Increasing diversity in Public Health

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 00:04 Dr. DuBois Bowman: If we're serious about our pursuits in public health, it's absolutely necessary that we train a diverse workforce. Without it, we'll fall short of our basic public health mission of achieving health and equity for all.

00:25 Narrator: There are many facets of health inequity. During this season of Population Healthy, we've examined several, including the ways that data can be weaponized against marginalized communities, how the stress of experiencing racism day-to-day can affect the physical health of people of color and many more. Today, we bring the focus to public health itself and what can be done to increase diversity in its ranks. Hello and welcome to Population Healthy. A podcast produced by the University of Michigan: School of Public Health. In this season of Population Healthy, we'll examine health inequities through the lens of race in America by talking to public health researchers, experts and others to learn more about what can be done to work toward health equity in our communities and across our country.

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01:19 Narrator: First up, Dr. DuBois Bowman, Dean of the University of Michigan: School of Public Health and professor of biostatistics. He is a tireless proponent of diversity within public health.

01:30 Bowman: For African-Americans, there are few instances in life where you can simply pull race out of the equation. When I got to Morehouse College, it was one of the first times in my life where race just simply didn't play the same kind of factor as it had previously for me, in all settings, whether educational or social or personal, and in other regards. I had privilege and the freedom to just relax and just be, and that was really transformative for me. There were a lot of faculty at Morehouse who invested tremendously in me. They position me and prepared me to go on to next stages of my education and life and to have success at those next levels. And they also inspired me, by way of their actions, for me to play that role for others. After I left Morehouse, I ended up pursuing my Master's degree in Biostatistics at the University of Michigan, and ultimately pursued my PhD at the University of North Carolina at Chapel Hill.

02:40 Bowman: And so it was interesting for me to go from a situation where race was not a factor, at Morehouse as an undergraduate student, defining myself as the only African-American and not just in one, but virtually all of my classes during my time as a graduate student. It was surprising to me. I'd just left Morehouse. One didn't need to make a convincing argument to me to indicate that there was talent out there, I just left it. Not only did I just leave it, but I know that that talent at Morehouse actually helped me grow, people who I looked up to, and so I knew that there were people out there who could do at least as well as I, if not better. That's when I really started to become active in broader efforts to increase diversity in the field of public health and biostatistics, in particular. I remember going to conferences during that time, and I would seek out opportunities to connect with other African-American students.

03:37 Bowman: And other professionals who, while maybe they were not underrepresented minorities themselves, were committed to efforts to try to increase diversity in the field, and I can usually count on one hand the number of other African-Americans at these conferences. In those early days, we would get together and grab coffee or lunch and talk about many things, but among the things that we talked about was the lack of diversity in the field and just contemplating what we should do about it. We thought that, "Well, maybe we should form a group." We weren't sure exactly how to go about doing it or what to call ourselves and should we be a caucus, should we be a committee? Soon thereafter, we have had a small informal, in retrospect, very under-resourced workshop as a part of the annual ENAR Conference. ENAR stands for the Eastern North American Region of the International Biometrics Society.

04:37 Bowman: And ENAR, as a region, represents the largest body of biostatisticians in the world. This small event that we had, in the interest of diversity at the ENAR meeting, ended up laying the foundation for an established annual event that has taken place every year since at the ENAR conference and continues today. Over time, I watched the number of African-American students, faculty, researchers, statistics professionals, steadily grow. And today, when I go back to the same conference and the same Fostering Diversity in Biostatistics Workshop, it's a joy for me to see people at various stages of their careers. We've made significant progress, but with that said, there's still a tremendous amount of work that I know needs to be done, but I'm optimistic that we're headed in the right path.

05:30 Narrator: Sometimes a single person can make the biggest difference in someone's professional life. For Dean DuBois Bowman, that mentor was Dr. Bill Jenkins.

05:39 Bowman: I still vividly recall the first time that I met Dr. Jenkins. I started college as a Math major, but did so without a clear career trajectory, and thought about possibly going to medical school. I enjoyed sciences in addition to math and had begun taking pre-med courses. And so, meeting Dr. Jenkins really opened my eyes to a new direction that combined my quantitative interests on the one hand with my interest in health. And I realized that public health and biostatistics would allow me to impact people more broadly. And looking back, it was one of those really defining moments in my life and ultimately my career. And the only time that he could meet with me, it was on Sunday afternoons or evenings, and I knew he had a million other things to do, but that never limited his openness and receptiveness to take time for me and to invest in me.

06:38 Bowman: The lasting lesson for me went well beyond the project that I was working on at the time. There were bigger lessons just as a model of how Dr. Jenkins devoted himself in his career to really trying to promote diversity and really investing his time that was already scarce to achieve that outcome. So I'm grateful for those lessons, those are things that I've carried with me since that time, and is part of the reason why I'm so committed to taking time for students and faculty in helping to take increased diversity in the field. Dr. Jenkins recently passed away, and I had the privilege of attending and making remarks at his memorial service. It was just a wonderful moment for me on stage being able to look out that in the auditorium full of people like me who were mentored, influenced, and inspired by Dr. Jenkins, and it just reinforced my appreciation and understanding of how broadly his efforts have impacted not just individuals like me, but the entire field of public health.

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07:51 Narrator: Ebbin Dotson is an Assistant Professor in the Department of Health Management and Policy at the University of Michigan School of Public Health. He is the Faculty Director of the Summer Enrichment Program. The mission of the program is to identify and train future leaders of healthcare organizations who will strive to eliminate health inequalities.

08:09 Ebbin Dotson: A few of the biggest challenges that exist when it comes to equitable healthcare in the US include access to quality healthcare and includes population health, strategic plan, or population health plan, and it also includes a level of understanding around those resources. The access issue for people of color is not just a healthcare issue, it's a sort of community dynamic, and we often relate it to population health. And I try to distinguish population health with the a big P, and population health with the a small p. And in that characterization, the small p population is around a community, the large P population goes to the United States, large regionalism. But when it comes to access with the small p, there isn't a strategy around taking care of communities.

09:05 Dotson: And I think when it comes to people of color, people of color live in certain communities with a high density of other people of color, and in that sense, that community doesn't often have a great healthcare plan, a planned way to take care of that community. When it comes to resources, what we've seen in recent times with pandemic, is it creates a resource shortage. And the strategic plan to take care of that community is difficult at best, and at worst, it's just not there, it's non-existent. And we saw that, it was highlighted in the worst way over the past several years, especially in Michigan. One, you have a water crisis in Flint that turned into an epidemic. You have now a healthcare crisis that turned into a pandemic, you have a racial crisis. And each one of those situation gives us more of the highlighting around, we're not prepared strategically to handle the healthcare needs of communities. And if we ever really wanna get to population health with a big P, we really have to start to think about how these strategies need to change based off of those localized or those smaller communities.

10:23 Narrator: Increasing diversity in healthcare leadership isn't just the right thing to do, it also makes good business sense.

10:29 Dotson: In my doctoral program, I worked at Kaiser Permanente, and I worked in one of their corporate offices called National Diversity. And talking about leadership, there was a black man heading the department. And as I've watched him and all the things that he did, one thing stuck out to me, and he would say this, "Diversity is a business imperative." I'm going, "Yes, that's what I'm working my dissertation on. I'm looking at leadership. I know leadership diversity is a business case." And he's like, "No, it is a business imperative." And understanding that over the years, and especially now, I get that. So the business imperative is, when you're trying to maximize growth and utilization, you're only as good as how many people come in the door, and you're only as good as how many of those people who come in the door is that you can get through.

11:21 Dotson: Our health care system over the past four decades is really good at throughput of Americans who have jobs that their employer pays, who are suburban-focused of European-American descent. And what that means is, over the past 40 years, that group has already bought into healthcare. There are groups that hadn't bought into healthcare because the healthcare system wasn't maximized for them. And so now, if you're a good business person, you're going to say, "Who haven't we reached in order to grow our business? What do we need to do for those populations or those customers that we want to address so that we can increase our volume and our throughput?" Health equity screams, those are individuals of color and those are populations of color. Those are vulnerable populations that, in the past, weren't necessarily profitable. And healthcare reform, in part, was about profitability of those groups. Healthcare reform was in part around how do we create access to those populations, and how do we make them reimbursable so that healthcare organizations see them as a profit.

12:35 Dotson: And so, when this Kaiser senior executive, Ronald Knox said, it's a business imperative, he was talking about Kaiser and the membership model that it had where they had to completely change the way that they looked at membership because they had already reached the "white population." The group that they hadn't reached and hadn't created a profit model off of were those of marginalized populations. And so in healthcare, if we wanna look at the business case for healthcare, especially around health equity, it is there.

13:07 Narrator: Not only does Dr. Dotson lead the summer enrichment program, he's also a grateful alum.

13:12 Dotson: When I was an undergrad at the University of Michigan, I found the University of Michigan Summer Enrichment Program, I was already focused on becoming a physician, I was already focused on going to medical school. I figured, in order to run a hospital or a healthcare system and create better access for the community that I came from, you had to become a physician. And once I found the University of Michigan Summer Enrichment Program, I realized, "Oh my gosh. There's another way to do this."

13:45 Narrator: Elisabeth Michel is a graduate of the University of Michigan School of Public Health and recently served as the Interim Program Director for the Summer Enrichment Program.

13:50 Elisabeth Michel: The University of Michigan Summer Enrichment Program is an eight-week internship program that prepares undergraduate students for careers in Health Management and Policy. We allow rising juniors and rising seniors to come to our program around 18 to 25 per year. They receive both the classroom exposure to topics of Health Management and Policy, as well as, experiential learning in an internship placement. So as part of the internship, students are placed at health institutions across Southeast Michigan, so this can include hospitals, health insurance companies, community-based organizations, or research institutions, and they all work on projects that expose them to the various aspects of management and policy. So they might be working on finance projects or operations work or policy initiatives, all of this is alongside senior leadership of these various institutions. Our students work with faculty at the University of Michigan on understanding what are the aspects of public health, what are health disparities, giving them that foundational knowledge and exposure to careers in health management and health policy.

15:07 Michel: The program has been around since 1986, and it's the first in the country of its kind. We are passionate about this program's purpose of changing the face of healthcare leadership because all of the students who participate in this program are focused on eliminating racial, ethnic, and socio-economic health inequalities. To date, since 1986, SEP has had over 700 alumni that have gone through the program, and many of them have gone to incredibly successful careers within Public Health and Health Management. They hold senior positions in their healthcare institutions. They've worked on important legislation, including the Affordable Care Act. We want to change the face of healthcare leadership, so that the leaders of healthcare reflect the populations and the communities that they serve. However, in order for that to happen, barriers to education, barriers to access to resources, those have to be addressed, and SEP is placed to do that.

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16:20 Dotson: I can tell you that when you have leaders of color in these leadership roles, those communities that they represent get a better shake, a fairer shake, more tension tied to how to solve those problems. And it's nice that in the past 20 years, there are a number of institutions and organizations that really do wanna change the face of healthcare leadership. When we think of how to increase those numbers, we have to increase throughput. So in our schools of public health, in our departments of management or health management and policy that we have here, Health Administration and in other places, we do want to create that next group of leaders who then become those senior executives in healthcare organizations. At Michigan, I think we're doing a really good job. Over the past few years, we've tried to increase our specific efforts at recruitment and retention, and having a summer program that focuses on undergraduate students, it helps us reach out to those individuals who are interested in becoming healthcare practitioners. And then hopefully, we can convince them that leadership is in their future.

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17:40 Bowman: Diversity in public health ties directly to our pursuit of excellence and impact. There have been numerous studies conducted about the benefits of diversity and diverse teams, and compelling evidence that demonstrates that diverse teams perform better. Additionally, in public health, it's critical that we understand the communities we serve and that the people working in public health reflect those communities. At the University of Michigan, there's a long history of community engagement, so we don't go into communities with a pre-diagnosed problem or a pre-formulated or a ready-made solution, rather, we work with communities in true co-equal partnerships. And in public health, we not only need to engage with communities, but we also must make sure that we're training people who reflect the communities where we're doing the work. This isn't only for Michigan Public Health, but it's across higher ed, we have to train our students to really face the complexity that's inherent in public health work. And so, I think it's an imperative that we take responsibility and ownership to really advance that goal.

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19:03 Narrator: This is the final episode of our season, Population Healthy: Race, Inequity, and Closing the Health Gap. Thank you for listening all season long. We hope you learned something that will help you make the world a healthier place. Please subscribe or follow our Podcast on Apple Podcast, Google Play, Stitcher, Spotify, or wherever you listen to podcasts. Interested in studying public health with us? Join our interest list by going to our homepage, publichealth.umich.edu and check out our programs and degrees and other helpful resources across our website. Be sure to follow us @umichsph on Twitter, Instagram, and Facebook to join the conversation, learn more from Michigan public health experts, and share episodes of the podcast with your friends and followers. You can also check out the show notes on our website, publichealth.umich.edu/podcast for more resources about the topics discussed in this episode. If you wanna stay up-to-date with the latest research and expertise from Michigan Public Health, subscribe to our weekly newsletter, Population Healthy. Head to publichealth.umich.edu/news/newsletter to sign up and be sure to join us next time. Thanks for listening and doing your part to make the world a healthier place for all.

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