Massive lines at food banks and limited access to fresh food during the COVID-19 pandemic highlight just some of the health disparities that exist in our communities. COVID-19 has brought to the forefront the idea that marginalized, underserved populations are disproportionately affected by pandemics. As physicians are on the front lines fighting this current pandemic, medical schools need to ensure that their students are adequately trained to address the next pandemic as well as the populations most likely to be affected by it.
Medical schools can teach students about health disparities, and the best way to do this is not necessarily in the classroom. We don't need a 50-minute lecture on food insecurities and health inequalities. The best way to learn about this subject is by experiencing it and getting involved with local communities. By taking meaningful action to identify the issues that our local communities are most afflicted with, medical students can lead the way in better understanding the needs of our different patient populations and the struggles they face. A program started at a medical school in Houston provides an example of how to achieve this.
Two years ago, several medical students including myself started a local community service project at a middle school in Houston: the nutrition education program. We met with teachers and staff at the middle school and identified a need to address food insecurity, minimal nutrition education, and lack of healthy food available in the community. The middle school is located in a food desert, with the majority of students receiving free breakfast and lunch through the National School Lunch Program. Medical student volunteers in the program examined the Coordinated Approach to Child Health curriculum and met once a week before school to discuss various nutrition lessons and ways to provide an affordable, healthy food item for breakfast every morning that could easily be purchased by parents or students.
Understanding the intersection between poverty, food insecurity, and dietary behaviors is crucial to understanding risk factors, health disparities, and higher incidence of chronic disease in certain communities. When a child tells you they must make their own dinner every night and are just not able to eat some nights, that really opens your eyes to food insecurity and the struggle for nutrition access that some communities face. When a kid comes to class with a bottle of Jolly Rancher soda (something I didn’t even know existed) that contains 78 grams of sugar per bottle, you begin to understand the need for nutrition education starting in early adolescence. When the majority of students have never heard of or tried hummus or Greek yogurt, you begin to realize that some communities may not have access to affordable healthy foods.
While we were able to learn so much from community service, the sixth and seventh graders were also very receptive to our program. It felt great when the same kids were eager to come back week after week wanting to learn more about nutrition. We were able to develop a relationship with these students and follow-up with the information we were teaching. It was most rewarding when the kids would tell us how their diets had changed and how they were able to incorporate into their diet some of the foods we introduced. One student specifically mentioned how she went home and told her parents the lessons she had learned, and that together, she and her parents completely changed their breakfast routine, from eating Pop-Tarts every morning to having a banana with peanut butter on whole wheat toast.
It is known that most medical students come from communities of high socioeconomic status. Taking part in our community service project provided an opportunity for young medical professionals to focus on the health and well-being of those most in need, an important reinforcement in medical training that can help reduce barriers to care potentially stemming from classism. Dedicating one hour per week to volunteer at a middle school helped medical students address a health care need in their local community. We were able to learn how food insecurities affect dietary behaviors, how poverty limits access to healthy food, and how health disparities exist, without even touching a textbook or sitting in a lecture hall.
If there are reforms to public health-based curriculum following the COVID-19 pandemic, the reforms should include opportunities for students to participate in community-based service projects. This can help medical students develop the tools and training needed to identify community issues, understand the health disparities that exist in underserved populations, and be prepared for the exacerbation of existing disparities during a crisis.
There is more that doctors and medical students can do to help patients. By considering patients in the context of the community, physicians can better understand the role they play and the implications of the kind of care they provide. Communities require more than just medications to be healthy; they need a way to bridge the gap between the patient and the community. Medical students can help accomplish this by learning to be compassionate and caring physicians to each individual patient as well as having a public health perspective towards medicine.
Amier Haidar is an MD/MPH dual-degree medical student at the University of Texas School of Public Health in Houston. Having an interest in health disparities, he started a community service project to address health needs at a local underserved middle school.