Dying to be Screened: Exploring the Unequal Burden of Head and Neck Cancer in Health Provider Shortage Areas.

Multiple factors contribute to disparities in head and neck cancer prevalence across the sociodemographic spectrum, including a lack of screening efforts in mostly underserved minority communities. African Americans and other ethnic minorities are at greater risk for late-stage diagnoses due to the lack of routine screenings and examinations. Advanced stage diagnosis profoundly limits treatment options, disease recovery, and survivorship. Differential access to care is frequently cited as contributing to delayed diagnosis in minority patients. Access to care is a complex concept that includes not only insurance status but also the equitable spatial distribution of health-care services. Recognizing this complexity, we explored the distribution of head and neck cancer cases seen at Grady Health System from 2010 to 2012 in order to identify geographic trends in disease prevalence compared to the distribution of oral health-care providers at the zip code level. We identified 53 cases of head and neck cancer spread across 36 zip codes primarily in the metropolitan Atlanta region. Geographic information systems analysis showed a spatial mismatch: increased disease prevalence and provider shortage in the mostly minority zip codes, and decreased disease prevalence and greater provider presence in the majority zip codes.

Exploring Persistent Racial and Ethnic Representation Disparity in U.S. Geography Doctoral Programs: The Disciplinary Underrepresentation Gap.

Underrepresentation among U.S. citizen racial and ethnic minorities in geography has a long history, one perpetuated through-and readily measurable by-its doctoral degree-granting record. This article examines the history of efforts to redress underrepresentation since the 1960s, explores modern underrepresentation, measures the degree of its persistence in the discipline and within individual departments, and identifies drivers that exacerbate the racial and ethnic representation disparity among U.S. citizens in geography doctoral programs. To quantify the degree to which the discipline is underperforming demographically, we contrasted the rate of domestic underrepresented minority doctoral degree conferrals with those of White doctoral recipients in geography, the social sciences, and the entire academy over a twenty-three-year period from 1997 through 2019. During that span, geography consistently trailed the social sciences and the academy: This underrepresentation gap has widened in the past decade. Four drivers were identified: (1) lack of dedicated funding for underrepresented minority doctoral students, (2) minimal prior exposure to academic and professional geography, (3) passive recruitment strategies, and (4) pervasive Whiteness of departments. We conclude with a call to action for geographers to meet the moral imperative of racial and ethnic representational equity by becoming agents of measurable change.

The Advancing Geography Through Diversity Program: A Framework to Address the Persistent Underrepresentation of Domestic Racial and Ethnic Minorities in U.S. Geography Doctoral Programs.

Domestic racial and ethnic minorities have been persistently underrepresented in U.S. geography doctoral programs. Efforts to improve diversity have taken many forms over the years, but most have been short-lived with limited success. In this article, we introduce the Advancing Geography Through Diversity Program (AGTDP), a four-pronged cohort-based model that systematically and sustainably increases the presence of African Americans, Hispanic Americans, and Native Americans in geography doctoral programs. The program is currently in its fourth year in the Department of Geography, Environment, and Spatial Sciences at Michigan State University. Context for the development of the framework is provided, followed by a detailed discussion of each pillar of the program: recruitment, support, engagement, and retention. We evaluate the current state of the program along with lessons learned for successful implementation. To date, the program has effectively increased the representation across all three underrepresented groups within the department's doctoral program. We believe the AGTDP can serve as a model for more widespread deployment to other geography departments.

Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar.

There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.

Neonatal mortality in East Africa and West Africa: a geographic analysis of district-level demographic and health survey data.

Under-five child mortality declined 47% since 2000 following the implementation of the United Nation's (UN) Millennium Development Goals. To further reduce under-five child mortality, the UN's Sustainable Development Goals (SDGs) will focus on interventions to address neonatal mortality, a major contributor of under-five mortality. The African region has the highest neonatal mortality rate (28.0 per 1000 live births), followed by that of the Eastern Mediterranean (26.6) and South-East Asia (24.3). This study used the Demographic and Health Survey Birth Recode data (http://dhsprogram.com/data/File-Types-and-Names.cfm) to identify high-risk districts and countries for neonatal mortality in two sub-regions of Africa - East Africa and West Africa. Geographically weighted Poisson regression models were estimated to capture the spatially varying relationships between neonatal mortality and dimensions of potential need i) care around the time of delivery, ii) maternal education, and iii) women's empowerment. In East Africa, neonatal mortality was significantly associated with home births, mothers without an education and mothers whose husbands decided on contraceptive practices, controlling for rural residency. In West Africa, neonatal mortality was also significantly associated with home births, mothers with a primary education and mothers who did not want or plan their last child. Importantly, neonatal mortality associated with home deliveries were explained by maternal exposure to unprotected water sources in East Africa and older maternal age and female sex of infants in West Africa. Future SDG-interventions may target these dimensions of need in priority high-risk districts and countries, to further reduce the burden of neonatal mortality in Africa.