Imagine this: Your doctor writes a prescription for blood pressure medication and another one for an exercise program to help lower your blood pressure and improve your health with physical activity. You visit your neighborhood community center to learn how to cook foods that will help you better manage your diabetes. You live in a community where there is access to health screenings, healthy food sources and transportation. And where solutions to social barriers to health care are co-created by the community and the health system.

This is the vision of Joshua Joseph, MD, and his collaborators at The Ohio State University College of Medicine and The Ohio State University Wexner Medical Center. Years of research and work to eliminate health disparities at the population level are making this vision a reality.

“There is no single solution to obesity, diabetes and heart disease,” says Dr. Joseph, assistant professor of Internal Medicine at the Ohio State College of Medicine. “It’s going to take all of us co-developing multilevel, multifaceted approaches.”

Research based on health equity

Dr. Joseph and his team are leaders in research on the role of stress hormones in diverse populations hit hard by common but often preventable diseases, such as heart attack, stroke, diabetes, insulin resistance and nonalcoholic fatty liver disease. The number of people who experience one or more of these diseases is rising around the globe.

Dr. Joseph sitting in the conference room
Joshua Joseph, MD, and his research partners are exploring new avenues to address community health. “It’s going to take all of us co-developing multilevel, multifaceted approaches,” he says.

Dr. Joseph knows too well how this continuing rise impacts the African American community especially hard. At just 8 years old, he lost his beloved grandmother after her second heart attack. He never got the chance to meet either of his grandfathers, who both died early from health-related issues. Today, his ability to transform these hard experiences into passion and become an exceptionally promising young researcher and clinician is continually recognized. He recently became the recipient of the Endocrine Society’s 2024 Richard E. Weitzman Outstanding Early Career Investigator Award.

His work to address disease through a health equity lens focuses on two hormones:

  • Aldosterone, which is produced in the adrenal gland and is involved in blood pressure control and metabolism.
  • Cortisol, considered the classic stress hormone involved in the flight or fight response.

Today’s environment, which is rife with chronic stress, contributes to some patients experiencing cortisol dysregulation, which can impact health and lead to the development of disease.

According to the American Diabetes Association, Black Americans are 60% more likely to be diagnosed with diabetes. Recent research points to lifestyle factors as a driver of obesity and diabetes.

“But those lifestyle factors don’t come out of thin air,” Dr. Joseph says. “This is why we need to look at communitywide structural drivers of health and engage with community members and stakeholders to address them.”

Casting a wide net to involve the community in research studies

Another unique component of Dr. Joseph and his team’s work is their focus on community-based research projects. These types of studies recruit community members to partner with Ohio State and existing health and wellness programs in the community to design and evaluate interventions. The interventions deemed successful are then scaled up and shared with larger communities.

One such program is Black Impact 100, a six-month lifestyle program in collaboration with the African American Male Wellness Agency and multiple academic, community and government partners to help improve the health of Black men.

Dr. Joseph at the Black Impact 100 info session
Joshua Joseph, MD, speaks to a group of community members as part of the Black Impact 100 program.

The program, co-led by Timiya Nolan, PhD, APRN-CNP, formerly an assistant professor at The Ohio State University College of Nursing who now works at The University of Alabama at Birmingham, aims to improve what the American Heart Association (AHA) defines as “Life’s Simple 7.” These are the seven factors known to be important in preventing cardiovascular disease and diabetes:

  1. Blood pressure
  2. Blood cholesterol
  3. Blood glucose
  4. Body mass index (BMI)
  5. Physical activity
  6. Diet
  7. Smoking status

At the beginning of the study, 100 Black men were recruited to work with health coaches and meet once a week for exercise and education.

The main goal was for these men to improve levels of Life’s Simple 7 through health education based on the diabetes prevention program and the AHA’s Check. Change. Control. program. The secondary goal was achieving blood pressure control, weight loss and improving physical activity by exercising at least 150 minutes per week. One month into the study, the men experienced drops in weight and blood pressure and developed strong bonds with one another and the researchers, which they described as a “brotherhood.”

“This is a testament to team science,” Dr. Nolan said. “We’re definitely a broad group of folks from different disciplines, but our common goal is to improve the health of Black men.”

Addressing the complex factors linking food, social needs and health

Another main goal of Dr. Joseph’s work is to use these research findings to bring about systemic change, address social needs and deliver evidence-based interventions to patients in the communities where they live.

“Our research shows that partnerships between health care systems and community-based organizations are a promising approach to improve diabetes control in food-insecure populations,” Dr. Joseph says. “We’re identifying which combination of efforts to address nonmedical, health-related social needs improve health outcomes.”

A study called LINK, which focuses on linking education, access to fresh produce and community referrals to improve diabetes care, is evaluating the combined effects of several interventions. Dr. Joseph works with study co-lead, Daniel Walker, PhD, associate professor of Family and Community Medicine at Ohio State, on the study, in which a racially and ethnically diverse group of participants experiencing food insecurity and uncontrolled type 2 diabetes will receive a combination of a food referral, diabetes and cooking education, and referrals to address other social needs. Dr. Joseph says this study will deliver insight into what is the right “dose” of these interventions to improve blood sugar in type 2 diabetes.

Dr. Joseph speaking at the Healthy Community Day
Joshua Joseph, MD, speaks to a crowd of community members at the annual Healthy Community Day, where health screenings, fresh food and education are provided to residents living near Ohio State East Hospital.

“Can we give food alone and blood sugar will improve, or do we need cooking classes too?” Dr. Joseph says. “Do we need to address social needs because if you don’t have transportation, you can’t pick up food?”

Cooking Matters for Diabetes is a pilot study that evaluated whether a cooking intervention that provided food — along with diabetes self-management education to encourage healthy eating and physical activity — would improve blood sugar control and diabetes self-management and efficacy. This study showed that it held promise as an effective method of improving diet-related self-care and health-related quality of life, especially among individuals living with food insecurity. The study is currently being evaluated in the larger LINK randomized controlled trial. A related study, led by Aaron Clark, DO, associate professor and chair of Family and Community Medicine at Ohio State. It seeks to understand the patient, provider and community factors that support the implementation and use of the Mid-Ohio Farmacy, a primary care clinic-based food referral program that partners with a regional foodbank. The program provides nutritious food to help people with health conditions.

Dr. Joseph standing in a garden holding tomatoes

Another effective program is Exercise is Medicine (EIM). It provides patients one-on-one and group sessions with personal trainers to increase physical activity to help prevent and aid in the treatment of chronic disease. Participants are coached throughout the process, which improves physical activity, blood pressure, weight, depressive symptoms and overall stress. The program has recently expanded to address health disparities in a historically marginalized community in Columbus.

A common theme of these efforts is that researchers are engaging directly in the community with patients on nutrition, exercise and health education. Dr. Joseph believes this is the way forward in eliminating health inequities and ensuring everyone benefits from proven strategies that improve health.

“We’re co-creating, co-developing solutions and generating the evidence to garner support of the entire health system, including payer partners,” Dr. Joseph says. “I am confident we can do this together.”

Working with the community for the community

Working together with residents and the local community, the Ohio State Wexner Medical Center is renovating a former library on Columbus’ Near East Side to develop a Healthy Community Center to address chronic health concerns. It will open in early 2024 and offer a teaching kitchen, a healthy café, wellness activities and a conference room for community gatherings.

Dr. Joseph standing next to construction site
Joshua Joseph, MD, stands at the site of the Healthy Community Center that will serve residents of Columbus’ Near East Side.

With programming developed through years of community input, Dr. Joseph will serve as medical director and will focus on nutrition, physical activity, financial literacy and workforce development.

“Providing equal access to health is the goal,” Dr. Joseph says. “Health begins at home, and the Healthy Community Center is a step toward providing access to health and advancing health equity.”

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