The Temple Center for Bioethics, Urban Health, and Policy: Working with Communities to Establish Health Equity An Interview with Dr. Norma Alicea-Alvarez

Posted by on January 16, 2015

Interviewed by Liz Shriver

Dr. Norma Alicea-Alvarez is the Director of Community Engagement and an Assistant Professor at the Temple University School of Medicine Center for Bioethics, Urban Health, and Policy (TCBUHP). Dr. Alicea-Alvarez teaches Community Engagement in the Master of Arts in Urban Bioethics Program. Dr. Alicea-Alvarez is also a board certified pediatric nurse practitioner. I spoke with Dr. Alicea-Alvarez about the TCBUHP, the numerous partnerships that the center has formed with local schools and agencies, and the importance of community engagement for medical students.

Q: Tell me about the Temple Center for Bioethics, Urban Health and Policy.

A: The Center for Bioethics, Urban Health, and Policy is a university-recognized center that was established 5 years ago as part of the Temple University School of Medicine by Dr. Kathy Reeves who is director of the Center. The vision of the Center is health equity and we address that vision through three pillars: community engagement, education and research.

Dr. Nora Jones who has developed the masters program, which to our knowledge, is the only graduate level program in the nation with a focus on urban bioethics, heads our education pillar. Through this program, we teach bio-ethical principles and application of those principles as they relate to cultural diversity, health, access to care, and research for those living in urban, dense, diverse communities. We study health disparities and how health behaviors and health care outcomes are affected by the quality of care people receive and by their environment. The vision of the center is to increase health equity in Philadelphia, neighborhood by neighborhood. To that end, we work with communities to address inequalities and support projects to mitigate disparate care.

What we know is that there is a mismatch between what people need and what is available to them in these dense, diverse, urban communities. Philadelphia has an abundance of available academic health centers, and yet we have some of the unhealthiest neighborhoods in the nation. We want to answer the question: What can we as a center do to promote health and prevent disease in local neighborhoods and how can we best meet the most prevalent needs?

Q: How do you determine what those needs are and how to address them?

A: Our work is all related to the social determinates of health. As health providers, we think we have a major influence on our patients’ health behaviors; but our patients spend a very small amount of time with us in an examination room. The impact we can have is about 20%. The rest of the impact on a person’s health behaviors are their social determinates, such as where they live, learn, work, and play. Are they experiencing poverty, food or housing insecurity? Are there language or transportation barriers? We look at these factors on a neighborhood level. Each neighborhood in North Philadelphia may have different needs based on their environment, cultural factors, and available resources. Dr. Mary Segal, who is head of our research pillar, is currently working on a research study addressing food insecurity in minority populations of North Philadelphia.

Q: What are some of your current projects?

In the Master of Arts in Urban Bioethics program, many students are also in our medical school, or are working professionals in other health related fields. It is an interdisciplinary program and students learn from each other and the community in our courses through our work with partner organizations. Our biggest programs right now with schools are with the Norris Square Community Alliance, Norris Square Head Start and Building 21, a new public high school in North Philadelphia. Diana Huang, our intern and a third-year medical student, developed a curriculum for Building 21 for a Health Education Studio. She recruited the help of other medical students and she will be doing 100 hours of STEM education with this school this semester. For a student to be in charge of a program like this is amazing. There is a teacher who partners with her but generally Diana is in front of the classroom. Right now she is teaching them about the organ systems and has created an interactive learning environment. We also provide Building 21 students with hands on experiences. For example, next week the students are coming to our Simulation Lab to listen to different body sounds and get a glimpse of what it is like to be a doctor. They will also learn about all the different careers that are available in health care.

We also work with Hope Partnership for Education, an independent middle school in North Philadelphia on 11th and Huntington, near several very busy intersections and a lot of drug and crime activity. Temple students have been working with the school to enhance safety measures as outlined by the school. For example, they have written letters to the police about getting crossing guards and having an officer available during start of school and at dismissal. Our community engagement students obtained Drug Free Zone signs in order to deter drug activity close to the school. We have also had Temple students support school nurses by creating a database for vaccine records for all of their students, so that they can present this to the school, the department of health and parents. Our students have also advocated for increasing the number of school nurses to one per building.

We have a CeaseFire program, headed by Marla Davis-Bellamy, which treats violence as a disease and we are working with a ‘Healing Hurt’ program that focuses on counseling for students who have experienced trauma. CeaseFire workers have been at Strawberry Mansion, Dobbins and Building 21 to promote non-violent strategies as options to disputes.

In addition to our school partnerships, we work closely with Asociación Puertorriqueños en Marcha for Everyone (APM). We have been working with them for two years with projects on asthma. For example, we are surveying individuals about re-admissions in hospitals for pediatric asthma. We want to know about issues regarding asthma symptoms, adherence to medications, the utilization of available services and what else can be done to address children’s daily barriers to asthma care.  We have conducted a flu vaccine clinic, and, together with Temple Center for Research Institute, implemented a research study called Temple Health Block-by-Block, which helps us gather data on many health issues and where families get their health care. APM Connectors go door to door asking families about their access to care, barriers and their opinions on what Temple can do to promote health care.

We’re currently working on a grant with APM, the Health Department, and other organizations collaborating to create a program that coordinates health services with social services, focusing on the social determinants of health.

Q: How has establishing the Center helped you partner with Philadelphia schools and community organizations in new ways?

A: Founding the CBUHP has helped us to recognize that it was only through community engagement and reaching out to our neighbors that we could increase our impact on health equity. For community members, it is hard to interface with Temple sometimes, so Temple has to go to them. Health care has to be taken to the community and become multi-directional and ongoing.

In the future I want to see us getting involved into even more communities. Specifically, I would like to get more involved in Allegheny West, Nicetown, and Beckett Gardens. The center is growing and therefore our student base is growing. As we continue branching out and partnering with these organizations, our impact will continue to grow and become sustainable within these neighborhoods to see our vision of health equity come to fruition.