Lovell's Food For Thought - Egos and Wanting Credit As Threats To Addressing Health Inequities

This Goes Beyond Race & Racism

Dr. Lovell Jones | 5/2/2018, noon
To paraphrase what Benjamin Franklin once said: If we do not all hang together, we will all hang separately. The ...
Dr. Lovell A. Jones retired as Professor Emeritus from the University of Texas M.D. Anderson Cancer Center

Almost a year ago, I wrote a “Lovell’s Food For Thought” entitled “Reinventing the Wheel As a Threat to Progress” (http://stylemagazine.com/news/2017/aug/18/lovells-food-thought-reventing-wheel-threat-progre/). A recent op-ed piece by a number of scholars on Genetics and Race has brought the above Lovell’s Food For Thought back to mind in terms of threats to addressing health inequities, the threat of egos and the need for credit (https://www.buzzfeed.com/bfopinion/race-genetics-david-reich?utm_term=.rsmD52q30#.iqYR907eP).

To paraphrase what Benjamin Franklin once said: If we do not all hang together, we will all hang separately. The question that remains is: how do we get people and/or organizations out of their silos, especially in terms of health equity? We sure are not effectively addressing health inequities by remaining in our silos, especially scientific and advocacy silos.

The response I mentioned above, was by 67 scholars, many of whom I know, regarding a New York Times article on Genetics & Race (https://www.nytimes.com/2018/03/23/opinion/sunday/genetics-race.html). The scholars’ article has let me know that there are people out there who are seeing the same thing—the need to move out of our specialties and see the broader picture. It gave me the impetus to begin to reach out again. And in doing so, another person, Dr. Brian P. Mangum, reiterated that multidisciplinary action to address underlying developmental, socioeconomic and political disparities is the root cause of the vast majority of issues we face. Also, there is generally a positive response to such an approach from those working on the front lines in the field. But there is significant resistance from key stakeholders, particularly policymakers and politicians. Why? In Mangum’s opinion, there are two primary reasons: first, politicians and politically appointed leaders have a time-limited mind frame that is focused on immediate results to show constituents in an effort to be re-elected. Thus, investing time and resources into solutions that could take decades before showing results, is not a politically expedient thing to do.

I would also include that those in leadership roles in academia, as well, also need to show immediate results to get papers published and/or grants renewed and get tenure. Dr. Magnum also indicate something that impacts all: we are territorial and do not want to risk our funding sources by stepping outside of our silos. Even within our own disciplines, we are territorial among agencies, fearing newcomers, outsiders or those who might approach things differently than we do. He recently saw this in Fiji, while conducting a training in disaster risk management. WHO, CDC, the EU and an Australian emergency management team were all conducting trainings at the same time, in the same city, but to different audiences and using different frameworks. There was no coordination. When he and others suggested a regional organization to coordinate such training, it was seen as intrusive and presenting a threat to each individual fiefdom of trainers -- hence, nothing changed. He continues to see this issue month after month in the areas where he works.

So, when the 67 Scholars came out to encourage their genetics colleagues “to collaborate with their colleagues in the social sciences, humanities, and public health to consider more carefully how best to use racial categories in scientific research. Together, we can conduct research that will influence human lives positively," this was music to my ears. This is because almost a decade ago, the Center for Research on Minority Health (CRMH) Fellows came together to place in the peer reviewed literature 10 lessons learned as trainees (King, Miranda et al., Journal of Cancer Education, 24:S26–S32, 2009). Ironically, the first lesson states that NO ONE CENTER, INSTITUTION, OR PROFESSION WILL SOLVE THE PROBLEMS THAT WE FACE. Franklin D. Roosevelt once said, “Today we are faced with the preeminent fact that, if civilization is to survive, we must cultivate the science of human relationships—the ability of all peoples, of all kinds, to live together and work together, in the same world, at peace.” Every year since 2002, the Health Disparities, Education, Awareness, Research & Training Consortium (HDEART C) has held a course entitled, “Disparities in Health in America: Working Towards Social Justice.” The course was an academic outgrowth of the Biennial Symposium Series on Minorities, The Medically Underserved & Cancer and includes speakers and consists of a diverse group of individuals, including molecular biologists, social scientists, lawyers, health policy experts, economists, ethicists, politicians, environmentalists and others.