Cancer is a nondiscriminatory disease — affecting people of all race, ethnicity, gender and religion — but for some populations, there are “barriers to being able to have the best quality of life possible,” says Monica Baskin, Ph.D., a professor in the School of Medicine Division of Preventive Medicine. Growing up in Atlanta, Baskin witnessed firsthand how difficult it was for many in her community to get the health care they needed.
Then, when her father died of colorectal cancer only a few months after diagnosis during Baskin’s senior year of high school, something in her sprang into action. Colorectal cancer is almost entirely preventable, she explained: With frequent and regular screenings, clinicians can locate and remove pre-cancerous polyps before they become malignant. Baskin says realizing that fact helped jumpstart a passion for better understanding and addressing health disparities that would eventually propel her into her career in preventive medicine at UAB.
“As a teenager, as a daddy’s girl, that was a fairly traumatic experience for me,” she said. “No one needs to die from colorectal cancer.”
Colorectal cancer and mortality rates are highest in black populations, according to the Colorectal Cancer Alliance (CCA). Between 2009-2013, colon cancer and rectal cancer incidence rates were around 20% higher for blacks than whites, and mortality rates in blacks are 40% higher than that of whites. The CCA also notes that incidence and mortality rates are higher across all populations in Deep South states such as Alabama, Mississippi and Louisiana. Baskin recognized those health disparities and saw them as an opportunity for change.
“We needed to come up with solutions — to make people aware and encourage them to apply an equity lens, to show people where to invest resources and target communities most in need.”
“At the core, I don’t want anyone else to lose their father so early in their lifetime,” Baskin said. “That drove me at the beginning to do the work I do today.”
Now, in her role at UAB, Baskin, who is also associate director of Community Outreach and Engagement at UAB's O'Neal Comprehensive Cancer Center, works to influence change in the field of health disparities action and research. A licensed psychologist, she uses research and community engagement to better understand and address social determinants of minority health and health disparities. She also is a tireless advocate for diversity and advancing health equity; she sits on multiple university committees devoted to these issues and is part of the inaugural Robert Wood Johnson Foundation Culture of Health Leaders Program. She also chairs both the Jefferson County Collaborative for Health Equity and the Jefferson County Health Action Partnership, which comprises more than 80 organizations and agencies working together to make the county a healthier place.
Her service work earned her the 2019 Odessa Woolfolk Community Service Award, which recognizes a faculty member who has rendered outstanding service to the Birmingham community in education, economic development, health care delivery, the arts, social services, human rights and urban and public affairs. Baskin will be recognized during the annual Faculty Convocation 4 p.m. Sept. 10 at the Hilton Birmingham at UAB.
The road to change
Baskin joined UAB faculty in 2003, intent on using her interest in community-based, participatory research to identify health care needs in Jefferson County and the surrounding areas. She began working with the Jefferson County Department of Health on the 2007 Community Roadmap to Health, which outlined a vision for a healthier Jefferson County, identified priority health concerns and set a new course for public policy.
“Early on, people weren’t willing to say that we had any disparities. They weren’t willing to say that place matters, that there are structural things that make it more challenging for some groups to access health care or to live a healthy lifestyle. People are not afraid to have these conversations now.”
As Baskin and others worked to create the Roadmap to Health document, she says it became obvious that certain people in Jefferson County had better health outcomes than others. She began mapping the population of Jefferson County — examining the racial and ethnic breakdowns of where people live when compared to health outcomes such as infant mortality and life expectancy. Together with leaders from the health department, the United Way of Central Alabama, the Community Foundation of Greater Birmingham and others, Baskin leads the Jefferson County Health Action Partnership (JCHAP), which works through community organizations, neighborhood coalitions and local advocates to support substantial improvement in the health behaviors and outcomes recognized as priority issues by Central Alabama residents. Baskin, along with colleagues from the health department, published their first Community Health Equity Report in 2013, and the JCHAP released the most recent in 2018.
“We took that report and thought it was the first step in terms of raising awareness [about health disparities] within the community,” Baskin said. “We needed to come up with solutions — to make people aware and encourage them to apply an equity lens, to show people where to invest resources and target communities most in need.”
Baskin’s involvement with the program dovetails nicely with her other work with the Robert Wood Johnson Foundation Culture of Health Leaders program, a three-year program that offers leadership development for leaders from all sectors and is based on evidence, informed by experience and grounded in principles of equity and social justice.
The Health Leaders program, Baskin says, focuses heavily on engaging the business sector in eradicating health disparities. Businesses want healthy employees, and there is significant economic loss when people reduce their productivity to care for a sick loved one or are sick themselves. Additionally, businesses looking to relocate or build in communities look for locations in which their workforce will be and stay healthy, which can lower a company’s out-of-pocket cost for employee health insurance.
“At the core, I don’t want anyone else to lose their father so early in their lifetime. That drove me at the beginning to do the work I do today.”
“We have to build cross-sector collaborations to have a real impact on the larger community,” Baskin said. “No one organization or agency can move the needle on social determinants of health; the health sector alone is not responsible for the health of a population. We need educational, business, community and faith-based investments. That’s what we had in mind for the Health Action Partnership.”
It’s this collective-impact model that Baskin says is the most crucial point in changing health outcomes for under-served populations in Jefferson County.
“In some ways, it’s like pushing a boulder uphill,” Baskin said. “Multiple people and organizations with lots of strengths and power and influence can help to make that happen — things like the Health Action Partnership, UAB’s Grand Challenge and other groups in and around Birmingham that see this as important.”
In the 16 years since Baskin started at UAB, she says she has seen promising growth in the way that people talk about and acknowledge the existence of health disparities. That honesty, she continues, is key in affecting real change, and documents such as the Roadmap to Health and Community Health Equity Reports are providing the data they need to start valuable conversations.“Early on, people weren’t willing to say that we had any disparities,” Baskin said. “They weren’t willing to say that place matters, that there are structural things that make it more challenging for some groups to access health care or to live a healthy lifestyle. People are not afraid to have these conversations now.”