Newly Funded New York City Center Aims to Reduce Health Disparities in Multiple Chronic Diseases
A multi-institutional group in New York City has united to address health disparities in multiple chronic diseases through the Center to Improve Chronic Disease Outcomes through Multi-level and Multi-generational Approaches Unifying Novel Interventions and Training for Health Equity (COMMUNITY Center). The vision of the center is rooted in public health tenets, recognizing that medical advances alone can only partially reduce the inequitable burden of disease in people of color. Reducing health disparities in chronic diseases requires multi-faceted approaches that intervene on structural, community, family and individual level determinants of health and well-being.
“In establishing this new collaborative center, we aim to reduce multiple chronic diseases in the communities that we serve across the New York City region, particularly in the Black and LatinX communities that face a much higher burden of chronic diseases such as cancer and heart disease,” says Mary Beth Terry, PhD, the Contact Principal Investigator for the Center and a professor of epidemiology at Columbia’s Mailman School of Public Health (Mailman).
“Our goal is to develop, test and implement solutions that can be scalable,” says Dr. Terry, who directs the Community Outreach and Engagement (COE) Office and co-leads the Cancer Population Science research program at the Herbert Irving Comprehensive Cancer Center (HICCC) at NewYork-Presbyterian/Columbia University Irving Medical Center, and directs the Chronic Disease Unit in the Department of Epidemiology at Mailman.
The COMMUNITY Center draws on strong collaborations between researchers, community organizations, clinicians and healthcare systems, public health agencies and other stakeholders and joins Columbia University Irving Medical Center (CUIMC), Weill Cornell Medicine, NewYork-Presbyterian, Hunter College, City University of New York (CUNY) and the Physician Affiliate Group of New York (PAGNY).
“Hunter College is delighted to be in partnership with Columbia, Weill Cornell Medicine, and PAGNY. Aligned with our mission, this grant creates the structure and pathway to address the root causes of health disparities in communities and work collaboratively to begin to solve them,” says Elizabeth Cohn, RN, PhD, associate provost for research at Hunter College-CUNY.
The new COMMUNITY Center is funded by a grant from the National Institute for Minority Health Disparities (NIMHD) to tackle the complex problem of persisting inequities in health care for patients suffering from chronic diseases, including cancer and cardiovascular disease, and risk factors that are common to both. The NIMHD’s mission is to support research and initiatives that will reduce the profound disparity in health status of racial and ethnic minority, rural, low-income, and other underserved populations.
“This is one of the few times NIH has broken down traditional research silos and funded studies to address multiple chronic conditions. Millions of Americans, especially BIPOC, are not privileged enough to live with just one chronic health condition,” says Erica Phillips, MD, MS, associate director of community outreach and engagement at the Sandra and Edward Meyer Cancer Center and the Jack Fishman Associate Professor of Cancer Prevention at Weill Cornell Medicine, and an associate attending physician at NewYork-Presbyterian/Weill Cornell Medical Center.
Bringing together investigators with expertise in behavioral and social sciences, epidemiology, biostatistics, data science, implementation science, health services, economics, environmental science, public policy, clinical translational sciences, and community engagement, the COMMUNITY Center will develop research projects that draw from multiple disciplines.
The research being funded by the new grant is centered on testing and interventions that leverage the researchers’ multiple level of influence from individual, interpersonal, community, and societal approaches. The chronic conditions addressed in the collaboration have been identified by and responsive to the voice and concerns of the communities the institutions serve. One such project, co-led by Olajide Williams, MD, MS, professor and chief of staff of the Department of Neurology at Columbia University Vagelos College of Physicians and Surgeons (VP&S), and Sidney Hankerson, MD, associate professor of psychiatry and a COE faculty adviser, is a randomized intervention trial focused on a community health worker model in Harlem churches, to increase colorectal cancer screening rates. An arm of that research also will address nutritional interventions to reduce colon cancer risk, as well as obesity.
“Although rates of colorectal cancer are extremely high among African Americans, screening rates remain low,” says Dr. Williams. “This trial hopes to address this by testing a community-based model designed to increase colorectal cancer screening and also reduce colorectal cancer risk through lifestyle modification focused on nutrition.”
Dawn Hershman, MD, MS, professor of medicine at VP&S and professor of epidemiology at Columbia’s Mailman School of Public Health, with co-leader Ian Kronish, MD, MPH, associate director of the Center for Behavioral Cardiovascular Health at CUIMC, is conducting a randomized clinical trial studying cardiovascular risk within breast cancer survivors. Their trial is addressing reported poor outcomes of breast cancer survivors’ adherence to cardiovascular disease risk factor medications.
“Among adults with chronic illness, approximately 30-50% do not take their medications as prescribed which is associated with increased mortality, hospitalizations and costs. This will be the first large-scale intervention trial to investigate a feasible, cost-effective strategy for improving adherence to multiple medications in diverse patients with multiple chronic diseases,” says Dr. Hershman.
Nour Makarem, PhD, assistant professor of epidemiology, with Parisa Tehranifar, DrPh, associate professor of epidemiology at the Mailman School of Public Health and faculty adviser for COE, are focusing on sleep intervention research, targeting the LatinX population in the Washington Heights neighborhood of Manhattan. Problems with sleep and persistent lack of sleep have been linked to multiple chronic conditions, including increased cancer risk, risk factor for cardiac disease, and increased risk for developing metabolic disease generally.
Dr. Terry notes that a big aim of the COMMUNITY Center is training and promoting early-career physician-scientists who are interested in addressing health care disparities research. One key piece to drive this is the Investigator Development Core, led by Daichi Shimbo, MD, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center, whose own research focuses on interdisciplinary research that increases the understanding of the behavioral, psychosocial and biological processes in the pathogenesis of the increased cardiovascular disease risk associated with hypertension.
“The overall goal of this core is to expand and diversify the workforce involved in conducting important chronic disease disparities research, aiming to reduce and eliminate health disparities and increase health equity,” says Dr. Shimbo.
Another initiative aimed at promoting healthcare disparities research is the development and funding for 10 new pilot awards targeting trainees. These pilot awards, the first set to launch in the spring of 2022, will be open to young investigators across all institution partners.
“Right now, we are all trying to think outside of the box and think about moving towards solutions for health disparities that are scalable, sustainable, and modifiable,” says Dr. Terry.
“I firmly believe that the answer to inequities in health care has to come from partnerships that are sustainable at the community level, that address multiple factors much earlier, prior to late stage disease,” she adds. “This is a real opportunity to work within the community, developing solutions that will have a long-term impact.”
Leading the COMMUNITY Center with Dr. Terry, co-PIs include Elizabeth Cohn, RN, PhD, associate provost for research at Hunter College-CUNY; Dawn Hershman, MD, MS, professor of medicine and epidemiology at the Columbia University Vagelos College of Physicians and Surgeons (VP&S), and co-leader of the Cancer Population Science program at the HICCC; Erica Phillips, MD, Jack Fishman Associate Professor of Cancer Prevention at Weill Cornell Medicine; Daichi Shimbo, MD, professor of medicine in the Division of Cardiology at VP&S; and Olajide Williams, MD, MS, professor and chief of staff of the Department of Neurology at VP&S.