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Category: Diversity, Inclusion, & Accessibility

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Five people seated at a conference table.

Since 2020, many people have actively sought out books, podcasts, webinars and other media to help them understand the origins of and ways to dismantle systemic injustices. People interested in incorporating anti-discriminatory techniques and practices into their daily lives may find it difficult knowing where to start. Taking large steps such as attending a rally or contacting your elected official may appear to be the only way to move towards change. But smaller actions are equally important and necessary. 

According to scholars, without education and a deeper understanding of systemic harms, it is difficult to address these harms or work towards solutions. Education is the first and crucial step in uncovering implicit and explicit biases. If you are interested in learning more about the history of racism, sexism, homophobia or any other form of discrimination, please visit GW SMHS Office of Diversity and Inclusion’s Anti-Racism Resources for Physicians or explore any of the resources listed in the references section. Journalist Anna North quotes educator and author Cornelius Minor in a Vox article, stating “Once you’ve educated yourself, the next step is “to actually take action that benefits the members of your community…”” (North, 2020, para. 22)

Scholars, activists and others have suggestions for allies who wish to address long-standing systemic issues:

  1. Be mindful of how you use social media: Social media is a useful tool for spreading awareness, sharing resource lists, connecting with like-minded individuals/organizations or listening to marginalized voices. Yet the ease in which people can ‘like’, comment or reshare posts means people may engage with content on a superficial level or mimic their peers without a deeper awareness of why an issue is important. This may be seen as ‘virtue signaling’ or ‘performative allyship.’ Virtue signaling is defined as “an attempt to show other people that you are a good person, for example by expressing opinions that will be acceptable to them, especially on social media.” (Cambridge Dictionary, n.d.) While performative allyship is “the practice of words, posts and gestures that do more to promote an individual’s own virtuous moral compass than actually helping the causes that they’re intending to showcase.” (Kersten, 2020, para. 6) Information moves rapidly on social media platforms and you may feel as if you need to share your opinion online. Before rushing to Facebook, Twitter or Instagram, ask yourself if you’re posting to alleviate your own anxiety or because you genuinely wish to show support and think about if there are alternative actions you can take instead of relying on social media. “With any kind of supposed social media activism, we need to be critical and examine who it’s actually helping and if there is a way it could be more effective.” (Rudhran, 2020, para. 11) There is no harm in expressing your support of marginalized communities online, but make sure your support is also visible and tangible offline. 
  2. Have difficult conversations: Challenging the opinions of your social circle can be hard and may activate complex emotions or responses. You may hear a harmful remark from a close friend or family member, but feel anxious about addressing the remark. “This physiological impact of conflict and stress prompts the brain to release cortisol and adrenaline into the bloodstream, putting the body into a fight, flight, or freeze response. In this state, we are biologically primed to respond to imminent danger–not to do complex thinking or bring our social graces to bear.” (Jackson, 2019, para. 23) Despite this, having difficult conversations not only provides space to educate and learn from others, but it also takes stress away from marginalized people who are already handling the stress of frequent systemic harm. If you’d like to engage in more in-depth conversations, there are resources that can assist you such as this guide from Teaching Tolerance or this article from Jamilah King. (North, 2020)
  3. Donate time or resources: Volunteering is a great way to connect with your local community. Nonprofit organizations often rely on volunteers to operate and deliver relief to the neighborhood. If there is an organization you’re interested in helping, research to see if they have volunteer opportunities. You can commit to becoming a regular volunteer or you can volunteer as your schedule permits. Consider bringing friends or family members with you as well. If you’re unable to volunteer your time, then think about making a financial donation to an organization if it is feasible. No matter how you decide to donate time or resources, supporting and uplifting organizations is a way to reaffirm your commitment to anti-discrimination ideals. 
  4. Speak out against discriminatory practices: Being aware of and understanding socioeconomic disparities enables you to speak out against discriminatory policies and practices that discriminate. In the workplace, long-standing hiring practices may unintentionally keep the selection pool small and homogeneous. If you’re in a position to evaluate hiring practices, speak up. “If you’re hiring, strengthen your own processes. Insist on open job listing and targeted recruiting to avoid an overreliance on referrals…Make sure candidate pools are diverse–with at least one person and ideally many people from marginalized groups. Finally, enforce fair application reviews and committee deliberations, watching for and calling out red-flag comments.” (Melaku et al., 2020, para. 32) You can also push back against harmful laws and regulations by contacting your elected representatives, attending community forums, signing petitions or by participating in other civic duties. 
  5. Admit mistakes: Being an ally means being visibly and vocally supportive of marginalized communities. But sometimes people make mistakes. If this occurs, it is best to admit to the mistake, pause for reflection and continue to show support where you can. “Being an ally is an ongoing process, and you are bound to say or do the wrong thing at certain points. Sometimes, the best way to learn is through trial and error. The important thing is to acknowledge when you’re wrong, and to not make those same mistakes again.” (Kersten, 2020, para. 10) View mistakes as opportunities to learn and grow. If someone corrects you, remain open and thank them for being willing to educate you. Being an ally does not mean you must aim for constant perfection. Instead it means offering support when you can and learning from any missteps you encounter. 

Education provides us with tools to grow and act as better allies. Action presents us with opportunities to show our commitment in tangible ways. Education and action create a steady cycle of allyship and advocacy that moves us closer towards an equitable and inclusive world. As this year’s Black History Month comes to an end and Women’s History Month approaches, spend time reflecting on how you wish to ally yourself with marginalized communities and search for opportunities to share your time or other resources with organizations in need of support. 

References:

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Image of Estelle Osborne. Estelle Massey Osborne (1901-1981) Paving the way for Black Nurses
Image from https://nursing.nyu.edu/news/events/30th-annual-estelle-osborne-legacy-celebration

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post celebrates Black History Month by honoring Estelle Massey Osborne, a Black nurse who helped pave the way for Black nurses who followed.

Estelle Massey Osborne, known as “Stelle” to her family, was a hugely influential figure in American Nursing. Osborne was born in 1901 in Palestine, Texas, and was the eighth of William and Betty Massey’s eleven children. After completing two years of teacher training at Prairie View State Normal and Industrial College, Osborne worked as a public school teacher for two years (Schomburg Center for Research in Black Culture [SCRBC], n.d.). Following an act of violence committed at the school that almost resulted in her death, Osborne moved to St. Louis, where her brother Edward was a dentist, to pursue a career in nursing (SCRBC, n.d.). 

When Osborne began her nursing studies, only 14 of the 1,300 nursing schools in the country admitted Black students (New York University Rory Meyers College of Nursing [NYU], 2020). During this time, the American Nursing Association (ANA) refused membership to Black nurses and the Navy would not enlist Black nurses (NYU, 2020). By the end of Osborne’s career, thanks to her hard work and dedication to advocacy in the field of nursing, she saw the fruit of her work through the positive changes in all of these organizations. 

In 1923, Osborne completed her nursing degree at the Graduate School of Nursing at St. Louis City Hospital, later the Homer G. Phillips Hospital (Encyclopedia.com, n.d.). In 1928, Osborne was the first Black nurse to receive the  Julius Rosenwald Fund scholarship (NYU, 2020). She then continued her education and received a Bachelor of Science degree in 1930 and a Master of Arts degree in 1931 from Columbia University Teachers College (SCRBC, n.d.). She was the first Black nurse to earn a Master’s degree (NYU, 2020). Meanwhile, she also spent time teaching at two local nursing schools and was the first African-American instructor at the Harlem Hospital School of Nursing (NYU, 2020). 

After completing her Master’s degree, she worked as a researcher for the Rosenwald Fund where she studied rural life in the deep South. Her work focused on investigating ways to improve health education and service to rural Black communities (NYU, 2020). Along with a team of scholars, she helped perform a behavioristic study on the health and welfare of Blacks in the South (Pitts Mosley, 2002). This research experience proved invaluable to Osborne’s later work and provided the exposure she needed to make an impact on professional nursing on a large scale (Pitts Mosley, 2002). 

Osborne served as the president of the National Association of Colored Graduate Nurses (NACGN) for five years from 1934 to 1939 (SCRBC, n.d.). The NACGN was “established to promote professionalization, education, and practice opportunities for Black nurses throughout the country” (Pitts Mosley, 2002). In 1940, Osborne became the first Black Superintendent of Nurses at the Homer G. Phillips Hospital in St. Louis (NYU, 2020). The Homer G. Phillips Hospital was the largest exclusively Black, city-operated general hospital in the world and at the time served over 70,000 people (NYU, 2020). Osborne also became the first Black female director of the hospital’s nursing school. 

During World War II, Osborne worked as a consultant to the Coordinating Committee of Negro Nursing for the National Council for War Service (NYU, 2020). In 1943, in response to a severe shortage of nurses both at home in the United States and overseas within the military, Congress passed the Bolton Act. The Bolton Act was considered the largest experiment in federally subsidized education in U.S. history and appropriated $160 million dollars of federal funding to 1,125 nursing schools across the country (Frances Payne Bolton School of Nursing [FPBSON], 2023). The Bolton Act also created the U.S. Cadet Nurse Corps which produced more than 124,000 nurse graduates over a five-year period (FPBSON, 2023). Osborne was instrumental in ensuring that Black nurses benefited from the Bolton Act funding in nursing education and financial aid (NYU, 2020). 

She was also influential in expanding the number of nursing schools accepting Black students and, with the help of strategic ally Eleanor Roosevelt, in convincing the U.S. Navy to lift its color ban and accept Black nurses in 1945 (NYU, 2020). As a result of Osborne’s influence, the number of schools accepting both Black and White students grew from fourteen to thirty-eight(Pitts Mosley, 2002). The Cadet Nurse Corps had also enlisted 2,000 Black students and was providing financial assistance towards their education (Pitts Mosley, 2002).

In 1946, Osborne became the first Black faculty member at what is now the NYU Rory Meyers College of Nursing (NYU, 2020). During her eight years at NYU, Osborne had the opportunity to mentor numerous Black students and nurses. “Her NYU affiliation also helped to disprove the belief that only White nurses were capable of obtaining and managing leadership positions in nursing” (Pitts Mosley, 2002). Over the next 20 years, Osborne would serve in numerous national leadership positions including as the first African American member of the American Nursing Association Board of Directors (1948-2952), Assistant Director of the National League for Nursing, the first Vice President of the National Council of Negro Women, a member of the National Urban League, and as an honorary member of Chi Eta Phi Sorority and the American Academy of Nursing (NYU, 2020). Osborne was named the NYU Department of Nursing “Nurse of the Year” in 1959 and was inducted into the ANA Hall of Fame in 1984, three years after her death (NYU, 2020). 

Estelle Massey Osborne’s impact on the field of nursing and on racial equity within the field is undeniable. Her influence and legacy live on through the long-lasting impact of her work. She did not back down from racial prejudices and worked to dismantle systemic racism within professional nursing. Her work has opened doors for Black nurses for generations to come.

References:

Encyclopedia.com. (n.d.). Osborne, Estelle Massey (1901-1981). Dictionary of women worldwide: 25,000 women through the ages. https://www.encyclopedia.com/women/dictionaries-thesauruses-pictures-and-press-releases/osborne-estelle-massey-1901-1981

Estelle Massey Osborne [photograph]. (n.d.). 30th Annual Estelle Osborne Legacy Celebration. https://nursing.nyu.edu/news/events/30th-annual-estelle-osborne-legacy-celebration

Frances Payne Bolton School of Nursing. (2023). The Bolton Act: Making the nursing profession more accessible to everyone. Case Western Reserve University. https://case.edu/nursing/about/history/bolton-act#:~:text=The%20Bolton%20Act%20of%201943,history%20of%20the%20United%20States

New York University Rory Meyers College of Nursing. (February 18, 2020) Celebrating Estelle Osborne, nurse trailblazer. NYU Rory Meyers College of Nursing. https://nursing.nyu.edu/news/celebrating-estelle-massey-osborne-nurse-trailblazer

Pitts Mosley, M.,O. (2002). Great Black nurses series: Estelle Massey Riddle Osborne. ABNF Journal, 13(5), 114-7. http://proxygw.wrlc.org/login?url=https://www.proquest.com/scholarly-journals/great-black-nurses-series-estelle-massey-riddle/docview/218904485/se-2

Schomburg Center for Research in Black Culture, The New York Public Library. (n.d.). Estelle Massey Osborne papers, 1943-1967. New York Public Library Archives & Manuscripts. https://archives.nypl.org/scm/20749

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February is Black History month, and what  better time to recognize and support the black community than by paying tribute to the many heroes of the past by visiting historical sites, or partaking in some of the many events that are happening within the D.C. area? 

If you are uncertain where to begin, why not visit the Smithsonian Museum of African American History and Culture? Open Wednesday through Sunday, and free of charge, all it takes is a reservation to visit the four-story museum, which opened in 2016. Its collection of thousands of artifacts  covers the arts to the civil rights movement, athletics and more. 

You can also visit the famous Lincoln Memorial at the National Mall. A tribute to President Lincoln who declared that all men were created equal in his Gettysburg Address, it also serves as the location of Dr. Martin Luther King’s “I Have a Dream” speech which is etched into the Memorial’s steps. Designed as a tribute to Dr.King's life, in 2011 his memorial was opened to the public and stands to this day, as a monument to the freedom, equality, and justice that he stood for.  

If you are looking for something other than museums, from February 10th to April 2nd, you can catch The High Ground at the Arena stage. A powerful story of resistance and recovery from trauma, this is a play you will not want to miss! 

When it comes to lessons learned from the past, Rosa Parks teaches us all a valuable lesson: “We will fail when we fail to try.” Find out more about Rosa Parks, and the impact she made at the dedicated tour at the O Street museum. To participate in the tour, make a reservation at their website. 

If you are feeling hungry, why not show your support by visiting a Black-owned restaurant? From tea and Ethiopian cuisine to southern comfort meals and seafood, even Ben’s Chili bowl can’t be beaten! 

Washington D.C. has so much to offer in the form of events, sights to see, museums, and presentations. To find out more about the ways you can attend, be sure to visit their website for specific dates, locations, and times throughout the month of February. 

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Photo by Wilson Rodriguez

Rev. Dr. Martin Luther King, Jr. is well known for his passionate and thoughtful speeches that examined racial discrimination in the United States, the negative impacts of poverty and a need for communities to rally behind and support vulnerable populations. One of his most well known speeches, ‘I Have a Dream,’ occurred on the steps of the Lincoln Memorial on August 28, 1963 during the March on Washington for Jobs and Freedom. 

Dr. King’s speeches primarily focused on education, access to housing, racial desegregation in public and private spaces and building an equitable country. But on March 25, 1966, Dr. King spoke at a meeting of the Medical Committee for Human Rights where he discussed racial inequities and health. The full transcript for this speech has not been discovered, though fragments of it were printed in newspapers. Similar to Dr. King’s other speeches, his speech at the meeting not only addressed the harsh realities of people of color, particularly Black Americans, in the country, but also urged the listeners to educate themselves on these inequities and pursue action to dismantle systemic oppression. 

Due to the lack of a speech transcript, there are different iterations of Dr. King’s words and thoughts on health inequity. Professor Charlene Galarneau uses the following quote in her article ‘Getting King’s Words Right’: 

“We are concerned about the constant use of federal funds to support this most notorious expression of segregation. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. 

I see no alternative to direct action and creative nonviolence to raise the conscience of the nation” (Galarneau, 2018, p. 5).

Galarneau states that these words were spoken during a press conference before the annual meeting and were documented by news sources such as the Associated Press. We may never know Dr. King’s exact words during the press conference or during his speech, but this quote shows that Dr. King understood the pressing need to address injustices in health. 

During the time of his speech, Black patients and healthcare providers were facing widespread discrimination in healthcare centers. Organizations like the Medical Committee for Human Rights sought to address the healthcare needs of underserved communities, while also building healthcare centers that would continue the work once the committee’s healthcare workers relocated. "A predominantly white organization, the committee would continue to assist civil rights workers in Mississippi and other southern states but shifted its focus to deal with health problems facing thousands of poor blacks who lacked any medical services” (Dittmer, 2014, p. 746).

Dr. King’s speech highlighted another area of society that suffered from racial and economic discrimination, thus furthering the divide between the privileged and the underserved. As Galarneau writes in her article “King’s words remind us that health and health care are social goods at the community and national levels. As such health and health care are socially created and require social responsibility in a collective agreement about what constitutes health in/justice” (Galarneau, 2018, p. 7).

Dr. King’s remarks are also a call to action. He believed that everyone had a role to play in dismantling injustices domestically and globally. He strongly encouraged people to seek out information about the issues related to racism and economic inequality and apply this knowledge to establish and maintain inclusive communities.

As we all spend the MLK holiday weekend reflecting on the words and legacy of Rev. Dr. Martin Luther King Jr., Himmelfarb Library would like to offer resources and promote events that build upon the advocacy work that Dr. King participated in. Himmelfarb Library’s Diversity and Disparities in Health Care, Diversity in Dermatology, and Humanities & Health Collection highlight library resources that explore topics related to inequities in health care and how to build a more inclusive health care system. 

On Wednesday, January 25 at noon, the Anti-Racism Coalition will hold the 7th Annual SMHS Dr. Martin Luther King, Jr. Lecture Series–Advancing the Dream: Why We Can’t Wait. Milken Institute School of Public Health professor, Dr. Wendy Ellis, will participate in a conversation about “race, advocacy, and finding your voice in the fight for racial justice…” Registration for this event is now open. 

If you are interested in taking action to address health inequities, consider joining local student or professional organizations such as White Coats for Black Lives, Antiracism Nursing Student Alliance, or Black Public Health Student Network. Collaborate with your peers to find creative solutions to teach the public about health injustices or search for local issues that may need your support. 

Dr. King understood that a coalition was required to build an inclusive and equitable future and we can honor his legacy by connecting with like-minded community members and seeking out their advice and feedback.

References:

Galarneau, C. (2018). Getting King’s Words Right. Journal of Health Care for the Poor and Underserved, 29(1), 5–8. https://doi.org/10.1353/hpu.2018.0001

Dittmer, J. (2014). The Medical Committee for Human Rights. AMA Journal of Ethics, 16(9), 745-748. https://doi.org/10.1001/virtualmentor.2014.16.9.mhst1-1409

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Image of open book and Christmas decorations
Image by Ylanite Koppens on Pexels

While we’re currently scrambling to study for finals, wrap up projects, and prepare for celebrations, soon there will be time to relax and kick back with a good book. Most of Himmelfarb’s collections are not your typical leisure reading, but you will find exceptions in a few of our special collections. The Humanities and Health collection, located in the nook on the first floor, has a variety of popular fiction and nonfiction books with a tie in to health topics or health providers. All of these books check out for a three week period with two possible renewals.

Browsing this collection you’ll find some bestselling fiction titles, including Homeland Elegies, Ian McKewan’s Saturday, and The Tiger’s Wife. Familiar nonfiction includes Dopesick, The Immortal Life of Henrietta Lacks, and Guns, Germs and Steel. You’ll also find many books about the experience of being a healthcare provider. Below are some other recommended selections from the collection.

All Boys Aren’t Blue: a memoir manifesto by George Johnson, 2020: A collection of essays by an LGBTQIA activist, recounting what it was like to grow up as a Black queer young man. It addresses gender identity, bullying, toxic masculinity and consent and has been a frequent target of recent book banning efforts.

Consumptive Chic: a history of beauty, fashion and disease, by Carolyn A. Day, 2017: In the early 19th century it became trendy to have tuberculosis, or at least look like it. An emaciated body and flushed complexion was the height of fashion. The book examines how fashion practices of the time may have made women more susceptible to the disease and recounts the history of the tuberculosis epidemic in Europe which caused 25% of deaths at its peak.

In Shock: my journey from death to recovery and the redemptive power of hope by Rana Awdish, 2017: Awdish is a critical care physician who found the tables turned on her when a severe hemorrhage caused her to lose her baby and put her close to death. After multiple hospitalizations, Awdish recognized how current medical practice puts physicians at an emotional distance from their patients and makes recommendations for taking down the barriers.

The Jump Artist by Austin Ratner, 2009: Philippe Halsman became famous for his photos of celebrities leaping into the air and collaborations with Salvador Dali. This book focuses on his conviction and imprisonment for the murder of his father in 1920’s Austria where anti-Semitism was on the rise. Halsman was pardoned after leading Jewish intellectuals of the time lobbied for his release.  

My Own Country by Abraham Verghese, 1994: Best known for Cutting for Stone, this memoir is about Verghese’s experience as a young infectious disease specialist working in a small Appalachian town in Tennessee at the beginning of the AIDS crisis. Verghese relates the prejudice he encounters, as well as the care and compassion, in meeting the clinical and emotional needs of his patients. 

Patient H.M.: a story of memory, madness and family secrets by Luke Dittrich, 2016: The victim of a botched lobotomy, Patient H.M. lost the ability to form long term memory. He became the most studied neuroscience patient, teaching scientists much of what is known about memory today. The book was written by the grandson of H.M.’s surgeon, who confronts his family history and the ethics of early neurosurgical procedures. Winner of the PEN/E.O. Wilson Literary Science Writing Award.

Ship Fever and other stories by Andrea Barret, 1996: Winner of the National Book Award, the volume includes a novella and several short stories involving science and medicine set in past and present. Mendel and Linnaeus are subjects, as well as relationships between scientists in the field. 

The Strange Case of the Broad Street Pump by Sandra Hempell, 2007: In 1830’s London a doctor uses unconventional methods to trace the spread of a cholera epidemic and make the connection to drinking water. The book which reads like a mystery includes details of life in Victorian England and the emergence of public health practices.

Is there a title on your leisure reading list that isn’t in our collection? You can check to see if it’s available from another academic library in DC and request a consortium loan. To search consortium library collections, use the Articles + GW & Consortium Catalog scope in Health Information @ Himmelfarb as shown below.

Screenshot of library catalog search box with scope selections menu

If another library has it, sign in to use the Consortium Loan Service request form to request borrowing and delivery to Himmelfarb Library. This quick tutorial video shows you how to make a request.

You can also check our Take a Book, Leave a Book Shelf (our free little library) for popular non-health sciences related books.

We wish all of our patrons a safe and relaxing winter break!

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Photo by EVG Kowalievska

The United States has a history of assisting vulnerable populations with community needs, often with varying degrees of success. The Indian Health Service (IHS), part of the Department of Health and Human Services, is one such government organization that provides healthcare for millions of Indigenous people and since its inception, the service has positively impacted federally recognized Native nations despite budgetary constraints. The Service employs physicians, nurses, dentists and other healthcare professionals to meet the healthcare needs of Indigenous populations and the organization sponsors professional opportunities for Indigenous students at both the undergraduate and graduate levels who express an interest in entering the healthcare field.

The Indian Health Service was created in 1955 and was born out of a long history of the United States government providing assistance to Indigenous nations. “The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article 1, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders.”(Warne & Frizzell, 2014, p. S263) The federal government would send military physicians to Indigenous communities in an effort to address the spread of diseases such as smallpox. Unfortunately the government spent far less money on the healthcare of Indigenous people in comparison to members of the military. In 1880, the Commissioner of Indian Affairs, Thomas J. Morgan requested more funding to cover expenses and he “calculated the disparity in resources, finding that the Army spent $21.91 per soldier and the Navy $48.10 per sailor, while the government only appropriated $1.25 per Indian patient.” (Trahant, 2018, p. 118)

In 1911 President William Howard Taft urged Congress to raise the salary of healthcare workers employed in the Indian Service. But the history of underfunding Indigenous healthcare continued. When the Bureau of Indian Affairs opened a health division in 1921, the system suffered from poor funding, unsanitary facilities and inadequate supplies which placed a strain on the quality of care provided. In 1955, Congress transferred the health programs away from the Bureau of Indian Affair to the newly formed Indian Health Service. They also raised the service’s budget from $10 million to $17.7 million a year. Finally in 1976, “Congress proposed a sweeping new authorization for Indian health programs. The Indian Health Care Improvement Act…called on Congress to appropriate at least $1.6 billion in new funding for Indian health, spending resources on improving staffing, facilities, access to care for urban Indian populations, and, for the first time, opened up Medicare and Medicaid revenue.” (Trahant, 2018, p. 119)

The Indian Health Service’s headquarters is located in Rockville, Maryland and has twelve service areas located across the country. The current head of the service is Roselyn Tso, an enrolled member of the Navajo Nation. Tso began working for the Service in the 1980s and has worked in many different capacities, including serving as the director of the Indian Health Service Navajo Area in 2019. The Indian Health Service provides access to hospitals, health centers, dental clinics and behavioral health facilities to Indigenous communities in the twelve service areas. The organization also offers healthcare education so people can improve their quality of health outside of regularly scheduled appointments. The Indian Health Service is one of the few federal organizations that prioritizes Indigenous applicants during the job search process and they also host funding opportunities for students interested in a career in healthcare. Scholarships are available for undergraduate, graduate and preparatory school students. The Indian Health Service also offers an extern program where participants earn valuable, hands-on skills while working in IHS facilities. 

While the organization continues to suffer from poor funding in comparison to other federal organizations, the Indian Health Service has improved the overall health of their patients. For example, the infant mortality rate for Indigenous communities has drastically decreased since 1955 and “The Centers for Disease Control and Prevention reported that, in the United States from 2004 to 2008, 84 percent of American Indians and Alaska Natives have a ‘usual place for health care.’” (Trahant, 2018, p. 120) Besides the lack of adequate funding, another criticism of the Indian Health Service is the organizations’ lack of focus on Indigenous people who live in urban areas.  Over the years, the IHS has sought  to provide resources to patients in urban areas,  and to meet the needs of over 2 million Indigenous patients.

The Indian Health Service was born out of the numerous treaties, legally binding agreements and promises made between the US federal government and the governments of Indigenous nations such as the 1832 treaty between the War Department and the Winnebago Tribe in Wisconsin in which the federal government promised two physicians in exchange for land (Trahant, 2018). The healthcare and administrative workers in the IHS search for creative solutions to meet the pressing healthcare needs of their patients. And by offering scholarships and externships, the organization aims to tackle the healthcare industry’s lack of Indigenous workers. The Indian Health Service’s mission is “To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level” and by fulfilling this mission, the IHS provides an example for other healthcare organizations committed to addressing health disparities in other vulnerable and underserved communities.

References:

Indian Health Service. (n.d.). Indian Health Service: The Federal Health Program for American Indians and Alaska Natives. https://www.ihs.gov/

Marcinko, T. (2016, November 13). More Native American Doctors Needed to Reduce Health Disparities in Their Communities. AAMCNEWS. https://www.aamc.org/news-insights/more-native-american-doctors-needed-reduce-health-disparities-their-communities. 

Warne, D. & Frizzell, L.B. (2014). American Indian Health Policy: Historical trends and contemporary issues. American Journal of Public Health, 104(3), S263-S267. https://doi.org/10.2105/AJPH.2013.301682

Trahant, M.N. (2018). The story of Indian health is complicated by history, shortages, & bouts of excellence. Daedalus, 147(2), 116-123. https://doi.org/10.1162/DAED_a_00495

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Headshot of Michael E. Bird
Photo credit: Leadership Academy for the Public’s Health

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post celebrates the contributions of Native American Michael E. Bird to the field of public health.

Michael E. Bird, a Santo-Domingo/Kewa Pueblo Indian from New Mexico, has more than 25 years of experience working in public health and with Native American populations. After growing up in New Mexico, California, and Utah, Bird earned his bachelor’s degree in anthropology and a master of social work (MSW) degree from the University of Utah (Berkeley Public Health, 2020). Bird worked as a medical social worker prior to completing his master of public health at the University of California’s Berkeley School of Public Health in 1983 (Berkeley Public Health, 2020).  

Cover of the American Journal of Public Health, Volume 104, No. S3 (June 2014).

Bird was the first Native American to serve on the National Policy Council of AARP, as well as the first Native American and social worker to become President of the American Public Health Association (APHA) (University of Utah College of Social & Behavioral Science (UT CSBS), n.d.). During his time as APHA President, the APHA’s journal, the American Journal of Public Health, published a supplemental issue focused on Native public health - a historic first for the journal.

Bird has also served as the executive director of the National Native American AIDS Prevention Center, and has worked with the Indian Health Service (IHS) for 20 years (UT CSBS, n.d.). Additionally, he has served as President of the New Mexico Public Health Association and has been a board member of numerous organizations including the Kewa Pueblo Health Corporation, and the American Indian Graduate Center among others (UT CSBS, n.d.).

Bird became aware of the public health issues facing Native Americans while working at the Santa Fe Indian hospital. He spoke of this experience in an interview with Berkeley Public Health in which he explained “ [I] wasn’t able to have the kind of impact I wanted to have, and that no matter how good I was, or what I did, that it was sort of a revolving door for patients. … That lack of opportunities for Native people was contributing to their health conditions.” (Berkeley Public Health, 2020). Bird went on to explain that working for the Indian Health Service made him even more aware of the constraints of working with an underfunded bureaucratic system that “didn’t provide enough support and leadership, and was not engaging tribal communities in a respectful, collaborative manner” (Berkeley Public Health, 2020).

In July 2020, Bird spoke about the disproportionate effect of COVID-19 on Native Americans during this same interview with Berkeley Public Health. Conducted early on during the COVID-19 pandemic, Bird stated that in New Mexico “Native Americans make up 11 percent of the general population but they make up 50 percent of the COVID-19 cases” (Berkeley Public Health, 2020). Bird explained that the Pueblo tribes and Navajo Nation, both significantly impacted by the pandemic, had high poverty rates and marginalized populations with people living without “adequate housing, water, or electricity, and COVID just compounds all these conditions. It’s not just obesity, it’s what created obesity” (Berkeley Public Health, 2020). 

In the July 2021 issue of Nation’s Health, Bird outlined some actions that can be taken to improve health inequities among Native American populations. “First, we need to ask ourselves how we got here, and what we’re willing to do to move in an ethical and humane direction” (Bird, 2021). He further explains that committing to “involve communities whose voices have been largely absent from the rooms where power and policies are created, which determine our future” is essential if we want to move forward (Bird, 2021).

In October 2020, Bird presented a session titled “Owning Historical Trauma: A Precursor to Strengthening Public Health” at the APHA Virtual Annual Meeting. Watch the following video to hear Bird’s thoughts on this issue:

“I think the other thing is that one of the polite terms that’s used is “comorbidities” for communities. It’s a polite way of really not addressing the real issue. The real issue is historical trauma, the real issue is poverty, the real issue is racism. … this is important because people don’t know the history of this country, particularly when it comes to native populations. People don’t understand the context, the nature of disparities, the nature of poverty, racism, and how history is tied to all of that.” ~ Michael E. Bird

(American Public Health Association, 2020).

Interested in learning more about Native American Health? Check out the Native Health Database. Take a look at our blog post about this resource to learn more!

References:

American Public Health Association (APHA). (2020, October 24). Michael Bird, MPH, MSW - National Consultant, National Policy Council for AARP . https://www.youtube.com/watch?v=OmRgzfKKe9M

Berkeley Public Health. (July 23, 2020). How can American get Native health right? A conversation with Berkeley Public Health alumnus Michael E. Bird. https://publichealth.berkeley.edu/news-media/school-news/how-can-america-get-native-health-right/

Bird, M.E. (2021). Then & now: 20 years later, has the American Indian and Alaska Native health improved? Nation’s Health, 51(1), 8.

University of Utah College of Social & Behavioral Science (UT CSBS). (n.d.). Michael E. Bird. CSBS Alumni, Emeriti, and Friends Spotlight. https://csbs.utah.edu/alumni-spotlights/m-bird.php

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October is Breast Cancer Awareness Month, a time when we show support for breast cancer patients and raise awareness of the disease and the importance of early detection. 1 in 8 women will receive a breast cancer diagnosis sometime in their lifetime. Though tremendous progress has been made in early detection and treatment since the 1980s, 43,000 women still die annually of breast cancer and there are significant disparities in who is more likely to survive.

“In the United States, age-adjusted breast-cancer mortality is about 40% higher among Black women than among non-Hispanic White women (27.7 vs. 20.0 deaths per 100,000 women from 2014 through 2018), despite a lower incidence among Black women (125.8 vs. 139.2 cases per 100,000 women)” according to a recently published Perspective article in the New England Journal of Medicine.1 The article asserts that Black women have benefited less from mammography than White women and that social determinants of health play a role. The higher incidence of hormone receptor (HR) negative cancer subtypes, including triple-negative, in Black women is another factor in survival disparity. These tumors are harder to detect by mammography, more aggressive, and not responsive to hormone therapy, making for a poorer prognosis than the more common HR positive subtypes. The NEJM article calls for making prevention and treatment of triple-negative breast cancer a national priority.

Recently there has been a campaign for alternate methods of early cancer detection for women with dense breasts. Dense breasts can make a mammogram more difficult to read. 38 states now require notification of women who have had a mammogram that indicated high tissue density. 16 states and the District of Columbia now also have expanded insurance coverage for these women, usually allowing an annual mammogram and 3D mammography, MRI, or ultrasound screening. However, most organizations in the US that author breast cancer screening guidelines do not recommend supplemental imaging for women with dense breasts. The National Cancer Institute (NCI) has an FAQ on dense breast tissue, breast cancer risk and screening.

Genetic testing for BRCA gene mutations also has the potential to reduce breast cancer incidence and mortality. 55%–72% of women who inherit a harmful BRCA1 variant and 45%–69% of women who inherit a harmful BRCA2 variant will develop breast cancer by 70–80 years of age.2 Testing is not recommended for the general public. Only those with increased risk for a BRCA mutation should pursue genetic counseling and potential testing. The NCI has a guide on BRCA cancer risk and genetic testing, outlining at-risk populations, benefits and harms of testing, and treatment options for those who have the mutations.

  1. Jatoi I, Sung H, Jemal A. The Emergence of the Racial Disparity in U.S. Breast-Cancer Mortality. N Engl J Med. 2022 Jun 23;386(25):2349-2352. doi: 10.1056/NEJMp2200244. Epub 2022 Jun 18. PMID: 35713541.
  1. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA. 2017 Jun 20;317(23):2402-2416. doi: 10.1001/jama.2017.7112. PMID: 28632866.

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Portrait of Dr. Antonia Novello.
Photo By United States Department of Health and Human Services

Dr. Antonia Novello is a healthcare professional who for many decades focused on improving the health of women, children and those most vulnerable in modern society. 

She was born in Puerto Rico on August 23, 1944 and is the oldest of three children. During her childhood, Dr. Novello suffered from congenital megacolon which impacted her large intestine. Treatment options were available, but due to her family’s financial situation, Dr. Novella was unable to receive surgery to cure the condition until she was eighteen years old. This experience had a lasting impact on her and was one factor that inspired her to pursue a career in health sciences. Dr. Novello earned a multitude of degrees and certificates including a Bachelor of Science and a Doctor of Medicine from the University of Puerto Rico in 1965 and 1970 respectively and a master degree in Public Health from John Hopkins University in 1982.  

After marrying Joseph R. Novello and moving to Michigan, Dr. Antonia Novello completed an internship and residency in pediatrics and a fellowship in pediatrics nephrology. She took an interest in nephrology after a beloved family member died due to complications with their kidneys. Dr. Novello practiced medicine in a private office for two years, but eventually transitioned to work for the National Institutes of Health (NIH) in 1978. Novello focused on health issues related to women, children and marginalized communities during her time at NIH. She was instrumental in the legislation that led to the creation of the national organ transplant registry and she also played a significant role in requiring all cigarette containers be labeled with a health warning. In 1989, President George H.W. Bush selected her as the new United States Surgeon General making her both the first woman and the first Hispanic American to fill the role. 

Novello served as the U.S. Surgeon General from 1990 until 1994 when the Clinton Administration began. During her tenure, Novello continued to advocate for women and children. “In March 1992, she and James S. Todd, executive vice-president of the American Medical Association (AMA), held a news conference at which they denounced the R.J. Reynolds Tobacco Company’s advertisements featuring the cartoon character Joe Camel, because research showed that it appealed to young children.” (Meier et al., 1997, p. 272) Novello was also vocal about the alcohol industry’s marketing practices, particularly the industry’s use of advertisements which showed people skiing, surfing or mountain climbing with alcoholic beverages close by as it suggested people could perform these activities while consuming alcohol. Novello also raised awareness on domestic violence and its impact on women. (Meier et al. 1997)

After 1994, when a new Surgeon General was appointed, Novello continued to work within the healthcare industry until her retirement in the 2010s. Novello currently spends her time between Puerto Rico and Florida and is still an active advocate for the health needs of others. Most recently during the COVID-19 vaccine rollout, Novello spoke with parents and other community members of the importance of vaccination and even participated in local vaccination clinics and programs. And in August of 2021, she and other living former surgeon generals participated in a White House event where they discussed “getting information and access to vaccines to communities of color, who have been the hardest hit during the pandemic.” (Sesin, 2021)

Novello has received recognition for her work as a healthcare provider and public health advocate. Some of the awards she has received over the course of her career include “the Public Health Service Commendation Medal (1983); Congressional Hispanic Caucus Medal (1991); Order of Military Medical Merit Award (1992); and the James Smithson Bicentennial Medal (2002).” (Brandman, 2021) Dr. Antonia Novello’s lengthy career is inspirational for people committed to serving their communities and her legacy of speaking up for women and children will have profound effects for years to come. 

References:

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Photo by Tom Fisk via Pexels.com

The Hispanic community is one of the fastest growing populations in the United States. According to census data, people who identified as Hispanic accounted for approximately half of the total population growth in the country between 2010 and 2020 and around 18.7% or 62.1 million Americans self-identify as Hispanic or Latino. (U.S. Census Bureau, 2021) Despite a significant presence in the country, less than 10% of all healthcare workers are Hispanic. Recent statistics and personal anecdotes suggest that having visible representation of Hispanic American healthcare workers will encourage more Hispanic individuals to pursue a career in the health sciences and allow Hispanic American patients to better connect with their healthcare provider.

On June 14, 2022, the Pew Research Center released a report entitled ‘Hispanic Americans’ Trust in and Engagement with Science.’ The report was based on survey data from nearly 15,000 U.S. adults and examined Hispanic Americans’ perceptions of both health sciences and the science, technology, engineering and mathematics (STEM) field. The authors note that overall “Hispanic adults hold largely trusting views of both medical scientists and scientists to act in the public’s interests. Hispanic adults’ encounters with the health and medical care system are varied, reflecting the diverse nature of the U.S. Hispanic population across characteristics such as nativity, language proficiency, gender, age and education.” (Funk & Lopez, 2022) Many Hispanic Americans have poor or no access to the healthcare field and for those able to regularly visit a healthcare provider, there are barriers to care, such as communication problems, that are present during these visits. The Pew Center report noted “Hispanic adults are less likely than other Americans to have health insurance and to receive preventative medical care.” (Funk & Lopez, 2022) Survey respondents shared many different opinions on the cause of health disparities within the Hispanic American population including working jobs with high health risks, language barriers, poverty and preexisting health conditions. When asked about solutions to address these health disparities many people responded that they believed increasing the visible representation of Hispanic healthcare workers would address these disparities. This sentiment is echoed by current Hispanic healthcare professionals:

Professional organizations such as the National Association of Hispanic Nurses and National Hispanic Medical Association connect Hispanic healthcare workers and develop meaningful communities. On the George Washington University campus, there is a local chapter Latino Medical Student Association. This organization will hold its 50th annual conference on January 27-28 in 2023 at John Hopkins University and the theme for the conference is “Un Futuro Para Todos: Highlighting Latino Innovation, Service, and Leadership in Medicine.” Registration for the conference is currently open and early bird prices are available until November 11th. To learn more about GWU’s Latino Medical Student Association, click here to view their website or email the organization at lmsa.gwsmhs@gmail.com.

Wandy D. Hernandez-Gordon writes in their personal narrative for AMA Journal of Ethics “Health professionals with cultural and language proficiency are critical to successful interventions, including health education, preventative medicine, and treatment. But these interventions are only the start in addressing the higher burdens and challenges that Latinos face in accessing quality health care. It is also critical to dissect and understand the systems and structures that both lead to and exacerbate health inequities.” (Hernandez-Gordon, 2022, p. 335) The Hispanic population in the United States continues to grow and it is important that they are able to access the full benefits of the healthcare system. In order to meet the needs of this diverse population, it’s important that more Hispanic healthcare professionals enter the field, share their experiences with their colleagues and collaborate with one another to offer long-lasting solutions.

References: 

Funk, C., & Lopez M.H. “Hispanic Americans’ Trust in and Engagement with Science.” Pew Research Center, Washington D.C. (June 14, 2022) https://www.pewresearch.org/science/2022/06/14/hispanic-americans-trust-in-and-engagement-with-science/

Hernandez-Gordon, W.D. (2022). Why Community Health Workers’ Roles in Latinx Communities Are Essential. AMA Journal of Ethics, 24(2), E333-339. https://doi.org/10.1001/amajethics.2022.333


United States Census Bureau. (2021). 2020 Census Illuminates Racial and Ethnic Composition of the Country. https://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html

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