July 1, 2025 • 27 mins
Health Affairs' Rob Lott interviews Uché Blackstock, CEO and Founder of Advancing Health Equity (AHE), on her experiences founding AHE in 2019, the mission statement of the organization to pursue health equity in health care, and her generational memoir, LEGACY: A Black Physician Reckons with Racism in Medicine.
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Episode Transcript
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Rob Lott (00:00):
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. Friends, it's good tobe here with you again. And this
week, it's time for another oneof those very special episodes
where we get to break the rulesa little bit and invite someone
who, even if they haven't, likemost of our guests, just
(00:26):
published a new research articlein the pages of Health Affairs,
they do have some authentic anddeep insight into the state of
the health policy universetoday. We're always so lucky to
hear those perspectives and tolearn from our guests'
experiences.
And today, we'll be learningfrom the one and only doctor
(00:48):
Uche Blackstock. DoctorBlackstock is a physician and
former associate professor inthe Department of Emergency
Medicine at, NYU School ofMedicine, where she was also
faculty director forrecruitment, retention, and
inclusion in the office ofdiversity affairs. She's the
(01:09):
founder and CEO of anorganization called Advancing
Health Equity, which we'll hearabout in just a moment. And
she's an author. Her book titledA Black Physician Reckons with
Racism in Medicine has beendescribed as a generational
memoir.
It was published last year andwas just recently released in
(01:31):
paperback by Viking Books.Doctor. Blackstock, welcome to A
Health Odyssey.
Uché Blackstock (01:37):
Thank you so much for having me. I'm also
gonna mention that it was aninstant Legacy was an instant
New York Times bestseller, whichI think speaks to really the
importance of the themes thatthe book covers.
Rob Lott (01:49):
Oh, wonderful. Well, I can't wait to hear a little more
about, your journey writing thatbook and what it's been like,
talking to readers, over thelast year. But first, maybe we
can start with that you founded.I just mentioned, Advancing
Health Equity, which describesits mission as, quote,
(02:12):
partnering with organizations ontheir journey to eliminate bias
and discrimination in healthcare. Can you tell us a little
bit about what that looks likein practice?
What's your day to day work?What kind of organizations are
you partnering with?
Uché Blackstock (02:28):
Yeah. So I I always call Advancing Health
Equity my third baby. I have twokids, and I birthed this this
organization about six yearsago, really because I wanted to
do work with health and healthadjacent organizations in a way
that was very authentic to me.And so through, several services
(02:51):
like trainings, assessments, andstrategic council, we help, as
you mentioned, a variety oforganizations on their health
equity journey. So we work withnonprofits.
We work with health hospitalsand health systems, departments
of health. We also work withpharmaceutical companies and
(03:15):
even some non health relatedorganizations that want to kind
of learn more about what theycan do in health equity space
since we know that health careis not just about health is not
just about health care. Right?So, we've really been able to do
some wonderful, wonderful work.For example, we did a a
department wide training withthe New York State Department of
(03:36):
Health over the last few years,and our recommendations to them
after the training andassessment, influenced them to
create health equity as theirpillar, as one of the pillars
for the Department of Health.
Rob Lott (03:51):
Okay. Great. So, that's a that's a great example.
And I'm wondering if you cansort of expand on that a little
bit. To what extent is this kindof work focus internally with
your partners sort of looking atthings like organizational
policy and practices, hiring,training, that kind of thing
(04:13):
versus more external focus, likechanging culture and societal
structures.
Is that even a usefuldistinction? How do you kind of
look at those mentions?
Uché Blackstock (04:25):
Absolutely. Because I feel like, a lot a lot
of the work we do is bothinternal external facing. So we
know that how organizationsfunction, how and and what
organizational culture is caninfluence, like, the work that
that is being done even if themission of the organization is
one that, you know, is analignment with our own. We know
(04:46):
that there are lot oforganizations that, you know,
want to do the good work, butmaybe don't know how to do it
well in a in a culture way. ButI think the other piece that is
really important is thinkingabout how organizations engage
with communities and patients.
And so we also do thoseassessments, needs assessments
(05:06):
with communities, focus groupswith with patients. And we also
look at policies. So we do whatwe call equity audits. So we
look at organizations andinstitutional policies. We also
look at policies involved withhow these organizations interact
with with community members aswell.
So in my opinion, the work isincredibly synergistic. You
(05:29):
cannot do the internal facingwork without doing the external
facing work.
Rob Lott (05:33):
So you founded the organization in 2019, I think.
And we know there have been somepretty big external shocks since
then, COVID nineteen, the GeorgeFloyd murder, these things have
really shaped the health equityspace in that time. But also I'm
(05:55):
sure maybe you've encounteredsome surprises and unexpected
realizations over the course ofyour work leading an
organization like this. Can youtell us about some of those
surprises you may haveencountered?
Uché Blackstock (06:11):
Yeah. You know, I think, you know, I think for a
lot of organizations, you know,2020 was that turning point for
them and and thinking abouthealth equity and and and and
the factors that cause racialhealth inequities and what they
can do about it. I think in thebeginning, a lot of it was just
sort of, like, level setting.Organizations just wanted to
(06:31):
they want there were there's alot of a lot of requests for
trainings and, just spaces wherepeople can have, like,
courageous conversations aboutthese really what so some people
are uncomfortable aboutimportant issues. And then we
noticed over the last few yearsthat they've really been asking
more for assessments, likeorganizational assessments,
(06:52):
program assessments, and and wedevelop strategic reports and
recommendations and strategies.
And then now more so we'relooking at more longer term
engagements. So theseengagements are engagements
where we are counseling them onhow do you integrate health
(07:13):
equity into your strategic plan.So that it's something that is
not necessarily in a silo, butit's something that everyone and
every role within theorganization is thinking about
and that you have really cleargoals for, you know, the next
three to five years.
Rob Lott (07:29):
Alright. Let's talk a little bit about your book, the
title of which is Legacy, whichI I understand is a reference to
maybe at least two things. Oneis the legacy of racism and
American health care stretchingback centuries and really
impossible to avoid today. Butanother is your mother's legacy.
(07:52):
She went to Harvard MedicalSchool, then so did you and your
sister, making you all Harvard'sfirst mother daughter legacy
graduates.
And in your book, write abouthow in the '80s and '90s, as you
were growing up, she served asthe attending physician in a
public hospital in Brooklyn, thesame neighborhood where she grew
(08:13):
up. And you write about how sheknew the community and the
people she served intimately andpracticed what we might today
call whole person care. And soin her own day to day practice
of medicine, she too wasadvancing the cause of health
equity. Is that, a fair way tosort of describe, perhaps the
(08:36):
sort of foundation of of herlegacy?
Uché Blackstock (08:38):
Yeah. No. Absolutely. And I think what
what's even more profound isthat, you know, my mother grew
up in the same neighborhood inCentral Brooklyn where she
practiced. And unlike me, shehad a very different set of of
circumstances growing up.
She grew up, in poverty, onpublic assistance, first person
(08:59):
in her family to graduate fromcollege, and then, through luck,
fortune, and hard work ended upat Harvard Medical School, and
really could have gone anywhereafter Harvard Medical School. We
know that most of the HarvardMedical School graduates go to
some Ivy League affiliatedinstitution for their residency
and then stay there. But mymother, what was really
(09:20):
important for her was to comeback to her community. And so
she came back to New York City,trained here, then worked for
many years in the sameneighborhood that she grew up
in. And I think what is soimportant about that is that I
think she had a really deepunderstanding of where her
patients were coming from.
And this understanding that weknow health is not just about
health care. It's about what'shappening, you know, on a
(09:41):
community level. And I think sheand some other, you know, black
woman physicians in ourneighborhood, they had an
organization where they wouldhold community health fairs, and
they would make sure folks hadaccess to, you know, housing
housing advocacy groups and,groups that were doing work
around food insecurity. So theywere really thinking about,
(10:04):
like, what health equity lookslike, before that expression was
even coined?
Rob Lott (10:09):
Sadly, I know she died in 1997 when, you and your
sister were 19. And, as someonemyself who's also lost a parent
in early adulthood, I can attestto my own experience at least
that there's always somethingpainful, but also maybe
bittersweet too in a way when Ithink about everything they've
(10:32):
missed since their passing, youknow, achievements and
disappointments, grandchildren'smilestones and big world
headlines, all the stuff, youknow, we didn't get to share
with them. And obviously, sinceyou lost your mother, a lot has
happened in your life, but alsoa lot has happened in health
(10:55):
equity, as you said, and in ourefforts as a society to confront
racism in healthcare, an effortwhich she obviously was a part.
What do you think your motherwould make of the state of
health equity in America today?
Uché Blackstock (11:13):
It's it's interesting because in Legacy, I
was able to include some of mymother's own writing from an
essay that she wrote in the inthe mid nineteen nineties. And
and and in that essay, she talksabout being a black woman in
medicine, but she also talksabout that the health
disparities that she sees. Andso thinking that so many years,
decades later, you know, eventhough a lot of really wonderful
(11:36):
work has been done and and we'veseen some improvements, however,
you know, we still see veryprofound, racial health
inequities in this country. Weactually see, like, all
Americans not doing well. Whenwe look at, you know, indicators
of well-being, like lifeexpectancy and maternal
mortality.
So that's for all racialdemographic groups. But then
(11:58):
when you look for people ofcolor, indigenous, and black
people, it's even more profound.So I think my mother would be,
sadly disappointed, that despiteadvances in research,
innovation, and technology, thatwe really haven't profoundly
closed that gap.
Rob Lott (12:16):
How would you describe the changes we've seen if we
have seen changes in in thespace over, the last five years
since you founded thisorganization, but maybe to put a
a finer point on it, over thelast five months?
Uché Blackstock (12:32):
Yeah. I mean, I think I would say five years
ago, I felt so incrediblyhopeful because, you know, I did
you know, I founded AdvancingHealth Equity in 02/2019. It was
before the pandemic, beforeGeorge Floyd, I saw a need
really to work withorganizations on their health
equity journey. Right? And sothen when COVID happened, even
though it was obviouslyhorrible, horrible, George
(12:54):
Floyd, horrible, but it kindajust validated, like, all of,
like, the work that I thoughtwas important to do.
And it and it felt reassuring tosee organizations dig, you know,
dig dig deeper into that doingthat work. And then and actually
operationalizing what healthequity looks like, like
integrating it into theirstrategic plans. Right? Like,
(13:15):
looking at what kind of data iscollected. Right?
And so and and then alsothinking about health equity in
terms of, like, qualityimprovement. Because when I
think about health equity, Ithink about you want probably
health outcomes for everybody.Right? Isn't that what everyone,
not only in health care, but inthis country wants? Right?
That's what you should want. So,you know, I think that, you
(13:36):
know, last few years, have tosay that there were times when I
could not even keep up with theclient inquiries into the into
the work that we were doing.However, that has totally
shifted. Mhmm. Especially in thelast five months, you know, I
can personally say we hadclients that have that are
academic institutions that havecanceled contracts with us
because they are worried aboutbeing penalized by the federal
(13:58):
government for doing healthequity slash DEI work.
I we've had delayed paymentsfrom from from from from
organizations, federal agenciesas they try to, you know, think
about what's happening and as asas funds are frozen. And so it's
I have to say it's, like, it'sit's devastating to see to see
(14:19):
this happening. I feel likethere are similarities in some
ways to 2020 to now and that interms of a lot of uncertainty.
But what I always thought then,I still think now is that we I
still have to stay in alignmentin in terms of the work that is
important to do. And, you know,I think that there still are
organizations out there thatwanna do the work.
(14:40):
And then also kind of maybe reframing how we how we speak
about the work, the mission andthe goals are still the same.
Rob Lott (14:46):
Fair enough. I want to hear a little more about how
you're, putting that missioninto action. But first, let's
take a quick break. And we'reback. I'm here talking with
(15:14):
Doctor.
Uche Blackstock. We've talkedabout some of the recent changes
we've seen in the health equityspace over the last few years
and the last few months. Goingback a few years, Doctor.
Blackstock, I know you heldprominent roles in academia,
associate professor, facultydirector, big positions. But
(15:38):
eventually you decided to stepaway from that.
And in early twenty twenty, youpublished an article in Stats
titled Why Black Doctors Like MeAre Leaving Faculty Positions in
Academic Medical Centers. Canyou tell us a little bit about
how you made the decision toleave academia and some of the
(16:00):
factors that, may havecontributed to that decision?
Uché Blackstock (16:03):
Yeah. Sure. You know, so I was, you know, I was
in a department of emergencymedicine, you know, at a, you
know, well known academic,medical center. And, you know,
even though it's one of thelargest departments, of
emergency medicine in New YorkCity, and even though, like,
it's in the middle of New YorkCity, one of the most diverse
cities in the country, itactually wasn't that diverse for
(16:26):
a long time. For most of thetime, was there as either the
only black faculty or one of twoblack faculty.
So it just didn't really seem tobe, an awareness of, like, the
importance of, you know,increasing diversity among
faculty. But it really was youknow, I did a lot of medical
education work, which I reallyenjoyed. But about seven years
in, I was appointed to a DI rolein our school's office of
(16:50):
diversity affairs. Super excitedabout it, tasked with focusing
on recruitment and retention ofwomen faculty and faculty of
color, as well as students andtrainees. And unfortunately, in
that role, it was just afigurehead role.
So it was very demoralizing whenI found that out that I wasn't
actually going to be empoweredto do something in that role.
(17:12):
And so I started thinking about,like, you know, is this kind of
is this the environment that Ireally want to be in where I
can't do work authentically andand show up as my full self? And
so I made this decision. I knowit sounds absolutely bold. And
so I I decided to, you know,found my my my company advancing
(17:33):
health equity so I could do thework the way that I wanted to do
it.
And then I thought maybe I'dstay part time in academia. But
then it became really clear thatI just kinda I wanted I wanted
to leave. I just wanted to,like, kind of be free of these
really, like, these institutionsthat I think, to be honest with
you, I write about this in thestat piece. They were not they
(17:53):
weren't even created with withblack faculty in mind. They at
the times they were created,they were created to exclude us.
And so I feel like the remnantsof that are still they're still
there.
Rob Lott (18:04):
Fair enough. I mean, perhaps with some distance now,
you've you've been out for a afew years. How would you
describe, what's what's workingand what's broken? You've just
sort of alluded to that here,about academic medicine more
generally.
Uché Blackstock (18:22):
Yeah. I mean, an interesting, like, to answer
that question now because I feellike, you know, academic
institutions, higher edinstitutions are, you know,
under more pressure. Right?Like, I just found out about
this. Don't know if it's aproposal saying that, medical
schools, can't use, like,there's a accrediting body
(18:43):
called the l LCME, that requiresthat medical schools have
diversity initiatives.
They just kind of had to get ridof that. You know? So I feel
like we are we're we're we'rebackwards. And I'm and I'm
wondering how can we still dothe work that's important,
right, but under these veryrestrictive environments.
Rob Lott (19:05):
So I guess in that context, I want to shift gears a
little bit and sort of thinkabout one of the starkest
illustrations of how far westill have to go when it comes
to health equity. One example isthe really shockingly persistent
disparities in black maternalmortality. And so, you know,
(19:28):
here at Health Affairs, a policypublication, so often when
assessing commentaries andperspectives, our editors look
for pieces that describe aconvincing mechanism or pathway
that connects a given policy orlack of policy perhaps to
various downstream healthimpacts. And so when we think
(19:50):
about black maternal mortality,that crisis, I'm wondering if
you can share some thoughtsabout what policies perhaps,
what interventions or obstaclesare translating to such
devastating mortality ratesamong black women.
Uché Blackstock (20:06):
And I always, like, use this statistic that
even myself as a black womanwith, you know, Harvard College
and and and medical schooldegree, I still am, like, five
times more likely than a whitewoman with an eighth grade
education to die of matermaternal complications. Right?
So, like, this is, you know,this is something that is not
protective by your profession orsocioeconomic status. And I
(20:30):
think that, you know, when wethink about the policies that
would address this, it has to bepolicies that, you know, are,
like, multifaceted policies. So,you know, obviously, about what
the perinatal workforce lookslike working on efforts to
diversify that, looking at howthe social determinants of
health in in in blackcommunities, how that impacts
(20:51):
health, looking at, for example,even the climate crisis, and how
we know that, blackneighborhoods because of the
legacy of redlining, they areessentially, like, these urban
heat islands.
And we know that that actually,is implicated in preterm
deliveries. And so those arejust obviously some some
policies I think are important.The other one that I think is so
(21:13):
important is thinking about, youknow, a lot of the, the deaths
that happen around, aroundbirthing happen in the
postpartum period. And a lot ofit is because in this country,
we have we don't have amechanism or system in place to
really care for people in thatpostpartum period. Most people
(21:33):
will either just have one or twovisits with their OB GYN, and
that's it.
And we know, like, the theCommonwealth Fund, you know,
this is such wonderful, healthpolicy work. You know, they talk
a lot about and and and they'veshown this in their data when
you compare The US to other highincome countries that, one,
because we don't have midwiferycentered model of care in this
(21:55):
country, that that leads to morecomplications, and it doesn't
treat the the pregnant person asa as a full, like, sort of along
the spectrum as a as a wholeperson. The other issue is that
we also need there to be systemsin place so that people are
followed after they give birth,followed very closely because,
you know, people go home, theydevelop high blood pressure.
(22:17):
There's no one taking their, youknow, taking their their,
readings, and then they developpreeclampsia or they're or
they're hemorrhaging out. No oneis going there to take care of
them.
And I think so I think paidfamily leave, paid sick leave,
all of these really, I wouldsay, policies that a lot of
other high income countries havethat we know improves,
(22:39):
postpartum outcomes could make areal difference.
Rob Lott (22:42):
So it's such a huge challenge, and I know this is
one of your your focus areas.And I'm wondering if you could
say a little bit just about howyou keep from being overwhelmed
when you've faced something sobig as this. Or maybe a more
realistic way to ask would bewhen you do feel overwhelmed,
(23:03):
how do you cope?
Uché Blackstock (23:05):
Yeah, I think recognizing that like this work
is all about like sustainabilityand being able to do it in the
long term and thinking about thelong game. I also try to look
for for hope and even in darktimes. But I think also what I
would recommend, I recommend formyself and other people, is
(23:27):
really to look hyper local andlocally at potential solutions.
Right? So when everything seemsso overwhelming, like I talk
about in the book, there's abirthing center in Minneapolis
called the Roots Birthing Centerthat was started by a black
midwife.
The mission was to providedignified and respectful care to
to to to black birthing people.And they've actually shown by
(23:48):
this model that they haveimproving maternal complications
and and and preterm delivery.So, like, there are a lot of
really wonderful community basedorganizations very, very close
to us doing a lot of thiswonderful work. So we have to
think about how we can amplifytheir work. How can we help fund
their work?
How can we, engage with them? Sothat gives that's kind of what
(24:09):
gives me hope during thesechallenging times.
Rob Lott (24:11):
That's that's a that's a nice way to to think about it.
I I appreciate that. Before wewrap up, one question we often
ask on this podcast is to askfolks to imagine if they could
snap their fingers or make amember of Congress or governor
or city councilor sort of takeyour advice no matter what you
(24:34):
say or sort of however youimagine it, if you could change
one public policy in order tomake American health care more
just and equitable, where wouldyou start?
Uché Blackstock (24:47):
Single payer universal health care.
Rob Lott (24:49):
Okay.
Uché Blackstock (24:50):
I'm I'm I'm a big supporter. I know that we we
have the data that shows thatthis country, we spend so much
on administrative costs. We'reincredibly inefficient, and we
have the worst health outcomes.And I don't well, I don't think
single pane of universal healthcare will solve everything. I
think it would make asignificant dent in how, how
(25:14):
people fare in life.
Rob Lott (25:16):
And how do you sort of put that aspiration in the
context of, you know, the nextfew weeks, the next few months,
the next year of potentialpolicy changes, if we can sort
of acknowledge that we'reunlikely to see that, you know,
in the in the near term, whatsort of more immediate changes
(25:37):
do you think might move us fromhere to there?
Uché Blackstock (25:41):
Yeah. I mean, I I also think well, one looking
again, like looking local, Imean, there are looking local,
state, I think there are a lotof really wonderful examples of
localities and states sort ofdoing doing this work around
making sure that, likeMassachusetts, making sure that
people have health insurance,you know, obviously supporting
Medicaid expansions, even thoughwe know that that's, you know,
(26:05):
up for being cut as well. But Ithink advocacy piece is really,
really important. So I am alwayscontacting my legislators. You
know, there are lot of reallygreat apps.
One is one is called five calls,where you can just, like, put in
your your name, your ZIP code,and they'll they'll send a
(26:26):
letter or a voicemail to to yourlegislators about these issues
that mean a lot to you.
Rob Lott (26:31):
Wonderful. Well, a great advice and a good spot to
wrap up. Doctor. UcheBlackstock, thank you so much
for taking the time to speakwith us today.
Uché Blackstock (26:43):
Thank you for having me. I forgot to mention
I'm a huge fan of healthaffairs. Even though I'm no
longer in academia, I love andlook forward to the issues and
and reading all the reallywonderful articles that you
published. So thank you for yourwork.
Rob Lott (26:58):
Well, wonderful. Thank you. And of course, we're always
eager to receive submissions andwould love to perhaps see some
pieces from you along the way,perhaps building on your book.
Here's my segue, A BlackPhysician Reckons with Racism in
Medicine, New York Timesbestseller generational memoir
(27:18):
available at bookstores now. Andto our listeners, thank you all
for tuning in.
If you enjoyed this episode,recommend it to a friend,
subscribe and tune in next week.Again, Doctor. Blackstock,
thanks for your time.
Uché Blackstock (27:34):
Thank you so much.
Rob Lott (27:37):
Thanks for listening. If you enjoyed today's episode,
I hope you'll tell a friendabout a healthy policy.
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. Friends, it's good tobe here with you again. And this
week, it's time for another oneof those very special episodes
where we get to break the rulesa little bit and invite someone
who, even if they haven't, likemost of our guests, just
(00:26):
published a new research articlein the pages of Health Affairs,
they do have some authentic anddeep insight into the state of
the health policy universetoday. We're always so lucky to
hear those perspectives and tolearn from our guests'
experiences.
And today, we'll be learningfrom the one and only doctor
(00:48):
Uche Blackstock. DoctorBlackstock is a physician and
former associate professor inthe Department of Emergency
Medicine at, NYU School ofMedicine, where she was also
faculty director forrecruitment, retention, and
inclusion in the office ofdiversity affairs. She's the
(01:09):
founder and CEO of anorganization called Advancing
Health Equity, which we'll hearabout in just a moment. And
she's an author. Her book titledA Black Physician Reckons with
Racism in Medicine has beendescribed as a generational
memoir.
It was published last year andwas just recently released in
(01:31):
paperback by Viking Books.Doctor. Blackstock, welcome to A
Health Odyssey.
Uché Blackstock (01:37):
Thank you so much for having me. I'm also
gonna mention that it was aninstant Legacy was an instant
New York Times bestseller, whichI think speaks to really the
importance of the themes thatthe book covers.
Rob Lott (01:49):
Oh, wonderful. Well, I can't wait to hear a little more
about, your journey writing thatbook and what it's been like,
talking to readers, over thelast year. But first, maybe we
can start with that you founded.I just mentioned, Advancing
Health Equity, which describesits mission as, quote,
(02:12):
partnering with organizations ontheir journey to eliminate bias
and discrimination in healthcare. Can you tell us a little
bit about what that looks likein practice?
What's your day to day work?What kind of organizations are
you partnering with?
Uché Blackstock (02:28):
Yeah. So I I always call Advancing Health
Equity my third baby. I have twokids, and I birthed this this
organization about six yearsago, really because I wanted to
do work with health and healthadjacent organizations in a way
that was very authentic to me.And so through, several services
(02:51):
like trainings, assessments, andstrategic council, we help, as
you mentioned, a variety oforganizations on their health
equity journey. So we work withnonprofits.
We work with health hospitalsand health systems, departments
of health. We also work withpharmaceutical companies and
(03:15):
even some non health relatedorganizations that want to kind
of learn more about what theycan do in health equity space
since we know that health careis not just about health is not
just about health care. Right?So, we've really been able to do
some wonderful, wonderful work.For example, we did a a
department wide training withthe New York State Department of
(03:36):
Health over the last few years,and our recommendations to them
after the training andassessment, influenced them to
create health equity as theirpillar, as one of the pillars
for the Department of Health.
Rob Lott (03:51):
Okay. Great. So, that's a that's a great example.
And I'm wondering if you cansort of expand on that a little
bit. To what extent is this kindof work focus internally with
your partners sort of looking atthings like organizational
policy and practices, hiring,training, that kind of thing
(04:13):
versus more external focus, likechanging culture and societal
structures.
Is that even a usefuldistinction? How do you kind of
look at those mentions?
Uché Blackstock (04:25):
Absolutely. Because I feel like, a lot a lot
of the work we do is bothinternal external facing. So we
know that how organizationsfunction, how and and what
organizational culture is caninfluence, like, the work that
that is being done even if themission of the organization is
one that, you know, is analignment with our own. We know
(04:46):
that there are lot oforganizations that, you know,
want to do the good work, butmaybe don't know how to do it
well in a in a culture way. ButI think the other piece that is
really important is thinkingabout how organizations engage
with communities and patients.
And so we also do thoseassessments, needs assessments
(05:06):
with communities, focus groupswith with patients. And we also
look at policies. So we do whatwe call equity audits. So we
look at organizations andinstitutional policies. We also
look at policies involved withhow these organizations interact
with with community members aswell.
So in my opinion, the work isincredibly synergistic. You
(05:29):
cannot do the internal facingwork without doing the external
facing work.
Rob Lott (05:33):
So you founded the organization in 2019, I think.
And we know there have been somepretty big external shocks since
then, COVID nineteen, the GeorgeFloyd murder, these things have
really shaped the health equityspace in that time. But also I'm
(05:55):
sure maybe you've encounteredsome surprises and unexpected
realizations over the course ofyour work leading an
organization like this. Can youtell us about some of those
surprises you may haveencountered?
Uché Blackstock (06:11):
Yeah. You know, I think, you know, I think for a
lot of organizations, you know,2020 was that turning point for
them and and thinking abouthealth equity and and and and
the factors that cause racialhealth inequities and what they
can do about it. I think in thebeginning, a lot of it was just
sort of, like, level setting.Organizations just wanted to
(06:31):
they want there were there's alot of a lot of requests for
trainings and, just spaces wherepeople can have, like,
courageous conversations aboutthese really what so some people
are uncomfortable aboutimportant issues. And then we
noticed over the last few yearsthat they've really been asking
more for assessments, likeorganizational assessments,
(06:52):
program assessments, and and wedevelop strategic reports and
recommendations and strategies.
And then now more so we'relooking at more longer term
engagements. So theseengagements are engagements
where we are counseling them onhow do you integrate health
(07:13):
equity into your strategic plan.So that it's something that is
not necessarily in a silo, butit's something that everyone and
every role within theorganization is thinking about
and that you have really cleargoals for, you know, the next
three to five years.
Rob Lott (07:29):
Alright. Let's talk a little bit about your book, the
title of which is Legacy, whichI I understand is a reference to
maybe at least two things. Oneis the legacy of racism and
American health care stretchingback centuries and really
impossible to avoid today. Butanother is your mother's legacy.
(07:52):
She went to Harvard MedicalSchool, then so did you and your
sister, making you all Harvard'sfirst mother daughter legacy
graduates.
And in your book, write abouthow in the '80s and '90s, as you
were growing up, she served asthe attending physician in a
public hospital in Brooklyn, thesame neighborhood where she grew
(08:13):
up. And you write about how sheknew the community and the
people she served intimately andpracticed what we might today
call whole person care. And soin her own day to day practice
of medicine, she too wasadvancing the cause of health
equity. Is that, a fair way tosort of describe, perhaps the
(08:36):
sort of foundation of of herlegacy?
Uché Blackstock (08:38):
Yeah. No. Absolutely. And I think what
what's even more profound isthat, you know, my mother grew
up in the same neighborhood inCentral Brooklyn where she
practiced. And unlike me, shehad a very different set of of
circumstances growing up.
She grew up, in poverty, onpublic assistance, first person
(08:59):
in her family to graduate fromcollege, and then, through luck,
fortune, and hard work ended upat Harvard Medical School, and
really could have gone anywhereafter Harvard Medical School. We
know that most of the HarvardMedical School graduates go to
some Ivy League affiliatedinstitution for their residency
and then stay there. But mymother, what was really
(09:20):
important for her was to comeback to her community. And so
she came back to New York City,trained here, then worked for
many years in the sameneighborhood that she grew up
in. And I think what is soimportant about that is that I
think she had a really deepunderstanding of where her
patients were coming from.
And this understanding that weknow health is not just about
health care. It's about what'shappening, you know, on a
(09:41):
community level. And I think sheand some other, you know, black
woman physicians in ourneighborhood, they had an
organization where they wouldhold community health fairs, and
they would make sure folks hadaccess to, you know, housing
housing advocacy groups and,groups that were doing work
around food insecurity. So theywere really thinking about,
(10:04):
like, what health equity lookslike, before that expression was
even coined?
Rob Lott (10:09):
Sadly, I know she died in 1997 when, you and your
sister were 19. And, as someonemyself who's also lost a parent
in early adulthood, I can attestto my own experience at least
that there's always somethingpainful, but also maybe
bittersweet too in a way when Ithink about everything they've
(10:32):
missed since their passing, youknow, achievements and
disappointments, grandchildren'smilestones and big world
headlines, all the stuff, youknow, we didn't get to share
with them. And obviously, sinceyou lost your mother, a lot has
happened in your life, but alsoa lot has happened in health
(10:55):
equity, as you said, and in ourefforts as a society to confront
racism in healthcare, an effortwhich she obviously was a part.
What do you think your motherwould make of the state of
health equity in America today?
Uché Blackstock (11:13):
It's it's interesting because in Legacy, I
was able to include some of mymother's own writing from an
essay that she wrote in the inthe mid nineteen nineties. And
and and in that essay, she talksabout being a black woman in
medicine, but she also talksabout that the health
disparities that she sees. Andso thinking that so many years,
decades later, you know, eventhough a lot of really wonderful
(11:36):
work has been done and and we'veseen some improvements, however,
you know, we still see veryprofound, racial health
inequities in this country. Weactually see, like, all
Americans not doing well. Whenwe look at, you know, indicators
of well-being, like lifeexpectancy and maternal
mortality.
So that's for all racialdemographic groups. But then
(11:58):
when you look for people ofcolor, indigenous, and black
people, it's even more profound.So I think my mother would be,
sadly disappointed, that despiteadvances in research,
innovation, and technology, thatwe really haven't profoundly
closed that gap.
Rob Lott (12:16):
How would you describe the changes we've seen if we
have seen changes in in thespace over, the last five years
since you founded thisorganization, but maybe to put a
a finer point on it, over thelast five months?
Uché Blackstock (12:32):
Yeah. I mean, I think I would say five years
ago, I felt so incrediblyhopeful because, you know, I did
you know, I founded AdvancingHealth Equity in 02/2019. It was
before the pandemic, beforeGeorge Floyd, I saw a need
really to work withorganizations on their health
equity journey. Right? And sothen when COVID happened, even
though it was obviouslyhorrible, horrible, George
(12:54):
Floyd, horrible, but it kindajust validated, like, all of,
like, the work that I thoughtwas important to do.
And it and it felt reassuring tosee organizations dig, you know,
dig dig deeper into that doingthat work. And then and actually
operationalizing what healthequity looks like, like
integrating it into theirstrategic plans. Right? Like,
(13:15):
looking at what kind of data iscollected. Right?
And so and and then alsothinking about health equity in
terms of, like, qualityimprovement. Because when I
think about health equity, Ithink about you want probably
health outcomes for everybody.Right? Isn't that what everyone,
not only in health care, but inthis country wants? Right?
That's what you should want. So,you know, I think that, you
(13:36):
know, last few years, have tosay that there were times when I
could not even keep up with theclient inquiries into the into
the work that we were doing.However, that has totally
shifted. Mhmm. Especially in thelast five months, you know, I
can personally say we hadclients that have that are
academic institutions that havecanceled contracts with us
because they are worried aboutbeing penalized by the federal
(13:58):
government for doing healthequity slash DEI work.
I we've had delayed paymentsfrom from from from from
organizations, federal agenciesas they try to, you know, think
about what's happening and as asas funds are frozen. And so it's
I have to say it's, like, it'sit's devastating to see to see
(14:19):
this happening. I feel likethere are similarities in some
ways to 2020 to now and that interms of a lot of uncertainty.
But what I always thought then,I still think now is that we I
still have to stay in alignmentin in terms of the work that is
important to do. And, you know,I think that there still are
organizations out there thatwanna do the work.
(14:40):
And then also kind of maybe reframing how we how we speak
about the work, the mission andthe goals are still the same.
Rob Lott (14:46):
Fair enough. I want to hear a little more about how
you're, putting that missioninto action. But first, let's
take a quick break. And we'reback. I'm here talking with
(15:14):
Doctor.
Uche Blackstock. We've talkedabout some of the recent changes
we've seen in the health equityspace over the last few years
and the last few months. Goingback a few years, Doctor.
Blackstock, I know you heldprominent roles in academia,
associate professor, facultydirector, big positions. But
(15:38):
eventually you decided to stepaway from that.
And in early twenty twenty, youpublished an article in Stats
titled Why Black Doctors Like MeAre Leaving Faculty Positions in
Academic Medical Centers. Canyou tell us a little bit about
how you made the decision toleave academia and some of the
(16:00):
factors that, may havecontributed to that decision?
Uché Blackstock (16:03):
Yeah. Sure. You know, so I was, you know, I was
in a department of emergencymedicine, you know, at a, you
know, well known academic,medical center. And, you know,
even though it's one of thelargest departments, of
emergency medicine in New YorkCity, and even though, like,
it's in the middle of New YorkCity, one of the most diverse
cities in the country, itactually wasn't that diverse for
(16:26):
a long time. For most of thetime, was there as either the
only black faculty or one of twoblack faculty.
So it just didn't really seem tobe, an awareness of, like, the
importance of, you know,increasing diversity among
faculty. But it really was youknow, I did a lot of medical
education work, which I reallyenjoyed. But about seven years
in, I was appointed to a DI rolein our school's office of
(16:50):
diversity affairs. Super excitedabout it, tasked with focusing
on recruitment and retention ofwomen faculty and faculty of
color, as well as students andtrainees. And unfortunately, in
that role, it was just afigurehead role.
So it was very demoralizing whenI found that out that I wasn't
actually going to be empoweredto do something in that role.
(17:12):
And so I started thinking about,like, you know, is this kind of
is this the environment that Ireally want to be in where I
can't do work authentically andand show up as my full self? And
so I made this decision. I knowit sounds absolutely bold. And
so I I decided to, you know,found my my my company advancing
(17:33):
health equity so I could do thework the way that I wanted to do
it.
And then I thought maybe I'dstay part time in academia. But
then it became really clear thatI just kinda I wanted I wanted
to leave. I just wanted to,like, kind of be free of these
really, like, these institutionsthat I think, to be honest with
you, I write about this in thestat piece. They were not they
(17:53):
weren't even created with withblack faculty in mind. They at
the times they were created,they were created to exclude us.
And so I feel like the remnantsof that are still they're still
there.
Rob Lott (18:04):
Fair enough. I mean, perhaps with some distance now,
you've you've been out for a afew years. How would you
describe, what's what's workingand what's broken? You've just
sort of alluded to that here,about academic medicine more
generally.
Uché Blackstock (18:22):
Yeah. I mean, an interesting, like, to answer
that question now because I feellike, you know, academic
institutions, higher edinstitutions are, you know,
under more pressure. Right?Like, I just found out about
this. Don't know if it's aproposal saying that, medical
schools, can't use, like,there's a accrediting body
(18:43):
called the l LCME, that requiresthat medical schools have
diversity initiatives.
They just kind of had to get ridof that. You know? So I feel
like we are we're we're we'rebackwards. And I'm and I'm
wondering how can we still dothe work that's important,
right, but under these veryrestrictive environments.
Rob Lott (19:05):
So I guess in that context, I want to shift gears a
little bit and sort of thinkabout one of the starkest
illustrations of how far westill have to go when it comes
to health equity. One example isthe really shockingly persistent
disparities in black maternalmortality. And so, you know,
(19:28):
here at Health Affairs, a policypublication, so often when
assessing commentaries andperspectives, our editors look
for pieces that describe aconvincing mechanism or pathway
that connects a given policy orlack of policy perhaps to
various downstream healthimpacts. And so when we think
(19:50):
about black maternal mortality,that crisis, I'm wondering if
you can share some thoughtsabout what policies perhaps,
what interventions or obstaclesare translating to such
devastating mortality ratesamong black women.
Uché Blackstock (20:06):
And I always, like, use this statistic that
even myself as a black womanwith, you know, Harvard College
and and and medical schooldegree, I still am, like, five
times more likely than a whitewoman with an eighth grade
education to die of matermaternal complications. Right?
So, like, this is, you know,this is something that is not
protective by your profession orsocioeconomic status. And I
(20:30):
think that, you know, when wethink about the policies that
would address this, it has to bepolicies that, you know, are,
like, multifaceted policies. So,you know, obviously, about what
the perinatal workforce lookslike working on efforts to
diversify that, looking at howthe social determinants of
health in in in blackcommunities, how that impacts
(20:51):
health, looking at, for example,even the climate crisis, and how
we know that, blackneighborhoods because of the
legacy of redlining, they areessentially, like, these urban
heat islands.
And we know that that actually,is implicated in preterm
deliveries. And so those arejust obviously some some
policies I think are important.The other one that I think is so
(21:13):
important is thinking about, youknow, a lot of the, the deaths
that happen around, aroundbirthing happen in the
postpartum period. And a lot ofit is because in this country,
we have we don't have amechanism or system in place to
really care for people in thatpostpartum period. Most people
(21:33):
will either just have one or twovisits with their OB GYN, and
that's it.
And we know, like, the theCommonwealth Fund, you know,
this is such wonderful, healthpolicy work. You know, they talk
a lot about and and and they'veshown this in their data when
you compare The US to other highincome countries that, one,
because we don't have midwiferycentered model of care in this
(21:55):
country, that that leads to morecomplications, and it doesn't
treat the the pregnant person asa as a full, like, sort of along
the spectrum as a as a wholeperson. The other issue is that
we also need there to be systemsin place so that people are
followed after they give birth,followed very closely because,
you know, people go home, theydevelop high blood pressure.
(22:17):
There's no one taking their, youknow, taking their their,
readings, and then they developpreeclampsia or they're or
they're hemorrhaging out. No oneis going there to take care of
them.
And I think so I think paidfamily leave, paid sick leave,
all of these really, I wouldsay, policies that a lot of
other high income countries havethat we know improves,
(22:39):
postpartum outcomes could make areal difference.
Rob Lott (22:42):
So it's such a huge challenge, and I know this is
one of your your focus areas.And I'm wondering if you could
say a little bit just about howyou keep from being overwhelmed
when you've faced something sobig as this. Or maybe a more
realistic way to ask would bewhen you do feel overwhelmed,
(23:03):
how do you cope?
Uché Blackstock (23:05):
Yeah, I think recognizing that like this work
is all about like sustainabilityand being able to do it in the
long term and thinking about thelong game. I also try to look
for for hope and even in darktimes. But I think also what I
would recommend, I recommend formyself and other people, is
(23:27):
really to look hyper local andlocally at potential solutions.
Right? So when everything seemsso overwhelming, like I talk
about in the book, there's abirthing center in Minneapolis
called the Roots Birthing Centerthat was started by a black
midwife.
The mission was to providedignified and respectful care to
to to to black birthing people.And they've actually shown by
(23:48):
this model that they haveimproving maternal complications
and and and preterm delivery.So, like, there are a lot of
really wonderful community basedorganizations very, very close
to us doing a lot of thiswonderful work. So we have to
think about how we can amplifytheir work. How can we help fund
their work?
How can we, engage with them? Sothat gives that's kind of what
(24:09):
gives me hope during thesechallenging times.
Rob Lott (24:11):
That's that's a that's a nice way to to think about it.
I I appreciate that. Before wewrap up, one question we often
ask on this podcast is to askfolks to imagine if they could
snap their fingers or make amember of Congress or governor
or city councilor sort of takeyour advice no matter what you
(24:34):
say or sort of however youimagine it, if you could change
one public policy in order tomake American health care more
just and equitable, where wouldyou start?
Uché Blackstock (24:47):
Single payer universal health care.
Rob Lott (24:49):
Okay.
Uché Blackstock (24:50):
I'm I'm I'm a big supporter. I know that we we
have the data that shows thatthis country, we spend so much
on administrative costs. We'reincredibly inefficient, and we
have the worst health outcomes.And I don't well, I don't think
single pane of universal healthcare will solve everything. I
think it would make asignificant dent in how, how
(25:14):
people fare in life.
Rob Lott (25:16):
And how do you sort of put that aspiration in the
context of, you know, the nextfew weeks, the next few months,
the next year of potentialpolicy changes, if we can sort
of acknowledge that we'reunlikely to see that, you know,
in the in the near term, whatsort of more immediate changes
(25:37):
do you think might move us fromhere to there?
Uché Blackstock (25:41):
Yeah. I mean, I I also think well, one looking
again, like looking local, Imean, there are looking local,
state, I think there are a lotof really wonderful examples of
localities and states sort ofdoing doing this work around
making sure that, likeMassachusetts, making sure that
people have health insurance,you know, obviously supporting
Medicaid expansions, even thoughwe know that that's, you know,
(26:05):
up for being cut as well. But Ithink advocacy piece is really,
really important. So I am alwayscontacting my legislators. You
know, there are lot of reallygreat apps.
One is one is called five calls,where you can just, like, put in
your your name, your ZIP code,and they'll they'll send a
(26:26):
letter or a voicemail to to yourlegislators about these issues
that mean a lot to you.
Rob Lott (26:31):
Wonderful. Well, a great advice and a good spot to
wrap up. Doctor. UcheBlackstock, thank you so much
for taking the time to speakwith us today.
Uché Blackstock (26:43):
Thank you for having me. I forgot to mention
I'm a huge fan of healthaffairs. Even though I'm no
longer in academia, I love andlook forward to the issues and
and reading all the reallywonderful articles that you
published. So thank you for yourwork.
Rob Lott (26:58):
Well, wonderful. Thank you. And of course, we're always
eager to receive submissions andwould love to perhaps see some
pieces from you along the way,perhaps building on your book.
Here's my segue, A BlackPhysician Reckons with Racism in
Medicine, New York Timesbestseller generational memoir
(27:18):
available at bookstores now. Andto our listeners, thank you all
for tuning in.
If you enjoyed this episode,recommend it to a friend,
subscribe and tune in next week.Again, Doctor. Blackstock,
thanks for your time.
Uché Blackstock (27:34):
Thank you so much.
Rob Lott (27:37):
Thanks for listening. If you enjoyed today's episode,
I hope you'll tell a friendabout a healthy policy.
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