“We need a shift in medical education to train physicians in structural competency — that is, understanding how structural determinants of health exist within a larger historical and social/cultural context. We could have a really big impact by committing, at the medical school and residency level, to train providers who will be able to recognize these forces and feel empowered to be real advocates for change in this area. If we do anything less, the idea will continue that a lot of the disease we see in patients is caused entirely by individual factors, choices and behaviors. Those factors are real, but it’s important to understand that there are also systemic forces, well above the individual level, that have even greater effects on health outcomes. We need to actively try to undo some of those systems.

“Here at Johns Hopkins Bayview, our internal residency program has a mission oriented around the intersection of health and justice. Through Medicine for the Greater Good, we give residents both lecture-based and experiential learning opportunities in topics like structural competency and the origins of health disparities. They are required to participate in an activity in partnership with a community-based organization so that they learn to connect with community leaders and to understand the communities their patients come from.”

Erica Johnson is an assistant professor of medicine and program director of the Internal Medicine Residency Program at Johns Hopkins Bayview Medical Center.

“We have to make sure we’re including African Americans and other historically marginalized groups at every stage of research. On the front end, we need a diverse group of scientists involved in the discovery and development process because that’s when we start thinking about potential off-target toxicities and what type of genetic differences could influence a drug’s effects.

“Then, of course, we have to make sure everyone who will be taking the drug is represented proportionally in its clinical trials. Although African Americans account for 13.4 percent of the population, a recent ProPublica analysis found that ‘less than 5 percent of Black patients were involved in trials for 24 out of 31 cancer drugs approved since 2015.’ And that’s even for treatments aimed at a type of cancer that they’re particularly susceptible to. From my own pharmacology research, I know that African Americans can be more likely to carry genetic variants that alter drug metabolism, leading to differences in drug effectiveness, so this is a very serious problem.

“Some say that the lack of minority inclusion is due to their lack of trust in health care professionals, and there’s probably an element of that, but there are also studies that show that African Americans are very willing to participate in trials — we just aren’t asked. I was happy to see that Meharry Medical School is going to be involved in COVID-19 vaccine trials. COVID-19 disproportionately affects Blacks, so it’s important to include a historically Black university as a trial site.”

Namandje Bumpus, the first college graduate in her family, is a professor and director of the Department of Pharmacology and Molecular Sciences.

“My response, in an institution with a long history of white privilege, is to show that people of color here can lead and make great contributions.

“What I wish we had more of is thoughtful solutions, taking into account each person, each segment of the population’s responsibility to make things better. There is way less of that than ‘statements of concern,’ which don’t create change. These are not new problems — it’s part of being Black in America.

“Our responsibility is to reach out to those with science interest and aptitude, and help them, reassure them there’s a place for them — in academia and specifically here at Johns Hopkins. We should make them feel like this is an environment where they can thrive. That’s my job, but also the job of the white majority to change the culture of exclusion. As others have said, ‘Justice will not be served until those who are unaffected are as outraged as those who are.’ We have a shared responsibility to fix academic medicine and create an environment of inclusive excellence.”

Robert Higgins is the first African American to hold the role of surgeon-in-chief or any departmental leadership role at The Johns Hopkins Hospital.

“We can’t just recruit underrepresented minorities and think we’re done. As diversity advocate Vernā Myers says, ‘Diversity is being invited to the party. Inclusion is being asked to dance.’

“[So] we have to look for ways to promote their work, guide them in terms of publications and access to grant money, and include them in our collaborations. We often know people of color who are qualified, but we tend to select people already in our network, instead of expanding our search. Ultimately, we need to have diversity in our leadership so that underrepresented minorities are part of the decision-making process.

“Inclusion of underrepresented minorities in medicine will directly benefit patients, since research shows that having a doctor who looks like you increases patient compliance. Patients will also benefit when medical research and subsequent protocols take into account the diversity of symptoms and outcomes experienced by those of different ethnicities.”

Crystal Watkins is an assistant professor of psychiatry and behavioral sciences at Johns Hopkins and assistant director of the Geriatric Psychiatry Outpatient Programs at Sheppard Pratt.

“We need to address the issue of racial disparities with the same level of urgency, commitment and resources that we’re putting into curing cancer and diabetes. To break institutional racism, hospitals, education systems and governments need to collaborate. Everyone has to feel the burden of health care disparities. We need to remodel how society behaves until there is equitable access to housing, education, etc.

“Three immediate priorities include a fully funded and staffed office of diversity and inclusion at every medical institution, the funding of health disparities research, and ongoing unconscious bias training for staff because, just like COVID-19, you might not know you have it [racial bias], but you should still be screened for it.”

Panagis Galiatsatos is an assistant professor of medicine and co-chair of the JHHS Health Equity Steering Committee in the Office of Diversity and Inclusion.

“For a long time, people have seen the disparate opportunities for African Americans in health, education, employment, housing and criminal justice as separate issues. Now people are starting to see the pattern — the broader underlying issue of structural racism. For those of us in health care, it’s time for self-reflection. What’s our role in it, as individuals and as institutions, even if unintentional? We go into medicine to make a difference, so the idea that we could be adding to people’s suffering is hard to fathom. But we have to ask, how are we impacted by the belief systems and social patterns of our larger society, with its entrenched ideas about the inferiority of people of color? We aren’t immune to the values around us.

“Concretely, we need to create health care systems respectful of everyone in our institutions, no matter their race or position. We have to hold our organizational leaders accountable for developing and implementing policies to assure that our practices do not allow biased, disrespectful behavior and do not place ethnic minorities or poor people at further risk for poor access to quality care. We all have to speak out and not allow racist behavior in our settings. We also have to make more efforts to build trust with those we serve: our patients and the communities they come from. We have to get to know them as people, learn what their challenges are, and help them get the support and resources they need when they leave our hospitals and clinics. Health equity has to be infused into everything we do.”

Lisa Cooper is the James F. Fries Professor of Medicine and Bloomberg Distinguished Professor of Equity in Health and Healthcare.

“Like everyone else, I was horrified by George Floyd’s tragic death. The protests and conversations that followed left us all thinking about our society and how so much of it just isn’t working for so many people. I wrote my monthly column for Clinical Psychiatry News about what I see as a systemic problem in health care: certain types of private practice are inherently racist — not in the sense that Black patients are being discriminated against — but the cost of seeing a doctor in private practice often creates a situation where the racial makeup of the patient population does not reflect that of the surrounding community. This is especially true in psychiatry, where there are not enough doctors, and half of psychiatrists in private practice don’t participate with any insurance networks because of the extra work it involves and the low rates of reimbursement.

“It’s clear that our system has become multitiered: Those with fewer financial resources are offered a different level of care, and sometimes no care at all. Patients with public insurance, or no insurance, have traditionally been offered treatment in community mental health centers, but these clinics are often unable to meet everyone’s needs. I have wondered if we might do better by people without insurance ‘networks,’ with their different deductibles and levels of reimbursement for in-network versus out-of-network care. While I don’t have an answer, I wanted to start the conversation.”

Dinah Miller is an assistant professor of psychiatry and behavioral sciences at the school of medicine.

“I think we have to ensure that Black students receive the funding and mentorship they need to be able to take advantage of universities and medical school while getting the research and clinical experience necessary for them to advance their careers.

“That means investment in high schools that can prepare Black students to compete in STEM majors (science, technology, engineering, mathematics) in college, providing summer opportunities in the lab and the clinic, removing the financial barriers to medical school, and mentoring them every step of the way so that our best and our brightest aren’t weeded out.

“The Johns Hopkins Summer Jobs Program is one way we are addressing this pipeline issue. Every summer, 500 high school students come here, across the institution, and many conduct research and work alongside clinicians, encouraging them in STEM careers and contributing to their enrichment and success.”

Alicia Wilson is vice president for economic development for The Johns Hopkins University and the Johns Hopkins Health System.

“We have to diversify our entire workforce, not just physicians, and create an environment, especially within the walls of Johns Hopkins, where everyone is valued and everyone feels empowered to speak up. In terms of faculty at the Johns Hopkins University School of Medicine, 9.2 percent are underrepresented in medicine and science. That number has been growing over time, so we’re going in the right direction, but we still have a lot of catching up to do. We’re still working against historical factors, like the release of the Flexner Report in 1910, which subsequently led to the closure of a lot of medical schools. Only two Black medical schools (Howard and Meharry) were left following the closures, at a time when Blacks couldn’t go to white institutions.

“Another thing we, as physicians, must do is start thinking about what caused the symptoms in the patient before us. We tend to focus on outcomes and can miss important contributors to the problem. The history of racism in our country comes with elements that affect health and create disparities, like exposure to environmental pollutants, reduced access to healthy and affordable food, and access to green spaces for physical activity. Only by addressing these contributors will we be able to achieve health equity.”

Sherita Hill Golden is a professor of medicine and the vice president and chief diversity officer for Johns Hopkins Medicine.

“At a national level, the U.S. needs to reconcile with its history, being very open about how [the nation’s] history of slavery has contributed to the disparities we see today. Actions have to be taken, like Germany after the Holocaust, to make amends, gestures like no longer allowing tributes to those who took part in it. The U.S. also has to acknowledge that many of the racist policies in place during the 1900s prevented Blacks from building generational wealth, which in turn magnified health disparities. This didn’t start overnight. It began the moment African people were brought to America against their will.

“I truly do believe the Hopkins leadership is working to right the wrongs regarding their relationship with the surrounding community. But they need to work on transparency. Let everyone know, ‘These are our new stances. This is how we plan to work with our neighbors. This is how we are investing in programs to uplift our local communities.’”

Agnes Usoro recently finished her residency in emergency medicine at Johns Hopkins and is now a part-time faculty member at the school of medicine and an attending physician in the Department of Emergency Medicine at Howard County General Hospital.

“First of all, academia has to acknowledge the deep history of racial inequality in this country and learn from it. Institutions of higher education have a duty to acknowledge their roles in perpetuating systemic racism too. Historically, a number of injustices in health care and medical research have occurred at Johns Hopkins, but a lot of people who come through here don’t know that. I think it should be a core part of orientation for new staff members, something used to teach people about the long-lasting effects of racism and discrimination.

“A second priority should be addressing racial inequality in our local communities by investing time and resources into them. I think the money from the proposed Hopkins police force should be reinvested in the community instead. Overpolicing the Baltimore community, which is majority Black, will not address the root causes of the crime that plagues our city. If Johns Hopkins really wants to address these issues, [leaders] need to provide more opportunities for city residents, especially educational opportunities, instead of trying to overcriminalize them.”

Michael Hopkins is a third-year Ph.D. candidate in biological chemistry at the school of medicine and CEO of Black Scientists Matter.