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Health Equity Challenges and Opportunities: A Conversation Between the AHA and AMA
Advancing health equity is a key priority for the American Hospital Association (AHA) and the American Medical Association (AMA), with both developing key initiatives and programs dedicated to these efforts. In this conversation, Joy Lewis, senior vice president of health equity strategies at the AHA, speaks with Aletha Maybank, M.D., senior vice president and chief health equity officer at the AMA, about the challenges in the health equity space, and the opportunities that can make a difference in health care across America.
Transcript
Tom Haederle
Advancing health equity is a key priority for the American Hospital Association and the American Medical Association. Both organizations have many initiatives and programs underway to support these efforts. But this work is challenging on many fronts.
::Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. This podcast features a conversation between the AHA's Joy Lewis, senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity, and Dr. Aletha Maybank, senior vice president and chief health equity officer for the American Medical Association.
::Tom Haederle
Hear them discuss some of the top challenges and opportunities for advancing this pivotal work. And now, let's turn it over to Joy.
::Joy Lewis
Is it fine to call you Aletha?
::Aletha Maybank, M.D.
That is fine. Okay. Absolutely.
::Joy Lewis
It's such a pleasure to have you here with me today. I've literally been waiting for this conversation for quite some time. And then you penned this...this piece we're going to talk about that was published in the New England Journal of Medicine in March, I think it was. And that accelerated our conversation today. But thank you for joining me.
::Joy Lewis
And just for our audience, a little bit about your career that has spanned quite a few inaugural leadership roles, including the role you currently occupy as the chief health equity officer at the American Medical Association. You were also the founding deputy commissioner for the Center for Health Equity at New York City Department of Health and Mental Hygiene. And the founding director at the Office of Minority Health in the Suffolk County Department of Health Services.
::Joy Lewis
You've taught medical and public health students on constructs related to health inequities, topics such as public health leadership and management, physician advocacy. I know that's a real area of emphasis for you. And community organizing and health. Maybe we can start by looking at, you know, given your background and experience in DEI and health equity, you, like many of us, are, really in a tough position right now.
::Joy Lewis
Our nation is seeing significant backlash efforts toward DEI efforts, across the board, frankly. And as I mentioned you took pen to paper and, you wrote a piece entitled, “The Plight of DEI Leaders: Heavy Expectations and Limited Protection.” And in that piece, you shared quite a bit about your personal experiences, about the attacks, the criticisms you're facing as a leader in this space.
::Joy Lewis
So let's start with something a bit closer in and a little more personal about how are you feeling and how are you coping with the demands of your role and the broader political environment within which we find ourselves, and maybe touch a little bit on why now? Why did you choose to write this piece at this particular time?
::Aletha Maybank, M.D.
Sure. Thanks, Joy, for having me on. Great to be in conversation and share space with you all the time, because I think that's an important part of how we cope. Truthfully, to be in community with one another, sometimes. And it helps support our own kind of experience to have shared validity of what we are going through.
::Aletha Maybank, M.D.
You know, in this environment, though, there's so much, you know, and there's so much, so many constant reminders of how people don't fully value other people. And for all these reasons that, you know, I just sometimes, you know, I could say, of course, I understand some historical nature and context and stories that people have been told.
::Aletha Maybank, M.D.
But, you know, when you're not rooted in that way. And I wasn't raised in that way, and it's still just so hard to want to even understand, you know, especially when people are harmed. And I, you know, the context of people being harmed should be appalling for all of us. But it's not. That just becomes exhausting. And you may have heard me say before, I feel now, especially at this point in my career, I didn't feel it as much earlier.
::Aletha Maybank, M.D.
But I’m paid to convince people to care about the humanity of others. Is really my overarching role because that's at the core of it. If we all actually valued each other and even in not understanding each other, knowing we don't know what we don't know. So a lot of my work is really in creating those kind of environments of which that happens, like I believe in the context of proximity. And that in order to actually get to that space of, of seeing and understanding being proximate to someone you know, Bryan Stevenson talks about that.
::Aletha Maybank, M.D.
Many people have talked about that. I think about, again, how I was raised by my mother. She, you know, grew up poor in another country but ended up having a, you know, a decent amount of privilege here because of the work she put it in her. She's a smart, brilliant person,so was able to create a lot for me.
::Aletha Maybank, M.D.
I did not grow up in the way that she did, and she recognized that and said, I can't have this, I don’t know if it's a false sense, but I need to have a more global sense of the realities of others. And so she would place me in the people's homes that did not have what we have. You know, and so I learned a lot about that and as a context growing up.
::Aletha Maybank, M.D.
But that's important in the work that we do. We talk a lot about the data pieces, which are important terms of accountability and seeing change over time. But I don't feel that that's the point of which people actually change their will and want to do better and be better and lead better. And so that's where I come back to
::Aletha Maybank, M.D.
I feel like a large part of my role is convincing people to see the humanity and to care about others in ways that are different than their own self-interest. And I wrote that piece, you know, in all honesty, because I was feeling a lot of pressure, from within institution, outside of institution, not really being, not knowing if people really see the complexity of the experience.
::Aletha Maybank, M.D.
And I knew just based on what was happening already and the kind of the news stream, folks like you who I was in conversation with. And so I wanted to create this space where I was going to kind of speak to it. The first iteration of this was actually a love letter. And it was a love letter to
::Joy Lewis
To yourself.
::Aletha Maybank, M.D.
No, a love letter to DEI colleagues across the country. Okay. With a different frame that was a little bit more and it started off more so kind of I see you, I feel you, you know, and it was more directed towards, you know, the leaders themselves. Now there's a secondary piece of that to how it turned out to be when I had to condense it, because of where it ended up being published.
::Aletha Maybank, M.D.
So I, you know, I wrote it because I felt the desire, one, to be in like solidarity with many of us doing this work. I wanted you all to be seen and heard in a way that typically people are not talking about it and people aren't asking us really how it is. There are a lot of assumptions being made.
::Joy Lewis
Wow. There's so much there, so much to unpack, starting from even your land of origin, at least in terms of your mom's history and where she's from. And, you know, I actually come from a very similar experience as being born and raised in Jamaica, where being black is actually celebrated. Right? The vast majority of Jamaicans look like me, and when you're the predominant culture — and granted there's white Jamaicans, Indian Jamaicans, Chinese Jamaicans — but the motto there, the Jamaican motto is "out of many one people."
::Joy Lewis
So everyone actually sees themselves first as Jamaican. It was shocking when I at 14 years old, came to Brooklyn and granted, there's quite a Caribbean community there. But quickly I started to realize it's a different game. It's a different way in which the dominant culture relates to black Americans.
::Aletha Maybank, M.D.
When you see yourself as presidents, doctors, all the rest, there's nothing telling you can't be or can't do, right. But when you get to an American society, no matter, even if you're in a predominantly black community or neighborhood, the structures and the systems and all these institutions that we work with, the work that we are doing, continually tells us we're not present, we're not seen, we're there in limited numbers.
::Joy Lewis
Well, thanks for taking, carving out some time. It sounds like it was cathartic for you to actually write this piece. And it's been well received by those of us in this space alongside working alongside you and others. So in the article, you mentioned that DEI leaders cannot be held accountable for their institutions’ decisions, right? Specifically, you have,
::Joy Lewis
“But higherDEI leaders cannot be held personally accountable for their institutions’ decisions. We are being scapegoated for our institutions’ decisions. While we have no power to make these decisions on our institutions’ behalf.” So can you provide a little more insight? And, what were you thinking as you were reflecting on being scapegoated? What in fact should DEI leaders be responsible for?
::Joy Lewis
Because it's certainly a mixed bag out there. And if you can share with our listeners a little bit more about your vision for our role to work behind the scenes where we're really trying to change people's hearts and minds, which is a tall order.
::Aletha Maybank, M.D.
It's a very tall order. But and because all these are very personal, because it's all about value, it's all about how we value people. Correct. So what I meant at that moment, I was getting a lot of, you know, the hardest part is when you feel like you're misunderstood. And when you work in an institution like the ones we work in, there are a lot of assumptions.
::Aletha Maybank, M.D.
Unless you know me personally, you know, and you know how I show up and you know my level of courage and my level of, you know, being very direct. And I am not my institution. You know, I am Aletha Maybank who is our chief health equity officer. Do I have influence at certain points? Absolutely. But I am not over the power of my institution.
::Aletha Maybank, M.D.
My institution has a board. It has a House of Delegates. There's an executive vice president. I'm supporting and working on behalf of these members and responding to policy that's passed. I don't create policy. I don't create statements or positions. And to get held accountable for it. And that's what was happening, and is happening was really hard because whether I align with positions or not, it's not my decision.
::Aletha Maybank, M.D.
And as an individual, it's really hard to take on the burden of an institution that's been around for over 175 years plus. I would be held accountable for the work that I'm to do. My work was to facilitate a process to begin to embed equity into the entirety of the enterprise of the American Medical Association. And that has been my work really in my former roles as well.
::Aletha Maybank, M.D.
And so following that roadmap, that usually means I need to create a strategic plan of some sort and create a team that can help do that, but also work with others across the entire enterprise. It's not just about me and my team, it's about also how I manage up and how I manage across and how I work with colleagues.
::Aletha Maybank, M.D.
That's the nature of my work. How well I facilitate my, this process and help support creating and contributing to the culture, the policies and the practices within the institution and how we measure them.
::Joy Lewis
You know, for you, it's 175 years, for me, we just celebrated 125 years last year. I mean, there's legacies, legacy thinking. There are structures in place that support the fact that we've been around this long, right. And so it is certainly a challenge. And for those who think we are not being disruptive enough, right,
::Joy Lewis
it's just it's hard to hear that.
::Aletha Maybank, M.D.
It is hard. And I think in the article I made sure, I want to acknowledge the role and the critical nature of our external organizing. That is paramount. It is absolutely paramount. We have changed and movements have been structure of change because of the organizing that happens locally in our communities, nationally, on a consistent day to day basis.
::Aletha Maybank, M.D.
The shoulders that we stand on. And because these institutions were not set up for us or by us, and most people who have been historically marginalized or colonized, we have to stop some level of the bleeding because these institutions weren't set up, they were harming us. And so we need to be here on this inside. And this is a hard part of the work
::Aletha Maybank, M.D.
truthfully. I don't feel this is a healthy work to doing equity work on the, that's what I've learned at this point in my career. I'm not saying it's not necessary, but I'm also clear it's also not fully healthy.
::Joy Lewis
I think I've also heard you say just in our conversations, you know, here and there, that you, you actually look forward to a day where our roles would not need to exist.
::Aletha Maybank, M.D.
Yeah. That's with anything and these aren’t, we aren't new to these roles, right. Roles probably came around in the ‘60s as civil rights you know. And then they started to hire the first of everything, you know, first blacks of everything to be in this, these institutions maybe a little bit before that. But you know, then you start to see the evolution and you have these laws and structures are passed.
::Aletha Maybank, M.D.
Somebody had to do the work of ensuring equal opportunity and access, that is afforded to us, you know, through civil rights law. But nobody ever really fully thought about the harm that's caused by all this. I think it was a good thing at one level. But these roles haven't fully evolved to a level of understanding and structure that more has to be in place to protect the individuals and those who are doing this work within the institution.
::Joy Lewis
So leaning into that a little bit more, how can these institutions protect us and help us feel safe when the there's this noise all around?
::Aletha Maybank, M.D.
Right. A couple examples and I'll start first with kind of, you know, the frameworks that are used. And I believe we should have frameworks that we use to, or plans whatever you want to say, that are built on some previous models that have existed. And so I've in our strategic plan and I mentioned, you know, that we've used the Government Alliance for Racial Equity that's been in evolution in development for over 20 plus years
::Aletha Maybank, M.D.
as a foundation. Just so that there's a level of consistency around the communication, people, staff are able to understand and buy into it. The part that has always been missing is the trauma-informed piece to it. And so I do believe and so we added that kind of around it, I would say California Department of Health has probably done some of the best work around ensuring that when they implement models of equity and frameworks within their institution, they're also building in trauma-informed systems and supports and ensuring that there's training from across as it relates to trauma-informed support, so that that safety…
::Aletha Maybank, M.D.
And I don't want to say, I think these institutions become more safe. I don't want, there's no ultimate safe within this in a context of these institutions.
::Joy Lewis
It's a continuum, right? Yeah.
::Aletha Maybank, M.D.
And I think, yeah, you know, we can create safer environments where people feel more included and they can show up as themselves and be themselves, and be responsive. So that's just, that's one thing. I think the other critical nature is, is top level leadership. If top level leadership is not on board with any of this, I don't see a point in doing any of this work, period.
::Joy Lewis
Couldn't agree more.
::Aletha Maybank, M.D.
It doesn't work. You know, I think the ability to that leadership then to create spaces or to allow their teams to have space and to develop space that inform some level of what is happening in terms of culture at the institution is absolutely critical also. Because again, you're getting ideas again from the folks who are most proximate to the experience of what it means to be an employee.
::Aletha Maybank, M.D.
It's different. My experience is way different than other staff members. Like, I understand where I'm positioned. I am at a position of power to some level and a large level, truthfully, compared to most team members. Now, I'm not saying I have...as I've mentioned, I'm very clear about my limits, very clear.
::Joy Lewis
But there's influence that you can, you can certainly wield.
::Aletha Maybank, M.D.
Absolutely. And so we have, you know, we have to do all that. But that's important, the leadership showing up and creating that space, having that consistency, communicating around it as well, not making assumptions that people know what it is. You have to have the comms plan.
::Joy Lewis
And you have to be redundant in your communication around it.
::Aletha Maybank, M.D.
That's right. Yeah. And so those are the things — that's kind of at the organizational space now for us who are doing, you know, more specifically for us is doing this work because that's all helpful for our work. Right? That's all helpful for how we were able to lead in this work. How the employees are helps us, right?
::Aletha Maybank, M.D.
Because who could who do people come to, you know, when there are problems? I'm sure you have heard many things that aren't particularly job-related to the role of, you know, chief health equity officers to some level. But you've heard, I'm sure, many complaints because you become the safe person that folks want to come to. Right.
::Aletha Maybank, M.D.
And if the institution is not showing up, the systems aren't working for staff, they're going to come to us and that burns us out. We have to hear all these stories and we don't know what to do with them half the time.
::Joy Lewis
No, you're spot on. Yeah. So you need the environment to beripe to do this work and to be supporting the work and to be supportive of the leaders who are, who are occupying these roles.
::Aletha Maybank, M.D.
It's the context of physician burnout, right? If you think about it in that way, right. It's the same thing system, structures, culture. Does it work for patients? It's not going to work for our physicians, right. Or other health care workers and providers. They're going to burn out. But the one other thing that I'll say in terms of protections is now, in light of getting death threats, and I know several of us have been in this space, I think, you know, there has to be the responsiveness and ability for our own kind of HR security department, whatever it is, that if we need security detail, we need safety plans,
::Aletha Maybank, M.D.
that needs to be provided as well.
::Joy Lewis
That's right. So down to the very granular tactical like, yes, some folks may need protection outside of the workforce, outside of the workplace.
::Aletha Maybank, M.D.
Absolutely.
::Joy Lewis
So one of the things I think I struggle with is not having folks show up for usright? So having to be that person at the table who consistently raises the equity considerations into whatever the conversation is that we're having. And, you know, I guess some of our critics would say that's a failure of on our part to, to embed equity into whatever the organization's doing.
::Joy Lewis
You and I know that is not — again, the system is designed to produce the results it's producing. So how do you get colleagues to be more than allies? But to actually own some of this work in a way that's meaningful and impactful to, to move the needle? What guidance would you offer up? In terms of taking actions and not waiting for the perfect evidence to act?
::Aletha Maybank, M.D.
Well, there's two quick two questions in that, but the first, this is where a top-level leadership is critical. And because I've been to several different institutions with different types of leadership, I understand the critical nature of when you have a leader that really holds your own colleagues accountable. You know, I've been in situations where I didn't have to do...that wasn't my role.
::Aletha Maybank, M.D.
My role was to establish the framework and the process to embed equity, not have to actually hold the accountability of my colleagues. And, you know, some of that is done now. But the challenge, if that's not done at the leadership level, the reality is not everybody wants to do this work. That's just real, right? So we have to accept that.
::Aletha Maybank, M.D.
So if we really are committed as an institution, then it's going to require somebody other than me who's the boss of other folks to hold people accountable. The other part of it, what I found is the better my relationship is with and I'm talking about individual colleagues, the more likely they are to show up with me. Now, some people are going to do that naturally, like they're just going to do that.
::Aletha Maybank, M.D.
And I've had that. I've had that where I am, I've had that before. But I realize the more tense my relationship is with somebody, the more resistance it is, the harder it is to get them. And so I, you know, there's a part of me and it's hard because I have to care about the entirety of the institution.
::Aletha Maybank, M.D.
But there's a part of me that at this point, I'm exhausted. And so I'm going to go to naturally, the folks who are ready and willing and just going to show up and step up, because that's where I have, that's where my energy, that's what I can handle right now. It's hard to continually fight folks, and it might not feel like a literal fight, but to constantly push up against resistance that can show up in so many different ways.
::Aletha Maybank, M.D.
And that's the other part of it that folks don't realize it. Like people can resist with a smile on their face and the decisions and what you get blocked out of. And you know it's very isolating, as I know many of us have experienced. And you just get to a point where you almost sometimes question like, why are we doing this work?
::Aletha Maybank, M.D.
You know, I understand the why, but there's an element of like, why? Like there's just it feels just so harmful and so frustrating, you know? But you have to then remember that there were harder fight, people were fighting harder fights than we are. And so that's kind of the obligation to it and also the hope of it, right?
::Aletha Maybank, M.D.
. Because we know that their work and efforts did help, did help things get better from the inside and outside. And so we are here, just as you said, continuing that legacy with the same hope that what we put forward is going to help people overall, everybody, not just even a singular group of people, but it's going to help everybody because it's going to help our society, it's going to help culture, and it's going to help the human condition and way of being.
::Aletha Maybank, M.D.
And so, you know, that's I don't know what helps you kind of move forward. But that's what I know...
::Joy Lewis
That North Star around,you know, making lives better, creating better conditions for people to show up in their own lives and be able to have access to those opportunities that are going to yield the outcomes that they want personally for, for themselves, for their families, for their communities.
::Aletha Maybank, M.D.
We have to believe it.
::Joy Lewis
We have to believe that.
::Aletha Maybank, M.D.
I only believe it because it's happened in the past, that's for me. You know, I only believe that that is possible because I have read, seen, witnessed it happen in the past across legacies and generations. Other than that, I don't know why I would believe it.
::Joy Lewis
Yeah. One of the things I'm compelled by is this notion of doing the work of equity coalition style. That's something I can get excited about. No, no one entity has all the answers. None of us in and of ourselves are going to be able to move the needle in a way that is, as significant as we say we want as a society.
::Joy Lewis
So you have been behind the rise to health coalition: AMA, IHI, other partners, including the AHA. Can you say a little bit more about the power of coalitions to actually sustain the work that is happening today for future generations? How do you lean into coalitions to make that happen?
::Aletha Maybank, M.D.
Yeah. So and I thank you for the question, because I'm also like really digging into making sure that when people when we say coalition, coalition could just mean a group of people coming together. But it's not just that. That's not how change happens. There's a context. I used to teach community organizing and health to public health students through Meredith McClure's book. And you mentioned it just a second ago.
::Aletha Maybank, M.D.
Anything that has produced change and any group of people have used tactics and strategies as it relates to community organizing, no matter who it is, right? And I think that's poorly realized and understood by those who are not community organizers. Organized medicine gets it because that's what organized medicine is. It's organizing, right? Yeah. And what is organizing about?
::Aletha Maybank, M.D.
It's building power with people so that people pay attention to the power. People pay attention to power, financial power, political power, collective power, people power. That's part of the point of being organized is to build power. And so to me, that's the nature of what a coalition at this day and age needs to be about, not just a group of organizations that come together in their individual contexts, have different ideas, but how do we build power to create and produce change?
::Aletha Maybank, M.D.
How do you build power so that people pay attention to you and you become a relevant entity, so that what you say and your influence is critical? That's the nature of AMA and AHA, right? You know, there's so much power, whether it's financial power, political power or financial power, I would say, and so we have a lot of influence.
::Aletha Maybank, M.D.
So people listen to us whether I would or not. I'm just saying they respond to that. Certain structures respond to that. Not everybody listens to us.
::Joy Lewis
But we're seen as relevant.
::Aletha Maybank, M.D.
To a certain segment of people. For those other people who hold power in political spaces. We're not seen as relevant to everyone.
::Joy Lewis
Exactly.
::Aletha Maybank, M.D.
If we are not meeting their needs. So I say that the coalition, to me, the vision is like, again, the opportunity to build power, the opportunity to be in community and the opportunity and you have to communicate within the context of that community, want to learn from one another and what we can do at our individual institutions. But then ultimately, collectively, what can we do to push, to advocate and to create changes that are structural?
::Aletha Maybank, M.D.
You know, and so that is absolutely needed. And then there's this other word of solidarity that's also been a little bit challenged in my vocabulary, and me trying to understand what it means to, to be that and what it means. And there are a lot of different, you know, there's different contexts to that. I recognize our theories around it.
::Aletha Maybank, M.D.
But the ability to be in solidarity for me means we have a similar vision and outcome. But we may not have the same like theory of change in tactics all the time, but there is a time where we need to come together for certain aspects of it, to push something forward, which means sometimes we may have to let something go.
::Joy Lewis
So I'm going to give you the last word. I mean, there have been several nuggets here along the way. And so I wonder, is there any last, you know, reflection from the piece you wrote from just thinking about the larger societal pressures, the political environment, you know, the space with in which we find ourselves today.
::Joy Lewis
Any words of encouragement for your colleagues who are doing this very difficult work?
::Aletha Maybank, M.D.
Well, if it's for my colleagues, my DEI colleagues, 'cause the audience matters, right? I understand when decisions have to be made, because I also think there's a certain point in time if you are not healthy, we have to do what's best for ourselves at the same time. And I say that because I think we need that as, not that people are going to just jump all of a sudden, but to just have that relief and give yourself permission that what you're experiencing is real and you shouldn't have to necessarily suffer through it at this given time, you know. And it's up to you at
::Aletha Maybank, M.D.
whatever point in time you want to be committed to it still. And that's fine if you want to stay. You know, nobody should knock anybody for their choices around how we do — or maybe not how we do but if we choose to do this work or not. And then I would say just for the larger context, there's no question that we all need to figure out how we're showing up at this moment in time.
::Joy Lewis
Well, I can't thank you enough for your time spent today. It has been, hopefully reflective for you and instructive for our listeners.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.
