9th Annual Culturally Responsive Healthcare in Iowa Conference – 1 June 2023

The following was contributed by Poorani Sekar, MD, Clinical Associate Professor of Internal Medicine, Infectious Diseases. Sekar was an event attendee, planning committee member, and former co-chair of the conference.

This year our committee decided to do something a little different and that was to have a theme for our conference ‘Beyond Healthcare: Addressing the social determinants of health.’ We have all learned about social determinants of health in school, but we truly lived in and saw it firsthand during the COVID pandemic, which highlighted poor outcomes in the BIPOC community.

The conference was held at the College of Public Health as usual, and it kicked off with presentation of the inclusive leadership awards. (Announcing the 2022 Inclusive Leadership Award recipients – The Loop (uiowa.edu).

Lynette Cooper, DNP, ARNP, FNP-C, gave a brief overview of social determinants of health. She impressed upon us that only 20% of health is from clinical care and the rest is determined by social factors.

Following her overview, we delved into some of the components that determine the overall health of a person. A panel discussion ‘Navigating Social determinants that Impact Access to Care’ and the panelists included Jeanine Abrons, PharmD, who is both faculty at the UI College of Pharmacy and co-directs the UI Mobile Clinics, and Tracy Rodgers, BS, who is with the Iowa Department of Public Health and directs the I-Smile project, ensuring dental care for vulnerable patients. Abrons said that in her work with the mobile clinic she meets people where they are. She gave examples of offering COVID vaccinations at La Regia Taqueria, and other restaurants around town. The UI Mobile Clinic has 14 sites and volunteer students and trainees (under the supervision of faculty), offering screening and treatment for common health conditions including diabetes, high blood pressure, and high cholesterol. They also offer acute care services, mental health services, as well as deliver vaccinations.

Rodgers spoke about the I-SMILE project in Iowa, which offers access to oral health for all Iowa children and pregnant women through contracts with dental providers. This was accomplished with contracts made with providers and organizations who were willing to accept patients covered by Medicaid insurance. She also spoke of the I-SMILE Silver pilot program offering a similar program to senior citizens in 10 counties in the state as well who unfortunately have lost access to dental care due to their insurance coverage changing after retirement. The session was moderated by Carrie Mean, LISW.

Next was a panel discussion ‘Addressing Social Determinants in the Community.’ The panelists included Julia Ganda, MSW, with the Center for Disabilities and Development, Janania Ladiester, BA, Student and Family advocate with the Iowa City Community School District, Corey Dion Lewis, BA, Health Coach at Broadlawns Medical Center, Des Moines, and Tracy Hightshoe, BA, Director of Neighborhood and Development Services for the City of Iowa City. This session was moderated by Sally Rieck, LMSW.

Ganda talked about the importance of community engagement and going to the community she serves. It takes a lot of time and conversations with people who have traditionally been marginalized and affected by the medical community to develop trust for their care with the healthcare provider. She spoke about her work with the Congolese community and refugees who had made Iowa their home.

Landiester spoke about her work with the Latinx community. She stated that as a Spanish speaker she was able to connect with the students and their families. She discussed the importance of mental health, which is something that carries a lot of stigma. She offered resources, dispelled any concerns, and also met her clients “where they were at,” including the parking lot, in their mobile home, making them feel comfortable and fostering trust with them, so that they would be open to exploring any of the mental health services that her organization offers.

Lewis discussed the various ways in which he ensured access to good health for patients who visited Broadlawns. As a health coach he does not just stop at teaching people about healthy eating habits, he ensures that they have access to the tools that make those habits stick. For example, he offers his clients a produce prescription, which can help them get fresh produce at participating markets. He also talked about the Tech and Teach programs through which people in the community can train as CNAs and hence able to help their community while having a job in healthcare.

Hightshoe stated that “healthcare happens in neighborhoods,” and it was quite important that how cities are planned and communities built impact the health of its members. She states that it has unfortunately been true that “ZIP codes predict quality of life” and this needs to change and looked at at the city planning level. She stated that things like lighting, noise pollution, air quality, and availability of green space impacted health. In her work with the city, she states there are grants up to $7500 available through the “Healthy Homes” program to repair and replace items that are contributing to poor health, including air quality. I personally learned a lot about the broader scope of things that affect health from this panel.

We were very intrigued to learn about medicolegal partnerships (MLPs), which address social determinants of health by ensuring access to equitable care for patients. This is something most of us hadn’t hear about. Two lawyers Emily Ehlers, JD, (Disability Rights Iowa) and Erin O. Planalp, JD, (Iowa Legal Aid) gave us an overview of MLPs. The session was moderated by David Moser, PhD. Ehlers and Planalp stated that if something in their clients’ life or environment is preventing them from good health, they offer legal remedies. They work on cases where clients have had Medicaid applications or prescriptions for medications rejected. They also go through legal channels when clients live in substandard and unsafe living conditions and ensure the homeowner or landlord remedies that. Nearly 130 hospitals and health care systems invest in MLPs so that their patients get the best access to good health as possible. Panalp is a member of the University of Nebraska Medical Center’s MLP. There are a few systems in Iowa that have MLPs as well.

Finally, the last session of the day was a keynote from Nalo Johnson, PhD, on the topic of ‘Addressing the Social Determinants of Health – The Philanthropic Role.’ She is the President and CEO of the Mid Iowa Health Foundation. This is a nonprofit organization that provides grants and invests in community building projects that transform systems to ensure people have the building blocks for good health. One of the projects of this foundation was the aforementioned prescription produce program. They also support Healthy Homes in Des Moines and successfully piloted UpLift, an Iowa program in which low-income individuals receive $500 monthly. UpLift tracks how the money is spent and compares health and well-being outcomes of stipend recipients to those who do not receive such a stipend.

Conference attendees that I spoke to learned about social determinants of health, particularly all of what goes into health of an individual the least of which Is actual clinical care. As we continue in our healthcare careers, we should all strive to remember that a patient whom we call “non-compliant” might be having issues of food and housing insecurity having to make the decision between basic needs and medications. The next time we are tempted to make assumptions like that we should all pause and ask the patient “the why” and, if able, try to connect them with resources in addition to medical care that would better their health.

The conference was chaired by Nicole del Castillo, MD, MPH, Director of the Office of Diversity, Equity, and Inclusion at CCOM and Clinical Assistant Professor in the Department of Psychiatry.

Planning Committee

Megan Carney, MSW, LISW
Margaret Chorazy, PhD
Lastascia Coleman, ARNP, CNM
Lynette Cooper, DNP, ARNP, FNP-C
Anne Crotty, MPH
Nicole Del Castillo, MD, MPH
Valerie Garr, MA
Jontell James
Krisha Keeran
Tara Martin, BA
Denise Martinez, MD
Michelle McQuistan, DDS
Lou Ann Montgomery, PhD, RN-BC
David Moser, PhD
Janet Niebuhr, MOL
Lama Noureddine, MD
Lori Raw, BA, CHCP
Celine Robins
Katie Robinson, MD, PhD
Poorani Sekar, MD
Barbara Stanerson
Julie Temple, BA
Ily Kristine Yumul-Non, MD

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