In the latest issue of Stanford Medicine magazine, dozens from the Stanford Medicine community, including professors, students, physicians, researchers and community partners, shared their thoughts about how social and cultural factors challenge health, health care and well-being.
And it didn't take long for a consensus to emerge: Achieving better, more equitable health outcomes for the most vulnerable people calls for understanding and addressing the cultural and societal challenges in places we live, work and play.
"Patients have an entire life outside the hospital and our clinics. What's happening there makes so much more of an impact on their care than anything I can do in a medical visit," said pediatrician Baraka Floyd, MD, who is leading an effort to help patients' families who often don't have enough food to feed their families.
"While the underlying reasons for this gap are complex and deeply structural," Stanford School of Medicine Dean Lloyd Minor wrote, "the lived reality is this: The color of your skin, the community you belong to, and the place you call home remain the largest predictors of health and longevity. Far more than your doctor or what's written in your DNA."
The new issue explores the impact on health of such social issues as homelessness, cultural stigmas about disease, and lack of clean water for school children. It also features conversations with experts on diversity and leading health policy change, and research uncovering secrets of longevity in people born and raised in Nicoya, Costa Rica.
Stories explored in the issue's introductory collection of stories include:
Speaking their language
Obstetric anesthesiologist Cesar Padilla launched the first National Latino/a Physician Day to draw attention to the need for hiring and supporting more Latino physicians.
His goal is to break health care barriers for people like a young Latina patient whose risky childbirth could have been deadly had Padilla not been able communicate with her in Spanish to calm her culture-based fears about epidurals.
"I felt elated after her successful delivery. But what if I didn't have that cultural connection?" Padilla said.
Since launching the Pride Study, Juno Obedin-Maliver, MD, Mitchell Lunn, MD, and their collaborators have built a national network of organizations to engage LGBTQ+ people in health research.
The efforts have resulted in the publication of dozens of papers on topics such as eating disorders, body dysmorphia, migraines, mental health, pregnancy and abortion among LGBTQ+ people. "Part of our work is making visible what has often been invisible in the past," Obedin-Maliver said.
After the cure
Oncologist Stephanie Smith, MD, and cancer support services nonprofit Jacob's Heart are identifying and addressing the reasons adolescent and young adult cancer survivors don't always follow aftercare guidelines.
The mostly Latino survivors and families described such challenges as housing instability and financial and language barriers. "We realized their cancer history is, in some ways, the least of their concerns," she said.
Are you going hungry?
Pediatricians are well-versed in tuning in to challenges families are facing that could affect a child's care, even without a systematic way to assess and find resources to help families solve them.
Now, pediatrician Floyd, is leading a project to modify the electronic health record system at Stanford Medicine Children's Health to include family surveys about social challenges they face.
The first two questions are about food access, including asking families about the likelihood they will run out of money to buy food.
With all the success of telehealth in providing virtual care since the COVID-19 pandemic began, technology has left behind people who don't have access to reliable internet service and devices or don't know how to use the technology.
"This is a sobering reality because these are the communities that stand to gain the most," said Tem Woldeyesus, MD, a clinical assistant professor working with Roots Community Health Center nearby in Oakland, California to train and find solutions for connecting these people.
Health data check
The Stanford Center for Population Health Sciences has provided hundreds of users with access to powerful databases for research subjects that range from a clinical study of sociodemographic disparities in the management of pediatric thyroid nodules to measuring and combatting systemic racism at the county level.
"Reducing social and health inequalities guides everything we do," said Lesley Sept, executive director of the center.
Citizen science for health equity
Abby King, PhD, a professor of epidemiology and population health, developed a mobile technology-based method of engaging citizens in research to help a few California jurisdictions make their cities and streets safer, more accessible and more walkable.
Ten years later, the Our Voice technology has helped citizens from Bogotá, Colombia, to Half Moon Bay, California, create solutions for their communities' most pressing problems. "Community members are often the people most equipped to understand and gather data about their local environments," King said.
Agents for change
While working as a care coordinator for pregnant patients in Chicago, Edo Ighodaro witnessed firsthand how socioeconomic factors can discourage patients from seeking care. After entering medical school at the Stanford School of Medicine in 2022, she joined its Leadership in Health Disparities Program that was developed in 1984 to empower medical students to fight against health care inequities and obstacles.
The program, said director Felipe Perez, MD, teaches participants the skills needed to become faculty members or leaders in tackling health inequities. "Seeing the medical students go through the program, you see them come in eager to change our health care system," said Perez. "We get to hear their vision of what a better tomorrow looks like."
Photos by Leslie Williamson; Stanford Medicine magazine cover and other illustrations by Bryce Wymer