomes as well as increasing the provision of life-affirming and compassionate hospital care for this population. She has also been working with hospital medicine colleagues on a partnership with GLIDE to create a longitudinal program to change the culture around anti-racism and equity in the division of hospital medicine and beyond. Dr. Dzeng has several recent papers on health equity and restorative and transformative justice approaches to anti-racism in medicine
Rita Hamad, MD, PhD leads The Social Policies for Health Equity Research (SPHERE) program, a research group that focuses on evaluating the health effects of social and economic policies. This research helps us to understand the role of social and economic factors—like poverty, education, and structural racism—in influencing racial and socioeconomic disparities in health. It also helps to provide evidence on specific policies to inform policymaking to attain health equity. Her current work looks at the US Congress temporary expansion of the Child Tax Credit (CTC) during the COVID-19 pandemic to provide economic assistance for families with children. Using data from the Census Bureau's Household Pulse Survey and a quasi-experimental study design, Dr. Hamad and her team examined the effects of the expanded CTC on mental health and related outcomes among low-income adults with children, and by racial and ethnic subgroup. They found fewer depressive and anxiety symptoms among low-income adults. Adults of Black, Hispanic, and other racial and ethnic backgrounds demonstrated greater reductions in anxiety symptoms compared to non-Hispanic White adults with children. There were no changes in mental health care use. These findings are important for Congress and state legislators to weigh as they consider making the expanded CTC and other similar tax credits permanent to support economically disadvantaged families.
Christina Mangurian MD, MAS’s NIH-funded research program focuses on promoting mental health equity, particularly among underserved minority populations. She founded and directs the UCSF Program of Research on Mental health Integration among Underserved and Minority populations (PReMIUM). She has decades of experience using large administrative databases to examine gaps in quality of care for people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder), including using Medicaid, and electronic health records data from Kaiser Permanente Northern California and two large public mental health care systems [New York State Office of Mental Health and San Francisco Health Network (SFHN)]. Dr. Mangurian has a secondary appointment in Epidemiology & Biostatistics, and through partnerships with the UCSF Population Health Initiative and community partners, she has started building several geocoded cohorts to identify service delivery gaps for underserved populations in San Francisco. These populations are drawn from electronic records of UCSF Health and the San Francisco Health Network (SFHN). These two delivery systems serve ~30% of all individuals living in San Francisco. With increasing recognition of the importance of place for healthcare, she is uniquely positioned to use these geocoded cohorts to apply precision population health methodology to promote mental health equity and has many proposals underway to utilize this work.
Kim Rhoads, MD is the founder and director of Umoja Health which was conceived by and out of the UCSF Helen Diller Family Comprehensive Cancer Center’s (HDFCCC) Community Advisory Board (CAB) in 2020 to rapidly mobilize to address the COVID-19 disparities facing communities of color. Its focus has been on building community coalitions with the capacity to address the underlying causes of health inequities by dismantling systemic racism and reimagining healthcare delivery. Umoja Health delivers public health education, health screenings, vaccinations, and cultivates a diverse community workforce. The effort centers community engagement, community data ownership, and efforts to transform institutions so that action is valued over talk, and impact is valued over impact factors.
Umoja Health has grown to engage with more than 105 community-based partners in San Francisco, Alameda and San Mateo counties, reaching more than 18,000 individuals for COVID-19 vaccinations (n=5,700); testing resources (n=3,500); distributing take home tests (n=2,000) mobilization (7,000 door knocks) and most recently, low barrier access to (prescribing) emerging therapies (Paxlovid; n=11).
Umoja Health has leveraged their COVID-19 direct service pop-ups to also offer stool based colorectal cancer (CRC) screening (Fecal Immunohistochemical test (FIT)). During their 30-day CRC screening campaign in March 2022, they reached more than 5,000 individuals with messaging and 30 individuals for CRC screening with 40% return rate and 2 FIT positives. Working with their large network of health system partners (Kaiser, FQHC’s and CHC’s), linkages to care were relatively easy and they were able to get these participants to colonoscopy within 4 weeks of positive test.
Umoja Health is now leading an effort to better understand how long COVID affects marginalized groups, having developed a Long COVID Community Advisory Board for the RECOVER study site at UCSF and recently hosting a long COVID town hall engaging 80 live participants and 150 views.
For 2023, Umoja plans to expand health screenings, including diabetes and cancer, and increase access to health care and insurance enrollment for disproportionately impacted communities of color; increase opportunities for workforce development and training youth in careers related to healthcare delivery and public health; and grow and strengthen the Umoja Health Coalition to address and overcome structural and institutional racism, so that black and brown communities have unprecedented opportunities to thrive.
Hilary Seligman MD, MAS’s work uses strategic science to influence policymakers to create policy, systems, and environmental changes that improve access to healthy food for households experiencing food insecurity. She is primarily recognized as a leader in research focused on understanding the health implications of food insecurity. Her policy and advocacy expertise focuses on federal nutrition programs (particularly SNAP), food banking and the charitable feeding network, hunger policy, food affordability and access, and income-related drivers of food choice. When Seligman began investigating food insecurity and its impact on health outcomes almost 20 years ago it was not a topic of interest in the health care community. Her biggest success is in partnering with others to recognize food insecurity as a critical driver of health outcomes, and therefore a topic that clinicians and health care administrators must be aware of and invested in changing.
Jack Turban, MD, MAS directs the UCSF Gender Psychiatry Program, where he provides clinical care for transgender and gender diverse adolescents. His research focuses on the ways in which public policies impact the mental health of transgender youth. His recent work includes testifying as an expert witness in Brandt v. Rutledge, a federal case challenging Arkansas’s recent ban on gender-affirming medical care for transgender youth. He also recently published a new study in Pediatrics that analyzed data from the CDC’s Youth Risk Behavior Survey and contested the argument from recent political debates that transgender youth come to identify as transgender due to “social contagion.” He often works to dispel misinformation about transgender youth through op-eds, including his piece in The Washington Post highlighting some of the misinformation that led Texas officials to label gender-affirmation for transgender youth “child abuse.”