The Quest for Justice: Improving Health

To increase equity, we must address racism and boost diversity in medicine, dentistry, and veterinary medicine, Tufts alumni and faculty say
Illustration of a face with a mask on. To increase equity, we must address racism and boost diversity in medicine, dentistry, and veterinary care, Tufts alumni and faculty say
“If we are going to see a more just future in the health-care arena, we have to address systemic racism and commit to a culture of health equity for all patients that we serve,” said Ana Sofia Lopes Johnson. Illustration: Adriana Bellet
September 1, 2020

Share

As the world reckons with racism, one truth is painfully clear: Dismantling it will require more than rhetoric. It will take sustained effort.

The Quest for Justice” is a series in which Tufts professors and alumni describe some of the actions they would like to see to create a more fair and equitable future.

Sandra Hernández: Make Health Care Equitable

The suffering and sacrifice created by COVID-19 are not fairly distributed. If you’re Black or Latino, you are more likely to contract COVID-19 and die from it. The drivers of this unacceptable disparity are societal. People of color are more likely to be exposed to the coronavirus because of where they live and work. They are more likely to have chronic Sandra Hernández, M84, is president and CEO of the California Health Care Foundation and previously served as director of public health for the city and county of San Francisco. Photo: California Health Care Foundationhealth conditions that worsen the impact of a COVID-19 infection. And they are less likely to have timely access to care that might save their lives.

Equipped with this knowledge, we as a society have no excuse for half measures. From the beginning, we should have been targeting testing to places and populations that face greater risk, ensuring that all essential workers—not just doctors and nurses—have adequate PPE, and working with affected  communities to design culturally appropriate contact tracing. We can’t fix the past, but COVID-19 will be with us for a while. We can still save lives by taking these steps now.

Longer-term, we can and should be redirecting more of our nation’s existing health-care resources to where needs are greatest and to strategies that address those specific needs. Ultimately, that means shifting the balance of health spending and investment from hospitals to primary care, building a more diverse and community-oriented health workforce, and using data to hold health systems accountable for differences in care by race or ethnicity.

The pandemic is writing a new chapter in our nation’s health-care system. We have an opportunity and a responsibility to shape how that story ends—by rebuilding the system to fully protect the public’s health and to deliver culturally appropriate, timely, and affordable care to all people regardless of race or class.

India Napier: Inspire Children to Enter STEM Fields

​India Napier, V20, is a veterinarian and postdoctoral fellow in the biomedical research training program at the Massachusetts Institute of Technology.​To create a more just world, veterinarians must address the racial imbalance within our profession. While whites make up about 76 percent of the US population, they are 91 percent of veterinarians, according to the most recent data from the US Bureau of Labor Statistics. Blacks, who are 13 percent of the population, represent just 2 percent of veterinarians, and Latinx people, who comprise 19 percent of the population, are less than 4 percent of veterinarians.

Why are there so few Black and Latinx veterinarians in the United States? One factor is that elementary-school children from underrepresented groups lack exposure to STEM programs, thus missing a critical opportunity to imagine themselves as the next generation of scientists and health professionals.

To increase Black and Latinx veterinary student applicant numbers, veterinary schools must invest in K–6 STEM pipeline programs. In 2017, while I was a student at Cummings School of Veterinary Medicine, I successfully lobbied to bring the This Is How We “Role” program to Cummings. The program, based at Purdue University, facilitates partnerships between veterinary colleges and elementary schools with children from educationally disadvantaged backgrounds due to socioeconomic status, race, or ethnicity.

Since then, Tufts veterinary-student and faculty role models have delivered veterinary-focused lessons to kids in grades one through six at Belmont Street Community School in Worcester. Tufts’ commitment to the “Role” program is a step in the right direction to diversifying the future veterinary workforce.

But Tufts can’t do this alone. All veterinary colleges must invest in predominantly Black and Latinx communities and provide equal access to K–6 STEM learning programs. Such collective efforts will help inspire minority children to become tomorrow’s veterinarians.

Ana Sofia Lopes Johnson: Commit to Health Equity

Family physician Ana Sofia Lopes Johnson, M01, is a member of the Tufts University School of Medicine board of advisors and past president of the Association of Black Women Physicians in California.Racial injustices continue to permeate our society and affect our health. Some people suggest that the real issue is poverty, but socioeconomic factors do not fully explain the health disparities we see in COVID-19, diabetes, hypertension, HIV, and other health problems that disproportionately affect communities of color.

Data on maternal morbidity and mortality show us that financial stability does not guarantee better health outcomes or fewer discriminatory encounters with health-care workers for Black mothers. 

If we are going to see a more just future in the health-care arena, we have to address systemic racism and commit to a culture of health equity for all patients that we serve. Tracking, aggregating, and evaluating outcomes by race and gender will provide valuable insight.

A more just future would also include ongoing implicit bias training as part of professional development for physicians and all other health-care workers. 

Physicians are uniquely positioned to dismantle racial stereotypes and myths, because we understand that good health is the cornerstone of a functional life. We cannot undo what has been done, but we have a duty to build a more equitable system.

Nicole Holland: Address Racism’s Impact on Dentistry

Nicole Holland, MG12 (health communication), is an assistant professor and director of health communication, education, and promotion at Tufts University School of Dental Medicine.Dentistry resides within the broader context of health care in our society, a system long permeated by racism. Racism led to past horrors such as the Tuskegee Syphilis Study, in which Black men were recruited with the promise of free medical care but actually had information and treatment intentionally withheld.

The dental profession is not immune to this racist legacy. It is no secret that George Washington paid 122 shillings for nine teeth removed from mouths of the enslaved—and that human teeth were used in his dentures. Additionally, while the first US dental school opened in 1840, Black students were not admitted into any dental school until 1867, and the nation’s largest dental association maintained discriminatory membership practices—including denying membership to Black dentists—until 1965, more than a century after its founding.

Despite advances, this racist legacy persists. Black people and other minorities still experience significant disparities in oral health and remain underrepresented in dental education and the oral-health workforce. Conversations around oral-health disparities remain more focused on differences than on actual solutions to achieve health equity. Access to care remains a challenge for many.

So what can we do?

As a profession, we must acknowledge the legacy of racism in health care and its ongoing impact on dentistry, and ask the difficult questions. What is the historical impact of racism both within and on our profession? What impact can dentistry have on racism today? What is my role in building a more just future in dentistry and society at large? The answers to these questions are multifactorial, and some are deeply personal.

We must also proactively and collectively engage policymakers, educators, and other stakeholders for an equitable oral-health system, especially for those who are most vulnerable.