Health Disparities and Equity (With Dr. Melva Thompson-Robinson)

Joe Gaccione 0:01
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Health disparities have existed for so long, but it feels like the last few years have put a bigger spotlight on them through various national and international incidents, not the least of which is the COVID-19 pandemic. Based on the Department of Health and Human Services, we define health disparities as preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. So how can we collectively change disparities to equity? Today, we are joined by Dr. Melva Thompson-Robinson, professor at UNLV nursing. She's also the editor of the Journal of Health Disparities Research and Practice. Prior to nursing, Dr. Thompson-Robinson was at the UNLV School of Public Health, she was the project director for the Southern Nevada Teen Pregnancy Prevention Project, which implemented an evidence-based intervention with African American youth ages 14 to 19 in African American faith-based organizations. Moreover, Dr. Thompson-Robinson was a member of the US Department of Health and Human Services, Regional Health Equity Council. Thank you for coming in.

Melva Thompson-Robinson 1:08
Thank you for having me.

Joe Gaccione 1:11
As a health professional, what are the biggest disparities that you see?

Melva Thompson-Robinson 1:14
So, when we talk about health disparities, we talk about differences in health status. And so, my work primarily focuses on racial and ethnic populations. And so, oftentimes they are sicker, they have less access to care, they are more likely to die from the health issues that they experience that our white counterparts oftentimes don't experience. And so, there's a lot of different reasons for this. Some people will say, you know, it's, “They just don't go to the doctor's,” and that's true, but part of that is because of this history of racism in this country as it relates to health. Some of it is about access and part of that is yes, people don't have health insurance, but then there's also places, and even in our community, where we don't have providers or where providers are leaving, leaving town and closing up shop. So, there's a lot of different things that go into it. Some of it too is just even, you know, people have to know that you can go to the doctor, or healthcare professional, and you can get treatment and care for whatever you might be experiencing. And there's preventative things like vaccines and whatnot. So, there's a lot of different things that contribute to our health disparities, just within the healthcare system, but also, we could talk about social determinants of health. So, you know, educational level. If you don't have education, then it's harder to access employer insurance, so most of us that have, you know, insurance through our jobs, you know, we tend to have a higher education, we've at least finished high school and so, if you haven't finished high school, then that factors into it. Then you start talking about income, which is related then to education, because the more education you have, the more income in theory you can make, you know, but we can also look at incarceration and the rates of incarceration and how that impacts the health of a community because it takes people who are able-bodied in a lot of sense out of a community. So, all of these things factor into why some populations are healthy or less healthier than others.

Joe Gaccione 3:39
And you have all those factors. And that, pre-, that's pre-pandemic too, and then you add COVID-19, and it just turns everything upside down. I mean, that's not a that's not a secret, that's an obvious thing that we all saw. Do you feel like now that, the pandemic is still around, COVID-19 still exists, conditions are more or less better, but do you think a lot of those disparities, do you think the spotlight on those disparities has maybe helped put more attention to fixing them or do you think it's about the same?

Melva Thompson-Robinson 4:10
I think initially with the pandemic, it showed, it shined a big light on the disparities. You know, people were sitting back, you know, and like I said, they were like, “Oh, my gosh,” you know, clutching their pearls, like, “I didn't know that people didn't have access. I didn't know that people had, you know, these things,” and then, you know, like, so like, from a healthcare perspective, when you start talking about “People don't have access,” and, you know, they, they, you know, the vaccines weren't getting into some of our poorest communities, but then you factor that with, “Who's an essential worker?” and looking at our racially and ethnically diverse populations, who were our frontlines not only in health care, but also and not, when I'm saying “in health care,” I'm not just talking about doctors and nurses, but also who's cleaning the room who's, you know, checking people, patients in when they're coming in, but then you factor in too like, we still had to go to the grocery store, we still had to, you know, get food. And so, “Who's working in meatpacking plants?” for example. “Who's working in the grocery store and checking us out when we're buying groceries or delivering food to us?” So, there was, there was a lot of people who were impacted, but because of their jobs, you know, they didn't have paid time off. They didn't have health insurance. They became, you know, very susceptible. Early on, you know, we had a president who was talking about, “This was an Asian American disease,” because it started over in China, and that led to a lot of people thinking, “Oh, well, Blacks,” for example, “African Americans don't get COVID-19,” and so, then, you know, people were basing their medical practice around, “Oh, well, you know, you can't have COVID-19, because that's an Asian-related disease.” So, it's impacted a lot of different things and shone a lot of light on just the differences in care that people receive. One of the things that, I think, to a point, never really got talked about a lot in the news was our Native American and our tribal populations and looking at, for example, like the Navajo, they experienced tremendous loss over the pandemic, due to COVID-19 and part of that is because just in how they live in multigenerational families, but then also part of it too, is just in the access to care, you know? So, you're having, you have small hospitals that are now having to transform into these major units to support breathing for people and not having the resources to do that, but then at the same time, we have a whole bunch of hospitals here in this county, people from the Navajo reservation, if they were reaching a point where they could, they were being life-flighted, and transported down into Phoenix for further care, you know? And so, that's like a five hour ride from parts of the Navajo reservation. So there's, you know, there's little things like that that people didn't, just didn't really understand that that's what these communities were facing. And when COVID hit, now it's like, boom. These people, people were hit pretty hard and communities were hit pretty hard and some tribal populations, there was concern that they might wipe out a whole tribe because of COVID-19.

Joe Gaccione 7:55
And I think, too, we realized what we might take for granted until we lose it or we have a risk of losing it, especially that access to care. If you're in a lower socioeconomic class, then it's not as easy to say, “I'll just, I'll just go to the doctor. I'll just, I'll just, you know, just go and you know, have to pay, you know, copay,” it's not that easy. Then when you bring in a virus that is, that is affecting everybody, and then it's like, then you're thinking, “Well, I can't go,” it's like, “I can't go to the doctor, because I might get sick. That's probably where it's going to be the worst. But if I don't go to the doctor, how do I get better?” You know, especially at the very beginning, when there was so much, and you alluded to this, like there was confusion about, “Well, who's affected by this and who's not?” It's, it's striking. Yeah.

Melva Thompson-Robinson 8:43
Yeah. And when, you know, when you're in multi-generational families, and so you've got, you've got younger kids, but then you've also got seniors as well, and thinking about, you know, like, “How I'm going to work and now I have to come home and deal with, you know, everybody, and I don't want to bring home whatever I have.” So, it, you know, it was, it was, it was serious for some populations, you know, and a lot more serious than I think sometimes people realize and, and people understood.

Joe Gaccione 9:17
Your research, we mentioned before, includes African American health, also sexual health, both could be intertwined with health disparities. Can you talk about what your research focuses on specifically?

Melva Thompson-Robinson 9:27
A lot of my research focuses on, on health disparities and health equity. And then, in terms of populations, it's been African Americans, but I've done the spectrum from chronic disease, so you know, physical activity and nutrition, all the way to teen pregnancy prevention, HIV prevention, done work with capacity building, so working with people from community-based organizations to build the capacity of their organization so that when funding comes into an organization, then the organization survives once that funding may disappear. So, it's been a lot of different things. My students have also pulled me in a lot of different directions, based on what they want to do. You know, I always try to teach them, you know, if you have the skills, then you can move across different disease areas.

Joe Gaccione 10:28
We mentioned before in the introduction, in addition to teaching, you're also the editor for the Journal of Health Disparities Research and Practice. We haven't really talked about this so much on the show yet, the editor role, when it comes to being a nurse being a health professional. Can you go a little more into that process and, and how it relates to nursing, how it relates to what you do?

Melva Thompson-Robinson 10:48
So, let me just, let me just kind of back up a little bit for people who are outside of academia, you know? One of the things that, in academia, that we do is we publish manuscripts, we make journal articles. And so, when I first came to UNLV back in 2004, going on almost 20 years here, one of my colleagues, Michelle Chino, and I, we were having a conversation, because at that time, publishing work, and she was Native American, so publishing our work around with different communities, there wasn't always an avenue for doing that. And so, at that point, she and I decided that we should start our own journal. And so, we came up with a Journal of Health Disparities Research and Practice, and we were intentional with the title around practice piece because some of what people want to publish as they work with communities of color is more of an applied research. It's not, you know, the, the, you know, randomized control trial kinds of things. And so, we started the journal and for many, many years, although I was editor, I was more of the face of the journals. She was, you know, the behind the scenes, making sure that we got things published and handling paperwork and things like that. Unfortunately, she left UNLV, and so the journal fell back on me. I was, for several years, many years, working with another colleague, Marya Shegog, and then she also left UNLV, and so the journal has fallen back on me. So, what that, what does that mean, as the editor? That means that one, I'm always looking for authors to submit articles to the journal, but the other part of it is, and really where I'm more involved in, is I'm out there identifying peers who can then review the article and say, “Yes, this is ready for publishing,” you know, “No, they need to make some edits,” or “I don't think this is worth publishing in the journal.” I then, you know, once the reviews come back in, I make decisions on whether or not things, you know, get rejected, they get accepted, they, people, authors have to do more revisions. And then from there, once we get enough articles in, enough manuscripts in, then I actually have to sit down and format everything and upload them back into the system for publication. So, I'm, I'm the one in Word, you know, making, putting it into our template and everything and then hitting, you know, letting the authors review it, make sure everything is okay, and then hitting the publish on that. It's a labor of love. It's not always something that I receive a lot of credit for. However, I will say that I was recently on a panel with some people from NIH, including the National Institute for Minority Health and Health Disparities, and the person from the National Institutes of Minority Health and Health Disparities, she was like, “Oh, we love your journal. We've published several things in there, and we want to continue, you know, to do that,” and I was like, “Well, you know, I'm kind of, kind of in a place where I'm like, ‘Do I want to continue this?’” and she's like, “You need to come up with a succession plan. You need to find somebody to take it over once you decide to leave, once you retire,” and she's like, “And you deserve to be able to retire and you deserve to be able to step down.” So, so now, that's become another thing for me to think about. The journal is indexed. We aren't quite yet on PubMed because, you know, there's been some things, some edits that we've had to make and then, of course, with the pandemic, that kind of slowed things down, and then I was on sabbatical last year. So, I'm hoping this year to, you know, move more into that. And we do, I believe, have articles published by nurses, but I'd like to continue to involve nurses in that, in part because we are getting articles like from medical students, and physicians who are teaching, and so we need people who can read it and understand and, you know, I have a public health background, so I don't always understand all the clinical stuff that comes in.

Joe Gaccione 15:32
Your UNLV teaching background is extensive, obviously nursing, public health, community health sciences, liberal arts, even. Public health, as you just mentioned, big part of your overall career. How do you plan, as you're relatively new to nursing at this point, the School of Nursing, how do you blend all those experiences into your new role?

Melva Thompson-Robinson 15:52
I think there's several different ways. And part of it, it took me a minute to, to really wrap my brain around all of this because I realized that I am, I'm not a nurse and I will never, you know, be a nurse, not this late in my career. While I don't see myself teaching undergrads and training people how to become a nurse, there are things at a graduate level or postgraduate level around health disparities and working with racially and ethnically diverse populations that I can contribute to that. Because I am a full professor, I've been here 18 years, this is 20-plus years as a faculty member, how have I survived in all of this and how do I work with my students? You know, like, one of the questions I remember being asked when I interviewed was, “How do I, how do I publish with my students?” and, you know, nursing faculty, at least at UNLV, haven't always done that. And so, you know, to be able to share some of my experience and expertise and in working with students, we were just at a retreat last week and talking, you know, about greeting students and, you know, interacting with students. And I met with one of my students today, and we had, we had an hour meeting scheduled, we still ended up being done in like, 30 minutes, but she only had like, five minutes, ten minutes worth of questions, but then it was, it was just general chit chat, you know, “How's, how were your holidays?” and “Oh, you know, Southwest,” we were talking extensively about that, because she's got companion tickets now on Southwest and I just got companion tickets on Southwest. And so, you know, we were just having general conversation, she's, over the years, has seen my kids grow up. And so, you know, she was asking, she watched, I have a son, who just finished playing football at UCLA, and so she watched him play, and so she was asking about him and how he was doing. So, you know, we were having that personal conversation. So, you know, we still didn't take up the whole hour, and I always allowed an hour for my students, for my graduate students in particular, because sometimes they just want to chat, you know, in addition to talking about, okay, you know, “Here's the edits you need to make to your perspective, here's the edits you need to make for your final defense,” kind of thing. “Let's think about your research question.”

Joe Gaccione 18:40
So much of what we've been talking about with health disparities, so much of the potential solutions, rests on policy making. We mentioned before, you're part of the Department of Health and Human Services, the regional equity, excuse me, Regional Health Equity Council. You know, were you privy to see how the sausage is made as far as policy creation goes, like, what was that experience like?

Melva Thompson-Robinson 19:01
So yeah, that was actually really, really interesting. So, I was on the Region Nine Health Equity Council. So, the US Department of Health and Human Services divides the country into 10 regions, and Nevada sits in region nine, which includes Nevada, Arizona, California, Hawaii, and the Pacific territories. And so, you, you know, interact with other professionals around the region, so, you know, it was always interesting for us trying to set conference calls, because afternoon here in Las Vegas is morning of the next day, in Micronesia, for example. And then we had support people from the East Coast, so now they're in the evening, we're In the afternoon, you know, then you've got Arizona and Hawaii that don't change time, so then, “Are you one hour ahead, are you the same time, are you two hours behind us or three hours behind us?” So, it always became interesting in that respect. And so, then in talking about, like, issues around health disparities, like one of the things that we ended up doing was writing an environmental scan document to really describe the region because all of us were familiar with our areas, but you know, when you talk about Arizona, it's not just like Phoenix and Tucson and Flagstaff, you've got a lot of tribal populations there. When you talk about Nevada, it's not just Clark County and Washoe County and Carson City, but then there's, there's frontier areas, essentially, you know, here in between Las Vegas and in Reno. And then, of course, you know, California, all of its diversity and its size and everything like that, but then you've also got Hawaii, which is a state in the Pacific, but then you've also got the territories out in the Pacific that have their own unique relationships with the US. So, we did an environmental scan to kind of lay out like, here's who we are as a region, and things like that, and that was very well received, but then you also, in talking to people and trying to understand, like the federal people, like how do you all make decisions? Like, you know, there was a strong focus at looking at California because of the diversity of California and seeing how that plays out across the rest of the country. But then, you know, I was always, sometimes I was the only person from Nevada on the council, you know, and I was like, “Yes, California is great, but a lot of Californians are moving to Las Vegas, and it has increased our diversity as a city. And so we're, we're, while California, as a state, is very diverse, Clark County, Las Vegas and the surrounding metropolitan areas are very diverse and reflective of a microcosm of what California is.” So, you know, it allowed us, you know, when you think about, "What is it that the feds are looking at for potential direction for policy based on population?” then it was, it was really interesting to see that they focus on California, but they also focus, to a point, on Nevada as well.

Joe Gaccione 23:03
That is all the time we have today. Dr. Thompson-Robinson, thank you so much for coming in.

Melva Thompson-Robinson 23:07
Oh, thank you for having me.

Joe Gaccione 23:09
Thanks for listening out there. Hope you have a great day.

Creators and Guests

Melva Thompson-Robinson
Melva Thompson-Robinson
Professor, UNLV School of Nursing
Health Disparities and Equity (With Dr. Melva Thompson-Robinson)
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