The world has changed in the year since the American Medical Association (AMA) named Aletha Maybank as its first Chief Health Equity Officer and founder of the AMA's Center for Health Equity, dedicated to eliminating the barriers to optimal health for all patients. COVID-19 has exposed health inequities that have always existed, Maybank said. But when US Government data omitted the disease's impact on Black, Hispanic, and Native American communities, she advocated for a change. “You can't fix something that you don't measure”, she said. Maybank helped organise an appeal to the Trump administration by the AMA and other health organisations to fill “the tremendous gaps” in the data, and now many more states are collecting data on how COVID-19 has hit these marginalised groups especially hard.
Maybank leads a weekly public Zoom discussion called “Prioritizing Equity”, where physicians and other health-care leaders focus on the root causes of racial disparities in medicine. One recent topic was police brutality, which has propelled protesters to the streets in cities in all 50 states and outside the White House. “Racism is a disease, and police brutality is a symptom of that”, Maybank said. She's proud of the AMA's board of trustees, who unanimously issued a statement this month declaring that racism is a public health threat and pledging to dismantle racism across the health-care system. Health inequities “are not random occurrences”, Maybank said. “They're avoidable and they're unjust.”
People have good health care “because they have opportunities and conditions that are set up for them to have optimal health. You have great education. You have wealth...you have housing. All of those conditions help support having optimal health”, Maybank explained. Her objective is not only to make health care accessible to underserved communities. “The goal is to improve health outcomes”, Maybank said. To accomplish that, it is necessary to address the factors that contribute to inequities, such as housing, jobs, wealth, education, and neighbourhood investment.
Maybank's public health and medical education career path along with “being in my own black skin for my entire life has absolutely prepared me for this moment”, she said. Maybank grew up in Harrisburg, PA. Her family moved there from New York City after her mother, who immigrated to the USA from Antigua, got a job in state government. “My mother believed we have a right to have what we have…even if people weren't going to help support her as a woman of colour and as an immigrant. She was still able to succeed because of her brilliance and resourcefulness”, said Maybank. “And she created a pathway for me.”
Maybank earned a medical degree from the Temple University School of Medicine in Philadelphia and went on to receive a Masters in Public Health from New York's Columbia University Mailman School of Public Health. In medical school and during her residency, she felt something important was missing: “You weren't encouraged to really delve into the context of patients' lives”, she said. “You diagnosed them based on how they looked in front of you, gave them some treatments, and then you let them out into the world without knowing if they can really follow up with that treatment.” But physicians need to take a wider view, she continued. “The reality is that health is not just about what happens within the walls of the doctor's office [because] the context of a patient's life is very critical to providing excellent health care.”
Maybank got her first opportunity to work on health equity issues in 2006 as Director of the Suffolk County, New York, Department of Health Services' Office of Minority Health. “She did a fantastic job”, said Brian Harper, then the county's Health Commissioner, who hired her, now Chief Medical Officer and Associate Professor at the New York Institute of Technology's College of Osteopathic Medicine in Old Westbury, NY. Maybank gained the trust and support of residents in the African American and Hispanic communities who generally viewed most county officials with some scepticism and might not seek help at county health-care facilities. From there, Maybank eventually served a much larger community, as Assistant Commissioner in the New York City Department of Health and Mental Hygiene's District Public Health Office, in Brooklyn, a borough with more than 2·2 million residents. Maybank moved up to Deputy Health Commissioner and also became Director of New York City's first Center for Health Equity, serving a city of over 8·6 million people. For almost 4·5 years, she managed a staff of 250 and a budget of US$28 million. “Dr Maybank was a trailblazer, brokering relationships with key people in the neighbourhoods to make sure that we were being more inclusive”, said Torian Easterling, now Deputy Commissioner at the New York City Department of Health and Mental Hygiene's Center for Health Equity and Community Wellness.
Maybank acknowledges that the high COVID-19 death toll among populations of colour and the killing of George Floyd in Minneapolis, MN, and other murders of Black people by police in the USA, are solemn reminders of how much more still needs to done to eradicate health disparities. But she is not discouraged by these recent events—quite the contrary, there is an urgency and energy to her work. “It's my responsibility, not just to myself but to all those people who opened those doors before I came, for those who were enslaved in this country, and for those who fought for justice”, she said. “I have to continue the fight in a very direct and bold, meaningful way that supports creating change.”
© 2020 AMA photographer Ted Grudzinski