James Hildreth, M.D., Ph.D. (Meharry Medical College), moderated a session to explore the role of industry, foundation, and philanthropic support to advance the goal of greater diversity and inclusion in science, engineering, and medicine. After short presentations by Garnesha Ezediaro, B.A. (Bloomberg Foundation), Michele Lezama, M.B.A. (National Action Council for Minorities in Engineering, Inc.), and Anthony B. Iton, M.D., J.D., M.P.H (California Endowment), most of the session was devoted to discussion among the panel and with participants.
BLOOMBERG FOUNDATION
Ms. Ezediaro focused on the Bloomberg Foundation’s partnerships with four historically Black medical schools: Meharry Medical College, Morehouse School of Medicine, Howard University, and Charles R. Drew University of Medicine. The foundation provided $100 million to these schools. “For us, it was alarming that these schools had not received a gift of this size in the past, individually or collectively,” she commented. She explained how the foundation decided to partner with the institutions. They started with data on the contribution of Black doctors to health, the debt of Black students entering and leaving medical school, and the long-term upstream impact of medical debt on communities. She explained, “We are not only focused on students but also years down the line, the students who can service communities.” The foundation did not approach the schools in a prescriptive way, she said, but asked how a partnership could be most meaningful. The gift provides up to $100,000 in debt relief for students and funding to institutions for wrap-around services.
She noted that scholarships are an important part of philanthropy, but she urged thinking of different models of funding. The excitement for a student to wipe away debt is very impactful, she said. She added the hope is that more foundations will support institutions to build capacity.
NATIONAL ACTION COUNCIL FOR MINORITIES IN ENGINEERING
Ms. Lezama explained that NACME (the National Action Council for Minorities in Engineering) was founded in 1976 to focus on engineering and computer science. Concurring with comments by other speakers, she said NACME has found that the top factors that explain why more Black students do not enter or graduate in these fields include preparation and financial need.
Ms. Lezama agreed with the need expressed by other presenters for corporate involvement and public-private partnerships. NACME keeps executives aware of relevant issues not only to increase their financial contributions to minority students but also to provide them access to competitive opportunities, such as in Silicon Valley. NACME works through partnerships with 40 universities, including four HBCUs. She noted the association is also looking at debt relief scholarship models and advocating for corporations to support them.
CALIFORNIA ENDOWMENT
Dr. Iton explained the mission of the California Endowment is to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians. Several years ago, Dr. Iton oversaw a health workforce study when it was recognized that implementation of the Affordable Care Act (P.L. 111-148) could provide new workforce pathways for students of color in the state. Through $130 million from the Endowment, efforts to diversify and expand the workforce were supplemented through loan repayments, scholarships, and increased residency spots, especially in low-income and communities of color that are under-doctored. He explained that California’s Proposition 209 bans the state from participating in affirmative action, but as a private foundation, the Endowment can earmark dollars.
In recruiting, supporting, and encouraging underrepresented minorities in the health professions, barriers to entry into these professions for African Americans, especially men, were identified. An analysis showed that African American students are affected much earlier in the pathway than at medical school. Many students experience a bottleneck at the community college level. Thus, the Endowment has started to focus earlier along the pipeline, especially on grades 9 to 12 and then into college. A partnership with a group called Health Career Connection has helped tighten the pathway programs, Dr. Iton said. He continued,
The bottom line is that it seems to me that we need a radical solution. We are not going to solve the problem with tinkering around the edges as we have done for decades. Access to pre-college and pre-medical school science training to equip especially African American males to meaningfully participate in the 21st century economy and health career space is needed.
He suggested a combination of online training and partnerships and that Silicon Valley and HBCUs can help greatly expand access. “We have to dramatically increase the pipeline of students who are prepared. We need something radical, not do the same things we have always done, with incremental increases,” he stressed.
DISCUSSION
Picking up from Dr. Iton’s observation about a focus on the earlier grades, Dr. Hildreth commented that preparation comes down to the quality of K–12 schools, which is linked to families’ incomes. He asked the presenters about solutions and the role of their organizations.
Ms. Lezama said that NACME has set what they call “big hairy audacious goals.” The first is a national bridge program. She noted that virtual opportunities can be created to give children, no matter where they live, access to the rigor needed to prepare for careers in engineering and computer science. To increase graduation rates, it is important to provide content in a culturally sensitive way to meet students where they are. Public-private partnerships can provide support, for example, to provide a financial structure that can incent talent to go into specific fields. The Federal Pell Grant Program could focus on science, technology, engineering, and mathematics (STEM) fields that the country needs by augmenting financial support to students who enroll in these fields, she suggested. She also stressed the importance of collaborations, noting groups with different areas of expertise can come together for better outcomes.
Ms. Ezediaro said the Bloomberg Foundation has a new portfolio focused on Black intergenerational wealth. “We are thinking about wealth building at the family, community, and institutional levels,” she explained. “We want to interrupt systemic issues that cause students not to be prepared or have the resources they need at various points.” While the specific intervention point has not been set, she said, the foundation is looking at how to fund community wealth models. The goal of the $100 million gift to the four medical schools, she added, is to give students more agency and choice in what they choose to specialize in. Students often make choices because they need to shorten their studies and earn an income sooner rather than later.
Dr. Iton identified critical junction points in the career trajectory of a “science-interested student,” one of which is the period from the end of high school to the beginning of college. He suggested an expansion of resources during that time. He noted many bright students struggle and become
intimidated by calculus or physical chemistry. They do not do well in those classes, then start to reconsider their choice. “There is such a squandering of talent when students run into the obstacles of calculus and chemistry,” he said, “but there is an opportunity to support them and keep their appetite for science alive.” Agreeing with Ms. Ezediaro’s observation that many students of color need to start earning an income, he suggested one solution may be career “ladders” as pathways to health careers. “Let people get a foothold in the health-care field where they can get paid and acclimated to the environment, then continue as they become nurses, physician assistants, or physicians,” he suggested. If they have “off ramps” to earn money, he added, they may hold on to science longer.
Dr. Hildreth noted that removing the intimidation factor requires students seeing role models, starting early in their schooling. As an example, he described a program at the University of California, Davis that teaches third graders to write computer code. He asked about other ideas for K–12 students. Dr. Iton replied that a point that emerged when looking at the K–12 STEM pipeline in California is that successful pathways programs have education, college, and employer components. He agreed that the educational component has to start young, and that expectations and a supporting infrastructure are required. Some programs struggle to keep African American men involved because of sports, he observed, and it is important to engage families to support their sons’ participation in the programs.
Ms. Lezama called for a strategic focus and partnerships with experts in K–12 education. “We want to make sure every student has line of sight to a 4-year program,” she said. NACME is in a collaboration called “Algebra by Seventh Grade.”1 Echoing Dr. Iton, she said calculus weeds out many students, and algebra leads up to calculus. One aspect of the partnership is to create information for parents to advocate for their children to get the math preparation they need.
Dr. Hildreth noted that HBCUs are producing fewer students who go on to medical school than in the past and said the infrastructure challenges in HBCUs must be addressed. When he asked how foundations, industry, and government could help, Dr. Iton replied, “This is about reparations. This is where the United States should invest its reparation dollars. Invest in opportunities for African Americans to repair the legacy of centuries of racism.” He said without this investment, the same outcomes will persist. “We need the commitment to acknowledge, tell the truth, and heal,” he stated. “HBCUs are a prime target for the investment necessary to bring about the repair.”
Ms. Lezama called for a national strategy that allows the country to educate the excellence that exists in communities, including more support for HBCUs. Ms. Ezediaro added the focus should be on institutions that have had a history of systemic underinvestment. She noted that the four historically Black medical schools produce most of the nation’s Black doctors yet are not key partners for many foundations.
Dr. Hildreth commented that the development of COVID-19 vaccines represents a “Sputnik moment” that shows what bold action can accomplish. “Something is calling out to us because of this moment, and we should not miss the opportunity,” he urged. Drawing from history, Dr. Iton reminded the group that [in the early 1700s], Onesimus, an enslaved man in Massachusetts, explained the technology behind smallpox inoculations to Cotton Mather, a New England Puritan clergyman, yet the history of vaccination depicts the discovery as one of “white brilliance.” He continued, “The narrative we have around African Americans in health in this country has been whitewashed. We need to change the narrative to change the policy. We have been at the leading edge of STEM, yet we hear that we are on the lagging edge. The narrative matters.”
Ms. Lezama urged reshaping the cost of education. She noted that her daughter is a medical student at New York University, and the fact that she can graduate debt-free is huge.2 Her daughter now has the expectation to work in an underrepresented area during her medical program, residency, and beyond. NACME is looking at how these models may apply in other fields so that financial barriers do not prevent entry. Ms. Ezediaro said many philanthropies have made commitments within the last year to think more deeply about equity. She acknowledged the work to be done in philanthropy to partner and learn what works, then to scale the programs that are working. She added that this includes how to get more people into the pipeline, as well as increase the representation in specific fields where more Black doctors are needed, such as cardiologists.
Dr. Hildreth asked the presenters about any changes in approaches they have seen in the context of greater realization about deep racial injustice. Ms. Lezama shared that the day after George Floyd’s murder, she was contacted by allies who wanted to see what they could do. She noted that “structural racism did not change on that day, but what changed was the
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2 In 2018, the New York University School of Medicine announced free-tuition scholarships for medical students who maintain satisfactory academic progress. For more information, see https://med.nyu.edu/education/md-degree/md-affordability-financial-aid/cost-attendance.
realization of what African Americans experience on a regular basis.” She urged the need “to be bold and leverage the opportunity. Use this moment in time to present the data and outcomes that if we invest, all will do better.”
Dr. Iton added that most of his career has been in public health, where “the patient is the community.” He commented that medical care only contributes about 15 percent to the health status of populations, with the rest occurring outside the doctor’s office, shaped by structural racism. He noted that most Americans do not understand individual versus structural racism, while acknowledging the challenges in having these discussions. “I talk about racism a fair deal. We should name it and be straightforward. But we have to be cognizant that minds go to individual racism. Structural racism is racism without a clear racist,” he said. Dr. Hildreth commented that part of his challenge at conferences where he is the only Black participant or when he was dean at the University of California, Davis has been to counter the belief that a diverse faculty could not be a quality faculty. Students cannot get excited about things they are not exposed to, and specialties with very low numbers of Black faculty perpetuate a situation of low numbers, Ms. Ezediaro said. She added that it is important not to hesitate to engage in controversial issues. Her portfolio focuses on intergenerational wealth for Black families, communities, and institutions, which means “the issues are not about today, they have been around for 400 plus years and at multiple levels.” She agreed with Dr. Iton that “we do not have language to talk about race. There will be people who hear and turn way and minimize the opportunities of impact. This is the moment to step into the widest view and dedicate work for Black people,” she stressed.
At the end of the session, the committee co-chairs summed up some of what was discussed during the workshop’s first day. Dr. Theodore Corbin (Drexel University) underscored that “in this Sputnik moment, science is key to make a difference, and Black men and women are huge contributors.” Dr. Barabino reflected that the conversations throughout the day built on the presentations by Dr. Raj Chetty (Harvard University) and Dr. Louis Sullivan (Sullivan Alliance). “This idea of what you start with and where you live—gaps between incomes, health, and wealth—is so stark,” she commented. She agreed with Dr. Iton’s point that African American stories need to “own the narrative.” Dr. Sullivan commented there is more than one solution to address the problem of inadequate representation in STEM fields, but he returned to Dr. Chetty’s research on the influence of location. He also said he found the engagement of the private sector encouraging. Dr. George Daley (Harvard Medical School) stressed the role of environment
and importance of strong mentorship, including teaching mentorship skills. Dr. Corbin concluded with the need for radical solutions and bold ideas.
