Access for all

IU-led efforts are reducing inequities in health services and outcomes across the state

How does your identity impact your health? How about where you live? In 2021, a study from Indiana University found that 17 miles separates the longest-living communities from the shortest-living in the Indianapolis metropolitan region -- a shocking gap in life expectancy of nearly 17 years in the heart of the Hoosier state. A mere mile can take a year off your life.

The reasons are complex, but race and ethnicity play a role. In Indiana, African Americans are nearly twice as likely to die from potentially treatable causes compared to other groups. It's also been found that Hispanics and African Americans are uninsured at higher rates, and that both groups are also more likely to be affected by a wide range of health risks.

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An IU medical student shakes hands with a patient at the IU Outreach Clinic in Indianapolis in 2016. Photo by Eric Rudd, Indiana University

IU-led initiatives across the state are seeking to address such inequities, working to build a stronger Indiana by advancing health access for all Hoosiers. Efforts include targeting disparities in breast cancer and diabetes, reducing exposure to toxic chemicals, and improving access to health care and other social services.

Breast cancer

At the IU School of Medicine, multiple research teams are working to understand the unequal impact of breast cancer.

Although women of color experience slightly lower rates of breast cancer, their risk of dying from the disease is higher. In Indiana, 28 African American women versus 20 white women will die of the disease. African American women are also more likely to develop breast cancer before age 40.

As a physician at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center -- Indiana's leading cancer treatment center and one of only 51 in the country designated as a comprehensive cancer center by the National Cancer Institute -- Dr. Kathy Miller has seen the impact of breast cancer on patients and their families up close and personal. It's an experience that motivated an interest in studying the factors behind racial disparities in medical experiences.

Along with other researchers at the school, she is conducting research on breast cancer in African American women, exploring why this group often develops a more aggressive form of the disease, and how doctors can tailor treatments to increase the number of survivors. Already, IU-led research on the genetic factors at play in breast cancer has revealed differences in African American women that appear to catalyze an aggressive form of breast cancer. Other work has found important differences in patients' reactions to common chemotherapy drugs based upon race, suggesting that recovery rates may improve if race is considered when drugs are prescribed.

Much of this scientific work depends upon the Susan G. Komen Tissue Bank, the world's first collection of healthy breast tissue, which was established over 15 years ago by forward-thinking researchers at the IU School of Medicine.

Type 2 diabetes

Breast cancer isn't the only difficult health issue that IU's doctors and scientists are confronting head on. The Diabetes Impact Project, or DIP-IN, is a wide-ranging effort to address the root causes of Type 2 diabetes, a complex condition that also disproportionately impacts communities of color in Indiana. Diabetes was Indiana's fourth-leading cause of death for African Americans in 2018, versus the seventh leading cause in the state.

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A visitor learns about the Diabetes Impact Project during the project's launch in 2018. Photo courtesy IU Fairbanks School of Public Health

Conducted in collaboration between the IU Fairbanks School of Public Health at IUPUI and community leaders in Indianapolis, DIP-IN targets the city's northeast, near northwest and near west side with activities to improve access to healthy food, reduce stress and create an infrastructure and culture that supports physical activity. Additionally, community health workers from IU's project partner Eskenazi Health are working in neighborhood clinics, helping people with tips for eating healthy, managing diabetes, and connecting with local doctors and other services.

"This focuses on prevention from an equity lens," said Patrice Duckett-Brown, executive director of the Fay Biccard Glick Neighborhood Center at Crooked Creek in Indianapolis. She said the project provides an abundance of leverage to change how we view our own health and address long-term barriers that narrate health disparities within our community."

Equality in care

IU provides multiple programs and opportunities to help faculty and students address the unconscious biases and systemic racism that play a role in health outcomes -- whether in the classroom, in the lab or in patient care. In response, IU provides multiple programs and opportunities to strengthen their ability to address these issues.

For instance, the IU School of Medicine's ICARE program prepares students, faculty and researchers to lead action and conversations on addressing systemic racism and race inequities.

"We cannot begin to erode systemic racism without having difficult conversations seeking to confront and overcome the inherent racial inequities and discrimination in our institutions," said Dawn Neuman, an associate professor of physical medicine and rehabilitation at the IU School of Medicine. "ICARE has significantly contributed to my personal growth; I feel more empowered to have the difficult conversations needed to address racial inequities."

Other cultural competency training programs include the Primary Care Reaffirmation for Indiana Medical Education program, which addresses the impact of systemic racism and care for Indiana's Black communities, as well as other educational programs that address subjects such as unconscious bias, cultural humility, bystander intervention, microaggressions and micro-resistance, cultural humility, safe space and LGBTQ+ care training.

Other related internal initiatives IU has launched include the Presidential Diversity Hiring Initiative and the Racial Justice Research Fund.

Protecting children from lead

Another IU-led effort with roots in Indianapolis' near northeast side is IUPUI's work to protect Hoosier children from exposure to toxic metals such as lead in drinking water, dust and soil.

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Volunteers assemble the water lead test kits at First Baptist Church North Indianapolis. Photo by Liz Kaye, Indiana University

In Indiana, blood lead levels are significantly higher in communities of color. And overall, more than 1 percent of all Hoosier children under age 7 who were tested for lead in 2019 had elevated blood lead levels. Lead exposure can cause lower IQs, higher impulsivity and ADD/ADHD, all of which have lifelong impacts.

To combat these inequities, the Center for Urban Health at IUPUI partnered with several faith-based organizations to distribute thousands of lead test kits across Indiana. The kits provide residents with free, reliable lab results on potential lead exposure in their homes -- information that is often out of reach due to barriers such as cost and lack of education on the risks of lead.

Strengthening Indiana families

Also working to safeguard the health of Hoosier children is the Strengthening Indiana Families program, an IU-led effort to reduce childhood maltreatment through the establishment of family resource centers across the state.

According to project leaders at the IU School of Social Work, Strengthening Indiana Families is a part of a larger effort to shift focus from reaction to prevention on the topic of child maltreatment. Indiana children experience nearly twice the national rate of maltreatment -- more than 14 per 1,000 children in 2020. The program's work concentrates a wide range of resources into a single location where children and caregivers are most likely to gather -- such as churches or the YMCA -- rather than spreading them out across a community, where busy parents are often unable to easily access. By making these resources easier to use, struggling families are more likely to get the help they need before reaching a crisis point, significantly improving their ability to stay connected and safe.

In partnership with multiple state agencies, Strengthening Indiana Families has opened family resource centers in four counties: Delaware, Grant, Madison and Tipton. Among other services, the centers provide parents and families access to free meals, baby products and hygiene products; peer recovery groups and support coaches; parent groups; legal assistance; fun family events; and access to experts who can help them navigate other community resources.

Delivering health care services

IU students, faculty and staff are active in delivering health care services straight to Hoosiers. The IU Outreach Clinic in Indianapolis, for example, provides free medical services such as exams, chronic disease management and physical therapy; dental services, such as cleaning, fillings and extractions; access to social workers; and legal aid. Among the many contributors who provide services to the clinic are students and faculty from the IU School of Medicine, IU School of Dentistry, IU School of Nursing, IU School of Social Work, IU School of Health and Human Sciences, and IU Robert H. McKinney School of Law.

The IU School of Dentistry also delivers low-cost dental care at the James Fritts DDS Clinical Care Center. Located in the heart of the IUPUI campus, the center provides basic dental services, as well as 24/7 support for special dental emergencies. On average, students and faculty at the facility treat more than 19,000 people each year.

Advancing health in rural communities

The opening of the new IU Regional Academic Health Center in Bloomington is pushing the frontier of high-quality medical care and education farther into south-central Indiana, a region in which 70 percent of counties report health care access as a top need, according to an analysis conducted by IU's Center for Rural Engagement and the IU School of Public Health-Bloomington.

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A group of medical students from the IU School of Medicine leave the IU Outreach Clinic in Indianapolis. Photo by Eric Rudd, Indiana University

The Center for Rural Engagement is also a partner on activities from IU's health science schools to expand health care access across rural Indiana, including efforts to reduce teen pregnancy, address substance abuse and provide access to technology that helps the elderly stay in their homes. A partnership with the IU School of Nursing targeting Orange and Martin counties is also providing high-quality nursing care to clinics in the region.

In other parts of the state, the IU School of Medicine's Rural Medical Education Program, centered at the IU School of Medicine-Terre Haute, emphasizes medical specialties that are in short supply in rural Indiana, as well as primary care. The program places medical students under the supervision of doctors who practice in rural settings, as well as places trainee doctors in rural clinics. The program draws upon IU's relationship with a broad network of rural hospitals across the state to provide students the chance to practice in communities similar to the ones in which they aim to serve upon graduation.