Why Are Only 5% Of Doctors African American? Dr. Louis Sullivan Tells Us

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Speaker 1: Welcome to Conversations on Healthcare. This week, we welcome former HHS
secretary, Dr. Louis Sullivan, president emeritus of the Morehouse School of
Medicine on inequity and minority health and medical professions. Now, here
are your hosts, Mark Masselli and Margaret Flinter.

Mark Masselli: When some Black Americans had questions about the safety and efficacy of the
COVID vaccine, our guest was out there with the facts and was encouraging
everyone to get vaccinated. [00:00:30] He's also leadi ng the way on making the
healthcare profession more diverse. None of this is a surprise to those who
follow the boots of Dr. Louis Sullivan. He truly is a legend.

Margaret Flinte...: Dr. Sullivan served as the US Health and Human Services Secretary in the George
H.W. Bush administration after a distinguished career as the founding dean of
the Morehouse School of Medicine. He's also the founder of the Sullivan
Alliance to Transform the Health Professions and of the Association of Minority
[00:01:00] Health P rofessions Schools.

Mark Masselli: Dr. Sullivan, welcome back to Conversations on Healthcare. It's so good to see
you.

Dr. Louis Sulli...: Well, Mark, thank you very much. It's my pleasure to join you.

Mark Masselli: Well, that's -

Dr. Louis Sulli...: And M argaret.

Mark Masselli: Well, that is great. COVID's taken a particular toll on the Black community,
especially in the early stages. In fact, a recent California study shows that 37% of
white people with COVID symptoms receive treatment compared to only 20 % of
Black people who receive treatment. I [00:01:30] guess the question is how in
our country, with all of its founding principles, are we still not able to get this
right?

Dr. Louis Sulli...: Well, we really have a dichotomy in the history of our health system because
when it comes to advances in science and technology, we lead the world and
have done so for the past half century or longer. But when it comes to delivery
of health services, we fall behind and we've seen that [00:02:00] by such things
as li fe expectancy for Black Americans and other minorities shorter than that of
whites, infant mortality for Black infants is twice as high, death rate from
cancer, heart disease, diabetes, and other conditions are higher. So we really
have this dichotomy, and part of it I say is a delivery problem. We have strong
science, but we have weak delivery. We need to find ways to [00:02:30] see that
all Americans, Black, white, yellow, red, what have you, that all Americans have
access to the marvelous science that ha s really to come out of our laboratories,
of our universities and research institutes. That's where we fall short. That's
what we need to do.

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And I look upon it as an investment in a better, stronger America. I think too
many people look upon investment e xpenditures in health as really [00:03:00]
dollars that should be avoided. But that's a mistake because I say that a healthy
nation really is a wealthy nation. If we can improve our health, we'll improve the
wealth and the strength and the stability of our country.

Margaret Flinte...: Well, Dr. Sullivan, you have a special focus on advancing health equity by
fostering programs that advance the training of people of color in the health
professions who deliver that care in the United States and around the glo be.
You have a [00:03:30] new book titled, We'll Fight It Out Here, A History of the
Ongoing Struggle for Health Equity. Tell us when it comes to that training, what
are the best strategies for winning in that struggle?

Dr. Louis Sulli...: Well, what we ha ve is really an unfortunate history. We have a dichotomy here.
From the founding of the country, there were these high principles of equality
and equal opportunity. Those are high principles, [00:04:00] but they are
principles that we as a country have fal len short on. The positive thing is we are
moving towards making that more of a reality throughout the 20th century, but
we have not yet reached that point. And by that I mean this, we have
differences in wealth, differences in health status, difference in educational
opportunities. So we need to work to eliminate these disparities because if
[00:04:30] we are able to do that, we will be a stronger country. We will have a
more stable democracy, we'll have a stronger economy, we'll have a healthier
citizenry . So all of those things would be positive for our country as a whole,
because those individuals who are impaired by illness or injury or poor health,
they are not as productive as they can be.

So if we work to see that they are [00:05:00] given the healt h services that they
need and they become healthier, they will contribute more to our society. They
will be stronger, better educated workers, they will produce more goods and
services, they will help us in our international competition with other countrie s.
So that's why I say these expenditures should be investments in a better United
States. That's the story that I try to tell.

Mark Masselli: Well, and it's such a well - told [00:05:30] story, and I hope every American buys
and reads your book because it e xplains how 40 years ago the Association of
Minority Health Professions Schools brought to light healthcare inequities and
precipitated virtually all minority health legislation since then. I'm wondering if
you could take us through a little ride through t hat time and also maybe where
do the gaps currently remain?

Dr. Louis Sulli...: Yes. Well, the Association of Minority Health Professions [00:06:00] Schools
came about in 1977. Of course, I'm a native Atlantan, graduate of Morehouse
College and went to med ical school at Boston University. When I went to
medical school, my goal was to become a physician to return to Georgia to
provide health services to Georgians, particularly African Americans, because in
the southwestern part of my state where we lived, [0 0:06:30] although I'd been

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born in Atlanta, there was one Black physician. He was someone I admired
because he had a capability that others didn't have. He had the ability to take
care of people who became ill or injured or needed other health services. He
was highly respected and he was revered in the community. That was my role
model. So I wanted to be like him.

Well, when I got to Boston University, [00:07:00] I learned a lot about medicine
that I had not known about. So it ended up I didn't become a pr imary care
physician. I ended up being a hematologist, a research hematologist and had
really graduated in 1958. And to make a long story short, by the early seventies,
I'd become professor of medicine at Boston University, my medical school alma
mater, an d I was doing research in nutritional anemias. Very exciting. I always
[00:07:30] loved science. I found it very rewarding to discover things and to
really work to improve people's health with blood diseases.

But Morehouse College decided they wanted to s tart a medical school. So as an
alumnus of the college, I was among the alumni contracted by the college. And I
ended up thinking, "Well, I came here in 1954, the year of Brown versus Board
of Education where I entered medical school. I came to Boston Univ ersity with
the idea of going back [00:08:00] to Georgia and taking care of people. And I
didn't give up doing things which I thought were important and exciting, but it
was really different from what I had planned when I entered."

So when that opportunit y came, I indeed accepted the opportunity, went back
and informed the Morehouse School of Medicine in 1975. That was the third
predominantly Black medical school then to exist in the United States. There
had been seven [00:08:30] at the time of the Flexner Report in 1910 that
resulted in tremendous changes in medical education. But of those seven Black
schools that existed in 1910, only two survived. Howard in Washington, that
opened in 1868 and Meharry in Nashville, Tennessee, that opened in 1886. So
when Morehouse opened with our first class in 1978, we were the first in the
20th century. We formed [00:09:00] associations not only with Meharry, but
also with the veterinary school at Tuskegee University in Alabama and Xavier
College of Pharmacy.

So the ass ociation was formed so that we could work together to supplement
each other's activities and to really work to have programs developed at the
federal and state levels that would support what we were trying to do. Because
like other Black institutions of hi gher education [00:09:30] at that time, and still
to some degree today, we were underfunded. So that's why the association was
formed. But the association grew so that it now has 12 health professions
programs that are members. We were able to take our act ivities and speak with
members of Congress or state legislatures and get programs enacted that really
supported what we were trying to do. So we were [00:10:00] expressing the fact
that health status for African Americans and poor whites also was not as go od
as that of more affluent individuals or majority populations. And of course, we

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made the argument that I've already stated that if we are able to have a
healthier population, it'll be a more productive population.

So we were fortunate in [00:10:30] tha t this message was listened to by
members of Congress, including the members of the Congressional Black
Caucus, and a number of programs were developed. And I would say that
because of that fact that we brought the health inequities to the attention of
peo ple in the Congress and in state legislatures as well as in the private sector, a
number of programs were enacted through the association. So that is what the
book We'll Fight it Out Here is all about, the history of the Association [00:11:00]
of Minority Health Professions Schools.

Margaret Flinte...: Well, that is so fascinating. And I agree with Mark, we hope everybody gets that
book and reads it. But Dr. Sullivan, as somebody who's been involved in
healthcare for almost five decades, I find it staggerin g that for all the advances
that have been made today, only about 5% of the nation's doctors identify as
Black. And I wonder, with all the work that's going on are we projecting over the
next [00:11:30] 10 years or 20 years that we'll see a significant shi ft in that end?
And what can each of us do on an individual personal, professional basis to try
and make the profession more representative and more diverse?

Dr. Louis Sulli...: Well, you're certainly correct in pointing out the fact that the representatio n of
African Americans among the nation's physicians is far less than what it should
be at 5%. But in 1950, the [00:12:00] year that I entered college, it was only 2%
of the nation's physicians were African American. During the sixties and the
seventies an d the eighties, with a lot of activities underway, stimulated by the
Civil Rights Movement and such things as the Great Society programs of Lyndon
Johnson, with the enactment of Medicare and Medicaid, the National Health
Service core programs and others, w e did increase the number of Black
physicians to 5%, [00:12:30] where it is today. Blacks, as you know today are
13% of the US population.

Margaret Flinte...: Right.

Dr. Louis Sulli...: So we really fall far short of where we should be if we were adequatel y
represented in our society. The reasons for that really are multiple, and it really
also means the responses will have to be varied. They are financial. First of all,
getting a health profession's education [00:13:00] is expensive. Many people
from low i ncome families cannot afford it. Secondly, we want to have well -
trained, well - educated people who are providing health services to our citizens.
So getting into a health professions program is competitive. You have to be well -
trained, knowledgeable, really not only in the sciences, but in a general
education so that you are able to communicate with people effectively and
understand complex [00:13:30] situations and be able to solve problems quite
rapidly when you're on the fly. So we have to have well - educa ted young people.

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Unfortunately, inner city schools where most African Americans receive their K
through 12 education, those schools so often are underfunded, inadequately
staffed with their teachers and support staff so that the strength of the
education they receive is [00:14:00] not as high. So the combination of lack of
resources to go to college after high school and on to graduate school or
professional school, that is there. So it's really a combination of lack of adequate
preparation, lack of finan cial resources, and also lack of role models.

I was lucky, as I mentioned, in having a role model in Dr. Griffin, but of a lot of
Black youngsters never see a Black health [00:14:30] professional. So they don't
have that view that they can and should work to become a health professional.
Then there is bias in the system. We're working to really diminish and eventually
eliminate bias and we are making progress. So I want to be sure that everyone
understands today, in spite of the fact that we have a lot of problems, we are
much better than we were 50 years ago, but we need to continue.

[00:15:00] The other thing I'd say is progress will take time. Developing a health
professional starts with that youngster in the community, the educational
opportunities tha t person has, the vision that they have, the financial resources
and the guidance that they have. So it really does take decades. So this is an
issue for the long term. So I would invite the support of everyone [00:15:30]
because we need to rev up our capa bilities here. They are better, but they still
didn't need to be even better than they are.

When I went to medical school in 1954, one - third of the medical schools in the
country were in the south. I could not go to a medical school in the south
because o f the legally enforced segregation. Well, that's different now. So some
of the schools that are doing well on diversity [00:16:00] are in the south, but
schools around the country, all of them working together need to do much
better. So that's what we hope to see.

Mark Masselli: Well, I think you hit the right point of we need to rev up our energy and focus
on this. Such an important area. In your book, you cover the waterfront of
issues, but one of the areas that you highlight is the rise of Newt Gingrich , fellow
Georgian in the House of Representatives, really as a turning point in the politics
in the United States. Wonder if you can describe for our [00:16:30] listeners his
influence on health policy and how do you think it continues to this day?

Dr. Lou is Sulli...: Well, Newt Gingrich was really quite influential. He was of course, a professor of
history at West Georgia College before he ran for Congress, and he seemed to
have a strong interest in science. And when he ran for Congress and was
elected, he visited me at Morehouse School of Medicine and [00:17:00] was
supportive of what we were trying to do then. And that was in the late seventies
and early eighties. Then in '89 when I became secretary, he visited me in
Washington. So I would say that he was someone who was an accomplished
academic, but I really was very surprised at the very conservative political
posture he took [00:17:30] when he became Speaker of the House and was

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quite strident in his views. So that he's someone that I think really has p romise
that was not fulfilled from my perspective in terms of what he could have
contributed to improving the health of our country.

You start a revolution that really we still see today. The degree of [00:18:00]
divisiveness between our two political par ties I think has really gone beyond the
brink. We now have a Congress that is not as functional, not as productive as it
can be, as it has been in the past. We need to find ways for our elected officials
to know they work for us, the people. Public service is a great honor and an
opportunity to improve your community. [00:18:30] So I would hope that we
are able to work with our colleagues who've been put in the elected office to
really come together to solve problems rather than to really have political
bat tles that really do nothing but really divide our country, so.

Mark Masselli: Dr. Sullivan, can I just follow up on that for one second because I want to pull
the thread all the way to today where it's not only we're divisive, but healthcare
is under attac k. [00:19:00] You saw it in the sort of partisan divide that occurred
on the vaccine itself, but health professionals now are really being challenged
for their credibility, and that's the first time we've seen that happen. Somehow
they've been politicalize d. How do we bring people together? And I know this is
something that you are very focused in on, but how do we bring this
divisiveness [00:19:30] and this undermining of the role model that you grew up
with, a health professional who you listen to and you learn from and you spend
a lifetime emulating? It seems that we're at a crossroads in America.

Dr. Louis Sulli...: Well, we are, and I say there are a number of things that really should be done.
First of all, we need to have all of our citizens [00:20:00 ] vote, become active at
the polls and make your elected representatives address the issues that we
have. So that's the first thing. Our health system for delivery purposes is
underfunded. One of the things, for example, is we need to strengthen our
system of public health because in the COVID pandemic, we saw the fact that
our colleagues at CDC were [00:20:30] really under stress and frequently had to
work in an environment where there was misinformation coming from our
senior elected officials, coming fro m the White House here. You remember
when the President Trump said, "Oh, this virus will be gone in two or three
weeks and you won't know it?" Well, our public health officials really were very
[00:21:00] disturbed by that and tried to correct the that wit hout having a
confrontation with the president.

But we found that for whatever reason, these kinds of statements, which are
incorrect or misinformation proceeded. And so as a result of that, among other
things, we've seen this politicization of science an d health where whether
[00:21:30] you wore a mask or not during the height of the pandemic became a
political statement. Whether you tried to have social distancing between people
at restaurants and in public gatherings, that became another issue. So that as a
scientist, you try to be objective and really follow what the data tells you
because science really should [00:22:00] be in the service of people. It should

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not be used for political purposes, but that was not the case. So that confusion
in the public has existed. And people, for example, who didn't understand the
scientific process, were suspicious of this vaccine because it had been
developed within 12 months of discovering this virus.

And I was in medical school when the Salk vaccine and the Sabin vaccines
[00:22:30] were developed for polio. It took years for that. But because of our
scientific technology that has been developed, we're able to develop the
vaccine for this new virus and develop an excellent vaccine. But people really
were confused b y that. So we need to support our public health system, see
that our state public health offices and agencies are funded, see that CDC
[00:23:00] and the other components of the public health system get the
support that they get, and also the science liter acy of the population needs to
be improved because part of the problem was the suspicion in our society that
this vaccine somehow was not good or was something else. That really is
because of a number of factors, but including the fact that people don't
un derstand how vaccines work [00:23:30] or the science behind them.

So we need to improve the scientific literacy in our population. We need to
support our public health service. We need to have more diversity among our
health professionals. We need to see that everyone has access to care through
having health insurance or a payment mechanism. All of those things are
necessary. But again, I emphasize if we do that, the returns on our society will
far exceed that investment [00:24:00] by having a healthier po pulation and a
more productive population.

Margaret Flinte...: Dr. Sullivan, from where you sit, I think you're a senior statesman for sure. You
have a great pulpit through your writing, through the book that you've just
done, interviews like this. But I'm curious, and I'd like to ask you, when we see
some of the individual platforms that some of the, and particularly the
Republican party leaders are taking, and I'm thinking specifically right now
about Florida governor [00:24:30] Ron DeSantis came out agai nst a recent
diversity job fair in a state and is blocking advanced placement courses in high
schools about African - American studies, are you reaching out to any of these
individuals on a one - to - one basis to try and have conversations, understand
where the y're coming from, and maybe try and have a one - to - one dialogue with
some of these very influential opinion shapers in the country?

Dr. Louis Sulli...: That's an excellent idea. We have not done that [00:25:00] thus far, but that
really is an excellent sugg estion that we will really see what we can do because I
would like to believe that everyone who aspires to be a public servant wants to
do the right thing for our people. So there can be a lot of confusion. And in the
hurly - burly of the political world, pe ople may not have the right information. So
I would like to see our health system and [00:25:30] science in general really
respected for its fidelity, its adherence to truth, to serve the needs of people
and not banded about for political purposes.

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And I would say that fortunately, when I was secretary from '89 to '93, I had a
lot of members of Congress, Democrat and Republican who were very
supportive of the health programs that we had and worked [00:26:00] together
in the Congress to implement new progra ms. We have a number of programs
that came into being during my time. Healthy People 2000, we launched in
September of 1990, and the Healthy People Movement to improve health
literacy and the healthy behavior of our population is still there. Support for
r esearch at NIH has grown over the years with both parties supporting it.
[00:26:30] We want to really try and return to a fact - based program that serves
the people. And so reaching out to our leaders I think is a great idea and we'll
really work to see if we can help change the environment.

Mark Masselli: Well, that's great. Let me get in one last question, Dr. Sullivan, and I also should
note Secretary Sullivan, so I'm not sure what trumps one, but I want to talk to
you about your own hometown, Atlanta and the CDC, where [00:27:00] it is
housed. You talked about it a little earlier, and I would say as part of that
conversation you were having about how we have to fund our public health
systems, I think the CDC took a lot of hits during the pandemic. Do you see if
there's a way out for them, what's the best way to navigate a very distrusting
public to try to bring back the sort of functionality that we all saw the CDC have
years [00:27:30] ago? And certainly you talked a little bit about public health,
but wh at advice would you have to the CDC? I know they're working on trying to
develop a road path forward. What do you have to say about that?

Dr. Louis Sulli...: Well, you're quite correct. The lack of trust or the loss of trust in our health
system is really part of a larger phenomenon that we are experiencing as a
society or as [00:28:00] a country because trust in our other institutions in our
society has also diminished. Trust in our judicial system, in our educational
system and religious divisions, all of those have really increased here. The
tremendous attention around immigration has been unfortunate because the
data showed that immigrants [00:28:30] coming to America really have
produced a lot of the jobs that we have. The farmers need to have immigrant s
to really help with the work on the farm, the planting and the harvesting, et
cetera. The workers in our restaurants and our hotels, immigrants contribute to
that. And so we are all immigrants who've come to the country. So to me, it is
ironic and unfort unate seeing people [00:29:00] really trying to resist
immigration when their parents or their grandparents or great - grandparents
were immigrants who came and provided a platform for them.

We are a country of immigrants, and our democracy has accepted and benefited
from that. We need to get back to that spirit. Now with the strategies to
improve trust in our health system, they are multiple. They [00:29:30] are as
follows. First of all, all of us in the health system need to understand that we
have a role to play in addition to our professional responsibilities of really
working with our communities to explain what we are doing and why it's
important and how it works, et cetera. But we need partners. There are some
institutions in our society that have a gr eater level of trust. I know in the Black

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community, the Black church is a very important institution. So a number of
health [00:30:00] programs are really provided by churches, whether they are
vaccination programs or well baby clinics or nutrition progra ms or other things.
So by working in partnership with those organizations will help. But we need to
hold our public officials accountable that they are there to serve the people.
They are there to make our country better, and they need to find ways to work
together.

[00:30:30] And I was fortunate in working for George H.W. Bush because he was
an individual who saw public service as an honor. He was a World War II pilot in
the Navy, as you know, was a hero there. He worked as the representative to
China to help open up China back in the sixties. He worked for the CIA and he
was a congressman from Texas and then vice president and president.
[00:31:00] So the spirit of public service, serving the people has to be the
mantra for those who serve in elected offi ce. Because if they do that and we as
citizens be sure that we elect people with that kind of orientation, those are the
things that will help. So that's what I urge everyone to do. It's everyone's
responsibility. It'll take time and effort, but it'd be wo rth the effort.

Margaret Flinte...: Well, Dr. Sullivan, [00:31:30] speaking of heroes and public servants, it's a true
honor to speak with you who exemplified that. Your work and dedication has
inspired all of us. Thank you for being with us, and thank you to our audience for
being here as well. You can learn more about Conversations on Health Care and
sign up for our email updates at CHCRadio.com. Dr. Sullivan, thank you again so
much for being with us.

Dr. Louis Sulli...: Well, let me end by thanking you and your colleagues at the Community Health
Center for all of the citizens [00:32:00] that you serve and what you do to
improve the communities where you operate. We need to have more
Community Health Centers around the country to serve our people, to incr ease
the health, the economic viability of our country, the educational strengths, and
the strength of our democracy. So thank you for what you do.

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