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A Broad Umbrella

New Institute Tackles Complex Issue of Health Disparities

Population projections for the South Texas region verge on overwhelming. By 2040, the State Demographer’s office says, there will be 6 to 8 million people living in the 43-county area between San Antonio and the Mexican border that UTSA serves. Seventy percent or more of these people will be Latino, African American or Asian.

And, if current trends continue, many of them will have different, often poorer, health outcomes than the country’s Caucasian majority. This will give rise to a serious public health problem for Texas and for the nation.

Today, most ethnic minorities are less likely to see a doctor regularly. Many groups are more likely to suffer chronic health conditions, such as obesity and diabetes. Often, they are at greater risk for having low-birth-weight babies. These and other health disparities arise from a complex interaction of social and biological factors, including economic, educational and social status; access to health-promoting and health care resources; genetic predisposition; and cultural values.

Those realities have given rise to one of the newest institutes at UTSA – the Institute for Health Disparities Research, where scientists from different disciplines can collaborate and find administrative support for research into underlying factors that contribute to differing health outcomes for different ethnic and social groups.

Thankam Sunil, associate professor of sociology and an experienced researcher in areas of maternal, infant and adolescent health, heads the institute.

Scientists and public policy analysts have recognized for years that health disparities exist, but these perplexing issues persist despite efforts to resolve them, Sunil said.

“They are still out there and they are still growing. Even though we have known for a long time that there are disparities, we still don’t have a clear understanding of how to tackle the situation,” Sunil said.

It is no longer enough, he said, to explain away a minority group’s worse health outcomes by blaming poverty. The reasons are complex, and thorough study is important to the development of effective public policy and public health programs, Sunil said. UTSA’s Institute for Health Disparities Research is an umbrella that offers scientists from different fields, including sociology, anthropology, biology and even engineering, a forum where they can converse with each other and collaborate on multidisciplinary research.

“This institute is trying to integrate basic biomedical and behavioral sciences to understand how health disparities occur and how best to address them,” Sunil said.

Sunil’s own research looks at a multitude of social issues involving family, child and adolescent health, including the issue of how to address the persistent problem of low-birth-weight babies in South Texas.

He is collaborating with Jill Fleuriet, an associate professor of anthropology at UTSA, to examine how uninsured immigrant women deal with pregnancy and prenatal care. Even though it might seem that the odds are against them, recent immigrants from Mexico actually tend to have healthy weight babies. But as they stay in the United States, they tend to have babies with low birth weight. Babies that are too small at birth often face myriad health and developmental issues that can persist throughout life. It is a significant problem among low-income and poorly educated minority women all across the United States.

“Most low-birth-weight babies can be explained by the traditional risk factors. But risk factors of low income, lack of prenatal care, and low levels of formal education do not apply as much to new immigrants from Mexico. We have to look at the social and cultural contexts for the reasons that Mexican immigrant women have healthier babies,” she said.

She and Sunil are collaborating with agencies and clinics in the Rio Grande border region with in-depth surveys and observations in the effort to understand what is happening.

“As they live here longer, the birth weights deteriorate,” Sunil said. “For some reason, the environment here is not conducive to good maternal health. We need to understand that. Why are we losing the protective measures that the immigrants bring with them?”

Health disparities also arise because of biological differences. William Haskins, assistant professor of research [WEH] and Director of the RCMI Proteomics & Protein Biomarkers Cores in the College of Sciences, said the new institute gives biomedical researchers like him more leverage to work at understanding these differences. Federal funding agencies have special initiatives for minority health issues, and UTSA’s new institute gives scientists a way to seek financial support for their research, he said.

Haskins, an expert in proteomics, or the large-scale study of proteins, contributes his biomedical expertise and perspective to the health disparities initiative. His research involves examining differences in responses to cancer. An emerging trend in this field is to look at groups of genes and evaluate how various forms of these genes express themselves as RNA and/ or proteins in cancerous tissues. These gene expression panels are being tested with different forms of cancer. Doctors are using them to guide treatment decisions for individual patients and to understand why some tumors are more aggressive and dangerous than others.

Three years ago, specialists in childhood leukemia published a study that looked at 38 different genes that produce RNA, or the message- encoding proteins that help other genes work properly. They found that the RNA levels could be used to predict how well individual patients responded to standard treatment for high-risk childhood leukemia.

“What the study showed is that a quarter of the kids with the worst outcomes were Hispanic/ Latino,” said Haskins. “With this form of leukemia, they are finding that children with genes from Native American ancestors are [also] more likely to have a worse outcome. What this says is that clearly there are biological changes that are linked to health disparities.”

Haskins is now working with several regional children’s hospitals to understand the genes and the proteins they produce. In turn, these correlative biology studies enable scientists, doctors and engineers to design new drugs that can target specific proteins.

“By studying proteins we can potentially identify new drug targets,” he said.

Sunil noted that the institute offers a broad umbrella where researchers with different interests, such as himself and Haskins, can find financial support and shared resources, even though they are looking at different pieces of the health disparities issue.

“We think this multidisciplinary approach will bring us new knowledge, along with new approaches to public policy and significant, high-impact technological developments,” he said.

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