Documenting Durham's Health History: Understanding the Roots of Health Disparities

Please note: This is an example of a team profile. This and other virtual showcase team profile examples were drawn from information in our annual report and other communications. They have been modified and were not actually authored by these teams.

Meghana Sai Iragavarapu ’21, Sujeiry Jimenez ’20 and Brian Rhee ’20.
Meghana Sai Iragavarapu ’21, Sujeiry Jimenez ’20 and Brian Rhee ’20 at Documenting Durham’s Health History: An Exhibition in the Trent Semans Center for Health Education, April 22, 2019.

By: Team Member 1, Team Member 2, etc.

Durham is known as North Carolina’s “City of Medicine,” and boasts a healthcare industry with more than 300 medical and health-related companies and medical practices. While Durham is a state and national leader in research and healthcare, the city is also home to racial and class disparities that have deep historical roots. Though we know these inequities profoundly influence the past and present health of Durham’s residents, little is known about the specific ways by which structural forces, policy decisions and group actions shape the landscape of health in contemporary Durham. This year, our team sought to uncover the history of Durham’s health disparities with the goal of expanding – and even transforming – the vision of healthcare in our community.

Our project team was structured as a social science/humanities lab, and featured a team of students, project leaders, faculty and community representatives. Throughout the year, we engaged with public health departments, community leaders and local health professionals, including the Lincoln Community Health Center, Durham County Department of Public Health, Durham County Public Library and the Duke Department of Obstetrics and Gynecology. By pairing historical research with an analysis of current health conditions, our team investigated questions relating to how social barriers affect health trajectories, such as “How did particular diseases affect different communities in Durham?” and “What kind of healthcare was available (both outpatient and hospital)to Durham residents? and “How have economic and racial barriers shaped accessibility both in the past and the present?”

Our team explored these questions through research, activities and outreach in five areas:

  • Contextualization and historical overview: Speakers and readings provided background on the history of Durham and its hospitals, including Duke, Watts, Lincoln.
  • Longitudinal data analyses and visualization: Using available records, our team described long-term secular trends in morbidity and mortality for Durham County since 1900, focusing on racial disparities.
  • Historical case studies: Our team identified four case studies focusing on specific epidemics or diseases with significant racial inequities, both historical and current, including: tuberculosis, maternal health, HIV/AIDS and diabetes.
  • Archival and contemporary research: We investigated each case study using various archival and contemporary sources, such as interviews with local stakeholders and oral histories, paired with an analysis of archival records at Duke Libraries and the Durham Country Public Library including vital records, photographs, maps, newspapers and popular media.
  • Exhibition and documentary production: The team developed exhibitions and documentary materials illustrating the findings of the research.

Durham Health History team exhibit.

Our research resulted in a variety of conclusions for each case study. For example, we found that disparities in the rate of diabetes in distinct neighborhoods in Durham are a result of the “siloing effect” (the lack of information flowing between groups) of neighborhood history, knowledge, resources and access. We also found that HIV-positive African Americans in Durham are faced with more social and health stigma compared to Durham’s white population, compounding existing socio-structural barriers and resulting in poorer health outcomes.

Our investigation into maternal health uncovered that while the desegregation of Durham hospitals opened access to more advanced medical care, it in turn resulted in a loss of important sources of community support for African American mothers. We also found that tuberculosis disproportionately affected African Americans in the post-WWI era due to structural inequities in the screening programs and behavioral interventions developed by the Durham County Board of Health.

Poster segment.

To share the findings of our work, our team created a research poster and designed three display panels for feature in public and private spaces that incorporate curated images, text and data visualizations. We also produced original audio and video documentaries based on interviews and oral histories conducted throughout the year. We exhibited this work in Spring 2019 at the Trent Semans Center for Health Education and created a traveling, multimedia, public exhibition that aims to increase the public’s awareness about the underlying causes and persistence of racial health disparities in Durham’s past and present.

Undergraduate team member Meghana Sai Iragavarapu ’20 also shared a personal reflection about her experience on the team:

Meghana.My sub-team focused on the history and perpetuating factors of diabetes in Durham. We interviewed employees from the Durham Public Health Department, historians, community health workers, and most importantly, Durham residents living with diabetes. We visited grocery stores and homes in neighborhoods only two miles apart and found shocking disparities. We were attempting to tell a story – one that addressed the complicating factors of racial discrimination, socioeconomic factors, language barriers and neighborhood segregation. Why do some residents in Durham have access to healthier foods than others? Why do some Durham neighborhoods have double the diabetes rates of others? Bass Connections allowed me to take a deeply personal interest of mine and turn it into an academic passion. Applying a critical lens to the disparity of diabetes in Durham encouraged me to work towards a sustainable version of myself. –Meghana Sai Iragavarapu