She explains how one of her patients living in a long-term care facility was given a medication to treat osteoporosis, but the medicine was administered incorrectly by crushing it first, which led to burning of the patient’s esophagus. The patient stopped eating and almost died.

“Fortunately, we were able to save her and send her home, where she healed and gained her weight back,” Antimisiaris said. “This is an example of the critical importance of medication literacy from the patient to the entire health care team.”

Polypharmacy, the use of multiple medications together, often associated with medication use risk, is usually associated with older adults, but is increasingly becoming more common among younger adults and children. With approximately 20,000 prescription and more than 300,000 over-the-counter products available to consumers, understanding on how to use medications and how they interact together has never been more important.��

“There’s nowhere in the health care system that you can go if you’re taking 20 drugs and say, ‘Here’s what I’m taking. Is everything ok?’,” Antimisiaris said.

UofL’s distinctive program��

The UofL Jean Frazier Polypharmacy & Medication Management Program is unique among colleges and universities in its dedication to education, research and outreach on the growing challenge of polypharmacy.

Originally launched through the , the FPMMP was created in 2007 through the support of philanthropist Jean Frazier, whose long-standing concern about polypharmacy aligned with the work led by then DFGM chair,�� James G. O’Brien.

Frazier’s interest in supporting a polypharmacy program was sparked after three people she knew well suffered from adverse medication issues within one year’s time – one of them, her mother.

“I started to wonder if there was anything I could do to help stop problems like this and I talked with Dr. O’Brien, who hired Dr. Antimisiaris, and that’s where it all started,” said Frazier.

Since 2007, Frazier said she is pleased with the progress in community awareness about polypharmacy through the efforts of the polypharmacy program.

“One of the things the program is doing that I am delighted with is a process of having people take an interest in their own health – understanding their illnesses and medications and knowing the side effects and interactions,” she said. “I think the program is beneficial and it is growing. It really is an asset for the community.”

Antimisiaris says 275,000 people die every year trying to use their medicines correctly, and adverse drug events account for more than 3.5 million doctor visits annually and 1 million emergency department visits.

“When you have one medicine from your cardiologist, one from your psychiatrist and three more you take over the counter, it’s a lot harder to monitor and predict the effects,” said Antimisiaris. “Usually, we don’t recognize it until they hit the emergency room doors. And by then, it’s often too late.”��

Making a global impact��

As a dedicated program focused on polypharmacy, UofL’s efforts are leading the way nationally and internationally in medication management expertise. In June 2023, the FPMMP worked with the Polish Ministry of Health and the Universities of Poznan and Warsaw to pilot a medication therapy management (MTM) project. Antimisiaris served as one of the ministry’s experts on MTM implementation and evaluation, providing advanced practice education.

Agnieszka Neumann Podczaska, Polish Ministry of Health’s Medication Management pilot project director, said the Frazier program partnership has been valuable for their program and for the field of polypharmacy.

“At Poznan University of Medical Sciences, the collaboration with Dr. Antimisiaris��helped us to understand the need of providing research in all aspects of polypharmacy, not only the influence on clinical assessment but also on barriers to medication literacy and systems, or lack of systems, of polypharmacy management in clinic,” Podczaska said.

In addition, she said observing the program emphasized the importance of engagement with diverse experts in health systems of care delivery, policy, incentives, literacy, international perspectives and governance.

Antimisiaris said the FPMMP is extending its efforts across the European Union (EU) to help bring medication management to more populations. “We recognize they face the same problems we do with gaps in medication management caused by policy and systems of health care,” she said. “I think this is a credit to UofL and to Mrs. Frazier that we have the stakeholders and leaders in the EU looking to us.”

Collaboration within the UofL community

Closer to home, the FPMMP is looking to leverage public health expertise and education in medication literacy to develop innovative programming in the polypharmacy space. Population and societal approaches that empower people are especially important to address system gaps, said Antimisiaris.

For example, the School of Public Health and Information Sciences recently launched a new course open to undergraduate students called “Medication Use: History, Science and Humanity,” designed to raise awareness and skills of students who will be better equipped citizens and advocates, beyond those working in health care.

Creative inter-disciplinary approaches also led to a collaboration with colleagues in the to examine pharmacy accessibility in care deserts (pharmacy deserts) that was funded by UofL’s .

With an average of 50 new prescription products approved for market annually, most of which are high-technology and unfamiliar, and nearly 50% of the US population taking at least one prescription medication, the challenge of effective and safe medication use will continue.

“What has happened is that our systems, policies and individual medication literacy have not kept up with the growth of medication consumption worldwide,” Antimisiaris said.

What motivates Antimisiaris is seeking innovative solutions to transform the way society interacts with polypharmacy and medication management.

“What are the systems and individual-level solutions needed to keep us healthy and safe? These are the questions we will continue to study,” she said.

The University of Louisville and partners have launched a new $1.5 million innovation challenge centered on tackling pressing problems in health equity, with 15 winners each receiving $100,000 to further their ideas.��

This new Reconstruct Challenge is led by the , in partnership with an innovation studio, with funding from the Kentucky Department for Public Health’s Office of Health Equity and the private operating foundation, .

Together, they will select five winners for each of the following categories: 1) food access, 2) maternal and child health and 3) non-emergency medical transportation (NEMT) and access in the Louisville region.��

“By bringing together the lived experiences of community members, academic expertise, industry knowledge and entrepreneurs, the goal is to create solutions in partnership with the people experiencing these health inequities every day,” said Ben Reno-Weber, challenge lead and deputy director of HEIH within UofL’s HEIH is an innovative partnership among UofL, and the focused on solving important health equity challenges through research, innovation and talent pipeline development.

Render is the executing partner of this grant and will launch the national call for innovations and the evaluation process. Each of the 15 winners will be awarded $100,000 in development funding and will participate in a 12- to 18-month proof-of-concept phase where they will work with community partners and UofL researchers to pilot their innovations in the Louisville region.��

“Addressing inequities in our communities is vital work because we know we are only as strong as our most vulnerable populations,” said Kentucky Public Health Deputy Commissioner for Clinical Affairs and Interim Director of the Office of Health Equity Connie White. “We need to work together to elevate all of us. The Kentucky Department for Public Health is happy to be a contributing partner.”����

Applications are now open on the Reconstruct Challenge , and an will be held July 27. After the initial pilot period, successful innovations will have the opportunity to receive additional funding to further scale.��

This innovation program builds on UofL’s track record as a research powerhouse and the prior successes of the two previous Reconstruct Challenges launched by Access Ventures in 2019 and 2022 addressing housing and barriers to employment, respectively. This Reconstruct Challenge series is funded by the Kentucky Cabinet for Health and Family Services and Access Ventures.��

“Poverty and its related challenges are cyclical and complex, and there are no silver bullet solutions,” said Access Ventures Managing Director Bryce Butler, who spearheaded the first two Reconstruct Challenges in 2019 and 2022. “We believe that if we work together, we can enact meaningful change and increase health equity in Louisville and Southern Indiana, which is why I’m so excited to expand Reconstruct with the help of new partners.”��

The inaugural ��in 2019, founded by Access Ventures, focused on finding creative solutions to the affordable housing gap in the United States and granted six innovations of $300,000 each. Winners included Padsplit, Working Your Way Home, Urban Institute, Nesterly, Haven Connect and mRelief, of which the latter three received $350,000 (mRelief), $100,000 (Nesterly), $100,000 (Haven Connect) in follow-on capital to further scale. Through the first program iteration alone, 71,725 lives have been impacted, over $51 million unlocked for families already, and a 22-fold return on impact realized through these six innovative solutions.

A second in 2022 focused on finding creative approaches to making employment more equitable, and $100,000 was awarded to each of five innovative solutions to deploy in Louisville and Southern Indiana.����

This set of Reconstruct Challenges is open to anyone in the United States as long as the beta test of the innovation takes place in the Louisville region.��Important dates for applicants:��

Supported by the University of Louisville, the Humana Foundation and the Health Equity Innovation Hub, the Air Justice website,, debuts at noon, March 28.

More than 50 UofL students have worked on the project since 2021 with a coalition that includes professors, community leaders and activists. The team conducted nearly 2,000 surveys around the Rubbertown area and also held workshops with residents to determine residents’ informational needs.

Rubbertown was named for the tire and synthetic rubber plants built there during World War II. Air quality in the area has suffered as a result. In west and southwest Louisville, the areas that border Rubbertown, residents are predominantly Black and other people of color, most of whom also experience poverty.

“The Air Justice team considers air quality an environmental health equity issue, one that has a lot to do with literacy or with how information about air quality is distributed in the city,” said Megan Poole, UofL assistant professor of English, College of Arts & Sciences. “The Air Justice website decodes the science and health effects of air pollution, uncovers the history of environmental injustice in West Louisville, amplifies residents’ stories related to air pollution, and directs residents to resources for reporting odors and pushing for increased air quality regulation.”��

In addition to Poole and the students, the��Environmental Health Literacy Coalition�����Գ����ܻ���:

• Shavonnie Carthens, assistant professor of law, Louis D. Brandeis School of Law;
• Keisha Dorsey, who formerly represented Louisville Metro Council District 3, an area bordering Rubbertown, and is now deputy chief of staff to Louisville Mayor Craig Greenberg, and
• the grassroots activist group Rubbertown Emergency Action (REACT).

Human health risks associated with the chemicals released in the Rubbertown area are over 10,000 times higher than the industry average.

“Even more pronounced is the inequity of this health issue,” Poole said. “Over 60% of residents identify as ‘minority,’ over 50% identify as Black, and over 52% experience poverty.”

This website launch is only the beginning of Air Justice’s health equity work. “This website is a communal work in progress,” Carthens said. The project aims to co-create health equity solutions alongside residents and local communities.

Air Justice also launched on Instagram (@airjusticelou) and Facebook (Air Justice Louisville) to begin engaging community members prior to the public launch of the website.��

The project has received over $350,000 through support from The Gheens Foundation,��and the Humana Foundation.

UofL News: How was the idea for the Health Equity Innovation Hub developed?��

Monica Wendel: The Hub is a collaboration between UofL, The Humana Foundation, and Humana Inc. aimed at closing health equity gaps. It became clear that health equity was a shared goal between the organizations. Realizing this shared goal, UofL Executive Vice President of Research & Innovation Kevin Gardner invited me to lead the development of the collaboration. Not long after, Humana’s inaugural Chief Health Equity Officer, Nwando Olayiwola, was named and both Humana and The Humana Foundation deepened their existing commitment to working towards equitable health systems for each person and community.

UofL News: Break down for us, please, the main mission of the Hub.��

Wendel: The mission of the Hub is to advance social and health equity for structurally marginalized communities. In recognizing that health outcomes and inequities are driven by social determinants, which in turn are shaped by structural determinants, the Hub is committed to working across multiple levels of social ecology in ways that provide communities made vulnerable equitable access to the resources they need to be healthy and whole. We are doing this by integrating the research power of the university, the resources of industry, the expertise of the community in these issues, and the ingenuity and creativity of innovators and entrepreneurs — especially those who hold minoritized identities — in solving health equity issues.

UofL News: Why is this work so important at this time?��

Wendel: Everyone wants to be healthy, but the choices people make are the choices people have. And we don’t all have the same choices – our health care, housing, food and other systems offer more choice and accessibility to some people than others. For Black and brown populations, LGBTQ+ populations, foreign-born populations, rural populations and populations living in poverty, the structures and systems enact and reinforce marginalization that produces health inequities.

It’s important here to differentiate between ‘disparities’ and ‘inequities.’ Health disparities refer to differences in risk, incidence, morbidity, disability and mortality in various conditions between different groups. Health inequities more specifically identify differences between groups that are unjust, unnecessary and preventable. The structures and systems we create and maintain produce inequities — we as a society are responsible for that. But that also means it can be changed. If it’s going to change, we have to change it.��Equity will not happen organically.

UofL News: Please describe the research aspect of the Hub.��

Wendel: A key aspect of the Hub is the integration of research, community engagement, innovation, entrepreneurship, strategic relationships and talent development to achieve specific outcomes toward advancing health equity. This integration is both the most innovative and the most challenging facet of the work; because of it, people in Louisville and beyond will thrive.

I have had the privilege of assembling a team of individuals who are rock stars in their respective areas of expertise. But doing things the way they’ve been done is going to continue to get us what we’ve got – which is inequity. So, our team is intentionally doing the hard work of not operating in silos of individual areas of expertise, and bringing all areas of expertise to the strategies and activities in each of our workstreams. In that way, we are advancing health equity at multiple levels of social ecology and interconnecting community sectors that likely would not otherwise be connected. Those cross-sector network relationships will transform systems to advance health equity and will endure long past all of us.��

Thanks to the Humana Foundation’s gift, the Hub is able to support minoritized researchers and novel health equity research. We put out our first call for research proposals in March, and through a rigorous review process, awarded over $1 million to fund 10 health equity research projects.

UofL News:��As a public health researcher, you’ve worked over 20 years addressing aspects of health inequity and factors related to social determinants of health. How does the Hub build upon what you’ve learned through your own research?

Wendel:��My vision and design for the Hub is grounded in several things I’ve learned over the course of my career. First, people have a right to self-determination. For minoritized populations, our systems have historically stripped away this right.��The people most impacted by health inequities of any kind are the most expert in those inequities, and often have valuable insights and innovative ideas for how to solve them. We must listen and engage the communities affected. Solutions brought in from outside those communities rarely have the intended magnitude of effects.

Second, we must work upstream and downstream at the same time and across sectors — advancing health equity requires organization and strategy. Although the United States has made some gains in health equity efforts, there is still much work to be done in addressing inequities and ensuring everyone has access to resources that support good health. Our downstream interventions must address immediate needs and advance health equity at that level.

But we cannot achieve sustainable gains in health equity unless we also work upstream, with communities that have historically experienced these inequities. For example, inequities in maternal health outcomes for people of color may result from lower quality of care, but they may also result from experience of racism within the health care system. Improving quality of care downstream only addresses part of the problem; if people do not seek care because of distrust of the health care system, they will not benefit from improved quality of care. There must be simultaneous work addressing systemic racism in the health care system. Thus, our upstream interventions must transform systems to reduce health inequities, while downstream, we work to ensure equitable access to health resources. Both of these efforts are necessary, and neither on its own is sufficient.

Third, our interventions must be planned for way beyond the term of a grant. Initiatives intended to advance health equity must not bring needed resources to a marginalized community that then disappear at the end of the grant; this results in real harm to real humans. Any kind of equity work requires intellectual and cultural humility and a conscious intent on doing no harm. There is no substitute.

The Hub was launched earlier this year as a collaboration between UofL, The Humana Foundation, and Humana Inc. aimed at closing health equity gaps facing vulnerable populations. The 10 projects awarded in this initial round of funding furthers this goal by tackling inequities in areas such as access to mental and physical health care and healthy food. Projects were eligible for up to $100,000 per year for up to three years.

Monica Wendel, who leads the Hub, said finding solutions for these challenges will create more choices for people in making decisions that affect their health.��

“These factors play a huge role in our health outcomes,” said Wendel,��a professor��in the UofL School of Public Health��and��Information Sciences.��“We all want to be healthy and whole. But��the choices people make are the choices people have. For communities that have been marginalized, their choices are greatly limited by structural and social barriers. Our goal with the Hub and with this research is to dismantle these barriers, create more choices and thus empower people and communities.”

The funded projects include:��

• • The Pharmacy Accessibility Index (PAI) Project (Lihui Bai, J.B. Speed School of Engineering);
  • Healing-Centered Capacity Building: Social Justice Youth Development Certificate (Aishia Brown, School of Public Health and Information Sciences);
  • An Examination of the Feasibility and Acceptability of a Racial Trauma Processing for Family Health Intervention (Emma Sterrett‐Hong, Kent School of Social Work);
  • Exploring Workforce Development, Well‐Being, and Organizational Readiness to Recruit, Retain Black American Adults Living in Low Resource Communities (Meera Alagaraja, College of ����ֱ�� and Human Development);
  • A Community-Engaged Feasibility Study of hrHPV Self‐Sampling for Primary Cervical Cancer Screening in Sexual and Gender Minorities (Mollie Aleshire, School of Nursing);
  • A Community‐based, Knowledge Translation Approach to Address Neighborhood Factors that Impact HIV Care Continuum Participation (Jelani Kerr, School of Public Health and Information Sciences);
  • Assessing risk factors associated with childhood lead poisoning in Jefferson County: Structural racism and a legacy of lead (Brian Guinn, School of Public Health and Information Sciences);
  • “Getting the Listening” in Louisville: Environmental Health Literacy and Justice in and around Rubbertown (Megan Poole, College of Arts and Sciences);
  • Empowered by the Sun: Exploring the Intersections of Housing Justice and Green Technologies in Louisville (David Johnson, School of Public Health and Information Sciences); and
  • Equity‐Centered, Trauma‐informed Teacher Preparation: Development and Study of a Teacher Residency Curriculum (Shelley Thomas, College of ����ֱ�� and Human Development).

Wendel said the Hub will work closely with researchers and their community partners throughout the projects and plans to open a new round of research funding in 2023. Many projects will be conducted in collaboration with Louisville-based Humana Inc., which will share anonymized data for research purposes.��

“We’re proud to back both research and underrepresented minority researchers to help communities achieve greater health equity and improved outcomes,” said Keni Winchester, director, strategy & community engagement at The Humana Foundation.��“Through the collective efforts of researchers, community partners and the University of Louisville’s Health Equity Innovation Hub, people in Louisville and beyond will thrive.”��

The Hub launched with a potential total investment of $25 million from the Humana Foundation, Humana Inc., and UofL, representing one of the largest single donations in the history of the university. Humana also recently announced it would donate a fully furnished eight-story building, located at 515 W. Market St., to house the Hub’s administrative team and programming.��

“This research is an important facet of the great collaboration we have with The Humana Foundation and Humana Inc.,” Wendel said. “These projects are designed to lead to scalable solutions to health equity issues here in Louisville and beyond.”��

The Health Equity Innovation Hub is an integrated, multidisciplinary collaboration among The Humana Foundation, Humana and UofL that is focused on groundbreaking research, talent development, entrepreneurship and innovation, with a deliberate emphasis on health equity, social determinants of health and digital health and analytics. The Hub seeks to develop solutions for health inequities in Louisville and globally.

“Humana is pleased to donate this building in the heart of downtown Louisville to UofL, and we continue to be strong supporters of the work being done to establish the Health Equity Innovation Hub,” said Nwando Olayiwola, chief health equity officer and senior vice president at Humana. “Having the Hub in close proximity to our downtown offices will allow for better collaboration and ultimately will result in greater impact for the important work being done to solve health inequities.”

“As we considered potential new uses for the 515 building, we knew that we wanted to find an occupant that would add to the vibrancy and diversity of downtown while also aligning closely with Humana’s mission to improve the health and wellbeing of our members and communities,” said Douglas Edwards, senior vice president of enterprise associate and business solutions at Humana. “We could not think of a better neighbor for the downtown business district than UofL.”

“We appreciate Humana’s generous donation of this building to UofL, as well as the ongoing support provided by Humana and The Humana Foundation for the Health Equity Innovation Hub,” said Lori Stewart Gonzalez, interim president of UofL. “We are excited to share more details about the building and the Health Equity Innovation Hub in the near future.”

The Hub is funded by a potential total investment of $25 million, including $10 million from UofL, $1.5 million from Humana and up to $13.5 million from The Humana Foundation. The investment by The Humana Foundation represents one of the largest single donations in UofL’s history and is contingent upon progress against the collaboration’s objectives and achievement of established milestones.

The Health Equity Innovation Hub is an integrated, multi-disciplinary collaboration among Humana, The Humana Foundation and UofL. The Hub will focus on groundbreaking research, talent development, entrepreneurship and innovation, with a deliberate focus on health equity, social determinants of health and digital health and analytics.

“Humana is committed to improving health equity and we will be intentional about addressing the underlying societal and structural factors that impede good and fair health, especially for people in communities that have been historically marginalized and made vulnerable,” said Dr. Nwando Olayiwola, chief health equity officer and senior vice president at Humana. “This unique collaboration with the University of Louisville and The Humana Foundation to create the Health Equity Innovation Hub is an exciting opportunity for Humana to partner with a leading research institution in our founding city where so many health disparities exist, establish shared goals and drive positive change beginning in local communities.”

Enabled by Humana and The Humana Foundation’s investment and support, the Hub will seek to develop solutions for health inequities in Louisville and globally. This includes the up-skilling and re-skilling of community members who have been underserved to provide a talent pipeline for Louisville’s significant concentration of major health care companies, thereby creating a pathway for family-sustaining jobs. The Hub will also conduct dedicated outcomes-based research on population and social health issues to derive a wide range of insights on how to mitigate health inequities and the adverse impacts of health-related social needs. In addition, the Hub will support diverse creators, innovators and entrepreneurs whose ideas can positively impact populations around the world that have historically been marginalized and underserved.

“UofL is a research powerhouse dedicated to making a positive impact on our world and addressing the challenges affecting the human condition,” said UofL Interim President Lori Gonzalez. “We are proud to work with Humana and The Humana Foundation to further health equity for all through this new Hub. Together, we can have a tangible impact that benefits our shared community and far, far beyond.”

UofL is among the top U.S. research institutions, holding the ’s��“Research 1” designation for doctoral universities with��very high research activity. In addition to being a Research 1 institution, UofL also holds the Carnegie community-engaged designation, which recognizes institutions that work with community partners to exchange knowledge and resources for public benefit. UofL is one of just 79 U.S. institutions to hold both designations.��

At UofL, the Hub is led by Dr. Monica Wendel, a renowned public health researcher with significant expertise in health equity. A national search is currently underway to fill the role of executive director. The Hub’s leadership team also includes Deputy Director Ben Reno-Weber, a seasoned tech entrepreneur who previously led the Microsoft Future of Work Initiative; Director of Community Engagement Ivory Rollins Cross, a Louisville native and community champion; and Director of Innovation and Social Entrepreneurship Natalia Bishop, who founded prominent Louisville co-working brand, Story Louisville.

“Everything affects our health, our health affects everything,” said Wendel,��professor��and��chair��of Health Promotion & Behavioral Sciences in the UofL School of Public Health��and��Information Sciences.��“We all want to be healthy, but��the choices people make are the choices people have. In seeking to advance health equity, then, we have to change the choices people have. And we have that opportunity.”

The Hub also will create and collaborate with advisory boards, including national thought leaders, community organizations and local community residents who are passionate about improving social and health equity in their neighborhoods, as well as local business leaders and mentors from a diverse cross-section of the health equity ecosystem.��

The launch of the Hub will further UofL’s three strategic research priorities identified and launched in 2020, which include: Empowering our Communities, Advancing our Health and Engineering our Future Economy. The investment from Humana will advance the first challenge, Empowering our Communities, with a focus on promoting equity by engaging partners and strategically integrating research, innovation and training to address complex social and structural issues driving health inequity.

“These are huge challenges that will impact our world for years to come,” said UofL’s Executive Vice President for Research and Innovation Kevin Gardner. “Through this Hub and work with our partners at Humana and The Humana Foundation, UofL research and innovation will help empower those in our community — promoting equity, eliminating disparities and strengthening the ability of all individuals to achieve well-being and prosperity.”

The Hub’s mission also is well-aligned with Humana’s of advancing the health of the communities it serves by addressing social determinants of health and the health-related social needs for its members and communities.