Chapter 18: The Health Disparities Education, Research and Training Consortium and Program
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Description
In this chapter, Dr. Jones discusses the creation of the Health Disparities Education, Research, and Training Program in 2002. He gives context, traces reasons for speedy implementation and covers political dimensions of this process. He describes how the goals of the course, how it worked, and various presenters. He emphasizes that the overall goal of the course is to change how people think about health, so they include economics, housing and wealth distribution in their understanding of what has an impact on health.He then talks about the impact of the first year's success, resulting in forty institutions now involved. He explains why MD Anderson pulled out of the project.
Identifier
JonesLA_04_20140501_C18
Publication Date
5-1-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Administrator; The Administrator; The Educator; The Professional at Work; Obstacles, Challenges; Women and Diverse Populations
Transcript
Tacey Ann Rosolowski, PhD:
-a sound check without even trying. All right, and now we are recording. And it is about eighteen minutes after ten, on the 1st of May, 2014, and we are in the Historical Resources Center Reading Room in Pickens Tower at the Research Medical Library. And I am meeting with Dr. Lovell A. Jones for our fourth session together. Thank you very much for coming in this morning.
Lovell A. Jones, PhD:
Thank you for having me.
Tacey Ann Rosolowski, PhD:
Sure. Okay.
Tacey Ann Rosolowski, PhD:
Well, we were strategizing a little bit before the recorder turned on and had some topics that we hadn't really covered in previous interviews and didn't want to give them short shrift. I guess the first one I had on my list was the global project, the Health Disparities Education, Research, and Training Consortium. Could you tell me how that got started and what its function is?
Lovell A. Jones, PhD:
Sure. It got started in 2002. I was introduced to Dr. Alvin Tarlov.
Tacey Ann Rosolowski, PhD:
I'm sorry. The name again?
Lovell A. Jones, PhD:
Alvin Tarlov.
Tacey Ann Rosolowski, PhD:
Tarlov, okay.
Lovell A. Jones, PhD:
T-r-a-v-o-u, T-r, yeah, l-o-u. That's [unclear]. Dr. Tarlov was kind of the father of social determinants on the U.S. side. He had been at Harvard and then University of Chicago. He had been head of medical department and biochemistry department, had retired from more jobs than I'll probably ever retire from, had been asked by Robert Wood Johnson to head its program with regards to identifying health scholars, health policy individuals, and had been recruited by five of the institutions in the Texas Medical Center, including Baylor and MD Anderson and Rice and UT Health now, to develop a Center on Social Policy. And Al's true interest was addressing the issue of the poor and underserved. And in meeting with him, I said to him-because he was given a good sizeable amount of money to start this Center, I think about somewhere between 5 and 10 million dollars, and I said to him, "Well, Al, that's going to be the last large amount of money you're going to get, because your vision in terms of addressing this is not something that the power structure within the City of Houston is going to be in favor of. Even though you're not in that vein, people are going to describe you, because you've said a Social Center to address policy, you're going to be probably framed as a socialist." And I said, "One of the things I've been interested in doing is trying to get the institutions within the Medical Center to all focus on health disparities as a unit, not to say that they shouldn't do their own thing, but to come together on some issue and focus on that to make some meaningful change." So Al said, "Well, why don't we get together and come up with a plan, invite some of the faculty that you know that are sympathetic but also have the ear of leadership that would be amenable to forming something." So we met with individuals from Baylor, from Rice, from UT Health, from Texas Southern, from the institutions within the five-six, actually, but five of the ones who were given any money [unclear], to figure out what we could do. And what we thought that would not be challenging would be to create an educational program, that we would create a course that no one else could replicate or come close to replicating. And that led to the initial formation of the Health Disparities Consortium. And we approached-University of Houston was part of the initial group. So we thought about either hosting a course that would rotate among three institutions-Rice, University of Houston, and Texas Southern-on an annual basis, and we were debating between Rice and University of Houston to really launch the course.
Tacey Ann Rosolowski, PhD:
Can I interrupt you just for a sec? Because you said you were trying to think of something that wouldn't be challenging. Did you mean challenging to the power structure of the city, to the institutions?
Lovell A. Jones, PhD:
To the institutions, something that we could do that wasn't a lot of money, that we could get funds for, that I could roll into a grant that I had from the Houston endowment, or at least a proposal I was putting forward to them that-
Tacey Ann Rosolowski, PhD:
Were you also thinking-I'm sorry, but I'm just trying to get a sense of why-so the challenging didn't have anything to do with content and concerns that you would be identified as socialists?
Lovell A. Jones, PhD:
The content was more-I guess the challenge is, at least in discussing with Al, is that the institutions had their way of doing things, and the way that they were doing it really wasn't working. It was working, in their eyes, they were getting something out of it, but the communities and those that we thought should be benefitting weren't getting anything out of it. And we didn't want to approach them in a way that said, "What you're doing is wrong, but we want you to do something that was additive," that they wouldn't feel threatened by. And educational courses are put together every day, and as long as they didn't have to put any money into it and that it would be of benefit to them, then we thought we would have an easier chance of getting it launched. And we did. In fact, the president of the University of Houston, Gogue at the time, was very supportive, very enthusiastic, and, in fact, we thought it was going to take us a little more than a year or more to get the course launched, and Gogue-I wouldn't say ramroded, but in less than four months, we had the course up and running as a sanctioned course on the University of Texas campus.
Tacey Ann Rosolowski, PhD:
What was his interest? Why was he so supportive?
Lovell A. Jones, PhD:
I still don't know. He left within two years after that and became president of Auburn University, and so I never really had a chance to sit down and talk to him. His deputy at the time, Strickland, Jerry Strickland, was a person I interacted with most, and Jerry's interest was, for lack of a better way of describing it, he was a social liberal that was looking for ways that he could address societal issues, and thought by training the next generation and making them aware of what the situation was and what some of the solutions were, that this would address the issue. So we held the course. There was only twenty-four, I think, individuals. But the lineup that we had for the first course that was at University of Houston was phenomenal. The only thing that I tell people I regret was that we didn't tape it, because the opening presenter was Francis Collins, now the director of the National Institutes of Health, and he and a colleague of his from Baylor did a three-hour overview of genetics, from Genetics 101 all the way through the Human Genome Project, and it was just phenomenal. I mean, it captivated the students. So we had a series of individuals who came in that just was a phenomenal set. So as people heard about it, we started getting more and more institutions interested in being a part. And so Al and I sat down and we said that the only way that an institution could become part of it is we would have to have a letter from their president saying that they would support our efforts in terms of doing things as a consortium, that they would encourage their faculty and students to participate in our efforts, and that if they ever wanted to leave the consortium, that they would have to write a letter to do so. And that came in-I think Al was very brilliant in terms of helping to formulate that, because we rotated, went through the rotation very easily. In fact, before we did the second course at Rice in 2003, we were pushed to start the course during the summer because Baylor said, "Well, we have our medical students who really can't do this course because it's a three-hour course in the evening on Tuesdays, and physicians and others. We could carve out a piece of time, if you have it in the summer, that we could make our schedules around." And we did, but we got very few physicians and medical students. (laughs) But it was something other institutions outside of Houston could be a part of and began to attract Houston universities, including those outside of the U.S. So we now have close to forty. We have forty institutions-
Tacey Ann Rosolowski, PhD:
Wow.
Lovell A. Jones, PhD:
-including the former Republic of Nigeria and three institutions in Mexico. So the course now we didn't have in the fall of this past year. With my retirement, both Anderson and U of H pulled out, not formally, because neither of them wrote a letter. (laughs) But the leadership here said, "Well, we've never seen a letter of commitment." I said, "Well, I'll dig one up for you. And it wasn't you. It was Dr. Mendelsohn who actually signed the letter, and if you would like to see the letter, I'll show you the letter." So I wrote to Dr. Mendelsohn and I said, "Listen, I have all these letters, and before I give them, I just want to let you know that this is being challenged, so that if someone comes to you, here are the letters." Then U of H just elected to terminate even my adjunct faculty position with them, and they said, "Well, we don't have anyone to teach the course." (laughs) I said, "Okay." And then I found out they hired a young woman to teach a course, a similar course out of a book, and I found that out the latter part of the summer, because the other consortium members that the course rotates through said-especially the guys at Rice. In fact, one of the leaders in the President's Office called me up and he said, "Dr. Jones, if we wanted our Rice students to go to another university to take a course that would be taught from a book, I could do that here." (laughs)
Tacey Ann Rosolowski, PhD:
Yeah, makes no sense.
Lovell A. Jones, PhD:
Said, "So we're not sending our students. But we need to fill that gap. Can you help us?" And I said, "Interesting enough, Texas A&M-Corpus Christie has asked me the same question, because we teleconference the course now to them, and they have these eighteen students that are signed up for it." So I'm going to have one of my fellows, former fellows lead-I have this archive of I don't know how many hundreds of presentation, most of them are Evergreen, and what I'm having my former fellow to do is go through the archive and see which is the most relevant and formulate a course based on the previous years. And I said, "The fallback is last summer's workshop was taped and is online, and we can mix and match that." So that's what was done. That was done for Rice, Dallas Science Center, and Texas A&M. Texas Southern elected not to do it because they had looked at the course that U of H and dropped it from its schedule because they said they weren't going to send their students over here.
Tacey Ann Rosolowski, PhD:
What do you think the impact of the course has been, you know, when it was running?
Lovell A. Jones, PhD:
Well, we've had close to four thousand students and individuals who've taken it. Dallas Science Center has started, as part of its MPH program, you can get a-well, it's [unclear]. That's an area of interest. You can get a certificate in Health Disparities. Anderson, I think, I don't know if they've launched it, but started a BS degree in Healthcare Disparities. U of H-Downtown-and they joined the rotation several years later-so it was four institutions in the rotation-started the program themselves. And then there was one other-oh, U of H. There is an area of interest that social workers can get certified in, in terms of Health Disparities. And so we're going to have the workshop this summer, because I got called up by U of H, interesting enough, because what they found out in the College of Social Work, Graduate College of Social Work, is that their students couldn't take the course that U of H was hosting because it wasn't graduate level. So they were like-
Tacey Ann Rosolowski, PhD:
Right. That's how institutions do business, and you have to kind of work with them. Crazy.
Lovell A. Jones, PhD:
So they approached me this spring and said, "Are you [unclear]? Because we have this group of students that this is a mandatory course for their program, and there's nothing for them." And I said, "We're holding a workshop, and if your students want to come and register for it, it's open to them." So this is also an anchor course for the Health Science Center's program, and so what we're doing now is looking at holding it, because Rice was the next institution in rotation, is hosting it at Rice this coming fall, and so get it back into the rotation.
Tacey Ann Rosolowski, PhD:
Now, what is your hope? You're putting in an elaborate course like this, you know, very strong, formal presentation of health disparities. What is your hope for the impact on these students that are taking and will take the class?
Lovell A. Jones, PhD:
What I've heard-in fact, I've put testimonials that a few students have written back to me about the impact that the course has had on their lives, especially from white students who've taken it, who've said they really did not grasp the complexity of health disparities, of what and how it impacted their lives, as well as their family and other individuals, and that in writing what they've written, they've encouraged their fellow students to take it because they will not look at health in the same way that they had before they actually took the course. So I think my overall goal is beginning to change how people think about approaching health and health disparities, but health in general, that it's more than people not showing up for care. There are other things that come into play, that it's not health alone but other areas. It's economics; it's housing; it's environmental; it's social, in terms of people's attitudes; it's wealth distribution. It's a complex issue. But if you know all these things and the role that they can possibly play, then you have a good idea of what you need to come up with in terms of addressing the issue, and you begin to establish dialogue with your non-health, non-science colleagues to think about how one will go forward and address the issue itself. And it's not-I guess one of the reasons I guess I'm [unclear], it's not a new discovery, because if we-not to say that discoveries aren't needed, but it's not going to be a magic pill or a magic drug or magic combination of drugs. It's going to be an issue of looking at the situation and what's needed to address it. For instance, I may have mentioned when we were doing the clinical trials here and this Physicians Group was very opposed to what we were trying to do because they said, well, the individuals that we were recruiting wouldn't be compliant, and therefore they wouldn't have the numbers that they would need, and they wouldn't be able to publish the paper and a whole lot of other things. And one specific case stood out where this individual was enrolled and they were having tremendous difficulty with him, and they said he wasn't complying and so forth. As it turns out-and he was a diabetic, and that was one of the issues, and as it turns out, the main problem he had was he didn't have a refrigerator. We changed out the refrigerator, he became one of the most compliant individuals they had. But it was health, but it really wasn't health, in that it was a social issue that was easily corrected by getting him a used refrigerator that worked, and then training him to put his insulin that he had at the time that was temperature-dependent. And most people assume now that most of the medications for diabetes is not temperature-dependent, which is true, but they're expensive, and this was a cheap way for him to be in control and get it at a reasonable cost or not cost, but he had to have a refrigerator.
Tacey Ann Rosolowski, PhD:
Right. Right.
Lovell A. Jones, PhD:
So it's those sorts of things that people don't think about in terms of addressing this issue, and then they'll fall into perception, and "He just doesn't care about his health. He doesn't want to be involved," blah, blah, blah. Well, that wasn't the case. And it set up a very confrontational relationship, because he thought he was doing what he needed to do. He was shooting himself every morning, and therefore he thought he was in control. And they were blaming him, "No, you're-." So they perceived that he was being untruthful and that he was a liar and he wasn't trustworthy, and so he said, "Well, if you don't think I'm truthful, why should I do what you say? Because if I tell you, you're not going to believe me anyway."
Tacey Ann Rosolowski, PhD:
So it's really interesting. I mean, the class obviously creates a kind of paradigm shift in each individual to suddenly say, "Wait a minute. This is the checklist of questions we need to look at in order to have a full understanding of health."
Lovell A. Jones, PhD:
Right. And I dare say if you go back and talk to each of those individuals, the vast majority will tell you that their approach to this probably has changed in a significant way.
Tacey Ann Rosolowski, PhD:
Mm-hmm. It would be interesting to see how that has had an impact on their professional lives since. I imagine it's pretty deep.
Lovell A. Jones, PhD:
Right. And that was one of the things that we were hoping to do before I retired, and I still have it in the back of my mind, is to, at least with the individuals who took the course, most of them were students, the vast majority, and so we could go back to their institutions and get their addresses and begin to do a follow-up in terms of more scientific follow-up and see where they are and what they're doing, because it's now twelve years since the first course and the first twenty-four students.
Tacey Ann Rosolowski, PhD:
Yeah, I'm sure there'd be some very revealing results from that.
Lovell A. Jones, PhD:
Right.
Recommended Citation
Jones, Lovell A. PhD and Rosolowski, Tacey A. PhD, "Chapter 18: The Health Disparities Education, Research and Training Consortium and Program" (2014). Interview Chapters. 614.
https://openworks.mdanderson.org/mchv_interviewchapters/614
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