Dr. Ray Greenberg on Health Disparities in South Carolina
Guest: Dr. Ray Greenberg – President’s Office, MUSC
Host: Dr. Linda Austin – College of Medicine - Dean’s Office, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Ray Greenberg, who is President of the Medical University of South Carolina. Dr. Greenberg has a special interest in epidemiology. Dr. Greenberg, I know that one of your top priorities as President, here at MUSC, has been the state of the health of the entire state of South Carolina. What is special about South Carolina? Why is it different from New York or Michigan, or any other state?
Dr. Ray Greenberg: Well, first of all, it’s a pleasure to be with you today, Dr. Austin. I appreciate the opportunity to talk a little bit about health disparities issues in South Carolina. South Carolina, of course, is a wonderful state. I think everyone who lives here is very proud of this state. We have a rich history and rich traditions. But one of the legacies that we have in this state is tremendous gaps in the health status of the population.
I think we often think about those in terms of the African-American population versus the White population. We think about is as the well-to-do versus those who don’t have as much economic resource. Or we think about it geographically as urban/rural differences within our state. The reality is that all three of those kinds of parameters are very much related to each other in South Carolina. African-Americans tend to have less financial resource. They tend to be more likely to live in the rural parts of our state. So, when we talk about differences in health status, any one of those descriptors, really, characterizes tremendous gaps in the health of our citizens.
Dr. Linda Austin: Looking particularly at African-American health, to what degree is that genetic? To what degree are the disparities genetic versus a function of rural issues or poverty issues?
Dr. Ray Greenberg: Right. That’s a great question, and I wish I had the answer to it, quite frankly. There’s a lot of research that’s going on trying to get at the underlying mechanisms for differences in health status. MUSC has been very involved in some of that research, particularly looking at diabetes. African-Americans have relatively high rates of diabetes. And the African-American populations living in the Sea Islands along the coast of South Carolina, where there has been much less marriage outside the population, are much more genetically like the Africans from which they came. That population has been of particular interest to us to study.
If you look at those populations in Africa, they have relatively low rates of diabetes. The descendents of those people, who come to the United States and are eating the diet of southern African-Americans, have very high rates of diabetes. So, it’s clear that there’s a genetic predisposition, on top of which, the environment; particularly the diet that people eat, plays into this very high risk of diabetes.
Dr. Linda Austin: I would guess, also, that activity level must play into that too. I may not be right about this, but I would just imagine that in Africa, folks are a lot more physically active than in South Carolina.
Dr. Ray Greenberg: Absolutely. All Americans lead a very sedentary lifestyle today, and it really doesn’t matter what part of the economic spectrum you’re from in the United States. Compared to other cultures, we really don’t exercise nearly as much. That clearly plays some role, not only in diabetes, but also, obviously, obesity, and hypertension, and heart disease, all of that cluster of diseases, and then the so-called metabolic syndrome that is a common risk factor for all of those conditions.
We’ve been trying to attack the problem of increasing exercise through our partnership with the AME (African Methodist Episcopal) Church in South Carolina. They have a program that includes Praise Aerobics, where people are using their spirituality to motivate exercising as part of their celebration of life. We’ve worked with them on dietary interventions as well. I think that’s a great example of where you can use important structures within the community as a vehicle to try to improve health.
Dr. Linda Austin: What are some of your favorite projects that MUSC is doing in this area?
Dr. Ray Greenberg: Well, I’ve just mentioned a couple of them. I think the work that we’re doing in the Sea Islands population is something that researchers in the rest of the United States, even at the best institutions, couldn’t do. We have a very important, very unique population resource here, and it’s important for us to study that population very thoroughly. They, I think, can give us a lot of clues in terms of the issue of genetics versus environmental exposure.
I think by partnering with community-based organizations, whether its churches or other organizations, to outreach to populations that we normally don’t see in the health care environment, or only when they have very advanced disease, in the emergency room, we, really, through these community organizations, can get out and be much more involved in preventive activities. So, those are a couple of things that I think are really quite important.
Dr. Linda Austin: Dr. Greenberg, thank you very much.
Dr. Ray Greenberg: My pleasure.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.