From left: Cynthera McNeil, Umeika Stephens and Tara Walker, health professionals and professors at Wayne State University, are the authors of Urban Health: A Practical Application for Clinical Based Learning. – Courtesy photo

(The Dallas Examiner) – Black communities are said to be disproportionately affected by COVID-19 across the U.S. with social determinants of health as a main factor that contributes to the disparities. Umeika Stephens, Cynthera McNeil and Tara Walker, professors at Wayne State University, wrote a peer-reviewed textbook Urban Health: A Practical Application for Clinical Based Learning. The book reveals these disparities and proposes some solutions to the issue.

Along with their careers in academia, Stephens is also a psychiatric nurse practitioner and family nurse practitioner; McNeil is an internal medicine provider in one of the city’s urban hospitals; and Walker is an acute care nurse practitioner at Ben Harper Hospital in the same city.

In reflecting on the years since the beginning of the COVID-19 pandemic, the professors expressed an initial surprise that the disparity was still as evident amidst a global crisis.

“It’s interesting to me. I am always shocked and surprised that a disparate community would have worse outcomes related to something like COVID,” Stephens said.

“This pandemic, while it impacted us from a health care perspective, it has so many other social ramifications as we look at just how people of color in general are treated within health care systems. And so, I think it highlighted a problem that we already knew was there. We talked a lot about social determinants of health and things like that. Those are not new concepts. They were not new concepts at the time that the COVID pandemic hit. I think that what it showed was a very significant, huge flaw in our health care system and provided probably the most singular evidence that we have had in a long time to show the difference of how African Americans and people of color are treated and our outcomes overall in health care.”

As professors, they have shared this knowledge with their students, who are future medical professionals.

“I tried to teach students about social determinants of health and how future providers have to be cognizant of other factors that impact the health and the health outcomes of underserved specifically earned urban populations,” McNeil said.

She went on to say that COVID-19 put a spotlight on areas of the health care system that have not worked well. Throughout time, the communities that have suffered the most have been those that were struggling in other areas. As someone in academia, she looked at how future providers should be taught based on the knowledge of the well-documented disparities.

“The disparity is talked about all the time, the statistics that talk about you know, low income low socio-economic status, low education level, poverty, the statistics talk about how disease is more prominent in these particular communities that also suffer from social determinants of health barriers. All of that’s already well documented. But what wasn’t documented was: how do we as providers that are supposed to be helping individuals, improve their health or maintain their health? And when COVID came in it really further highlighted the disparity that was already there and allowed for a platform to really highlight the disparities in the health care system from all sectors. And then the result of this disjointed health care system on underserved populations. So my role as the educator is how am I going to train future providers to be able to be equipped to navigate and to help the patients improve their health outcomes in the midst of all of these disparities?”

With the knowledge that the systemic issues existed across the country, they felt a good step in finding solutions on a wider scale was to document their journeys through the health care system as nurses, academics and providers and offer insight for improving the health care system.

“Well, the first solution was writing a textbook that would teach practical skills to providers that do not have a lived experience in working with minority populations or underserved populations or urban populations,” McNeil said. “I think people take for granted that working in urban communities is a skill, the way that you have to borrow and negotiate for things that should be a standard of care.”

The professors asserted the textbook can be beneficial to everyone but specifically improve the provider-patient relationship.

“Our attempt was to improve the patient-provider relationship to better train providers to understand the lived experiences of patients. Because in this particular moment, we have to work with the patients where they are,” McNeil said.

“So, our book and our perspective is really about the here and now and the lived experience. While we wait and try to make a change on Capitol Hill, legislation and all that type of stuff, people are living their day-to-day lives and that’s kind of where we would want to have the impact.”

The book covers learning how to network and make interprofessional collaborations to help patients, such as getting uninsured patients the health care and services they deserve. Since medical guidelines been outlined based off a resource rich mindset, experience has revealed to them that adjustments must be made to make the guidelines meaningful to the lives of patients in underserved communities, according to the authors.

Additionally, the book was intentionally written in a non-technical conversational style to be utilized by different professions, including but not limited to other medical areas, social work, any area that focuses how to interact with disparate communities. Various professions can use it as a starting point or a foundational piece to open dialogues about critical issues and have those serious conversations acknowledging the lived experience of patients in communities that lack proper resources and how to care for them.

The authors wanted to ensure the book was easily accessible. It is available as a free download at

As of Wednesday, the textbook had been downloaded by 24 universities and educational institutions, plus one library and 21 health establishments and other businesses. In total, it has been downloaded 733 times and in 59 countries.

Robyn H. Jimenez/The Dallas Examiner contributed to this report.

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