Spenser Hayward admits he had only a surface understanding of the connections between poverty and health before he started medical school in August 2015. Hayward and about 50 of his new classmates arrived on campus a few days before the start of medical school orientation to participate in the first-ever Health Disparities Boot Camp, which was sponsored by the School of Medicine’s Office of Diversity and Multicultural Affairs. The group learned about the profound impact that income can have on a person’s health. “I wanted to become more culturally self-aware, and better able to understand the differences between my experience and that of my future patients,” Hayward says.

The first Health Disparities Boot Camp was so well received that, starting this year, its content has been incorporated into the “Patient, Doctor and Society” course as part of the required first-year curriculum for all incoming medical students.

Nadia Richardson, Ph.D., associate director of the Office of Diversity and Multicultural Affairs, volunteered to take the lead in designing a pre-orientation elective activity on health disparities.“The patient population is becoming increasingly diverse, and as a result, training is necessary in order for all physicians to effectively provide the best possible care for everyone they encounter,” says Nadia Richardson, Ph.D., associate director of the Office of Diversity and Multicultural Affairs. “Also, a growing body of research continues to highlight that providing culturally incompetent health care actually contributes to the persistence of health disparities and, ultimately poor health outcomes for under-represented populations.”

Richardson joined the Office of Diversity in 2014 and volunteered to take the lead in designing a pre-orientation elective activity on health disparities. In its first year, about 25 percent of the incoming class participated in a two-day Boot Camp that covered topics related to implicit bias, health disparities, social determinants of health, and culturally responsive care.

One aspect of the program that stands out for Hayward was when the presenter showed a map of the Birmingham area superimposed with the life expectancies of residents of each area. “I was shocked to see the large variance between those who lived downtown, near UAB, and those who lived in communities like Vestavia Hills and Mountain Brook,” he says.

Students also watched the documentary Unnatural Causes: In Sickness and in Wealth. The film shows how, while higher-income families may take a walk near their homes for exercise, lower-income people may work shift work or long hours, making it difficult to find time to exercise, or they may be unable to find safe areas to exercise in their neighborhoods after dark.

Life Expectancy by Census Tract,
Jefferson County, 2005-2009“That moment stays with me because it was an example of something I had always taken for granted—access to safe outdoor spaces—that many lower income Americans don’t have,” Hayward says. “I think there are many of these subtle differences that affect health, and I’ll have difficulty appreciating them if I don’t become cognizant of them through programs like this.”

Richardson is currently in talks with other schools on campus to potentially offer a joint Health Disparities Boot Camp for a variety of health professions students. So far, the health disparities discussion has made a lasting impression on students. “Health disparities education is essential in medical training because so many health issues have significant social determinants,” says Hillary Duenas, who attended the 2015 Boot Camp. “In training to become physicians, we must not only learn the language of medicine; we must also learn the language of our patients and their communities.”

By Nancy Mann Jackson