Paul D. Juarez, PhD, and Patricia Matthews-Juarez, PhD, moved to Memphis from Nashville in April, and have spent the months since then trying to get to know their new home. And while they are reveling in what’s right about their adopted city, they are even more interested in what’s wrong with it.
The couple came to Memphis to set up a new center at the University of Tennessee Health Science Center to research, measure and document health disparities here. They were recruited by David Stern, MD, executive dean of the College of Medicine, who charged them with much more than just crunching numbers.
“He said, ‘We’ve got to move the needle here,’ ” Dr. Matthews-Juarez said, recalling their early interview with Dr. Stern. “He didn’t say, ‘You have to change things.’ He said, ‘We have to change things,’ and so we felt totally convinced that he was on target.”
Co-directors of the new Research Center on Health Disparities, Equity and the Exposome, they will not only research health disparities, but they will use the data to empower the community to turn those numbers around and improve overall health and wellness in Memphis and statewide.
“It’s not just research for research’s sake,” Dr. Matthews-Juarez said. “We’re going to make an impact on this community by finding this information out and then working through community organizations to do something about it.”
The Message, the Mission and the Methods
The center and its work may require some explanation for non-scientists. The couple are well aware that not everyone knows what health disparities are, and even fewer can define an exposome.
They are only too happy to explain. “Disparities are really differences in terms of health outcomes that are due to social systems and other factors,” said Dr. Juarez. “It’s not just having worse outcomes. It’s sort of the systematic differences in outcomes in terms of race and ethnic groups, and the things that cause the disparities.” Outcomes include morbidity, mortality, life expectancy, conditions and behaviors.
An exposome is a measure of the impact of the environment on an individual’s health throughout life. “It’s a term growing out of the environmental health movement,” he said. The center’s exposome model looks at the natural environment (the air, water and land); the man-made environment (buildings, transportation, community resources); the social environment (poverty, education, racial segregation); the policy environment, (federal, state and local laws). All of these affect health outcomes in some way, he said.
Those categories will be the framework for gathering data on health disparities in six broad areas: cancers; cardio-metabolic diseases, including diabetes, cardiovascular disease and obesity; HIV and sexually transmitted diseases; maternal and child health, including infant mortality, low birth weight and preterm labor; intentional and unintentional injuries; mental health and substance abuse.
The couple did similar research at Meharry Medical College in Nashville, where he was director of the Health Disparities Research Center of Excellence and she was Associate Vice President for Faculty Affairs and development, director of the Research Training Core for the Health Disparities Research Center of Excellence and a tenured professor in the Department of Pediatrics.
They met in the doctoral program at Brandeis University (he received his doctorate seven minutes before she did), married in 1981 and have two grown daughters. They have worked in the same departments at the same institutions most of their married life. “But this is really the first time we’ve worked together,” Dr. Juarez said.
“Where I am a much more assertive person, he’s direct like me, but he is a much more diplomatic person than I am,” Dr. Matthews-Juarez said. “We do well together as a team.”
They were active in the Nashville community, working on issues of intimate violence and HIV prevention, and setting up two charter schools there. They had no plans to leave, when they were approached with the opportunity to come to Memphis. “Dr. Stern was so convincing,” she said.
“We had passed through Memphis once, but really never spent any time here,” Dr. Juarez said. Now, they live downtown. “We got here, and we love it.”
But they know there is much work to be done here. “When we came to Memphis, we were really fascinated by the gap in health for poor African Americans, as compared to other African Americans living here,” Dr. Matthews-Juarez said. “And when you looked at it within the whole context of Memphis city, you began to see, wow, why these broad gaps?”
And so, they are reaching out to community organizations and neighborhood associations, gathering information about the health of the city, recruiting staff and building contacts that will help them tackle the chronic health problems, including infant mortality, diabetes, hypertension, kidney disease, breast cancer and violence. Their ultimate goal is to arm citizens with data, so they can ask the right questions and move toward solutions.
“Our approach is really a neighborhood approach,” Dr. Juarez said. “All health is local, and it really has to be focused on neighborhoods and getting people to work together to identify problems and identify the solutions.”
Moving Forward
They are looking at why mortality rates for African-American women diagnosed with breast cancer are twice as high as those for white women. “What we’re trying to do here is look at what are some of the intervening factors,” Dr. Matthews-Juarez said. They are working with existing groups to gather data on why poor African-American women don’t get screened, diagnosed and treated earlier, what are the cultural fears and myths that prevent them from accessing treatment and how best to work together to improve the situation.
They are collaborating with the CANDLE study, which since 2006, has followed pregnant women to identify what factors during the pregnancy and the baby’s early years affect development and ability to learn. They are putting together a grant proposal to use the exposome framework and CANDLE data to study the effect of the environment on the growth and development at a molecular level of children in utero up to age four.
“We got a list of all the neighborhood associations in the city and we’ll start going out and meeting and working with them, trying to help them identify what are the major health problems they see in their community,” Dr. Juarez said.
“The dynamic duo of Pat and Paul will have a tremendous positive impact on addressing and ameliorating health care disparities in Memphis,” Dr. Stern said. “Their appetite and energy for community engagement will highlight health disparities as a major emphasis of the College of Medicine. I look forward to their contributions as researchers and implementers of better access to health and wellness services for all in our region.”
The two are confident the baby steps they are taking now will pay off in the future. “Getting everybody at the table, maybe it won’t happen this year, maybe it will happen next year,” Dr. Matthews-Juarez said. “We expect that we’ll have a whole lot of people coming together.”
Information About The Research Center on Health Disparities, Equity and the Exposome:
• Health disparities are typically described in terms of differences in the incidence and prevalence of morbidity, mortality and other health outcomes and conditions that exist in specific population groups when compared to an index group. They are experienced individually, but reported collectively in terms of excess morbidity, disability, years of life lost, decreased quality of life, loss of economic opportunities and perceptions of injustice and inequality.
• The “exposome” measures lifetime exposures from conception to death. The Center is building a 30-year longitudinal database of 17,000 socio-behavioral, built, natural and policy variables that will show “hot spots” of unequal burden of diseases by groups and diseases. This visualization through GIS (or geographic information systems) mapping is one tool being used to ask scientific questions about health disparities.
• Six priority areas have been identified as health disparities areas in Memphis/Shelby County:
- Cardio-metabolic disease: heart, diabetes, obesity, hypertension, stroke
- Cancers: breast, cervical, colorectal, lung, prostate
- Child and maternal health: infant mortality, low birth weight, asthma
- HIV/AIDS/STIs: Syphilis, Gonorrhea, Chlamydia
- Intentional and unintentional injuries: child abuse, youth violence, domestic violence, motor vehicle accidents, falls, drug overdoses
- Substance Abuse/Mental Health: anxiety, depression, suicide, alcohol and drug abuse
Source: Information Supplied by Dr. Patricia Matthews-Juarez