An Interview with XinQi Dong of Rutgers University’s IFH (Episode 34)

July 10, 2018

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Darcy Grabenstein: Hello from SmartLinx Solutions! In today's podcast, we'll talk with XinQi Dong, Director of Rutgers University's Institute for Health, Health Care Policy, and Aging Research. In addition to the institute directorship, Dong will serve as the inaugural Henry Rutgers Professor of Population Health Sciences. Most recently, he was a Professor of Medicine, Nursing, and Behavioral Sciences at the Rush University Medical Center and the Associate Director of the Rush Institute for Healthy Aging. His research and advocacy have been recognized by many national and international organizations, including awards by the American Public Health Association, American Geriatric Society, Gerontological Society of America, and International Congress of Gerontology and Geriatrics. He was the first geriatrician to receive the National Physician Advocacy Merit Award by the Institute on Medicine as a Profession. This year, he was elected to the prestigious American Society of Clinical Investigation. He has served as a commissioner for the Commission on Law and Aging at the American Bar Association, and he chaired the workshop on elder abuse prevention for the Institute of Medicine's Global Violence Prevention Forum. A native of China, he completed his geriatric fellowship at Yale University Medical Center. Welcome.

XinQi Dong: Thank you, Darcy, it's great to be with you. And thank you for having me on.

DG: First I'd like to congratulate you on your new role. We're really honored to have you as our guest today. So I want to start with a basic question. What are your short- and long-term goals as head of the institute at Rutgers?

XQD: Sure, thank you, Darcy. I think short term, we want to further build our infrastructure at the Institute for Health. We want to create an environment that's nurturing for investigators to do research, not only to do research but also to translate research into meaningful impact in practice and policy. Long-term-wise, we want to set forth the five-year strategic plan in our future. And we really want to embrace population health issues more comprehensively and use the institute as the hub for investigators across New Jersey area, as well as across the country, to really think about advancing population health initiatives, not only to inform New Jersey residents but also across the country as well.

DG: Great. I know there are many components to the institute. I think our listeners would be especially interested in the Division on Aging. So could you tell us more about the division and the type of research that it conducts?

XQD: Sure. Aging is an important part of what I do, me as a geriatrician, as a gerontologist, and certainly very close and dear to my work over the last 20 years. When you look at Institutes for Health Aging Initiatives, it's really a wide range of work that has relevance to aging, ranging from our work on health policy, looking at public aid populations, to some looking at caregiving, and understanding intersections between culture and violence and mental health amongst diverse populations, and really finding a link between our etiological research that we do to be able to translate and link that with health services research that is conducted in the institute. And, equally important, the work that we've done here to really inform practice and policy so that the people's lives could be positively impacted through the research that we conduct.

DG: Thank you. I know this is near and dear to your heart. Could you tell us a little more about the institute's violence prevention initiatives?

XQD: Sure. It is a topic that I have dedicated the last 30 years of my work. And when you think about violence, it's such a pervasive public health issue, and yet it receives very little public attention. And yet when we think about global statistics, one out of three women in their lifetimes will be victims of physical and sexual abuse. And when you think about especially underdeveloped countries, those statistics are even higher. And yet, we don't necessarily always understand enough about how to prevent primary prevention, secondary preventions in those vulnerable populations.

Our goal is really to think about violence not necessarily through the unique perspectives of this specific age group, whether it's elder abuse or from a partner violence or child abuse through its own singular lens, but rather trying to connect the violence across the family and its influence on people across generations. And I think that approach holds really a novel potential to think about violence in a family setting and how that impacts much greater physical issues. When someone doesn't feel safe at home, issues like diabetes and heart disease sometimes come to a secondary level in terms of are we really understanding the most important things that impact their lives if they're not safe and secure at home settings.

DG: That's a very good point. I'm going to switch gears here. I know that healthcare disparity is a hot topic these days, in terms of across the world and then between genders as well. In fact, I recently attended a conference in DC about women and healthcare disparity. So could you shed some light on this topic for us?

XQD: Sure. You know, when you look at New Jersey as a whole, it's a bit of a paradox as I was learning and moving to the New Jersey area in the sense that New Jersey is ranked some of the highest across the country in terms of health data. According to American Health Ranking, New Jersey ranked 11th in the overall health status. Dental care ranked first in the country. Infectious disease ranked the second best in the country, and infant mortality ranked the third best in the country. But yet, on the other side of it, especially through the lens of health disparity, they were ranked in the lowest in the country, and especially across underrepresented minority groups.

And I think the issue is more than just health disparity, it's also a health equity issue. There are many social and cultural determinants of health disparity, and there are smart people across the country have tried to understand how to understand the causes of disparity and how to mitigate the consequences of health disparity. And I think we're just beginning to scratch the surface through the work that we are doing in the Institute for Health, trying to understand not only the deeper social determinants of health disparity and health equity, but through our lens of cultural determinants of health disparity and health equity. I think through those lenses, I think we can shed better light onto really what are the fundamental determinants that we have yet to ask. Until we understand those root cause issues, then we can set forth a better approach to care for those patients across the healthcare and social services and policy settings as well.

DG: Correct, thank you. What current trends do you see in healthcare? I know that in industries such as long-term care, nursing shortage is a huge issue. So what trends do you see? Where have we been? How far have we come as a society? And where do you see the industry headed as a whole?

XQD: Darcy, that's a great question. Certainly as you can imagine it's a highly complex question and involves so many different dynamics both locally and nationally. You know health policy is national but often comes down health policy issues, they're local, they're regional. It's more than just access to healthcare policy, it's more than just policy initiatives at the regional or national level. It's also about local, you know.

My experiences caring for patients over the last 20 years is that many of my patients, especially underrepresented minority patients, they have insurance but yet they don't uptake insurance necessarily. They have the right level of services available to them, but they don't always utilize them. Their help-seeking behavior can be very interesting and difficult, especially for those who English is not their primary language. So I think there's also a lot of culture and stigma and disbelief in trusting in the healthcare system that we don't always navigate for patients.

And you know, as a healthcare provider, as a caregiver myself, you know I had a family member who was ill, even though I was a healthcare provider it was incredibly difficult to navigate the healthcare field. Now I often ask myself the question that if a healthcare provider who is somewhat knowledgeable in this field has such difficulties, I can't imagine what someone who does not have that language and background can go through. So the policy issue that you asked certainly requires comprehensive coordinated efforts across multiple sectors to really address more than just access issues but we were talking about implementations and talking about understanding community barriers, understanding the voices of the seniors, their family, what is it that prevents them from taking the necessary steps to think about prevention and interventions to improve their health over time.

DG: Thank you. Is there anything else that you'd like to touch on? Any initiatives upcoming that you'd like to share with us today?

XQD: I think for the Institute for Health moving forward, you know, I'm currently actively listening to the voices of not only institute faculty and staff and members, but also across the university and across the New Jersey area. And we're very excited, I'm certainly very excited to be moving the institute forward and think about what our next five years are going to be in terms of the strategic planning process and the implementation of that over time. Our goal for the Institute for Health is not only thinking about knowledge generation but knowledge translation. And we want to make our institute visible, valuable, and viable with the support of Chancellor Strom and RBHS, we are really at a pivotal time moving our institute forward and I think I'm very excited to take this role.

DG: Thank you so much for taking time out of your busy schedule to join us today. And to all our listeners, thank you for taking the time to tune in. If you'd like to learn more about the Rutgers Institute, visit IHHCPAR.rutgers.edu. And if you'd like to learn more about SmartLinx and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com.

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