Urmimala Sarkar, MD, MPH (she/her/hers) is a professor of medicine at the University of California San Francisco (UCSF) in the Division of General Internal Medicine.

She is also the Associate Director of the UCSF Center for Vulnerable Populations, which works to improve health and reduce disparities through “discovery, innovation, policy, advocacy, and community partnerships.”

In this second part of the Disability Awareness Month series, Dr. Sarkar speaks on her work in the Center for Vulnerable Populations, the importance of human-centered design, and her hopes for continued change in health care. Her views do not represent those of her employer.

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Check out these resources to help your solution or organization center disability advocacy.

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In Full Health (IFH): What inspired some of your work in medicine and your research interests — particularly those of accessibility, disability, and chronic conditions?

Dr. Urmimala Sarkar: I became interested in medicine because it combines social justice with the creativity that comes with being a scientist — it’s about thinking of new and interesting questions and how to answer them. I always knew that I was going to be a scientist and an academic. My lifelong passion for social justice comes from being child of immigrants and seeing how much of health comes from outside the health care system. Medicine was a very natural way for me to combine these interests.

IFH: You wear many hats at the university and in your community — one of which is as the Associate Director of the UCSF Center for Vulnerable Populations. Can you speak about your work there?

Dr. Urmimala Sarkar: The Center for Vulnerable Populations is a UCSF Research Center that is based at San Francisco General Hospital. There are many investigators who study a whole range of topics relevant to marginalized populations both locally and worldwide. We really have an eye towards doing research that we think will improve the health of the patients that we take care of at San Francisco General.

We believe that when we design new innovations in healthcare, we need to think about equity first. We have a belief that if we keep delivering health care the way we have been delivering it, then we’re going to keep getting the same inequitable outcomes that we have been getting. The Center is that link between doing innovative work and also trying to bring it into practice in our own communities.

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Expressing Gratitude

Margot Kushel is the director of the Center for Vulnerable Populations, and she’s really amazing. She’s done a lot of advocacy around disability within the university. Her area of expertise is aging and homelessness, and how our unhoused population is aging and becoming increasingly disabled. She does a lot of work around trying to help people get off the streets and into proper supportive housing. She is a longtime mentor to me and has shaped a lot of my thinking around disability advocacy.

Urmimala Sarkar, MD, MPH
Professor of Medicine, University of California San Francisco | Associate Director, UCSF Center for Vulnerable Populations

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IFH: What are some of the top accessibility challenges you have observed in your work as a physician — and what role do you see digital health technologies playing to address some of these challenges?

Dr. Urmimala Sarkar: I want to acknowledge, first, that I’m not an expert on issues of ableism in the health care system. From my clinical experience as a primary care provider and from the experiences friends and colleagues with disabilities have shared with me — I would say we are so far from where we need to be in terms of delivering equitable care to our friends and our community members with disabilities.

Everything about the way that health care is structured creates inherent barriers for folks with disabilities. Even tasks as simple as clinic scheduling aren’t designed with the understanding of the challenges people with mobility issues may face in getting to the clinic on time.

Just even that very simple thing of getting the correct accommodations for folks who have a significant hearing impairment. These things are basic, and it’s not that we don’t know what we need — we fall short in the implementation of the right solutions.

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IFH: Your research interests also focus on human-centered design and working with patient advocates. What have you taken away from this collaboration?

Dr. Urmimala Sarkar: Patient advocates and disability advocates have this saying, “Nothing about us without us.” Although that has become a byword in certain communities, it really needs to penetrate throughout health care and how it’s delivered.

One of the challenges of participatory research is asking folks who already spend more time than they may want to focused on their own health and illness for more of their time and expertise. We must always center gratitude for the collaboration of the patients, families, and advocates that work with us.

I have learned from doing human-centered design with a range of patients and families, that there is a lot of interest in engagement. There is also a lot of creativity in patient, family, and community groups that would make health care better. We are well-served by co-creating innovations with the people our solutions serve.

IFH: How do we as a society need to shift our understanding of what disability means? And how might that change how we respond to issues of accessibility or build new health solutions?

Dr. Urmimala Sarkar: How our society currently views disability, chronic illness, lack of health, and even framing around a need for accommodations doesn’t serve people.

I came up in a very tight-knit, immigrant community in Southern California, and I think that gave me the gift of a more collectivist perspective. We live in a very individualistic society, and I fundamentally believe that a more mutual aid framework, a more collective mindset is what is needed to actually accommodate — not the concept of disability, but the concept that everyone needs care.

We are interdependent and your health and needs will change over your life course. The individualistic perspective doesn’t actually serve anyone.

IFH: What is your advice for health solution developers when designing health solutions for people with disabilities or chronic illnesses?

Dr. Urmimala Sarkar: I truly hope that in my lifetime we outgrow the idea of Disability Awareness Month. There needs to be upfront attention and design for inclusiveness. I would say that about chronic illness. I would say that about questions of language access, race, ethnicity, health literacy, and ranges of ability.

We are never going to create solutions and systems that work for everybody if we don’t design for that upfront. So I hope that health care leaders and solution developers will co-create systems and solutions with the people that they’re trying to serve.

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