Combating systemic racism to diversify healthcare and clinical research

Tung Nguyen, a health equity researcher, leads several anti-racism efforts at the University of California, San Francisco.Credit: Susan Merrell

Decolonization of Science

Science is steeped in injustice and exploitation. Scientific evidence from marginalized people has been erased, natural history samples taken without consent, and genetic data manipulated to support eugenics movements. Without the recognition and redress of that legacy, many people from minority ethnic groups have little faith in science and certainly do not feel welcome in academia – a persistent obstacle to the level of diversity that many universities profess to strive for.
In the next in a short series of articles on the decolonization of life sciences, Tung Nguyen, who was appointed associate vice chancellor for research integration, diversity, equity and anti-racism at the University of California, San Francisco (UCSF) in September, offers advice for health research reforms. Nguyen, a health equity researcher who is also director of the UCSF Asian American Research Center on Health, says efforts to counter racism begin by engaging underserved communities and nurturing diverse health research and public health trainees.

I went to medical school because I didn’t see health care and health research that addressed the needs of the Asian community in the San Francisco Bay Area — the part of California I moved to as an 11-year-old non-English speaker when my Family emigrated from Vietnam. For the past 20 years, I have conducted research in the field of health and equity, with a focus on cancer interventions.

The world of health research has many anti-Asian aspects in this country. The lack of data on a racial identity is always a sign of racism because it essentially means that part of the population is invisible. For example, we know that about one-third to one-half of Asian Americans do not speak English well enough to take a medical survey conducted in English. The “Asian” responses to such a survey include only English speakers; Also, despite the diversity of Asian cultures, all “Asian” respondents are lumped together.

Lack of urgency

Although some institutions try to hire different candidates, there is a fundamental lack of urgency when it comes to addressing systemic racism. The problems I mentioned are all structural problems. I think there can be no systematic change without involving everyone involved – from the heads of medical departments to the members of the communities that the institutions are said to serve.

In 2020, my colleagues and I established an Anti-Racism Task Force at the University of California, San Francisco. Using a community engagement approach, we have convened a committee of 25 members, including institutional and community leaders, staff, faculty members and trainees. Over the course of a year, we gathered information from across the university and produced a report with 160 recommendations – from funding research that examines the structures that perpetuate racism to more community engagement in science.

Most institutions are too top-down. I have learned that academic hierarchy is a fundamental challenge to working on campus justice. White males tend to be over-represented among faculty members, while non-faculty staff tend to have more women and under-represented minority groups. We make sure staff and faculty members meet and are aware of – and acknowledge – the power dynamics that exist. Otherwise our efforts would not be comprehensive.

To better diversify study participant recruitment, in 2021 my colleagues and I formed the Research Action Group for Equity, or RAGE—an acronym we deliberately chose because we resent the lack of health data and minority participation and this also want to make things uncomfortable for the powerful. RAGE works with the UCSF Clinical & Translational Science Institute to ensure recruitment is an inclusive process. We engage community leaders who are bicultural or bilingual to provide translation support or to address cultural issues.

If my colleagues and I can diversify the health workforce at UCSF, we can definitely improve the economic status of different communities as well as the reach of biomedical research in those communities. We received a US National Institutes of Health BUILD award to address the lack of diversity among biomedical researchers. If you want minority students and trainees, you have to go where they are. In our case, we recruited trainees from San Francisco State University, a Hispanic-focused institution that serves minorities. For example, we trained these young researchers and healthcare professionals to be clinical research coordinators, to lead studies and conduct experiments.

This expands the employment opportunities of these trainees and diversifies their involvement in research. But when people talk about efforts to increase the number of young scientists from diverse backgrounds, I hate the term “pipeline program.” “Pipeline” implies that you must first put yourself in a pipeline and come out the other end where the system wants you to come out. Additionally, if the pipeline produces a steady stream of talented graduate students from underrepresented communities, but the system does not increase the number of senior positions held by those individuals, this is not a pipeline problem. Instead, it’s a dam problem – pun intended; There are structural barriers to diversity in the workplace that need to be addressed.

UCSF has its own ongoing challenges in anti-racism efforts, but the institution has been transparent. It features a dashboard that highlights racial, ethnic, and gender diversity among faculty members, staff, and trainees. The situation fluctuates, and the numbers have never been large for groups normally underrepresented in medicine, such as blacks and Hispanics. But it is important that the problem becomes visible so that we can actually improve.

It is frustrating that successful diversity, equity and inclusion programs are often unsustainable. Underrepresented groups are used to people coming and going with money. I helped develop the AEIOU Principles, which will form the basis of my work as the newly appointed Deputy Vice-Chancellor for Inclusion, Diversity, Equity and Anti-Racism in Research. A stands for accountability and anti-racism, E stands for engagement, I stands for individual-centred institutional change, O stands for opportunity, and U stands for unity. These principles are key to progress in the fight against racism. The system needs to change for underrepresented groups to thrive, and that requires more opportunities. Oppressive structures perpetuate oppression by making people perceive a zero-sum game – if someone wins, someone else must lose. To increase diversity, equality and equity, we must stop playing off one group against another.

This interview has been edited for length and clarity.

Combating systemic racism to diversify healthcare and clinical research

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