By Krista Bennett Demaio
American medicine has not been an even playing field for women or people of color. These innovators are working to change that.
The research that has come out of the pandemic is eye-opening: Black people are dying of Covid-19 at almost twice the rate of whites. Women and girls are disproportionately suffering from the socioeconomic impacts of the pandemic (lost jobs, wages, poor mental health)—and the list goes on. Now more than ever, there are gaping social and racial inequities in America’s modern-day healthcare system.
These disparities exist in almost every area of medicine, including asthma, diabetes, cancers, cardiac care, and gynecological and maternal care. Some specifics: Black women are three times more likely to die from a childbirth complication than white women. And women, especially women of color, are grossly underrepresented in clinical trials for life-saving medications.
The five women you’ll meet here have made it their missions to improve these grim stats—and the lives of the people they represent. They’re bringing awareness to racial, social, and gender disparities in medicine, influencing the policies that contribute to them, and reducing healthcare inequities in this country.
Hetty Cunningham, MD, associate professor of pediatrics and director of equity and justice in curricular affairs at Columbia University’s Vagelos College of Physicians and Surgeons
What she’s doing: Introducing an anti-racist approach to medical education
“A person’s life expectancy is closely linked to their zip code,” says Hetty Cunningham, MD, who is the director of equity and justice in curricular affairs at Columbia University’s Vagelos College of Physicians and Surgeons and who is featured in Oprah’s new documentary, The Color of Care.
Cunningham points to historically racist policies—known as redlining—that once designated where Black people could and couldn’t live. “The results of that segregation have caused significant impacts on healthcare,” she says. “When you look at disparities in Covid, asthma, maternal and child mortality, you’ll find they very closely map along the top of the redlining or segregation maps created.” Structural racism has also created a false narrative that people of color don’t care about their healthcare or education—and these stereotypes have led to individual racism in the medical field, she says.
Cunningham is working to address racism in healthcare through a medical school initiative. “We’re teaching budding doctors in medical school to recognize these systems around the care we provide,” she says. At the Columbia University Vagelos College of Physicians and Surgeons (VP&S), students approached the faculty and said they weren’t being taught to take care of people of color, which led to VP&S Equity & Justice Fellowship—which Cunningham works on. It was designed to counter racism and promote a more inclusive curriculum.
Cunningham points to examples such as textbooks saying healthy gums should be coral pink, which is not the case for people of color. Or that a sign of a healthy baby is its pinkness. “I’ve been a pediatrician for 30 years; I’ve thought about race my entire life, and it never occurred to me,” says Cunningham. “It took students coming in with a fresh lens, saying, ‘We’re not being prepared for the job we need to do.’” And it’s these student voices that are critical to anti-racism and health equity work in medical education. “These young people can see things we cannot see—and we have to have their input if we’re going to get better.”
Leslie Cho, MD, director of the Cleveland Clinic Women’s Cardiovascular Center
What she’s doing: Making it easier for women to participate in medical trials
Heart disease is the number one killer of women. The American Heart Association’s widely publicized Go Red for Women campaign put that stat on the map back in the early 2000s. Yet, almost two decades later, women continue to be undertreated for cardiac issues—they get diagnosed later, and they are underrepresented in clinical trials for heart disease treatments, according to Leslie Cho, MD, director of the Cleveland Clinic Women’s Cardiovascular Center, which aims to address this very issue and get women the treatment and preventative care they need.
“We have approved drugs ‘for everybody’ based on trials mostly done on men,” Cho says, which is especially problematic for dosing. Even the first trials of estrogen’s effect on heart health were done on men in the 1970s. “It took two decades before estrogen was studied in women,” Cho says.
Cho says these gender disparities in clinical cardiac research start at the top. “After looking at cardiovascular trials published in top-tier medical journals such as the New England Journal of Medicine and JAMA, we found that women made up less than 10 percent of trial leadership.” Increasing that number may lead to more women participants. “We know from the business world that a more diverse team yields different viewpoints and out-of-the-box thinking,” she says. “Unfortunately, this concept has not yet translated to medicine.”
Making it easier for women to participate in trials may also influence the numbers. “Trials are often quite onerous when it comes to onsite visits, which is not great if you’re a primary caretaker.” Remote monitoring and doing trials in numerous hospitals (including community hospitals) may help reduce the time burden. Social determinants (education, neighborhoods, economic stability, etc.) also play a role. “If you don’t live in a neighborhood with access to good healthcare, you’re not going to get into trials,” she says.
For Cho, getting women into clinical trials goes beyond finding new treatments. “It’s that idea that we’re intimately tied to each other’s health,” Cho says. “If someone isn’t healthy, we all pay for it.” When you’re part of a trial, you not only help yourself, but you’re helping someone else, too, she says.
Ricki Fairley, CEO and cofounder of Touch, The Black Breast Cancer Alliance
What she’s doing: Improving outcomes for Black women with breast cancer
Over a decade ago, Ricki Fairley was diagnosed with stage III triple-negative breast cancer (TNBC), which is known to be extremely aggressive. After a double mastectomy and six rounds each of chemo and radiation, Fairley’s cancer returned. “My doctor said, ‘You’re now metastatic; you have two years to live.’” Fairley did some research and found the Triple Negative Breast Cancer Foundation, which set her up with a TNBC specialist who put her on an experimental drug. “And I’m still here 10 years later,” she says.
With a new lease on life, Fairley felt a calling to advocate for other Black women battling breast cancer—so she cofounded Touch, The Black Breast Cancer Alliance, an organization that provides resources for women of color. The stats for women of color with the disease are startling: Black women have a 40 percent mortality rate versus white women and have a 39 percent recurrence rate of breast cancer. Black women under 35 get breast cancer at twice the rate and die at three times the rate of white women. In trying to understand the why behind these concerning numbers, Fairley looked to the drug industry. She discovered that Black women only account for 3 percent participation of clinical trial research.
“I looked back at the drugs developed 20 to 30 years ago, which are now the standard of care for breast cancer, and guess what? There were no Black bodies in that research.” This is problematic because research has shown that the tumor characteristics are different in Black women than in white women. “It’s a different disease for us—a constellation of exposures, experience, and a lack of science that causes Black women to face disproportionately worse outcomes,” says Fairley.
Yes, social determinants are major factors, but Fairley wanted to explore the emotional barriers keeping women out of trials. She found that Black women with breast cancer had a fear and mistrust of both physicians and pharmaceutical companies due to a medical history steeped in racism and false information. So Fairley and her team developed a communications movement called WhenWeTrial.org and the hashtag #BlackDataMatters, which provides education on clinical trials in a clear, conversational way—like talk among girlfriends, or “breasties,” as Fairley calls them. And it has resonated in a big way. “We’ve been in the market for less than two months, and we’ve signed up 300 women for clinical trials.”
Brandie Carlos, founder of Therapy for Latinx
What she’s doing: Making mental health help easier to access for the Latinx community
When a close friend died by suicide in 2018, Brandie Carlos felt lost. “He and I both struggled with depression, and we always helped each other get through it,” says the Los Angeles resident. Alone with her grief and trying to cope, she started searching online for a therapist she’d feel comfortable talking with but couldn’t find anyone who looked like her. “I came across Therapy for Black Girls, a directory of Black therapists, and thought that there must be something similar for Latinos.” But more searching proved there wasn’t—despite the need being great. Only a third of Hispanic people experiencing any mental illness receive some sort of mental health help, compared with 50 percent of non-Hispanic white people.
Carlos decided to start the resource she so desired herself. “It felt like a divine assignment,” she says. A short time later, Therapy for Latinx (therapyforlatinx.com) was born. Today the directory has approximately 800 Latinx therapists across the country in 39 cities (with more therapists being added all the time) and is a free mental health resource for about 10,000 visitors a month. Users simply go to the site, find an expert near them who is a good fit, and reach out. “There are so many people in our community who have never been heard,” Carlos explains. “And feeling validated in your own story is one of the most important elements of healing.”
Latinos of all ages have found help through the site, including the older generation, who traditionally never ask for assistance, Carlos says. “One woman recently told me, ‘I found my mom a Spanish therapist on your website. Thank you so much.’ Hearing stories like that fuels me on the tough days.”
Next up, Carlos is hoping to help even more members of her community. “The online directory is a great start, but there is a huge demographic that can’t afford therapy. My dream is to start the first Latino mental health hotline,” she says.
Joia Crear-Perry, MD, founder and president of the National Birth Equity Collaborative
What she’s doing: Saving lives of American mothers and babies
Women in America have a higher risk of dying from childbirth than in any other high-income nation. And for Black and Hispanic women, that number is two to three times higher. “We are the only high-income nation where that rate is going up,” says Joia Crear-Perry, MD, founder and president of the National Birth Equity Collaborative. In some areas, such as New York City, Black women are eight to 12 times more likely to die than their white counterparts, regardless of education level or income. The risk factor is simply being Black, she says. “When someone has lung cancer, we blame smoking, and not the individual. Yet when it comes to black folks, we blame the individual and not the racism that’s harmful to the individual, or the gender oppression that is harmful to women,” says Crear-Perry.
The goal of the National Birth Equity Collaborative (NBEC), which has been in existence for seven years, is to provide respectful maternity care. “We looked to the most impacted people in the U.S. and asked what they would want to thrive—not just survive—a pregnancy,” says Crear-Perry. The responses almost all came down to trust. “These patients want us to trust them; trust that they care about themselves and their families, but they have barriers to care.”
To eliminate—and help physicians understand—those barriers, the NBEC works with hospitals and the American College of OB-GYN to implement birth equity training. Most recently, the organization is asking the White House to look closely at how they approach reproductive and sexual health and well-being. This includes providing access to healthcare, contraception, maternal and infant care, comprehensive paid family leave, and mental health support. Crear-Perry is hopeful for what’s to come for maternal outcomes for women of color. “The president has said that health is a right. And that’s super exciting because once you say those words, we can actually operationalize them,” she says.
See Original Article at Oprah Daily