Shelley White-Means always thought she’d be a CPA. That is, until a friend in college challenged her to dream.
“He said, ‘Shelley, do you really want to crunch numbers all day long? What do you really want to do?’ ” she recalled. That got her thinking about her hometown of Memphis and its many problems with health and health care. “I said, ‘I’d like to one day do something to help that.’ ’’
For decades, she has worked to accomplish that dream. A health economist with a PhD from Northwestern University, Dr. White-Means has championed research into issues related to health disparities and health equity long before they came to the forefront of academic and clinical health care.
Disparities Facing African American Women with Breast Cancer
Dr. White-Means, a professor of health economics in the Department of Interpersonal Education in the College of Graduate Health Sciences at the University of Tennessee Health Science Center and a faculty member of the Institute for Health Outcomes and Policy, is the principal investigator on a paper published this month by the International Journal of Environmental Research and Public Health. Using focus groups, her research examined the impact that community based breast cancer support organizations have in helping underserved and African American women at risk for or diagnosed with breast cancer in Memphis.
“There are community based support agencies that are vital for the survival of African American women in Memphis with breast cancer,” Dr. White-Means said. These groups, which help women overcome economic, social, and psychological barriers to diagnosis and treatment, include breast and cervical cancer programs funded by the Centers for Disease Control and Prevention, as well as navigator programs, and support groups that provide education, social, and psychological support to African American women. “The work that needs to be done is to have a greater interaction between providers and the health care system and the community based support groups.”
Her research found community based support groups are especially visible at health fairs and during October, Breast Cancer Awareness Month. But less so at other times. “What’s lacking are the primary care providers and possibly oncologists interacting with these support groups to provide information in the primary care offices, so there is a connection between these support agencies on behalf of their patients when women visit a medical office,” she said.
Finding her Mission
Born in what was The MED, now Regional One Health, and a 1973 graduate of Memphis’ Hamilton High School, Dr. White-Means has served on the faculty at Cornell University and the University of Memphis.
Her first job after graduate school kindled her interest in health disparities research. She worked with a sociologist to examine the health care utilization and workforce productivity of migrant farmworkers. This sowed the seeds for recent research into the relationship between occupation and health status.
Dr. White-Means joined the faculty of UTHSC in 2004, bringing her dedication to address health disparities in her city. When she received federal funding to do research on the subject, she included her graduate students. Together, they began mapping disparate health outcomes in Memphis. “That is when we started seeing the nature of the disparities,” she said. “Certain communities in Memphis were always on the map in the lowest ranking of everything.” These communities corresponded to the zip codes of the poorest residents in the city.
From 2009 to 2012, Dr. White-Means, her students, colleagues at UTHSC and LeMoyne-Owen College, and various community organizations with the help of funding from the National Institute on Minority Health and Health Disparities, developed and ran the Consortium for Health Education, Economic Empowerment and Research (CHEER). The organization was designed to enhance outcomes and increase the health status of the population in Memphis’ poorest inner-city neighborhood by addressing food insecurity and food deserts, performing health risk assessments, investigating breast cancer disparities, conducting community health summits, and other programs.
“Our emphasis was community-based participatory research collaborations that engaged many agencies that today would be described as ‘social determinants of health’ organizations,” she said. “This focus is very popular now, but at that point, it wasn’t.”
In 2013, CHEER facilitated a dialogue between the medical community and African American breast cancer survivors as a first step to try to understand the reasons breast cancer is more deadly in the African American community. In 2017, she received funding from the Tennessee Department of Health to document the many factors that contribute to Memphis having one of the largest disparities in breast cancer mortality in the country between white women and African American women.
Dr. White-Means is happy with the global focus on health disparities and health equity now, as she continues her work to identify solutions for achieving health equity. These solutions address necessary changes within health care systems, as well as changes in social determinants of poor health outcomes based on where individuals live, work, and play.
In October, Dr. White-Means presented a paper at the Hooks Institute for Social Change at the University of Memphis on the impact of job types on individual health. Titled, “Workplace Setting and Job Types as Determinants of Health Disparities,” the paper harked back to her original work with the migrant farmers.
She said she produced the paper to make people aware that the jobs they have chosen will impact health outcomes. Gig-market or contract jobs that don’t carry health care coverage tend to be filled by minorities. “We need to look at what is going on in the labor force,” she said. “It’s not just about wages. Employees need to be aware that job choices and the growing racial divide in the quality of jobs impact health over the lifetime.”
At this point, Dr. White-Means said she feels she has made a contribution, but there is more to do. She is especially pleased that the university has adopted the social determinants of health as the focus of its Quality Enhancement Plan, a multiyear transformative learning initiative. Understanding the role of social determinants is a critical area of emphasis in Memphis, a city that reports racial and ethnic disparities in most health outcomes, she said.
“We want to make sure every student who enters the doors at this university has a knowledge of, application in, and training in the social determinants of health,” she said. “It’s not a taboo to talk about these kinds of issues. Cultural competency is important. Students need to understand that socioeconomics, education, and other factors not only affect health status, but also impact patient compliance and how health providers communicate and interact with patients in order to understand their needs.”