Tackling systemic racism to diversify health care and clinical research

Health-equity researcher Tung Nguyen guides a number of anti-racism efforts at the University of California, San Francisco.credit: Susan Merrell

decolonization science

Science is steeped in injustice and exploitation. Scientific insight has been erased from marginalized people, natural-history samples taken without consent and genetics data manipulated to back eugenics movements. Without acknowledgment and redress of this legacy, many people from minority ethnic groups have little trust in science and are certainly not welcome in academia – a continuing barrier to the levels of diversity that many universities claim to pursue. Huh.

In the next part of a short series of articles on demystifying biosciences, the associate vice chancellor for research inclusion, diversity, equity and anti-racism was appointed at the University of California, San Francisco (UCSF) in September. To improve health research. Nguyen, a health-equity researcher who is also the director of the UCSF Asian American Research Center on Health, says anti-racism efforts begin with engaging underserved communities and nurturing diverse trainees in health research and health care. Huh.

I studied medicine because I didn’t see health care and health research addressing the needs of the Asian community in the San Francisco Bay Area – the part of California where I moved as an 11-year-old non-English speaker after my family returned from Vietnam. Gone from For the past 20 years, I have been conducting health-equity research, focusing on cancer interventions.

There are many aspects of the health-research world in this country that are anti-Asian. A lack of data on racial identity is always a sign of racism because it essentially means that a part of the population is invisible. For example, we know that approximately one-third to one-half of Asian Americans do not speak English well enough to participate in medical surveys conducted in English. ‘Asian’ responses to such a survey would only include English speakers; Furthermore, all ‘Asian’ respondents would be lumped together, despite the diversity of Asian cultures.

lack of promptness

Although some organizations are trying to hire diverse candidates, there is a lack of urgency when it comes to addressing systemic racism. All the issues I mentioned are structural problems. I think there can be no systemic change without involving everyone – from medical-department heads to members of the communities they supposedly serve.

In 2020, my colleagues and I created an Anti-Racism Task Force at the University of California, San Francisco. Using a community-engagement approach, we convened a committee of 25 members, including institutional and community leaders, staff, faculty members, and trainees. Over the course of a year, we sought information across the university and produced a report with 160 recommendations – ranging from funding for research that examines the structures that perpetuate racism, to greater community engagement in scholarship.

Most of the institutions are very top-down. I learned that academic hierarchy is a fundamental challenge to making equity work on campuses. Faculty members are over-represented among white males, while non-faculty staff members are over-represented among women and under-represented minority groups. We ensure that staff and faculty members meet and acknowledge and take into account the power dynamics that exist. Otherwise, our efforts will not be inclusive.

To better diversify the recruitment of study participants, in 2021, my colleagues and I created the Research Action Group for Equity, or RAGE — an acronym we intentionally chose because we are outraged about the lack of minority-health data and participation , and we want to make things uncomfortable for the powers that be. Rage works with the UCSF Clinical and Translational Science Institute to ensure that recruitment is an inclusive process. We engage community leaders who are bicultural or bilingual to provide translation support or address cultural concerns.

If my colleagues and I can diversify the health care workforce at UCSF, we can certainly improve the economic standing of diverse communities as well as access to biomedical research in those communities. We have the US National Institutes of Health BUILD Award for addressing the lack of diversity among biomedical researchers. If you want minority students and interns, you have to go where they are. In our case, we recruited trainees from San Francisco State University, a Hispanic-focused, minority-serving institution. We trained these junior research and health professionals, for example, clinical research coordinators, to manage and conduct studies.

This expands the job opportunities available to these trainees and diversifies participation in research. But I hate the term ‘pipeline program’ when people talk about efforts to increase the number of early career scholars from diverse backgrounds. ‘Pipeline’ implies that you have to fit into a pipeline to start with and you come out the other end where the system wants you to come out. Furthermore, if the pipeline is producing a steady stream of talented PhDs from underrepresented communities, but the system does not increase the number of these people in senior roles, that is not a problem with the pipeline. Instead, it’s a dam problem—pun intended; There are structural barriers to workplace diversity that need to be overcome.

UCSF has had its own continuing challenges in terms of anti-racism efforts, but the institution has been transparent. It has a dashboard that highlights racial, ethnic and gender diversity among faculty members, staff and trainees. The situation fluctuates, and the numbers have never been great for groups typically underrepresented in medicine, such as black and Hispanic people. But it’s important that the problem is visible so that we can actually make improvements.

It is disappointing that successful diversity, equity and inclusion programs are often not sustained. Under-represented groups are used to being people who come in with the money and then go away. I have helped develop the AEIOU Principles, which will be the foundation of my work as the newly appointed associate vice-chancellor for research inclusion, diversity, equity and anti-racism. A is for Accountability and Anti-Racism, E is for Engagement, I is for Person-Centered Institutional Change, O is Opportunity, and U is Unity. These principles are vital to making progress against racism. For underrepresented groups to succeed, the system has to change, and that requires increasing opportunities. Oppressive structures perpetuate oppression by making people feel like a zero-sum game – if someone wins, someone else has to lose. To promote diversity, equality and justice, we need to stop pitting one group against another.

This interview has been edited for length and clarity.

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