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For Consuelo Wilkins, good health should belong to all

This article first appeared in the St. Louis Beacon, Nov. 17, 2011 - The Washington University Institute for Public Health recently launched its Center for Community Health and Partnerships. Dr. Consuelo H. Wilkins, associate professor at the university's School of Medicine, heads the initiative.

Wilkins has been working for years to give minority patients a voice in the health-care research in which they participate. In 2009, she was a key organizer of "Our Community, Our Health," a conference co-hosted by Darcell P. Scharff, associate dean at the Saint Louis University School of Public Health. The conference aimed to help researchers realize the importance of minorities to medical research -- and to recognize that academic priorities were not necessarily their top medical concerns. Since then, Wilkins has been prodding researchers and residents to find common ground and work together to address health disparities.

Wilkins' duties at the School of Medicine include directing a program she created called CARE, Collaborative Assessments to Revitalize the Elderly. The program takes services and education on disease prevention into the community for seniors in St. Louis. Wilkins believes that CARE is the nation's largest group of minority seniors who meet and exercise together regularly.

Wilkins recently spoke to the Beacon about the Center for Community Health and Partnerships.

The interview has been edited for length and clarity.

How would you sum up the center's mission?

Wilkins: This new center is really an investment in university and community partnerships that will remain long past specific research projects. The center wants to be responsive to the community. We don't want to approach health disparities or health initiatives with the feeling that we know everything or that we have all the answers. We want to use our research expertise, and the community's as well, to solve some health disparities.

Why is there a need for a center like this since there is already so much focus on health disparities?

Wilkins: There is still a disconnect between the academic medical center and the community as it relates to health. I'm delighted that Washington University is committed and putting resources into a program that will have a formal way to interact with the community. We are going to work together to come up with some initiatives. We've learned if the community is not really involved in the decision-making, then the initiatives won't be successful. How many programs have you heard about that sound great but never really go anywhere? Or don't get the (expected) outcomes because the community hasn't embraced them or been part of putting them together or at the table when the initiatives were designed? Giving people a voice in the decisions is going to be a priority for us.

How does the center intend to engage people?

Wilkins: One of the first things we are going to do is establish a community health speakers' bureau. We are trying to develop a group of speakers who are knowledgeable about health and know how to communicate with people. One goal is to think about things from a public health perspective. What do we know that already works that we are not doing enough of? If I tell people that they need to exercise, they already know that. But there is still a barrier, something to keep people from exercising. What are we doing that's different, that's going to help them to thrive wherever they are?

Are centers like yours unique?

Wilkins: If you look at schools and institutions that have more of a natural connection with the community, they have either a department of family medicine or a school of public health. We are not training as many people who are interested in primary care or community health, so we don't have that natural workforce and trainees who would interact with communities. We're seeing more institutions like ours that are more research-focused and are branching out to find better ways to connect with their communities.

Is there any community concern about this initiative?

Wilkins: The criticism about the work we've done in the community is that it has been research-driven. When the project is over and the research funds are gone, people pack up their bags, leave the programs and their community partners. They write more grants. If they get more money, they go back out. But this (center) is an institutional commitment that the work that we're doing will stay. That doesn't mean there won't be projects with funding that runs out. But we are committed to staying and staying involved and being a part of the community as opposed to letting the research and research dollars drive all of our efforts. That's a new and a strong commitment that we haven't had before.

How will the center increase dialogue between the university and the community?

Wilkins: The training and education are going to be for community organizations as well as the faculty. There are principles of community engagement or guidelines we should always follow. One is building sincere partnerships and making sure there is equity at the table. For instance we offer grant writing and program evaluations. On the academic side, we will help (researchers) understand what really is happening in the community and the complexities in providing services in neighborhoods without a lot of resources. One of the challenges is recognizing that we all have expertise and assets, but there are also barriers for getting these initiatives going. We want to make sure people are all engaged and on the same page.

How have researchers developed partnerships in the past?

Wilkins: Within the university, especially in the medical school (where) we have a really decentralized organizational structure, so many groups want to engage with the community, or are engaged with the community, that we have no idea who is doing what. The reason that we are so successful as a research institution is that I can have my own great idea and write the grant, get the funding and do it without having to talk to a lot of other people. But other people could be writing similar grants and asking community organizations for similar things. It's really a challenge because we don't know who is doing what. We have to do a better job because we don't want to burden our community partners. In addition, we have a number of community advisory boards. We could consolidate some of those, get better responses and be more effective in how we utilize them.

What universities offer good models for some of what the center wants to do?

Wilkins: Harvard is at the top of the list because it has a very active school of public health. It has also spent a number of years working to recruit researchers and faculty from either under-represented minority groups or people interested in health disparities. Harvard also has a big cultural competence training program and what's called a disparity solution center. It focuses on improving health communication, involving simple things about way you talk to patients and engage them about their own health.

Because you wear so many hats within the medical school, I would think that adding another responsibility would be pretty taxing.

Wilkins: This is something I feel very passionate about. I do hope that by being able to consolidate some of the efforts into the center, maybe I'll be working a little bit less (laughter). When I started my research (career), my goal was not just to develop programs that would give me publications and funding, but that would really change the way people think about their health and empower them to be more active in their health. I still think that is extremely important, but there are a lot of barriers in doing that.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.