How Students Are Contributing to Health Equity Research at Tufts
Emma Fleisher, A20, M24, volunteered with children with special needs from a young age. Her mother was a special education teacher who emphasized the importance of working with children and adults of varying developmental statuses. Then, right before Fleisher left for college, her dad passed away.
“I experienced the impact of illness during a very transitional age between high school and college,” Fleisher says. “That's why I'm interested in intersecting chronic illness and transitional age groups. I think there's a very strong opportunity to focus on health equity with this population.”
From the summer after her first year of medical school through graduation, Fleisher worked with Center for Health Equity Research (CHER), a collaboration between Tufts Medical Center and Tufts University School of Medicine. CHER aims to address research disparities in health care by focusing on women and underrepresented populations. It also seeks to understand the factors that influence diversity in the biomedical workforce.
“This center is about doing actionable research on a huge array of social and economic issues that play out across race, ethnicity, gender, and different populations that have some kind of barrier to access,” says Chloe Bird, director of CHER and the Sara Murray Jordan Professor of Medicine at the School of Medicine.
Bird has been advocating for health equity throughout her career, having made the ethical case for including women in clinical trials for the National Institute of Health (NIH) Revitalization Act of 1993. The bulk of her work today is in continuing the fight to prove that researching women’s health outcomes benefits everyone. Part of that work includes her participation in the National Academy of Science Engineering and Medicine committee conducting a U.S. Congress-mandated evaluation of the NIH's work on women's health and health care.
CHER also encompasses diverse health equity expertise from its affiliated faculty, like physician Sebastian Ramos, an assistant professor at the School of Medicine who studies equity in maternal-fetal health outcomes as the principal investigator of the Mother Infant Research Institute, and Amy LeClair, an assistant professor at the School of Medicine and Graduate School of Biomedical Sciences whose research focuses on health equity for vulnerable populations.
“A ‘colorblind’ approach doesn’t work. People have different experiences in the world based on their social identities,” says LeClair, a medical sociologist. “When people come to us for health care, all of those identities are part of who we need to understand to deliver the best patient-centered care.”
Students like Fleisher are an integral part of the research being conducted at CHER. LeClair trains and mentors Tufts students at the center, some of whom come from the Master of Public Health Program to complete their required Applied Learning Experience, while others might come through the Building Diversity in Biomedical Sciences Program. But there are many paths for students to get involved with the center.
“People have different experiences in the world based on their social identities. When people come to us for health care, all of those identities are part of who we need to understand to deliver the best patient-centered care.”
Amy LeClair, assistant professor at the School of Medicine and Graduate School of Biomedical Sciences
During her time at CHER, Fleisher analyzed annual self-evaluations of faculty within the Internal Medicine Department at Tufts Medical Center and the ways in which they talked about and incorporated DEIJA (diversity, equity, inclusion, justice, access) efforts into their scholarly activities. Fleisher also worked on a simultaneous research project outside of CHER that focused on the experiences of perceived racism by the families of children with autism while interacting with the health care sphere.
Currently in a combined internal medicine and pediatrics residency program at Vanderbilt University, Fleisher got a window into her future as a health care professional while conducting the CHER study. She says the evaluations taught her that to truly prioritize DEIJA efforts as a health care provider or scholar, they need to be incorporated into every facet of one’s work at all times, for all patients.
“Working with CHER has created a career path that I didn't know existed before,” Fleisher says.
Seeing Oneself in the System
Raviv Rose, A23, has always been interested in social justice and health care without quite knowing what their path would look like. After their three-year involvement with the Brazilian Immigrant Health Study, Rose joined CHER through the Tufts Summer Scholars Program in 2021 as a research assistant to launch the SOGI Project.
The U.S. health care system has no agreed-upon standard for collecting information on sexual orientation and gender identity (SOGI) at the federal level. As of 2019, just over half of community health centers had SOGI data for more than 75% of their patients, according to one study.
“If we’re not able to collect data on a person’s identity when we complete their electronic medical records, we are effectively rendering those people invisible,” LeClair says.
Rose and two other Tufts students, Olivia Barker, A24, and Eilish Carpenter, MG23 (MPH), are co-authors on a recently published paper titled “Health Care Workers’ Perspectives on Collecting Sexual Orientation and Gender Identity (SOGI) in the Adult Primary Care Setting.” Its results are based on interviews of clinical and non-clinical staff at Tufts Medical Center regarding their experiences with LGBTQ patients, their perspectives on collecting SOGI data, and potential barriers and facilitators to incorporating it into their workflow.
One conclusion they drew from the study is that there is an opportunity to improve training professionals on SOGI-related topics across the health care system, from administration to billing to IT.
“Most of the people we talked to were extremely willing and interested in inviting this change, but they had a well-reasoned caution against inadvertently doing more harm than good,” Rose says.
Projects like the SOGI study are emblematic of the work CHER does to put communities that were previously left behind by mainstream health advocacy on the radar of the health care system.
Rose says their time at CHER led to their subsequent role with the NIH as an Amgen Scholar at the National Heart, Lung, and Blood Institute studying intersections of racialized stress and cardiovascular disease. They will start medical school at Boston University next year. In the meantime, they are working as a community organizer.
“I saw how underrepresented people like me are on the provider side of the health care system. The SOGI Project with CHER revealed how much work there is still left for us all to do,” Rose says. “The project really reinvigorated my connection to medicine.”