Road Map for Anti-racism in Health Care and Health Education

The anti-racism protests that started upon the death of George Floyd on Memorial Day launched a nationwide movement toward a more just society. Academic medicine has been among the institutions that have taken steps to reinforce anti-racism values—a commitment that took on added importance considering the health disparities that were revealed by the COVID-19 pandemic.

A task force was appointed by Columbia University Irving Medical Center leadership in mid-July and charged with identifying transformative actions needed to make CUIMC “an organization that is truly anti-racist, diverse, multicultural, and fully inclusive.” The task force and its working groups, with broad representations from throughout the medical center, were asked to recommend changes in communications and culture, with emphasis on recruitment and support of our faculty, staff, and community; curricular content; student, faculty, and staff diversity and success; community partnership programs; research in health disparities, social injustice, and racism; and clinical programs.

An email to the CUIMC community, signed by the four deans, explained the importance of the task force’s work: “As individuals and participants in groups engaged in science, population health, medicine/clinical care, education/training, and community programs, we must confront the issues of structural racism and implement durable anti-racist solutions. We need to articulate a thoughtful and deliberate set of priorities that cross all our domains of activities. These need to be matched by expeditious implementation so that we can witness and experience rapid progress. Moreover, implementation also requires constant feedback and self-evaluation so we do not lose sight of our aspirations, commitments, and values.”

The task force was chaired by Olajide Williams, MD, professor of neurology, and Rafael Lantigua, MD, professor of medicine, and coordinated by Anne Taylor, MD, vice dean for academic affairs in VP&S and senior vice president for faculty affairs and career development at CUIMC. The task force, charged with considering ways to assess and eliminate racism from all aspects of the medical center’s work, was asked to identify and make recommendations to reduce the impact of racism in six health-related areas, recommendations that were to be specific, actionable, durable, and have measurable anti-racist outcomes. The task force submitted its preliminary report with priority recommendations for the six areas studied:

Faculty Recruitment, Retention, Advancement, and Leadership

• Examine current recruitment, retention, and career advancement procedures for unintended bias against faculty from groups underrepresented in the health sciences.
• Address ways to increase recruitment and retention and promote advancement of faculty from groups underrepresented in health sciences at all levels with particular attention to leadership opportunities and pipeline strategies.

Education, Training, and Curricular Change

• Identify what is needed to educate/train our faculty, staff, researchers, trainees, and students to develop a racism-free CUIMC.
• Recommend creation of sustainable structures for addressing anti-racism training for faculty, staff, and students on an ongoing basis.

Health Care Disparities, Solutions, and Social Justice Research

• Make recommendations for the development of a CUIMC comprehensive research program in health disparities to encourage meaningful short-, medium-, and long-term solutions.
• Make recommendations for the development of a CUIMC research mentoring network for faculty, students, trainees, and others interested in health care disparities, solutions, and social justice research.

Clinical Care

• Develop a set of principles for bias-free patient care as well as an institutional position on racism.
• Make recommendations for the development of structures to foster equity and minimize bias in all aspects of patient care that includes an operational collaborative framework for working on these issues.

Community and Public Service (building upon existing CUIMC efforts)

• Add to current CUIMC-wide approaches to sustainable participatory community outreach efforts that build trust and health in our local communities.
• Make recommendations for leveraging and enhancing CUIMC-wide resources for addressing social determinants of health, including their intersection with structural racism in our local communities.

Civility and Professionalism

• Formulate principles of professionalism and behavioral expectations with attention to respect across race, ethnicity, sexuality, gender orientation, and religious beliefs.
• Recommend creating structures that promote the awareness of these principles across CUIMC.
• Recommend development of reporting structures that are constructive, fair, equitable, and transparent and that minimize risk of retaliation by those who report.

The task force recommendations and proposed action items are being shared with the CUIMC community for feedback. Implementation of recommendations will include strategies to measure short-, mid-, and long-term outcomes.

“If we can succeed in implementing these recommendations—and I believe we can—we will be national leaders in modeling diversity, equity, and inclusion in our research, patient care, education, and population health,” says Anil K. Rustgi, MD, interim EVP and Dean of the Faculties of Health Sciences and Medicine. “We owe it to future generations of health care professionals and we owe it to the legacy left by previous generations.”

Implementation of the task force recommendations will complement these new and long-term programs that are in place to strengthen diversity:

The full report from the taskforce is available online here.

BALSO Then and Now

A racist incident led to the creation of an organization to foster support and comradery
By Brittany King

Michelle Clark’76 applied to Columbia’s medical school on a whim. “A friend of mine got a paper application, sat me down, and told me to fill it out right then and there,” she recalls. So, she did, hesitantly. “I knew it was a phenomenal school, but I thought ‘Oh, I’ll never get in,’” she says.

She did get in and in the fall of 1972, she entered what is now VP&S excited about what was ahead. But something happened during the first year. “My Black classmates and I were sitting in the back of a lecture hall one day,” she says. The room was dark because the lights were at the front of the hall and the professor hadn’t arrived yet to turn on the lights. When the professor arrived and flipped on the lights, a nervous hush fell over the classroom, Dr. Clark recalls. “Someone had written in chalk ‘N*gg*rs get out of P&S.’ I knew people had issues with us being there, but still it caught me by surprise.”

The incident led to an emotional meeting with Black, white, and Latinx classmates as well as members of faculty. “I remember there being a lot of emotion in that room,” Dr. Clark says. She knew that regardless of the outcome of that meeting, her peers of color needed to get organized. So, during the winter of 1972 and into the beginning of 1973, she organized a group of students into a group known today as the Black and Latino Student Organization, or BALSO. BALSO had as its initial goals: Get involved in the community by hosting health fairs, create a variety of study groups, and support fellow Black and brown students in the college.

Today, BALSO is still doing many of the same things Dr. Clark and her peers set out to do in the early 70s. Before the pandemic, the group hosted film nights, monthly lunches, and an annual jazz mixer. The group also works within the Columbia community and beyond to amplify awareness of complex health issues facing communities of color by sponsoring talks and workshops on health care topics.

Following the death of a classmate, who died of COVID in the midst of the Black Lives Matter protests, Vivian Lewis’77 brought classmates and fellow alumni together via Zoom to check in and brainstorm how they could best support current students involved in BALSO. Led by Dr. Lewis, the group is in the beginning stages of forming an alumni BALSO group that will support the campus organization through mentorship.

“We realize that while many things have changed, so much has stayed the same,” says Dr. Lewis. “That’s structural racism, and that term can work as an excuse, but it also sums up a set of problems that are so entrenched it can seem overwhelming. Still, it shouldn’t be a reason to not do what you can to make changes. I think our group will be able to provide resources and support that will be valuable to current students.”

Dr. Clark is on the psychiatry faculty of the University of California San Francisco medical school and also works as an independent contractor in correctional mental health. Dr. Lewis ​is professor emerita of obstetrics and gynecology and chair of the Mentor Development Group for the Clinical & Translational Science Institute at the University of Rochester’s School of Medicine and Dentistry. As a recent appointee to the VP&S alumni association board of directors, she is getting new insights into ways that the institution is adapting to challenging times.

Residence Hall to be Renamed

Columbia University President Lee Bollinger announced in an Aug. 28, 2020, email that Bard Hall, the residence hall that opened in 1931 and has since housed generations of medical students, will no longer be known as Bard Hall.

The decision followed deliberations by a group convened by Interim Provost Ira Katznelson to review Columbia names and symbols associated with issues of race and racism. The group convened in June following weeks of unrest surrounding racial and social injustice. The group decided unanimously to recommend removal of Dr. Bard’s name from the residence hall. The building was named for Samuel Bard, the founder of what is now the Vagelos College of Physicians and Surgeons. His historical contributions as a renowned physician and as George Washington’s doctor were augmented in recent years with the revelation that he was a slave owner who, on at least one occasion, advertised a reward for the return of a fugitive slave.

“We all understand how careful we need to be in shaping the environment, symbolic as well as physical, in which we ask our students to live and to call home,” President Bollinger wrote. “These are sites with the special resonance that comes from mixing the personal features of daily life with the formation of lasting friendships and a sense of community with a shared mission, together with a period of life involving extraordinary intellectual and professional growth. The change I am conveying here, however, also feels urgent not only for the individuals who have been asked to call Bard Hall home, but for the many students, staff, and faculty in the broader Columbia community, and especially vivid at Columbia University Irving Medical Center, where the contradiction between the egalitarian health service norms they cherish and slavery’s denial of full human standing is starkly blatant and offensive.”

President Bollinger said he would announce a new name for the building at 50 Haven Ave.—“a name that represents our University’s values.”

After President Bollinger’s email was distributed, VP&S Interim Dean Anil Rustgi sent an email showing his enthusiastic support for the announcement. “Having a building on the medical center campus named in honor of a slave owner is a contradiction of our fundamental commitment to equality and social justice,” wrote Dr. Rustgi. It diminishes any efforts we have undertaken or will undertake to create an environment that is truly welcoming to all who work here, study here, come here for medical care, and/or reside in our neighborhoods.”

One of Dr. Rustgi’s initial priorities as interim EVP and dean was to address the issues of race and structural racism. “In the weeks before I officially assumed this role, the specific issue of Bard Hall was raised by faculty and students as an example of how the medical school and center environment is seen through the eyes of our Black colleagues as well as other groups.”

Dr. Rustgi called the renaming of Bard Hall the beginning of a deeper conversation about race and structural racism as a task force and working groups assigned to make recommendations completed their work.

The residence hall opened in September 1931, a few years after the medical school moved to Washington Heights to become part of what was then Columbia-Presbyterian Medical Center. The 11-story Art Deco building was designed by James Gamble Rogers, the architect behind many of the medical center’s original buildings.

Bard Professorship

Donald W. Landry, MD, PhD, chair of the Department of Medicine and the Hamilton Southworth Professor of Medicine, formerly had the additional title of Samuel Bard Professor. After reviewing historical records provided by a member of his faculty in June 2020 about Dr. Bard’s history of slave owning, Dr. Landry repudiated the Bard chair the next day, calling it “an honorific without honor.”