I dared not correct my elders, though my knees buckled at certain constructions, to say nothing of the contradictions. We didn’t answer “sir” to teenagers, so why did grandma answer “sir” to a white teenager? My push for justness in conversation earned me a few beatings and some alienation, and cost me a new pair of shoes. Still, my abstinence persisted, not so much as an act of rebellion, but as an outcry for clarity in a confused young life knocked topsy-turvy by race. More specifically, I balked unknowingly at this early parental pressure to get me converted, born again, and socialized into a state of inferiority—to be made a Negro. (Journalist and author Les Brown, “The Night I Stopped Being a Negro”)
By the 1970s the word Negro had become just as socially unacceptable to [Black] people as the images that depicted brutalized water-hosed bodies, terrorized by racialized canines and police batons.
There was a new energy. Black people shone like diamonds – with blowouts, Afro puffs, bell bottoms, and a rhythmic cadence that evoked a revolution that was indeed televised, called Soul Train. Edified by ancestors and predecessors who paid the price for them to take up the mantle, they lifted every voice and sang a new song called, “Black is Beautiful,” all the while chords from Marvin Gaye’s “What’s Going On” both pierced the soul and woke the unconscious.
The signs of the times were beyond palpable. In 1971, the average cost of gas was 36 cents a gallon and a dozen eggs a mere 53 cents. Today, those costs have increased by more than 100 times, but what has remained consistent are the economic, social, and medical injustices that continue to be fought downstream – if at all. Social determinants of health that led to preventable chronic disease for things like hypertension and diabetes have made little strides nationally over the past 52 years, while the maternal mortality rate for Missouri Medicaid-insured, Black birthing people continues to escalate at a rate 8 times higher than white privately-insured birthing people.
A New Thing
Something else happened in 1971. It was the year the University of Missouri-Kansas City School of Medicine started its medical program, led by Provost E. Grey Dimond, M.D. and Dean Richardson Noback, M.D. Out of the gate, Dean Noback required that 10% of the inaugural class represent minoritized people. He wanted the program’s student body to represent the community it would serve. Michael Weaver, M.D., President and CEO of Kansas City-based Mission Vision Project (MVPKC), was one of four African American students accepted into UMKC’s inaugural medical school class of 40 and would be the first African American person to graduate from the program’s inaugural class.
Dr. Weaver grew up in Kansas City near 27th and Prospect. He was the product of two parents who were both educators in the Kansas City Public School system. Thanks to early exposure to the health professions through a Medical Explorers Post at Research Hospital, Dr. Weaver solidified his interest in medicine.
“I always knew I wanted to do something science-related,” Dr. Weaver said. “I was a bit of a science nerd. But it wasn’t until I really had a chance to see patient care first hand up close that I knew this is what I wanted to do.”
Those experiences caused a ripple effect that aligned perfectly with what he’d do next. Dr. Weaver graduated from high school the same year the six-year medical program at UMKC started. “And so the idea of being able to complete medical school in six years rather than eight years was perfect,” he said.
Dean Noback’s intentionality to recruit and hold spaces for a percentage of Black medical students at UMKC in 1971, came one year before Kansas City’s first Black-owned and operated hospital, Wheatley Provident, closed, and 14 years after the area’s segregated system of medicine opted to integrate for primarily financial reasons.
According to the AMA Journal of Ethics, racism is one of the major causes of health problems in the U.S. Between 1970 and 2004, the Black-white mortality gap resulted in more than 2.7 million Black deaths – making racism a more potent killer than prostate, breast, or colon cancer.
It’s no secret that Black and Brown patients are less likely to receive adequate cancer screening or even organ transplants. Oftentimes this is due to physician bias and health care reimbursement structures that offer financial disincentives for caring for people of color.
Medical racism abounded even before legalized segregation that created systemic medical injustices for Black and Brown people. This has resulted in a stagnation of the number of Black physicians to a meager 4% increase over the last 120 years, according to a UCLA study. Simply stated, the number of Black physicians has remained the same since 1940. Today, Black people make up roughly 13% of the U.S. population, but only 5% of all practicing physicians according to Fortune.
Pursuing racial justice in medicine includes aggressively recruiting and supporting Black and Brown people to ensure the workforce reflects the diversity of the community. But the path to medical school, particularly for students of color, is often fraught with challenges.
‘Makes me wanna holler’
“It was one thing to get accepted into medical school,” Dr. Weaver said, “but then I was like, ‘Oh, but I can’t afford to go to medical school.’” Fortunately, UMKC had a scholarship available that made it possible for him to pursue his medical education.
But not all Black medical students have a Dean Noback in their corner or have access to scholarship dollars to carry them through med school. In fact, most don’t. To add to that, most Black students lack what Jamila, Dr. Weaver’s wife and MVPKC partner, calls social capital – a mom, dad, or close family friend who is a doctor, to help them navigate medical school.
Dr. Weaver can relate. He worked as an EKG technician and orderly at Saint Luke’s to help pay his way through medical school.
Financial barriers often act as the resounding coup de grace that makes medical school out of reach for Black and Brown students. “Finances are the barriers that create inequities,” Jamila said. “Students come in with varying financial resources, which means when extra costs are incurred for books, tests, and tuition, some students simply swipe a credit card, or send mom and dad a note for funds, and stay focused fully on school.”
For other students, this financial ease is unfathomable. They don’t come from backgrounds with intergenerational wealth. “And so, when they walk into school and they’re thinking, ‘I’m so glad I got here. I’m ready. I’m going to study and be all in.’ Then they find themselves dealing with financial aid every semester, not sure if they have enough to cover expenses. Then there’s the flat tire, the car repairs, and other unexpected expenses that become the burden that distracts from the ability to focus on school. They have to get a job, while their peers are fully focused on studying.”
Black borrowers carry more student debt, repay their loans at lower rates, and default at higher rates than their non-Black peers. A recent report by The Education Trust noted the relationship between student loan debt and systemic racism by pointing out the overlapping vulnerabilities, like unequal wealth distribution and rising college costs.
An AMSNY report found barriers for underrepresented students include:
- First-generation students are forced to navigate undergraduate degrees on their own, without guidance from parents with firsthand knowledge of how the system works.
- Improper guidance and advice from college counselors about applying to medical school.
- Working to pay tuition and/or provide support to their families, interfering with time dedicated to school and affecting grades and graduation rates. Only 11% of low-income students earn bachelor’s degrees within six years.
- High costs associated with applying to medical school, including MCAT prep courses, which are necessary for all test-takers, as well as the high costs of applications, travel to interviews, professional attire, as well as other factors that could grow to at least $10,000 dollars.
- Black and Brown students score significantly lower on the MCAT often due to a dual focus on work and school.
“That’s what leads to educational inequities and disparities related to testing outcomes and lower matriculation rates for Black and Brown students,” Jamila said. “Because we have intergenerational wealth disparities, how do we level the playing field? Change happens when people pull their lever of power to make a difference.” Jamila also attended UMKC for graduate school. She attended nursing school at St. Luke’s where she later worked as a facilitator for diversity, equity, and inclusion – which is where she met Dr. Weaver. Her career path also includes compliance and oversight for the Department of Health and Human Services Office of the Inspector General, where she made recommendations for how agencies can make improvements in serving patients and beneficiaries. She was later tapped to lead their equity and inclusion work and now supports MVPKC full-time.
Get Up, Stand Up: The Mission Vision Project
Dr. Weaver started mentoring students over two decades ago, and recently formalized the work by founding the Mission Vision Project KC (MVPKC), a 501(c)(3) nonprofit, which he runs with wife, Jamila. MVPKC’s mission is to increase the matriculation of students who are African American, Hispanic/Latin, and Native Peoples entering health science programs – with a focus on medicine – by collaborating with area hospitals, academic medical centers, and community partners. MVPKC’s mission is to inspire students to envision careers in health care.
To support mentorship, financial guidance, board test preparation, residency planning, and medical specialty selection, MVPKC has held Critical Mass Gathering (CMG) events that coalesce area minoritized physicians, CMG alumni, area medical schools, philanthropic organizations, and other community-based organizations. After attending, students report an increased sense of belonging within the medical community, awareness of career opportunities in medicine, and confidence to complete their course of study and enter residency.
After finishing medical school and residency, and then running Saint Luke’s Emergency Department, which he did for 17 years, Dr. Weaver was asked to mentor students attending UMKC’s medical school. After a while, other medical schools like the University of Kansas and Kansas City University were asking for the same thing.
“So I started doing these one-off mentorships and realized if I can really get all of the minoritized students together from all three medical schools, wow, then what a sense of visualization, what a sense of community, and what a sense of belonging that there are people who look like you who are having the same struggles and trying to attain the same goals,” he said.
“What we often hear from students is that their classmates have dads, moms, uncles, or neighbors who are doctors,” Jamila said. “They have the social capital to navigate medical school, to know what to expect, what to do, what not to do, and how to fit into the health care space. Well, if you are a person who doesn’t have anybody to ask questions, guide you, or help you navigate the process, then you are feeling lost. So, the Critical Mass Gatherings is a space where students come together to increase their social capital, network, learn from each other, and meet Black practicing professionals who are CMG alumni and who come back as mentors.”
Seventeen years ago, MVPKC held its first CMG event. Its most recent event last October was its biggest with more than 160 alumni, students, and other guests in attendance. Dr. Weaver, Jamila, Dr. Noback and his wife (who are both in their late 90s) have remained close friends. As for the nonprofit, it continues to build on its legacy by expanding upstream to include K-12 students who participate in mentorship programs to gain a sense of belonging and early exposure to the health professions. More recently, MVPKC launched the Physician Pathway Project which offers high school students at Lincoln College Preparatory Academy and Sumner Academy of Arts and Sciences a vision and pathway for pursuing medical school. This includes seeing the landscape of health care career possibilities and having the support, advocacy, and resources so that students can become highly qualified applicants.
“When we started the nonprofit, we realized that students can’t just wake up and say, ‘I want to go to medical school next year.’ Even though UMKC accepts students right out of high school, you just can’t start this journey your senior year. You must be STEM prepared, and you have to have the nurturing and mentorship,” Dr. Weaver said. “It’s impossible to hit a target you can’t see.” MVPKC has a mantra, “If you can see it, you can be it!” In Missouri, there are 75 Black students enrolled in AP courses for every 100 Black students who would need to be enrolled for the state to achieve fair representation.
There also needs to be community investment. GEHA, a nonprofit that provides health insurance to federal employees, provided academic scholarships to eight Black students at The University of Kansas School of Medicine last year. “Institutions have the power to make this investment in our community,” Jamila said. “The wage gap is real. We are both sitting here doing this work because institutions invested in scholarship funds. Neither of us came from intergenerational wealth that would fund our education.” Jamila added that three of the students who received GEHA scholarships volunteered with the MVPKC, serving as K-8 peer mentors and on the CMG committee. “The power for GEHA’s investment in those students is already working in the community,” she said. “Those students will be graduating in two more years, then they’ll walk into residency. The work we do is about nesting and tethering these students here. This is the power of what happens when the community invests because representation matters. They will bring culturally congruent care to Black patients.”
Fight the Power
Medicine has been a complicated and often traumatic saga for Black people. The path forward to equitable, anti-racist care must confront the medical distrust exacerbated by incessant experiments on Black bodies throughout history, subpar treatment for chronic diseases, and unnecessary barriers to quality health care.
For many Black people, the word “Black” signifies strength, unity, struggle, resistance, resilience, beauty, creativity, and excellence among other modifiers. When “Black” is coupled with “doctor”, hope arises for a nuanced system of care for Black people by someone who is culturally literate, who sees them, gets them, understands them, is them. Too often, a trip to the doctor for Black people comes with the same angst as a traffic stop. It’s a fact that the lack of Black doctors contributes to inequities. Studies show that Black patients treated by Black doctors have better health outcomes and experience higher patient satisfaction.
Political determinants of health (voting, government, and healthy policy) also play a monumental role in fostering separate but unequal systems of care for Black and Brown people. Education, transportation, housing, and income disparities, as well as food insecurity, access to quality health care, racism, sexism, ableism, nationalism, homophobia, xenophobia, public safety and other social determinants of health are rooted in racist political systems and constructs designed to perpetuate inequities. It is essential that these determinants are distilled and communicated in such a way that voters are activated to pull their lever of power at the ballot box to block or eject officials at federal, state, and local levels who champion oppressive policies that maintain the status quo. Additionally, white-led medical associations must also make sweeping changes to atone for historical practices that perpetuate medical racism and implicit bias.
“With this shared understanding of context and history, and to be effective with our programming, we ask institutions to have courage, to take action, and to move their levers of power. We must advance health equity through an individual and collective commitment to addressing structural racism,” Dr. Weaver said.
About this Work
MVPKC is a member of the Kansas City Health Equity Learning and Action Network (the LAN), under the leadership of the Health Forward Foundation and in partnership with the Institute for Healthcare Improvement (IHI), and the KC Health Collaborative (KCHC). The LAN actively develops comprehensive strategies and action plans to dismantle medically racist systems that circumvent optimal health and perpetuate health inequities for people of color. The Physician Pathway Project was developed as a part of MVPKC’s work with the LAN to increase the Black, Latin, and Indigenous pipeline of health professionals.
With more than 50 organizations participating, the LAN provides a forum for engagement, girded by a shared agenda, with education, training, tools, and expertise to markedly change systems, policies, and structures. The goal is to eliminate disparities in health care delivery, while realizing measurable improvements steeped in equity-centered, culturally responsive health outcomes for all health care consumers.
This article is the second of a series of articles that cover the systems-change work of the LAN and several of its members. Tonia Wright is the publisher and editor-in-chief of accessHealth News, which covers health policy and health equity-related topics.