Dr. Amelie Ramirez

Waging war on health disparities

Monday, December 15, 2014by Catherine Duncan

For 30 years, this world-renowned leader in reducing health disparities among Hispanics has dedicated her life to using research, innovative educational communications and community outreach to promote healthful behaviors.

Diabetes. Obesity. Cancer.

Growing up in Laredo, Texas, Amelie G. Ramirez, Dr.P.H., professor of epidemiology and biostatistics and director of the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio, recalls observing the devastating effects of these and other diseases on the Hispanic population in South Texas.

“At that time, I had no idea that my path in life would involve helping individuals suffering from these afflictions,” she said.

With encouragement from her parents, Dr. Ramirez and three of her brothers became the first generation in their family to attend college. “Our parents stressed the importance of getting an education because no one can ever take that away from you.”

After starting at Laredo Junior College, she transferred to the University of Houston where she majored in psychology. After earning her bachelor’s degree, she returned to Laredo and started working with the South Texas Health Planning Organization. Through this organization, Dr. Ramirez met students from the School of Public Health at The University of Texas Health Science Center at Houston.

“I heard such great comments about the School of Public Health in Houston that I ended up going there. I earned my master’s and doctoral degrees from there,” she said.

Her first health campaign

While in Houston, Dr. Ramirez, then an assistant professor of community medicine at the Baylor College of Medicine, began examining the impact of heart disease on Hispanics at the university’s famous DeBakey Heart Center.  

“At Baylor, I learned to blend health communication research, education and outreach,” she said. “I worked on my first educational health campaign on high blood pressure. It was called El Asesino Silencioso or The Silent Killer. The campaign was geared to the Hispanic population in Houston,” Dr. Ramirez said.

“At that time, Hispanics were only 6 percent of the U.S. population. They were suffering from high blood pressure and cardiovascular disease at high rates but were being left out of educational efforts. That is when I really saw and understood the disparities in health in the Latino population,” she added.

She learned that the Hispanic population’s higher rate of such diseases was tied to obesity. This led her to write and then receive a grant to create a weight reduction program called Cuidando su Corazón alongside Dr. John Foreyt, a prominent obesity and cardiovascular researcher. When she began to serve on national health disparity committees, Dr. Ramirez learned there was no concentration on the Hispanic community. “They were concentrating on white, black or other.”

Dr. Ramirez said the key to these educational campaigns is the use of mass media and mobilizing the community, which she learned from Dr. Alfred McAllister at the School of Public Health.

“Dr. McAllister recruited me to work with him on a tobacco prevention program along the U.S./Mexican border. We based our work on the social cognitive theory developed by Albert Bandura,” she said. “This theory taught us that real people – if you show them a message with people who look like they do – will identify with the person and will think,  `If that person can do it, then I can too.’ ”

They developed a technique called behavioral journalism. “We developed a message with real role models and combined them with a doctor. The combination of the two created a powerful message,” Dr. Ramirez said.

She employed this model nationally in 1992 for a six-site, 9,600-case study that was the first study of its kind to identify major differences in health knowledge and behaviors among different Latino population groups. That study eventually became Redes En Acción: The National Latino Cancer Research Network, an ongoing project that has yielded novel cancer research advancements in clinical trials, genetic testing and patient navigation; trained more than 200 Latino researchers; and led to thousands of community events and educational materials.

Creating the Institute for Health Promotion Research

In 2006, she came to the UT Health Science Center at San Antonio to create what is now called the Institute of Health Promotion Research.

“My passion is based on the knowledge that our Hispanic population has not received enough information on how to reduce and prevent health problems. They develop more of the chronic diseases. And, as time passes, their rates of getting these diseases have continued to rise,” she said.

Now Hispanics are the largest minority population in the United States. They make up 17 percent of Americans, Dr. Ramirez said. “They are younger, have less education, do not have the best health insurance, and have more modest incomes.  

“The advertising industry is targeting them in marketing campaigns that often promote products high in sugar and fats. They don’t have the knowledge and information to resist the many unhealthy items that are marketed to them,” she said.

With funding from the Robert Wood Johnson Foundation, Dr. Ramirez has helped to create and oversee the Salud America! project to target Latino childhood obesity. As in her early work, this project is based on research, training and community outreach.

Through Salud America!, 20 grantee researchers leveraged $1.5 million in funding into more than $30 million in new research funding. She and her team also have developed a national Salud America! Growing Healthy Change website where people can geo-locate the latest policies and resources in their towns and read and watch Salud Hero stories to learn how they can spur healthy change.

“With this website and all of its resources, we hope to have a ripple effect. We want to change the tide,” she said. “Our goal is to reduce and potentially eliminate health disparities and to promote healthful behaviors among Latino populations.”