Bill of Health

December 1, 2020  • Institute Staff

The Aspen Ideas: Health program hosted a series of free, public, digital events this year on topics including Covid-19 testing and tracing, advances in Medicare and Medicaid, and the art-brain connection. One event, hosted in September, focused on two of the biggest stories of the year: Covid-19 and racial equity. Dr. Uché Blackstock, the founder and CEO of Advancing Health Equity, has seen firsthand how the pandemic has highlighted inequities throughout the health system and is actively working to change that. Blackstock spoke to Dr. Lipi Roy, a clinical assistant professor at NYU Langone Health and a medical contributor to MSNBC and NBC News, about everything from the effect of Covid-19 on minority populations to leaving academia for a career in social justice.

LIPI ROY: How has this current coronavirus outbreak highlighted or reinforced the need to address health disparities and inequities? And why is diversifying the health care workforce a key element to advancing health equity in the United States?

UCHÉ BLACKSTOCK: One of the reasons why I founded Advancing Health Equity was because there were significant preexisting racial health inequities, even prior to the pandemic. Often in my talks and trainings, I talk about how we’ve heard about the Black maternal mortality crisis. That has gotten a lot of press over the last few years. But there’s also an infant mortality crisis, with Black babies being more than twice as likely as white babies to die within their first year of life. That’s a wider disparity now than it was 15 years before the end of slavery.

We also know that Black men have the shortest life expectancy. Communities of color carried the highest burden of chronic disease even before the pandemic. Even in my own work—in my clinical work, I still work part-time in urgent care—I noticed at the beginning of the pandemic how my patient population had shifted from a very racially and socioeconomically diverse population to mostly Black and brown patients. Many of them were essential workers and service workers. I saw with my own eyes who this pandemic was impacting the most. The pandemic has unveiled these profound inequities that have always been there. We’re seeing them in a starker fashion, and we’re seeing Black, Latin, and indigenous populations being decimated by this virus.

There was an older Black man who came in with Covid-19 symptoms. He had Covid pneumonia. I wanted to send him to the emergency department, and he said to me, “Doc, honestly, I’m scared to go there because I don’t think I’ll be treated well.” Essentially, he meant that as a Black man, he did not think he would get the care he deserved. And we have seen in the data from the pandemic that there are disparities in care depending on which hospital you go to; there may be some accentuation of provider bias. So these were valid and just concerns that this patient had. I was glad he was able to express them to me, and we were able to have a conversation
about it.

LR: We know that Black and Hispanic individuals now make up about 30 percent of the US population, yet they are only 15 percent of first-year medical students. So what gaps in the physician pipeline are preventing more minority students from pursuing careers in medicine?

UB: Again, the pandemic is revealing these inequities, and we know that a diverse workforce is one of the solutions, though not the only solution, to addressing these inequities. People need to understand that the same problem—racism—that has led to these racial inequities among patients is also the problem that’s leading to the lack of Black physicians. The social determinants of health, such as employment, education, and transportation, are all important to developing communities. If you don’t have opportunities for wealth, how can your family ever afford to send you to college? If you live in communities that have experienced disinvestment and you have never met someone who is a physician, you have no role model. If you’re going to chronically underfunded schools that offer, unfortunately, a poor-quality education, you may not even be prepared for a medical education. This pipeline has to start from kindergarten. We need mentoring. We need resources going into schools in underrepresented communities starting from the very beginning, with targeted intentional programs that support students all the way through the pipeline.

LR: Beyond creating diversity and inclusion task forces, what other meaningful actions can hospitals and health systems take to support minority physicians and to combat gender bias and racism?

UB: In my own experience in academic medicine, I got to see firsthand what it’s like to be a Black woman physician within academia. I learned that, yes, these task forces can be useful, but they really are Band-Aids. What we need is buy-in from institutional leadership. We need to have CEOs and deans of medical centers and medical schools who legitimately care about these issues and understand that if you have an equitable working environment, that’s going to trickle down to the care you provide. These values need to be instilled in strategic plans and to be part of every leadership person’s role, not just the chief diversity officer. The chief diversity officer should not be the only person thinking about diversity, equity, inclusion, or antiracism. It should be within everyone’s roles and responsibilities. Otherwise, what happens is people say: “Oh, that person’s dealing with it. It’s not my problem.” It really should be all of our problems.

We also need to review practices and policies within institutions to see how they create bias and racism and sexism. Because we know these policies, whether intentional or unintentional, do that. So there needs to be more intentionality at every step of the way within these organizations.

LR: What advice would you give to a young Black woman looking to pursue a career in medicine today?

UB: The journey I thought I would take as a physician has been very different than the journey I’m currently on. I thought I would stay in academic medicine for the rest of my career. But I’m actually creating this new path. I was just promoted last year to associate professor, and people thought I was crazy when I said, “I’m leaving to start an organization that focuses on addressing racial health inequities.” People looked at me like, “What are you thinking?” My message not just to young Black women thinking about medicine but really anyone who really wants to do advocacy and even social justice work is: Your future may look different than what you thought, but you really have to take that leap of faith. If you believe in your mission and you walk that path, then everything will ultimately work out.

Watch the full event below: