Health Equity Championby Nora Dunne | photography by Teresa Crawford
Melissa Simon is on a mission to reduce health disparities in every sector, from education to research to clinical care.
When Melissa Simon, MD, MPH, ’06 GME, was an undergraduate in college, her first advisor told her she didn’t have a “rat’s chance in hell of getting into medical school.”
She had grown up in an impoverished neighborhood of Detroit — “in the bottom 1 percent,” she says. And she had no connections — didn’t know any doctors, for example, except her own pediatrician back home.
But it goes without saying that Simon proved her advisor wrong.
As a kid, she earned a scholarship to a private school outside of Detroit. The only student there from a low socioeconomic background, she witnessed from an early age the stark contrast between the haves and have-nots. But she received a top-notch education, was admitted to the University of Chicago and moved to the new city, sight unseen.
Disregarding naysayers — and her own fears that she did not belong — Simon went on to earn a master’s degree in public health at the University of Illinois at Chicago and a medical degree at Rush Medical College. After residency at Yale University, she came to Northwestern for a fellowship in family planning, and she never left. Almost 15 years later, she is not only a physician; she is a scientist, educator and fierce advocate for health equity.
“I saw my family members struggle to get access to the healthcare they needed,” says Simon, the George H. Gardner, MD, Professor of Clinical Gynecology and the founding director of Feinberg’s new Center for Health Equity Transformation. “Today, everything I do, every sector I cross, is about finding ways to improve health and healthcare delivery so that all types of people, from all types of backgrounds, can achieve the health that they want.”
“We can’t do ‘business as usual’ if we are going to advance health equity and transform our city’s and country’s health.”
THINKING OUTSIDE OF THE BOX
Much of Simon’s work revolves around understanding and revising the underlying structures that perpetuate healthcare inequities.
“So many things intersect with health: housing, physical activity spaces, exposure to violence, food availability, transportation, education opportunities,” Simon explains. “We need to really think about how we can design healthcare delivery while acknowledging and incorporating those factors.”
Simon has done just that in her work developing patient navigation programs across Chicagoland. West of the city in DuPage county, for instance, she found that uninsured Spanish-speaking women were at risk for stalled follow-up care after receiving an abnormal breast or cervical cancer screening result compared to English-speaking patients. Delays can lead to less effective treatment and lower chances of survival. Personal barriers like low income, low health literacy and distrust in the healthcare system played a role in the disparity, but so did external structures.
“We mapped the public transportation routes and the health and human services organizations across the county — they did not match,” Simon says. “DuPage doesn’t have the same infrastructure or public health safety net that we have in the city — there is no public hospital, for instance. Suburbs have not been designed to be accessible to poor people, yet they are the areas where many new immigrants and those from lower socioeconomic backgrounds go.”
In addition to leading the new Center for Health Equity Transformation, Simon serves as vice chair for clinical research in the Department of Obstetrics and Gynecology and as a professor in the Departments of Preventive Medicine and Medical Social Sciences. She is also co-leader of the Cancer Control and Survivorship Research Program and the Community Engagement and Outreach Program at the Lurie Cancer Center.
Simon’s team trained bilingual patient navigators to help these women obtain timely follow-up care after receiving an abnormal test result. Navigators made appointments, provided interpreter services and referred patients to community resources like transportation and legal counseling. With a navigator’s emotional and logistical support, disparities in follow-up care disappeared. Simon directs similar programs in Chicago’s Chinatown and South Side neighborhoods, and downstate in rural Illinois.
“In all of these projects, we’re thinking about how we can design healthcare delivery around the needs of different patient populations so they can have good experiences and outcomes,” Simon says. “The goal is to lift everyone towards health.”
She says one key to improving healthcare for traditionally underserved patient populations is getting them involved in research — as participants in studies, but also as partners who inform research questions, study design and data analysis and dissemination. Her team is currently collaborating with the Chicago Public Library to raise awareness of clinical trials across demographic groups typically underrepresented in trials.
“The data we extract out of research is only relevant to the people who participated, or the people whose biological specimens were studied,” she says. “This is part of the reason we see disparities between populations.”
For example, in 2007, Simon was part of a team that set out to understand why the death rate from breast cancer was 68 percent higher for black women in Chicago compared to white women. They created the Metropolitan Chicago Breast Cancer Task Force to study the data and talk to stakeholders — women in the community — and learned that African-American women faced barriers to obtaining breast cancer screenings and access to imaging specialists to have their mammograms interpreted. The task force’s research and advocacy led Illinois legislators to pass a new, one-of-a-kind law in 2015 establishing a standard level of breast care for all women in Illinois.
“The breast cancer death rate is now closer to 40 percent — we’ve contributed to closing the gap between black and white women’s mortality,” says Simon.
One of the structures Simon feels most passionately about is education — specifically, making sure that young people from underrepresented and nontraditional backgrounds can succeed in the field of healthcare.
“Growing up, I was surrounded by a loving family, but I didn’t have that roadmap ahead of me that I’m able to so well articulate for my four children now,” Simon says. “I was very lucky: I was the beneficiary of philanthropy that funded me through 12 years of private prep school and then college. Without that investment, I don’t know where I would be today.”
To improve diversity in the healthcare workforce, Simon designed a massive open online course called Career 911 that shares strategies and stories to convey to students that a career in medicine and healthcare is attainable. Launched in 2015, the course has supplemented curricula at Chicago Public Schools and academic enrichment programs like the local chapter of GEAR UP, a national organization funded by the U.S. Department of Education to give low-income students exposure to higher education.
“One of my goals in life is to impart as much social capital to as many people as possible, especially people who would not have had such an opportunity otherwise,” Simon says.
She also runs a research fellowship program through the Chicago Cancer Health Equity Collaborative, funded by a National Cancer Institute grant to the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Simon founded the initiative with the University of Illinois at Chicago (UIC) and Northeastern Illinois University (NEIU) to build bridges between Chicago universities that aim to reduce cancer disparities in Chicago’s low-income neighborhoods.
“We designed the fellowship program to break down the usual silos that exist across institutions,” she explains. “We have Northwestern undergrads working with UIC, NEIU and Chicago City College students in an intensive research training program for health equity. All the students, regardless of their institution and background, have something to contribute to each other’s learning. Ultimately, we create a stronger community of colleagues that will move forward together.”
INTERSECTIONS WITH HEALTH
Simon’s work addresses the many factors that underlie health — and perpetuate healthcare inequities.
VOICES ON THE GROUND
Simon says that she has “grown up with Northwestern” during her nearly 13 years on Feinberg’s faculty, as both she and the institution have solidified a focus on community engagement and outreach. The Center for Health Equity Transformation, a joint center between the Lurie Cancer Center and the medical school’s Institute for Public Health and Medicine, is a natural progression of their work: a hub for students, faculty and staff to work together to build research infrastructure, advance workforce development and collaborate with community partners.
“This center is not window dressing — it is a visible commitment from Northwestern to work side-by-side with community members to try to transform some of the deeply ingrained inequities that exist in this city,” Simon says.
While Simon’s research and training programs are already making a difference to community members on both micro and macro levels, she is also helping individual patients and entire populations through her clinical activities. Every Tuesday, Simon works as an attending physician in obstetrics and gynecology at the Prentice Ambulatory Care (PAC) clinic, providing perinatal care to low-income patients who are uninsured or on public aid. And as a member of the U.S. Preventive Services Task Force, she makes recommendations on clinical services spanning from screenings to counseling to medications for primary care clinicians and their patients across the country.
In the PAC clinic, her team is interviewing women about their experiences with violence, trauma and other social factors that impinge on health and the receipt of healthcare. On the task force, meanwhile, she advocates to have more community members review the group’s recommendation statements to ensure they are appropriate for all the diverse populations of the United States.
“Community members are integrated into everything I do,” Simon says. “It’s important to me to have that ground-level voice at every table.”
Despite all of her efforts and successes so far, she insists: “We’ve only scratched the surface. Even if you pick just one disease state or one population or even one community area of the 77 in Chicago, there’s so much work still to be done.”
Listen to an episode of the Breakthroughs podcast featuring Simon.