If you went looking for a place in America that shows how social and behavioral factors affect health, Louisiana would be a good place to start.
In the latest report from America’s Health Rankings, the state placed 50th in overall health outcomes—driven by its rock-bottom status in socioeconomic factors, including entrenched poverty; by low rates of healthy eating and exercise; and by high rates of risky sexual behavior.1,2 Louisiana also ranks fifth-highest in cancer mortality, with a large share of cases linked to toxic air pollution,3 and ninth in obesity, which affects 38% of its residents.4
Such data have roots in Louisiana’s hospital system, which for generations physically segregated insured patients from the uninsured. Transitioning away from that system has been bumpy at times, but it was aided when Governor John Bel Edwards embraced Medicaid expansion in 2016, extending coverage to more than 600,000 people.5
For those who see a healthier future for Louisiana, these are times of hope. The national focus on health equity is driving new partnerships and investment in those institutions that have long served the state’s Black residents, who make up a third of the population.6
The idea is simple: Any solution that can improve health in Louisiana is likely to work elsewhere.
In April, the pharmaceutical maker Takeda announced a groundbreaking partnership with Xavier University of Louisiana, the nation’s only Catholic and historically Black university. Described as multimillion-dollar, long-term investment, the Takeda-Xavier partnership will fund a technical research and exchange center on Xavier’s campus and build programs to raise enrollment of minority patients in clinical trials, among other steps.7
The partnership, said Anne McCall, PhD, Xavier’s provost and senior vice president for academic affairs, will “further our joint goal of health equity through the education of young people who seek to promote a more just and humane society.”7
Located in New Orleans, Xavier is well known for its school of pharmacy and for its ability to produce high numbers of Black undergraduates who go on to become physicians. In fact, Xavier plans to establish its own Graduate School of Health Sciences and Medical School.8,9 Beyond that, Xavier has deep roots in New Orleans’ civil rights history: Shortly after the Takeda announcement, the university received a $2.5 million grant to transform a dormitory that once housed the Freedom Riders into a science and technology center.10
Xavier’s success in educating minority health professionals, as well as its status in the community, were factors in Takeda’s pursuit of the partnership, said Lauren Powell, PhD, MPA, vice president of US Health Equity and Community Wellness at Takeda, who earned her undergraduate degree from Xavier.
“We are excited to support Xavier University of Louisiana on this first of its kind partnership with Takeda as a way to put our commitment to health equity into action,” Powell said. “We look forward to this purposeful collaboration and the ways that we can benefit from learning from the true experts on how to build trust and lay the foundation to continue to advance health equity for generations to come. We were very intentional with our efforts in selecting the right partner and recognize Xavier as the historical incubator for future Black and Brown health professionals and as a community pillar for change in Louisiana.”7
Elements of the Partnership
Takeda’s initial investment, McCall said in an interview, will be $3 million over 3 years. The first year of the partnership will involve lots of listening on both sides, which Powell said is key because Takeda is in this relationship for the long haul. “This is not something we see as a onetime initiative,” she said. “We really want to invest in long-term relationship building—understanding that it will take more than just 1 or 2 years or just a couple of months to actually move the needle on health equity.”
Health care informatics. The centerpiece of the partnership will be development of a technical resource and exchange center, or T-REX. Both Powell and McCall said this initiative will bolster Xavier’s capabilities in health care informatics, including its ability to leverage data to promote health equity in New Orleans and across Louisiana. McCall said this will complement ongoing efforts to improve programs in pharmacy administration. Xavier already offers an academic program in public health and health equity, she said, and this fall will offer health informatics at the master’s level.
“For all of these programs, we’re seeking to use data more effectively to achieve practical improvements in people’s health,” she said. “To do that, we need to use big data sets—some of those cost money—and we need a specialist who can help our faculty become more proficient in using them and to actually help run some of that center.”
Clinical trial participation. The second element of the partnership calls for increasing participation from underrepresented minorities in clinical studies. Xavier already has a track record in this area, McCall said, and the partnership will expand efforts to educate its students, as future health professionals, on the importance of clinical trials. Here, McCall said, Xavier’s history of training pharmacists and its credibility are key. “Pharmacists, in particular, are really credible translators of needs for clinical studies with our neighborhood population, our student population, our community broadly,” she said.
Powell wrote her graduate dissertation on increasing minority participation in clinical research and said a key step involves “remaking the language” around clinical trials. A person’s decision whether to take part in a trial starts long before a diagnosis of cancer or some other disease, she said. “How do we make…the understanding of what clinical trials are more accessible to people?” she asked. “How do we start to normalize this as a part of health care—just receiving health care and in pursuing health care in general?”
Supporting research. A third piece of the partnership will offer funding for postdoctoral research and graduate fellowships, McCall said. “It’s really hard to make a big difference without a robust team, and we’re a small university,” she said. Giving faculty support from postdoctoral scientists will allow for better and more rapid translation of faculty research into real-world settings.
New graduate programs. The Takeda partnership comes as Xavier makes plans to expand its graduate offerings and pursue its own medical school, which would join Louisiana State University Health Sciences Center schools in New Orleans and Shreveport and Tulane University School of Medicine as the state’s fourth medical school.9 This would join the new master’s in public health and health equity and a master’s program for physician assistants that just graduated its first class. “We’re looking at other programs, in particular genetic counselling and physical therapy,” McCall said, which would be done with another key partner, Ochsner Health system.
Confronting a History of Health Disparities and Distrust
Powell and McCall agree that an essential piece of improving health equity is building trust among those who have been underserved for generations. That’s where Xavier fills a critical need: With its long-standing role in New Orleans’ civic life and its recent collaborations, the university occupies a unique place in Louisiana’s health care ecosystem.
“We know that Xavier University of Louisiana is one of those [institutions] that is deeply trusted by the New Orleans community, by the larger Louisiana community, by the deeper South, and the entire Southern and Gulf Coast region,” Powell said in her interview. “We wanted to pursue a partnership with the experts on how to build trust. We see opportunities to learn from failure—and that deeply motivated our desire to want to learn from them and to want to partner with them on this initiative.”
Given Louisiana’s history, trust among Black residents toward the health system is far from assumed.
The loss of “Big Charity.” The scenes the nation saw on television after Hurricane Katrina hit in August 2005—of poor, mostly Black New Orleanians left behind in a drowning city—were emblematic of Louisiana’s 2-tiered heath care landscape: one that offered multiple hospital choices for those with insurance, while those lacking coverage were treated in 10 charity hospitals around the state. Primary care was almost nonexistent for these patients. For the poor, accessing health care often required travel and long waits—sometimes measured not in hours, but in days.11
However flawed, this system made Charity Hospital in downtown New Orleans a health care hub for the city’s poor—and a renowned training ground for emergency care. Health Affairs reported in 2006 that nearly three-quarters of Charity Hospital’s patients were Black, and 85% had annual individual incomes of less than $20,000.12 Thus, shuttering “Big Charity” after Katrina was highly controversial. Although many experts believed this was a crucial, necessary step toward the goal of bringing neighborhood-level care to the region’s poor, in the short term, the loss disrupted countless programs—including substance abuse care and treatment for HIV13—and in some ways exacerbated disparities that the Xavier-Takeda partnership must now address.
Mental health also suffered. “During the city’s rebuilding in the aftermath of Hurricane Katrina, little priority was given to addressing the human recovery and psychosocial needs or the poor, vulnerable communities of color, and women and children in particular,” researchers from Tulane University wrote in 2018, citing a survey that found New Orleanians reported 4.4 days per month of poor mental health, higher than state and national averages (4.3 days and 3.6 days, respectively) as the state’s number of psychiatric treatment beds fell.14
By October 2005, about 8400 households had applied for Medicaid through 1 of 200 shelters, but 58% were denied because of Louisiana’s historically strict Medicaid standards.15 A decade later, half of public school children in the hurricane zone reported posttraumatic stress disorder, and Black residents were more likely to report difficulty in managing stress.16 A 2013 report on health disparities found that New Orleans’ history of racial and economic segregation meant that life expectancy in the healthiest and least healthy ZIP codes varied by 25.5 years.17
Xavier after Katrina. The storm hit as Xavier was thriving—enrollment had passed 4000 students. With every building flooded, enrollment fell 40% but has returned to around 3600 undergraduate and graduate students.18,19 Then-president Norman C. Francis, JD, aggressively rebuilt the campus with an eye toward creating more programs in science, technology, engineering, and mathematics (STEM). Francis also served the entire region as chair of the Louisiana Recovery Authority, which distributed $10.4 billion in federal funds to rebuild the city, most of it to homeowners. Over the next decade, Xavier joined a health care research consortium that boosted rates of cancer screening and made strides in reducing smoking.20,21
Xavier also filled crucial research gaps. Cirecie West-Olatunji, PhD, director of the Center for Equity, Justice, and the Human Spirit, developed a world-class, 31-hour credentialing program for mental health response following a war or natural disaster. She was recently tapped to create mental health modules for psychologists in the Ukraine.22
After Francis retired in 2015, Xavier President Reynold Verret, PhD—an immunologist by training—redoubled efforts to train underrepresented groups in STEM areas, both to aid research and to educate more qualified teachers. Xavier has strengthened its relationship with Ochsner Health, which has expanded its footprint in New Orleans and across Louisiana and the Gulf Coast.23 In November 2020, Verret joined Edwards and Ochsner officials to launch a $100 million initiative to improve access to care for the underserved and to promote health disparities research.24 Separately, Ochsner and Xavier created the Ochsner-Xavier Institute for Health Equity Research to combine resources in collaborating with “partner health providers, government, insurers, employers, schools and other community organizations.”25
“One of our strengths comes from our friends and partners,” McCall said. The Ochsner partnership connects Xavier and its Center for Minority Health with the state’s largest provider of health care to Medicaid patients. Xavier’s legacy in pharmacy means it has graduates in every city hospital, including the New Orleans VA Medical Center built after Katrina. Today, she said, Xavier is branching into chronic care management through a health and wellness center in suburban Harahan.
“We’ve done work in our community for forever. We have the oldest pharmacy college in the state,” she said. “So, we have our own kind of footprint in implantation, too, but this is going to take it to the next level.”
Creating Models for the Nation
Takeda’s funding and involvement “gives us an opportunity to make sure that everything that we do is data driven,” McCall said. “It doesn’t change what we do, but it changes dramatically how much of it we can do and the impact that we’ll have—both here and elsewhere.”
That’s the ultimate goal, McCall and Powell say. If Xavier can use Takeda’s funding and expertise to build data sets to drive research, and Ochsner’s partnership can offer opportunities to test what works, then the goal of lifting Louisiana’s health outcomes ranking above 40th in the country seems possible.25
“One of the reasons why we actually focused on Louisiana is because we understand that in health equity work, what we’re ultimately thinking about is how to center the most marginalized in our care,” Powell said. “If we had a health care system that centers the most marginalized and made sure that their health outcomes were positive, it would actually work for everyone,” she said.
In other words, moving the needle in health equity starts in places like New Orleans. Powell concluded, “We can take what we’ve learned to help spread that across other communities and across other regions of the country.”
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2. Overall public health impact, Louisiana. America’s Health Rankings. December 7, 2021. Accessed July 23, 2022. https://www.americashealthrankings.org/explore/annual/state/LA
3. Tulane study: Louisiana’s severe air pollution linked to dozens of cancer cases each year. News release. Tulane University. January 13, 2022. Accessed July 23, 2022. https://bit.ly/3vgUUVJ
4. State of obesity 2021: better policies for a healthy America. Trust for America’s Health. November 10, 2021. Accessed July 24, 2022. https://www.tfah.org/webinars-briefings/state-of-obesity-2021/
5. Gov. Edwards celebrates the 5-year anniversary of Medicaid expansion that continues to save lives, jobs, rural hospitals and reduce the number of uninsured Louisianans. News release. Louisiana Department of Health. July 1, 2021. Accessed July 24, 2022. https://ldh.la.gov/news/6227
6. US Census Bureau. Quick facts, Louisiana. Accessed July 24, 2022. https://www.census.gov/quickfacts/LA
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10. Grove R. Xavier University transforms Freedom Riders’ hall into a STEM center. Ebony. May 7, 2022. Accessed July 24, 2022. https://www.ebony.com/news/xavier-university-transforms-freedom-riders-hall-into-a-stem-center/
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15. Cohen Ross D. Many Katrina survivors seeking Medicaid in Louisiana shelters remain without coverage. Center on Budget and Policy Priorities. October 12, 2005. Accessed July 24, 2022. https://www.cbpp.org/sites/default/files/atoms/files/10-12-05health3.pdf
16. Huelskotter T. Hurricane Katrina’s health care legacy. Center for American Progress. August 20, 2015. Accessed July 24, 2022. https://www.americanprogress.org/article/hurricane-katrinas-health-care-legacy/
17. Community Health Data Profile: Health Disparities in New Orleans. New Orleans Health Department. June 2013. Accessed July 26, 2022. https://www.nola.gov/health-department/data-and-publications/reports/health-disparities-in-new-orleans-community-2013/
18. Hepburn S. From storm to STEM: rebuilding Xavier University. Forbes. July 23, 2015. Accessed July 23, 2022. https://bit.ly/3OBoDiV
Xavier University of Louisiana. University profile, 2021-2022. https://www.xula.edu/opira/2021-2022-university-profile.pdf
19. Lipinski J. Norman Francis to retire after 46 years as Xavier’s president. The Times-Picayune. Updated July 19, 2019. Accessed July 24, 2022. https://www.nola.com/news/education/article_5b368955-511a-5e40-9056-ccbdd7aaa5e5.html
20. Caffrey M. Status in the states: In Louisiana, will privatization affect efforts to stop cancer? Am J Manag Care. 2013;19(SP9):SP303.
21. Xavier CEJHS director asked to prepare mental health modules to help Ukrainian psychologists. News release. July 18, 2022. Accessed July 23, 2022. https://bit.ly/3cLYT6g
22. About Reynold Verret. Xavier University of Louisiana. Accessed July 24, 2022. https://www.xula.edu/ccsde_about/presidentoffice/about-reynold-verret.html
23. Ochsner and state leaders announce 10-year vision for a healthy state. News release. Ochsner Health. November 13, 2020. Accessed July 23, 2022. https://news.ochsner.org/news-releases/ochsner-and-state-leaders-announce-10-year-vision-for-a-healthy-state
24. Ochsner-Xavier Institute for Health Equity and Research. Ochsner Health. Accessed July 24, 2022. https://www.ochsner.org/institute-for-health-equity-and-research