Cheryl Clark MD, ScD, is a hospitalist and researcher in the Brigham’s Division of General Medicine and Primary Care, and director of Health Equity Research & Intervention in the Center for Community Health and Health Equity (CCHHE). Clark has devoted her research to understanding the ways social determinants of health influence equity and the risks and resiliency factors underlying cardiometabolic diseases and cancer.
In a Q&A with CRN, Clark shares her background, vision and the questions that drive her.
Q: How do you balance your clinical and research roles?
I’m a very active clinician, both a busy hospitalist as well as an academic researcher. What’s important about hospital medicine at the Brigham is that it allows us to be professionally active in multiple roles that contribute to promoting health and improving the lives of patients. Many of our hospitalists are active in global health or quality improvement, or other efforts to improve health equity and address health inequities for patients who we serve within the hospital, within surrounding communities or across the globe.
I see my clinical and research roles as very complementary. As a hospitalist, I see patients with conditions that are medically and socially complicated, so I have an opportunity to think deeply about what could happen differently to promote health equity. And then I have the space to think about collaboration, research and implementation to make those changes possible. It drives me to think more creatively about ways we can innovate to promote health equity.
Q: What are some examples of projects underway at the Brigham to help address health equity?
The Brigham is a host institution for the All of Us Research Program, a national endeavor to create a robust and diverse biorepository of information on social factors, behaviors, biology, and clinical data on more than 1 million people. The National Institutes of Health, which funds All of Us, is forward in its thinking about other factors that contribute to health and wellbeing and how they combine and play out for people from all walks of life. All of Us is a resource that will make it possible to do work that advances science for a diverse population, and it also makes us look at our methods for populations in research to be more inclusive. That’s what drew me to the program.
Another of the powerful movements in health care recently is the rise of accountable care organizations, as a structure to incentivize high quality care that is cost-effective. I think there is a benefit to these kinds of programs and an opportunity to address social determinants of health as a part of putting together these novel payment and care delivery systems. It has been very gratifying for me to participate in conversations at the Brigham about how to create systems that address social determinants of health, including community partnerships. It’s been helpful to draw on my background in social epidemiology to think about how to design systems of care to do that.
Q: You’ve described your research as focusing on social determinants of health as explanatory factors for racial and ethnic disparities. Can you elaborate on this, especially in the context of cardiometabolic diseases and cancer?
The influences of behaviors and social determinants can be quite similar across disease models. Stressors like financial pressures can have effects on our bodies. One of our studies examined the ways that fat accumulates in the body over time, related to whether a person lives in a socioeconomically advantaged or disadvantaged neighborhood. And that fat accumulation can predispose someone to risk of heart attack and other adverse health outcomes.
We’re getting increasingly sophisticated in our understanding of the biology of inequity and how to address those inequities head on. One important issue in the way we talk about social determinants is that the conversation is often focused on needs, such as housing and security. What we’re learning is that we have to be a lot more structural in our thinking: how do we value the capacity and assets of individuals and work in collaboration with communities to confront historical and political factors that underlie inequities?
Q: What about racial disparities in preventive care? What are some of the most pressing challenges or glaring examples of disparities in prevention?
Traditionally, we’ve thought a lot about prevention from the perspective of promoting lifestyle changes and behavioral changes such as exercising or eating a healthier diet. But increasingly we’re starting to consider the context around that: having a neighborhood that’s safe to exercise in and reducing stress so that when a person does eat healthy foods, it’s metabolically easier for them to maintain a healthy physiology. There are many things that we can do to implement, study and promote a healthy lifestyle, but a big piece of addressing social and structural determinants of health is understanding and addressing it within context and making it easier to be healthy. It’s a key part of prevention.
Q: Are there any thoughts that you’d like to share about this year’s Discover Brigham keynote by Kyu Rhee, MD, MPP on the concept of health “techquity”?
For me, the most important principle in health equity promotion is that this work doesn’t happen in a silo or within one group. It’s great to see the idea of health equity being prioritized in the world of technology and innovation. Hearing a leader from IBM talk about the importance of health equity in the work he does — it’s deeply important. And it’s been gratifying to work with Brigham Research Institute to highlight the importance of technology and innovation in promoting health equity.