Yearning to Breathe Free

Alumni, Community, Arches

When it comes to health and health care, people of color are at a decided disadvantage. We asked some Logger experts what can be done.

Preparing for a new baby during COVID-19 was not what Jamilia Sherls-Jones ’05 had hoped for. She wanted to touch the soft cotton of newborn onesies, turn over car seats to choose just the right one, judge—in person—which stroller, crib, and changing table were best. Instead, she was forced to do most of her baby shopping online. Many of her prenatal appointments went online, too.

But the inconveniences of COVID-19 were not the only pregnancy challenges confronting Sherls-Jones. During the weeks before the baby’s arrival, as Sherls-Jones and her husband organized the house and her mother prepared the baby’s room, decorating it in pinks, greys, and lavenders, with a rabbit theme, a disturbing fact hung in her mind: Black women in the U.S. suffer pregnancy- and childbirth-related deaths at alarming rates—three to four times more often than white women. Even being more highly educated isn’t enough to protect Black mothers in this country: A college-educated Black woman is at 60% higher risk of maternal death than a white woman with just a high school diploma. Sherls-Jones knew that being informed wasn’t enough to protect her—the knowledge, she says, “doesn’t necessarily make me immune from being a statistic.”

Jamilia Sherls-Jones ’05

Sherls-Jones has a professional interest in the subject, as well: A doctorally prepared nurse and a public health professional, she is the director of health equity at MultiCare, one of Washington’s largest medical systems, with 10 hospitals and numerous clinics across the state. Sherls-Jones (who also is a Puget Sound trustee) heads a department with an enormous task: promote fairness in health by identifying and dismantling health disparities—the differences in health and health care that relate to the color of a person’s skin, where they come from, their education level and sexual orientation, and the size of their bank account.

In the U.S., the disparities are stark. Black men, for example, are twice as likely as white men to die prematurely from stroke. Heart disease kills more Black people than white in this country, as do prostate and cervical cancers. Babies born to Indigenous women in the U.S. are 60% more likely to die than those of white or Hispanic mothers. Hispanic children have the highest rates of obesity in this country. And Black children have a 500% higher death rate from asthma compared to white children.

While there’s increasing public awareness of these racial gaps in health and health care, no health challenge has so fiercely exposed health disparities in this country as COVID-19, which has disproportionately infected, hospitalized, and killed people of color. Across the country, from city neighborhoods to rural towns to Indigenous communities, people of color are bearing the brunt of the virus, with the Centers for Disease Control and Prevention reporting that some are nearly four times more likely to be hospitalized with COVID-19 and more than twice as likely to die from it than white people.

Illustration of the Statue of Liberty's foot poised above a young woman standing next to the statue

From the get-go, people have been trying to figure out why COVID-19 seems to be zeroing in on communities of color. “The dominant narrative,” says Benjamin Lewin, Puget Sound professor of sociology and anthropology, “is to talk about comorbidities”—health problems that COVID-19 patients were experiencing before they contracted the virus, such as heart disease, high blood pressure, or diabetes. The conventional wisdom is that people of color tend to have more of those underlying health problems, and that’s why they’re more likely to contract the coronavirus. “But,” Lewin explains, “that’s only part of the picture.”

Lewin’s research focuses on the intersection of sociology and medicine, and he and Sherls-Jones agree that the comorbidity explanation overlooks all of the social factors that shape a person’s health, such as a person’s income and education level, the conditions in which they work, the quality and stability of their housing, the kind of neighborhood they live in, their food security, and the amount of stress in their lives. According to the World Health Organization, these social factors are responsible for between 30% and 55% of a person’s health. These conditions play an enormous role in determining which people experience health conditions that put them at greater risk for contracting COVID-19—and for becoming more seriously ill if they do.

Professor of Sociology and Anthropology

Benjamin Lewin

"To address health inequalities, we have to address social inequalities."

Housing is one social factor that has shaped some of the glaring COVID-19 disparities. If a family of six can only afford a two-bedroom apartment, social distancing is impossible and the virus is more likely to spread. In addition to overcrowding, even low-quality housing is often too expensive for residents, requiring them to skimp on other expenses, such as health care or food. And poor housing often lacks adequate kitchen or plumbing facilities, amenities needed to ward off infectious diseases. In one nationwide study, researchers at Brown University found that as the amount of poor-quality housing increased by 5%, the incidence of COVID-19 leapt 50%.

Sherls-Jones argues that there’s another variable that “should be called out and explicitly stated as a factor that can greatly influence one’s health”: racism. Years of redlining—the practice of denying mortgages to Black home buyers, which was once sanctioned by the federal government—have left Black communities with unequal access to credit, the building block for financial stability and advancement. She also points to racial inequalities in education, such as disparities in suspension rates, absenteeism, and access to high-level math and science classes; these inequities sometimes begin as early as preschool and can lead to lasting differences in schooling, a factor tied to health later in life.

What’s more, science has found that racism can take a toll on a person’s health. Melvin Rouse, an assistant professor of psychology at Puget Sound, says racism can be viewed as a form of repeated trauma that can make a person more susceptible to disease, such as high blood pressure or cardiovascular disease. A 2019 article in the journal Neuroendocrinology pinpointed the impacts of racism down to the molecular level, showing that it changes how the body responds to additional stress.

Looking Out for All of Us

Ned Culhane ’06 has spent his entire career with the National Institutes of Health, but never before has he worked on a research project that carries such far-reaching potential as the ambitious undertaking known as All of Us.

Launched in 2018, All of Us aims to gather health data from at least 1 million Americans, including populations historically underrepresented in biomedical research. People of every race, ethnicity, sex, gender, and sexual orientation are welcome, says Culhane, and the comprehensive data set will support thousands of research studies designed to improve human health.

Employing a trove of medical data contributed by participants—surveys, electronic health records, and blood and urine samples, to name just a few—All of Us already has spurred more than 500 research projects. In a recent budget update to Congress, NIH pointed out that the data will help answer a litany of questions across the medical spectrum: Can genetic and other factors better predict type 2 diabetes? Which factors are associated with maternal mortality among African American women? What influences opioid misuse in the face of chronic pain? And so on.

At Puget Sound, Culhane double majored in psychology and politics and government. He parlayed an NIH internship into a full-time job as a program analyst with the National Center for Complementary and Alternative Medicine, and later spent five years as an NIH senior legislative analyst. Today, as director of strategic relationships for All of Us, he oversees interactions with Congress and government agencies, and he vets prospective partnerships. He marvels at the notion that enterprising students might someday engage with the project’s data in their own research endeavors. “We really want to enable our data to empower scientific discovery,” he says.

—Christopher Hann

“There are additive effects of life experience that lead to subclinical disease,” says Rouse. “And, eventually, that cascades into full-blown clinical conditions.”

Rouse’s research has focused on the ways that hormones change gene expression, a field known as epigenetics. Research on Holocaust survivors, reported in Scientific American, has shown that effects of trauma can even be inherited by subsequent generations. It can alter stress hormones and predispose the children of trauma survivors to anxiety disorders. Similarly, the trauma of racism, Rouse explains, also can be passed down to the next generation, showing up in the way genes are turned on. This change in gene activity can lead to a host of bad health outcomes, including making a person more susceptible to chronic pain.

Bias in medical care is another factor that shapes health. Rouse believes that he lived this firsthand: His father died prematurely at age 60 after multiple strokes left him debilitated. The family tried again and again to get him medical interventions, but felt ignored by doctors. They concluded that racial bias was at play. Despite being a middle-class, educated Black family, Rouse says, “we still weren’t believed, still weren’t given proper care and attention.”

In December 2020, a video posted on social media by Susan Moore, a Black woman suffering from COVID-19, went viral when she claimed that she was receiving poor care at an Indiana hospital because of her race. Moore—herself a physician—described feeling extreme pain but said that her white doctor refused to give her appropriate pain medications. “He made me feel like I was a drug addict,” she said in the video. “I maintain if I was white, I wouldn’t have to go through that.” She was eventually discharged, and not long after that, she died of complications from COVID-19.

“I wasn’t surprised,” Sherls-Jones says of watching the video. “It doesn’t matter what social status you have—in the end, you’re a person of color, you’re Black, and that’s what people see.”

• • •

There are many other ways that racial minorities have been left out of quality health care. For years, people of color and women have been underrepresented in biomedical research, resulting in incomplete data on these populations. Even artificial intelligence used in medical care can be biased. Recent research published in Scientific American uncovered racial bias in a widely used AI system to determine which patients warranted the highest level of attention, resulting in Black patients being put at lower priority for more rigorous care.

History also shapes health. The Tuskegee study is a powerful and often-cited example: The U.S. Public Health Service recruited hundreds of Black men in Alabama in the 1930s for a study investigating the progression of syphilis. The participants were kept in the dark about the true nature of the study, and treatment was withheld from the men as dozens of them died needlessly from the disease. Even though public outrage halted the project in 1972, the study left a legacy of distrust of the medical establishment in the Black community. And the experience of Henrietta Lacks, a young Black woman whose cervical cancer cells were sampled in 1951 and subsequently cultured and commercialized without her or her family’s consent, has underscored suspicion among many Black people toward health care institutions. Such instances have made people of color skeptical of government warnings, Sherls-Jones explains, and in some cases, less likely to seek out health care and routine screenings or to follow their doctors’ advice.

Experts in the field recognize that reversing health disparities is no small task. One promising strategy is to diversify the population of medical professionals, says Kirsten Wilbur ’85, M.S.O.T.’08, a professor in the Puget Sound School of Occupational Therapy and lead author of a recent paper about diversity in the health care workforce. “When Black and brown patients see themselves reflected in their health care workers, they’re more likely to seek out those services,” Wilbur says. In a study among Black men in Oakland, Calif., patients were more likely to participate in voluntary health screenings when treated by Black doctors.

Melvin Rouse, assistant professor of psychology

Opting in to these screenings, the study estimated, could reduce mortality from cardiovascular disease by an astounding 19%. “Without a diverse workforce, we’ll just be reinforcing and continuing with the barriers that have been erected,” Wilbur says.

Diversifying the medical workforce will take a multipronged approach, Wilbur believes. One strategy is to expose middle and high school students of diverse races and backgrounds to the wide variety of professional opportunities in the health sector. She points to the Healthcare Careers Academy, a program of the Tacoma public school system, as a step in the right direction. The program helps prepare students for work in the health care industry through partnerships with MultiCare, Puget Sound, the University of Washington, and other entities.

But just getting more students of color into health care education programs will not suffice, says Erik Wallace ’96, associate dean of the University of Colorado Medical School’s campus in Colorado Springs. When it comes to addressing health disparities in medical schools, he says, “we haven’t been doing a good enough job.” One approach that the Colorado Springs campus has tried is to put students in the shoes of members of underserved communities as part of their training. Wallace’s medical students spend two days in a simulation of what it feels like to live in poverty, which (pre-pandemic, anyway) involved sleeping on the floor at a homeless shelter and then spending the following day on neighborhood streets, seeking out city services. The goal is to help aspiring physicians empathize with their patients, develop trust with them, and deliver more equitable care.

Ensuring equitable care is at the center of Sherls-Jones’ work at MultiCare. Since taking the helm of the health equity efforts there five years ago, she and her team have instituted multicultural competency training for all staff members, which helps health care providers identify and address their own biases and deliver compassionate care to all patients. Sherls-Jones also has been engaged in a major effort to gather data on treatment outcomes from across the hospital system, producing a dashboard of information that can be sorted by patient race, ethnicity, language, gender identity, and sexual orientation. Throughout her work, Sherls-Jones seeks input from a community health equity advisory board which represents the diverse populations MultiCare serves.

She has already zeroed in on one significant health disparity: the higher rates of late diagnosis and death from breast cancer among Black women in Pierce County. She has helped launch a pilot program that involves a team of Black community health providers who offer informal workshops on breast health for Black women. The impacts from the program are rippling out across the community, as workshop participants talk to friends and family members about what they’ve learned.

Erik Wallace ’96

For many people looking at health disparities, the real challenge lies in tackling societal causes of poor health. “To address health inequalities,” Lewin says, “we have to address social inequalities.” There may now be national momentum for this. The first-ever federal health equity task force plans to look at health inequalities caused or worsened by the pandemic. The chair of the task force, Marcella Nunez-Smith, has underscored the need to put equity at the center of the federal pandemic response, “not as a box to check but as a shared value, woven into all of the work that we do,” she said during an online event in December 2020. Sherls-Jones is excited that this is a meaningful step in the right direction, ensuring that policies and legislation are examined “through the lens of equity,” she says.

But getting at the root causes of health inequities is a daunting challenge. “It’s much harder to change institutions than to tell someone to start eating better or to go exercise,” Lewin says. And Rouse, despite the recent national push to address health inequities, says he isn’t overly optimistic. Being realistic about the prospect of meaningful social change, he explains, “is Black tradition.”

The rollout of COVID-19 vaccinations has presented the Biden administration with a test case for its commitment to equity. When you have limited resources, explains Wallace, you’re going to exacerbate health disparities. As of mid-March, among vaccine recipients who reported their race and ethnicity, the CDC confirmed that white people were 10 times as likely to be vaccinated as Black people, and more than 40 times as likely as American Indians or Alaska Natives. The lesson, Sherls-Jones says, is that “trust is a really big issue.” It’s critical, she explains, that vaccine providers partner with trusted community entities and take an individualized approach to vaccine distribution in different locales.

Kirsten Wilbur ’85, M.S.O.T.'08

Sherls-Jones’ daughter was born just after Thanksgiving, a healthy baby girl at six pounds, 13 ounces. It took Sherls-Jones weeks to heal from an unplanned cesarean section she underwent after her baby’s heart rate dropped multiple times during labor. But Sherls-Jones felt the medical care she received was compassionate and that her providers truly listened to her. Now, as a new parent, she’s thinking about health disparities for pediatric patients. She knows that research has shown that Black children do better when they are treated by Black doctors. But there are no Black pediatricians in her area that she’s aware of.

Going through pregnancy and childbirth made Sherls-Jones understand the abysmal health statistics for women of color in the U.S. in a personal way. “I’ve been there,” she says. And motherhood has given her a newfound commitment to working on maternal mortality in her role at MultiCare. “I’m really devoted to this issue,” she adds. When it comes to ensuring equity in health in this country, the challenges are enormous. Sherls-Jones is hopeful that her personal commitment—and that of like-minded colleagues—ultimately can make an enormous difference.

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