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Health, Science, Environment

St. Louis' German immigrant experience is model for tackling today's health disparities

This article first appeared in the St. Louis Beacon, April 18, 2012 - When the Rev. Starsky D. Wilson talked about health disparities at a conference Monday at the History Museum, he chose to focus on the experience of a marginalized community of limited literacy, widespread poverty and little medical attention.

He might have been describing a poor black neighborhood on St. Louis' north side, but, in fact, the minister was referring to St. Louis' German immigrants during the 1880s. His point? That African Americans and other minorities aren't the first to endure health inequities, and that the problem can be reversed with the right mix of community and faith-based action.

Wilson, president and CEO of the Deaconess Foundation, was the main speaker at this year's Our Community, Our Health conference. Sponsored jointly by Washington University and Saint Louis University, the program seeks to build community partnerships that help to make medical care accessible to all.

"We have historical guidance in this matter," said Wilson. "In St. Louis history, we find that there was a group at the margins of our city's social network in the 1880s. Their cultural baggage, limited literacy, lack of access to appropriate care, poverty, socially stigmatized status" amounted to a century-old version of "minority health disparities."

At that time St. Louis was a generally prosperous city, fourth largest in the nation, with its share of poor sanitation, poor social services, blighted housing, and overcrowded conditions that led to disease. "City Hospital was theoretically open to anyone, but German immigrants were said to have felt unwelcome because of their language barrier," Wilson said.

It's no wonder, he adds, that "leaders of this marginalized group gathered in 1889 at St. Peter's Church," then at 14th and Carr streets, to establish what became the Deaconess Society. Its purposes included nursing the sick and caring for the poor and the aged, done by deaconesses or nurses. Wilson called the system a "church-related community-based entity that would restore the mission of caring, healing and teaching."

Just as this culturally sensitive collaboration of institutions and the community helped to uplift the immigrants, Wilson says the same must be done today. "They knew that the only hope for reconciliation was their collective action," he said. "The same is true for us."

He praised St. Louis for having "some of the finest research institutions, leading hospitals, an integrated network of health centers, vibrant community-based organizations and generous nonprofits, and caring, progressive communities of faith."

He urged the region to do much better, saying that simply "reducing health disparities is too low a goal post" for a region with so many resources.

In addition to his appeal, the audience heard research presentations from Melody Goodman, an assistant professor at Washington University School of Medicine; Keon L. Gilbert, an assistant professor at Saint Louis University School of Public Health; Jason Q. Purnell, an assistant professor at the Brown School at Washington University; and Pamela Xaverius, an assistant professor at Saint Louis University School of Public Health.

Purnell pointed to research showing a correlation between education and health, saying, "One reason we believe this is true is that with more education comes more income. With more income comes the ability to purchase things like residences in safe neighborhoods, quality housing and medical care." 

Research shows that between 1981 and 1998, people with some college "any college at all, added 1.4 years to their life expectancy." Between 1990 and 2000, he said people with some college added 1.6 years to their life expectancy, while people with high school diplomas or less added nothing.

He said lack of access to health care accounts for 10 percent of premature mortality in the United States. But behavioral patterns are a much bigger factor in premature mortality.

"A black male in north St. Louis has about a 10-year differential compared to the average life expectancy in the city. It's troubling to us, and we should redouble our efforts" to increase life expectancy.

Purnell said society can do the most good by addressing socioeconomic conditions that can have an adverse impact on health and life expectancy.

Xaverius, an epidemiologist, talked about the value of preconception care, which involves assessing women's health before pregnancy. Her research is being done in collaboration with the Maternal, Child and Family Health Coalition and other community partners.

The work is important, she says, because the right interventions can help reduce the incidence of low birth weight babies and fetal deaths, conditions which tend to be higher among African-American women than among whites. Xaverius stressed that collaborating with community partners is one key to better birth outcomes for the at-risk population.

Since its first conference in 2009, the Our Community, Our Health program has been co-directed by Dr. Consuelo Wilkins, director of the center for Community Health and Partnerships and an associate professor at Washington University School of Medicine; and Darcell P. Scharff, associate dean and an associate professor at St. Louis University School of Public Health.

Wilkins says the annual conference demonstrated the value of collaboration with other researchers and the community. She also says the federal Office of Minority Health was doing a better job in promoting activities occurring during Minority Health Month. More than 100 events are taking place nationwide, including about a half dozen activities in Missouri. 

Scharff added that Monday's event was a bittersweet moment because Wilkins is leaving in June to become executive director of the Meharry-Vanderbilt Alliance in Nashville. Scharff praised Wilkins and said the local conference on disparity would continue after her departure.

When the initial federal program began in 1990, it didn't cover disparity. Now, she says, eliminating disparity "is very much on the agenda for organizations that deal with chronic disease and prevention from disease." 

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