Drs. Islam, Kim, Lewis, and Taylor, authors of the Annals of Epidemiology 2023 Best Junior Investigator Paper Award winner: “Neighborhood characteristics and ideal cardiovascular health among Black adults: results from the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity” explore the compelling association between desirable neighborhood characteristics and cardiovascular resilience among Black Americans. Their paper can be found in the January 2022 issue (Vol. 65) of Annals of Epidemiology.
Read the full article here:
https://www.sciencedirect.com/science/article/pii/S1047279720304270
Episode Credits:
- Executive Producer: Sabrina Debas
- Technical Producer: Paula Burrows
- Annals of Epidemiology is published by Elsevier.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Patrick Sullivan (00:12):
Hello, you're listening to EPITalk
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,Editor-in-Chief of the journal,
and in this series we take youbehind the scenes of some of the
latest epidemiologic researchfeatured in our journal.
Today we're talking with Annalsof Epidemiology's 2023 Junior
(00:36):
Paper of the Year Award winner,Dr Saba Islam, co-first author,
Dr Jeong Hwan Kim and theirco-authors, Drs.
Tene Lewis and Herman Taylor,about their article
"Neighborhood Characteristicsand Ideal cardiovascular health
among Black adults (00:50):
results from the Morehouse- Emory
Cardiovascular (MECA) Center forHealth Equity".
You can find the full journalarticle online in the January
2022 issue of the journal at www.
annalsofepidemiology.
org.
I'll do a brief introduction ofour guests.
Dr.
Saba Islam is a clinical fellowin the Advanced Heart Failure
and Transplant CardiologyProgram at Brigham and Women's
(01:13):
Hospital, Harvard Medical School.
Her research interests are inunderstanding the social
determinants of health incardiovascular health and
disease.
In particular, she's interestedin geriatric cardiology and
implementing novel strategies toimprove care and delivery for
this vulnerable population.
Dr.
Jeong Hwan Kim is an advancedheart failure and transplant
cardiologist at Brigham andWomen's Hospital and the Boston
(01:34):
VA.
He has clinical interest intaking care of patients with
advanced heart failure requiringadvanced heart failure
therapies such as cardiactransplant or ventricular assist
devices.
His research interests lie inthe understanding of the
cultural determinants ofcardiovascular disease outcomes
in the US, such as geographicdisparities and social
determinants of health.
Dr.
Tene Lewis is a, professor ofepidemiology in the Rollins
(01:57):
School of Public Health at EmoryUniversity.
Her primary area of research isin psychosocial epidemiology,
with an emphasis on racialdisparities in cardiovascular
disease.
She has a particular interestin understanding how
psychological and social factorscontribute to the
disproportionately high rates ofcardiovascular disease
morbidity and mortality inAfrican-American women compared
(02:17):
to women from other racialethnic groups.
And Dr.
Herman A.
Taylor is an endowed professorand director of Morehouse School
of Medicine's CardiovascularResearch Institute.
Dr.
Taylor is known for his work incardiovascular disease
disparities and in establishingthe groundbreaking Jackson Heart
Study in African Americans.
This is a study that's madecontributions of international
(02:37):
significance.
Currently he's leading researchat the intersection of clinical
medicine, artificialintelligence, multi-omics and
social determinants of health.
Doctors, thank you for joiningus today.
So we're going to dive intotalking about your paper a
little bit and I'd like to juststart, maybe, with Dr.
Islam and ask you to talk alittle bit about the purpose of
(02:59):
the study.
What was the research questionthat you set out to answer?
Saba Islam (03:02):
Yeah, thank you for the introduction.
So the purpose of our study wasto understand which positive
neighborhood features wasassociated with improved
cardiovascular health in acohort of Black Americans living
in the Atlanta, Georgia area.
We were trying to elucidatewhich factors may promote
cardiovascular health in thecommunity, or cardiovascular
(03:25):
resilience, and our hope wasthat, you know, the findings
that we see in this study caninform public health
interventions in the future.
Patrick Sullivan (03:32):
Great.
So this is for Dr.
Islam or Dr.
Kim, either one.
What are the epi methods thatyou used to try to identify
these factors that might beassociated with the cardiac
disease outcomes?
Saba Islam (03:44):
So we used a cross-sectional study design to
explore the positiveneighborhood factors that is
associated with cardiovascularhealth in the Black adult cohort
living in Atlanta, Georgia.
So our hope was that, you know,showing this association and a
cross-sectional study wouldagain, you know, in the future
allow us to perform longitudinalstudies to further elucidate
(04:06):
these associations and hopefullyagain inform public health
interventions.
Patrick Sullivan (04:11):
Just to go a little bit deeper into that how
are the data that you used,collected, and were they at the
individual level or theneighborhood level or sort of?
How is that data structured?
Saba Islam (04:21):
I can let Dr.
Kim take that, because he wasintimately involved in that
process.
Jeong Hwan Kim (04:27):
Sure.
Thank you for the opportunityto explain a little bit more
about our paper, which is veryexciting.
This was actually part of thelarger project called MECA
that's conducted between EmoryUniversity and Morehouse School
of Medicine under the funding byAHA.
So we had a very ambitious planto look at multi-layers of the
social determinants of healthfor the Black Americans living
in Atlanta, Georgia.
So we started with a separatepaper that was published a
(04:49):
little bit before this paper,looking at the census tract
level determinants ofcardiovascular health for Black
Americans, looking at theneighborhood characteristics
based on the census tract level.
The current paper that we'retalking about is at the
individual level.
We recruited, not targeted to acertain census tract to
represent the whole region.
We purely recruited peoplebased on the clinical criteria,
(05:11):
based on the age of 30 to 70,and without known cardiovascular
disease, and we wanted to seeand there's perception of
neighborhoods at the individuallevel and how that correlates
with their left, basicallycardiovascular health scores,
called left self-assessmentscore by AHA.
So it is an individual-levelpaper but, however, it's in the
context of our attempt tounderstand in multi-layer,
(05:31):
multi-level analyses of what isit that's actually driving the
better cardiovascular healthamong Black Americans in Atlanta
, Georgia.
Patrick Sullivan (05:38):
Great.
Thank you.
And so what were some of thosemain findings or key conclusions
you had from this level at thatsort of first individual data
levels phase?
Saba Islam (05:48):
Yeah, I can speak a little bit to that.
So the main takeaway from thiswas that social cohesion, which
includes activity with neighbors, was associated with higher
odds of ideal cardiovascularhealth, which was defined as the
American Heart Association'sLife's Simple 7.
For certain outcomes, it wasnoted that there was a two times
higher odds of improvedcardiovascular health with one
(06:11):
standard deviation increase inthis neighborhood perception
score.
Patrick Sullivan (06:15):
And what were some of those factors that had
that positive relationship?
Saba Islam (06:20):
It was the social cohesion and the activity with
neighbors.
So the neighborhood socialenvironment we noted was
extremely important forcardiovascular health in our
cohort.
Patrick Sullivan (06:29):
So why, then, is it important to focus on?
I mean, these are sort ofpositive aspects, and a lot of
the work that we all normally dofocuses in a, maybe because
we're thinking of causality, butwe get more into things that
have a negative impact on therisk.
Can you talk a little bit aboutthe decision to focus on like
these positive factors in thisanalysis?
Jeong Hwan Kim (06:49):
So that's very important.
As I alluded earlier, the themeof the MECA project is
resilience within BlackAmericans for cardiovascular
health.
Basically, we have labeledbeing an African American or
Black American being a riskfactor for cardiovascular
disease traditionally speakingin clinical medicine.
Yet we're ignoring thehumongous amount of basically
(07:09):
intraracial heterogeneity withinthe population because some
people, some group of people atleast 50% of the African
Americans that we know of do notsuffer from significant
cardiovascular disease, based onstatistics.
So something is already workingfor them to be resilient toward
any adverse events ofcardiovascular disease in their
life.
So I think that we werefocusing on the positive aspects
(07:30):
and promoters of cardiovascularhealth in efforts to find out
and identify potentialinterventions that are more
novel, that are already workingin place in these people's lives
and in neighborhoods.
So that was a different anglelooking at the same program,
same problem.
However, we are hoping thatthey'll enlighten us in terms of
what is actually more feasibleand more practical and more
(07:51):
effective in terms ofintervention.
Patrick Sullivan (07:53):
Yeah, I really appreciate that because I think
this is a theme in sort ofwhere we are in the world, which
is that Black race has beenassociated with so many health
conditions and but of courseit's almost never Black race.
It's really how society hasprovided, you know, for the
people who live in ourcommunities.
And so really getting specificabout you know what those
(08:15):
factors are and the extent towhich they have been shaped by
decisions that have been made incommunities is so critical.
And then I think the focus onresilience also is kind of
upside down from where we oftenare in describing quote unquote
risk factors.
But these resilient factors arein some ways, much.
There's a much more direct pathto say if these factors are
associated with better outcomes,then we're not trying to take
(08:38):
away things, we're trying toenhance things that improve
health.
So you know, in that sort ofcontext, what do you think the
implications are for policyaround cardiovascular health,
for practice, particularly forBlack Americans or for people
who may live in thesecommunities where the research
was done?
So what do you think we do withthis to improve health?
Saba Islam (09:06):
So I can speak a little bit to that.
So you know, the communitiesthat we live in are extremely
important.
I recently moved, and I movedinto a community where, you know
, people have lived here forgenerations and you know just
like the level, you know likethe support of safety that you
feel is just so important, andthis is just me talking about
myself personally.
So I think that is especially soimportant for communities.
You know, vulnerablecommunities that have been
(09:26):
disparately affected by a lot ofhistoric policies that are
extremely cringeworthy and stillpolicies that are made that are
extremely, extremelycringeworthy.
I think that you know theresearch that we did shows, you
know, like positive aspects ofcommunities and our hope is that
this will inform public healthofficials first of all,
(09:49):
hopefully not to put thosecringeworthy policies in, but to
also invest in communities toimprove the social structure of
these communities.
You know, for example, a lot of, you know Black neighborhoods
have been desperately affectedby gentrification, for example,
and that takes away thecommunity bonds that are there.
So you know, our hope is thatwhat we're showing in a
(10:11):
scientific way will help, youknow, policymakers advocates
create more favorable policies.
Patrick Sullivan (10:19):
Great.
Saba Islam (10:20):
That will hopefully help the health of the
communities.
Patrick Sullivan (10:24):
Right, and there is other research around,
just sort of the impacts ofgentrification on multiple areas
of health, and it's obviously,you know, complex and complex to
figure out what to do with thatfrom a policy perspective.
I'm going to bounce around justa bit here and ask to talk just
a little bit about, you know,how this research will make a
difference in terms of the kindof structural inequities, and
(10:47):
I'm going to see if Dr.
Lewis and Dr.
Taylor want to jump in a littlebit, and then I'm going to come
back.
I've never had four you knowscholars at once, so we'll try
and navigate.
Tené Lewis (11:05):
Sure, I'll speak to that a little.
So you know it's interesting.
We did this researchpre-pandemic, right?
So this is before shutdown,isolation, et cetera, and what
you heard people talking aboutwas how much breaking those
bonds, right, so how much beingisolated impacted their mental
health, their physical health,and for some people that was the
worst part of the pandemic.
It was the fear of COVIDactually was not as problematic
(11:27):
as the social isolation, to thepoint where the Surgeon General
declared that we were in themiddle of a loneliness epidemic.
Right, and so you see theopposite, what happens when you
don't have social cohesion andactivities with neighbors?
Right, and so this is sort of,I think, almost you know our
paper, I mean, and we weren'tthe only people to find this, I
(11:48):
do want to say that, right.
But there is a bit ofprescience there, right, in
terms of, you know, puttingforth this notion that it
matters who you are surroundedby, it matters in your
neighborhood, and again, weshould just to sort of big
picture.
The questionnaires ask aboutthings like safety and crime and
(12:10):
all of that, and those aren'tthe factors that seem to make
the difference.
What made the difference wasreally thinking about?
Do you have thedisconnectedness with your
neighbors?
And so, when we think aboutstructural racism, when one of
our papers came out, it was inthe middle of 2020, 2021.
And someone was saying, well, wedon't need, we don't really
need to care about resilience.
We need to care aboutstructural oppression and
discrimination and so on, and Iabsolutely think that those
(12:32):
things are important, right, andso we need this top down as
well as this bottom up approachto really thinking through how
to improve the health of BlackAmericans in these communities.
So I do think we want to bethinking about these things in
concert, right, they operatesynergistically.
And so, when we talk aboutstructural factors, those things
, I think, to use Saba's term,you know there have been a lot
(12:55):
of cringeworthy policies, right,and unfortunate policies, but
at the same time, communitiesthemselves talk about the fact
that they don't only want totalk about the negative things,
right, that there are strengthsin these communities, there are
assets, and how do we leveragethose assets?
As we wait for policies tochange, as we advocate for
(13:16):
policies to change, what arethings that people are already
doing that we can leverage tocontinue to improve the health
of individuals and the health ofcommunities.
Patrick Sullivan (13:25):
Thank you, Dr.
Taylor.
I saw a lot of nodding and somemore thoughts coming.
Herman Taylor (13:30):
Well, first of all, I have to say that it is
incredibly, really gratifying tohear our former postdocs, who
helped us tremendously and inmany cases drove us in this work
, articulate some of theoriginal and originating ideas
that Dr.
Lewis, Dr.
Arshed Quyyumi, who is also atEmory, and others at Morehouse
(13:54):
and Emory wanted to get peoplethinking about.
We wanted to challenge thenarrative that Black health is
bad health and in fact, if youlook at the true experience of
African Americans over the last400 years, it's a story actually
of triumph in many ways.
However, when we do groupcomparisons on health, we see
(14:18):
evidence of gross inequities,certainly gross disparities,
that are devastating and lethal.
So that's important, as Dr.
Lewis and others have alreadysaid.
It's important for us to lookat that and we're drawn to that
problem.
Certainly, for 30 years I'vebeen drawn to that problem.
But, looking a little bitdeeper, we avoid, I think, the
(14:40):
danger of others have called ita single story again, that black
health is bad health.
What we're exploring is how isit that people that have
experienced, I'll go a littlebit further than cringe-worthy
that have experienced at timesnear genocidal conditions, how
is it that out of that you canhave a modern population that
(15:04):
has this vast heterogeneity inoutcomes.
Certainly, the disparities isalmost a duh moment.
Given the whole, the totalityof the differences that the two
populations have undergone,you'd expect disparities, but in
fact there are many successesof individuals and communities
where people are living long,healthy lives that are really
(15:26):
quite impressive as you begin tothink about it and catalog it
and so forth.
So we wanted to understand whatcontributed and this was a
beginning exploration intofinding explanations at the
census tract level, at theindividual level and in broader
context.
And this work would not havebeen possible without great
thinkers like Dr.
(15:46):
Lewis and our dynamos, theenergetic postdocs who really
helped drive this work.
Patrick Sullivan (15:52):
Thank you.
I want to just further on thelast piece of what you talked
about a little bit, because thisis the first time we've had
four you know authors and Ithink, as we think about what
goes on behind papers I mean youstarted to talk about this a
(16:12):
bit in terms of how the researchwas conceived and the
historical picture and how thesethings are framed that's a
piece for me of what's behindthis paper.
But the other story is we havefour colleagues across
institutions and at differentstages of career who work
together to make this happen,and I think that's inspiring and
I think that's worthunderstanding.
So when you think about youknow, the roles in this project,
(16:34):
I wonder just if each of youmight want to say just a few
words about how you see some ofthe main things you did and how
you benefited from working withyour colleagues, and that
obviously goes in all directions.
So this, this isn't a plannedquestion, but like what's the
main thing you saw yourselfdoing?
And then what's something thatyou really learned or grew in or
(16:56):
thought about differentlybecause you were working with
this group of colleagues?
And since it's a surprisequestion, I'll let anybody who
wants to jump on that first youcan raise your hand and jump in.
Yeah, Dr.
Kim.
Jeong Hwan Kim (17:10):
Yeah, that's actually very interesting.
And the question I asked myself, kind of spending years with Dr
.
Lewis and Dr.
Taylor as a postdoc fellow-what am I doing here?
Because I am trained as a heartfailure cardiologist at this
point.
I'm a clinical person, mainlyday-to-day.
I see individuals.
We are immersed with theday-to-day chronic activities
and treatment plans andmanagement plans, diagnostics,
(17:36):
and we forget what's going onoutside the hospitals a lot on a
day-to-day basis.
When I came to Atlanta for myresidency training and I trained
at Grady for my residency andthen 99% of the patients that I
saw in my clinic were AfricanAmericans suffering from
multiple traditionalcardiovascular comorbidities
that we often talk about, yet Iwas not really thinking a lot
about what's going on outsidethe hospital.
But the opportunity for me towork on this paper and this
(17:58):
project frankly and then meetwith the people who are outside
of clinical medicine and meetwith the epidemiologists and
meet with the statisticiansabout study design, analyses and
talking with psychologists, Ithink these are the things that
would not have been possible forme from kind of traditional
linear training track of being acardiologist.
Yet I took a sidestep and thenI was able to immerse myself to
(18:21):
think about what is actuallygoing on outside the hospital
and they made me reallyappreciate these- one, the gross
disparity of the cardiovasculardisease in the communities in
the communities.
And second, you know, toappreciate the actual society
and communities that thesepatients live in and then you
know, understand them as more of, in a way for the better, lack
of word.
It's maybe a package right?
(18:42):
It's not just individual'sproblem that he's having,
someone's having hypertension,diabetes that's uncontrolled.
There's something that'splaying a role in their lives,
in their family situations andcommunities that are making them
hard to you, hard to adhere tothe medical therapies that I
would like to get on board in aclinic.
I think that really made me abetter clinician, to think about
not just as one patient in aclinic room, but more as a
(19:06):
patient that I'm treating butI'm also treating the population
that I'm seeing and facingevery day.
That really made me grow as aclinician as well, and obviously
there's a growth.
As you know as uh, you know asI do more analyses and do the
studies and research studies, Iappreciate the intricacies of
how I study these things in anacademic way, this convincing
way to the audience, but in theend, at the end of the day I
(19:27):
felt that I grew as a person,but also as a clinician, to to
be able to kind of appreciatenot only the individual patients
, but beyond the walls of thehospital.
Patrick Sullivan (19:36):
Thank you so much.
Saba Islam (19:37):
I guess I'll go ahead after that so a lot of my,
you know interest in working inhealth disparities actually
kind of stems from my ownbackground.
So you know I'm first generationBangladeshi immigrant.
You know my parents are from alower income background so we
struggled quite a bit, you know,and so that's always been very
important to me.
And Bangladesh is also, youknow, like there's a large
(19:59):
community in New York andthere's a lot of health
disparities in that.
So my interest in working withcommunities comes from there and
I also did my training, myresidency training, at Boston
Medical Center, the old BostonCity Hospital, which is similar
to Grady, so it is the safetynet hospital and over there I
(20:19):
feel very fortunate about mytraining.
You know being able to seepeople from various walks of
life and there's so much, youknow like there are medications
that we can prescribe, but youknow there's so much social
determinants of health thatmatters into good outcomes for
the not just, you know, healthoutcomes that you're measuring,
but also quality of life for thepatients.
So you know, you know inresidency you work with patients
(20:41):
, you do things on a day-to-daybasis, but what I realized is
that you know to really changethings globally you have to do
it in a methodological way.
So prior to joining the Emoryprogram.
I actually did not have anyresearch background, but I knew
that I wanted to work with you,know vulnerable communities and
to help their quality of lifeand also to help health outcomes
(21:04):
.
So I ended up, you know, joiningthis and I was just so
fortunate, you know, and Ifollowed Dr.
Kim's steps.
He's laid such a wonderfulfoundation.
So, in terms of this paper, he,you know, actually started it
even before I joined, done a lotof the analysis, had presented
preliminary findings atdifferent conferences, so I
already had an amazingbackground to build on.
And, you know, I came to Emoryand I worked with wonderful
(21:27):
mentors Dr.
Lewis, Dr.
Taylor you guys mentioned Dr.
Quyyumi, and there were othermentors as well who had
different expertise, and I wasable to learn from all you guys
you know Dr.
Lewis in epidemiology, Dr.
Quyyumi, who's a cardiologistwho focuses on subclinical
cardiovascular disease, Dr.
Taylor, of course, you know,and then Dr.
(21:49):
Searles, who's a basicscientist, to bring all of those
things together, I just learnedso much about methodology,
about combining different fieldstogether, and that's what is
what you know like made MECA soamazing that we were able to
combine so many different fieldstogether and have so many
interesting and importantfindings that are just, you know
(22:11):
, a start to hopefully improvinghealth, findings that are just,
you know, a start to hopefullyimproving health.
Tené Lewis (22:15):
Sure, so I am just beaming because I'm so proud
they did an amazing job.
But I should also say I thinkone of the things we haven't
talked about is the fact thatnot only did they move into
epidemiology as individualstrained in cardiology right,
neither of them have a master'sdegree in epidemiology or
(22:36):
anything of that sort they movedinto thinking about what is
really difficult.
You know, sort of conceptually,this idea of resilience.
When we started publishingthese papers, reviewers were
like what are you talking aboutand what is the stressor and how
can you say that?
You know, Black race is astressor, and so on and so forth
(22:57):
.
And they actually reallygrappled with this.
This would be difficult forsomeone with a PhD in
epidemiology and I know thisbecause I train students to
think about psychosocialconstructs and they're different
because they're not objectivelymeasurable.
It's not like you're measuringblood pressure, it's not like
you're measuring cholesterol.
You're measuring something thatis subjective, it's
(23:19):
self-reported and the literatureis mixed on exactly what is
this and how do you measure itand how do you think about it.
And they were able to not onlygrasp the methods and you know
the writing and everything elsethat we do but really dig deeply
into this psychology literaturethat really talked about what
do we mean when we talk aboutresilience?
(23:39):
And I remember sitting witheach of them individually.
You know Jeong Hwan startedfirst and then Saba came after
him and he's like well, I wentback and I found this original
article where they were talkingabout orphaned children in
Europe.
That's honestly where some ofthis literature began, and so I
think what that is particularlynoteworthy, because their peers
weren't doing that.
(23:59):
So they're meeting with, youknow, epidemiologists and
psychologists and the othercardiology fellows are doing
basic science and looking overat them, like you know.
So sorry for you all that youhave to grapple with all of this
complexity, but they werereally- so, I you know, I think
we're we're not giving them or Iwant to give them even more
(24:21):
kudos for this, because it wastwo steps beyond what would
typically be done in acardiology fellowship, even
focused on research.
It was not bench science, itwas not pure clinical research,
it was really this amalgamationof a few different disciplines,
all of which, the majority ofwhich were different from the
(24:41):
discipline that they originallytrained in.
So I think that was, for me,particularly eye-opening and
encouraging, and I'm just, youknow, incredibly grateful and
proud to have had theopportunity to work with them.
They're smart and brilliantpeople.
Herman Taylor (25:00):
Absolutely.
Let me 100% endorse that.
And the very first lecture Igave as cardiology faculty was
related to disparities in someof the contributors as we
understood them now more than 25years ago, and after getting
some good questions, I got aquestion that was actually meant
a little derisively to thetopic and the person asked me,
(25:23):
Dr.
Taylor, now understand, I ambrand new, Dr.
Taylor, are you a cardiologistor a sociologist?
Now, that was meant to be atleast mildly insulting.
If I were given that questionagain today, I would say
absolutely I'm not a sociologist, because that is an extremely
(25:44):
difficult field that takes deepexpertise to really be a master
of.
But what I would also say is, asa Black cardiologist, I cannot
afford to be just a cardiologist.
I cannot afford that because mypersonal mission in being a
(26:05):
cardiologist is to try to helpestablish equity, access and a
level of sensitivity andhumility in this profession to
truly provide for people whotraditionally have not gotten
the care that they should've ortraditionally didn't understand
how to utilize the care that wasavailable to them to the
(26:26):
optimal degree.
Now we've trained andinfluenced, hopefully, a couple
of future leaders in cardiologyand and I believe they've been
trained to not just be aphysiologically- based,
hemodynamically- basedcardiologist, but rather people
who will inject a degree ofhumanity and humility and
(26:51):
understanding in their practicethat perhaps their forebearers
didn't typically have.
So, like Dr.
Lewis, I am extremely,extremely proud of them and
really that I think, among theoutcomes of our MECA adventure
here between Morehouse and Emory, producing young leaders like
this is probably one of thethings I'm most proud of.
Patrick Sullivan (27:12):
I am going to leave things there, because I
think that what each of the fourof you just said is profound
and insightful and meaningfuland better than any way that I
could summarize this.
I do want to say that when westarted this series of podcasts,
so we want to talk toresearchers about their work and
how they made the decisions andwhat they found but Behind the
(27:36):
Paper is meant to get at thisfull world of how we identify
ourselves as researchers, howour relationships actually shape
the work that we do, and it'sso meaningful to me to see our
listeners can't see, but I cansee on my Brady Bunch on Zoom-
You know these two earliercareer researchers and these two
(27:56):
mentors who work togetheracross institutions to do
something that added suchinsight and with the whole
framework about resiliency andhow we think about race as a
marker for disease and how wequantify that.
So I am just going to say thatit's been my privilege to hear
you talk about your work, to seeyou interact with each other
(28:19):
and to understand that it reallyrepresents such a meaningful
developmental piece, I think,for our earlier career
colleagues, and I'll put myselfon the bottom row with the later
career colleagues and say thatthese are often the things that
make our jobs so worthwhile.
So I'm just grateful to all ofyou for the work that you've
done, for your openness andtalking about this and for
(28:39):
bringing your work to Annals,and I'm so glad that we could
give it recognition, and so I'llencourage our listeners to find
the paper, to read it in full,on the Annals of Epidemiology
website, and I will thank ourguests today.
Thank you to Drs.
Islam, Kim, Lewis and Taylorfor joining us.
It's such a pleasure to havethis discussion with you, and I
(29:03):
hope that our listeners willstay tuned in.
Join us again on the nextepisode of EPITalk and, in the
meantime, visit us at annalsofepidemiology.
org to access this paper and seethe other papers in the journal
.
Thanks to each of you for yourwork and for sharing what you
have today.
Saba Islam (29:19):
Thank you, thank today, thank you, thank you,
thank you.
Patrick Sullivan (29:22):
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPITalk, brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
(29:44):
featured on this episode andmore from the journal, you can
visit us online at www.
annalsofepidemiology.
org.
Hello, you're listening to EPITalk
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,Editor-in-Chief of the journal,
and in this series we take youbehind the scenes of some of the
latest epidemiologic researchfeatured in our journal.
Today we're talking with Annalsof Epidemiology's 2023 Junior
(00:36):
Paper of the Year Award winner,Dr Saba Islam, co-first author,
Dr Jeong Hwan Kim and theirco-authors, Drs.
Tene Lewis and Herman Taylor,about their article
"Neighborhood Characteristicsand Ideal cardiovascular health
among Black adults (00:50):
results from the Morehouse- Emory
Cardiovascular (MECA) Center forHealth Equity".
You can find the full journalarticle online in the January
2022 issue of the journal at www.
annalsofepidemiology.
org.
I'll do a brief introduction ofour guests.
Dr.
Saba Islam is a clinical fellowin the Advanced Heart Failure
and Transplant CardiologyProgram at Brigham and Women's
(01:13):
Hospital, Harvard Medical School.
Her research interests are inunderstanding the social
determinants of health incardiovascular health and
disease.
In particular, she's interestedin geriatric cardiology and
implementing novel strategies toimprove care and delivery for
this vulnerable population.
Dr.
Jeong Hwan Kim is an advancedheart failure and transplant
cardiologist at Brigham andWomen's Hospital and the Boston
(01:34):
VA.
He has clinical interest intaking care of patients with
advanced heart failure requiringadvanced heart failure
therapies such as cardiactransplant or ventricular assist
devices.
His research interests lie inthe understanding of the
cultural determinants ofcardiovascular disease outcomes
in the US, such as geographicdisparities and social
determinants of health.
Dr.
Tene Lewis is a, professor ofepidemiology in the Rollins
(01:57):
School of Public Health at EmoryUniversity.
Her primary area of research isin psychosocial epidemiology,
with an emphasis on racialdisparities in cardiovascular
disease.
She has a particular interestin understanding how
psychological and social factorscontribute to the
disproportionately high rates ofcardiovascular disease
morbidity and mortality inAfrican-American women compared
(02:17):
to women from other racialethnic groups.
And Dr.
Herman A.
Taylor is an endowed professorand director of Morehouse School
of Medicine's CardiovascularResearch Institute.
Dr.
Taylor is known for his work incardiovascular disease
disparities and in establishingthe groundbreaking Jackson Heart
Study in African Americans.
This is a study that's madecontributions of international
(02:37):
significance.
Currently he's leading researchat the intersection of clinical
medicine, artificialintelligence, multi-omics and
social determinants of health.
Doctors, thank you for joiningus today.
So we're going to dive intotalking about your paper a
little bit and I'd like to juststart, maybe, with Dr.
Islam and ask you to talk alittle bit about the purpose of
(02:59):
the study.
What was the research questionthat you set out to answer?
Saba Islam (03:02):
Yeah, thank you for the introduction.
So the purpose of our study wasto understand which positive
neighborhood features wasassociated with improved
cardiovascular health in acohort of Black Americans living
in the Atlanta, Georgia area.
We were trying to elucidatewhich factors may promote
cardiovascular health in thecommunity, or cardiovascular
(03:25):
resilience, and our hope wasthat, you know, the findings
that we see in this study caninform public health
interventions in the future.
Patrick Sullivan (03:32):
Great.
So this is for Dr.
Islam or Dr.
Kim, either one.
What are the epi methods thatyou used to try to identify
these factors that might beassociated with the cardiac
disease outcomes?
Saba Islam (03:44):
So we used a cross-sectional study design to
explore the positiveneighborhood factors that is
associated with cardiovascularhealth in the Black adult cohort
living in Atlanta, Georgia.
So our hope was that, you know,showing this association and a
cross-sectional study wouldagain, you know, in the future
allow us to perform longitudinalstudies to further elucidate
(04:06):
these associations and hopefullyagain inform public health
interventions.
Patrick Sullivan (04:11):
Just to go a little bit deeper into that how
are the data that you used,collected, and were they at the
individual level or theneighborhood level or sort of?
How is that data structured?
Saba Islam (04:21):
I can let Dr.
Kim take that, because he wasintimately involved in that
process.
Jeong Hwan Kim (04:27):
Sure.
Thank you for the opportunityto explain a little bit more
about our paper, which is veryexciting.
This was actually part of thelarger project called MECA
that's conducted between EmoryUniversity and Morehouse School
of Medicine under the funding byAHA.
So we had a very ambitious planto look at multi-layers of the
social determinants of healthfor the Black Americans living
in Atlanta, Georgia.
So we started with a separatepaper that was published a
(04:49):
little bit before this paper,looking at the census tract
level determinants ofcardiovascular health for Black
Americans, looking at theneighborhood characteristics
based on the census tract level.
The current paper that we'retalking about is at the
individual level.
We recruited, not targeted to acertain census tract to
represent the whole region.
We purely recruited peoplebased on the clinical criteria,
(05:11):
based on the age of 30 to 70,and without known cardiovascular
disease, and we wanted to seeand there's perception of
neighborhoods at the individuallevel and how that correlates
with their left, basicallycardiovascular health scores,
called left self-assessmentscore by AHA.
So it is an individual-levelpaper but, however, it's in the
context of our attempt tounderstand in multi-layer,
(05:31):
multi-level analyses of what isit that's actually driving the
better cardiovascular healthamong Black Americans in Atlanta
, Georgia.
Patrick Sullivan (05:38):
Great.
Thank you.
And so what were some of thosemain findings or key conclusions
you had from this level at thatsort of first individual data
levels phase?
Saba Islam (05:48):
Yeah, I can speak a little bit to that.
So the main takeaway from thiswas that social cohesion, which
includes activity with neighbors, was associated with higher
odds of ideal cardiovascularhealth, which was defined as the
American Heart Association'sLife's Simple 7.
For certain outcomes, it wasnoted that there was a two times
higher odds of improvedcardiovascular health with one
(06:11):
standard deviation increase inthis neighborhood perception
score.
Patrick Sullivan (06:15):
And what were some of those factors that had
that positive relationship?
Saba Islam (06:20):
It was the social cohesion and the activity with
neighbors.
So the neighborhood socialenvironment we noted was
extremely important forcardiovascular health in our
cohort.
Patrick Sullivan (06:29):
So why, then, is it important to focus on?
I mean, these are sort ofpositive aspects, and a lot of
the work that we all normally dofocuses in a, maybe because
we're thinking of causality, butwe get more into things that
have a negative impact on therisk.
Can you talk a little bit aboutthe decision to focus on like
these positive factors in thisanalysis?
Jeong Hwan Kim (06:49):
So that's very important.
As I alluded earlier, the themeof the MECA project is
resilience within BlackAmericans for cardiovascular
health.
Basically, we have labeledbeing an African American or
Black American being a riskfactor for cardiovascular
disease traditionally speakingin clinical medicine.
Yet we're ignoring thehumongous amount of basically
(07:09):
intraracial heterogeneity withinthe population because some
people, some group of people atleast 50% of the African
Americans that we know of do notsuffer from significant
cardiovascular disease, based onstatistics.
So something is already workingfor them to be resilient toward
any adverse events ofcardiovascular disease in their
life.
So I think that we werefocusing on the positive aspects
(07:30):
and promoters of cardiovascularhealth in efforts to find out
and identify potentialinterventions that are more
novel, that are already workingin place in these people's lives
and in neighborhoods.
So that was a different anglelooking at the same program,
same problem.
However, we are hoping thatthey'll enlighten us in terms of
what is actually more feasibleand more practical and more
(07:51):
effective in terms ofintervention.
Patrick Sullivan (07:53):
Yeah, I really appreciate that because I think
this is a theme in sort ofwhere we are in the world, which
is that Black race has beenassociated with so many health
conditions and but of courseit's almost never Black race.
It's really how society hasprovided, you know, for the
people who live in ourcommunities.
And so really getting specificabout you know what those
(08:15):
factors are and the extent towhich they have been shaped by
decisions that have been made incommunities is so critical.
And then I think the focus onresilience also is kind of
upside down from where we oftenare in describing quote unquote
risk factors.
But these resilient factors arein some ways, much.
There's a much more direct pathto say if these factors are
associated with better outcomes,then we're not trying to take
(08:38):
away things, we're trying toenhance things that improve
health.
So you know, in that sort ofcontext, what do you think the
implications are for policyaround cardiovascular health,
for practice, particularly forBlack Americans or for people
who may live in thesecommunities where the research
was done?
So what do you think we do withthis to improve health?
Saba Islam (09:06):
So I can speak a little bit to that.
So you know, the communitiesthat we live in are extremely
important.
I recently moved, and I movedinto a community where, you know
, people have lived here forgenerations and you know just
like the level, you know likethe support of safety that you
feel is just so important, andthis is just me talking about
myself personally.
So I think that is especially soimportant for communities.
You know, vulnerablecommunities that have been
(09:26):
disparately affected by a lot ofhistoric policies that are
extremely cringeworthy and stillpolicies that are made that are
extremely, extremelycringeworthy.
I think that you know theresearch that we did shows, you
know, like positive aspects ofcommunities and our hope is that
this will inform public healthofficials first of all,
(09:49):
hopefully not to put thosecringeworthy policies in, but to
also invest in communities toimprove the social structure of
these communities.
You know, for example, a lot of, you know Black neighborhoods
have been desperately affectedby gentrification, for example,
and that takes away thecommunity bonds that are there.
So you know, our hope is thatwhat we're showing in a
(10:11):
scientific way will help, youknow, policymakers advocates
create more favorable policies.
Patrick Sullivan (10:19):
Great.
Saba Islam (10:20):
That will hopefully help the health of the
communities.
Patrick Sullivan (10:24):
Right, and there is other research around,
just sort of the impacts ofgentrification on multiple areas
of health, and it's obviously,you know, complex and complex to
figure out what to do with thatfrom a policy perspective.
I'm going to bounce around justa bit here and ask to talk just
a little bit about, you know,how this research will make a
difference in terms of the kindof structural inequities, and
(10:47):
I'm going to see if Dr.
Lewis and Dr.
Taylor want to jump in a littlebit, and then I'm going to come
back.
I've never had four you knowscholars at once, so we'll try
and navigate.
Tené Lewis (11:05):
Sure, I'll speak to that a little.
So you know it's interesting.
We did this researchpre-pandemic, right?
So this is before shutdown,isolation, et cetera, and what
you heard people talking aboutwas how much breaking those
bonds, right, so how much beingisolated impacted their mental
health, their physical health,and for some people that was the
worst part of the pandemic.
It was the fear of COVIDactually was not as problematic
(11:27):
as the social isolation, to thepoint where the Surgeon General
declared that we were in themiddle of a loneliness epidemic.
Right, and so you see theopposite, what happens when you
don't have social cohesion andactivities with neighbors?
Right, and so this is sort of,I think, almost you know our
paper, I mean, and we weren'tthe only people to find this, I
(11:48):
do want to say that, right.
But there is a bit ofprescience there, right, in
terms of, you know, puttingforth this notion that it
matters who you are surroundedby, it matters in your
neighborhood, and again, weshould just to sort of big
picture.
The questionnaires ask aboutthings like safety and crime and
(12:10):
all of that, and those aren'tthe factors that seem to make
the difference.
What made the difference wasreally thinking about?
Do you have thedisconnectedness with your
neighbors?
And so, when we think aboutstructural racism, when one of
our papers came out, it was inthe middle of 2020, 2021.
And someone was saying, well, wedon't need, we don't really
need to care about resilience.
We need to care aboutstructural oppression and
discrimination and so on, and Iabsolutely think that those
(12:32):
things are important, right, andso we need this top down as
well as this bottom up approachto really thinking through how
to improve the health of BlackAmericans in these communities.
So I do think we want to bethinking about these things in
concert, right, they operatesynergistically.
And so, when we talk aboutstructural factors, those things
, I think, to use Saba's term,you know there have been a lot
(12:55):
of cringeworthy policies, right,and unfortunate policies, but
at the same time, communitiesthemselves talk about the fact
that they don't only want totalk about the negative things,
right, that there are strengthsin these communities, there are
assets, and how do we leveragethose assets?
As we wait for policies tochange, as we advocate for
(13:16):
policies to change, what arethings that people are already
doing that we can leverage tocontinue to improve the health
of individuals and the health ofcommunities.
Patrick Sullivan (13:25):
Thank you, Dr.
Taylor.
I saw a lot of nodding and somemore thoughts coming.
Herman Taylor (13:30):
Well, first of all, I have to say that it is
incredibly, really gratifying tohear our former postdocs, who
helped us tremendously and inmany cases drove us in this work
, articulate some of theoriginal and originating ideas
that Dr.
Lewis, Dr.
Arshed Quyyumi, who is also atEmory, and others at Morehouse
(13:54):
and Emory wanted to get peoplethinking about.
We wanted to challenge thenarrative that Black health is
bad health and in fact, if youlook at the true experience of
African Americans over the last400 years, it's a story actually
of triumph in many ways.
However, when we do groupcomparisons on health, we see
(14:18):
evidence of gross inequities,certainly gross disparities,
that are devastating and lethal.
So that's important, as Dr.
Lewis and others have alreadysaid.
It's important for us to lookat that and we're drawn to that
problem.
Certainly, for 30 years I'vebeen drawn to that problem.
But, looking a little bitdeeper, we avoid, I think, the
(14:40):
danger of others have called ita single story again, that black
health is bad health.
What we're exploring is how isit that people that have
experienced, I'll go a littlebit further than cringe-worthy
that have experienced at timesnear genocidal conditions, how
is it that out of that you canhave a modern population that
(15:04):
has this vast heterogeneity inoutcomes.
Certainly, the disparities isalmost a duh moment.
Given the whole, the totalityof the differences that the two
populations have undergone,you'd expect disparities, but in
fact there are many successesof individuals and communities
where people are living long,healthy lives that are really
(15:26):
quite impressive as you begin tothink about it and catalog it
and so forth.
So we wanted to understand whatcontributed and this was a
beginning exploration intofinding explanations at the
census tract level, at theindividual level and in broader
context.
And this work would not havebeen possible without great
thinkers like Dr.
(15:46):
Lewis and our dynamos, theenergetic postdocs who really
helped drive this work.
Patrick Sullivan (15:52):
Thank you.
I want to just further on thelast piece of what you talked
about a little bit, because thisis the first time we've had
four you know authors and Ithink, as we think about what
goes on behind papers I mean youstarted to talk about this a
(16:12):
bit in terms of how the researchwas conceived and the
historical picture and how thesethings are framed that's a
piece for me of what's behindthis paper.
But the other story is we havefour colleagues across
institutions and at differentstages of career who work
together to make this happen,and I think that's inspiring and
I think that's worthunderstanding.
So when you think about youknow, the roles in this project,
(16:34):
I wonder just if each of youmight want to say just a few
words about how you see some ofthe main things you did and how
you benefited from working withyour colleagues, and that
obviously goes in all directions.
So this, this isn't a plannedquestion, but like what's the
main thing you saw yourselfdoing?
And then what's something thatyou really learned or grew in or
(16:56):
thought about differentlybecause you were working with
this group of colleagues?
And since it's a surprisequestion, I'll let anybody who
wants to jump on that first youcan raise your hand and jump in.
Yeah, Dr.
Kim.
Jeong Hwan Kim (17:10):
Yeah, that's actually very interesting.
And the question I asked myself, kind of spending years with Dr
.
Lewis and Dr.
Taylor as a postdoc fellow-what am I doing here?
Because I am trained as a heartfailure cardiologist at this
point.
I'm a clinical person, mainlyday-to-day.
I see individuals.
We are immersed with theday-to-day chronic activities
and treatment plans andmanagement plans, diagnostics,
(17:36):
and we forget what's going onoutside the hospitals a lot on a
day-to-day basis.
When I came to Atlanta for myresidency training and I trained
at Grady for my residency andthen 99% of the patients that I
saw in my clinic were AfricanAmericans suffering from
multiple traditionalcardiovascular comorbidities
that we often talk about, yet Iwas not really thinking a lot
about what's going on outsidethe hospital.
But the opportunity for me towork on this paper and this
(17:58):
project frankly and then meetwith the people who are outside
of clinical medicine and meetwith the epidemiologists and
meet with the statisticiansabout study design, analyses and
talking with psychologists, Ithink these are the things that
would not have been possible forme from kind of traditional
linear training track of being acardiologist.
Yet I took a sidestep and thenI was able to immerse myself to
(18:21):
think about what is actuallygoing on outside the hospital
and they made me reallyappreciate these- one, the gross
disparity of the cardiovasculardisease in the communities in
the communities.
And second, you know, toappreciate the actual society
and communities that thesepatients live in and then you
know, understand them as more of, in a way for the better, lack
of word.
It's maybe a package right?
(18:42):
It's not just individual'sproblem that he's having,
someone's having hypertension,diabetes that's uncontrolled.
There's something that'splaying a role in their lives,
in their family situations andcommunities that are making them
hard to you, hard to adhere tothe medical therapies that I
would like to get on board in aclinic.
I think that really made me abetter clinician, to think about
not just as one patient in aclinic room, but more as a
(19:06):
patient that I'm treating butI'm also treating the population
that I'm seeing and facingevery day.
That really made me grow as aclinician as well, and obviously
there's a growth.
As you know as uh, you know asI do more analyses and do the
studies and research studies, Iappreciate the intricacies of
how I study these things in anacademic way, this convincing
way to the audience, but in theend, at the end of the day I
(19:27):
felt that I grew as a person,but also as a clinician, to to
be able to kind of appreciatenot only the individual patients
, but beyond the walls of thehospital.
Patrick Sullivan (19:36):
Thank you so much.
Saba Islam (19:37):
I guess I'll go ahead after that so a lot of my,
you know interest in working inhealth disparities actually
kind of stems from my ownbackground.
So you know I'm first generationBangladeshi immigrant.
You know my parents are from alower income background so we
struggled quite a bit, you know,and so that's always been very
important to me.
And Bangladesh is also, youknow, like there's a large
(19:59):
community in New York andthere's a lot of health
disparities in that.
So my interest in working withcommunities comes from there and
I also did my training, myresidency training, at Boston
Medical Center, the old BostonCity Hospital, which is similar
to Grady, so it is the safetynet hospital and over there I
(20:19):
feel very fortunate about mytraining.
You know being able to seepeople from various walks of
life and there's so much, youknow like there are medications
that we can prescribe, but youknow there's so much social
determinants of health thatmatters into good outcomes for
the not just, you know, healthoutcomes that you're measuring,
but also quality of life for thepatients.
So you know, you know inresidency you work with patients
(20:41):
, you do things on a day-to-daybasis, but what I realized is
that you know to really changethings globally you have to do
it in a methodological way.
So prior to joining the Emoryprogram.
I actually did not have anyresearch background, but I knew
that I wanted to work with you,know vulnerable communities and
to help their quality of lifeand also to help health outcomes
(21:04):
.
So I ended up, you know, joiningthis and I was just so
fortunate, you know, and Ifollowed Dr.
Kim's steps.
He's laid such a wonderfulfoundation.
So, in terms of this paper, he,you know, actually started it
even before I joined, done a lotof the analysis, had presented
preliminary findings atdifferent conferences, so I
already had an amazingbackground to build on.
And, you know, I came to Emoryand I worked with wonderful
(21:27):
mentors Dr.
Lewis, Dr.
Taylor you guys mentioned Dr.
Quyyumi, and there were othermentors as well who had
different expertise, and I wasable to learn from all you guys
you know Dr.
Lewis in epidemiology, Dr.
Quyyumi, who's a cardiologistwho focuses on subclinical
cardiovascular disease, Dr.
Taylor, of course, you know,and then Dr.
(21:49):
Searles, who's a basicscientist, to bring all of those
things together, I just learnedso much about methodology,
about combining different fieldstogether, and that's what is
what you know like made MECA soamazing that we were able to
combine so many different fieldstogether and have so many
interesting and importantfindings that are just, you know
(22:11):
, a start to hopefully improvinghealth, findings that are just,
you know, a start to hopefullyimproving health.
Tené Lewis (22:15):
Sure, so I am just beaming because I'm so proud
they did an amazing job.
But I should also say I thinkone of the things we haven't
talked about is the fact thatnot only did they move into
epidemiology as individualstrained in cardiology right,
neither of them have a master'sdegree in epidemiology or
(22:36):
anything of that sort they movedinto thinking about what is
really difficult.
You know, sort of conceptually,this idea of resilience.
When we started publishingthese papers, reviewers were
like what are you talking aboutand what is the stressor and how
can you say that?
You know, Black race is astressor, and so on and so forth
(22:57):
.
And they actually reallygrappled with this.
This would be difficult forsomeone with a PhD in
epidemiology and I know thisbecause I train students to
think about psychosocialconstructs and they're different
because they're not objectivelymeasurable.
It's not like you're measuringblood pressure, it's not like
you're measuring cholesterol.
You're measuring something thatis subjective, it's
(23:19):
self-reported and the literatureis mixed on exactly what is
this and how do you measure itand how do you think about it.
And they were able to not onlygrasp the methods and you know
the writing and everything elsethat we do but really dig deeply
into this psychology literaturethat really talked about what
do we mean when we talk aboutresilience?
(23:39):
And I remember sitting witheach of them individually.
You know Jeong Hwan startedfirst and then Saba came after
him and he's like well, I wentback and I found this original
article where they were talkingabout orphaned children in
Europe.
That's honestly where some ofthis literature began, and so I
think what that is particularlynoteworthy, because their peers
weren't doing that.
(23:59):
So they're meeting with, youknow, epidemiologists and
psychologists and the othercardiology fellows are doing
basic science and looking overat them, like you know.
So sorry for you all that youhave to grapple with all of this
complexity, but they werereally- so, I you know, I think
we're we're not giving them or Iwant to give them even more
(24:21):
kudos for this, because it wastwo steps beyond what would
typically be done in acardiology fellowship, even
focused on research.
It was not bench science, itwas not pure clinical research,
it was really this amalgamationof a few different disciplines,
all of which, the majority ofwhich were different from the
(24:41):
discipline that they originallytrained in.
So I think that was, for me,particularly eye-opening and
encouraging, and I'm just, youknow, incredibly grateful and
proud to have had theopportunity to work with them.
They're smart and brilliantpeople.
Herman Taylor (25:00):
Absolutely.
Let me 100% endorse that.
And the very first lecture Igave as cardiology faculty was
related to disparities in someof the contributors as we
understood them now more than 25years ago, and after getting
some good questions, I got aquestion that was actually meant
a little derisively to thetopic and the person asked me,
(25:23):
Dr.
Taylor, now understand, I ambrand new, Dr.
Taylor, are you a cardiologistor a sociologist?
Now, that was meant to be atleast mildly insulting.
If I were given that questionagain today, I would say
absolutely I'm not a sociologist, because that is an extremely
(25:44):
difficult field that takes deepexpertise to really be a master
of.
But what I would also say is, asa Black cardiologist, I cannot
afford to be just a cardiologist.
I cannot afford that because mypersonal mission in being a
(26:05):
cardiologist is to try to helpestablish equity, access and a
level of sensitivity andhumility in this profession to
truly provide for people whotraditionally have not gotten
the care that they should've ortraditionally didn't understand
how to utilize the care that wasavailable to them to the
(26:26):
optimal degree.
Now we've trained andinfluenced, hopefully, a couple
of future leaders in cardiologyand and I believe they've been
trained to not just be aphysiologically- based,
hemodynamically- basedcardiologist, but rather people
who will inject a degree ofhumanity and humility and
(26:51):
understanding in their practicethat perhaps their forebearers
didn't typically have.
So, like Dr.
Lewis, I am extremely,extremely proud of them and
really that I think, among theoutcomes of our MECA adventure
here between Morehouse and Emory, producing young leaders like
this is probably one of thethings I'm most proud of.
Patrick Sullivan (27:12):
I am going to leave things there, because I
think that what each of the fourof you just said is profound
and insightful and meaningfuland better than any way that I
could summarize this.
I do want to say that when westarted this series of podcasts,
so we want to talk toresearchers about their work and
how they made the decisions andwhat they found but Behind the
(27:36):
Paper is meant to get at thisfull world of how we identify
ourselves as researchers, howour relationships actually shape
the work that we do, and it'sso meaningful to me to see our
listeners can't see, but I cansee on my Brady Bunch on Zoom-
You know these two earliercareer researchers and these two
(27:56):
mentors who work togetheracross institutions to do
something that added suchinsight and with the whole
framework about resiliency andhow we think about race as a
marker for disease and how wequantify that.
So I am just going to say thatit's been my privilege to hear
you talk about your work, to seeyou interact with each other
(28:19):
and to understand that it reallyrepresents such a meaningful
developmental piece, I think,for our earlier career
colleagues, and I'll put myselfon the bottom row with the later
career colleagues and say thatthese are often the things that
make our jobs so worthwhile.
So I'm just grateful to all ofyou for the work that you've
done, for your openness andtalking about this and for
(28:39):
bringing your work to Annals,and I'm so glad that we could
give it recognition, and so I'llencourage our listeners to find
the paper, to read it in full,on the Annals of Epidemiology
website, and I will thank ourguests today.
Thank you to Drs.
Islam, Kim, Lewis and Taylorfor joining us.
It's such a pleasure to havethis discussion with you, and I
(29:03):
hope that our listeners willstay tuned in.
Join us again on the nextepisode of EPITalk and, in the
meantime, visit us at annalsofepidemiology.
org to access this paper and seethe other papers in the journal
.
Thanks to each of you for yourwork and for sharing what you
have today.
Saba Islam (29:19):
Thank you, thank today, thank you, thank you,
thank you.
Patrick Sullivan (29:22):
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPITalk, brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
(29:44):
featured on this episode andmore from the journal, you can
visit us online at www.
annalsofepidemiology.
org.
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