UNC Health Talk

Research with the People

Why do the poor have worse health outcomes than others? Why do racial and ethnic minorities have worse health outcomes? What about kids in rural areas in Eastern North Carolina? What about inner city adults? These are a few of the questions that drive Giselle Corbie-Smith, MD, MSc, the director of the newly formed UNC Center for Health Equity Research.

The answers aren’t easy. The research that must be undertaken to tease out the answers takes years. But since coming to Carolina in 2000, Corbie-Smith has embraced the challenge head on. As part of her work, she gathered community members of Nash and Edgecombe counties – police and politicians, ministers and doctors, educators and activists and public health officials – to come up with ideas to help prevent the spread of HIV. She called it Project GRACE, and it has trained lay health advisors to go into communities to battle misinformation about HIV.

Corbie-Smith also directs CARES Services – Community Academic Resources for Engaged Scholarship –a unit under NC TraCS that teams UNC researchers with health care providers and community members to find research-based solutions to health problems in North Carolina.

For this work, and much more, Corbie-Smith has earned a Leadership in Health Disparities Research award from the National Center for Minority Health and Health Disparities. At UNC she’s been honored with the James E. Bryan Award for Public Service, the Jefferson Pilot Fellowship, and the provost’s Engaged Scholarship Award for Community-University Partnership. Most recently she was named Kenan Distinguished Professor and a Humanities Academic Leadership Fellow with the Institute for the Arts and Humanities.

We sat down with Dr. Corbie Smith to discuss her path into medicine and her work at the UNC School of Medicine, the NC TraCS Institute, and the Sheps Center for Health Services Research.

Why did you pursue an undergraduate degree in biology and what was the driving force behind attending medical school?

I didn’t know about the stereotype that girls don’t like science; I just always enjoyed the analytical aspects of math and science. My major at Cornell was biology; I minored in genetics, which 25-plus-years-ago was a pretty simple field. I loved the visual nature of it all. A lot of the work involved drawing and studying what happens in the development of an organism. This not only tapped into my aptitude for science but also the way I learned; I’m a visual learner.

As for medical school, well, my mom is a nurse and she felt I should be a physician. But like most teenagers, I kind of went in the opposite direction. I did volunteer at a hospital and in the community, but I didn’t decide to go to medical school until my senior year in college. By then everyone else had applied and I still hadn’t taken my MCATs. Plus, I needed to save money and I wanted to keep studying science. So I took a year off from school and worked for the Board of Education in Brooklyn, at a law firm, and in a genetics lab.

It wasn’t until I got on the wards as a third-year medical student that I felt like I found my place in the world, and that had to do with the interactions I had with patients and understanding in a really powerful way the importance of that relationship.

At that point of my medical education we saw mostly patients in crisis. I trained at Albert Einstein College of Medicine in the Bronx. So a crisis there didn’t just involve a physical ailment; it involved the social forces that conspire to lead to chronic and acute illnesses.

After graduating from med school in 1991, where did you work and what led you to pursue a master’s degree in clinical epidemiology?

During my residency at Yale, one of things I will always be grateful for is how our attending physicians really encouraged us to ask challenging questions, not just about the patients we were seeing but also the social context that our patients were in. I remember when I was a senior resident, Nicole Lurie – who has remained a mentor for me – gave a lecture about research and vulnerable populations. It so resonated with the questions I had about the way we were providing care for patients. I went on to read her work and the work of others in this emerging field of health disparities. It was a defining moment, and I could see how my clinical work would very easily inform the research questions that were bothering me about the care I was seeing that leads to poor outcomes among underserved populations—ethnic, racial, sexual minorities, for instance.

What are some examples of health inequities inherent in the country and in the U.S. health care system? What causes these disparities?

Well, that’s the enduring question. There are well-established social determinants of health that go beyond the health care context, things such as poverty, residential segregation, differences in opportunity based on socio-economic status that track by race and ethnicity, a whole range of things. Early childhood opportunities, in education for instance, are also powerful predictors of future health outcomes. We’re even learning about what happens in utero and how that can predict future health outcomes.

And of course there’s the gene-environment interaction as well, which still resonates with me, though I tend to put a bit more emphasis on environment. These are the things we mean when we talk about health disparities.

What do you think you can accomplish as a researcher to lessen health disparities?

Well, most of my work now happens with community partners and collaborators. It isn’t just the research result that can affect health outcomes; it’s also about the research process that can affect those social determinants of health – when we collaborate with communities and answer and address the questions that they feel are of most concern in their communities. This way, the work we do will be more relevant. We engage community collaborators based on their own expertise and understanding of their communities. This allows us to build capacity in those communities to continue doing research; it allows for dissemination of evidence-based interventions, rather than each church or community-based organization developing their own solution to a problem. They can actually have access to evidence-based interventions that they know work and can be adapted to their local context. It allows us to move discoveries more quickly into populations to improve health, just by that collaboration.

One example is Project GRACE. We work together with community leaders on HIV prevention and cardiovascular disease reduction. Now, we’re really pushing our interventions throughout the eastern part of North Carolina, where health disparities – according to race and ethnicity – have been well documented in a whole host of chronic illnesses.

As director of the new Center for Health Equity Research, what goals have you set and what do you hope the center can accomplish for underserved communities?

The UNC School of Medicine and the Department of Social Medicine have made a substantial investment in the center, and my goal is for it to be a catalyst for more of the research that can address health inequalities within our state. Also, I think it can attract new investigators for this work – either new investigators, in general, or experienced researchers who are now starting to look at health inequalities as part of their research. I want this center to be a place where they can find resources, services, and support to make a difference and to translate their discoveries into improved health in North Carolina.