Advancing Health Equity Across the Lifespan
Author(s)
GSSW
Communication Team
Brave Idea: GSSW Assistant Professor Tyrone Hamler focuses his research on health inequities, chronic illness, aging and the intersection of mental and physical health. He has a particular interest in understanding and addressing health disparities in chronic kidney disease and exploring aftercare services and donor family experiences in organ procurement organizations. Professor Hamler is a faculty affiliate in the University of Denver Knoebel Institute for Healthy Aging, serves as vice chair of the Gerontological Society of America Minority Issues in Gerontology Advisory Panel and is a member of the editorial board of the Journal of Nephrology Social Work.
Resources:
Prof. Tyrone Hamler studies health equity in kidney disease for older Black Americans
Enacting Antiracist Practices in Research through Healing-Centered Engagement
Transcript:
Dean McCoy:
Hello, I am Professor Henrika McCoy, dean of the University of Denver Graduate School of Social Work. Welcome to Episode 21 of our Brave Ideas for Social Change podcast series, which draws on GSSW expertise for fast moving discussions on emerging research practice and policy innovations that will spur social change. Today’s guest is GSSW Assistant Professor Tyrone Hamler, who also is a faculty affiliate of DU’s Knoebel Institute for Healthy Aging. Dr. Hamler’s research is focused on health inequities, chronic illness, aging, and the intersection of mental and physical health. He has a particular interest in understanding and addressing health disparities in chronic kidney disease, as well as developing aftercare services in organ procurement organizations. Notably, Dr. Hamler serves as vice chair of the Gerontological Society of America’s Minority Issues in Gerontology Advisory Panel, and he’s on the editorial board of the Journal of Nephrology Social Work. Dr. Hamler, thank you so much for sharing your research with us today.
Professor Hamler:
Yes, thank you for having me.
Dean McCoy:
So your research is focused on a particularly challenging aspect of life: aging, illness and death. How did you develop your interests in focusing on people who are navigating those life stages or experiencing such overwhelming outcomes?
Professor Hamler:
I think for me, my interest came from seeing folks in my family navigate the aging process and the resources that were available, and some of the resources that were unavailable, just for my own family. My experience also in the field working in social work, just seeing the lack of services for folks, but also seeing needs in areas where I really think that older adults needed to be really thought about. And that is what drove me to really look at this area, and I’ve always had a lot of reverence for older adults in general and the wisdom and knowledge they have. So I think it fit pretty well with just my own personal beliefs, too.
Dean McCoy:
Okay. So your research agenda really centers health equity. What are the types of equity issues that you explore in your own work in particular?
Professor Hamler:
I wish I could say that there were not so many areas and things to be looking at, but there are a lot of important equity issues that are in health right now that are really timely and important just for us in general. So the things I’m interested in are mental and physical health disparities. I’m looking at things like depression, anxiety. I’m also interested in how folks navigate coping with chronic illness and some of the stress and coping that comes up for folks in their lives from middle age to older age as they’re sort of living and how those things manifest themselves later on in people’s lives.
Dean McCoy:
Okay. So would you please discuss how kidney disease is the leading health threat in the United States? And of course, it’s one of your specific research interests. So, the CDC estimates that more than one in seven U.S. adults have chronic kidney disease, which directly affects more than 35.5 million Americans. Notably, kidney disease is more prevalent among older adults and Black adults. Would you share with our listeners the magnitude of this chronic illness and how it impacts the individual who is navigating kidney disease as well as their family and their larger community?
Professor Hamler:
Yeah. I also want to say that just over 500,000 people are on dialysis in the United States. So this is a huge emerging health problem and chronic kidney disease, unfortunately, is not going away. A lot of my work focuses on yes, highlighting the disease, telling folks what it is and some of the problems that come along with being diagnosed with CKD (chronic kidney disease). But I also am interested in those conditions that are antecedents to CKD and their prevalence. Those are things like high blood pressure, diabetes, which also impact older adults and particularly Black older adults much more than other groups.
Dean McCoy:
I think anyone that drives to a Black neighborhood will see the increase in dramatic number of centers where people go and get dialysis care. Do you think that that will continue to be an upswing? I mean, it’s really noticeable. You can drive through a neighborhood, and you see one every five blocks out of nowhere, which to me feels like a very new phenomena compared to maybe 10 years ago.
Professor Hamler:
Yeah, I think that dialysis unit is, most of them are for-profit. There are some that are nonprofit, and they have to go where their customer base is unfortunately. And so for us, we’re going to see more of those units concentrated in our areas because that’s where people are, that’s where the need is. Folks are needing to be at a facility. For reference [as] a social worker, When I worked in the field, I was one social worker for 116 people. A clinic usually has about anywhere between 60 to a hundred people normally. So imagine you go to a neighborhood and you see three clinics, you can pretty much guarantee there’s about 240 to 300 folks being treated, individuals who are being treated for dialysis in that space. So yes, I think that the need is going to stay there because right now the number of diabetes and high blood pressure, which are the most two common antecedents, they’re not decreasing, they’re increasing. And I think there’s various reasons for that, but I think we’re going to see an increase in CKD.
Dean McCoy:
Wow. So you recently published several articles related to kidney disease, including one in the prestigious American Journal of Kidney Diseases. Would you please tell us more about your research and your specific findings?
Professor Hamler:
Yes. First, that was definitely a labor of love that I did with my colleague Dr. Tiffany Washington at the University of Tennessee, who was … one of my mentors in this area. What we were looking at is recommendations for social connectedness, and that’s for folks who were on dialysis. And we were looking at that in light of everything that had changed with the COVID-19 pandemic. Folks were on dialysis. In some ways, they have a natural built-in social network with the folks that they go to the clinic with the clinic staff, so like nurses, physicians, dialysis, patient care techs, folks that they see every day. But we wanted to explore how we could help folks who are in the industry think about how to decrease things like social isolation. So we provided … a couple recommendations of some measures that have been tested and improved into the research and looking at … ways to keep people socially connected during these really, really difficult times.
Dean McCoy:
So you’ve also examined the impact of having kidney disease on the decision-making of older Black Americans. What have you found?
Professor Hamler:
Yes, decision-making was really my entry into the kidney disease world. I was really interested in the decision-making process because there are so many points when you’re diagnosed with kidney disease. So it’s staged similar to cancer, Stage 1 through 5, with 5 being much more severity and disease. And so when folks are Stage 1 through 3, typically the interventions are, they’re primarily medical. Okay, change your diet, we’re going to supplement your medications, things like that, increase your meds, decrease certain meds, etcetera. But once you get past Stage 3, there’s 3A and then 3B, and then there’s 4 and 5. And once you get to those stages of chronic kidney disease, a lot of more intense decision-making starts particularly. You have to start thinking about, okay, am I going to do dialysis? Am I going to try to pursue a kidney transplant? What am I going to do right now? Or am I going to maybe pursue palliative care or conservative care? And conservative care may mean staying on medications but not doing dialysis. And then there’s different types of dialysis. So all of those decisions were in my head remembering being a social worker. And I really wanted to research some of the science behind why folks make certain choices when they make choices. Are there disparities or differences when people are presented these choices based on their identity?
Dean McCoy:
Wow, that’s really interesting. So you’ve also previously mentioned that a goal of your work is to improve patient outcomes to better patient care at all stages of kidney disease. So obviously we hope to prevent kidney disease or at least slow the progression. However, you’re also looking at the later stages that you just talked about, including kidney transplantation. So what [have] you been finding?
Professor Hamler:
Well, I agree that my goal would be, of course, the eradication of CKD and not having folks end up on dialysis. That’s what I would love, but I know what’s realistic probably is to try to decrease the amount of folks who end up getting to Stage 4 and Stage 5 CKD. The outcomes that I’ve been interested in looking at are things that have been shown to impact and influence how folks make decisions. So things like mental health outcomes like depression and anxiety. But even most recently, I’ve been looking at health related social needs, and … the social determinants of health. Sometimes in the literature they’re referred [to] as health-related social needs. For one of my most recent studies, I’m looking at health related social needs among the dialysis population and addressing those things I think are modifiable things where a social work intervention actually could be really effective and can impact folks being able to access care, get their medicine, things like that.
Dean McCoy:
Okay. So you’ve been very clear that health equity is how you approach social justice, thus you’re advancing justice through your research while also helping to advance anti-racist and anti-oppressive research methods. So please tell us a little bit more.
Professor Hamler:
Yeah, for me, that’s a strong part of my, I think my professional identity, both as a practitioner and now as a researcher. And I use my experience in the field to really inform the work that I do and to help me connect with community partners and communities as I do this work. So being outwardly anti-racist and outwardly anti-oppressive is important to me. It’s important to how I look at framing and in doing the work all the way from the conceptualization of the work to thinking about research questions to the methods I’m going to use to how I engage with folks who are helping with the research, the participants themselves, maybe my community partners, but then also through dissemination. I want to do that in ways that are equitable, that are accessible, and to decode some of the research jargon that folks get. Yes, I have to speak in that sort of jargon for journal articles. We have to do that, that’s our language. But I also want to decode that if necessary for folks [so] the findings and things can be accessible to the everyday person. So that’s a big part of how I look at things. And I think anti-racism sort of undergirds that whole perspective.
Dean McCoy:
Well, I know that you’re certainly doing that in terms of being engaged and doing community work, so I appreciate that. I think many of our listeners will. So I also know that this is a really difficult time to be a scholar who is focused on issues of equity and justice due to many changes at the federal level, and really a growing trend that dismisses long and accepted systemic and structural injustices in our society. We have also a time in our society that is dismissing science … For our listeners who are not in academia, what are some of the challenges facing scholars like yourself, particularly for those who, in your case, you’re still untenured or an assistant professor? For our listeners that may not understand that?
Professor Hamler:
Yeah, that’s a difficult question, but my perspective is that it is. There are a lot of attacks and from a lot of different angles. So, if you ask me about my personal experience being a Black man in academia, I think it is a really hard time right now being untenured. It’s uncertain, right? But I feel like in uncertainty … sometimes it’s opportunity. And one thing that I think that we have to do as scholars, as faculty members, is we will sometimes have to be brave. There are times where we are going to have to toe the line on difficult issues, and we’re going to have to maybe navigate that space. But being brave and also adhering to the underlying social work code of ethics, and some of those principles like dignity and worth of a person, those are all things that I think should guide what we are doing with our students and with our research.
But it is a hard time. And the thing that I think that we need the most, other than just support, just even the instrumental support of people checking in, that’s helpful. But the material resources, and where those have been allocated have also changed since things have changed nationally. So many of the grants that were out there that were looking at things like diversity and equity and inclusion, those don’t exist anymore. So many researchers like myself, we’re going to find other sources and other ways to get grant funding, whether that’s working with foundations, whether that’s working with community agencies. But you have to think, if you look at the broader picture, that’s what everyone is doing as well. Everyone knows that they’ve got to go to the foundations and they’ve got to really talk to and work with folks. So how to help us is if there are ways to really put us in contact with folks who are interested in the advancing of, and particularly social science, which is what we do, that would be something that would be helpful and things that people could do. We’re going to be here and we’re going to continue to fight, and we’re going to continue to put social justice … first.
Dean McCoy:
So it sounds really like your message to many young scholars … is to continue to look for ways to continue to do the work that is needed. And for academic institutions like ours that is in the middle of a capital campaign, for people to understand that the reason for campaigns like that are because there is a loss of federal resources …
Professor Hamler:
Right.
Dean McCoy:
And there is a need to find private philanthropy to be able to fund the work that needs to continue to happen, because we can’t look to those federal resources to do it. But that universities can be able to garner their own support from individuals who care about moving that forward and to be able to do that. And so philanthropists have a role to play. Researchers have a role to play, scholars have a role to play. The everyday person has a role to play, and that’s really important for all of us to galvanize, to be able to move forward science.
Professor Hamler:
Yes.
Dean McCoy:
So, I would ask if you would perhaps leave our listeners with a call to action, how do you think they can join work to advance health equity?
Professor Hamler:
Yes. So for me, it is, stay alert, stay active, keep yourself informed of what’s going on, because the laws and the changes are fast paced. There [are] changes every day. There [are] new laws and new proposals every day. Part of my job, I feel like, is to have not a handle on everything, but to know a good amount of those things. And I think also as a private citizen, I feel the same way. So for people listening, I would say read, advocate, trust your judgment, and keep in the fight because we need you.
Dean McCoy:
Well, Dr. Hamler, thank you for those inspiring words, and thank you for sharing your research with us.
Professor Hamler:
Thank you.
Dean McCoy:
So to everyone listening, thanks for taking the time to learn about such an important topic. Please subscribe to our Brave Ideas for Social Change podcasts for more conversations like this one. You can learn more at socialwork.du.edu/change.
