When Public Health and Urology Intersect: Finding the Path Forward

(UroToday.com) The first Urology for Social Responsibility conference kicked off with an opening by Alec J. Calac, a MD/PhD student at UC San Diego and member of The Pauma Band of Luiseno Indians. Offering a welcome blessing, the group then acknowledged that the land that UC San Diego occupies is ancestral land of the Kumeyaay Nation. Showing the dearth of American Indian and Alaskan Native representation in medical faculty (<0.5%), medical students (<1%), and medical curriculum (11% of medical schools include Native American health topics), Mr. Calac called on the group to be forces of positive change.

Dr. Cheryl Anderson, PhD, MPH, MS and Dean of the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science then gave the first keynote speech of the conference. She noted that public health is the natural extension of individual clinical care, with public health being organized community efforts to optimize the health status of every individual. Drawing on her experience and research in chronic disease prevention in underserved populations, she highlighted the public health achievements that have consistently increased life expectancy over the 20^th century, including vaccine development, seatbelt use, tobacco restrictions, and increased family planning resources.

However, the 21^st century has seen a drop in life expectancy with mental health, suicide, forced migration, and the recent COVID-19 pandemic all playing significant roles.

Further, Dr. Anderson notes that upstream factors often are the real drivers that affect our patient’s health, with clinical care only addressing 20% of a person’s “health”. She points that racism is a public health crisis. The practice of “Redlining” started in the 1930’s with the New Deal and discriminated against providing home-buying loans to individuals residing in “risky” areas, these individuals were disproportionately minorities. These government level practices 90 years ago set the stage for many of the disparities in health care we see today, with zip code being one of the highest predictors of life expectancy. She powerfully states that “Genes may load the gun, but our environment is what pulls the trigger.”

Building on her research with chronic disease, especially cardiovascular health, Dr. Anderson then discussed the landmark Presidential Advisory from the American Heart Association published in 2020 by Churchwell et al. This advisory details structural racism’s direct link to decreased cardiovascular disease and stoke outcomes in Black Americans. The report details that the “path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups.”

And next, the group is faced with a challenge: “I challenge you to link these same factors to Urologic outcomes.” A pause is held as many in the room contemplate the weight of burden on our patients and communities.

The talk ends with a call to action. Emphasizing that these conversations of public health, structural racism, and the effect on our patients should not be held in isolation. All of us have the potential to effect change and push for justice. “We cannot wait for others, we need to turn inwards.”

1. Achievements in Public Health, 1900-1999: Changes in the Public Health System. JAMA. 2000;283(6):735–738. doi:10.1001/jama.283.6.735
2. Churchwell K et al; on behalf of the American Heart Association. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association. Circulation. 2020;142:e454–e468. doi: 10.1161/CIR.0000000000000936