James E Page Jr. Vice President and Chief Diversity Officer, Johns Hopkins Medicine
June 24, 2016
Leaders are not always born that way but circumstances push them to that level. Trained at Purdue University in Computer Technology, I thought I’d be an engineer for the rest of my life, but I find myself charged with leading diversity and inclusion efforts in the world’s most prestigious institution of medical research and I am doing so in a city that inspired “The Corner”, “The Wire” and “Homicide.”
When my dear friend, fraternity brother and civil rights advocate, The Reverend F Willis Johnson, asked me to impart my thoughts in his new book aiming to guide faith-based leaders on how to address race and injustice in their communities, I was hesitant. A spiritual man myself, I am a trained engineer who has led both high technology companies and health systems through the turbulences and complexities of diversity issues especially pertaining to employee relations, strategic preparedness, patient care and training. And while solving racial injustices has been broached as a potential goal at many places I have worked, I have always felt this was an overly ambitious goal for any single organization. But my lifelong experiences and especially recent events in the country and the world have made me realize that as a change agent, and given my unique position, I have both the obligation and opportunity to stand up to injustices in my community. I firmly believe my steps were ordered and my family and I were guided to Baltimore, to Johns Hopkins at this time, not because the road would be easy, or the material rewards abundant. I believe that I was sent to this role at this time because the role of an advocate, a voice, a Diversity leader would be needed at Johns Hopkins Medicine. This is why I feel honored and humbled to have been asked to participate in this pivotal work and agreed to lend my voice to this guide.
In his report to the Carnegie Foundation “Medical Education in the United States and Canada”, Abraham Flexner shaped medical education in the twentieth century. Flexner’s vision for medical education was closely modeled after his Alma Mater, Johns Hopkins University. The institution continues to serve as a beacon for medical education more than one hundred years later as can be illustrated by comments made by the President of the Association of American Medical Colleges, Dr. Darrel Kirsch: “As goes Hopkins so goes the rest of academic medicine.” Global leadership is in fact ingrained in Johns Hopkins’ mission of “improving the health of the community and the world by setting the standard of excellence in medical education, research and clinical care.” It is for that reason that I feel that my experiences and insight will help Chief Diversity Officers and other diversity leaders in academic health centers throughout America and the world frame their stand on social injustices and contributions to remedy them, especially within institutions that are located in cities in which urban decay and poverty prevail.
In the 2016 annual meeting of the Association of Academic Medical Colleges (AAMC), Dr. Peter Slovin, chair of the AAMC Board of Directors, argued that “the issues of racial bias and racial disparities should be discussed and addressed by … medical schools and teaching hospitals.” Recognizing social unrest in Ferguson, Baltimore and Staten Island, Dr. Slavin asserted that the root causes of social unrest are tied to root causes of health inequities. Similarly, in his new op-ed, “The Disease of Poverty,” Sir Michael Marmot implores us to seek the “cause of the causes”—the social conditions that give rise to unhealthy lifestyles. Both renowned scientists and social change advocates note that in Baltimore City, people living just a few miles apart have starkly different prospects in longevity. Those living two decades less reside in a place where half the residents are unemployed, one-third of the homes are boarded up, and almost two-thirds of residents don’t have a high school diploma. There is thus a strong rationale that addressing health disparities is a place-based issue and cannot be addressed without addressing social injustices.
Leaders as Change Agents in Health Settings
In recent years we have been witnessing a growing appreciation of diversity and inclusion as core elements of the success, mission and vision of academic medical centers. As a result, many schools and teaching hospitals have elevated their efforts in diversity and inclusion moving to hire senior leaders to serve within the C-Suite in leadership positions to spearhead diversity and inclusion efforts, creating the Chief Diversity Officer (CDO) positions. The fact that many of the academic health centers are positioned in America’s urban settings some within areas of urban decay, blight and disinvestment where health statistics are no better than these seen in undeveloped countries – brings to light the difficult question of social and economic accountability that academic health centers and their CDOs face.
How do we leverage our capital?
Many CDOs around the nation in and outside the health industry have been given a “seat at the table” with respect to executive leadership. Like me, some CDOs are also corporate officers at their institutions, and are often the “go to” person when racial issues emerge and for that matter when any issues pertaining to American marginalized communities arise, and global challanges for multinational organizations. The past year has been most eventful. Racial tensions around the country, and world, have grown as new technology puts altercations between police and the community on the national frontline; a particular contentious election year with rhetoric unlike any other we have known; the Fisher v. University of Texas Supreme Court debate and ruling; national debates around immigration and the proposed Dream Act; swift changes to the nation’s demographics and its electorate, with America’s public schools having already made the minority majority transition; and of course LGBTQ issues such as the Supreme Court ruling on same-sex marriage, the trans-gender bathroom debate, and the hate-inspired massacre in Orlando.
Having the bully pulpit in our institutions we need to think how to leverage our unique positions. Being among the few minorities in the C-Suite CDOs choose our battles carefully, as many of the issues we are asked to weigh in on are extremely sensitive and very hotly debated in the public domain, and in a country that clearly is widely divided. Moreover, the political rhetoric and the public discourse in Presidential rallies, cable news talk shows and social media make it very clear that bigotry and ethnic centrism are alive and well. For us, achieving equity in academic medicine is an uphill battle. The fact that ethnic/racial minorities continue to be underrepresented in senior level academic ranks, on boards of trustees\ directors and within executive levels in academic medicine has been at times blamed on “window dressing” and “tokenism” when it comes to institutional diversity strategies and leveraging resources. I have always believed that our charge as leaders and change agents is to meaningfully work diversity to our advantage. We must make diversity and inclusion an essential, understood, agreed upon and individualized component of organizational success. It is not enough for us to tolerate our differences. It is not enough for us to merely celebrate or appreciate each other’s differences or to be sensitive to each other’s differences. We don’t do this work because of “food, fun and flag” of diversity, but rather to make meaningful, lasting and systemic changes. It is time for us all to stop and think how to leverage the capital that our titles and jurisdictions bestow on us for the good of the institution, community, city and country.
My Story
April of 2015 was a very eventful month for me. On Saturday, April 11th 2015 I was devastated to learn of the untimely passing of my friend, mentor, Fraternity Brother, and civil rights activist, Dr. Levi Watkins Jr. I was still new to Maryland having moved there just eight months before from Cincinnati, Ohio to assume my new role as Vice President and Chief Diversity Officer for Johns Hopkins Medicine. The next day, while I and my colleagues were trying to grapple with Dr. Watkins’ loss, a 25 year old man living just two miles away from the Johns Hopkins Hospital campus was arrested. I haven’t heard his name until April 18, 2015 when the first protests were being held in Baltimore while Freddie Gray was laying in coma from injuries he suffered on the faithful day of April 12. I don’t remember much of the early hours of Monday, April 27, the day Freddie Gray was laid to rest, but mayhem and chaos were taking over as the day progressed. That evening I was watching TV in disbelief as the national media portrayed a city engulfed in flames. Gray's death placed Baltimore in the international spotlight and set the stage for riots the likes of which had not been seen in the city since the death of the Rev. Dr. Martin Luther King Jr. in 1968. I was thinking about the civil rights movement realizing that this might be this generation’s way of seeking their justice, making their voice heard, saying enough is enough and cry out for their rightful place in what is known worldwide as “the land of opportunity”. Watching these events play out took me back to my childhood home in Indianapolis, police tanks are pulling in front of my home and I am watching my mother harassed by the police as she is unloading groceries from her car to take them into our house.
It was the summer of 1995, Freddie Gray was five. (Reverend) F. Willis Johnson and I were practicing with other fraternity brothers for a step show. This routine involved tossing bricks, and needless to say, someone stood when they should have ducked. We rushed to the emergency room with our injured fraternity brother and were interrogated by police and medical staff about the cause of the injuries. At this time I realized that my friends, my neighborhood was beginning to riot. In Indianapolis, a 21 year old black man, Danny Sales, is allegedly beaten up by police during a drug trafficking crackdown while his hands are tied behind his back two blocks from my childhood home. Police claim he was trying to run away and fell. Demonstrations break out, bricks are thrown at police and a drug store is looted. Police fires tear gas into the crowd and arrests dozens of protestors. The then Mayor, Stephen Goldsmith calls the events “mini riots.” This happens amidst allegations that Indianapolis Police is overreaching to perceived increase in crime by stepping up aggressive policing and harassing African American youth - treating them all as violent gang members. No smartphone cameras bring these events into the national discourse, but for me and my three brothers these events are life changing and sobering. I was thinking about the familiar narrative around the outbreak of violence in American cities that makes it fit into our experience of past protests from cities like Ferguson, North Charleston, Los Angeles, Staten Island and Baltimore. Lack of opportunity and hopelessness amidst mounting tensions reaching the boiling point and then violence erupts, demonstrations dispersed and then people go home and cities begin the process of cleaning up. What is wrong with that script and when will it stop?
My parents raised four black boys from nothingness to see each of these boys receive undergraduate and then a graduate degree, while they themselves obtained college and Master’s degrees as working parents. They wanted their sons to have opportunities to pursue a life free of oppression, discrimination and squandered opportunity. They wanted to shield us from all that they have endured growing up.
Raising a Black son in America, I too get concerned about his future. I get concerned that people will see him but fail to realize his beauty, his wit, his smarts and his tremendous potential. A friend of mine once told me that I did not have to worry about my son being mistaken as dangerous or harmful. It was implied that I am different, my family is different, we are safe and my degrees, titles and connections will shield my son from the dangers associated with being Black in America. Our country must realize we are raising an entire generation that is not living the American Dream, but simply surviving the American experience. We have seen an entire generation (including my generation) alter its expectations and behaviors because of how they look, and perceptions that others have about an individual’s outward appearance. American is seeing an entire generation of men, women, boys and girls who:
Understand they will be followed in stores.
Expect to be “mistaken" for the help.
Know they will be petted on their head because their hair is "interesting."
fear airports because their hair and scalp will be searched by a TSA agent.
Have been stopped because they “fit the description of. . .”.
Live in communities where realize the chance of being pulled over for a DWI is lower than their chance of being pulled over for a DWB (Driving While Black).
Become fearful and viscerally anxious when they see a police officer around while driving.
Have had to coach or have been coached, for safety, on what to do and not to do when encountering a police officer.
Alter fundamental components of who they are or how they conduct themselves so they can “fit in” at work.
What my friend did not understand is that I had been followed in stores, that I had a gun pointed at my head by both police officers and strangers. What this friend did not understand is that I and people who look like me are not seen for who we really are, for what we believe in, or for the gifts we have to offer – but rather through the narrow and confining lens of decades of stereotypes, prejudice and bias. Viewing people narrowly, or putting them in boxes, literally and figuratively is dangerous – it denies opportunity in a land whose promise of a Dream is regardless of race, color, sex, creed, age, who you love or how you identify. These confining boxes are the common thread between Danny Sales from Indianapolis, Michael Brown from Ferguson, Tamir Rice from Cleveland, Walter Scott from North Charleston, Trayvon Martin from Stanford, Freddie Gray of Baltimore and countless scores of individuals not captured on anyone’s mobile phone.
As an African American father I constantly remind my son to stand tall, pull his shoulders back, and hold his head high. I tell him to always look another man in the eye, and choose his words deliberately. And while I remind my son to hold his head high in the morning, I impress upon him his obligation to end everyday on his knees thanking God for the advantages he have been given. I tell him these things because I take my charge in raising a man as one of my most important duties. I want my son to come back home to me, safely, so I can hold him firmly in my arms and tell him how much I am proud of him. So, it pains me that in 2016, I have to tell my son when confronted by police officers to avert his gaze, keep quiet and to humble himself. It pains me that being black in America in 2016 still means laughing when there’s nothing funny; dancing when you don’t like the music and playing the game when all you want to do is flee. Being black in America today, means bowing your head when you want to run, and tightening your lips when you want to cry for help. And while I have degrees, a title, leverage and a seat at the table, that does not make me immune from racism, shield my friends from prejudice, protect my loved ones from negative implicit biases. However, my seat at the table, my title, my understanding of business, my knowledge of corporate environments, and my council provided to executives in times of crisis does provides me the opportunity and obligation to help ensure the arch of our actions bends towards justice, that it bends towards universal respect, dignity and respect.
The Johns Hopkins Experience
Johns Hopkins can be foreboding to some. Setting the tone for academic excellence in medicine and capturing the top-tier ranking among all leading hospitals in the United States for 22 years it is often viewed as an “elite” institution placing academic prestige ahead of service. However, Johns Hopkins’ commitment to supporting the underserved is ingrained in its mission. The institution was founded in 1867 as the first American research university, with funds bequeathed by a Quaker merchant who sought to create a university-based health center that would provide care to all people, “regardless of sex, age, color or ability to pay.” Hopkins also decreed that his estate will be used to operate a “colored orphan asylum” which in fact operated in the years of 1875 to 1924. However, turbulent times in American history, the urban flight of the 1960s and social and economic upheaval resulted in a contentious relationship between Johns Hopkins and the East Baltimore community. Deep issues of mistrust plague the two and it’s against this backdrop that the events of spring 2015 ensued.
When the eyes of this world turned to Baltimore last year as protests erupted in our streets, urgency steered our collective efforts. My advice and leadership were called on and together as leaders of Johns Hopkins we came to realize that our history, lived experience and future are intertwined with the community we call home and that the health and well-being of Johns Hopkins are inextricably tied to the physical, social, and economic well-being of Baltimore. We agreed that we don’t simply reside in the community but rather are the community; our successes, progress, discoveries and challenges are a reflection of our community’s success. Moreover, being one of the largest employers in the state of Maryland, at Johns Hopkins Medical Institutions over one quarter of all employees come from eighteen of the most economically depressed zip codes in the state. These employees and their families therefore face housing, educational, and built environment challenges impacting their entire quality of life.
With this realization, we set to reaffirm our commitment to demonstrating the pivotal role that academic health centers play in improving the social determinants of health in urban neighborhoods. To start with, Johns Hopkins leadership surveyed faculty and staff, asking, “What are the opportunities for Johns Hopkins—in engaging with the city we love and serve?” Although responses varied by employees participating in our race dialogues, we heard a resounding call to level the economic playing field, leading us to assemble seven different task forces with diverse mandates but with a single goal: strengthening families and whole neighborhoods by creating better opportunities for all. To that end, we have launched HopkinsLocal, which directs substantial resources into local businesses. In addition, we are intensifying existing programs in education, working to eliminate health disparities and strengthening economic vitality through hiring programs and job training. We are doing so by drawing on the expertise of neighborhood residents, educators, philanthropic organizations, elected representatives and community leaders, in addition to the wealth of intellectual resources that Johns Hopkins itself can offer.
While Johns Hopkins reaffirmed its commitment following the spring of 2015 unrest, the enterprise has intensified its efforts to change the trajectory for the children, youth and families of East Baltimore. This affirmation followed a report published in April of 2015 based on a Harvard study conducted by economist Professor Raj Chatty and his group. The study concluded that among the nation’s 100 largest jurisdictions, the one where children face the worst odds of escaping poverty is the city of Baltimore. Education inequalities are pervasive in Baltimore city. According to the 2009-2013 American Community Survey (ACS), less than one-third of Baltimore City residents over 25 have completed at least a four-year degree. In some neighborhoods, this number is as low as 5%. Believing that education is society’s biggest social equalizer, Johns Hopkins has a strong track record of nurturing the educational pipeline in its communities through an abundance of programs.
Two of the most enduring school partnership at Johns Hopkins are the Baltimore Scholars Program, and the Dunbar Hopkins Health Partnership. The Baltimore Scholars Program offers full scholarships to high-achieving Baltimore City public or charter school students accepted into Johns Hopkins University. The Dunbar Hopkins Health Partnership is a nearly-30-year collaboration to increase the number of diverse health professionals. This partnership, a creative collaboration between the high school and multiple divisions of the Johns Hopkins institutions, aims to enhance the educational pipeline and ultimately increase the number of talented, underrepresented health professionals and biomedical scientists to ensure workforce diversity in the health care industry. The Paul Laurence Dunbar High School for the Health Professions (PLDHS) is one of four citywide 9-12 schools and is located adjacent to the Johns Hopkins East Baltimore campus. The school currently enrolls 857 students who travel from across the city to attend Dunbar. Many come from neighborhoods with the highest poverty, unemployment and crime rates. The student body is predominantly African American (96%), and most Dunbar graduates are first-generation college students. The shared commitment between Dunbar and Johns Hopkins to prepare Dunbar students for post-secondary education and careers in health care revolves around three key areas: promoting a college-ready culture in the school; providing professional development to Dunbar faculty to advance their instructional practice; and providing exposure and experiential learning opportunities for students in the Health Professions pathways by leveraging the resources of Johns Hopkins. We have just announced our newest innovation, the P-TECH program (Pathways in Technology Early College High School) which creates a school-to-industry pipeline for students in science, technology, engineering, and mathematical fields. The program will offer health science degrees in areas of concentration such as health information technology, respiratory care, or surgical technology. The programs partners with Baltimore City Public School and Baltimore City Community College.
Conclusion:
Diversity is integral to the excellence and success of any institution, but it is vital for academic health centers. Its promise is essential in delivering extraordinary experience in healthcare to our patients, employees, students, volunteers, trainees, communities and suppliers. Diversity helps organizational success if managed well. However, diversity can be viewed a burdensome nice-to-have by institutions, as it can be as complex as finance, operations, human resources or supply chain management. Leaders esteemed for their ability to leverage diversity can have an unparalleled opportunity to step up to the plate and exceed operational goals in a very unique way. Change is daunting, and all of us know that injustices in our society are extremely hard to solve as they are caused by flawed human character and depend on political will.
We must begin somewhere though and we should do so by setting goals that will help stretch our institution, community, city and our country to become more accepting of our differences. Towards those goals we should employ incremental and transformational strategies and focus on achieving gains even in the face of obstacles. Destroying the boxes that confine us, has not been easy. We will stumble, we will falter and we will fail at times, but we must keep trying. Serving as champions of equity and holding our institutions accountable will help us restore ourselves as places of trust. Just like places of worship, health settings are places of trust. These are places where a person comes to be mended, to heal and to be whole again. We may not completely understand how or why these places of trust work, but there is a trust . . . faith that makes the word from a spiritual leader and the works from a physician Wonderful. These places are meant to accept all of God’s creatures when they have nowhere else to turn, providing them with a safe haven where respect, dignity and trust prevail. When we fail to meet these expectations, we breach that trust, and the wounds run extremely deep, impairing the relationship between the institution and the community which it professes to serve. Bruised trust can take generations to restore. We need to leverage our trust centers and stand behind our promise of respect, dignity and trust for all. Reverend Willis Johnson talks about the duty of Christian leaders to embody the “promise of hope.” He says that this hope does not promise unrealistic, sweeping, or grand instantaneous change, but rather small steps forward so that “justice might begin to trickle down.”