Navigating the Path to Equity: Insights from Aletha Maybank, MD, MPH

Aletha Maybank, MD, MPH, serves as the chief health equity officer at the American Medical Association (AMA), and has spent nearly 5 years spearheading initiatives to address health diversity, equity, and inclusion (DEI). In her role, she emphasizes the importance of internal transformation within institutions to truly champion health equity. Maybank shared the keynote speech “Advancing Equity in Health Care” at the 20th Annual Skin of Color Society Scientific Symposium on March 7, 2024 in San Diego, California in conjunction with the 2024 American Academy of Dermatology Meeting.¹

Equity is top of mind for Maybeck on the heels of several recent news events including the Johns Hopkins Medicine chief stepping down after the backlash over her definition of privilege2, a Texas government official prioritizing ban DEI initiatives one of his priorities3, and the University of Florida eliminating its DEI office.4

Building Equity from Within

Maybank emphasized the significance of addressing internal institutional issues before attempting external health equity efforts. She said "We cannot do health equity outside of an institution unless we figure out how to get our own house in order." Acknowledging the importance of building from within, she urges institutions to align their values with their actions.

Centering Marginalized Voices

To achieve health equity, Maybank emphasizes the need to center the experiences of marginalized communities. She explained that understanding the unique challenges faced by those who have been historically marginalized is essential. "How do we center the people, the voices, the experience of those who have been most marginalized?" Maybank asked, challenging institutions to prioritize the perspectives of those who have long been excluded from the decision-making process.

Directness and Compassion

Maybank's direct approach to conversations about equity is a hallmark of her advocacy. She acknowledges that, at this point in her career, she values directness, urging others to confront uncomfortable truths. Maybank emphasizes that compassion must accompany directness to create meaningful change. She encourages individuals to call out inequities and actively support those who have been in the fight for justice.

While data is crucial, Maybank contends that real change happens at the emotional level. She asserts, "It's at the point of connecting with somebody else's heart and emotions that sustainable change happens." Maybank calls for a shift from relying solely on data to fostering genuine connections and understanding. Her approach underscores the importance of empathy in driving transformative change.

Challenging Dominant Narratives

Maybank openly acknowledged the challenges she faces in her role, expressing the need for support. She recognizes the difficulty of the current environment and the toll it takes on those leading equity efforts within institutions. Maybank encourages a collective approach, emphasizing the need for solidarity and support among colleagues.

Maybank identifies false narratives that undermine equity efforts, such as blaming individuals for health inequities or perpetuating hierarchical values. She urges the need to challenge these narratives and emphasizes the importance of redistributing resources to counteract systemic biases.

The Role of Institutions

Maybank highlighted the importance of institutional policies and commitments to drive change. She referenced the AMA's pledge and policies against racism as critical tools that have empowered her to speak out. Maybank emphasizes that equity efforts should not be limited to racial disparities but should encompass a broad range of marginalized groups.

The AMA addressed the topic saying, “The AMA recognizes that racism in its systemic, structural, institutional, and interpersonal forms is an urgent threat to public health, the advancement of health equity, and a barrier to excellence in the delivery of medical care. The AMA opposes all forms of racism. The AMA denounces police brutality and all forms of racially motivated violence. The AMA will actively work to dismantle racist and discriminatory policies and practices across all of health care.”¹

Between 2020 and 2023, the AMA house of delegates passed the following resolutions to:

• Name and act on racism as a public
health threat
• Rid the health care system of racial
essentialism; recognize race as a social, not a biological, construct
• Support the elimination of race as a proxy for ancestry, genetics, & biology in medical education, research, & clinical practice
• Advocate for and promote racism-conscious, reparative, community engaged interventions in the health system
• Implement healthcare and organizational policies and cultural changes to prevent and address racism, discrimination, bias and microaggressions

Truth, Reconciliation, and Healing

Maybank delved into the historical impact of the Flexner Report, acknowledging the harms it caused to minority medical schools. She discussed the AMA's commitment to truth, reconciliation, and healing, recognizing the need to address past injustices. Maybank expresses the importance of acknowledging historical wrongs and working toward tangible solutions.⁵

Resources For Clinicians to Ensure Equity

The AMA has published a guide called “Advancing Health Equity: A Guide to Language, Narrative, and Concepts” available to all health care professionals. It delves into health equity language, data behind why narratives matter, and a glossary of key terms to familiarize yourself with.⁶

Maybank also noted that more than 50 years of publication illustrations of patients in procedural descriptions for the Current Procedural Terminology Pro Book have been updated to include skin of color depictions. The AMA Ed Hub modules offer deep dives on health equity issues, training, and resources. She added the Ed Hub also consolidates the AMA’s broad content resources and covers timely practical, ethical, and clinical topics.

Do you have a favorite resource or pearl to ensure you are using inclusive languages and practices? We’d love to hear from you! Email DTEditor@mmhgroup.com.

References

1. Maybank A. Advancing equity in healthcare. Presented at: 20th Annual Skin of Color Society Scientific Symposium; March 7, 2024; San Diego, CA.
2. Price L. Johns Hopkins Medicine chief diversity officer steps down after viral backlash over “privilege” definition. Baltimore Sun. March 6, 2024. Accessed March 7, 2024. https://www.baltimoresun.com/2024/03/06/johns-hopkins-diversity-officer/.
3. Confessore N. “America is under attack”: inside the anti-D.E.I. crusade. The New York Times. January 20, 2024. Accessed March 7, 2024. https://www.nytimes.com/interactive/2024/01/20/us/dei-woke-claremont-institute.html.
4. University of Florida eliminates all DEI positions due to new state law. 6abc Philadelphia. March 4, 2024. Accessed March 7, 2024. https://6abc.com/university-of-florida-diversity-and-inclusion-dei-uf/14489690/#:~:text=University%20of%20Florida%20eliminates%20all%20DEI%20positions%20due%20to%20new%20state%20law&text=diversity%20officer%20position-,The%20University%20of%20Florida%20is%20eliminating%20its%20chief%20diversity%20officer,by%20Republican%20Gov.%20Ron%20DeSantis.
5. Duffy TP. The Flexner report--100 years later. Yale J Biol Med. 2011;84(3):269-276.
6. Advancing Health Equity: A guide to language, narrative and concepts. American Medical Association. 2021. Accessed March 8, 2024. https://www.ama-assn.org/about/ama-center-health-equity/advancing-health-equity-guide-language-narrative-and-concepts-0#:~:text=Designed%20for%20physicians%20and%20other,language%20and%20why%20it%20matters.