Race & Public Health in America

Transcript for Student Voices

Ashish Jha/Dominique Bannerman

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You’re listening to Student Voices, a podcast featuring student-led interviews of Brown University faculty based on the Race & in America panel discussion series, curated by the Center for the Study of Race and Ethnicity in America in partnership with the Office of the Provost.

Dominique Bannerman I'm Dominique Bannerman, a first-year Master of Public Health student with a concentration in the Generalist Program, specifically focusing on racial disparities in cardiometabolic health. And I'm speaking with the Dean of the School of Public Health, Ashish Jha, about the recent panel discussion on Race & Public Health in America.

My first question to you, Dean Jha, would be: in the previous panel, you spoke about three key themes: structural racism and social determinants of health; internal issues of the health system; and the trust and knowledge, or lack thereof, of the current health system. How have you used this knowledge in your own clinical practice and what steps have you taken to combat these issues?

Dean Ashish Jha: Dominique, first of all, thanks for having me part of this conversation. It's a really great place to start. As a clinician, I've always believed, like every doctor and every nurse, 'Oh, I personally don't discriminate. I'm somebody who treats everybody equally.' But the truth is that all of us believe that, and yet it turns out the system does not treat people equally at all. It does not treat people equitably at all. And so I have begun with that knowledge and with the assumption that my own perceptions of my clinical practice are not good enough. And that has meant that when I take care of patients who are Black or Latino or Native American, if I decide that there is a therapy that I don't think they're eligible for--or a test--I make sure that I ask myself hard questions, why am I making this decision? I really try to spend extra time engaging with patients.

But ultimately I believe that these are not things that one can do individually looking at themselves, that these are broader structural and organizational fixes. And so in each of the hospitals that I have worked in, I have advocated for, and I've usually been able to push the organization to do systematic data collection and review of how patients are cared for in that institution, so that it's not just about 'what am I doing,' but 'what are we all doing and how are we acting differently.' And then obviously it goes well beyond what any institution can do. There are broader societal issues, and my approach on how to counter that has been to try to do research and identify where the gaps are, to highlight what potential solutions are so that we can continue to work on these problems, not just with individuals, not just with individual institutions, but as society at large.

Dominique Bannerman: Great, thank you. My second question is: a medical student in London by the name of Malone Mukwende created a diagnostic handbook called Mind the Gap, which contains images and descriptions of clinical signs and symptoms in Black and Brown skin. He felt it was necessary because he noticed that many medical students are only taught to recognize them in white people. In what other ways can we supplement our own learning to close gaps such as Mukwende did?

Dean Ashish Jha: Yeah, I thought that's a really fabulous project and it's totally true. When I think about everything from how we recognize skin diseases to joint problems. The photos of somebody with a hot knee, an infected knee; it's always a white knee with red. Things look different in brown skin. Right? They look different in dark skin. And that has not been taught in medicine in the same way. And that means not only do we get the impression that white is normal and everything else is not, but clinically, then we're likely to miss those things when we see more subtle versions of it in clinical practice. That's a huge problem. So I love that specific example of showing the manifestations of disease in Black and Brown skin.

I think there's a lot of those kinds of issues that we have built up in medicine. The way we think about, for instance, kidney function. We've built up a whole thing that interpretation of kidney function is different in Black people than [in] white people. One of the things that has a deeply racist origin that really goes back to slavery is this idea that Black people have a different pain tolerance than white people. And I will tell you, you'd be shocked how many doctors walking around today believe that Black people have a higher pain tolerance than white people. It's just stunning. So a lot of this kind of mythology about biology and race continues to pervade medicine today. One of the things I certainly talk about and advocate for is really looking much more carefully at our entire medical education process to say 'when do these ideas creep in? How do they creep in? How do we counter them? And how do we really root them out of medical education?' Again, some of these are ideas that may even have a reasonable origin, but some of them are, as I said, downright racist and from the days of slavery. And it's really important that we take them out.

Dominique Bannerman: Okay, so my final question is, while Brown has afforded me a remarkable opportunity to make my own impression in public health. What words of advice do you have for me and my peers, particularly my fellow students of color, in pursuing this path?

Dean Ashish Jha: Yeah. My advice to you, Dominique -- not that you need my advice, but I will give it to you anyway -- is be bold, be aggressive, take on the big topics. Think about what really matters and go work on that and go solve it. I think too often people are told, 'that problem is too complicated, it's too entrenched, it's too long-standing. You can never fix it.' That's, first of all, a recipe for making sure that nothing ever gets fixed. But second, that kind of advice is, I think, particularly offered to women and to people of color: that something is maybe too complicated, too big. My advice to you is ignore all those naysayers; ignore the detractors. Think about what really matters to you, what do you want to see better in your lifetime, and get working on it now. And be bold and be ambitious, because that's what it's going to take to make systemic change in our country and in the world.

Dominique Bannerman: Thank you so much, Dean Jha.

Dean Ashish Jha: Thank you so much for having me on.

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Student Voices is a feature of the Race & in America digital publication series developed by the Brown University Library. Our theme music is “see the unseen” by Butter. Explore the series at DigitalPublications.Brown.edu