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University of Arizona seeks to decrease disparities in health care

As our state and nation confront a rapidly changing U.S. health care system, the University of Arizona is responding to critical challenges in new and impactful ways, including addressing health disparities, improving the health of populations and achieving favorable health outcomes.

Health disparities — differences in health outcomes across groups of people — adversely affect people who have experienced greater obstacles to health on the basis of factors such as race, ethnicity, gender, age and/or geographic location, such as rural and border areas. Although health disparities tend to focus on those groups historically linked to discrimination or exclusion, the reality is that every person in Arizona, and the nation, is adversely impacted by health disparities.

We all can appreciate the impact at the individual level of being at greater risk of disease and illness — lost wages and employment opportunities, less time spent with family and friends, or diminished overall quality of life. The adverse impact of health disparities extends to a much broader, societal level due to the resulting economic consequences, including the increasing cost of health care and lost business efficiency and productivity. In response, the UofA is committed to reducing health disparities and improving the quality of life for all Arizonans. We are leveraging our clinical, research and scientific expertise to reduce the individual and societal burden of diseases, including cancer, type 2 diabetes, heart failure and asthma.

Population health and health outcomes are relatively new concepts that focus on understanding the health of groups — why some are healthier than others, for instance — and how to improve the health of entire populations by reducing health disparities between groups. The Institute of Medicine notes that population health outcomes are “the product of multiple determinants of health, including medical care, public health, genetics, behaviors, social factors and environmental factors.” In addition, the National Prevention, Health Promotion and Public Health Council has recognized the central role of behavior in health care and prevention. The council’s 2010 Annual Status Report noted that the most effective approach to addressing the leading causes of death is to reduce and prevent underlying risk factors, such as physical inactivity, poor nutrition and tobacco use.

Changes in the health-care delivery system are being driven by three urgent needs:

• To improve the experience of care for patients

• To improve the health of individuals and populations

• To reduce the overall cost of health care

Cost is a major driver of the push for change, as the growth in the nation’s health spending continues to outpace improvements in the economy. National health expenditures will exceed $3 trillion dollars in 2014 and are projected to reach $5 trillion and comprise 19.9 percent of gross domestic product by 2022, according to estimates published in the journal Health Affairs in September 2013.

By leveraging the UofA’s already established strengths in behavior research, disease control and prevention, and community engagement, we are putting into practice new initiatives aimed at reducing health disparities that will positively impact the overall cost of health care for Arizona while improving the productivity and quality of life across the state, from children’s performance in school to the adult workforce’s on-the-job efficiency to the independence of our seniors.

Through the research and training programs of the UofA’s five health sciences colleges (College of Medicine — Tucson, College of Medicine — Phoenix, College of Nursing, College of Pharmacy, Mel and Enid Zuckerman College of Public Health), our NCI-designated University of Arizona Cancer Center and the patient care activities of the University of Arizona Health Network, we are uniquely positioned to improve health outcomes statewide — from mortality rates to health-related quality-of-life indices.

The UofA has expertise in the key determinate factors of health, including individual behavior (through, for example, the UofA Center for Integrative Medicine and the UofA Mel and Enid Zuckerman College of Public Health’s Arizona Prevention Research Center), social environment (UofA Southwest Environmental Health Sciences Center), physical environment (Arizona Poison and Drug Information Center at the UofA College of Pharmacy), and genetics (UofA BIO5 Institute).

Health disparities and population health and health outcomes are two of four theme-based “areas of excellence” — including precision health and neuroscience — recently identified by UofA leadership as priority areas of research and clinical care. Precision health uses genetic profiles to guide decisions regarding prevention, diagnosis and treatment of disease and drug development, for more accurate diagnosis and treatment that is person-centered. Neuroscience focuses on the development, structure and function of the nervous system and the impact on behavior and cognitive functions, as well as on stroke, aging and Alzheimer’s disease.

With these four areas as our focus, the UofA is poised to advance its reputation as a leading academic institution through efforts to reduce health disparities and improve population health locally and globally, through research initiatives, strategic partnerships and community engagement.

— Joe G.N. “Skip” Garcia, M.D., is senior vice president for health sciences at the University of Arizona.

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