‘Chipping Away’ at the Iceberg of Health Disparities

When the goal for your life’s work involves eradicating diabetes or eliminating the world’s health disparities, it can be tough to know whether any given day in the office, classroom or lab was a success.

For Kelly Palmer, PhD, an assistant professor in the University of Arizona Mel and Enid Zuckerman College of Public Health, knowing she is part of a larger cause keeps her motivated.

“I feel like it’s a big iceberg, and we're just chipping away,” Dr. Palmer said, adding that every chip she makes is one less for a future scientist to make.

Dr. Palmer was appointed to the College of Public Health’s faculty in January 2022, just weeks after graduating from the college with her doctorate. Her research focuses on diseases that disproportionately affect Black people, especially Black women. Among them are diabetes, heart failure, obesity and cancer.

Even though Dr. Palmer isn’t a medical doctor – the career she envisioned as a child – her work today is still centered on the life mission she decided on when she was young: to help people live healthy, happy lives. In fact, Dr. Palmer said, a career in public health may help her bring health and happiness to even more people than she could have as a physician.

“No matter where I go, I may not directly see patients getting healthier, but knowing that maybe one day policies will change based off the work that I’ve done, that is going to have an impact, and it’s going to impact more people,” Dr. Palmer said. “I just have to hope and trust that’s going to happen.”

Same destination, different path

Growing up in Akron, Ohio, Dr. Palmer dove into science early as she set her sights on becoming a doctor.

When she was 12, Dr. Palmer’s sixth-grade teacher helped her apply for a scholarship program through the Department of Education. The program’s activities required a six-year commitment from Dr. Palmer until she graduated high school. If she completed the program, she would receive a scholarship to the University of Akron.

Dr. Palmer received the scholarship and went on to earn undergraduate degrees in microbiology and natural sciences from the University of Akron.

After graduating in 2005, Dr. Palmer moved to Washington, D.C., and began working in a biodefense research lab while she studied for the Medical College Admission Test. She entered graduate school in 2012 at Indiana University – Purdue University Indianapolis (IUPUI), where she intended to eventually enroll in medical school. But Dr. Palmer struggled with the MCAT and began to wonder whether a career in medicine was the right choice.

She got a nudge to go in a different direction while working in a diabetes research lab at IUPUI. Despite being in the university’s School of Medicine, the lab was largely focused on public health, Dr. Palmer said. She got hooked.

“I just really fell in love with the work, with the lifestyle interventions, working with the community partners, and the implications for the work, like reducing diabetes prevalence,” Dr. Palmer said. “It was just like, ‘Yes, this is it; I love this.’”

A discussion with a senior researcher in the lab helped Dr. Palmer realize the impact she could have with a career in public health.

“The idea of seeing patients sounded great, but the fact that I could potentially impact hundreds, thousands or more people at once was even greater,” Dr. Palmer said.

She earned her master’s degree in health sciences from IUPUI in 2014.

‘Leave things better than the way you found them’

Dr. Palmer came to the University of Arizona Health Sciences in March 2017, first as a staff administrator helping administer grants, overseeing human resources activities and more. She began her doctoral studies later that year in the College of Public Health’s Health Behavior Health Promotion program.

Although Dr. Palmer loved her job, she felt lonely as a student. Out of the eight or nine PhD candidates in her program, Dr. Palmer was the only woman of color.

“I never experienced any overt acts of discrimination or racism, but there’s a sense of just not feeling connected,” she said.

She turned to a fellow PhD candidate in the program who had experienced similar feelings, and before long, their network grew into an informal support group that included students from other programs in the college.

The group eventually became the Students of Color Accountability Group, an informal group of students from across the five UArizona Health Sciences colleges.

The group, Dr. Palmer said, quickly became committed to helping its members remain on track in their programs. Members organized writing sessions and shared resources. They also built an online, shared spreadsheet of their academic and professional goals, and tracked their progress to hold one another accountable.

“A lot of times what happens is underrepresented and marginalized racial groups don’t make it because they don't feel supported,” Dr. Palmer said. “We wanted to make sure everybody met their goals and graduated – that’s what we’re here for.”

The group expanded its calls for accountability beyond just its members and met with several Health Sciences faculty members and deans to share their concerns about marginalization and to explore ways to address it, Dr. Palmer said.

Several months after that meeting, a national uprising in response to the murder of George Floyd by a Minneapolis police officer brought the issues of social and racial justice into sharper focus. The Students of Color Accountability Group members surveyed fellow and former students to gather their thoughts on race relations in the College of Public Health, and how previous matters were or weren’t addressed.

They presented a report summarizing the findings, along with recommended resolutions, to Dean Iman A. Hakim, MD, PhD, and her council. The report included very detailed, intimate stories from students, Dr. Palmer said.

“Their voices were heard,” Dr. Palmer said. “No one left that meeting confused about what was going on with the students of color.”

As a result of the meeting, the college began a process to establish an Office of Diversity, Inclusion and Equity, and to hire an assistant dean to lead it. The Students of Color Accountability Group, Dr. Palmer added, is now regularly consulted by college leadership to ensure students are well-represented.

“It’s more than I ever could have thought – I was just trying to find some friends,” Dr. Palmer said of the group and its impact. “I’ve always thought you should leave things better than the way you found them, so I really feel like it actually helped me decide to stay on as faculty and to take this position.”

Always asking: ‘Why?’

Dr. Palmer’s research is broadly focused on how society, policy and culture contribute to health disparities and inequities, particularly for Black people.

“I’ve really been interested in how culture plays into interventions and behaviors as well as things like structural racism and perceived discrimination and how that shapes health equity,” Dr. Palmer said.

But more specifically, she researches the disproportionate share of cardiometabolic diseases – such as diabetes, heart disease, obesity and cancer – among Black women.

According to the American Heart Association, heart disease affects 49% of Black women in the U.S., and nearly 50,000 die each year from heart disease. Stroke – a condition whose risk increases with heart disease – also disproportionately affects Black women in the U.S., according to the association.

“If we live in this country and have access to the same resources, then we should all be kind of even-keeled,” Dr. Palmer said, “but we know that’s not the case.”

Her latest research explores whether hair salons frequented by Black women are suitable places to reach and educate them on ways to help prevent diseases that disproportionately affect them.

Nearly two centuries of racist and unethical medical and research practices led to widespread mistrust in many Black communities toward doctors and researchers, Dr. Palmer said. The result, she added, is that Black people are widely underrepresented in medical research.

To bridge that gap, researchers often turn to other community institutions that may be able to help them reach Black people, offer health exams or do research. Much of that work has been done with churches, barbershops and hair salons, Dr. Palmer said.

Previous studies have shown that health outreach work in barbershops seemed to be effective at reaching Black men who may be susceptible to high blood pressure, prostate cancer and other diseases. But in reviewing the research literature, Dr. Palmer found that similar studies in hair salons designed to reach Black women were not as rigorous. Dr. Palmer was not satisfied with that.

“I’m the kind of person who likes to keep asking why – I’m about as bad as my 5-year-old,” Dr. Palmer said.

About hair salons, Dr. Palmer asked herself a bigger question: “Is this a space that we really should even try to conduct this work?”

To find the answer, she designed her own study and spent much of 2020 conducting remote interviews with stylists and their clients at salons across the U.S. The results were mixed, Dr. Palmer said.

“They weren’t necessarily like, ‘Yeah, come on in and talk about diabetes; I want my stylist to take my blood pressure.’ That really wasn’t the sentiment,” Dr. Palmer said. “They were kind of like, ‘That’s weird, I’m there to relax, I don't need somebody taking my blood pressure.’ But they weren’t completely opposed to it; they just wanted it to be packaged in a certain way.”

Dr. Palmer’s findings don’t mean salons are not a good way to reach Black women and help them get access to health care, she said. But it could mean that some programs – especially those that try implementing health care interventions in the stylist’s chair – may not be effective. Building on those findings, Dr. Palmer plans to find other approaches in salons that may work better.

Having done the study means other researchers now won’t have to spend time on methods that likely won’t work, Dr. Palmer said. She’s already chipped away that piece of the iceberg.

It’s personal

On Jan. 15, Dr. Palmer was asked to deliver a speech at the Pueblo Gardens MLK Breakfast, an annual event organized by Tucson’s Pueblo Gardens Neighborhood Association that recognizes the work and legacy of Dr. Martin Luther King Jr. and raises money for college scholarships for local students.

Dr. Palmer, in her remarks, drew a direct line from Dr. King’s tireless civil rights activism to the opportunities Dr. Palmer had as a kid in Akron raised by a single mother – opportunities that led her to her career.

“He fought for his dream to come to fruition,” Dr. Palmer told the crowd. “And because of not just his dream but his action, I stand before you here today.”

Dr. Palmer does not take lightly the notion that her career as an academic could also create opportunities for others, especially students who may feel the way she did at the beginning of her PhD program. She embraces the responsibility, she said.

But as a researcher, Dr. Palmer’s work is personal in a different way. In 2020, she was diagnosed with heart failure – one of the many diseases that disproportionately affects Black women. She now watches her sodium intake, gets regular exercise and works to reduce stress in her life, all interventions she knows well from her research.

Dr. Palmer said she doesn’t have time to dwell on her own diagnosis – she stays focused on her family and her work.

“Black women are my mother, my sister, my cousin, the members of my sorority, Alpha Kappa Alpha,” Dr. Palmer said. “It’s important to me to try to help us as much as I think I can.”