Community Support, Partnerships, and Inclusive Environments for Black Students and Professionals in Science, Engineering, and Medicine: Proceedings of a Workshop (2024)

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Community Investments

Hannah Valantine, M.D., M.R.C.P., F.A.C.C. (Stanford University) expanded the discussion about the creation of strong partnerships that benefit the community. She noted that to the extent these partnerships can be created, knowledge can be better translated to benefit the community. The participants were Katina R. Beard, M.S.P.H. (Matthew Walker Comprehensive Health Center, Inc.); Amon Millner, Ph.D. (Olin College); Edie Stringfellow (Center for Global Health Innovation); and Donna Thompson, R.N., M.S. (Access Community Health Network). They highlighted the work of their organizations and then engaged in conversation to discuss examples of community voices and organizations that address potential isolation or belonging, and the role of partner organizations such as government, industry, and others.

OVERVIEW OF ORGANIZATIONS REPRESENTED

Matthew Walker Comprehensive Health Center

Ms. Beard explained that the Matthew Walker Comprehensive Health Center in Nashville, Tennessee, is a federally qualified center that was started by Dr. Matthew Walker, Sr., former surgery department chair at Meharry Medical College, civil rights leader, and a pioneer in community care. About 18,000 patients a year across Middle Tennessee receive clinical services, dental care, behavioral health, pharmacy services, and other types of care. To get to the core of the topic, Ms. Beard pointed to the center’s commitment to engage in the health of the entire community beyond individual patients. The center hosts support networks and professional education in various disciplines to diversify the workforce in race, ethnicity, and location. The center is also focused on people’s movement out of poverty, such as through employment training and identification of community leaders.

Olin College of Engineering

Olin College was established to be experimental by design, explained Dr. Millner about the engineering school and its 350 students. The focus is on finding ways to make the most significant education possible that can contribute to “Engineering for Everyone.” As he finds in his lab, the Extending Access to STEM [science, technology, engineering, and mathematics] Empowerment (EASE) Lab, students have the most learning opportunities when they can engage with people across several generations of engineers. To connect alumni and working professionals, college students, and high school and younger students, Dr. Millner suggested a focus on “nested investments,” rather than a “pipeline.” One such nested-investment program is when undergraduate engineering students work with high school students to reinforce what they have learned in class, such as design reviews, and form relationships with the younger students. This exercise also allows the college students to go out in the community and see potential solutions to authentic problems. The high school students in turn, engage middle school students.

Center for Global Health Innovation

Ms. Stringfellow shared how the Center for Global Health Innovation incorporates community health workers into solving complex medical problems, which includes compensating and appreciating them as trusted medical advisors in the community. The center works with diverse patients and providers to move treatments and devices from bench to bedside faster. The goal is to close opportunity and distribution gaps and to solve systemic exclusion. In addition to considering systemic exclusion based on race, she stressed, “We cannot ignore the discussion of our brothers and sisters who have neurodiverse abilities and physical challenges when we talk about some of those exclusionary practices in medical research and the biomedical workforce.”

The Center for Global Health Innovation received a Health Resources and Services Administration (HRSA) grant to employ 123 community health workers from seven states. An important component was to “roll up data” from them to communicate to HRSA headquarters. “It wasn’t communications going one-way,” she pointed out. “We were learning what was important to those communities to address what they see as medical needs.” The effort also involved getting more students into the biomedical

innovation economy pipeline. She noted that industry needs to be made aware that Black and Brown innovators with good ideas often do not have the safety net to be able to take risks. Pathways to this economy are needed for those who do not have access points. She added that a landmark building in Atlanta, Georgia, is being repurposed for innovative community health access.

Access Community Health Network

As Ms. Thompson described, the Access Community Health Network and other community health centers excelled during COVID-19 in reaching people. Located in Chicago, Illinois, Access Community Health encompasses 35 sites and serves 180,000 unduplicated patients. She said in her learnings over the years, partnerships can only work if there is alignment of a common mission and mutual understanding. Without those qualities, the relationship is only transactional and will not last. The hardest thing, she observed, is when everyone comes to the table with their own perspectives. It is essential to align with common priorities. When planning a new facility in an area in a western suburb, her staff attended focus groups expecting to hear about concerns about chronic diseases. Instead, seniors and parents expressed their biggest fears about safety from wild dogs roaming the area. “It’s always important to learn what is top of mind,” she said. “The ability to hit other issues is limited if you are not addressing the top concern.”

She also stressed the value of the data created at a community health center and the value in leveraging the data to coordinate and improve services related to health, food security, and related issues. Patients also need to own their information. When patients access their electronic health records, they are also given the opportunity to go online to register to vote. “We are reminding our patients that they have a voice, and the voice should be heard.” Echoing other presenters, she noted that community health workers must get the wages to sustain themselves and build on their role as a stepping stone in their careers. Many times, this is their first paying job. Investments in training, such as in technology, can provide them with transferable skills in health care or other professions.

DISCUSSION

Dr. Valantine commented on the concept of community health centers as a movement. She noted the value of the centers to increase diversity in

clinical trials and in making community voices heard. She then raised a series of topics with the presenters.

Role of Partnerships and Trust

Dr. Valantine reflected on the need to build trust to grow the next generation of workers in the biomedical ecosystem. Ms. Beard stressed that she likes to “connect dots.” Having worked in the field for 25 years, she has seen the need for a potential partner, especially a larger organization, to understand the community first and then offer support, rather than coming into a situation with a savior complex. As CEO, she recognizes that the Matthew Walker Center must only get involved when there is a win for the community. It has a strong reputation and is seen as a gatekeeper and convenor. “I have been around long enough that we have to question [a potential partner]: Why are you coming, why are you here? We have to hold people accountable to the work they say they want to do.” Dr. Millner concurred with Ms. Beard, particularly related to accountability and trust. He noted that engineers often have a sense that they can solve other people’s problems with their skillsets. “We have to reframe this. All have funds of knowledge that are powerful and useful.” He added that relationships that get off on the wrong foot can lead people going in opposite directions. He also stressed the need for people to trust themselves and bring their “whole self” to a situation, rather than assimilate to meet certain expectations, for example, related to dress or hair.

Related to trust, Ms. Thompson commented, “What I have learned over the years is sometimes you have to eat crow.” She recounted receiving a REACH (Racial and Ethnic Approaches to Community Health) grant many years before the Affordable Care Act (P.L. 111-148) to engage women in early detection of breast cancer. Communities of faith were involved, but several advocates challenged her about why push for mammograms when women are uninsured and thus unable to access screening and treatment should cancer be detected. “I remember the thought of how can we move a program if we are giving people a pathway to education but not the resources they need.” She added that she went “hat in hand to hospitals” to find screening and treatment services for uninsured women. Trust is critical across the entire ecosystem, Dr. Valantine commented.

Resources

Dr. Valantine remarked on the need to leverage resources, so that programs have greater scale and access. Ms. Beard noted that her center also received a REACH grant, which began their program of participatory research. Starting with a small-scale project to educate people about how to self-advocate for their care, they tested different materials. To advance community health research, the center has set up a studio where researchers can discuss their projects with the community, and the community can weigh in. This model also brings in revenue for the organization in working with academic partners and is being scaled up to increase access for patients. Ms. Stringfellow commented that the Center for Global Innovation focuses on “glocal activation,” by which she means to “leverage everything around you.” With Atlanta as a diverse base, the center has set up programs there that may be adaptable elsewhere, such as enhanced mobile units. Pharmaceutical companies see that Historically Black Colleges and Universities and Minority-Serving Institutions can serve as treatment centers for their surrounding populations to offer access, opportunities, and distribution to improve health outcomes. It is also important to empower people with their own health data and improve health literacy at every opportunity, she added. In her travels locally and globally, she works to empower the next generation to see themselves involved in a range of STEM-related fields. She noted that people can start at any age to take advantage of upskilling their skillsets through apprenticeships and technical schools. However, she stressed:

Diversity, equity, and inclusion (DEI) benefits everyone through opportunities for more meaningful research, wider recruitment, and better science, Dr. Valantine observed. She also called out the “diversity tax” in which minorities are expected to do the work without remuneration. Ms.

Stringfellow described some of her group’s efforts to set up a biobank, a seed fund for entrepreneurs, and other mechanisms for increased diversity. She noted that if they could do it as a small organization, “it’s time for biotech and pharma to live up to their goals and pledges that they set after the murder of George Floyd.” Dr. Millner shared a framing he uses when communicating with companies. He reminded the group that when young people are learning about their cultures in elementary school, they learn to look at what is reflected around them, as with a mirror. He suggested that biotech companies embrace the mnemonic MIRROR—Movement to Invest in Reciprocity and Re-imagine Outreach Relationships. The term “outreach” implies that a person is on the outside and the company has no interest in them being on the inside. Investment should be reciprocal with people invited in.

Dr. Valantine commented on the shift in how DEI is framed from when she began her career. Ms. Thompson also reflected on her early days in community health. Chicago has world-renowned research and health systems, but even with that, members of her organization were pushing to serve as more than a convenor. Ten years ago, with a National Institutes of Health investment in community health, they established their own center for innovation on the grounds of a community health center in the South Side. It is important because they can evaluate outcomes and lead the research. Academic researchers often come into the community and then disappear after they write their papers. The bottom line that community members stress is that “we don’t want to die from these diseases, we want to participate, but we do not want our data to be used in some paper but never taken back to the community.” Community members should not just be the participants but partners in the research, Dr. Valantine concurred.

In response to a question about the benefits and opportunities to Black communities, Ms. Stringfellow said, “DEI is not just a nice thing to do. It solves health issues, expands economic opportunities, and allows companies to grow their portfolios.” She noted that patients who are Black and Brown should challenge assumptions to develop protocols and ask questions about the use of their data. “Move the burden of participation,” she added, such as at community centers around people’s schedules. The most frequent clinical trial participants, older Caucasian men, usually have more flexible time and resources to do so. Dr. Valantine noted the myth that Black and Brown patients and clinical trial participants are hard to reach; “they are not hard to reach, they are hardly reached.” She expressed optimism that the presenters and others are changing the narrative.

FINAL THOUGHTS

Asked by Dr. Valantine to share final thoughts, Ms. Beard urged a greater recognition of the assets within the community and working with populations who are easily missed. Ms. Thompson underscored the need to “understand what our worth is.” She added that when she forms partnerships, especially with corporate America and hospital systems, she insists on meeting with the CEO to “talk business.” Dr. Millner pointed to emerging technology as a fundable area with many opportunities to get involved. Ms. Stringfellow closed by stressing the need to identify STEM protégés and protégées early on and nurture them, as is done in music and athletics.

Dr. Malcom closed the session by reflecting on the presenters’ points about building real commitments, partnerships, and community. Relationships must be nurtured with recognition of the knowledge and other assets that the community holds. “We have the opportunity to change the narrative that this is the right thing to do, and it is the smart thing to do,” she concluded.