Commentary: Dr. Rashmi Shetgiri and Dr. Roberto Vargas on the 2023 LACHS Survey( continued)
Ferrer, Dr. Shetgiri, and their colleagues have developed very positive relationships with key campus leaders and research scientists over the years.“ We’ ve always had great relationships with the University. Most recently, our work together during the pandemic was very successful. Both institutions are aligned in reducing inequities, and CDU is a leader in training the future public health workforce,” noted Dr. Shetgiri.
II. Analysis by Dr. Vargas
To the question of how pervasive in scope is the 2023 LACHS survey, Dr. Roberto Vargas, Assistant Dean for Health Policy and Inter-Professional Education within the College of Medicine and Director of the Health Services Research and Policy Pillar of the Urban Health Institute, offered his understanding of how this particular survey design took shape.“ The research team was intentional as to whom they sampled, covering a representative group of folks within the County to ensure that they have some balance. To my understanding, they also do that by geography. If you look at the survey website, they typically will put in documentation about their approach and how they chose whom to interview and why,” he noted.
The specific combination of race, ethnicity and poverty are important baseline factors. They are important for a survey done by a public health department because the responsibility for the overall population of a geography like Los Angeles County must consider health disparities faced by racial and ethnic groups who vary in their cultural practices and lifestyles, as well as factoring in the health disparities that exist for non-ethnic minority people who are poor. And so that range of disparity in terms of people who have money and who don’ t, and the range of disparity of people who have a history of being marginalized because of race, ethnicity, or predisposed factors that affect health, are included, so that there is understanding of the full breadth of where public health resources should be spent and used.
“ If you’ re a public health department responsible for the entire population, identifying groups that might have disparate outcomes, and potentially associating those factors that you can get from a survey for predisposing modifiable factors, this was essential. What makes the survey more valuable than just describing the fact that people who are poor or who are Black or Latino face worse health outcomes is that they ask respondents questions that will allow the research team to say,‘ Well, if we look at a respondent’ s survey responses about whether they have access to healthy foods, to be able to stratify that out, to determine that people who are poor also have a lower likelihood of getting vaccines or having healthy access to food, that gives you something that’ s actionable to say we
LACHS- Dr. Barbara Ferrer
need to go to these regions in these neighborhoods where poor people live and bring them resources,’ he noted.
“ Then there are the non-modifiable components, which might not be able to change but still identify people at higher risk. That offers an opportunity to plan an effective outreach strategy. You need to reach out to those individuals that are higher risk to help them access care, or to help them get resources that might provide benefits.”
There is a section that reports a near 40 % obesity rate among African Americans alongside the finding that over one third of the same population reports living in homes that are nutritionally insecure. Is that determination contradictory?“ No, not at all,” said Dr. Vargas.“ When we talk about food insecurity, we don’ t attribute or associate food insecurity with starvation, and I think that a lot of people think, well, if you can’ t afford food, then you should be skinny.
“ The issue about food insecurity is that when you don’ t have enough money to buy healthy food, then you use your scarce resources to buy the most affordable food. And oftentimes, the most affordable food is processed foods, or foods that are of nutritional value that is not consistent with maintaining a healthy weight. High in fat oftentimes, high in calories, but not nutritionally valuable in terms of fresh fruits and vegetables, lean meats and things of that sort.
“ The association of African Americans’ race and obesity is multifactorial. You know, some of this is because of a higher percentage of African Americans being in a situation where they can’ t afford healthier options, and a higher percentage living in communities that don’ t have readily available access to healthy foods, but also live in communities where they may not feel safe or have access to areas where they can exercise. Then there are biomedical differences that might also be driven by social determinants. If you are more likely to be stressed, or more likely to have less sleep, that higher stress level is associated with changes in how your body metabolizes food and fat that also leads to obesity,” he continued.
CDU College of Medicine | PG. 21