interviews
Call It What It Is
by LaShyra Nolen
July 1, 2020
This interview with LaShyra Nolen, Harvard medical student, and the first Black woman to become class president, was conducted and condensed by franknews.
frank | You've written and spoken about your experience within a dual reality – of being both a medical student at Harvard, and a person committed to your own identity and equity.
LN | The dual reality is you're training at the best medical school in the world, but there is so much suffering going on in your community. And whatever knowledge you gain still isn't going to necessarily translate to the improvement of the condition of Black people. For example, I could go on to become the best surgeon in the world. I could save the life of a Black patient. But they can go outside, drive home, get stopped by a police officer, move too fast, and get killed.
That is the dual reality. You're learning, but you're not necessarily getting to the root cause of the suffering of your people.
You always have to think about it from both of those perspectives, that of a student and that of a Black person in America.
In addition, you go into class and you are expected to maintain professionalism. You are expected to just talk about the science and to talk about the assignment at hand – when that same morning you watched yet another police lynching of a Black man. You're trying to deal with those emotions, and you have no idea how it's going to be taken if you say, "Hey guys, I'm really not doing that well. Another Black man was killed. Racism is pervasive in our country and we're all complicit in it." It is a challenge that all Black professionals have. You have to walk in and put on this face, even though internally you are dealing with the turmoil and hurt of your community.
What does this moment feel like at Harvard, as a student?
As a medical student, I feel like I can speak out more than my mentors or faculty members who are more ingrained into the system of medicine. Academic medicine is very hierarchical. The higher up you go, the more you have your hands tied, and you can't speak as much truth because you're trying to move up to an associate professor position so that you can finally start to use your voice. I know that there's a risk that comes with speaking up, but I, personally, can no longer just pretend like everything's okay, and allow people to continue to suffer in silence. Even the most brilliant people have been complicit in racism, and some of them genuinely have never even thought about it.
They've grown up in a bubble, their entire lives, and all this is happening and they're just like,
"Oh my gosh, I'm a good person. I'm not racist." And you kind of have to be like, "No, but you really are though."
These brilliant people who are excellent in their field, are just now realizing they're complicit in this system.
Again, I am happy that's occurring, but I'm always just like, look how much it took for us to get here. NASCAR is just now removing the Confederate flag. Suddenly now I have Juneteenth popping up on my Google calendar. I'm like, what?
My classmates and professors have really been amazing actually. We are all from different backgrounds. Some are fourth-generation physicians, and some grew up on reservations and are bringing medicine to indigenous folks. All of them realize that the system needs to change, and they have been so supportive. Beyond just talking the talk and posting the black box on Instagram, they've been reaching out to me saying, “Here are the notes from class today. I got this recording for you because I know you've been putting in work on the advocacy front.” That's true allyship to me. I've really been pleasantly surprised and happy to see the support that I've gotten from my classmates.
There has been a widespread acknowledgment that COVID is affecting communities and people of color at much higher rates. I am curious if you think there has been an appropriate conversation around why that’s the case?
I think that in order to understand that we have to look at our history, and at policy. The original ill was, of course, chattel slavery. This country has not valued Black lives. The policy reflects that, and policy ties into our healthcare. That history of systemic discrimination is important to look at to examine the current landscape of COVID-19.
Redlining decided where people live in this country, and which communities our government and our local city councils were going to invest in. Black communities were not invested in. As a result, Black communities have not had access to the basic resources that they need to survive and thrive. They don't have access to healthy food. They don't have access to safe places to exercise. They are exposed to environmental pollution. They have less access to education. I mean, then you look at who is more likely to be an essential worker - Black people are overrepresented.
It doesn't end there. Once people get into the clinic, they have to deal with the biases and systemic racism in the hospital system. There are studies that have shown there are medical students and residents who still think that Black people have a higher pain tolerance.
We can take maternal mortality as an example of treatment differences. Black women, at all income levels, are dying disproportionately compared to white women. When they get to the hospital, doctors don’t believe their pain. I mean, it happened to Serena Williams. It is safer for Black women to not engage with the healthcare system because of the violence and harm it causes.
How do you think mistrust of the medical system compounded the COVID crisis?
I think it all comes back to this conversation of access, right? When COVID-19 first hit, the testing centers were predominantly located in affluent communities, and a lot of Black communities were left without access to testing. The lack of Black physicians and Black health care professionals means that when Black patients come in and say they have COVID-19 symptoms, they are less likely to get treatment compared to white people.
If you know there are no testing centers in your neighborhood, you know there is no representation in the hospital, and you know that you are going to be discriminated against once you walk in that door, you know your life is being devalued. That knowledge prevents Black people from seeking care from our healthcare system. With anecdotes of horror coming from your community, of course you are going to be nervous to trust the healthcare system.
What does a better understanding of investment into public health look like to you?
I think we need to turn all of the conversations that we've been having into public health initiatives. Racism was declared a public health emergency in Boston. That is the direction I think we should be moving in.
We need to move beyond equality to think about equity. We need to recognize that not everyone is on the same playing field. We need to truly make sure everyone's specific situation is taken into consideration. We do that by investing in those communities, and by looking at how we make sure they have access to good education, access to health care, access to housing, access to good food. Improving the conditions where people live, work, pray, play will improve their healthcare outcomes and our healthcare system.
Of course, we need things like the physical exam, but often patients go into that physical exam with preexisting chronic diseases caused by disparate suffering. Going as upstream as possible will lead to better healthcare outcomes and in the long run, improve healthcare costs. Even if investing in public health didn't improve healthcare costs, I still think that it's the moral thing to do. I think we're too driven by what's going to save money in our country. We need to do what's right.
Everyone deserves to have the basic resources they need to live out a viable, joyous life. Right now we are doing nothing to guarantee that.
Someone said to me once, we’re too focused on raising the ceiling and not at all focused on raising the floor in the American healthcare system. Do you feel like this starts as a medical student?
I can definitely speak to that culture. As a medical student, I'm really passionate about community activism. I am passionate about making sure that everyone has access to healthcare, and ensuring that we're teaching medical students anti-racism so that they don't go out and further harm communities. I can spend two years doing that – serving on committees, writing up reports, and changing curriculum at my institution. But my peers who are spending the same time publishing papers on very specific proteins and disease processes might have a better chance at residency.
In medicine, you're not incentivized to do work that you don't get credit for. You always want to be able to publish, and activism isn't always publishable.
It has been the responsibility of Black students, students of color, and indigenous folks to improve their institution. They do the work so that they can thrive and survive, and so the next generation can do the same. But at the same time, they still have to do everything they have to do as a medical student to get to the next level. I'm literally trying to improve the very environment that I'm suffocating in, while also trying to handle everything else that medical students are expected to.
There was a letter early on from public health officials advocating for protest as it’s needed to fight racism within the healthcare system. Does that feel new or was it already a part of the conversation?
I think it's always been a part of the conversation for those who have been oppressed.
But that is what is special about this moment. We literally had a global pandemic that exposed the disparate suffering of Black people across the country, across the globe. And then on top of that, you have back to back to back killings of Black people. It's heartbreaking that it took this much for us to start having these conversations, but we are having them, and people can’t run away from them.
There are no distractions. We're not going to get anywhere if people don't name systemic racism for what it is.
We need to say Ahmaud Arbery. We need to say Breonna Taylor. We need to say their names, and we need to name the issue at large.
Big-name organizations are just finally starting to realize that this is something that they need to get on board with. It’s hard to know if it's really genuine or not. I think that people don't want to be on the wrong side of history. Regardless, learning is still happening. I'm very happy that anti-racism is becoming the status quo and that we are having these conversations. We need to continue to push the envelope to get people things they need to live a good life.
interviews
Money Alone Is Not Enough
by Michelle Miller-Adams
May 10, 2019
This interview with Michelle Miller-Adams, a professor and senior researcher at the Upjohn Institute, was conducted and condensed by frank news.
Part One of this conversation is available here.
When you look at and consider all of your research over the years, what is your ideal version of 'free college' programs? And how do you push what you know and what you're curious about to the forefront of our national conversation around college affordability?
As we enter another presidential primary, what would you like the conversation to look like? What do you think the most critical debate around this issue should be?
That is another great question, and actually, I'm about to start thinking seriously about it, because I'm about to write a book on this topic.
While I hope the ideas in my book will influence the national discourse, I'm not holding my breath for a national program, because I just think that politically, it's a really tough lift. If you look at the history of policy innovation in our country, this is exactly how it happens. Things get pioneered at the local level, and then they spread to other local communities, and then they may jump up to the states, and then maybe eventually, they'll find their way into federal policy. I just think that even though all the Democrats are talking about this, once they get in power, and depending who winds up in the Congress, a nationwide free-college program is not a surefire outcome.
That being said, we had a proposal in 2015 from President Obama that made a great deal of sense. To me, it's still the gold standard model out there for triangulating all of those various needs. It was called America's College Promise – no legislation was ever introduced but the policy proposal was out there. It was a federal-state partnership that would make community colleges tuition free. If states opted to participate–- and there were performance requirements if they did – the federal government would foot most of the bill. And importantly, it was designed to be a first dollar program.
That leads me to your question. I especially value programs that have universal eligibility. Basically, in programs like these, everybody can take a crack at it.
In a perfect world, which we don't live in, a first dollar program is far preferable to a last dollar program, because it has that better equity impact, where low-income students also get new money, and then they can use their Pell Grants to pay part of the way of their living expenses. If you do a universal program, and you focus it on community colleges, as Obama's program did and as Tennessee and Rhode Island do – whether first- or last-dollar – you are doing some de facto targeting. You are targeting low and moderate-income students, because honestly, Tatti, do you know many wealthy students who went to community college?
Very few.
Right. There may be a few, but that might just be the price you pay. If an affluent student is headed toward an elite or even semi-elite four-year institution, they're probably not going to make the decision to go to community college to get their $2,000 a year scholarship. On the other hand, students who weren't necessarily going anywhere, or those at the margin who are stressed in terms of finances, may decide to go to community college, and students on a four-year track may decide to start at the community college and cut their costs dramatically. Students do that all the time. I teach at a large state university, and we have plenty of students who started at a community college because it's cheaper – and then transfer to the four-year school to get their bachelor's.
Two other things are really important. One powerful lesson that we have learned over the years is that simplicity is your ally in these programs. With complex programs there's just too much confusion around the messaging. New York State has a program called the Excelsior Scholarship, and it's really innovative in one sense, which is that it allows students to go to public four-year institutions, as well as two-year community colleges, which is great. However, there is so much fine print that very few students actually qualify for the scholarship.
The simpler the better. If you can say it in a couple sentences, that's a good sign. But the other important element is this question of support. Thinking seriously about what kinds of resources are needed all along that educational continuum to help students, particularly those who haven't been successful in school, access higher ed, be successful in getting there, staying there and completing is really important.
Tennessee Promise has a mentorship program, and while the mentorship component is not as intensive as it was for the predecessor local program, it marks a recognition of the value of mentorship in helping students be successful in higher ed. Tennessee also has an adult free community college program called Tennessee Reconnect, and even that has a support structure built in. It doesn't come out of public money. It comes out of the philanthropic sector. There are a lot of ways to do this, but it's important to recognize that the money by itself is not going to change your outcomes that much.
As a short digression, I've been really busy, so I haven't been very active on Twitter, but I do want to respond to Pete Buttigieg's response…
He was pretty negative about free college. He basically said there's this huge college wage premium, where people with college degrees get paid a lot more than people who don't, and that's absolutely true. And he doesn’t like the idea of people without college degrees subsidizing those who are going to get the college wage premium. I think he misses the boat on this. The point of Promise programs is to bring those people who aren’t headed for college – whether because of confusion about the process or lack of financial resources – into the process so they can go on and get some of that college wage premium. Right?
Another presidential candidate, Elizabeth Warren, has come out with a number of big equity-based policy ideas and one of the latest is her plan for tuition-free college and student loan debt relief. Her ideas are bold and not always fully practical, but this one had an important element, which is that if we're going to make public colleges and universities tuition free, we had better also address the student loan burden. One of the challenges of free college is that if you come up with a national program, you still have all these people walking around with this huge student loan debt. So there's a real equity challenge there, if you aren't going to do something about the people who already got indebted, then it's sort of just a generational unfairness.
We're having that discussion in Michigan. Our new governor, just this week, introduced legislation for three tuition-free college initiatives, one for community colleges, one for four-year publics and one for adults, closely modeled on Tennessee, but there's no component that deals with the student debt situation, and the legislation. Because we have this very Republican Congress it's probably not going to go very far, but we'll see.
It’s a fascinating aspect of the free-college movement. A lot of money is being committed to support free-college initiatives without a lot of evidence about what they do and don’t accomplish. I know that because we sit here at ground zero of trying to generate some of that evidence, and there are many, many, many things we do not know. This is not a heavily researched, proven model where we really understand what we're doing.