What does it take to narrow racial health gaps in the U.S.? – Center for Public Integrity

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Black women in the U.S. were 3.5 times more likely than white women to die of causes related to childbirth from 2016 to 2017, a new study published last week found — a gap that is wider than previously estimated. It’s just one of a long list of racial health disparities in a nation that spends more than 19% of its annual gross domestic product on health care.

Dr. Rachel Villanueva is trying to get the word out about these disparities. She’s the president of the National Medical Association, a group of more than 30,000 Black medical doctors founded in 1895, when Black doctors were denied admission to the American Medical Association. She’s also an assistant professor at the New York University’s Grossman School of Medicine, and she spoke to the Center for Public Integrity after a day of treating patients in her role as an OB-GYN at her practice in New York City.

This conversation has been edited for length and clarity.

Public Integrity: The pandemic and the protests over George Floyd’s death spotlighted ongoing racial health disparities in the U.S. What have the last two years been like for the National Medical Association in light of these major events? What discussions are you having?

Villanueva: Many people had no idea of these disparities that exist, but I think that was really why we were founded. For us, these are the conversations that we’ve been having since we started. These disparities really have not significantly improved for Black Americans even since the founding of NMA. We have always been at the forefront, even when other organizations were against Medicaid and Medicare and civil rights expansion and the Voting Rights Act, to make sure that we improve the health of our community. We are excited that now there’s more of a kind of movement, more of a national push to make a difference, to really address these things in a substantive way.

Race is an independent factor for poor health outcomes in our country. That was documented in the 1980s by [the U.S. Department of] Health and Human Services. They came up with recommendations that are still the recommendations now, that we are still trying to achieve: increasing access [to health care], increasing education, diversifying the workforce, collecting better data. That’s been a huge issue: We have only part of the picture of what’s happening in the pandemic, communities where we don’t even have race data.

Health is not just what happens in the hospital. So much of it is what people bring into you as a doctor. “Social determinants of health” is a very common phrase now, because it’s been in the news. Just understanding that it’s access to good health care, but also access to green spaces, education, investment in communities of color — all of those things that factor into poor health outcomes for patients.

Public Integrity: Studies indicate Black patients have better outcomes with Black doctors, but African-Americans are underrepresented in medicine. What are some specific ways to interest young, Black students in medical school? What are some things that you think society should do to try to make that happen?

Villanueva: Black physicians are only 5% of the workforce, so we’ve only increased very minimally over the past 100 years. It’s shocking when you think about it.

Different ZIP codes within the same city can have such differences in access to just educational opportunities, books, resources. It’s not going to be in college that we get those students interested in medicine: It really has to be at a very young age that we expose students that may not otherwise see a healthcare professional or physician that looks like them. And not just doctors. We need individuals of color in nursing, physician assistants, respiratory techs.

One of our members has a program called Mentoring in Medicine, and it’s just an outstanding program. They do a lot of career fairs for kids in grade school, exposing them, giving them opportunities to shadow, do research projects, helping them with everything from applications to SATs to how to take tests. Very often some of these students are coming from communities or families where no one went to high school, no one even understands how to interview. Sometimes people can’t even really understand that someone might not understand what would be appropriate clothing to wear for an interview, how you present yourself. Really investing in those children, in those communities is what’s needed. It always comes down to funding, which is the worst thing to need because that’s always the hardest.

Public Integrity: How have your personal experiences as a Black woman shaped the way you practice medicine?

Villanueva: I come from a family of physicians. My parents immigrated from Haiti. My dad was a physician there and then came to the United States to do his residency. My mother’s brother was a physician. Her father was the dean of the medical school in Haiti.

My grammar school was almost like the United Nations, and I really didn’t think about race so much. We were all friends: Black, Asian, Hispanic, Italian immigrants, Irish immigrants.

As I became older, I became much more aware of race. I think people don’t always realize what they’re saying to you, but they’re saying things like, “Well, you’re different. You’re Black, but you’re not really. You’re not like them.”

In medical school, I went to Yale, which is very Ivy League and white, and New Haven is really a poor area. I very much understood how privileged I was and that I had an opportunity being a Black person to really impact the students that were in New Haven. We did a lot of exposure programs. They would come to the Yale campus and would see science. I think that impacted me quite a bit.

And being subjected to racial comments, even by people in the hospital assuming that you are either cleaning or the nurse, even though you’re wearing something that says doctor on it. Or experiences that I have when people don’t know that I’m a physician, when I’m in a patient role. People don’t understand how the healthcare system really treats people who are either the uninsured or underinsured, how poorly they get treated within the same system, even within the same hospital.

Public Integrity: You’re an obstetrician. Some of the early advice on pregnancy and COVID-19 vaccines was very confusing. What do you say to pregnant patients who are hesitant to get vaccinated for COVID-19 even now?

Villanueva: It’s a conversation. It’s really one person at a time. Pregnant women were not part of any of the trials, initially, so of course they’re going to think, “Well, we don’t know what it’s really going to do.” There is a lot of misinformation and fear. They don’t want to do something that’s going to harm the baby, which is totally understandable. The vaccine seems to have gotten developed so quickly, even though really it wasn’t developed that quickly. That message also gets lost: These [mRNA technology] platforms were being used for quite some time before. They pivoted so it could be used against the COVID-19 virus.Now we actually do have real-world data from all the people that have used it. A large percentage of pregnant women have gotten vaccinated. Being sick with the virus itself is when you have to worry about your pregnancy outcomes, hospitalizations and deaths.