WATCH NOW: COEE Hosts the Inaugural MaryAnn Black Distinguished Health Equity Lecture
Marcella Nunez-Smith, MD, MHS, presents "Health Equity in Action: Applying COVID-19 Lessons to the Cancer Equity March"
The Duke Cancer Institute Community Outreach, Engagement, and Equity program (COEE) hosted the inaugural MaryAnn Black Distinguished Health Equity Lecture on Feb. 9, 2023, in honor of the late MaryAnn Black, "for her extraordinary leadership, enduring impact, and powerful advocacy across the community." The event will be annual.
Black was a career social worker in Durham, North Carolina, who served on the County Board of Commissioners, worked as the associate vice president of community relations at Duke University Health System, and served in the North Carolina House of Representatives. Black died of cancer in March 2020, but her legacy lives on in the thousands of lives touched by her work in the areas of healthcare and education.
The distinguished speaker for the inaugural lectureship was Marcella Nunez-Smith, MD, MHS; associate dean for Health Equity Research and C.N.H. Long Professor of Internal Medicine, Yale University School of Medicine; and associate director, Yale Cancer Center. Her presentation was titled "Health Equity in Action: Applying COVID-19 Lessons to the Cancer Equity March."
Nunez-Smith's research focuses on health and healthcare equity for marginalized populations with an emphasis on the social and structural determinants of health, the influence of healthcare systems on health disparities, and the advancement of community-academic partnered scholarship. She previously served as senior advisor to the White House Covid-19 response team and chair of the Presidential Covid-19 Health Equity Task Force, and co-chair of the Biden-Harris Transition Covid-19 Advisory Board. Nunez Smith is also an elected member of the National Academy of Medicine.
Before Nunez-Smith began speaking, an all-star cast of Duke Health and EDI (equity, diversity, and inclusion) leaders from across campus, as well as MaryAnn Black's sister, paid tribute to Black, her work, and what she stood for.
Tomi Akinyemiju, PhD, Associate Director, COEE
I'm really excited to be here to honor the life and legacy of MaryAnn Black and welcome our distinguished guests. I came to Duke in 2019 and unfortunately did not get to meet MaryAnn, but in working with Nadine (Barrett) and Kimberly and Valerie, the more I heard about MaryAnn, the more I was inspired. I just felt so proud to be here in this institution and trying to follow in the steps of such an iconic legend. The work that she has done at Duke, in Durham, and in North Carolina continues to have a strong impact and serve as a model for the rest of us in the work that we are trying to do here in improving health and health care for our patients and our community.
My hope is that we leave here energized and inspired, and I think it will take all of us in this room combined to come close, maybe not even to the impact that she had, but I am confident that we can can do that.
Eugene Washington, MD, MPH, MSc, Chancellor for Health Affairs at Duke University, and President and CEO of the Duke University Health System
About MaryAnn Black
I'm deeply honored to be sharing some comments with you about our dear colleague and your friend MaryAnn Black at the inaugural Mary Anne black distinguished Health Equity Lecture. That sounds great, doesn't it? What a joy and honor it is to be with you and share a few words to celebrate the life and legacy of state representative MaryAnn Black.
In my role as Chancellor, MaryAnn was one of the first individuals that I met. When anyone met MaryAnn you first noticed that she has a warm personality and a pleasant demeanor and always a big smile. After speaking with her you soon realized she was a deeply caring person. She was a natural nurturer. She was also a very very smart person. She was versatile, extremely talented, and wise. She was a person of high emotional intelligence. When you spent a little bit more time with her you realize she was a mission-driven individual and her mission was, and I quote, "Doing good with the aim of improving the lives of people, particularly those who are underserved or living in vulnerable circumstances.
As associate vice president of Community Relations at Duke Health, she was the person who made sure that we kept community health and our community partners on the agenda at the highest level of our organization — whether that was as a member of our senior executive team or at the level of our Duke Health System Board of Directors. She was a person who helped us to be accountable, and by us, I mean both we and our colleagues here at Duke, but also our Community Partners across a range of sectors and disciplines. In her mind, first and foremost, we are here to be accountable to the people that we are here to serve.
... It is now almost three years since MaryAnn's passing. She's remembered as the quintessential public servant, an amazing individual, and a general in the battle for social justice and for equality to many of us. MaryAnn was not just a dear colleague and a close partner, she was also a dear
friend as she was for me and my wife Marie. Today when I think of her, I first think about that big infectious smile and then I think about what she left us with in the form of inspiration, wisdom, and commitment to carrying on her work
As part of MaryAnn's legacy, Duke Health continues to have community health as one of our missions. As many of you know most academic health centers typically have three missions: research, education, and patient care, but here we come to the table with a fourth — and that is community health. MaryAnn laid the foundation and led the work that elevated community health to the level of other missions. In fact, there's an argument that we make that education, research, and patient care are a means to an end where the ultimate end is improving the health of the communities we serve. It was MaryAnn who led the development of this core value for the Duke enterprise. Every day, she elevated the expectations of our role at Duke and what we could contribute in the community and she also elevated the expectations of our Community Partners for what we could achieve together for the people that we serve.
Durham Project Access
One remarkable achievement was Durham Project Access, an initiative that came about as a result of MaryAnn being the bridge between the community and Duke Health to address a specific problem, the deficiency of specialists available out in our community. Individuals were taking advantage of community-based primary care, but couldn't get access to a specialist once they had a diagnosis and this community-led project addressed that acute problem and has had a lasting impact that still endures.
Durham City of Medicine Academy
MaryAnn's vision also extended into areas that benefit future generations, including Durham City of Medicine Academy. She realized we could address health and healthcare through the development of the next generation of healthcare professionals, by providing educational opportunities to students in our community.
A third example was Healthy Durham. MaryAnn led Duke in this endeavor, but it also involved many partners including leaders from faith communities, businesses, government, education, and a host of nonprofits. They gathered together with the aim of not just improving healthcare but also focusing on those underlying socioeconomic determinants of health: food security, housing, transportation, early childhood development, and jobs. Through this multi-stakeholder multi-disciplinary coalition, we're just beginning to take on these higher-impact projects that are meaningful.
Mrs. Barbara (Faye) Brooks, MaryAnn Black's sister
I actually come with mixed emotions and as I told Dr. Washington I'm going to stand in for my nephew, but I am honored to be here.
And my focus is to talk about MaryAnn, my sister, the mother of two young men, one still alive, the grandmother of one, and the aunt of five nieces and nephews.
MaryAnn was a caring person, a lady of integrity, a lady that based her decisions on
research — research seeking information from those she felt had the correct knowledge. She would call you on the phone and say, "I need to have an understanding of this; would you help me get the answer for that ?"
She was a lady that loved to travel in the United States, London, China, and any place. She loved to travel and she wanted her sister to go along, but I was a little bit timid. I'm the one behind the scenes, so I didn't have the opportunity to go many places with her out of the country but we would have a wonderful time.
She loved beauty, and for those who knew her, you know she loved clothes and flowers.
She invited family along to visit various states and countries and she would take them along to see the beauty of God's creation.
She was an aunt who never hesitated. When her nieces graduated from college, she was there. Whatever it was, when they would call up and say, "Auntie," she would get on the plane or Auntie would drive. And what a legacy she has left for them.
She was the lady who stood strong in the midst of an illness and I'm sure many of you did not really know of this journey, but there's one lady in here who I'm sure (did) and that's Mrs. Dzau.
This is the Cancer Institute, so I would like to give you a few words that I know that my sister would say. And if you take them (these words), you will not only help yourself, but you will help the patients that you have the opportunity to encounter.
The first one would be COURAGE. She had a lot of courage and Dr. Washington is aware of this as well. She researched to find 'what is out there that will help me on my journey.' And so, encourage your patients to stay focused on what they need to do even though the outcome may not be what they want it to be. But just let them travel this journey the best way that they can. Be assertive. If the doctor says no, say 'Well let's research this and go find out, even if I have to get another doctor.'
CARE about yourself and others as you walk your path in life. She cared about herself, but she cared about others as well.
ENERGY Now, some days she wouldn't have the energy. But because of her motivation, she would say, 'Faye let's walk a little bit.' She could walk faster than I and we could take a few steps. She was always ahead. But keep the energy whatever that energy is — if it's for you personally or the energy for what you do as a healthcare provider. Love it. And because I've been in healthcare I would say, 'If you don't love it like MaryAnn loved it, get out because it's not for you.'
And RESEARCH, continue your research and say, 'Is this best practice for the patients that we are going to serve?' And if you feel that, based on your research, it is not, then again I would say, 'It's not good for the public.'
And so MaryAnn, my sister, not only left a legacy for Duke, because as the saying goes, 'She bled blue,' but she left a legacy for her family. It is difficult for me every day I try to wear something that represents MaryAnn to keep her close. I thank you for this opportunity and her brother thanks you as well and especially her nieces and her nephews. And again, I want to publicly say to Dr. Washington, 'Thank you so much.'
And I know you know her but I would like for Ruth Dzau to stand because that is the lady that brought the orchids, brought the soup, stayed up, and kept me connected from Florence, South Carolina, to Durham, North Carolina, and she is such a jewel. (LISTEN/WATCH Ruth Dzau's recollections of MaryAnn Black)
Nadine Barrett, PhD, Founding Director, Duke CTSI (Clinical Translational Scientific Institute) Center for Equity in Research, and Associate Director, Community Engagement and Stakeholder Strategy at DCI and Duke CTSI
There is nothing like a family giving a testimony about the impact that a person has had not just in our community but in their lives as a family. I think I speak for all of us here, I'm honored that you have taken the time to share another piece of MaryAnn, your sister, and for your family to share her with us to make our community better and most certainly toward us making a difference toward advancing health equity. So, thank you so much.
I want to highlight Valarie (Worthy) and Kim (Monroe) who were with us when we started the Office of Health Equity and Disparities.
I'm the founding director of The Office of Health Equity and Disparities for the Duke Cancer Institute, the first office of its kind and certainly one that led nationally and locally in terms of making a difference. And the key person that was a part of that from the very beginning was Dr. Mike Kastan who shared some reflections last night, which was really moving; talking about the impact that MaryAnn Black had when he first came here as director of the Duke Cancer Institute.
On Community Engagement
We all talk about what authentic engagement means. MaryAnn was very clear on what that meant. It didn't mean 'keep getting the community involved.' It didn't mean 'making sure you asked the community a quick question and then go and do what you do.' It meant, 'you're in the community, with the community, working together with the community, and ensuring that the priorities, the feedback, the insights of the community, is integrated into everything we do.' So, when we started the Office of Health Equity and Disparities MaryAnnwas instrumental in bringing together with Valarie and others an amazing Advisory Council. They were people who were movers and shakers in the community who MaryAnn knew very well and they were grassroots people that MaryAnn knew very well and they were patients whom MaryAnn knew very well. She did not hold back on ensuring that she had not just an impact on everyone's lives, especially those who are marginalized, but she was involved with every stakeholder that played a part in improving health — from the patient to the community, the family, the caregivers, you name it MaryAnn had them involved. So when I looked at our Community Advisory Council that's what it reflected. It reflected her heart, her passion, and all of those who are involved in really and truly making a difference for our community. So through that Office we did a lot of great things. It was foundational.
I remember the day that I met MaryAnn when I first started at Duke 11 years ago... She made sure that we met once a month, faithfully. We also shared a common birthday. It wasn't the same day, but my birthday is October 1st and hers is the 3rd. So on October 2nd of every year she and I would head on down to the Umstead and have lunch. It was great because we would talk about a lot of things. She wasn't just interested in 'how are you working' but 'how are you taking care of yourself,' 'how are you taking care of your community,' and 'what are the things that you're doing now, Nadine, and how is it working for you.' And we would really share things back and forth with each other to find out how we make sure that we never lose sight of our community and make sure that we're fully engaged with who we're talking to.
MaryAnn was instrumental in helping us (director Mike Kastan, deputy director Steve Patierno, and Valarie Worthy) on the back side of things. We brought together a room full of over 321 community members and providers to talk about how we improve cancer care access and quality. We actually had a waiting list of about 85 people because we had met capacity at the Marriott. It wasn't just bringing people together, but it led to a report and we developed a strategic plan with the community. This was the heart, passion, and commitment, that MaryAnne instilled.
It was something that we all were really committed to, as people who want to see our family members, people who look like us, get the great care that they need when they need it and in the quality they deserve.
I think that some of us remember (the late) Dr. Sharon Bynum Elliott and all of these incredible people that were a critical part of that network. Our Community Advisory Council became a family and it's because we all knew one thing — we wanted to make a difference, we had to make a difference, and we had to speak for those who have no voice. That was a critical part of what we did at the Cancer Institute.
When we look at MaryAnn, we look at her impact on politics, we look at her impact on Duke, and we look at her impact on the community. Even while serving in the political realm, in all of those areas, she never lost her focus on the community. She never lost focus on what is it that we need to do to make a difference.
On Last Words & Legacy
A few weeks before she passed, I actually called her and she answered the phone and I'll never forget that last call. I said, 'MaryAnn, how are you doing, what's going on.' And she goes, 'Wait, tell me what you are doing, tell me some stories, what impacts are you having in the community.' That's all she wanted to hear, talk about, and listen to.
To me, her legacy is that no matter what I'm doing, where I am, or where I go, it is important for me to never ever lose sight of our community. Never ever lose sight of why we do the work that we do within the Cancer Institute and beyond and never ever stop being relentless; ensuring that we are doing everything — all the work personally and in our jobs — to make a difference in bringing down structural systemic racism and advancing equity in our society.
We can continue to keep her legacy alive by ensuring that everything we do when we come through our doors and when we're at home and in the grocery store is about advancing equity, making change, and treating people the way that they deserve to be treated regardless of what your own personal beliefs may be.
Kimberly E. Monroe, MPA, Program Manager, Community Engagement, Office of Community Health, Duke Health
MaryAnn was a trailblazer who dedicated her life to promoting health equity and addressing disparities and access to quality healthcare. She recognized that access to quality healthcare is a basic human right and the way to improve access and health outcomes is to work with the experts, the people that we are trying to help in the community. She always said that the community was the experts and if we just listen to them, they will tell us how to help them.
It's because of her tireless efforts and unwavering passion that we are all gathered here today.
I came to the Office of Community Health in 2005 and I had the distinct honor and privilege to work side by side with MaryAnn and the community on so many important issues. She came to Duke with experience in direct patient care. She was a social worker and an administrator of a community health center. So she said, we were 'already two peas in a pod.' We would talk about systems and how difficult it was for people to navigate them.
We liked to spend some time discussing (things) over tea, and an oatmeal raisin cookie for me, because I like oatmeal raisin cookies, and she would give them to me. >
The Patient's Lived Experience
We would talk about the (patient) history and the physical; the H & P process for those of us in healthcare and how traumatic that could be for patients in times ofcrisis, so she was excited to hear about the programs that were coming out of the (Duke) Cancer Institute with Valarie and others who were (patient) navigators. She (MaryAnn) said what if they could start sooner? What if we could start by training the clinicians and talk more about that H & P (process).
She said it should be a dialogue and not a monologue. It should be an ongoing exchange of information. And she stressed the importance of listening to the patient's lived
experience and rich history because that history often impacts their physical and emotional health. And I keep that with me in all the work that I do. So, it's so important to authentically connect with the people you are trying to help. She pulled together people within the community and across to develop the principles of community engagement that we use as the foundation of how we work together and how we respect each other.
It's my hope and prayer today that when we all leave this lecture we recommit ourselves to the work that Marianne was so passionate about continuing — that open dialogue, working with the community to ensure that everyone has the opportunity to lead healthy and fulfilling lives.
Marcella Nunez-Smith, MD, MHS, Associate Dean for Health Equity Research, Yale University School of Medicine, and Associate Director, Yale Cancer Center
You know on this walk for health equity there are valleys and peaks and today feels like a peak.
To know that there is someone who left for us such a clear roadmap of what to do to be difference-making.
In my day jobs I think a lot about cancer and cancer in Connecticut at The Smilow Cancer Hospital and the Yale Cancer Center (a collaboration between scientists and physicians at Yale School of Medicine and Smilow Cancer Hospital).
Our catchment is the entire state of Connecticut and you know I could query people on what your images are of Connecticut but we are an incredibly diverse state that is a microcosm of the rest of the country, and we have among the steepest and greatest income and wealth inequality right in our little tiny state. We face many challenges but also many opportunities.
We really have to stay so focused on root cause and speaking to what drives and underlies the persistent disparities that we see. They are multifactorial. They are structural. They are intergenerational. And some of it requires some really difficult truth-telling and discussion. We have to name it as many people have already said here today.
In both Covid-19 and in cancer disparities we need to recognize not just historical, but also contemporary racial injustice. You know the slide says the distrust and the misinformation and disinformation that's out there (as a factor contributing to Covid-19 and cancer disparities), but we also need to own where we have been limited in our trustworthiness. And that can be tough for us; that internal self-look and that interrogation. And then understanding the lived experience of people and what a privilege it is to be able to prioritize health. What a privilege it is to have access to high-quality healthcare in our country, still, and what the realities are of having limited discretionary resources, particularly when facing a diagnosis of cancer. Not to mention the disproportionate burden from environmental exposures and other risk factors and coexisting conditions.
Maybe 10 to 20 percent of the variance we see in health outcomes has to do with genetics or biology.
How do we think and talk about and really own as healthcare providers and health systems, the fact that if we're working towards health for our patients, we need to be centering on social and economic factors? There is (also) variance here that's due to differences in how we take care of our patients and healthcare quality standards. So, it's smaller, yes, as a percentage than the socio-economic drivers, but dare I say it's inexcusable that in 2023 we should not be comfortable saying that where you get your care should determine the level of quality care that you receive. So I want us all to be committed to that within our health systems
Early on in the pandemic... we knew that people who self-identified as Black were experiencing very very high mortality rates from Covid-19, but it took many months right for us to realize what was happening in many other communities.. we all know the intersectional identities here. If you think about people with disabilities, which is a large percentage of our population, and early on we just did not have awareness, we did not have that data. And it's inexcusable right, it's its own form of violence when people cannot see themselves in our data and this is what happened in Covid and we can't let it be our norm that it's okay to not collect, report, and act on data for different groups.
For more of Dr. Nunez-Smith's powerful lecture, continue listening at timecode 42:00 or begin listening to her lecture from the beginning at timecode 34:00.