Faculty Spotlight: Joe Feinglass
IPR associate uses science to fight health inequities
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IPR associate Joe Feinglass studies health inequities and tracks the effects of the Affordable Care Act.
The “power of data to inform the public” is what research professor of medicine and IPR associate Joe Feinglass sees as defining his academic career.
Feinglass began studying racial disparities in health access, treatment, and outcomes after obtained his PhD in public policy in 1988. For the past 25 years, he has been analyzing and publicizing health data at Northwestern’s Feinberg School of Medicine, where his long-held interest in health inequities has also been shaped by his previous experiences as factory machinist, 1960s activist, campaigner for Chicago mayor Harold Washington, and community college professor.
When Feinglass began his work at Northwestern, the large billing and coding data sets collected by the Medicare and Medicaid programs were just becoming available to researchers. The data enabled him to study the variations in medical practice around the country, exposing quality of care issues. He became intrigued and concerned by the huge racial disparities—particularly pronounced in Chicago—in treatments and outcomes in women’s health, breast cancer, and vascular surgery and amputations.
Feinglass and his colleagues documented in a 2000 Archives of Surgery article that among those hospitalized for peripheral vascular disease between 1993 and 1997, patients living in poor African-American zip code areas in northern Illinois had between 14 and 36 percent higher odds of having a leg amputed versus undergoing limb saving bypass surgery than those of the same age living in better-off, mostly white zip codes.
Revisiting the issue using a larger dataset from 1987–2004 in the Journal of Vascular Surgery in 2008, Feinglass and fellow researchers found that racial disparities remained constant through the period, even as the absolute number of amputations dropped. The 1.27 million people living in zip codes that were more than 50 percent African-American were more than five times as likely to have an amputation than the 5.4 million metro Chicago residents living in zip codes that were less than 10 percent African-American.
In more recent work on breast cancer, Feinglass has continued to focus on the association between race, socioeconomic status (SES), and health outcomes. In a 2015 issue of the Annals of Epidemiology, he and his coauthors observed a large gap in death rates from 1998–2011 for women with breast cancer. Those in the lowest SES category were 27 percent more likely to have died from any cause than those in the highest SES.
Access to Care
Another aspect of Feinglass’ work is reforming healthcare delivery, and he urges a “public health orientation” when considering healthcare access. His research in community health and his teaching in Feinberg’s Master of Public Health (MPH) program have led him to examine how people, especially chronically sick and disabled people, can better access care.
In a 2017 research review in Population Health Management, Feinglass and his colleagues examined “home-based primary care”—longitudinal care to the homebound—as “a real alternative” to emergency department and hospital visits that might save money and improve patients’ health outcomes. Their analysis showed that home-based care “holds the greatest promise for delivery system reform.”
Feinglass recommends that policymakers pursue more home-based care that includes a social services team. “The current hospital system is unsustainable,” he contended. “We have to integrate medical care with home- and community-based social services.”
The Role of Health Insurance
“If you believe that preventive medicine saves lives,” Feinglass pointed out, “then health insurance is a huge accomplishment.” A significant focus of his research is on the health effects of the lack of health insurance.
“It’s hard to measure exposure to being uninsured,” Feinglass noted, because those likely to lack insurance often do so intermittently. But by drawing on data from the Health and Retirement Study, he and fellow researchers were able to track uninsured people as they became eligible for Medicare.
In results published in 2006 in the Journal of General Internal Medicine, they showed that although Medicare did not lead to immediate health benefits for people who were uninsured before age 65, after two or more years of continuous coverage, the uninsured no longer had a higher risk of adverse health outcomes than those people who had private insurance prior to Medicare.
Feinglass has been tracking the impact of the Affordable Care Act (ACA) in Illinois since 2014, notably its effect on increased emergency department usage by newly insured people. He notes that of the 1.5 million people who were uninsured prior to the ACA becoming law, 650,00 now have some sort of insurance, mostly Medicaid.
Though Feinglass sees the ACA as “terribly compromised,” he points out that people’s self-reported health is better and their self-reported stress is lower when they obtain health insurance.
Feinglass sees his study of the effects of health insurance as his most important policy-related research, and he is passionate about the role that policy research can play in changing public opinion.
“Research can be used for good or evil,” he reminds us. He wants to use it for good.
Joe Feinglass is research professor of medicine (general internal medicine and geriatrics) and preventive medicine and an IPR associate.
Published: August 23, 2017.