Doctoral Student Investigates Health Equity “Siloes” in State Health Departments

A survey of state chronic disease practitioners found that while many were committed to health equity in theory, few believed it was part of their job, according to a recently published paper by Karishma Furtado, a doctoral student in public health at the Brown School.

Furtado, who also received her MPH from the Brown School in 2015, was the lead author of the paper, “Health Departments with a Commitment to Health Equity: A More Skilled Workforce and Higher Quality Collaborations,” which was published in the January issue of Health Affairs, one of the top policy journals in the U.S. The senior author was Ross Brownson, Bernard Becker Professor and Director of the Prevention Research Center (PRC).

Furtado’s work with Brownson, who suggested the topic, and other authors was an enriching experience born of faculty/student collaboration that is at the core of the Brown School experience.

“My faculty and practice advisors are exceptionally good at linking PhD students to opportunities that fit their interests,” Furtado said. “I was given substantial responsibility and leadership on proposing and drafting manuscripts and contributing to grant applications from the first months of my PhD program.”

Other authors were Amy Eyler and Cheryl Valko of the PRC; and Carol Brownson, Zarina Fershteyn and Marti Macchi, of the National Association of Chronic Disease Directors.

The research team surveyed 537 state practitioners about their views on health equity, the principle that all people should achieve their full health potential regardless of social position or circumstance. Just 11 percent agreed that health equity fell within their purview and 2 percent identified it as their primary focus.

Furtado said one reason for the low numbers may be that equity is “siloed” in state health departments, which may designate a particular office to handle equity. The study recommends departments find ways to collaborate among offices or merge objectives to build in equity as a department-wide priority.

“Chronic disease prevention practitioners have critical roles to play in advancing health equity,” she wrote. “Instituting policies that make health equity the work of all public health practitioners and equipping those practitioners with the knowledge, skills and resources needed will expedite progress.”

The authors analyzed the data and submitted a manuscript, all in about six weeks, a process Furtado said was “intense.”

“A big part of what made it manageable was that Ross was always there to help keep things on track,” she said. “I brought my research question and analytical ideas to him, we talked it through and he gave feedback. We then came up with a plan, and he gave me the autonomy to make it happen. It was a really challenging and wonderful experience.”

Furtado’s doctoral research interests, as well as her work outside of the Brown School with an organization called Forward Through Ferguson, focus on health and racial equity. For her dissertation, she is studying the mental health effects of, and interventions on, the discipline gap. This gap refers to the far disproportionate rate at which black and Hispanic students are disciplined in school compared to their white classmates.