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More than easing the suffering of patients

Yale Medicine Magazine, 2014 - Spring


When Helena Hansen, M.D. ’05, Ph.D. ’05, decided to go to medical school, she wanted to learn more than just how to relieve the suffering of individual patients. Just as health care professionals use biotechnology to treat patients, they should also understand and act upon the institutional, social, and cultural influences on people’s health. “I wanted to combine medical training with community-based research,” Hansen said, adding that “it was important to understand how social forces influence health.”

Now an assistant professor of anthropology and psychiatry at New York University Langone Medical Center, she continues to study those intersections of social forces and medicine, with a goal of providing accessible care to all. She studies community-based health movements and the ethnic marketing of pharmaceuticals. She recently completed a one-hour documentary video that examines the historical and contemporary political-economic forces shaping the treatment of opiate addiction in the United States.

Hansen traces her interest in social inequalities to 1992, when she graduated from Harvard and took a job as program officer at the National AIDS Fund’s New Jersey office. “It was the early ’90s, people were dying like flies, but it was an exciting time in AIDS policy,” she said. “We were helping to design studies, inventing community collaborations.”

She went on to the M.D./Ph.D. program at Yale and completed her doctoral studies in anthropology rather than the basic sciences most students choose. That was the start of a wide-ranging career that, in her first year of the program, brought Hansen to Havana with a delegation of medical students who visited the clinical research facilities of the Instituto de Medicina Tropical Pedro Kouri. For her doctoral thesis, Hansen did fieldwork in Puerto Rico on Pentecostal ministries founded and run by people recovering from narcotics addiction. The ministries operate a network of faith-based detox units and residential rehabilitation centers that comprise the majority of the drug treatment programs in Puerto Rico. They are modeled on similar ministries in the inner cities of the United States.

During her residency at the New York University Langone Medical Center/Bellevue Hospital, Hansen continued to study social causes of health disparities. Part of her work included a political-economic and ethnographic study of buprenorphine, a synthetic opioid approved by the FDA in 2002 to treat opioid addiction. Opioid maintenance treatment, she realized, fell into two tiers—office-based buprenorphine therapy largely available to affluent abusers of prescription opioids, and DEA-regulated methadone clinics for low-income heroin injectors. The result, according to Hansen, was a further stigmatization of drug addiction, and a shift in emphasis away from psychiatric services as a component of recovery to cursory 15-minute medication checks. With funding from NIDA, she is comparing primary care-based addiction treatment with psychiatry-based substance abuse programs to determine their impact on the stigma that patients experience, as well as how the programs affect patients’ social networks and access to resources.

Her interest in video began with the realization that journal articles do not draw a broad audience. She had been participating in a video therapy group started by an art therapist and two patients with production and editing experience. Members narrated and produced fictional stories, commentaries, or documentaries about their lives. When she shows the videos, Hansen said, residents and premed students are better able to engage with the subject matter—the political and ethical quandaries of treating opiate addiction with opioid medications. In an academic setting, she learned, video "is a really good tool for communicating."

Hansen has observed that interest in the social forces that shape health inequalities is growing among clinicians. With her colleague Jonathan Metzl, M.D., Ph.D., she organized a series of conferences and a special issue of the journal Public Library of Science Medicine on the topic of what she and Metzl term “structural competency.” The term indicates the need for physicians and other health practitioners to work at the level of institutions, policies, and community collaborations to reduce health inequalities. At their first conference on structural competency in 2012, they expected to fill a room with capacity for 70 people—more than 200 showed up, a blend of medical school faculty and students, state and city health policy makers and administrators, community health advocates, and social scientists. “We need to think and act collectively around health and health care,” Hansen said. “Clinicians need to collaborate with others who have expertise in education, housing, and city planning. There are myriad ways to work across disciplines to create better health conditions.”

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