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Building the ‘Cathedral’ of Health Equity

Aug. 13, 2020

Jewel Mullen is in the business of cathedral-building.

That’s how she describes the work she was hired to do as Dell Medical School’s associate dean for health equity, a position she has held since 2018.

The work is rooted in aspiration and takes years to complete. It’s collaborative, arduous, vast in scope. The result is built to last and breathtaking in its grandeur, says Mullen, M.D., MPH, MPA.

For Dell Med, that result will be delivering on its mission to help revolutionize how people — all people — get and stay healthy.

A Strategic Map for Health Equity

Dell Med’s blueprint is a one-page document, modestly called the Health Equity Strategic Map. It’s been six months in the making, the result of a process that started with bringing together multiple stakeholders from inside and outside the medical school to brainstorm what health equity looks like from their diverse perspectives.

“These think tank sessions, four in all, included medical students, faculty, cafeteria workers, security — everybody,” Mullen says. Through other forums, she brought into the conversation Ascension Seton, Dell Med’s hospital partner, and Central Health, the local public entity that helps Travis County residents with low income access quality care, as well as partners like Community Advancement Network and Austin Public Health. Mullen also hired experts in organizational leadership and strategy to conduct in-depth interviews with senior leadership.

The result of all that fact-finding and soul-searching is the high-level map, drafted over two days by the 18-member strategic planning group under the consultants’ guidance. Its priorities range from building an understanding of and support for health equity within Dell Med to ensuring it is integrated into medical education and research to collaborating with the community to reduce health inequities. The map is ambitious — and leaves plenty of room for implementers to decide how best to achieve and measure steps toward these goals over the next three years.

The Work of Implementation

“You can’t just come with a playbook that says, ‘Do this, do that,’ and you’re there,” Mullen says. A big part of her job, she adds, has been relationship-building and conveying the meaning of health equity across the medical school and broader health ecosystem.

So what does health equity mean to her?

First, she wants to be clear about what it’s not: “It’s not about inclusion or workforce diversity or community projects. And it’s not just about race, although racial equity is a fundamental component,” she explains. Rather, it’s about creating the opportunity for optimal health for all people and communities, and changing policies, systems and behaviors that determine them — the “hearts and minds” work that can be painfully slow yet exhilarating. It’s work that must be wholly embraced by leadership so it’s not dismissed as token, add-on or peripheral to the “important” stuff.

It’s about providing effective communication for people who do not speak English and who are deaf and hard of hearing; analyzing and responding to clinical data to assure quality and access to care don’t vary by race, ethnicity or language; creating health care spaces that are accessible to people who are older and disabled; tailoring research to reflect and serve diverse populations and assure they are treated fairly; and incorporating topics like historic and contemporary racism in medicine in medical curricula.

Dell Med is trying to promote the best opportunities for health and health care despite the systemic biases built into U.S. systems. That work can only be achieved with visionaries like Jewel Mullen driving us to think and behave differently.

Stephen Strakowski, M.D.
Vice Dean of Research

Implementation of the map is underway. For example, one team is working on defining core competences for health equity across the medical school curricula. Meanwhile, Mullen has been recruiting partners from Dell Med, Central Health and Ascension Seton to lead the various areas of work.

“We’re also focused on growing our leaders’ understanding of and commitment to health equity — a top priority,” Mullen says.

It’s only the beginning, because Mullen’s goal is both simple and herculean: “We need to make our accomplishments match our aspirations,” she says.

Interested in learning more about health equity? See Mullen’s list of recommended reading »