EP81 Diversity in Public Health Academia with Dean Cheryl Healton and Dr. Melody Goodman

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I AM GPH Podcast EP81 Diversity in Public Health Academia with Dean Cheryl Healton and Dr. Melody Goodman
EP81 Diversity in Public Health Academia with Dean Cheryl Healton and Dr. Melody Goodman 

Alexandra Arriaga: Hello everyone, and welcome to another episode of I AM GPH. My name is Alexandra Arriaga, and today I am very excited to share with you a special episode honoring Black History Month in which we will have our very own Dean of the School of Global Public Health, Dr. Cheryl Healton, as well as Dr. Melody Goodman. Dr. Goodman is not only Associate Dean for Research, but she is also an associate professor of biostatistics here at NYU. The two of them will be talking about racial and ethnic diversity in academic settings due to the fact that back in 1999, Dean Healton published a very important study called “The Shape of Our River,” and years later, Dr. Goodman collaborated with her on a new report called “Racial and Ethnic Diversity in Academic Public Health: 20 Year Update.” And today the both of them are going to discuss their work. If you would like to learn more about racial and ethnic diversity in academia, as well as the importance of representing minorities in this setting, please stay tuned. Welcome Dean Healton and Dr. Goodman, we're so glad to have you join us for this podcast conversation about diversity in public health academia. So in 1999, Dean Healton, you published a very important study called, “The Shape of Our River.” And years later, let's fast forward to 2019, you collaborated with Dr. Goodman on a new report called, “Racial and Ethnic Diversity in Academic Public Health: 20-Year Update.” And now we have both of you here today and we get to discuss your work. To start us off, Dean Healton, can you tell us more about the backstory of “The Shape of Our River”? What moved you to publish this article?

Dr. Cheryl Healton: Well, I think when I wrote that article, I was the Chairman of Sociomedical Sciences at Columbia University, and that was for a special issue which was about linkages between the community and academia, which in some places are very strong and in other places are quite weak. And one of the reasons that they are weak when they are weak is an absence of diversity both within the student body as well as on the faculty. I found myself disconcerted by the fact that at that time there was only one African American faculty member in the entire school. And I set about changing that, at least for my department where I could work with faculty to make a change. But I realized as I was doing it, that it wasn't just about one institution, it was about a lot of institutions. And so I pushed to publish the data, I asked the association to make it available for this special issue. And this book had just come out from Harvard, I think it was Harvard University Press called, “The Shape of The River.” And it was about the experiences and futures of people of color and other minorities that attended the top 20 universities in the United States and what happened to their careers. And it drew a number of conclusions, but one of them was earning a doctoral degree was a watershed event that changed the trajectory of the careers of individuals. And yet, it was not happening in substantial numbers. That was one of many of the findings. So then when I looked at the data, I was deeply disheartened by the percentage of underrepresented minorities who were earning PhDs and the number who were becoming tenured associate professors or professors. The numbers were almost across the board under 1.5% and in some cases zero with respect to Native Americans. So that's why I wanted to draw attention to it because I'm a great believer that if you don't see the problem, you can't fix the problem. If you don't acknowledge the problem, you can't fix the problem.

Alexandra Arriaga: Absolutely. And this paper was published in 1999 and like you mentioned in it, you concluded that the present leaders of the nation's public health system will, in large measure, determine the shape of our river. So let's fast forward two decades and now you are Dean of a school of public health. How have things changed and what does the river look like today?

Dr. Cheryl Healton: Well, I think the river looks better than it did in 1999. However, I think the amount of progress, as you'll hear from Dr. Goodman in a minute, is suboptimal. In other words, I don't think we should be patting ourselves on the back. And I think that if we do, we're kidding ourselves. So I think we still have a substantial problem. And I do think that there are people who care a great deal about it in the Association of Schools of Public Health, and in many health profession schools, and some health professions have done better than public health. There are a lot of reasons for that, they're complex. But I don't think we should rest on our laurels because we still have a lot of problems. And it's not just about fairness for the individuals who should have the right to have a great career. It's also what they'll do in those careers that would be different than majority populations holding all of the cards in those careers.

Alexandra Arriaga: Absolutely. And Dr. Goodman in your paper, “Racial and Ethnic Diversity in Academic Public Health: 20-Year Update,” you've argued that the pace of change has been too slow. Can you elaborate on that?

Dr. Melody Goodman: So I think the 1999 paper was really a call for action. And the reason why I think the pace is too slow is because I graduated undergrad in 1999 and went to grad school shortly thereafter. And many of my peers are now senior people in whatever profession that they're doing. And during the time when I was an undergrad, there was a real concerted effort. My undergrad was funded by the National Institutes of Health, a minority access to research careers grant. So I think we were making investments in increasing diversity in science. And so I would think that 20 years later, one would hope to see more of a outcome from the investments that were being made. And I think for me it's also really personal. I never had a black professor ever in undergrad or in graduate school. And so when I was deciding what I wanted to do when I left graduate school, being a professor wasn't even really on my radar because I just thought people like me don't do this type of thing. And for me, obtaining a PhD was a major change in my life's trajectory. It really helps with upward social mobility, it can really change the lives of people and their families and really communities as a whole. I think minority scholars like myself are more interested in minority health issues, more likely to study these types of problems more likely to do work that gives back to the communities where they've come from. I think everyone studies things that are interesting and impactful to them in their lives. You may study cancer because you might have cancer in your family or diabetes and the like. And so I think those of us who grew up in low income communities, where the social determinants of health are a reality and not something we study in school, we're really passionate about those issues and we can also engage in those communities in a way that is way more authentic because we really understand what it's like to be in that space and what those circumstances are like. And so I would have hoped that 20 years later, instead of producing one or two a year, which I think most of the top schools made the commitment to do, that they would have produced cohorts of minority scholars who would now be out and be in the field as practicing academics.

Alexandra Arriaga: And what are some strategies to increase the number of minority faculty in academia today? What's the way forward?

Dr. Melody Goodman: So I think here, retention is the key. I think most places have figured out how to recruit minority faculty. What you'll see is you'll see a lot of people at the junior level: instructor or assistant professors. But for some reason, either they don't stay in academia and sometimes that's because they're great and they get pulled out into good government jobs or other public health initiatives. But you're not seeing them obtain tenure at the rates that I think we would want to see them attend tenure, and we're definitely not seeing them at the full professor level. And so I think for the field, retention is what's key, not what makes someone come into this profession because I think minorities had been invited to the table for a long time, but maybe don't feel included in the family meal, right. And so then they really don't want to stay in that space, and so I think we really need to focus on retention. And part of that is also valuing different types of science. So the NIH released a report that basically said that, scientists who study things like the social determinants of health, disparities, women's health, things that minority scholars are really passionate about, don't get funded at the same levels of people who study genetics and other sort of more biological sciences. And so I think if you're in a space with a work that you do and you're passionate about that's treated less than or inferior, why would you want to stay in that type of environment?

Alexandra Arriaga: Where's the motivation? Absolutely. And in your report you also mentioned the idea of a minority tax. So can you tell us more about that and what sorts of obstacles and barriers exist for minorities in academia?

Dr. Melody Goodman: So I think, because there are so few of us, we're often asked to do more and we often want to do more. Minority students are more likely to seek out minority faculty. I complained that I never had a minority faculty member, so I would never turn away a minority student who came to my door and asked for support or just a discussion, a chat about career or life or whatever. I think we’re asked to serve on more committees because there's a push for diversity on different committees. So I think we're asked to do a lot more service. I think we have to address stereotypes in the classroom, so I think we work a lot harder to be effective teachers to combat the stereotypes that and preconceived biases that students may have when they see a minority faculty member in the classroom. And I think because our research is sometimes considered inferior, we have to work extra hard to show the rigor of the science that we're doing. And if everything is harder, if every part of your job is harder, it's like paying a higher tax rate. Being a professor is already an immensely hard and time consuming job if you want to teach well and do great research and provide good service to the field. But if every part of that is much harder, it's like paying extra tax money. It's like earning less for every dollar that you make.

Alexandra Arriaga: Interesting, okay. And in an ideal world, the knowledge and impact that happens at NYU would be able to benefit the community and not just be contained within the ivory towers. So can you tell us about some of the initiatives you're involved in for engaging people outside NYU, especially youth?

Dr. Melody Goodman: So I'm really interested in the idea of research literacy and having lay community people be research literate. Because I think the way we talk about health, particularly to general audiences has changed. And there was a period where we were pushing sort of health literacy, but even now when we market medications to people, the commercials require you to have some understanding of the research that they use to generate those facts that they're spewing out to you, including the benefits of the medicine, but also the side effects. And particularly for minority communities, it's been a passion of mine because a lot of health research is done in predominantly white, predominantly well educated populations. And it's not clear if and how all of those findings will translate to other populations. And so I think, even the general public needs to be a little bit cautious when they hear certain claims about who are they generalizing from, who were the people in those samples and how does that relate to me and my family. So the work that I've been doing has been developing training curriculum and training programs for lay audiences. We started with adults, we've done work in Long Island, New York and St. Louis and also in Mississippi. And in the summer of 2018, we adapted it for a group of young black girls in Newark, New Jersey to teach them how to use research as part of... they were in a summer camp that was focused on social action. And so we wanted to show them how to use research and data to push their social initiatives forward.

Alexandra Arriaga: That's amazing. Yeah. Do you mind sharing some of the things you saw? What was one of those experiences that was really memorable for you?

Dr. Melody Goodman: So I always love to do community engaged work because I think if you bring in the people who are affected by an issue into the solution, they're going to be way more creative about how to solve it, one. But they also have some insights that those of us who've trained at the top Ivy league schools just don't have. So no one knows what it's like to live in a community better than the people that live there. And no one knows what it's like to have a disease better than someone who has that condition, right? Even if you're trained a lot on whatever that disease is. And so I think when we train our youth and we challenge them, they come up with great things. So a couple of things have come out of that, and one was Youth Mental Health Week. So they basically started a social action campaign and they had all these nice buttons that basically told adults to shut up and listen. I mean they said it in a much nicer way like breathe, listen, but basically, they wanted to get the message out that adults have to listen to youth when they talk about their mental health and that it's important that we don't tell youth what they're thinking, but that we hear what they're telling us because sometimes really important issues can be solved as someone would just listen to what the youth were saying. They've also done a lot of work to help combat period poverty. So there's lots of girls in places in the U.S. and internationally that can't afford feminine hygiene products, and they built kits and took kits out and really did a social campaign about period poverty. So I think the issues that they're focused on are ones that are real relatable to them. And I think ones that sometimes us adults don't always think about and researchers think about and hearing it from the voice of a youth I think just has a different type of impact. When general audiences hear you talking about their mental health, they're talking about not having access to feminine hygiene products. Sometimes these are things that we take for granted and so it's nice to see you two are passionate about these types of issues and help give them some of the ammunition they need to move these great initiatives forward. So for me, it's helping them do what they were already going to do just a little bit better. Like these are their ideas, we're not taking credit for any of the work they're doing, we're just trying to help them do what they were already going to do in a little bit better way so they have a lot of data and evidence and research to support their initiatives.

Alexandra Arriaga: So on that same note about youth and now focusing a little bit more on youth at NYU, Dean Healton, I used to think that we were very lucky at NYU because of the amount of diversity in our student body and our faculty members. I mean, I'm an international student myself, and I see plenty of people that come from all over the world, faculty representing every ethnicity possible. So. I've always felt very lucky, but I'm starting to think and more understand that it has probably been a conscious and purposeful decision. So maybe that's why we're surrounded by this amount of diversity. So we fast forward years into the future and faculty in schools of public health around the country are diverse and strong. What sorts of ripple effects do you think that would have for society?

Dr. Cheryl Healton: Well, I think a lot of the comments that Melody has just made are quite relevant. For example, the point that she made that if you are from a community that has been disadvantaged and you yourself have been raised in a community that's disadvantaged and then you obtain some tools, you're more likely to use your knowledge, your tools, and your innovative ideas to improve the circumstances of people who are similarly situated to where you once were situated. I think that's fairly well documented. And so something as simple as one of those individuals becomes the head of an NIH branch or the head of a sub-branch within the NIH, and I've seen this happen. And all of a sudden they are able to, from within, change the shape of the type of questions that are being put out there for academicians to respond to and to solve. So the point that Melody made earlier that there's a disproportionate emphasis on hard science and less interest in social science across the NIH branches. I see one tiny bit of light at the end of the tunnel there with the emergence of epigenetics because more and more it's becoming clear that something like biological genetics interdigitates with the lived experience of people. Something as simple as being genetically predisposed to a certain mental illness, not being manifest in someone who's not subjected to daily stress and being manifested in someone who is and so no longer is there this dichotomy, and I think the absence of that dichotomy is helping to change the approach to research. And I think some of these realities about the real world health consequences of challenging circumstances are coming to the floor in ways that they hadn't before. So I think we'll see a major change in the type of research that's happening. I think we'll see on a global scale a lot more interest in the biggest problems that are killing the most people. The U.S. alone has had a year over year four year decline in life expectancy, we just now had a turnaround, a slight uptick. That has not happened since the Spanish flu of 1918, that there was a four year long decline in U.S. health life expectancy. So we know that, dubbed the “diseases of despair” that are driving this decline in life expectancy, that beneath that there are a thousand stories and people who come from impoverished communities, they bring a lot of those stories with them and a lot of sensitivity to those problems and a lot of motivation to try to improve them. That's not to say that majority individuals don't care about these problems as well, they certainly do. But I still don't want us to get too excited because NYU is very, very diverse for a lot of reasons. This school looks the way it does for a lot of reasons. We're one of the most diverse schools in the United States among schools of public health and one of the most diverse here at NYU. NYU is in a vibrant city that attracts people from around the world and it's easier to have a diverse school here than it is in some other settings, and you can even make an argument that is diverse as we are, we are not as economically diverse with respect to candidates to come here who are from the local community. And this is a problem that has been raised with me, and I hear it, and I want us to figure out what we're going to do about it. We're an expensive school and even with a robust financial aid package, it's hard for us to be as attractive as a school that has a state-based tuition, for example.

Alexandra Arriaga: Absolutely. So going back to what Dr. Goodman said, she mentioned that social research is getting less funding than other types of research. So what would you say to those people who are not allocating as much funds to social research?

Dr. Cheryl Healton: Well, from my perspective, the strongest argument is you don't understand the power of social research. And anybody who's worked in public health for any length of time knows that it's one thing to have the scientific breakthrough. Let's take as an example, if we had developed an AIDS vaccine. It's quite another to convince the entire world to accept that vaccine. So you have a role for basic science and it's critically important, and then you have a role for public health practice, which is also critically important because it's sort of like you have a cure but you don't use it. The classic example right now is vaccine hesitancy, which is taking over the world sort of by wildfire. All of a sudden, people whose lives have been historically saved from fully preventable diseases are now getting those diseases because they've convinced themselves, or someone has convinced them, that it's not good for them. You're not going to solve that problem of vaccine hesitancy in a laboratory somewhere. You have to solve it with real world intervention research and communications and all sorts of things that are in the classic public health toolkit.

Alexandra Arriaga: Absolutely. How about you, Dr. Goodman, what do you think?

Dr. Melody Goodman: Yeah, I agree. I think from what we know about science and public health right now, if you gave me someone's zip code, I could tell you more about their potential health outcomes than if you gave me their genetic code. I think we're working to learn more about genetics, but in this very moment, we know that poverty is a killer. We don't need any more research to tell us that fact, and if we address poverty, we would fix a lot of potential health issues. So I think there are things that we know already from public health that we're not implementing because we're still trying to figure a lot out about individual health. And I agree with Dean Healton that both are important, but I don't think both are treated equally as important. And I think public health has the potential to take individual and biological and clinical treatments and broadly introduce them to the world in a way that increases how efficacious they could be multiplicatively, and so to not value this discipline the way that you value others is making a crucial mistake in terms of the way we approach health and health research in general because I do think they compliment each other really well. And also there's some things that we already know from public health that we haven't followed through on that could really impact even whether we needed to further investigate some of these clinical issues because we could solve a lot if we made a conscious effort to improve poverty in this country and in some other countries we could solve a lot of potential health issues, and we already know that.

Dr. Cheryl Healton: Yeah. So what that indicates is, part of the problem is a lack of political will because Melody is correct about the crowbar that eradicating poverty could be and when we have not done it. But we do see worldwide a reduction in extreme poverty. That is the one glimmer of hope and that has happened virtually everywhere. But whether that momentum will continue is critically important.

Alexandra Arriaga: Absolutely. And so Dr. Goodman, let's just pretend that right now somewhere in the South side of Queens, there's a young African American girl who is starting to learn about statistics and is curious to learn more. And she's listening to this interview right now. What would you say to that little girl?

Dr. Melody Goodman: I would say continue being curious and try to learn more. I think sometimes we're limited about what we do in terms of what we're exposed to and what we know and what our social networks know. I had no idea what biostatistics was. So if you don't know what that is either, it's fine. I didn't even know what biostatistics was when I graduated undergraduate school. So the idea that someone may not know what this is, I don't think that is a slight to them. I hope that they're listening and googling and becoming curious, because that's how I found biostatistics was the Googler. And I think because we live in a world where data is so immensely important and it's coming out in the volumes and the types and the different ways that it is. Anyone who is interested in data and statistics can really build a decent life for themselves and you can study anything with statistics. So biostatistics is a study of health but people do education, they do physics and maybe become astronauts or rocket scientists as my family thinks I am because they can't say biostatistics. I think if you're interested in data you could solve social justice issues, you could work on climate change. I mean you could work in any field if this is your interest and so whatever you're passionate about, there's statistics behind it. In fact, I geeked out the other day I was watching a basketball game with a friend and they like did this short little interlude and it was all statistics about his shooting percentage and the arc in which he shoots the ball and like my friend was like, you just got all into that. And I was like, it's just so cool that I think we're now using statistics and new and different ways and we're exposing it to people that probably don't even realize that they're getting exposed to statistics. But anybody who's interested in sports has been exposed to statistics for a lot of time. But I just think the quality of the data that we have now is just so cool and interesting that we know the angle at which someone is shooting the basketball and where they are on the floor and what their percentage of making that shot is from that exact place, right. And so I'm interested in health and so that's why I do this type of statistics. But I think if anyone's interested in statistics, they can do whatever it is that they're interested in. There's usually some data and statistics behind that field.

Alexandra Arriaga: That's so funny, I hadn't thought about that, but yeah, you're absolutely right. And so as a final thought, what more must public health leaders do today to ensure health disparities between population groups are significantly reduced? I know it's a very charged question.

Dr. Melody Goodman: So I think that we definitely need to train more minority scholars, but I also think we need to work on people's implicit biases. And one of the things that I hope I do, just by showing up every day, when my students walk into the classroom, it changes what they think a biostatistician looks like. For me biostatistician was some old white guy with glasses who was kind of nerdy.

Alexandra Arriaga: Probably what most people think.

Dr. Melody Goodman: But I hope my students now don't have that type of bias when they think about a biostatistician. I hope they think about a faculty member who listens to hip hop music and knows a little bit about pop culture and is going to make funny jokes in the classroom, but is also going to teach them rigorous statistics, right? And so just that sort of mind switch of that bias of what they think about when they think about what a biostatistician looks like, what a professor looks like, what a smart or intelligent person looks like, changes the way that they interact with people in the world. And so I hope our students by being exposed to each other and the level of diversity that we have, and I agree we could do better, but I do think we are a really diverse student group, I think you guys are lucky to study here. And we have a really diverse faculty for a school of public health. Again, I think we could do better, and I speak about all the time, Dean Healton knows, but compared to our colleagues, I think we're way more diverse. And I think in general public health is a more diverse field than some other disciplines because it attracts certain types of people who are interested in these public health issues and are passionate about this. So I hope that our students now, when they interact with people, will interact differently because when they see a black woman struggling, they may think she could be a professor, she can be really smart, she could be a biostatistician instead of thinking, she's homeless or she's a drug addict or whatever the negative stereotypes may be. And so I hope that our students will really change the way they interact with the world because I think that's what public health is about. Really changing the way that we interact with communities in it and other people in the world.

Alexandra Arriaga: Yeah. And in this case, representation definitely matters.

Dr. Cheryl Healton: Well, I would just add that, that's a great answer that Melody just provided, I'm going to take a more macro approach to it and to say that we live in trying political times. I'm sure many generations have said that before us here today. But eradicating these unjust differences in health access and health status and income inequality, that's going to take a lot of political action that public health can be a part of and historically really has been a very important part of. But they can't do it alone. It's really about the whole national mindset and the international mindset. And I'm optimistic, but I'm also a realist. So I think it's going to take a lot of people working really hard to make that a reality.

Alexandra Arriaga: And what would you say to young public health students who are minorities about having a career and fighting for what they believe in?

Dr. Melody Goodman: So there's two sort of mantras that I have. One is everything will be alright in the end, if it's not alright, it's not the end.

Alexandra Arriaga: Oh, I like that.

Dr. Melody Goodman: So sort of just keep pushing for what you want and what's meant for you is meant for you and no one can take that away. Whatever mark you were meant to put on this world, you will do it, whenever the right time is, whatever the right space is. And even though sometimes it feels like the world is working against you, you have a mean teacher that doesn't want to give you the A you want or whatever you feel like your personal life crisis is, when something is meant for you, it's meant for you. There's no one or nothing that can stand in your way from doing it. And so if you're passionate about something and you want to see a change, you just have to keep moving forward despite sort of any setbacks that you...

Dr. Cheryl Healton: The only thing I say, and I say it to all students, whether the majority or minority is something that was said to me by a sociology professor that I had when I was a freshman in college and that was, maintain your idealism and get into the system. And it's a funny thing to say, but first of all, if you're not idealistic and if you feel downtrodden, then you're not going to have any idealism to maintain. So part one is find a way to fuel idealism in yourself if you don't naturally have it. And the second is to use that fuel of idealism. Meaning you have an ideal, you know what you want to create and then set about creating it. And being in the system doesn't mean you're of the system and it doesn't mean that you believe in the system, but it is being in the system and changing it from within, that is actually one of the surest ways to get from point a to point B.

Alexandra Arriaga: So taking a seat.

Dr. Cheryl Healton: Yeah. Whether you like it or not, whether it's comfortable or not, whether you have to raise your voice or not. It's interesting, when you're in a position of power, whether you're an Associate Dean or you're a Dean or you're a professor, you always have to figure out how can you communicate to people that you want to hear what they're unhappy about. People always assume that you don't want to hear that. The assumption is people who are in a certain position only want to hear good things and yet it's the exact opposite. If you only hear good things, you really never get anything done. The only way you can improve things is if people are speaking out about it. So even though you won't always have people welcome you with open arms when you criticize the situation because they'll be defensive or because they won't see a path to improve it, or maybe they literally don't agree with you, whatever. And it's hard to do, it's hard to be kind of the leading edge of pushing, but I do think that that is what changes the world. There have to be leading edge pushers. Not everyone has the personality for it. Sometimes you just want to grab hands with the pusher and go with them, but it's really crucial. Otherwise, things won't change.

Alexandra Arriaga: Well, thank you so much for the great advice, and it's been a pleasure talking to you too.

Dr. Melody Goodman Thank you for having us.

Dr. Cheryl Healton: It's wonderful.