Home Institution: Case Western Reserve University
Field: Family Medicine and Community Health
My Driving Question
What is the role of primary care in cultivating social capital to support a patient’s movement out of poverty?
Upstream determinants of health, such as poverty, cause inequities in health outcomes for individuals and populations. Poverty remains one of the most recalcitrant determinants of health, often layered with the complicated effects of systems and structures that perpetuate inequities around race, gender, sexual orientation, class and religion. Clinicians, working in a health system that increasingly commodifies care and actively discourages integrating functions, see the results of these upstream health determinants, but are not supported to meaningfully address them. As a family and public health physician, Dr. Gullett believes that it is vitally important to understand the root causes of the current fragmented system and to address the identified opportunities for integration of care to reduce the health effects of poverty.
To that end, Dr. Gullett has been piloting a pragmatic program to address the conditions of both individual and community poverty known as Getting Ahead in a Just-Gettin’-By-World with patients in her clinical practice. This program is built on the framework of Bridges Out of Poverty, which enables people living in all 3 economic classes (poverty, middle class and wealth) to work together toward solving poverty through shared understanding. Getting Ahead consists of 16 three-hour sessions in which participating “investigators” – people living in poverty – simultaneously examine their own and their community’s experience of poverty while developing their own future story. Structured discussions consider historical and contemporary conditions, causes of poverty (individual behavior/choices, community conditions, exploitation and systems/structures), language, resources, and the hidden rules of class, among other topics.
During this ongoing research, Dr. Gullett has observed that Getting Ahead investigators frequently identify their primary care team as their (often sole) source of bridging social capital. Bridging social capital is a critical resource necessary for moving out of poverty. As a Nova Institute Fellow, Dr. Gullett is systematically building on this observation, using methods that enable understanding of Getting Ahead investigators’ life-course trajectories, to inform understanding of how individuals move out of poverty, and how primary care can be better understood and supported to serve as an impetus for movement out of poverty through bridging social capital. Elucidating the value of primary care in cultivating social capital as a means for movement out of poverty has the potential to serve as a key element of broadly characterizing and redesigning the role of primary care as a force for integration in the US health system.
Heidi Gullett, MD, MPH, was born and raised in Youngstown, Ohio. She completed her undergraduate degree in Biochemistry and Sociology/Anthropology at Denison University in Granville, Ohio, her MD at Wright State University in Dayton, and her MPH in Health Policy at Portland State University. She completed a combined residency in Family Medicine, Public Health, and General Preventive Medicine at Oregon Health and Science University in Portland, Oregon, and is boarded in both specialties. Following residency, she served in the National Health Service Corps in rural Jellico, Tennessee, and in her hometown of Youngstown.
Education and Training
- Diplomate, American Board of Family Medicine
- Diplomate, American Board of Preventive Medicine
- MD, Wright State University
- MPH, Portland State University
- BS, Denison University
- Community Health Hero Award, Neighborhood Family Practice, 2018
- Alpha Omega Alpha Honor Medical Society, 2018
- Tom Mettee, MD, Foundations of Clinical Medicine Teaching Award, 2018
- Charles Kent Smith, MD and Patricia Hughes Moor, MD Professorship in Medical Student Education in Family Medicine, 2017
- Partners in Education, Evaluation, and Research (PEER) Faculty Partner Recognition, 2015
- Kenneth G. Reeb, MD Family Medicine Residency Award for Excellence in Teaching, 2013
- CWRU SOM Medical Student Family Medicine Mentorship Award, 2013
- Academy for Healthcare Improvement Second Place Award for Curricular Innovation, 2012
- Jack H. Medalie, MD Family Medicine Residency Enhancement Award, 2012
- OHSU Family Medicine Merle Pennington, MD Outstanding Resident Achievement Award, 2007
- National Health Service Corps Scholar, 2001-04
- Dension Excellence in Service Volunteer of the Year, 1999
- Granville Kussmaul Service Award, 1999
Peer Reviewed Articles
- Addressing Tobacco Cessation at Federally Qualified Health Centers: Current Practices & Resources Journal of Health Care for the Poor and Underserved. Accepted for publication, expected August 2019.
- Primary Care Resident Training for Obesity, Nutrition, and Physical Activity Counseling: A Mixed-Methods Study. Health Promot Pract. 2016 July 8. PMID: 27402722
- Primary care residents’ knowledge, attitudes, and self-efficacy regarding obesity, nutrition, and physical activity counseling. Journal of Graduate Medical Education. 2015; (2): 388-394. PMID: 26457144
- Metrics in Assessing Improvements in Primary Health Care. Annual Review of Public Health. 2014; 35:423-42. PMID: 24641561
- A Recipe for Collaborative Practice Improvement and Community Development for Health. London Journal of Primary Care. 2013;5:74–7. PMID: 25949693
- Addressing structural racism is key community health priority in Cleveland. NEJM in response to Structural Racism and Supporting Black Lives: The Role of Health Professionals. October 19, 2016.
- Make health more than just a number by reducing health disparities in Cuyahoga County: Heidi Gullett and Greg Brown (Opinion), Cleveland Plain Dealer. August 3, 2016.
- Personal view: Big-picture thoughts on a healthier region. David Margolius and Heidi Gullett. Crain’s Cleveland Business, February 21, 2016.
- National Media Coverage
- As health navigators, students see value of team approach. AMA Wire. February 20, 2016.
- Life Expectancy in Cleveland. NPR Here and Now, July 19, 2016. (Radio) See more research papers on PubMed