News and Commentary An Enduring Commitment to Health for Minority Populations

As the relatively new President of the Josiah Macy Jr. Foundation, I spent the past year learning more about the Foundation’s history. The key figures, guiding ideas and values, and historic accomplishments all provide a rich backdrop from which we as an organization chart our path forward. The exercise of learning and honoring one’s history is a powerful one.

As we celebrate Black History Month this February, we have a similar opportunity to recognize the achievements, stories, and history of black Americans. In my review of the Macy Foundation’s work since its inception, I am proud to note the Foundation’s consistent focus on supporting minorities in the health professions. This has been the case since the 1960s; its upsurge coincided with the civil rights movement. In reviewing the Foundation’s priorities today and setting a new strategic plan for the coming years, I wish to reaffirm and renew the Macy Foundation’s commitment to supporting minorities in the health professions. The Foundation pledges to support individuals, organizations, and projects that cultivate equity, diversity, and belonging in learning environments for health professionals—focus areas that we believe are the underpinnings of better health for all people.

The Early Years

Kate Macy Ladd, the founder of the Josiah Macy Jr. Foundation, demonstrated a personal interest in supporting marginalized populations. Mrs. Ladd’s progressive background as a Quaker shaped her philanthropic interests; she was forward-thinking for her time (1863–1945) and specifically wished for her Foundation to advance health care for minorities. Her brother Everit Macy’s early support of Hampton Institute (a historically black college) and Tuskegee Normal and Industrial Institute (co-founded as a teacher’s college for black students by Booker T. Washington) demonstrated that the Macy family sought to support minority-focused organizations. 

Shortly after the Macy Foundation was created in 1930, the Foundation together with the Commonwealth Fund were the first funders of the newly created National Medical Fellowships (NMF), a program to support minority medical students. Support from the Macy Foundation for these scholarships has continued from that time to the present day.

When Dr. John Bowers became President of the Macy Foundation in 1965, he convened a conference on the topic of black Americans in medicine. The conference report notes an urgency to find solutions to the issues of “identification and recruitment in high school and college, guidance, preparation, admission, and financing” of black students for careers in medicine. It concludes with a charge:

Change must come from all corners; it must involve everyone… [It] means federal financial support to educate every [black American] to the limit of his individual capacity. It means vast social, cultural, and economic programs. The foundations can launch programs to point the way…

Dr. Bowers was also involved in the launch of the Morehouse School of Medicine in Atlanta, initially with a grant from the Macy Foundation and then by facilitating important connections between the school and other foundations such as the Rockefeller Foundation and the Ford Foundation. During this same period, the Foundation elected women and black men as Board members; Dr. Harold Amos became the first black person to join the Macy Foundation’s Board of Trustees in 1974. The diversity of Board membership continues to the present day with women and persons from various racial and ethnic backgrounds providing leadership for the Foundation.

Perhaps one of the most significant outcomes during this era was a commissioned special report entitled Minorities in Medicine: From Receptive Passivity to Positive Action 1966-76. The findings offered in this report, arguing the negative effects of racism and the need to support minorities in the education system, proved to be so compelling that they were included in oral arguments delivered in front of the U.S. Supreme Court. The case, Regents of University of California v. Baake, took place in 1978 and upheld the use of affirmative action but invalidated the use of quotas in medical school decision-making.

The 1980s and ‘90s

Whereas Dr. Bowers and the Macy Foundation’s Board of Directors focused on increasing the number of black students entering medical school, his successor, Dr. James Hirsch, sought to reach a larger pool of potential health professionals by directing the Foundation’s efforts on the pipeline. In 1982, shortly after Dr. Hirsch assumed his role as President, the Macy Foundation began to award grants that would enhance public high school programs in “economically distressed communities composed largely of minority populations, such as New York City; New Haven, Connecticut; rural Alabama; and on a Navajo reservation in Arizona.” A 1987 Macy Annual Report called the achievements of those participating high school students “little short of amazing.”

Noting the success of his predecessor’s investment in public high school science programs, Dr. Thomas Meikle Jr., Macy President beginning in 1987, and the Macy Board awarded a $4.5 million grant funding the creation of Ventures in Education (VIE), an organization charged with replicating the programming started during Dr. Hirsch’s tenure. In 1996, Academic Medicine published a study of the program, highlighting that “at least 7.3% of the Ventures graduates [entered] medical school and nearly 70% of those applying subsequently [were] accepted.” An iteration of the program still exists today under the new name Ventures Scholars.

The 1990s to Today

My two immediate predecessors, Dr. June Osborn and Dr. George Thibault, laid out grant making areas that were relevant to advancing minorities in health care. Near the conclusion of Dr. Osborn’s term, one could readily see that “minorities [were] interwoven into the fabric—the mission—of the Macy Foundation.” One of Dr. Thibault’s early grants went to Dr. Fitzhugh Mullan and his colleagues at The George Washington University Medical School to support their ranking of allopathic and osteopathic medical schools according to the schools’ “social mission”—a concept stressing an institution’s contributions to advancing health equity and addressing health disparities. The team’s work proved transformative to health professions education and ultimately led to the creation of the Beyond Flexner Alliance.

Although I am early in my tenure as President here at the Macy Foundation, I look forward to continuing the important efforts of those who led the Foundation before me. I envision a future where minorities—be it of race, ethnicity, gender, religion, sexual orientation, and/or disability—feel a sense of belonging as well as equity in health professions learning environments. We want all learners and teachers to feel welcomed in the learning environment so that they can offer the best possible care to the patients and communities they serve, with the ultimate goal of achieving health and healthcare free of bias, discrimination, and inequity.

The Macy Foundation is proud of its Macy Faculty Scholars Program, a competitive national program that is developing leaders in health professions education. Much of the work of the Scholars directly relates to confronting issues pertaining to minorities in the health professions. Two such Scholars and their projects are:

  • Cristina Gonzalez, MD, MEd, Associate Professor of Medicine at Albert Einstein College of Medicine, is investigating how educators teach students about implicit bias, with a specific focus on racial implicit bias. Her time as a Macy Faculty Scholar spanned 2016–2018. Most recently, Dr. Gonzalez’s work was published in Academic Medicine, using transformative learning theory as a guide for implementing strategies related to implicit bias and also suggesting that such an approach can help to advance social justice.
  • Cheryl Woods Giscombé, PhD, RN, PMHNP, MSN, Melissa and Harry LeVine Family Distinguished Associate Professor in Quality of Life, Health Promotion, and Wellness in the School of Nursing at University of North Carolina at Chapel Hill, served as a Macy Faculty Scholar from 2015–2017. Her work focused on the development of the Interprofessional Leadership Institute for Mental Health Equity to address factors leading to mental health disparities. One specific aim of her work included increasing diversity within the pipeline of mental health professionals.

In addition, Dale Okorodudu, MD, Assistant Professor of Medicine at the University of Texas Southwestern Medical Center, recently received a 2019 Macy President’s Grant in support of Black Men in White Coats, an organization founded by Dr. Okorodudu to increase the number of black men in medicine through exposure to role models, summits, and mentoring opportunities. The lack of meaningful numbers of black men in medicine is a national crisis and one that Dr. Okorodudu is aiming to change.

Today, national organizations such as the American Medical Association, Accreditation Council for Graduate Medical Education, and Association of American Medical Colleges are taking concrete steps to address pervasive issues related to diversity and inclusion. The struggles faced by minorities in medicine remain a deeply disturbing reality that we cannot overlook. Dr. Uché Blackstock recently described some of these persistent problems in her opinion piece published in STAT. As we can tell from her poignant words about minorities in the health professions, there remains much work to do. The projects noted above are commendable and highlight the type of efforts that I hope will become even more widespread in both research and in practice.

Looking Ahead

Each year, Black History Month features a theme to commemorate the occasion. This year’s theme is “African Americans and the Vote,” in honor of significant anniversaries of both the Fifteenth and Nineteenth Amendments (granting black men the right to vote and women’s suffrage, respectively). The ability to have one’s voice heard, counted, and respected is vital, no matter if the setting is at one’s polling place, in the classroom, within the workplace, or elsewhere. Providing a welcoming, supportive space for a diverse array of voices so that all feel welcome in the health professions community is just one of the motivating factors behind the Macy Foundation’s commitment to those who are underrepresented in the health professions.

The Macy Foundation strives to contribute to positive changes in policy, attitudes, and culture in the health professions and the health professions learning environments. In the coming weeks, we will discuss in greater detail our new strategic plan, including the thinking behind our first priority area: Equity, diversity, and belonging in the health professions learning environments. Why is this a priority area for us? Improving the health of Americans must include all Americans, and this means addressing issues of health disparities. For too long black Americans have endured an unequal burden for unequal care, and we aim to change this. As always, I look forward to your feedback and to reading your proposals for Macy Foundation funding support. Together, we must insist that black Americans, as well as other minorities, have opportunities for education and health, and health care that are truly equal so that we learn from our painful past and commit to a promising future.

I encourage you to sign up to be the first to know about our new funding priorities.


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