Cynthia Gómez: On the Road for Health Equity

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

—World Health Organization, 1948

The woman's hands clutch a cigarette, her long, unkempt black hair framing a face that remains unseen by the camera. The shame of being a drug addict, she explains, is nested with her role as an important player in the fight against HIV as she provides condoms and clean needles to those who show up at her house. Her home is also a “shooting gallery” for injection drug users in the border town of Juarez, Mexico.

The woman's story as well as those of women united in the battle against HIV at an Oklahoma women's prison; on the streets of Washington, DC; in the poorest New Orleans, Louisiana, neighborhoods; and in drug-trafficking areas of Miami, Florida, are part of a hard-hitting documentary film project¹ highlighting health and social justice issues—just one of the many remarkable efforts spearheaded by Cynthia A. Gómez, PhD.

CYNTHIA GOMEZ TRAVELS more than 100 000 miles each year to tackle the mammoth problem of health disparities, and she does so with a unique style that blends science with real-world programs and great listening skills. With health equity as her guiding principle, Gomez works to effect lasting change not only in the field of public health but in people's everyday lives as well.

As founding director of San Francisco State's Health Equity Institute (http://www.healthequity.sfsu.edu), Gómez brings academic prowess as well as community-based solutions to the daunting problem of health disparities. Her colleagues praise her for being a gifted leader, an innovative thinker, and someone who can blend science with practice. “She really is an amazing person and scholar,” said Rafael Diaz, PhD, professor of human sexuality studies and ethnic studies at San Francisco State University. “I think one of the things I admire about her is she has been able to navigate very successfully the world of funded research. At the same time, she has kept one foot very grounded in the community.”

On any given weekday, Gómez might be hard at work behind her desk, negotiating a partnership looking into what happens to kids enrolled in Head Start once they reach fifth grade. Or she could be in a northern Maine rainstorm observing an HIV education program for Native American migrant blueberry pickers or in Washington, DC, advising a group on how to best steer funding toward their efforts to prevent HIV infection among urban sex workers.

Shaking hands with President Bill Clinton at the White House one day, talking about HIV prevention with women prison inmates the next, Gómez logs 100 000 frequent flyer miles each year to conduct outreach and give hands-on advice to groups that work to improve health status, especially for the underserved. “I absolutely think she's a terrific hero,” said long-time colleague Steve Cadwell, PhD, a Boston, Massachusetts, area psychotherapist who worked with Gómez at a community health center in Boston during the early days of the AIDS -epidemic. “Initially I think she was very much on the ground level recognizing the importance of advocating for gay men. She also saw early on that lesbians were affected and people of color were affected. And she's really dedicated herself to educating, teaching, and doing research on all those fronts and taking a leadership role in it both in her academic and governmental positions.”

Those positions are too numerous to list but have included working as a clinical psychology fellow with Harvard Medical School and director of children's mental health services for the South Jamaica Plain Health Center in Massachusetts. Gómez was codirector of the Center for AIDS Prevention Studies at the University of California, San Francisco. She served on an advisory board with former surgeon general M. Joycelyn Elders and as a committee member for such groups as the Institute of Medicine, the Substance Abuse and Mental Health Services Administration, and the National Institutes of Health.

Her expertise and ability to bring different ideologies to the same table led to her serving as an appointed member to the Presidential Advisory Council on HIV/AIDS under both Presidents Bill Clinton and George W. Bush. In 2008, California governor Arnold Schwarzenegger appointed her to the first California Public Health Advisory Committee. “She's been a wonderful source as someone who's both committed to the cause and mission but also connected to the outside world,” said Kimberly Hensle Lowrance, deputy director of Public Responsibility in Medicine and Research, where Gómez serves on the board. “I want people who make me think in new ways. She very much does that. We adore her.”

A self-described “Latina mutt,” Cynthia Gómez is a third-generation Mexican American whose older siblings do not speak Spanish. When she was six years old, she moved to a remote village in Ecuador where her father was working for a tuna cannery. During the four years she spent there, she was exposed to not only the Spanish language but also a culture in which there was no middle class, only the very wealthy and the very poor. “I had a very early exposure as a child to differences, and differences that were uncomfortable for people,” Gómez said. “It really did affect me, I think, just experientially in having all that exposure and seeing extreme poverty. My best friends in Ecuador lived in shacks where there was no running water.” Yet she had a chauffeur to drive her to school because of her father's status.

She then lived in Puerto Rico from 1968 to 1975 before attending college in Boston, where she lived until moving to San Francisco in 1991. Her Spanish accent is Puerto Rican. “I confuse people,” she said with a laugh. Told that being bilingual would hinder her, Gómez found the opposite to be true as she pursued a career in mental health. Still, her heritage sometimes was a barrier. “I think by being Latina, often, people had lower expectations about what I could accomplish,” Gómez said from her office in San Francisco. “I think that's just sort of our long-term prejudices and stereotypes. There have not been a lot of role models to demonstrate otherwise.”

She has become that very role model to students as well as colleagues and acquaintances. Her assistant, Angelica Martinez, came to Gómez eight years ago with an interest in HIV and the ability to speak Spanish but no prior research background. Because of Gómez's encouragement, the single mother has conducted more than 1000 research-related interviews and over time led some health equity research projects. “There's never the boss aspect of her,” Martinez said, seated on the plush, dark green couch in Gómez's office, where coworkers are encouraged to pop in and speak their minds. “I think she believes in people before they believe in themselves.”

That quality, said National AIDS Fund president and CEO Kandy Ferree, is what will be Gómez's lasting mark not only on the field of public health but also on society. “I think the one thing that stands out is Cynthia's commitment to leadership development,” said Ferree, who has worked with Gómez for about a decade. “We could talk all day about all the amazing research she does and the boards she sits on and the amazing work of those boards, but what stands out for me is her own ability to be a leader … her willingness to lend her skills and expertise to a broad array of individuals and organizations but also her commitment to training the next generation of leaders. I'm not sure that there's any better legacy to any of us than the commitment she has to that level of training.”

Although she carries a smart phone, Gómez has not enabled it to receive e-mail because she recognizes the need to be connected yet not constantly distracted. She has no call waiting on her home phone. “People are shocked to hear a busy signal,” she said with her easy laugh. But what Gómez learned from her clinical days and still puts into practice is that “nothing else is happening except what is happening at that moment—it's vital to the relationship.”

Last spring, Gómez was in Washington, DC, in the midst of an eight-week travel blitz that had her in a different city each week, visiting community-based organizations in Gaston, North Carolina; Detroit, Michigan; Atlanta, Georgia; Memphis, Tennessee; and New York, New York, among other places. On a visit to the National AIDS Fund, she said a main goal of the Health Equity Institute is to change the paradigm of research and the reason people decide to participate in studies. “How do we change how we engage and treat human subjects so people don't feel like guinea pigs but instead see it as their right, that it's a ‘count me’ model?” she said. “It's only a few years back that women were not included in clinical trials… . If we can change that paradigm from, ‘oh, you're being experimented on—the legacy of Tuskegee’—to ‘I need to be counted in order for this research to be relevant to me,’ then research findings will apply more accurately to all segments of the population,” she said. “It's about parity in science.”

A teacher and researcher whose work has zeroed in on barriers to HIV-prevention strategies for women and particularly Latina women,^2,3 Gómez also has a passion for building bridges when it comes to applying that research to real-world problems. “Scientists are horrible at translating things into practice,” she said. “We speak to each other. We've created this amazing science, and we don't have the right bridge to application.”

Gómez did not start her career with the intention of addressing health disparities but wanted to be a child psychologist from a young age. “Really, the public health exposure came after I graduated from college and my first job was as a community health outreach worker,” she said. “In a sense, my first job was about equal opportunity.”

At the clinic where she worked, if people missed an appointment, Gómez found them and made sure they came in. She also worked to address barriers to health care, such as a lack of childcare or transportation.

Cadwell worked with Gómez at a community health center in Boston, where they volunteered to colead a support group for HIV health providers at the Fenway Community Health Center, which had become the epicenter of HIV treatment in the area. “What we both recognized was that the caregivers were getting burned out,” Cadwell remembered of the doctors, nurses, and social workers treating AIDS patients. “Talk about heroes. Those folks were really out there committing themselves during the trauma of the early part of the epidemic when there weren't the antivirals, when people were dying very difficult, painful deaths, and the providers were feeling hopeless and helpless.”

Gómez and Cadwell ran the provider support group together for a few years before she moved to California and continued to make her mark in the public health field. “She's been able to keep speaking out and reaching out to get resources for people in the margins,” Cadwell said. “She really applies herself—her intelligence, her stamina, her dedication—to what she sees needs to get done. And she's really unflinching when she gets an idea.”

While visiting the Native American migrant blueberry pickers in northern Maine, Gómez learned one woman created an HIV-education–themed bingo night because bingo was a popular activity. Gómez was on hand to help peer educators articulate their intention when it comes to HIV education and prevention, both to help find funding support and so other tribes can replicate the program. And she also wanted to help group members understand the science behind behavior change so barriers and solutions could come to the forefront. “Some of our public health can't just be instinctual,” Gómez said. “You have to bring in the science.”

As director of the Health Equity Institute, Gómez steers myriad projects such as one seeking to understand the impact of adding a community garden program to an elementary school in a predominantly black neighborhood where fresh, healthy food options are lacking, and obesity, diabetes, and cardiovascular disease are prevalent. “We're trying to understand if it increases their consumption of fruits and vegetables and if that spills over into adults in the community,” she said about the Healthy Eating Active Living Local Partnership. The program aims not only to improve eating habits but also to give kids a “multiple set of skills,” Gómez said, including taking pride in the beautifying aspects of a thriving garden. “That's the stuff that keeps me very real in what I do,” Gómez said about both the community-based interventions and student film projects. “My motto has been, ‘I will only create real-world programs.’ Otherwise, what are we doing?”