Spring 2021

Toward more inclusive medicine

U of M family physician Andrea Westby on teaching future health care providers to honor the needs and priorities of the communities they serve

A prepandemic scene from the University of Minnesota's family medicine residency program at the M Health Fairview Clinic - Bethesda in St. Paul.
All images courtesy of the University of Minnesota Medical School

Last October, Andrea Westby, a family physician and faculty member in the University of Minnesota’s North Memorial Family Medicine Residency program, was named the inaugural Josie Robinson Johnson Endowed Chair in Justice, Equity, Diversity, and Inclusion in the Medical School. The position, which was funded by the University and donors, honors the contributions of the civil rights activist and community leader, whose work broke down barriers to education, housing, and employment in Minnesota and beyond.

Westby, who practices at the University of Minnesota Physicians’ Broadway Family Medicine Clinic in north Minneapolis, has been a leader in diversity, equity, and inclusion work within the Medical School’s department of family medicine and community health. Here, she shares her observations about the impact of racial and social inequities on health and how this new position will help shape health care in the future.

Andrea Westby

Family medicine is on the front line of health care. What racial and social inequities do you see?

Any of the disparities we see outside the clinic, we see in the clinic. Patients and communities of color experience worse care and worse health outcomes as compared with white patients and communities. We see profound disparities in access to quality medical care, to specialists, to hospitals. Clinic location, transportation, insurance access, as well as the fact that even within family medicine, the majority of our providers are white, contribute to the disparities.

How does being a member of a marginalized community affect a person’s health? 

Systemic racism affects access to resources that impact health. There are social and structural drivers of health—lack of access to nutritious foods, not having a safe place to live, lack of green space. For example, there’s some good data on how the amount of green space in a neighborhood affects cardiovascular health and blood pressure. So when we see people of color clustered in areas that are more industrial, with higher exposure to toxins and less green space, we’re going to see more diabetes, hypertension, heart disease in that population. Discrimination and bias—and the way that affects chronic, toxic stress—also play a role.

Have you seen this play out in regards to COVID-19?

Patients of color are more likely to work jobs that don’t allow them to work from home. They are more likely to have more people living together in a household and are unable to quarantine and protect themselves from exposure to COVID-19, and they are treated differently by the medical system as well.

How did you get interested in equity, diversity, and inclusion work?

I’ve been trying to reflect on that. Having grown up in a rural community in Minnesota, and having a lack of economic privilege, I could see how the system worked differently for me than for those who had economic privilege and who lived in well-resourced areas. That helped me be able to see where there were problems.

In my work, I see how historically, we have placed more value on certain people based on things that are not at all under their control and how the system treats people differently. This translates very much into the way we see racial inequity play out.

You co-direct an initiative within the department to address equity, diversity, and inclusion. What have you been doing?

We’re looking at the cultural climate, our workforce, our faculty and staff, our trainees, and clinical care. We have a number of initiatives to support trainees—to make sure they feel safe, welcome, respected and that they belong, no matter their background and identity. And there’s a lot of faculty development work happening: How do we provide people with the opportunity to practice microaggression and harassment disruption? How do we encourage people to create a safe environment for all people? How do we support the people who’ve been targeted?  

In terms of clinical care, I believe that if we center on people who are least likely to experience good health within our current system, our system will work for more people. Instead of saying, “Let’s do something that will work for 90 percent of the people, and the other 10 percent will have to figure it out,” let’s figure out how we make sure we help and are centered on that 10 percent. If we do that, it will be easier for the 90 percent.

One of the goals of the endowed chair position is to cultivate strong community involvement. What will this facilitate?

Many times, community or patient advisory boards are driven by the health care institution, where we decide the priorities and what to focus on and then run it by people to see what they think. What we’re trying to do is flip that, to shift the power.

My hope is that we can engage with the community in a way that we have their priorities and needs at the forefront of how we educate, how we do research, how we provide care. And we don’t want to just involve patients but also people who live in the community and who are choosing not to come to us for care. We need to learn from those folks to make sure we’re doing a good job for everyone.

We recently created a community engagement and development coordinator position. The coordinator’s role is going to help us make sure we’re creating relationships that are mutually beneficial. We’re trying to get all clinics to have a community champion to help lead and guide our work so we can do it in a way that’s equity empowered vs. health care driven.  

How will the position help train the next generation of family physicians?

The chair has really solidified equity and justice into the mission of the department in a way that’s long-lasting. It is going to better prepare our future health care providers to be thinking about equity and center the voices of those most impacted, so we can move forward together and shift the allocation of resources toward those who need them the most. That’s the only way we will make headway when it comes to reducing disparities.

Josie Robinson Johnson

Have you met Josie Robinson Johnson?

Only virtually. It’s such an honor to be in the same space as someone who’s been so dedicated to improving the lives of those in our community. I only hope to do her vision justice.

What are your thoughts about being the inaugural chair?

One of the things that’s challenging is being a white leader in diversity, equity, and inclusion, and especially holding a chair named after someone who is such an amazing African American civil rights hero.

It’s something that I’m somewhat conflicted about. I think it’s so important to center the work of the people who have come before and allowed for me to be in this space, and to ensure that I’m listening with humility, knowing that I’m going to make mistakes, knowing that my background and my identity and my positionality only allow me to see the things I know. I’m constantly trying to listen and learn in a way that is authentic and moves things forward for everyone.

I’m hoping what we can do through this position is to create a space where it isn’t one person leading, so I can share money and power in order to ensure we are elevating voices and ideas, and create a more nuanced understanding of and relationship with each other, with our patients, within our department, and within our community.

Kim Kiser is editor of Legacy magazine.