Pipeline Programs Create a Path Toward Health Equity

What do you want to be when you grow up? There was no hesitation in my young, determined mind when I answered: a doctor. I marveled at the idea of racing down bustling halls, cracking the complicated patient case and attending to patients whose misfortune had brought them to the hospital.

I soon realized that medicine is not “Grey’s Anatomy.”

Medicine is far more predictable, and as I would come to realize, relatable, than what I once thought as a young, Black aspiring doctor. Our healthcare system is plagued with health disparities that repeatedly and disproportionately impact the health outcomes of Black patients and other patients of color, yet public health systems and medical academia continue to appoint leaders to tackle these disparities who don’t represent the communities most impacted. Taking racial justice seriously in medicine means making sure that the health system has more leaders from those communities.

Historically, academia has functioned to prevent people of color from entering and succeeding in medicine and academia. There are strict requirements tied to resources that communities of color have historically been excluded from as a result of educational, residential, and place-based discrimination. These practices, and other forms of racial bias, have challenged racial minorities and disadvantaged them from entering and practicing in academic fields like science and medicine. Without adequate diversity in such fields, our increasingly diversifying population will continue to face significant health disparities.

This means that on an alarming scale, white physicians and research scientists are informing the health interventions for patients of color by considering what it might feel like to be a person of color impacted by structural and societal barriers. I’ve sat on conference calls, listened to group discussions, shadowed physicians, and given presentations all focused on how to understand and improve adversity that disrupts patient care and quality of life. But when I am questioned, directly or indirectly, by my non-Black colleagues and larger medical community, to better understand my roots, my day-to-day thoughts, my existence, I realize that perhaps I have misunderstood the question. They are asking me to understand the academic systems that will appoint me to work with them but not the communities I come from and seek to serve.

To better understand communities, we must include the community members themselves. Research shows the benefits of diverse medical teams. Diversifying medicine and academia are critical to reducing and potentially closing longstanding health disparities and emergent COVID-19 inequalities. It is crucial for our healthcare system to reflect a more representative field of practitioners, researchers, and public health leaders if we are to attain more equitable health outcomes. Increasing medical pipeline programs for underrepresented students is one promising way to move toward health equity and improve rates of entrance into medicine and academia.

When I joined the University of California San Francisco (UCSF) as an SF Building Infrastructure Leading to Diversity (BUILD) fellow, academics in the pipeline program were working towards greater health equity through collaborations with communities. SF BUILD is a paid inaugural pipeline program for historically underrepresented students to undergo immersive training and mentoring from faculty within the biomedical work force at San Francisco State University and UCSF. Many SF BUILD scholars have published manuscripts on novel approaches to issues that impact the communities they come from, such as cancer therapeutics in Latina women and the impacts of stereotype threat in Black men. Similar programs such as MARC (Maximizing Access to Research Careers) and RISE (Research Initiative for Scientific Enhancement) have also increased the number of historically underrepresented scientists in biomedical fields by offering research experiences, tuition, and mentoring for higher education pursuits. These programs have not only extended opportunities that promote contributions from scientists of historically underrepresented backgrounds, but also expose the level of talent and novelty residing within these communities.

Programs like SF BUILD, MARC, and RISE have given me and other underrepresented students the opportunity to contribute to public health and biomedical endeavors in capacities that were often denied to the generations before us. I will be the first in my family to have applied for and been recruited by combined MD/PhD programs in the public health sciences. Having received several first authored manuscripts and grants awarded in medicine and health disparity research, I am just beginning. I aspire to create systems of comprehensive care in Black neighborhoods and urban sectors that lack resources and access to preventative care. It has been the support of pipeline programs that has helped me achieve and aspire to accomplish more within our healthcare system.

I can only imagine what future medicine and academia pipeline programs can foster from community ambassadors seeking to do more than understand disparities from the outside. We need more people in medicine working to serve their own communities. Investing in pipeline programs is an important step in showing a real commitment to tackling racial disparities and building a system where our patients can be heard, understood, and cared for.

Joi Lee is a project and policy analyst at the Bixby Center for Global Reproductive Health at the University of California San Francisco.