AMAF Forms Consortium of Institutions to Address LGBTQ+ Health Disparities

The American Medical Association Foundation (AMAF) recently announced that several of Harvard Medical School’s (HMS) affiliated hospitals in collaboration with Fenway Health in Boston and Vanderbilt University Medical Center (VUMC) in Nashville will participate in the AMAF National LGBTQ+ Fellowship Program consortium of institutions. They join the pilot fellowship at Icahn School of Medicine at Mount Sinai in New York City and the 2021 inaugural institution at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin.

Launched in 2020, the fellowship program aims to provide enhanced physician training, education, and cultural sensitivity while bringing awareness to the health care and institutional barriers faced by LGBTQ+ and intersecting communities. The program’s ultimate mission is to ensure that all LGBTQ+ patients receive the highest standards of care while helping transform the landscape of medical education. The addition of two exceptional teaching institutions to the program demonstrates the AMAF’s commitment to moving the needle and taking the fellowship to scale nationwide.

“The AMAF is uniquely positioned to serve as a convening force to improve LGBTQ+ health equity by facilitating collaboration and knowledge sharing between key stakeholders and institutional leaders that will transform health care systems to be LGBTQ+ inclusive and affirming,” says William Sternfeld, MD, president of the AMAF Board of Directors. “The result will be a workforce of LGBTQ+ health specialists with a rich body of knowledge that can be shared with all medical schools and health care professionals.”

The AMAF Board of Directors unanimously approved the recommendation from its Fellowship Commission on LGBTQ+ Health to award the two grants. With the vision and support of the AMAF LGBTQ+ Honor Fund Founding Donors and led by John D. Evans, the Commission is a collaboration of thought leaders, educational specialists, physicians, and philanthropists who provides oversight on the development of the AMAF National LGBTQ+ Fellowship Program. As volunteers, the Commission has provided tremendous leadership in the development of this unique program and completes a rigorous and thoughtful review of applications.

Several factors were noted in the Commission’s recommendation to the AMAF Board to accept HMS Fenway and VUMC fellowships into the program, such as the extensive network of clinics across HMS affiliates and Fenway Health that serve LGBTQ+ patients from adolescence through older adulthood. HMS also established the Sexual and Gender Minority Health Equity Initiative to teach students foundational clinical skills in LGBTQIA+ health care while exploring the intersections of anti-LGBTQIA+ stigma with racism, ageism, and ableism. The fellowship will extend and deepen this foundational work by implementing LGBTQIA+ health training systemwide for fellows, residents, and faculty. HMS-affiliated clinical sites participating in the fellowship include Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital. Boston Children’s Hospital, Cambridge Health Alliance, and Mount Auburn Hospital will serve as supplemental clinical elective sites.

“Our multisite Harvard Medical School-Fenway Health LGBTQIA+ Fellowship team is honored and thrilled to have the opportunity to join the AMAF National LGBTQ+ Fellowship Program. Now more than ever, we need to equip the next generation of physician leaders in LGBTQIA+ health with the skills to provide comprehensive and affirming care for all LGBTQIA+ populations, across the lifecycle, with a focus on serving marginalized LGBTQIA+ communities,” states Jennifer Potter, MD, a professor of medicine at Beth Israel Deaconess Medical Center and HMS, and director of the LGBTQIA+ Population Health Program and cochair at The Fenway Institute.

The AMAF Fellowship Commission also recognized VUMC’s commitment to personalized medicine and to improving outcomes for LGBTQ+ patients at VUMC and across the United States. Established in 2012, VUMC’s Program for LGBTQ+ Health has a 10-year track record of investing in LGBTQ+ health and promoting national leadership in patient care, education, research, and advocacy for the LGBTQ+ community. The clinical LGBTQ+ program at VUMC includes the Clinic for Transgender Health that brings together specifically trained experts to provide and coordinate comprehensive care for transgender and gender-nonconforming adults. The fellowship program will intercalate LGBTQ+ health education with all disciplines and throughout curricula at all levels of learners. VUMC’s organizational expertise in data informatics will allow for rapid dissemination of internal and external outcomes.

“We are incredibly excited and grateful to be a part of this consortium, in this group of academic medical centers working together to promote inclusive and personalized care for patients,” says Kyla Terhune, MD, vice president for educational affairs at VUMC.

The fellowship initiative is in response to persistent, pervasive disparities regarding access to and quality of health care experienced regularly by LGBTQ+ individuals. Studies show that 80% of medical students demonstrate a bias of LGBTQ+ patients, leading to 1 in 5 LGBTQ+ adults avoiding health care services due to fear of discrimination. The result is not just harmful—it is deadly. The AMAF and participating institutions will address these inequities while building on existing foundations of diversity, equity, and inclusion strategies that support affirming LGBTQ+ services. The AMAF welcomes individuals, foundations, and corporations to join the conversation and connect with the Foundation to ensure all LGBTQ+ Americans have access to medical care.

— Source: American Medical Association Foundation

Vertical Farming: Location a Key Factor to Success, Says IDTechEx

Vertical farming, the practice of growing crops indoors on vertically stacked layers, has received no small amount of interest over the last few years. Vertical farms commonly tout impressive numbers, such as using 95% less water and providing crop yields 20 to 30 times that of conventional agriculture. These claims, among many others, have seen many vertical farming start-ups being founded alongside large amounts of industry funding; funding for the industry reached a record high in 2021, with over US $1 billion being raised across the entire industry. The recent IDTechEx report, "Vertical Farming 2022–2032," details the economic and technological factors shaping this rapidly growing industry.

With crops being grown indoors under controlled environments, a selling point used by multiple vertical farms is that they can grow crops anywhere—even in the heart of a city. This has led to proponents of the industry envisioning "smart cities," where vertical farms in city skyscrapers help feed the urban population. While this is achievable in principle, the truth is that the choice of location for vertical farming is much more involved and intricate than it may appear from these claims alone. Choosing an ideal location can be one of the most important factors in determining the success of a vertical farm.

Some vertical farms may choose to set up their facilities in preexisting facilities, such as abandoned warehouses. In these cases, identifying the suitability of the venue is the first point of consideration: vertical farms are very energy intensive, and it is important to ensure the facilities chosen can support these energy loads. In addition, the ergonomics of the facility is also important; should the layout not be given proper consideration, this can impede workers and decrease worker efficiency. As labor costs are typically among the largest sources of expenditure for a vertical farm, improving labor efficiency to reduce these costs is of paramount importance.

While growing crops in the center of a city may seem ideal, the reality is that this may be counterproductive. Obtaining and maintaining such a location is expensive and can contribute significantly to the operating expenditure of a vertical farm while presenting logistical challenges in distributing produce; the "last mile" of food distribution is often the hardest. Having a farm right next to the consumers themselves may also be less ideal than instead choosing a location near food distribution centers, as this allows for more efficient delivery of produce. As distribution centers are typically located on the outskirts of cities, the cost of land is also much cheaper. This is the approach chosen by UK-based Jones Food Company, which chose Scunthorpe as a location for its vertical farm—this is a relatively low-cost location located near food distribution centers and a network of motorways that could still reach many consumers in a day, even if it isn't right in the middle of the capital city. Vertical farms should carefully consider their place in the supply chain before establishing a base.

On a larger scale, vertical farms may prove more profitable in different geographical regions. Vertical farms can reduce water usage significantly over conventional agriculture, and the high degree of control over the growing environment allows them to grow crops in extreme climates—where such crops may not otherwise be able to grow. In return, vertical farms demand more energy to carry out growing operations. To maximize their potential, vertical farms would ideally be located in regions of water scarcity, such as Sub-Saharan Africa and the Middle East, or in areas with extreme climates, such as in Scandinavian countries, where the low amounts of sunlight and high costs of regulating greenhouse environments single out vertical farms as an optimal solution. The amount of agricultural land available is also an important factor—regions looking to increase food security and reduce reliance on imports while facing challenges in acquiring sufficient agricultural land would find vertical farms to be ideal. A particularly prominent example of such a country is Singapore, which has demonstrated much interest in vertical farming over the last few years.

Beyond the considerations of water scarcity and temperature, the general availability of fresh produce and the distribution networks of given countries should also be considered. Vertical farms use the added freshness and higher quality of their crops as a primary selling point, but these are typically offset by higher prices. Should there already be a large supply of high-quality produce made available at lower costs, vertical farms will find it hard to distinguish their own produce and may struggle to establish a significant market share. The converse would also be true; should a country lack easy access to fresh produce, vertical farms are expected to see much demand for their produce. An example of such a region would be the Middle East: leafy greens typically travel several thousand miles to reach stores, resulting in consumers facing high prices and low-quality products. The high price of conventionally farmed leafy greens, alongside government subsidies, makes it easier for vertically farmed produce to approach price parity while providing much fresher, higher-quality products.

While the choice of location is an important consideration, it is only one of many others that must be given proper thought. Only through proper optimization of growing operations to improve efficiency and reduce costs can vertical farms reach their true potential. In the IDTechEx report, "Vertical Farming 2022–2032" many further important factors for consideration are discussed in detail, and the future of vertical farming is evaluated through 10-year market forecasts.

For more information, including downloadable sample pages, visit www.IDTechEx.com/VertFarm.

— Source: IDTechEx