Skin In The Game

Health equity goes beyond mere access to healthcare. It means that all people, regardless of their background or circumstances, have the same opportunities to realize their full health potential. Unfortunately, in the Philadelphia region, there are significant disparities in these important areas among our city’s diverse communities.

For one, there’s a lack of access to nutritious foods in many underserved neighborhoods across the city. The ratio of stores across Philadelphia that sell only packaged and processed foods to stores that stock fresh fruits, vegetables, and whole grain options is around 10 to 1, according to this report by the Philadelphia Department of Public Health. The same report found that the concentration of these types of low-to-no-produce grocery stores goes up as the income of the neighborhood as a whole goes down. 

In other words, very many of Philadelphia’s lowest-income neighborhoods qualify as food deserts and the poorer the neighborhood, the more overabundant the unhealthy food options. 

There’s also a lack of access in underserved communities to non-emergency medical care, which is often cost-prohibitive. In that vein, these same communities are also facing a lack of access to mental health and social support resources for coping with chronic illness, which are often considered luxuries.

The implications of this health inequity lead to unfavorable health outcomes in communities across the city: some have higher rates of chronic disease, lower life expectancy and poorer overall health, and, often overlooked but equally impactful, reduced community well-being, wherein health issues prevent individuals from contributing meaningfully to their communities, which has the consequence of restricting overall growth and prosperity.

One distinct way all these disparities are made manifest at once among the most underserved communities in Philadelphia – highlighting the broader issue of how poverty intersects with healthcare outcomes – is the appearance of chronic skin conditions at disproportionate rates, specifically eczema.

Grounding our understanding through eczema 

More than 31 million people in the United States endure the discomfort of eczema, a staggering figure that includes up to 20 percent of children in the United States alone. 

This chronic skin condition, characterized by redness and itching, encompasses a spectrum of inflammatory diseases, with atopic dermatitis reigning as the most prevalent variant. Atopic dermatitis, in particular, is triggered when allergens —both internal and external— ignite the body’s immune response, sparking inflammation and painful flare-ups across the skin’s surface.

The battle against eczema extends beyond skincare routines, as everyday household items —soaps, shampoos, laundry detergents, even common foods and dust— lurk as potential immune system irritants, complicating prevention efforts. The task of constantly mitigating these triggers becomes a daunting reality for individuals grappling with this condition.

The emotional burden is profound, as eczema’s impact can inflict a spectrum of intense emotions—from stress and anxiety to anger, depression, and social isolation. It takes a toll on both mind and body, leaving sufferers grappling with a complex interplay of physical and emotional challenges.

The Disparities

It becomes fairly apparent that the disparities that lead to skin health inequity are along socioeconomic lines, which are often also racial. The lowest-income neighborhoods in Philadelphia are predominantly Black and Latino and it is in these communities where the inequity is felt most deeply. 

Black people in the US face a higher prevalence of atopic dermatitis than their white counterparts, and that applies to both adults and children. Twenty percent of Black children nationwide are diagnosed with eczema compared to their white (16%), and Hispanic (8%) peers. 

Annette Bryant, known to the community as Gynger and owner of Nett’s Natural Juices, has to travel by bus with her two children to access fresh fruits and vegetables, and although it’s tiring, she is dedicated to the pursuit of health for herself and her family. When her daughters developed severe eczema at a young age Gynger began to notice how the food they were consuming affected their health.

“I noticed that certain things that [they] were eating would make it [the flare-ups] worse, and eating fruits and vegetables really made the difference in [their] eczema to this day.”

Gynger is well aware of how economic disparities can directly contribute to severe skin conditions, as she lives in a food desert in North Philadelphia.

“There’s more liquor stores and corner stores in my neighborhood than there are grocery stores. We have very little access to fresh produce.” 

The health outcomes of communities in a food desert, obviously, are generally unfavorable. Medical science is still exploring the direct link between diet and eczema, but it is well established that a lack of access to balanced nutritious options leave community members at risk for a range of preventable chronic illnesses that include Type 2 diabetes, hypertension and other diseases that disproportionately affect Black Americans. 

Which is why Gynger decided to sell her all natural fresh pressed juices in corner stores. “I wanted to make healthy foods more accessible because what you consume impacts way more than just your stomach.”

In a study that highlights racial disparities in the everyday impact of eczema, research from 2019 shows Hispanic and Black children are more likely than white children to miss school due to an eczema flare-up. Anxiety and stress, frequent companions in the lives of eczema sufferers, serve as potent catalysts for flare-ups, perpetuating a vicious cycle of discomfort and psychological distress. 

Indeed, access to dermatological care, nutrition and mental health resources to manage eczema flare-ups becomes a basic necessity out of reach for many residents grappling with economic hardships. Another 2019 study found that Black and Hispanic children were nearly three times more likely than white children to receive medical care for atopic dermatitis – including emergency medical care. At the same time, Black children whose condition was poorly controlled were significantly less likely to see a dermatologist than white children with a similarly poorly controlled condition. 

The implications of these disparities are profound, reaching beyond physical discomfort to negatively affect educational attainment, social opportunities, and overall quality of life. As we delve deeper into the intersection of poverty and skin health, it becomes evident that systemic barriers exacerbate the challenges faced by marginalized populations, perpetuating cycles of inequality.

For Norreal Robinson, the founder of holistic skin care company Beans Buttas, the decision to confront eczema head-on emerged from a deeply personal journey. In seeking guidance and treatment of her own eczema, she experienced firsthand the limitations of conventional medical approaches to treating all dimensions of a condition; that is to say, acknowledging the underlying causes and non-medical factors and treating them all (rather than just the superficial symptoms) for overall wellness. She was informed at various points in her treatment journey that her eczema was neither hormonal nor linked to her diet or environment. Current research endeavors aim to dig a little deeper for connections conventional medicine may have missed, and they’re starting by listening to the communities most directly impacted by health inequity in addressing chronic skin conditions. 

A new approach that ADDs UP

Researchers at the University of Pennsylvania have already begun identifying an intricate web of connections between quality of life, poverty, and atopic dermatitis. Armed with a short survey, they’ve forged partnerships with community members, delving into the multifaceted effects and impacts of eczema. While speaking with community members a startling reality is revealed: eczema’s prevalence far surpasses conventional wisdom, with triggers extending beyond environmental factors to encompass dietary choices and consumption habits.

Enter ADDs Up (Atopic Dermatitis Disparities Study – University of Pennsylvania & Philadelphia Partnership), an innovative approach to understanding and treating eczema. Through in-depth interviews with community members, this initiative aims not only to unearth the root causes of eczema but also to forge vital connections to resources—be it for food, shelter, or holistic care – for those affected. 

Studies, like ADDs Up, seek to address the root causes even when traditional medicine is ignorant of its own limitations. In the words of ADDs Up recruiter and self-ascribed “citizen scientist” Yuhnis Sydnore,

“When your mind is weary, when you’re troubled, that triggers all sorts of other things in your body to not work.”

Indeed, the holistic approach championed by ADDs Up acknowledges the interconnectedness of mind and body, paving the way for comprehensive solutions that address the root causes of eczema while nurturing overall well-being.

Before studies like ADDS Up can be successful though, they first have to be able to overcome a set of unique challenges linked to the distrust of medical institutions in Black and brown communities. It’s been extremely difficult to encourage Philadelphians to participate in this research. Yuhnis acknowledges the centuries of trauma that medical studies have inflicted on Black communities historically. He is often educating communities of color on the laws that have been enacted to protect participants in research studies since historical events such as the Tuskegee syphilis study. But he intimately understands how mistrust is reinforced by health system issues and discriminatory practices that continue to this day.

Barely Scratching The Surface

In the landscape of dermatology, philanthropy flows like a mighty river, yet its currents often veer away from addressing the most urgent needs of those grappling with poor skin health. Despite foundations pouring half a billion dollars annually into dermatology research nationwide, scant attention is paid to the profound impacts of conditions like eczema—a reality that hits hardest among marginalized communities. While doctors and researchers benefit from ample funding, individuals directly affected by skin ailments find themselves trapped in a labyrinth of inaccessible solutions.

For many, the path to healing is fraught with obstacles, particularly for the economically disadvantaged. Managing eczema takes a toll on mental health and financial stability. The expenses of appointments, missed work or school, and treatment costs weigh heavily on families, perpetuating cycles of stress.

Amidst these challenges, glimpses of progress emerge. In California, the nonprofit Coalition for At-Risk Restoring Youth (CARRY) operates a free dermatology clinic for at-risk youth and foster care recipients. As the only known non-profit organization in the U.S. addressing the skin issues of at-risk and foster youth, CARRY nurtures self-esteem and resilience, vital tools for a vulnerable population. 

As inequality deepens, philanthropy must rise to the occasion. It’s not solely about research funding; it’s about implementing accessible solutions. Philadelphia can replicate successful models from California to alleviate skin health disparities, for the empowerment of those most deeply impacted by eczema.

Disparities are making our skin crawl

When it comes to skin health disparities, Philadelphia stands at a pivotal crossroads. The journey towards accessible, equitable dermatological care requires a multifaceted approach—one like ADDs UP, that leverages resources, expertise, and community partnerships. By embracing holistic solutions, Philadelphia can break down barriers to care, offering a lifeline to those grappling with the hidden burdens of eczema.

In the end, eczema treatment is not just about funding research or prescribing pharmaceuticals; it’s about creating practical solutions that uplift individuals from the trap of skin health disparities. It’s about recognizing the interconnectedness of mind, body, and community, and forging a path towards healing that honors the diverse experiences of all Philadelphians.