Expanding Equity and Diversity Is Paramount to Stanford Medicine Mission
Alyce Adams, PhD
The coinciding crises of the murder of George Floyd and the COVID-19 pandemic marked a transformative moment in our nation’s history. One reignited the demand for social justice; the other highlighted the glaring inequities in health outcomes due to ethnicity and zip code.
Together they galvanized the Department of Medicine’s existing commitment to focus on the social determinants of health, as one’s environment, ethnicity, food security, and access to clinicians and pharmacies all impact one’s lifelong health. The department launched a slew of new health equity activities and programs in the 2021–2022 academic year, and new research spinning off pandemic data helped government agencies and health care providers discover ways to address their own deficiencies in treating underserved populations.
The coinciding crises also prompted the department to pledge to take a louder stand against racism moving forward.
“Our Stanford Medicine community came together to declare, ‘Enough is enough,’” says Terrance Mayes, EdD, associate dean of equity and strategic initiatives and executive director of the Commission on Justice and Equity at Stanford Medicine. “We pledged that at Stanford Medicine we will not remain silent. We will do everything we can to effect meaningful change.”
“Our Stanford Medicine community came together to declare, ‘Enough is enough... We will do everything we can to effect meaningful change.”
- Terrance Mayes (Photo by Robert Most)
“We have an opportunity to be leaders in leveraging data and technology advancement to inform the development of health systems and policies that promote health equity.”
– Alyce Adams, PhD
Taking Up the Challenge
The Department of Medicine has long strived for more equity and diversity in its own healthcare system and within the Stanford School of Medicine curriculum, with dozens of programs on the medicine campus, as well as community outreach programs nationwide.
In 2004, the medical school created a new leadership position meant to attract more women and underrepresented minorities to postgraduate and faculty positions. Hannah Valantine, MD, professor of cardiovascular medicine, was the first to hold the post of senior associate dean of diversity and leadership. The school has since implemented dozens of programs for students, residents, postdoctoral scholars, and faculty members to promote diversity, equity, and inclusion.
Valantine notes that women now comprise 47% of all Stanford Medicine department chairs.
“Stanford Medicine has been working on faculty diversity and has made great progress with gender equity,” Valantine says in this Q&A. “My point is that if we can do this for gender inequality, we can do this for race and ethnicity, because the pool of qualified people exists.”
She is promoting additional training to combat unconscious bias and racism and gathering diverse groups to conduct team science and apply for NIH grants.
“The key to team science is bringing together a diverse group of people,” she says. “We want that collection of different ways of thinking to enhance our research and patient care.”
That focus on team science is one of the chief reasons why Alyce Adams, PhD, joined the Stanford Medicine faculty.
“I came to Stanford because of the opportunity to collaborate with scientists from across diverse disciplines to understand and address the drivers of health inequities,” says Adams, the inaugural Stanford Medicine Innovation Professor and professor of epidemiology and population health.
“Few places have the potential to conduct transdisciplinary health equity research on a single campus,” she says. “Plus, Stanford is known for innovation and data science. We have an opportunity to be leaders in leveraging data and technology advancement to inform the development of health systems and policies that promote health equity.”
Equity in Cardiology
While cardiovascular disease is the number one killer of women in the United States — causing one in three deaths each year — fewer than 15% of cardiologists are women. Women make up fewer than one-fourth of surgeons in the United States, yet a recent study shows that 32% are more likely to die during postoperative care if their surgeon is a man.
When Department of Medicine Chair Robert Harrington, MD, a cardiologist, was chair of the American Heart Association, he helped launch Research Goes Red, part of the Go Red for Women initiative designed to encourage women to take charge of their heart health.
“We’ve also created a women’s research working group designed to make sure that we’re reviewing submitted grants in a gender-equitable way, and that we’re including more women as part of all of our science committees,” Harrington says in this Q&A about health equity and the gender gap in cardiology. “Right now, our committees are roughly 42% women, and we’ve made a public commitment to get that to 50% in the next few years.”
Revelations Born of COVID and Racism
The Stanford Medicine magazine devoted an issue, Closing the Gap, to address racial inequity in medicine — and some of that meaningful change has come from research born of COVID-19.
Stanford Health Policy research discovered that unequal vaccination rates in the U.S. compounded existing disparities in cases, hospitalizations, and deaths among Black and Hispanic populations. Data from a slew of projects by a new COVID modeling team of faculty and students aided public health officials, hospitals, state governments, and policy makers as they planned for and mitigated the impact of the virus that has taken more than a million lives in this country.
“Narrowing vaccination disparities to produce better and more fairly distributed health outcomes is simple enough to say and appeals to ideals of equal access and justice,” says Jeremy Goldhaber-Fiebert, PhD, professor of health policy. “But achieving this goal is as challenging as it is important.”
Indeed, Stanford School of Medicine Dean Lloyd Minor, MD, stated in a letter to readers of the Stanford Medicine magazine that the best predictor of a person’s health remains the zip code.
“The insidious effects of racism have become abundantly clear during the pandemic. Anti-Asian hate crimes have soared nearly 150% amidst rising xenophobic rhetoric,” Minor wrote. “And nationally, Black, Latinx, and American Indian people are about four times as likely to be hospitalized with COVID-19 as white people, and nearly three times as likely to die of it, according to the Centers for Disease Control and Prevention.”
Minor emphasized that all departments within Stanford Medicine must acknowledge and address institutionalized racism within the U.S. healthcare system. He noted that in 2002, the Institute of Medicine published the report Unequal Treatment, which revealed that racial and ethnic minorities receive poorer quality care even after controlling for factors such as insurance status and income.
“Nearly 20 years later, we continue to see reports of differential treatment for patients of color at hospitals around the country,” he said, pledging that Stanford Medicine would make social determinants of health a research priority as well as the recruitment and training of a more diverse workforce.
The ability to reach our patients where they truly live … makes it easier for our patients to see us and for them to potentially participate in research. These ambulatory sites are a critical part of our future.
– Robert Harrington, MD
Furthermore, Minor said, the medical school intends to grow its care for the greater Bay Area community through its outpatient centers along the Peninsula and in the East Bay, like those in the often-underserved cities of Oakland and San Jose. Minor noted that clinics like the Stanford Medicine Cancer Center in South Bay and Stanford Medicine Cancer Center in Emeryville, both staffed by Stanford faculty, expand the network of clinical trials for rare diseases and cancer to a more demographically diverse population.
Department Chair Harrington echoed the need for this increased accessibility.
“The ability to reach our patients where they truly live … makes it easier for our patients to see us and for them to potentially participate in research,” Harrington told The Stanford Daily. “These ambulatory sites are a critical part of our future.”
Being Black in a White Coat
Acknowledging that there are too few Black clinicians in white coats and too few women surgeons in cardiovascular and orthopedic surgery is among the other keys to health equity — and better outcomes for patients. A Stanford study showed that Black men being treated by Black physicians have better health outcomes. Yet according to a report by the Association of American Medical Colleges, as of 2018, only 5% of physicians were Black and 5.8% of doctors were of Hispanic ethnicity.
Stanford emergency room physician Italo Brown, MD, says he uses his ethnicity as a strength and strives to help aspiring minority clinicians to meet their full potential.
“It’s important to me to be a river to one’s people,” he said in this Stanford Medicine magazine article about trust in medicine, explaining that the phrase comes from Lawrence of Arabia. “It means to be somebody who, with everything else you get, everything that you receive, you flood it to the communities you come from — to the people who have no access to it. To be a reservoir, a tributary, is living up to your ultimate potential.”
Italo Brown, MD, from Stanford Medicine Magazine
It’s a constant reminder, he said, of why he chose health care. “Tons of people sacrificed, died, prayed, and invested for me to be able to do this.”
In 2021, the medical school launched a new health equity project called The REACH Initiative, a series of programs dedicated to training a new generation of leaders in medicine and science who will actively promote health equity, racial equity, and social justice work to reduce our society’s devastating health disparities. With a $25 million gift from an anonymous donor, REACH will fund more than 700 students from historically underserved communities who will pursue health equity.
Stanford Medicine’s New Department of Health Policy
The Center for Primary Care and Outcomes Research within the Department of Medicine became its own full-fledged Department of Health Policy in fall 2021 — the 13th basic science department within Stanford School of Medicine.
The new department provides a focal point for health policy at Stanford University and the medical school at a time when policy research, decision science, and data modeling have played a vital role in the understanding and prevention of the coronavirus pandemic. The department will also be a major hub for research and policy impact to promote health equity.
Stanford Health Policy (SHP) remains the umbrella organization across campus representing the medical school with the new department as well as the Center for Health Policy in the Freeman Spogli Institute for International Studies within the university. SHP faculty, fellows, students, and researchers investigate how social factors, economics, law, financial and insurance organizations, health technologies, and personal behaviors impact the accessibility, quality, and cost of health care.