Public health: How this DO is improving access to care for patients in the Mississippi Delta region

Brookshield Laurent, DO, is a physician and educator who is making big impacts on health, health care and medical education in Northeast Arkansas and the surrounding Mississippi Delta region. In 2019, she became the founding executive director of the Delta Population Health Institute (DPHI), the community engagement arm of the New York Institute of Technology (NYIT) College of Osteopathic Medicine’s Jonesboro, Arkansas campus.

Through teaching medical students and advancing health and health care for underserved regions, she is providing an important link between these two groups. Reaching the patients of the Delta and creating a culture of health through policy, systemic and environmental change to further these goals is her passion.

Dr. Laurent also serves as chair of clinical medicine for NYITCOM-Arkansas. She is a native of New Jersey and completed her medical degree at Rowan University School of Osteopathic Medicine. She then went on to complete a residency in family medicine at Christiana Care. We will now take a dive further into learning more of what is going on in the Delta with Dr. Laurent.

You were involved with health care policy relatively early in your medical career. What were some key interactions that you had along this journey?

My journey in medicine led me to discover factors outside the examination room that were strong drivers of health outcomes, despite my best efforts to provide care. These factors were beyond what I was trained in medical school to address. I had a desire to engage with those factors, which compelled me to pursue more training in health policy.

I started my health care policy training in residency, as I was accepted into the AOA Training in Policy Studies (TIPS) program. The founding director of the program was Barbara Ross-Lee, DO, who was also, at that time, vice president of medical affairs and dean at NYITCOM.

At the completion of the TIPS program, she invited me to apply for a faculty position at NYIT College of Osteopathic Medicine in 2012 and that started the path to where I am now.

As time passed, I wanted to go further into health policy and I was accepted into the Osteopathic Health Policy Fellowship, which was sponsored at that time by the American Osteopathic Association. Now AACOM sponsors the fellowship.

Through this fellowship, I had the opportunity to engage with multiple stakeholders and policymakers and become equipped in analyzing and creating policies. Then, in 2016, and again through the leadership of Dr. Ross-Lee, who led the establishment of the second site of NYITCOM, I was appointed chair at NYITCOM-Arkansas.

You’re leading the Delta Population Health Institute (DPHI). What’s the purpose of the institute, and how does it align with NYITCOM-Arkansas?

The Delta Population Health Institute exists to address social determinants of health to eliminate health disparities in the Delta and to create a culture of health.

We team up with nontraditional partners of health such as economic developers, community developers, people in education and folks who are in the food system (from production to consumption). We invite these stakeholders to envision a culture of health in their sector.

We ask these nontraditional partners to think about where health engages and intersects with their particular sector. We then build initiatives around that intersection to support the vision of health in respective communities.

We know that there are populations who have more challenges with health outcomes, specifically, in Black, indigenous and people of color (BIPOC) populations; there are also inequities among sexual and gender minorities.

We work with stakeholders and communities to address these health disparities to improve the opportunity of health for everyone, specifically rural communities in the Delta.

What are some of the major challenges that you come across in northeast Arkansas and the surrounding Delta that you are facing in closing these health care gaps?

One of the major challenges is that we need more physicians in the Delta region. In addition to addressing the physician shortage, we need to eliminate barriers that cause community members to have to weigh their health and health care against going to work, feeding their children or putting a roof over their head.

If we can, from a policy perspective, support economic mobility/stability, social cohesion, educational advancement and encourage communities to think holistically about their health and health care, we can accomplish a lot.

The challenges are complex, deep and long-standing due to historic injustices. There is a lot of work to be done in the Delta. At the same time, I recognize the resiliency of the people who were here before NYITCOM Arkansas, who have done great things and are committed to the health and well-being of their communities.

How does the DPHI’s mobile medical unit, the Delta “Care-A-Van,” bring health care access into these underserved communities?

Medical students from years one through four and beyond can participate in health care through our mobile medical unit, which works in partnership with health care entities within the community and supports filling the gap for areas without the proximity of a health care system. With our mobile unit, we can provide direct primary care and telemedicine services for specialty care.

Due to the pandemic, we’ve focused significantly on COVID-19 vaccinations and testing, but apart from that, we perform cardiovascular and mental health screenings as well as provide health education. We will be expanding our preventive care through cancer screenings as well as women and children’s health.

We give our medical students an opportunity to provide care to community members under the supervision of faculty members. This is how our students become engaged in rural health care.

What are some of the policy engagement changes that the DPHI is trying to make?

The first phase of our vision was to establish and strengthen partnerships with multiple stakeholders who can create these policy engagement changes. These policy changes are not only at the state and federal level, but also within employers, small businesses and local municipalities. We aim to educate our partners on the value of creating a culture of health and provide recommendations for ways they can achieve it.

One framework we present to our partners is the application of the Health in All Policies framework. Not only in legislative law, but policies on every level have an impact on health.

For example, if a municipality is considering policies that deal with increasing sidewalks in their community, the health impact is the walkability of neighborhoods, access to space for physical activity or safety for those community members with various modes of mobility.

A Health in All Policies framework allows people to explore how policies can affect the overall wellbeing of people over years and generations.

What advice do you have for medical students outside of NYITCOM-Arkansas who want to get involved in something similar to the DPHI?

One of the things I love about osteopathic medical students is that they are very driven in service-leadership. When there is a need in the community, our medical students are way ahead in action and in their desire to make change. I challenge students to think about the issues they are trying to solve more critically.

Whenever my students are engaging with a community-based organization, I often ask them to think of it this way, “If you are volunteering at a food pantry, for example, should the problem you want to understand and attempt to address is ‘Why aren’t there enough volunteers’ or rather is it ‘Why is there food insecurity in this community?’”

The reframing of this question can bring about a different understanding of the problem and different plausible solutions.

I encourage students to not only be satisfied with putting in volunteer hours, but also tackle the “WHY” of the problem. I would like our students to think big, so that they can start thinking about how a community can start adapting a culture of health and thinking about policies that can give equal opportunities for health.

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