Karen Joynt Maddox’s career as a health policy researcher sparked from an initial interest to affect change in the world around her. Today, Joynt Maddox, MD, MPH, associate professor with the Cardiovascular Division and Co-Director of the Center for Health Economics and Policy at the Institute for Public Health at Washington University, is doing just that, helping to define, educate and develop health policy and equity through research.
After completing her undergraduate degree in education policy, Joynt Maddox pivoted and headed to medical school. And, it was there while rounding on the wards that she soon realized that she was doing policy yet again. “When I was talking to patients I realized there is a complex interplay between social risk, economic opportunity, and health … all these bigger picture things can influence a patient’s outcome,” remembers Joynt Maddox. “It was then that I understood how much policy was really driving people’s health.”
Medical school was followed by internal medicine residency and a cardiology fellowship. During fellowship, Joynt Maddox pursued a Master of Public Health degree and training in health policy research before joining academic medicine in a faculty role in 2011.
Three years later, an unexpected opportunity arose to take a role with the US Department of Health and Human Services, working on the intersection of health policy and social determinants. This broad range of experience helped Joynt Maddox solidify her health policy focus. “I got to see firsthand how health policy can make an impact on patients, which is why we are here in the first place.”
For the last four years, Joynt Maddox has been at Washington University, still researching how health policy impacts peoples’ lives. She feels that more professionals with a clinical perspective need to be involved in the discussions around health policy, and finds that interest among clinicians is growing.
From her mentoring work within the department, Joynt Maddox sees that health policy and public health are much more front of mind, particularly among trainees considering how to combine an academic career with an interest in health policy and equity. “A lot of medical students come to me asking whether it is possible to do health policy and equity work as a career. They come to medical school knowing they care about these issues, but not knowing how to turn those interests into a career pathway.”
While at WashU, Joynt Maddox has been an active mentor to many students and trainees. Former clinical cardiology fellow and current faculty member, Gmerice Hammond, MD, MPH worked with Joynt Maddox for two years as part of a cardiovascular health policy research fellowship, during which her focus was the intersection of racial equity and health policy. Together they published “A Theoretical Framework for Clinical Implementation of Social Determinants of Health” in the October 2019 issue of JAMA Cardiology on the need to address social determinants of health to reduce racial health care inequities and improve population health.
Much of Joynt Maddox’s research over the years has focused on improving the measurement of the quality and efficiency of physicians, hospitals, and health systems; understanding the impact of policy interventions on health care, with a focus on value-based and alternative payment models; and reducing disparities in care, with a focus on vulnerable populations including racial and ethnic minorities, individuals living in poverty, individuals with disabilities, frail elders, and those in rural areas. Her research specific to rural populations and stroke risk was featured recently in the documentary “Bridging the Great Health Divide”. In the film, Joynt Maddox weighs in on the growing fatalities from stroke and the lack of access to emergency and preventative care in rural areas.
Since the pandemic began, her research has expanded to focus on health disparities in relation to COVID, with a particular focus on the effects of the disruption COVID has caused in usual health care delivery. In May 2021, she was the senior researcher on a study entitled “Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths during the COVID-19 Pandemic in the United States” published in the journal Circulation. The research concluded that during the COVID-19 pandemic, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic.
The spillover effects of COVID have highlighted major weaknesses in our health care safety net. We need to have a better understanding of those effects, how they have impacted vulnerable populations, and what mitigation strategies will be most effective to reduce inequities in the future.Karen Joynt Maddox, MD, MPH, Associate Professor of Medicine, Cardiovascular Division and Co-Director of the Center for Health Economics and Policy at the Institute for Public Health at Washington University
Research on the horizon for Joynt Maddox includes studying the effects of COVID’s nursing home “lockdowns” on socially vulnerable older adults living in long-term care, as well as examining differences in the way COVID disrupted health care for people living in rural versus urban areas. In the long term, she hopes to identify the ways COVID’s “spillover” effects could widen inequities in cardiovascular and cerebrovascular disease well after COVID-19 is under control.
According to Joynt Maddox, “The spillover effects of COVID have highlighted major weaknesses in our health care safety net. We need to have a better understanding of those effects, how they have impacted vulnerable populations, and what mitigation strategies will be most effective to reduce inequities in the future.”