TOKENS PODCAST: S4E13
What role might race play in today’s ever-increasing gaps of social and economic inequality? And what might we be able to do about it? In this episode, we explore this topic with Dr. Andre Churchwell, world-renowned cardiologist and Chief Diversity Officer at Vanderbilt University, who suggests that a life of cultivated virtue and diversity may serve to bridge such gaps. “We are all prone to making blanket judgements based on our own past experiences, our families’ experiences, our communities’ experiences,” says Dr. Churchwell. “So the key for all of us is: let’s get to know each other.”
ABOUT THE GUEST
In May 2020, Dr. André L. Churchwell was named Vice Chancellor for Equity, Diversity & Inclusion and Chief Diversity Officer for Vanderbilt University after having held the offices in an interim capacity since June 2019. In order to devote more time to his Vanderbilt University diversity role, in July 2021, Dr. Churchwell stepped down from his position as Chief Diversity Officer for Vanderbilt University Medical Center and Senior Associate Dean for Diversity Affairs at Vanderbilt University School of Medicine which he held since 2014. In addition to his diversity role, Dr. Churchwell is a Professor of Medicine (Cardiology), a Professor of Radiology and Radiological Sciences, and a Professor of Biomedical Engineering. He serves on many medical school committees including the Admission and Promotion Committees. In 2005, he was named the Walter R. Murray Jr. Distinguished Alumnus by the Association of Vanderbilt Black Alumni for lifetime achievements in personal, professional and community arenas. And in 2015, Vanderbilt University endowed him with the Levi Watkins, Jr., M.D. Chair for achievements in the area of diversity and inclusion.
Churchwell graduated from the Vanderbilt School of Engineering magna cum laude in 1975. He won the Biomedical Engineering Student Program Award that same year. He received his medical degree from Harvard Medical School in 1979 and later completed his internship, residency and cardiology fellowship at Emory University School of Medicine and affiliated hospitals in Atlanta. In addition, he was the first African American chief medical resident at Grady Memorial Hospital (1984–1985).
Churchwell received the J. Willis Hurst Award for Best Clinical Teacher in 1991 from Emory and in 2004 he was named the Emory University School of Medicine Resident Alumni Distinguished Achievement Award winner. For the past ten years he has been named one of the nation's top cardiologists in “The Best Doctors in America.”
In 1986, while at Emory, he was also named Most Outstanding House Officer, made an honorary Morehouse Medical School class member and he received a Robert Wood Johnson Foundation Minority Medical Faculty Development Award.
In 2010, he was awarded The Distinguished Alumnus Award of Vanderbilt University School of Engineering. Along with his physician brothers Kevin and Keith, he received the 2011 Trumpet Award for Medicine.
In 2012 and 2013, The Vanderbilt University Organization of Black Graduate and Professional Students (OBGAPS) honored Dr. Churchwell with one of the organization’s first Distinguished Faculty Awards. He was also recognized with an American Registry Most Compassionate Doctor Award. From 2010-2013 on, he has been awarded the Professional Research Consultants’ Five-Star Excellence Award—Top 10% Nationally for “Excellent” Responses for Medical Specialty Services and Overall Quality.
Furthermore, he was elected in 2012 to serve as the southern representative for the Group on Diversity and Inclusion for the AAMC (American Association of Medical Colleges). In 2013, he helped create The Hurst-Logue-Wenger Cardiovascular Fellows Society (HLWCFS) of Emory University School of Medicine and was elected the first President of HLWCFS. In 2014, he was named one of the “Top 15 Most Influential African-American Health Educators” by Black Health Magazine. In addition, Vanderbilt University Medical Center has been named by BlackDoctor.org as a Top Hospital for Diversity from 2018-2020.
Dr. Churchwell served on the Board of Trustees for Cumberland University in Lebanon, Tennessee from 2015 to 2020. In 2016, he was named to the American Institute for Medical and Biological Engineering (AIMBE) for his work in biomedical engineering education. And in 2017, he received the Vanderbilt University Pioneer in Diversity Award.
Dr. Churchwell has served on the editorial board of a number of peer-reviewed journals and has served as a reviewer for the Journal of the American College of Cardiology. He currently serves as an Associate Editor for the Biomedical Engineering Society’s (BMES) internationally recognized Cardiovascular Engineering and Technology Journal.
Churchwell lives in Brentwood, Tenn., and is married to Doreatha Henderson Churchwell, a retired nurse educator at Vanderbilt University Medical Center. They have two children: Crystal A. Churchwell and André L. Churchwell Jr.
ABOUT TOKENS SHOW & LEE C. CAMP
Tokens began in 2008. Our philosophical and theological variety shows and events hosted throughout the Nashville area imagine a world governed by hospitality, graciousness and joy; life marked by beauty, wonder and truthfulness; and social conditions ordered by justice, mercy and peace-making. We exhibit tokens of such a world in music-making, song-singing, and conversations about things that matter. We have fun, and we make fun: of religion, politics, and marketing. And ourselves. You might think of us as something like musicians without borders; or as poets, philosophers, theologians and humorists transgressing borders.
Lee is an Alabamian by birth, a Tennessean by choice, and has sojourned joyfully in Indiana, Texas, and Nairobi. He likes to think of himself as a radical conservative, or an orthodox liberal; loves teaching college and seminary students at Lipscomb University; delights in flying sailplanes; finds dark chocolate covered almonds with turbinado sea salt to be one of the finest confections of the human species; and gives great thanks for his lovely wife Laura, his three sons, and an abundance of family and friends, here in Music City and beyond. Besides teaching full-time, he hosts Nashville’s Tokens Show, and has authored three books. Lee has an Undergrad Degree in computer science (Lipscomb University, 1989); M.A. in theology and M.Div. (Abilene Christian University, 1993); M.A. and Ph.D. both in Christian Ethics (University of Notre Dame, 1999).
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TRANSCRIPT
Lee: This is Tokens. I'm Lee C. Camp.
There has been of course much discourse of late surrounding the nature of the role race plays in today's still-prevalent gaps in social and economic inequality.
In our recent interview with Dr. Quincy Byrdsong, we began to explore this question especially with regards to American healthcare, examining at some length the infamous and horrifying Tuskegee Syphillis Trials.
Quincy: These individuals think that they're being treated for syphilis. When in actuality they have no intention to treat these individuals. This went on for 40 years.
Lee: The explicit racism inherent in the implementation of that study is unavoidable:
Quincy: There was a scientist that was involved in the study that said the Negro, serves a better purpose in the laboratory than in the classroom.
Lee: Continued troubling disparities raise the issue of cause: which is a highly polarized matter, even prompting here in Nashville, for example, the Tennessee state legislature to pass legislation against the teaching of critical race theory, which is one theory positing systemic explanations for the ongoing disparities.
The increasing polarization around such questions gives rise to what seems to many to be a mutually exclusive choice as to how we shall account for such troubling social realities.
For some on the so-called Right, distressing outcomes are a consequence of a failure of individuals: a failure of individual initiative, virtue, or work ethic. The failure of individual racists. The failure of individuals who need to take advantage of opportunities given them. For some on the so-called Left, distressing outcomes are a consequence of unjust systems: structural realities which give rise to privilege for some, and marginalization and oppression and violence to others. The failure of racist systems. The failure of collective power, powers to relinquish advantage.
What if rather than immediately jumping onto one end of that apparent dichotomy we ask a different question. Namely: what if, really, they're both, in important ways, right? How might we hold together, simultaneously, the concerns raised by both? The importance of cultivating the classic virtues like courage, temperance, fairness, industriousness, alongside the necessity of addressing ongoing systemic challenges? What might such a two-fold approach look like?
Andre: The work of diversity inclusion and equity is a purely intentional act.
Lee: That's Dr. Andre Churchwell, chief diversity officer for Vanderbilt University, and a holder of all manner of high honors as both a cardiologist and pioneer for diversity in the field of healthcare.
Dr. Churchwell's career exhibits one engaged with, grappling with, working for equity and fairness in the midst of systems which press down or marginalize;
Andre: We want to look at those sets of actions that we all can participate in that alleviate that diminish, that kind of remove racism and the barriers that racism presents for different members of our communities.
Lee: Simultaneously, his life points to the indispensable task of cultivating virtue. He inherited this sort of two-fold approach from his father, Mr. Robert Churchwell, a respected black journalist in the middle of the twentieth century, working for, surprisingly, the more conservative newspaper in Nashville, The Nashville Banner.
Andre: He modeled a life that he wanted us to emulate.
And so all these sometimes subtle, sometimes not so subtle lessons about the power and value of courage, justice, temperance, wisdom. He being the brilliant man he was knew that was the kind of thing he needed to try to push into the skulls, of his, uh, his knucklehead children.
Lee: Today: a fascinating interview with Dr. Churchwell on the racial disparities which plague America's healthcare system, and the surprising way a life of intentionally cultivated diversity and virtue may act to dissolve such issues both personally and systemically.
Andre: The key for all of us is let's get to know each other.
Lee: All this, coming right up.
INTERVIEW
Lee: Dr. Andre Churchwell is a native Nashvillian son of groundbreaking Nashville journalist, Robert Churchwell. Dr. Churchwell graduated from the Vanderbilt School of Engineering, Magna Cum Laude in 1975, won the biomedical engineering student program award that same year, received his medical degree from Harvard Medical School in 1979, later completed his internship, residency and cardiology fellowship at Emory University School of Medicine. In addition, he was the first African-American chief medical resident at Grady Memorial Hospital. Dr. Churchwell received the J Willis Hurst award for best clinical teacher in 1991 from Emory. And in 2004 was named the Emory University School of Medicine, resident alumni distinguished achievement award winner.
And for a ten-year period he has been named one of the nation's top cardiologist and the best doctors in America. Today Dr. Churchwell is the vice chancellor for equity, diversity and inclusion, and chief diversity officer for Vanderbilt University. Dr. Churchwell, honored to be with you today.
Thanks so much for coming to be with us.
Andre: Thank you for asking.
Lee: Yeah, it's a privilege to get to spend some time with you today. You come from a family with lots of medical impact upon the country. Tell us a little bit about your family.
Andre: Sure. You know, it's interesting if you go back in time, you know, you would ask why in the world am I a physician and why are my younger brothers physicians? Well, dad and mom were not doctors. You know, traditionally you see that as a path forward for people to enter medicine.
Dad was a first generation college graduate, through the greatest generation finishing Fisk University on the GI bill, about 1949, thereabouts, and then went on to become a journalist, being hired by The Nashville Banner. Jimmy Stallman, the publisher owner of that paper did it for a business reason, not because he had any real commitment or connection to civil rights at the time.
Lee: Hmm.
Andre: But thank goodness for that because dad had to feed his family. So we were thankful Mr. Solomon hired him and mom was a school teacher and came from Bell Buckle, Tennessee. Walked from Bell Buckle, Tennessee, hitchhiked to come to Cameron High School. Think about that. These people were gritty.
Lee: Indeed.
Andre: These people had, I don't know, they were made of sterner stuff than I think we could ever imagine, despite whatever challenges my brothers and I may have faced in our training. But that was a good backbone.
We stood on their shoulders. They were the giants.
And, uh, it just so happened though, I liked to write and read as dad inculcated in us. I like math and science. And because of some family health issues in our family to some close members, I got really turned on to the power and value of science being applied the human condition.
And so, uh, I was off and running though. Though I went to Vandy for engineering and finished in biomedical engineering, I was on the path to kind of apply engineering and apply physics to solving human problems. And I love the human connection of getting close to people. There's nothing like being a physician or a nurse. You’re given the most privileged position of any vocational application you could ever imagine.
Getting into the lives of people. And I think my younger brothers, my, who are eight years my junior, who were twins, saw the older brother, really excited about science and medicine. And they had a proclivity for that too. And so I went on and as you mentioned, I finished Vandy engineering, Harvard Med School, trained at Emory in cardiology. Keith, the twin brother, finished Harvard College, WashU Med School, trained at Emory like I did in cardiology, was the second Black chief resident at Grady Hospital. How about that one?
And Kevin, his older twin, finished MIT and then Vanderbilt School of Medicine. My mother always said he chose the right school of medicine, uh, the correct school of medicine. And then he trained at Boston Children's Hospital in pediatric and pediatric critical care medicine. And as fate or providence, probably more likely, and of course the will of my strong willed father, all got us back here by about 1993 to 1994. We were here 15 years together working at Vanderbilt. So we're certainly committed to medicine and its application into the health of our patients.
Lee: When you think back to the grit of your parents, what were some of the kind of concrete or specific ways they helped inculcate that character in you?
Andre: Well my mom, though she didn't talk about it all the time, there were certain periods she'd bring up the walk from Bell Buckle to Nashville as a 15- year old girl with a suitcase.
Lee: Kind of equalizes any kind of struggles you might have?
Andre: Oh yeah. I mean, I made a C in calculus. I mean, give me a break. You know, she would say, she would say, give me a break, but, and then dad, dad was more silent about it.
But he was of that generation where they didn't talk much about World War II, didn't talk much about the strife that they faced. Though, growing up, particularly in high school, we began to realize that writing for The Banner certainly didn't win him any great awards out in Black Nashville, because the banner was the conservative paper.
Lee: Right.
Andre: The more right directed papers, as opposed to The Tennessean. And, John Segan thought his paper was more progressive, more liberal, but, we began to understand that dad took that platform and did all he could to message out the importance of civil rights and race relations. Though he was limited at times. It was almost like in the movies that you see, where someone's writing has been erased or blackened out on a sheet of paper, many of his stories on key civil rights movements or acts or violence here in Nashville never saw the light of day. It's interesting. If you actually, a couple of years ago, the Frist Museum actually had a, actually last year, had a display from the civil rights exhibition in the public library. Photos from The Tennessean and The banner, many of the photos from The Banner on the civil rights movement, were seen for the first time in that exhibition. And that was one of the points of showing that. The Tennessean photos were in the paper. Some of the photos, maybe, I don't know what percentage, many of the, of the photos from The Banner photographers were seeing the light of day for the first time.
Lee: That's remarkable. Other particularities that you would learn in time about what your father's experience was like in that location?
Andre: We did. And, you know, he was quite a strong man, the most impressive man, person, I've ever met, to be honest with you.
First off, we did find out that, in his first years from 1949 to, for about five years, he was not allowed to write in the city room. He had to write at home and then bring his copy in and give it to the city editor, copy to his editor and then leave.
So it took five years before they would let him have a desk in the city room, in the, in the room where all the reporters occupied. And when they gave him a desk, it was near the bathroom.
And, so, you know, dad well, I tell you, he, he managed this and he didn't let us know about it. And, he offered a lot of lessons about a virtuous life in terms of how to fight your way through this kind of stuff.
But still also look to the bright side and try to serve mankind as he did through his writing and through the best he could to tell the stories of people in Black Nashville who were being marginalized or, being put out.
The other thing that was very impressive about him is that he was smart. He realized when he would have to cover an event down in Alabama, let's say in March. He made it very clear to the White or Black photographer. We're not stopping. We're going to fill the car up. We're going to pack some sandwiches and we're going to drive all the way through the state of Alabama.
This is 1962 or 63. It's not going to pay for us to have a Black man with a white collar shirt on and a tie and suit stopping at some Southern White owned filling station.
Lee: And the threat of it being a journalist as well?
Andre: Absolutely. Absolutely.
Lee: He's literally the embodiment of, you know, in the history of civil rights movements, some of which I've read, it's the, Black veterans who come back to the United States and they've just fought for our country. And then they come back to a sort of severe discrimination that become the precipitating players in the civil rights movement.
Andre: Right. And, you know, there are a number of stories about that. Particularly the Tulsa story that was World War I, the Black soldiers who returned. And there was a Black young man who was put upon or said he made advances to a White woman in a, in an elevator. And the soldiers came, the Black veterans came from the Black neighborhood in Tulsa with their arms to protect the young man, which set off one of the giant race rides in America. And, but a lot of those soldiers came back from World War I, World War II, energized, galvanized to do more, to push more, to advance the cause of race relations and freedom and justice in this country. And, uh, they served as a backbone, I think, to the civil rights move.
If you look at many of these people, A. Phillip Randolph, Whitney Young, all these guys were veterans.
Lee: When you mentioned a moment ago, the ways in which your example of your father inculcated sort of virtuous habits in your life. Do you think of that process for yourself as primarily something that you mostly picked up just by being his son and being around him? Or were there specific things he would say repeatedly that helped or both? How did you experience that?
Andre: Well, it was both. You've nailed it. I think one of the things he was very concerned about, but spent a lot of time working on our knuckleheads, our young knucklehead selves about, was the importance of reading and reading widely.
And so in our little small, house, less than 2000 square feet, that's still there on ninth street in east Nashville that he and mom built for a couple of thousand dollars in 1958, the largest room he built in that house was his library.
It was the only room that had an air conditioner in the wall. So there's a message. So his comments would be like, okay, here's summer here's the lawnmower. I just bought a brand new lawn mower. You can now make part of the tuition for Vanderbilt, Andre, or Robert Jr, at TSU, by going out and cutting the yards of our neighbors, which is fine. I think the temperature gets up to near a hundred degrees, a hundred percent humidity, or I'll pay you the same amount of money if you sit in the air condition library and read these books and write reports.
Lee: Really?
Wow.
Andre: So, that was an easy choice. And so though not knowing how, how smart he was. So he had me read all three volumes of Ernest Hemingway's great works. So, The Sun Also Rises, A Farewell to Arms, and For Whom the Bell Tolls and write reports.
And then he had me read the definitive biography at the time of, Hemingway, which is probably three times as large as all the books. And little did I know he was, he was using the power of books and how they could transport you from that little small den library to the bullrings in Madrid, to the street corners in New York City, to the battle lines of World War I in an ambulance.
And in doing so widened your worldview by leaps and bounds, it never would have happened, uh, if we just went outside and cut grass and just played baseball all day. But along the way he used what I call a model life.
He modeled a life that he wanted us to emulate, to watch. So he would explain why he made certain choices all the way down to why he bought a certain car, or why he listened to Billy Eckstein, or why it was important to listen to Bruno Walter conduct the New York Philharmonic. And why, while you're down on the floor, Andre rubbing and waxing the floor in your room every Saturday that you have to do, I'm playing, NBC's laugh in the metropolitan opera for you to hear Don Giovanni. And so all these, sometimes subtle, sometimes not so subtle lessons, about the power and value of strong morals, courage, justice, temperance, wisdom.
All these things that Confucius or Socrates inculcated into the leaders of those different cultures. He being the brilliant man he was, knew that was the kind of thing he needed to try to push into the skulls, the thick skulls of his, uh, his knucklehead children: myself, my brother and my older brother, my younger twin brothers and my sister Merissa.
It was a model life and there were certainly stern lessons when it was appropriate, but more importantly, there were lessons of, how you need to serve a mankind through whatever you choose to do in your life.
Lee: So most recently you've moved in after many years of doing outstanding work in cardiology. You've more recently moved into a role as vice chancellor for diversity equity and inclusion and chief diversity officer for Vanderbilt University.
Has this been a sharply unexpected development or what kind of, was the invitation like for you to jump into that role?
Andre: Yeah, well, that's great. It's good to explain this because that’s a part of the life journey. I think it’s important to explain how do you go from, uh, east Nashville to Vandy, to Harvard Med School, to Emory. And now you're sitting at Vanderbilt, in Kirkland Hall that you never imagined as a student you'd ever enter the front door for that matter and ran past over to the engineering school every morning, back in the early seventies. One, it's that life of service and life of the mind, that dad inculcated. And so as you finish into medicine, I mean, by the sheer force of the practice of medicine, you have to be connected to people.
And you have to understand the differences in varieties and challenges that people of all ages, genders, gender identities, races, ethnicities, place of origin. You have to understand all of that stuff in order to take care of them, to understand how the mind and the issue of their behavior influences their health or their heart disease in my case.
And so in that journey, through medical school and training in cardiology at Emory, and more importantly, being a leader as the first Black chief resident, I had to run that 1100 bed hospital at Grady Hospital. That was only me and a few other chief residents back in the day. So I learned administrative skills, but it all came down to the fact that I began to understand the issues of behavior, leadership skills, and the issues of diversity and inclusion that were quite evident playing out in the wards at Grady, a predominantly Black hospital, playing out in Atlanta and playing out in America for that matter. And so it became a, fairly easy few steps to go from being a physician, to being a physician leader in diversity at the time. And you have to recognize that our journey on diversity inclusion and equity, which is the way I kind of think about it as kind of a slow sloping incline. That though I walked in the door, in the mid, late eighties, it was all about just trying to get the med school class to have a few people of color in it.
The predominant med school classes at the time of our White institution were predominantly White, and there was only maybe one or two African-American or fewer Hispanic kids in those med school classes. And so Emory at least had the right mind, the Dean said, hey, we need to do better about this.
And so, I think, they gave me the tools and the resources to start diversifying the medical school class. That's foundational. You've gotta at least have med students who can become residents, who can then become doctors, right? To change the work force. So I got really excited about that. I learned how to do that, and it was challenging to be able to sit in a room of predominantly White folks in admissions committee and try to help them understand the power of diversity.
And I had to go through a lot of educational tools with them to help them understand that, for them to even understand how to take care of people of different colors, and backgrounds and races, they needed to have students, staff, physicians around them to help them understand those issues that are fairly unique and nuanced.
And it began to take place though, slowly I might add. And then from that, I began to read and become quite educated broadly about need to be involved as a physician leader in diversity inclusion in medical education. So it's more than just the foundational billing of a med school class to have diverse elements in it, which is the student, which is really important.
But what about the culture and climate in the school?
You can bring kids that are Black or from marginalized groups into the school. But if the culture and climate is antisocial or anti-Black or anti-Semitic or whatever it might be, those students will not thrive. They will not be successful. They will probably likely leave the school.
And so I began to realize the power and value of building a climate or culture in a school or institution that owns up recognizes and values diversity, wherever it is. Staff, cleaners in the kitchen, people mopping the floor, faculty, too, for that matter, researchers. And so I began to understand it's not just workforce, but it's culture and climate, and now you have to start working on pipelines because there's a lot of barriers for kids from east Nashville to get into the Vandy undergraduate to Harvard Med School.
So we have to understand where those barriers are, what they are, and began to try to bring them down. And then probably more recently though, I would say, that incline has been fairly, you know, it's hard to push that boulder of racism, that old Sisyphus legend, up the slope to the top is freedom and belonging.
It's hard to do it. If it keeps rolling back down the hill, we think every so often with integration of schools in the early seventies, that boulder is going to go up the hill, rolls back down after a period of years. Currently in the wake of George Floyd, there's been a huge, huge galvanizing force in this country where it's not just African-American people or Hispanic people or Native Americans or Asian-American, Pacific Islanders, who are pushing the boulder. It's, multi-generational, it's most high ethnic, it's all kinds of folks that are now putting their shoulders to the boulder of racism, prejudice, antisemitism that is pushing the boulder up the hill now in a more steady pace.
And that's, what's going to make the difference, I think, in our country. And it's those forces that are at play for those of us that work in diversity inclusion now, whether it be in med schools or universities, that we're using to help us with our leaders, our chancellors, our other vice chancellors, our deans to move the balls forward in those elements of workforce, pipeline development, culture, and climate.
Lee: That’s a terribly helpful picture of some of the structural and systemic realities that you've had to deal with over decades now, I guess, and then other systemic or structural realities continue to come to light in healthcare itself. Uh, I was looking today at a November, 2020 presidential advisory from the American Heart Association, the headline “call to action structural racism as a fundamental driver of health disparities.” In whom your brother Keith…
Andre: I was going to say, I think that’s Keith Churchwell’s paper. Yeah. Yeah. A little brother is a fairly high up administrative leader in the American Heart Association, as he sits in his position as the President of Yale New Haven Hospital. How about that? And his twin brother, Kevin, who I talked about earlier is now President and CEO of Boston Children's Harvard Hospital.
So, they haven't done so poorly following in the wake of the old man, Andre Churchwell, older brother here, but.
Lee: But talk to us then about those health disparities he's pointing to.
Andre: Oh boy, they're deep and those are probably our most serious problematic issues to try to solve because they're there embedded in our systems.
Let's begin just purely from the social determinants of health.
"Social determinants of health" is a term used to describe the social conditions, whether voluntarily chosen or not, which correlate to various measurable outcomes with regard to health. They may include factors like socioeconomic class, employment status, education, access to grocery stores, and, believe it or not, even one's zip code.
If you start there and begin to put your shoulder to that particular issue, those are the impediments that before patients even get to the hospital who live in north Nashville, for example, the 3728 zip code, African-Americans in an area where there's no parks work out. There's gunplay. There's have violence or crime.
So the kids are under constant psychosocial stress. The issues about hypertension and health are tied to the psychosocial stress of being a minority in an impoverished community like that. The lack of markets that have green vegetables. So brain food, that's not available, healthy food that eating, mostly food from, uh, McDonald's in the like. And then you couple that with the lack of access of clinics. There are very few medical clinics. Now there's Meharry’s there, but there's not very many medical and not many private practice offices located over there as opposed to around Baptist Hospital.
Then there's just the access, whether or not can you get to the doctor's office from there? Or do you have to make a decision of going to your job that only pays minimum wage, so you can put food on the table, as opposed to paying for your your medication?
I'm going to see the physician. And so there's a whole host of things that are related to poverty, minority stress, psychosocial stress, income, lack of social capital to be able to change the people around you in the Metro council or change the view of what should be funded for those communities.
A whole host of things we call the social determinants health. They determine your health outcome, even before you get to the hospital. And if you look at zip codes, 3728 versus some of our more wealthy zip codes on the west side of town, there may be 10, 15 year age difference in terms of survival, particularly for men just based on what zip code you're living in.
And so, those are dramatic. Not to mention the fact that being in chronic psychosocial stress raises the susceptibility for certain diseases, whether it be cardiovascular disease. Maybe more susceptibility we think for COVID infections. We think maybe the twice the rate of COVID infections we see in African-Americans and Hispanic-Americans may be tied to some of these psychosocial stresses and things that raise their susceptibility for these types of illnesses.
And it's not just for COVID, we've known it for years for hypertension, diabetes, stroke, and the like.
Lee: I've seen some discussion about whether those social determinants are more closely linked to socioeconomic status or race. What's your take on that?
Andre: It's both, it's both. And as a matter of fact, if you look at. A great study was done by the American Cancer Society a few years ago. Let’s leave Nashville. Let's go to Appalachia over in east Tennessee and look at White Appalachians, low SES status.
Lee: SES is shorthand for Socio-economic status.
Andre: And look at what happens if you have breast cancer diagnosed there compared to here in Nashville, in west Nashville if your White women with breast cancer.
And what you find is because of the lack of access to clinics to Knoxville or to Bristol and the like, they have higher rates mortality. And they have higher morbidity because they can't get to the doctor earlier. They don't get screened earlier. They don't know to get screened earlier, issues related to SES and education level.
So you can see how the lower SES status, and poverty and education really are main drivers of healthcare outcomes, independent of race.
Lee: You're listening to Tokens: public theology, human flourishing, and the good life. We’re most grateful to have you joining us. If you would like to hear more about the troubling history of health inequity in the United States, then check out our recent episode with Dr. Quincy Byrdsong.
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Recently heard from AJ Buse {AY JAY byoo-SAY} who's been listening in on Nashville public radio on Sunday afternoons. He wrote in with both praise as well as some grammar critique. As one who has sometimes been merciless to my students, given them a C for single comma splice, I thought it was rather appropriate to be called out for forgetting proper usage of the word "comprise." One should never say that our band is "comprised of." Mr. Buse, you are correct. I know better. I've read Strunk and White's The Elements of Style which, in fact, anyone who ever writes anything ought to read. My thanks for the reminder.
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This is our interview with Dr. Andre Churchwell. Coming up, we'll hear more about the potential origins and causes of health inequities; as well as the ways in which a life of cultivated diversity and virtue may serve to undo such issues both individually and systemically.
Part two in just a moment.
HALFWAY POINT
Lee: Welcome back to Tokens and our interview with Dr. Andre Churchwell.
In what ways do you see these various contemporary social disparities? We had had one guest recently who pointed to ways in which this could be construed as a quite literal legacy of slavery and some of the social realities that occurred following, the Civil War. What's your take on that?
Andre: Yeah, I think so. And one of the other key factors that locks, let's take again for example, the 3728 zip code. Issues around housing and property value and property tax. If you can't move out of the low SES neighborhoods that aren't supported, the schools don't have high property tax because the income stream there is not as sufficient as other parts of our city, then your schools won't be resourced as much. So it becomes a positive, unfortunately, feedback loop that perpetuates people staying in that environment, being locked into that particular set of conditions, of social determinants of health, that lead to generational issues with health outcomes, lack of education.
And so property tax and the issues around housing is a clear example of a structural barrier.
Lee: There's obviously a great deal of conversation occurring throughout the country, but even, especially in Nashville with Tennessee state legislature, for example, in which there are a lot of people pushing back particularly sharply against notions of structural racism, or pushing back at the concept of anti-racism, for example. How do you personally, given your experience with these various systems and structures, how do you process and apparent on a willingness or inability for someone to take seriously the realities of those things?
Andre: Well, my father said you change the minds of those you can change. And you look for allies, amongst your white colleagues, and non-African-American colleagues to push that boulder we've talked about up the hill. And you hope with continued education and providence and your faith in how mankind can change, that those types of issues can be addressed. I do believe you have to be thoughtful about this. I think people can change. You know, I look at using the word anti-racism is, is a field of study and it has been around for decades. It precedes anything that we've talked about here recently, but to diffuse that term, which can have a loaded meaning based on where you are and who you are, what about just actions against racism?
That's what we're talking.
All of what we've discussed here is that no one wants racism, and so we want to look at those sets of actions that we all can participate in that alleviate, that diminish, that kind of remove racism and the barriers that racism presents for different members of our communities.
Lee: It does seem to me that when that sort of consideration you point to is rightfully understood, it ought to make it, I think, easier for us to engage these questions.
Andre: I think that's correct.
Lee: Because it's asking questions, not about whether any one given person is maliciously racist, but it's asking as I understand it, are there policies and practices that we have in place as a community that do not ensure or make available equitable experience?
Andre: You know, the thing that I at my late stage of, education and training and age, I'm still learning. And one of the things that's really important I want everybody to think about is what I call the five finger rule. This will help us all move the ball forward.
I'm a lefty. I'm holding my left hand. I want you to think about who are the closest people in your lives that you call your closest friends, that you would list on your five fingers. You can’t include family, no family members, okay? No relatives. Not just significant others. But ask if they're all from the same identity group and gender. You have work to do, because to understand what people from marginalized groups are facing, you're gonna have to get to know people intimately from those groups.
We are all prone to making blanket judgements based on our own past experiences, our family's experiences, our community’s experiences, that inform us to make rapid sequence impulsive, automatic decisions about people who are different from us. So whether you believe it's called implicit bias, unconscious bias, blind spots, I like blind spots alike. Because if your family is White or your family's Black, for that matter, you're going to be brought up to think about people who are different from you in a certain way. So the key for all of us is let's get to know each other and I can count three out of my five closest folks over the year that I would call right now are not Black, okay? And not male. And so I think if we work on the sense of a treasured set of friends that become a community of friends that are different from who you are and your points of origin. You can continue having your buddies from the old neighborhood in there to east Nashville, don't get me wrong, but this has to be intentional.
The work of diversity inclusion and equity is a purely intentional act. Where we have failed, I think, in many cases in America, is that we've assumed if we just put the water on the flowers, they’re gonna grow.
It'll grow organically. The growth, the friendships, the connections, the changes that need to occur in our society will just naturally occur if we change one law, or we place one Black president in office. No, it doesn't work that way.
We have to, as individuals begin to recognize, we have to build a community intensely of, diverse people, who we feel that we're intimately connected with. And in doing so, all those ideas that we have about our differences begin to melt away.
And we begin to understand how really originally we are more alike. We want for our grandchildren, our children, our communities, our parents. It's very much the same, but the problem is getting past crossing what I call the interpersonal chasm that exists between all of us.
It does take work to do, but boy, it's a grand thing to do, to get out and to meet people.
You know, man, it's hard to go across the room. Well didn’t you go across the room when you saw your beautiful wife over there, you know, 30 years ago? That was a little bit unnerving to do. Well, you need to go across the room make yourself, it's gonna be uncomfortable to meet that person who's different from you for the first time and stick out your hand to begin to develop a relationship.
Lee: How do you see this legacy from your parents with regard to character? I was pleased a moment ago. Because I, in teaching moral philosophy, I often point to courage, prudence, temperance, and justice.
And I think you're one of my first guests who's ever listed those off in a conversation before I brought them up. So I'm delighted with that. So…
Andre: I think dad whispered those from heaven in my ear while we were sitting here. Yeah.
Lee: So when you think about, this work you do in the eye and this sort of legacy of thinking about the virtues and the virtue traditions, and character. How do you see those cross fertilizing?
Andre: Absolutely. It helps in terms of the cross-fertilization, of being able to cross the interpersonal chasm. If those are foundational in you, it makes it easy for you to reach across the aisle with that outstretched hand, to the person who is different from you. Okay? It affords you the opportunity to be wrong, but to know that you did it for the right reason, okay? They may feel you were wrong, but you did it for the right reason to reach out and to try to engage them. I think also, it helps you understand as you teach and educate young people what you need to bring. I talk about, in a lecture I gave, I think it's online, not a lecture, just maybe a short conversation about character, the character filter we all need to think.
You may go out and bay at the moon on Broadway all night. But if you're coming back into Lipscomb or into Vandy to educate or to work there as a staff member, I want you to go through the character filter to bring your best self to work. And that means to once again, align yourself around those virtues.
Intemperance get rid of intemperance, get rid of arrogance, get rid of hubris, okay? Filter those things out and let's bring in all the stuff that's gonna make you and your engagement with your staff, your colleagues, your patients, your administrative people, much richer and probably much more effective.
Lee: Yeah.
Given your work and your career, I would make up that to watch the sort of distrust of medicine and science must be particularly difficult. But what's your experience been like in that regard?
Andre: No. I agree. It's as we've watched the discussions around vaccine and vaccinations and testing for COVID, it is a bit depressing. But I'm reminded as I go into my, my library, which is a little bit bigger than dads, but not much more, and begin to go through the books. There've been many times in the history of man where we've had people return to alchemy, so to speak, and to disbelieve science.
And so I think this is nothing new. It's just something that we're facing at this time in our history of the world. I think the key is keep telling the facts, keep telling the truth. Lean on those virtues, but keep telling the truth, keep reporting the truth. And what I've been seeing are people changing.
My own sense, my own belief, my own readings of history, medical history, says we will get through this.
Lee: How do you navigate or give an account for the potential impact that something like the Tuskegee Syphilis Trials would have had upon contemporary distrust in the African-American community towards the medical community?
Andre: Right. Yep. Absolutely. You know, the Tuskegee Trials, which many people who are listening may not know, is trialed early part of the 20th century, where the national health service actually had a set of African-American nurses, giving Black men down in Tuskegee syphilis to see the natural history of that play out, horrible.
And when that became known, it really raised a lot of red flags and a huge amount of distrust in the African-American community towards healthcare and physicians. And there've been other situations similar to this such as the Henrietta Lacks HeLa cells, as you probably are familiar with at Johns Hopkins. A similar type of issue.
And so that has certainly played a role, we think, in terms of at least the African-American communities lack of commitment to vaccination. But I think it's also have to recognize it's in the mix, I think, in that general stew of having to make some decisions about what you're going to do in the course of a day, between going to work, not being able to get off of work to get a vaccination.
And then that being your natural way of habit is to not be engaged in your health. Because you don't have the money to take care of it. You don't have the money to get medications. And you've had to commit yourself to other things for the success of your family. So that's just one other issue that plays into not getting a vaccine, cause it's taking time out of the day.
It's just part of that health thing you're avoiding. If you look at hypertension as a, kind of a index case of this kind of thing, if you look at African-Americans. For every level of hypertension, every blood pressure up compared to the White population, it’s more calamitous cause they've had it longer. It’s more extensive.
And so you see bigger strokes, larger heart attacks and much more, kidney failure from hypertension. So, I think that what you're seeing that the current administration is doing, white house is doing, is correct. Building a taskforce that has trusted members of those communities, of those marginalized communities.
So bring in church leaders, bring in pharmacy leaders, bring in beauty parlor leaders that are trusted members of those communities into discussion to the people who are coming to those businesses around importance of vaccination. Uh, so we have to use every tool in our toolbox. If it's not just your local Black physician or Hispanic physician, let's talk about other people that have trust in those communities. And so you'll see a lot of that being played out here in Nashville, as well as around the country.
Lee: Yeah, remarkable. What these days beyond what we've already discussed gives you particular pause or concern, and what would be markers of some hope or anticipation about good things happening with regard to your field?
Andre: Yeah, well, medicine. I think that, I was talking to a couple of patients the other day and, I'm a cardiologist. And so I have seen in my 30-year career, the growth of amazing new technologies: stents, coronary stents, new drug therapies for heart failure, ACE inhibitors, and I won’t get into the details, but a whole bunch of new drugs as well as other procedures, like putting in valves in the Cath lab rather than opening up a chest. And so a whole host of either new devices or new therapies that have changed the course of people's lives. We have seen definite changes and reductions in mortality and heart failure, reductions in mortality for people with certain types of coronary disease, certain types of valve disease that would not have survived.
There are people that are getting valves in a non-surgical manner, that would have died. I have patients that just would not be with us today because they were too old. They had too many co-morbidities for the traditional open-heart procedure to get through it, that are now alive and thriving and having good lives, you know, good quality of life. That along with length, we've been able to afford them.
And so that gives me great hope because America, which has been at the Vanguard of new technology innovation is still pushing.
I see more things coming down the road. I think the thing we have to address that is the underbelly of those issues, that are barriers, to help for certain marginalized members of our communities we've not solved yet.
And I think as we raise the level of success in therapies on one side of the ledger, we have to now remove barriers for healthcare access and for sustained health for many of our marginalized population members, whether they be White, low SES staff members in rural Tennessee, or African-Americans living here in north Nashville on the Barrios of LA.
Lee: Are you seeing some signs of hope that that concern and need is being taken seriously?
Andre: I think so. I mean, there've been some things that there's some steps, some slow steps. The development of federally funded health clinics that take care of, you know, no matter if you have money or not have been a huge boom and a way to move forward in delivering care.
The Matthew Walker Comprehensive Health Center here in Nashville is a huge model of that that sits right there on Jefferson street that takes care of people who otherwise would not have care, medical care. And there are others that are now around in the neighborhoods like that. So that's a big step forward, but I think there are other things like the Affordable Care Act that was put in play, has really given millions of people who didn't have an opportunity for medical insurance, healthcare insurance.
And other things that are being put out by the Congress, as well as this administration. A lot of work to do, though, a lot of work to do. It looks like we're, you know, the rate and pace of change of success in new technologies as at a certain slope that we're not even close in terms of dealing with the issues of healthcare in our marginalized populations, slope is going up, but not at the pace, not at the same rate.
Lee: Any other sorts of issues or concerns that we haven't touched on that you'd like to add in any of these conversations?
Andre: I think, you know, one of the things I'm really as an educator, really keenly interested in and something that. I'm on the national, on the round table to the National Academy of Sciences on Blacks in STEM, of both Black women and men in STEM. And they're kind of the model for not just for all marginalized groups, Hispanic or otherwise.
And we're really taking a hard look at the fact that, if you're going to move the ball along on innovation for black scientists or have a larger workforce of African-American or Hispanic physicians, we're going to have to really invest more in the pipelines earlier. And invest more in public education. And invest more in looking at ways and models of improving access to public education so that all schools have the type of resources that they need to be successful. Yeah. We're looking at that.
Lee: Well, this thing, Nashville, and music city. I also hear that you happen to enjoy singing a bit.
Andre: Well, now that you mention it.
Lee: Is that correct?
Andre: Let's see, there are some things out there on the ether, in the ether that you have probably seen.
Lee: I have seen a few.
Andre: Seen me out there doing, and, uh…
Lee: I, that I rather enjoyed. As a matter of fact.
Andre: Well, I thought you had asked me this, so I will, I will share with you part of a hymn, a gospel hymn, that I occasionally sing, sing to the patients, uh, that come to my clinic. Not a reason to come to my clinic alone. Hopefully not. I don't think they're coming to hear me sing, but, uh, is this an old one called “In The Garden” and I'll share some of this.
Lee: We've been talking to Dr. Andre Churchwell, celebrated cardiologist, and today, vice chancellor for equity, diversity and inclusion, and chief diversity officer for Vanderbilt University. Thank you so much, Dr. Churchwell.
Andre: Thank you for the opportunity.
Lee Camp: You've been listening to Tokens: public theology, human flourishing, the good life.
If you would like to hear more about the troubling history of health inequity in the United States, then check out our recent episode with Dr. Quincy Byrdsong.
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