Inspirational Black Men and Women in Medicine: Dr. Karen D. Lincoln of UCI Public Health On 5 Things You Need To Create A Successful Career In Medicine
An Interview With Jamie Hemmings
You are a person of influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea could trigger.
In the United States today, black doctors are vastly underrepresented. Only 5% of physicians nationwide are black. Why is it so important to have better representation? What steps can be taken to fix this discrepancy? In this interview series, we are talking to successful black men and women in medicine about their career, their accomplishments, and how others may follow their path. As a part of this series, I had the distinct pleasure of interviewing Karen D. Lincoln.
Karen D. Lincoln, PhD is a professor of environmental and occupational health as well as the director of the UCI Center for Environmental Health Disparities Research at University of California, Irvine Program in Public Health. Lincoln is an academic and public scholar whose work highlights societal and social factors that contribute to health disparities. Her research, writing and advocacy are rooted in the African American experience and across the fields of social work, sociology, and gerontology.
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit more. Can you tell us a bit about your childhood “backstory”?
My mother was one of 11 children. She was born in a very small town, Baldwin, Louisiana. Currently there are about 1800 people in that town. My father was born in Orange, Texas and raised in Austin. They met in Sacramento, where my sister and I were born. My father served in a segregated Army. He later worked as a barber and a computer operator. I was a daddy’s girl and a little bit of a tomboy. My parents divorced when I was nine and then I lived with my mother after that. We lived in Crescent Park, an affordable housing community in Richmond, California from fifth grade through high school. I dropped out of high school in 10th grade. When I returned about a year later, my high school counselor, Mrs. Burkhalter, was very angry at me. I was generally a good student, so she went ahead and put me in the 11th grade, which was the grade I was supposed to be in, and she threatened me that if I didn’t get a 3.5 GPA at the end of the semester, she would put me back in the 10th grade and force me to complete it. I completed 11th grade with a 4.0, and ultimately, I was the only African American in my class to graduate with honors from my high school.
Can you tell us a story about what brought you to this specific career path?
My father had a number of health complications including diabetes in his forties. He ultimately lost one of his legs due to amputation. He had vision impairment which ended his career as a barber, which is the thing he loved the most. He also had other health problems including stroke, congestive heart failure, end-stage renal failure and depression. My dad died in a very low-quality nursing home. Even though his doctor said that he could be cared for at home, he didn’t want his daughters to take care of him. I wrote about my dad in an Op Ed that I published in The Wall Street Journal, to talk about the importance of long-term care, particularly planning for it, something that my dad didn’t do and something that I learned a lot about during his demise. He didn’t do that when he was healthy, and many of us don’t do that when we’re healthy. This is one of the experiences that is the foundation of my work analyzing the social, psychosocial and public health factors related to health disparities among Black Americans for over 20 years.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
In the academic world, most people will view me by my Google scholar standing, the number of publication citations, the fact that I was ranked among the Top 2 percent of scientists, etcetera, but this does not really capture what it took to become who I am as a scholar. My lived experience, along with the collective experiences of black Americans, informed my scholarly work, the questions I asked, how I framed them, my approach to examining these questions. So, likewise the people I interact or collaborate with all have a story of how they got here that is worthy of learning more about so that it can inform and improve our work together.
Can you share the most interesting story that happened to you since you began your career?
To support myself through my undergraduate career at UC Berkeley, I worked full time on the Golden Gate Bridge and probably only got two hours of sleep a day. After I completed my undergraduate education and started graduate school at the University of Michigan, , I was very sleep deprived. Several years ago, my mother was diagnosed with moderate to severe dementia which is quite tragic and also a wake up call, because researchers have linked sleep deficiencies and poor sleep quality to cognitive impairment. In fact, my current research focuses on studying the impact of poor sleep quality and cognitive impairment among African Americans. This is an example of how research imitates life, I suppose. At the very least, it is another example of how I’ve used my lived experience to inform my work. Confounded with the knowledge that historically sleep has been elusive for African Americans, I am even more charged to advocate to our communities on how important sleep is to our health and well-being. A growing body of research suggests that racial/ethnic differences in sleep deficiency, including extreme sleep duration, sleep-disordered breathing, and insomnia, may help explain disparities in a multitude of diseases like cardiovascular disease, sleep apnea, Alzheimer’s disease and more. Black Americans are two to four times at risk of developing ADRD than non-Hispanic Whites. They are also more likely than Whites to be untreated and undiagnosed with AD, to experience an earlier onset, to have more severe symptoms, and to have less access to information about AD. I hope my research is waking up the academic and general community on how important sleep is on our health and well-being.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Listening to learn rather than to respond. Effective mentoring, teaching and leadership require you to understand and respond to the needs of those that you are trying to train, support and lead.
Embracing different ways of knowing. My work as a researcher in communities is built upon the recognition and acknowledgement that there are different ways of gaining knowledge. For some it is formal education, tradition or culture. For others it is our lived experiences that primarily inform our worldview. Lived experiences are also informed by those other ways of knowing. But, the old adage “experience is the best teacher” rings true especially in my work with older African Americans. The success and effectiveness of my community-based participatory research starts with getting to know the real lived experiences of people. Within these stories we come to know the strengths and resourcefulness of people, their priorities and how we can support them. This process of listening, exchanging, and respecting how people come into knowledge produces trust and mutual respect that is crucial for the work that I do.
Your Perspective on Diversity and Inclusion
Can you share three reasons with our readers why it’s really important for there to be more diversity in medicine?
The experiences of African Americans are worthy of study in and of themselves. We don’t need to be compared to anyone else. There is more than enough to learn about in our own lived experiences to inform policy, practice, and research in medicine.
There is a history of unethical and egregious behavior in science but that is not necessarily the reason why we have concerns and lack of trust in the healthcare system. It is personal experience that often is the cause of the mistrust which is why we need diversity in medicine to challenge those assumptions and build better trust with Black communities.
In 2023 many African Americans are avoiding care because of racism and discrimination in healthcare settings. Far too many physicians express doubt that there are health disparities or that discrimination occurs. Medical students are still being taught that Black bodies are different from white bodies. Our skin is thicker or we don’t experience pain in the same way as white patients. This is just not true. Diversity goes beyond counting the number of minoritized students or physicians. Diversity requires that we acknowledge historical and contemporary racism, understand that it negatively affects patient outcomes, and hold others and ourselves accountable for the care, experiences and outcomes of patients who have historically been marginalized, underserved and mistreated. We must change the culture of medicine. I honestly believe that it can be done.
As things stand today, what are the main barriers for black men and women to enter the medical field?
We have a pipeline problem. We have to see it to believe it. The lack of Black doctors and their lack of visibility sends a message that it might not be possible. We also need to encourage students to pursue a career in medicine. But, we must also acknowledge the inequity in our schools, be it disparities in suspensions, detentions, expulsions, or AP classes for Black students. These things are socially patterned, with many Black students being penalized for behaviors that are misunderstood, unnecessarily elevated to a heightened level of concern, that might be related to environmental factors or stressors, or that can be addressed in less punitive ways. If we want to solve the diversity problem, we only have to look as far as our public school system. These same issues occur in private schools as well.
From your perspective, can you share a few things that can be done by the community, society, or the government to help remove those barriers?
For public schools who serve minority students there needs to be both a representation of those who teach and what they teach. I personally have experienced the power representation has on inspiring excellence through my son. In the whole school, my son is the only African American student and he has a male African American teacher and it matters. The teacher’s ability to frame education as a responsibility and privilege gives student’s the idea that knowledge is power. In addition, there needs to be a revolutionized curriculum design that encourages students to go into medicine by highlighting the work African American doctors are doing, especially in Black communities. It is best to lead with examples and teaching case studies of African American doctors can inspire students to go into this field. Yet, the most important aspect that students need is financial support. Unfortunately, for profit educational institutions tend to target minority students and the tuition alone racks up major student debt for them. Our government and philanthropists need to provide more fellowship opportunities, mentorship and financial aid support to minority students to encourage and support their journey well beyond medical school. The promise of President Biden’s loan repayment plan is a step in the right direction but the pushback from elected officials showcase how much work is still needed. We need to inform our elected officials of the impact of systemic racism and discrimination in education.
What are your 5 things I wish someone told me when I first started my career in medicine and why? Please share a story or example for each:
Seek out like-minded peers and programs that are doing the work that you want to do. I feel fortunate that I can say that I don’t wish I knew something different before I started my career because my mentor sought me out and introduced me to a supportive academic community that supported me. While I was at the University of Michigan, I was part of the Program for Research on Black Americans. There I had examples of strong, successful Black scholars who demonstrated the kind of researcher that I wanted to be and how I could serve my community.
My mentors from 30 years ago are still my mentors today and have passed so much knowledge and support on to me. I continue their legacy as I mentor the next generation. The extent to which you can find a mentor that is not just a great scholar or physician but also someone who has lived experiences that you can relate to. My mentors are people who navigated academia and their struggles and triumphs gave me examples of what is possible as a researcher and scholar myself.
We have to understand that it is not an easy road in academia and especially in medicine. I am constantly reminded that I’m black and that I’m a woman because of the culture and structure of the academy. . But this is not an indictment of my work because my work speaks for itself. I am a reflection of my community, our strength and resourcefulness, challenges and triumphs. So, what I do is not about me — my role is to do what I can to elevate my community and tell our truth.
Share information. Never withhold the information that can help you because it can help someone else as well. Uplifting your peers can create a community that you will need in academia and medicine.
Be reminded of your goal and grounded in your purpose. It will provide fuel when you are weary but also humble you when you’re successful.
You are a person of influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea could trigger.
To listen to learn — not listen to respond. Listen and admit what we don’t know and learn from people who have lived through their experiences and can attest to their knowledge. Just like in team science — we see the value in how different experts bring expertise and different perspectives to solve a research problem. I want to see a “team science” approach applied to our community because each member brings value and their knowledge and can contribute to finding solutions to their own problems. There are a lot of lessons learned from examples like the George Floyd protests that occurred around the world. Many communities came together from diverse backgrounds and lived experiences to harness their power and raise awareness about social injustice and offer solutions. Ultimately, they changed the world in many important ways. In practice, we can learn to listen to patients and their families to arrive at sustainable solutions that are informed by the entire team. This approach can help remove bias and dismantle assumptions and lead to patient-centered care.
Is there a person in the world or in the US with whom you would love to have a private breakfast or lunch with and why?
I would have loved to have lunch with my late grandmother. Her grandmother was a slave and her mother was Native American and her father was Creole. With a third grade education, she worked hard to support her family of 11 children. Her dream was for all her children to graduate high school and would have never dreamed beyond that. Let alone having a Black president, a granddaughter with a PhD, and more. I want to know her story — her struggles and pains. She had a saying “I worked until my heart slept.” That mantra gave me strength throughout my academic and professional career. Older people are the key to resourcefulness because of all they have seen and done. She was already so inspiring to me and didn’t even know it. If our older community can survive through segregation and the many brutal injustices under that system, then it should give us strength to believe we can get through life’s challenges.
How can our readers best continue to follow your work online?
You can learn more about my research on my profile page https://publichealth.uci.edu/faculty/lincoln-karen/. You can also learn about my community health education program called Advocates for African American Elders on our website https://www.aaaeonline.com/ On social media, you can find me on Linkedin and Twitter.
Thank you for these fantastic insights. We greatly appreciate the time you spent on this.
