For the simulation, around 50 people were separated into about 15 families. Each participant role-played a family member with a specific profile and a set amount of money. They had to visit mock-ups of public transportation, grocery stores, and various offices like employment, housing, and healthcare.
Jenna Dick is the community engagement and health equity proram manager in UNCW’s College of Health and Human Services. She said the simulation taught the group what it feels like to apply for things like housing assistance.
“But then you had to wait a couple weeks to actually receive it. If you didn't do that until later in the month, you didn't receive your housing assistance in time; you essentially would be evicted or unhoused. And so I think that's something so important for our Wilmington community to understand, is that it's not as simple as just going and getting a job,” she said.
Dick said some of the participants, who are students preparing for careers in public health, social work, or nursing, are learning valuable lessons about their future clients or patients.
“When you're treating someone in the future, if they are unhoused or seeking housing and trying to attain employment, things like that, and they have high blood pressure or diabetes, the amount of stress that is exacerbating those health issues it's compounding, and I think that our future providers need to understand that,” she said.
Colette Waddill is a clinical assistant professor in the School of Nursing and the coordinator for the simulation. She said the exercise shows how the social determinants of health play a critical role in anyone’s life. These include things like education level, ethnicity and race, employment status, health literacy, and medical insurance. In the simulation, participants experienced what it was like not to have a leg up in society.
“Everybody has to prioritize, and food and housing are a prioritization, so they may forgo medications, you know, employment, education was pretty low on that. As we saw, not many people went and tried to further their education because they're so stuck in just meeting their bare necessities,” she said.
Waddill heard some of these frustrations from the participants throughout the simulation. They said they were “anxious” and “stressed” if they couldn’t get housing, employment, or medical support. Conversely, participants said they were relieved if they could get a housing voucher or had enough money to pay for doctors’ visits or medications.
One reason Waddill got into health equity work is that in southeastern North Carolina, maternal and infant mortality and morbidity are high in marginalized populations, so she wanted to find out why. She said that studying health inequities means that researchers are investigating the realities of the community.
“If you haven't received prenatal care because you can't access it because of transportation or lack of insurance, or just poor health literacy, not even understanding that you need that prenatal care, obviously, your outcomes are going to be quite different than somebody who has gone through that care,” Waddill said.
Pam Balogh is a clinical assistant professor in the School of Nursing at UNCW. Like her colleague Waddill, she said scenarios in the simulation mimic what some of her Pender County Public Health patients struggle with. She gives an example of how economic barriers impact health.
“‘Well, I see you were referred, but tell me about that. What was going on with that you didn't get to that referral?’ And they're like, ‘We don't have a way to get there.’ And so it turned that conversation from ‘Oh, well, let's figure out how we can help you get transportation, if that's even an option,’” Balogh said.
Stephanie Todd is a Pender County Health Department educator who participated in the simulation. She said another barrier is not knowing the available resources.
“We offer primary care on a sliding fee scale, and a lot of people don't realize that when we're out in the community, so we're not just like restricted to one type of service in our department; we also have a dental clinic, and we have a mobile truck that goes out,” Todd said. She added that they help their patients apply for Medicaid and Medicare if they meet the qualifications.
As UNCW’s health equity program manager, Dick said that the public needs to see what hurdles those who make lower-incomes face.
“For us to best serve other people, we really have to put ourselves in their shoes and to understand that so many things that we take for granted are just not available to everyone or accessible to them,” she said.
According to Waddill, they are measuring that throughout the simulation using before-and-after surveys with participants.
“What we're evaluating is whether empathy for this population has improved through this experience,” Waddill said.
However, the work of equity has come under fire recently from the Trump administration as they scrub references to diversity, equity, and inclusion. Dick said researchers are well-aware of this new environment and are making some changes.
“As we were developing the research for this, and just different ways of having to phrase things, it's challenging, because I feel like there were a number of years where we were making a lot of progress in being more inclusive and trying to make sure that everyone was represented, and that's still always our goal, but we kind of have to be a little bit strategic about it,” she said.
To overcome another future limitation of the simulation, Dick might include a scenario in which a family member has experienced a traumatic event. She has worked at the Domestic Violence Shelter and Services, Inc., Coastal Horizon’s Rape Crisis Center, and with survivors of human trafficking in Raleigh and said that people need to know how much trauma “sets people back or even just prevents them from moving forward.”
Dick has seen some success stories throughout her career, but sometimes, unfortunately, people don’t get over traumatic experiences.
“I think that there's kind of a misconception that things work out in the end; it takes a lot of strength and willpower and dedication to take yourself out of traumatic experiences and find a way to move forward,” she said.
