Maisha Standifer of Satcher Health Leadership Institute at the Morehouse School of Medicine On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented Populations

Develop better ways for patients, especially younger ones, to keep up with their health. We can do this through digital applications, including the “mHealth” apps and digital and printed materials that keep patients in the know about their health.

Healthcare disparities continue to affect underrepresented populations, leading to unequal patient outcomes. Social, economic, and cultural barriers often hinder access to care, appropriate treatments, and equitable health services. How can we bridge these gaps and ensure that all patients, regardless of background, receive the highest standard of care? In this interview series, we are talking to healthcare providers, policy makers, community leaders, researchers, and anyone who is an authority about “How We Can Improve Patient Outcomes for Underrepresented Populations”. As a part of this series, I had the pleasure of interviewing Maisha Standifer MPH, PhD.

Maisha Standifer, MPH, PhD is the director of population health at the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, Georgia. Dr. Standifer has over 15 years of applied health program administration, evaluation and research expertise, including health policy development and analysis, mixed methods research and examining health disparities and inequalities domestically and globally.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

My first name means “the life,” my middle name means “to serve,” and my last name means “of the people,” so my life is to serve the people. As a child, I was raised in a household full of love, advocacy, and aspirations to ensure that anything I did represented my family and heritage. My parents and grandparents were local community leaders and politicians who were always fighting for people who did not have a voice or a seat at the table. I learned early on about inequities in healthcare as I watched dearly loved family members succumb to various illnesses and conditions because of it. Initially, I thought it was their choice to do so. However, I learned that they succumbed to those illnesses and conditions because determinants of health, including policies, were inequitable. Their suffering and deaths negatively impacted various stages of my life. It prompted me to inquire about how and why our society has gotten to a place where healthcare is inequitable. I also remember family members and close friends being diagnosed with HIV/AIDS in the ’80s when the disease was severely stigmatized, which forced people not to discuss their diagnosis. I would hear people say, “He had a bad case of pneumonia,” or “She had a bad neighborhood affiliation.” I thought, “What does this mean?” and “Let’s get to the root of the problem.” I want to make a difference using my voice, knowledge, career trajectory, who I am, and how I was raised to bring a voice to people around me.

I honed my skills in community-based research as the lead coordinator for a barbershop prostate cancer education program in Tampa, Florida, where I fell in love with community-based research. A combination of academia, research, and community work is always a great balance for me because I listen to, understand, and feel the people I speak for and represent in academia and institutional settings. My team and I trained barbers as community ambassadors to talk about prostate cancer because we knew that Black men disproportionately suffer from this form of cancer more than any other race. There are a number of things that contribute to this disparity, including limited access to education, health care, and testing mechanisms. We wanted to educate Black men as a high-risk patient population that may not go to the doctor but will go to the barbershop. The more time I spent in the barbershop, the more I understood that it is a man’s comfort zone.

Can you share the most interesting story that happened to you since you began your career?

The most interesting story since I began my career is meeting and working with Dr. David Satcher, being fully aware of his grand stature in public health, his professional journey, and understanding his purpose. He founded the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta, Georgia. As a Spelman College senior, I participated in a public health science internship where Dr. Satcher was a speaker at the graduation. During that time, he was transitioning from his role as a Center for Disease Control and Prevention director to becoming the first Black U.S. Surgeon General under the leadership of former President Bill Clinton. During the graduation ceremony, I spoke with him and told him how grateful I was for his advocacy and work in the public health field and for eliminating healthcare disparities.

I also told him how much I would love to work for him. Over the next 25 years, I would see him at public health conferences and meetings and on television networks like CNN and CNBC. It was a full circle moment for me when I was afforded the opportunity to work at the Satcher Health Leadership Institute, initially as the director of health policy and now as the director of population health. I reminded him of when I met him at the public health science internship graduation and told him how much I wanted to work with him. Even though I do not think he remembered our initial meeting, the moment always remained with me. As the saying goes, “It is not always what someone says to you, but how they make you feel.” He made me feel like anything you want to accomplish is possible, and it is permissible to dream beyond the present. Dr. Satcher has allowed me to dream even beyond the initiatives and policies he has established. Having an opportunity to work with him and my office being next to his, to honor his legacy and long career, is extraordinary for me. Knowing his legacy will live on through the healthcare professionals he has trained and how he has led leadership and training opportunities at the Satcher Health Leadership Institute and beyond is humbling.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Three life lesson quotes are relevant to my life and profession: “Treat others how you would like to be treated,” “Talk to others how you want to be spoken to,” and “Understand others and their experiences as you talk and interact with them.”

Sometimes, when communicating with other people, it can be challenging to understand what a person is trying to say because we are not all raised the same way and do not react or communicate the same way to life’s circumstances. Understanding communication and other people’s backgrounds will help you always treat people with love and kindness. More often than not, you will reciprocate the energy that you send out. However, if you don’t, it’s okay, and always remember to keep moving forward.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is a medical professional who understands their patients’ cultural, race, ethnicity, and gender backgrounds and their healthcare journeys that show where patients are coming from and the steps they want to take to achieve their individualized goal of a healthy lifestyle. To be clear, a healthcare provider is not limited to a doctor or physician; instead, it is a professional who addresses the healing needs of a patient who is experiencing challenges in a specific area of health.

After the passing of my husband, I needed a mental health therapist to help manage my grief and mourning and provide me with ways to effectively communicate with those around me, particularly our children. To further cope with my grief, the therapist encouraged me to journal, and I also received coloring books as gifts from those close to me to manage the grieving process.

The definition of an excellent healthcare provider can be defined by shared ethnicity, gender, and life experiences. As a Black woman, I may opt to visit a Black female Obstetrician-Gynecologist because she may better understand my perspective. After all, we have shared life experiences, including maternal health and childbirth.

I am a whole health patient, so I define an excellent health provider as a professional who can navigate my health journey and say, “You can relax with me,” and “You’re in good hands.” Overall, it is essential for a healthcare provider to reassure patients and offer mutual respect, especially for the patients’ backgrounds. The healthcare provision process must be very careful and accepting. Sometimes, the patient may not be ready for certain things or services, but accepting and hearing is key.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

One of my favorite books is My Quest for Health Equity: Notes on Learning While Leading (Health Equity in America), written by my mentor, Dr. David Satcher. I also enjoy reading Daniel E. Dawes’ The Political Determinants of Health and listening to podcasts featuring Tabitha Brown, a social media personality and Emmy-winning host and actress, and affirmations from Academy Award-winning Actress Viola Davis.

These resources enlighten my career and personal journey, ensuring they intertwine and intersect with my spirituality. Attending church and having a spiritual leader are central and essential parts of me. These people and things are critical to my future as it relates to the people I serve.

Are you working on any exciting new projects now? How do you think that will help people?

At the Satcher Health Leadership Institute, our team is completing several great, rewarding, and novel projects. One of our primary projects is Georgia Thrives, a campaign sponsored by Gilead Sciences to end the HIV/AIDS epidemic.

Our team is linking cancer and HIV-related projects and examining the intersectionality in women who are diagnosed with HIV and succumb to cancer. Unfortunately, this disproportionately happens among people of color. Health inequities occur across multiple life areas known as social determinants of health. If you know someone experiencing discrimination because of their HIV diagnosis, their housing and transportation can also be impacted.

For studies on breast, anal, and colon cancers, we are working to have better patient-centered outcomes by exploring laboratory science and clinical outcomes, referred to as bench-to-bedside, treatment mechanisms, including an innovative project examining medical cannabis for pain management. Although it has been largely stigmatized, medical cannabis is a plant-based medical treatment option that has a medicinal purpose in treatment and prescriptive-oriented formula.

These projects are critical to our work at the Satcher Health Leadership Institute.

Ok, thank you for that. Let’s now jump to the main focus of our interview. What are the primary barriers that underrepresented populations face when seeking healthcare?

One of the primary barriers that underrepresented populations face when seeking healthcare is the lack of healthcare insurance, which leads to other barriers. External factors such as stress, family situations, including child rearing and marital status, job loss affect your physical and mental health. However, when a person does not have access to healthcare insurance to make an appointment for an annual exam with their primary care physician, mentally, they may become ill-equipped to deal with their life’s circumstances. This can also happen when there is no healthcare insurance for a person to get an annual dental cleaning or for a female to visit a gynecologist to get a pap smear. Continuous neglect of your health over the years can lead to detrimental or fatal outcomes, which is disheartening.

A lack of healthcare insurance also causes a person to lack the knowledge and ability to effectively navigate various healthcare environments to gain better education and treatment options for themselves or their loved one. For example, when my husband was diagnosed with cancer, because I work in an environment where there are many healthcare provisions, education, and treatment options, in addition to considering chemotherapy, I could look at other options to treat his condition. Because they do not have healthcare insurance, many people may lack understanding and experience in navigating various healthcare environments.

How can healthcare providers build trust with patients from diverse backgrounds, especially in communities that have historically experienced medical neglect or discrimination?

An excellent example of how healthcare providers can build trust with a patient from a diverse background is when visiting with an obese patient who needs to lose weight to avoid any further risks to their overall health. The physician should not assume that the patient’s obesity is the result of their overeating and recommend that the patient reduce their daily diet intake to 500 calories. Instead, let’s examine other factors in their life that can affect their weight. Excessive weight gain may stem from a genetic condition, including a thyroid issue, hormonal imbalance due to menopause, or another health condition.

To address the patient’s specific needs, the physician must communicate effectively with them and may refer them to other healthcare providers, such as a nutritionist or a registered dietitian, who can help them along the way. All of these things are essential for a physician to build a positive and truthful relationship with their patients from diverse backgrounds.

What role does cultural competence play in improving patient outcomes, and how can medical professionals be better trained to meet the needs of underrepresented groups?

Cultural competence plays a pivotal role in improving patient outcomes. A physician’s ability to display compassion and flexibility while caring for patients is challenging to do in the present day. Unfortunately, gone are the days when each family member had the same doctor, and the doctor spent an hour with each patient, assessing and caring for their needs. For the average doctor appointment, physicians visit with their patients for seven to eight minutes.

Our society is shifting in terms of medical care and systems, meaning that patients have to be flexible, too. However, despite patients’ flexibility, the physician must still be communicative and culturally responsive to the population they are servicing. They should not use a combative or authoritative tone when they learn about patients not taking their medication as directed. Patients who do not take their medicines as directed may not like the side effects or cannot afford to pay for them.

I am grateful that Morehouse School of Medicine, for the past 20 years, has been one of the few national medical programs that trains students in community health during their first year of medical school. We divide our 100 medical students into cohorts of 10 and engage in community health instruction at a local organization where they learn about models, theories, qualitative and quantitative methods, and explore and examine what’s happening locally. They also interact with various populations and engage in the interworking of organizations, including developing and participating in creative programming. Students learn and bond with the perception of their locality. Teaching students how to be culturally responsive in medical training is critical.

It is also essential to focus on what we say and how we say things when servicing populations where English is a second language. In my experience, I was part of a medical team that provided breast cancer screenings for Hispanic female farm field workers. We found several lumps on these women’s breasts. However, their priority was caring for their families, which meant relocating every three months to work the farm fields in various states across the country. For them, their families’ needs were more important than theirs.

Another example of cultural responsiveness is when I and my team were invited into a local mosque in Tampa, Florida, to speak to nearly 25 Muslim women. Before this, I did not know that Muslim women were only permitted to visit with women medical providers who were most likely Muslim. Due to their spirituality, these women were fully covered, except for their eyes, and did not speak to or look at us. They also were not permitted to explore their bodies, including doing self-breast exams. Having medical services at the mosque was novel because it is not commonly done, especially with women who do not practice Islam. We had to frame the discussion as family wellness education. We had to have a nurse conduit to speak with the women about their health. The women were encouraged to train their husbands to complete their breast exams since they were not permitted to do so.

Can you share any successful strategies or programs that have been implemented to reduce health disparities and improve outcomes for underserved communities?

Some of the most successful strategies I’ve seen have been related to community-based research. After working at the Center for Disease Control and Prevention for 10 years, my mentor told me that I would be great in a career as a cultural medical anthropologist since I am a community-based professional who enjoys talking and doing community fieldwork. She also told me I would be productive as a community-based researcher, so that’s where I set my career.

Going to nontraditional venues such as beauty salons and churches to educate underserved populations is one of the most successful research strategies. I am preparing to implement a lung cancer study in the local nail salons, beauty supply stores, and fitness gyms. As researchers and medical providers, we understand that people do not like to go to their doctor visits, but they do go to other places. I am aware of a number of initiatives nationwide where researchers conduct studies in nontraditional locations, including gentleman’s clubs. Researchers and medical providers can be impactful in several ways, and having key strategies is essential to reducing health disparities among underserved populations.

How can technology and telemedicine be leveraged to reach underrepresented populations who may face geographic or financial barriers to traditional healthcare services?

The COVID-19 pandemic taught healthcare organizations, providers, and patients how valuable technology and telemedicine are. Organizations must be very strategic when implementing technology and telemedicine, which are dramatically improving the ability to access difficult-to-reach patients. They must implement strategic methods to show patients how to access and navigate these to gain access to their health records and stay in touch with their physicians.

As a researcher at the Veteran Affairs office (VA) in Tampa, Florida, I had to ensure that veterans, especially those living in rural spaces, knew how to connect with their physicians and gain online access to participate in their doctor visits uninterrupted. Some of the veterans lived 200 miles away from the VA healthcare facilities. The VA had to deploy mobile health stations to travel to rural clinics in places such as Immokalee, Florida, to ensure the veterans had full access to healthcare.

To reduce veterans’ concerns about having daily guides to help them access their emails and the healthcare website, the VA decided to offer computer training. Overall, there were many opportunities and implemented strategies to let people, who were part of patient populations who were challenging to reach and were not very knowledgeable about digital applications and access, know about the implemented changes.

From a financial standpoint, everyone has a cell phone, but now healthcare systems want patients to own a smartphone to use mobile health, or “mHealth,” apps. Over the last 10 years, the demand and use of these apps have soared. Most healthcare systems, including Morehouse Healthcare, now have appointment-setting technology that sends texts to patients when their doctor visits are confirmed, which is very different from 20 years ago.

As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve patient outcomes for underrepresented populations? Please share a story or example for each.

1. Expand accessibility to healthcare and healthcare insurance. Sometimes patients do not go to the doctor because they do not have reliable transportation, insurance, or money to pay for their visits.
2. Develop better ways for patients, especially younger ones, to keep up with their health. We can do this through digital applications, including the “mHealth” apps and digital and printed materials that keep patients in the know about their health.
3. Ensuring we have culturally responsive communication platforms. Oftentimes, it is not what we say, but how we say it. Let’s establish communication portals, such as websites and mobile apps, that take into consideration patients’ cultural, spiritual, and racial backgrounds.
4. Increase access to training and financial aid for future medical staff. Provide more training and financial aid opportunities for future medical staff to earn their education and excel in careers as physicians, physician assistants, nurses and other much needed healthcare roles that will contribute to enhancing patient outcomes.
5. Having more accessible healthcare. Having mobile healthcare clinics near patients’ homes and returning to a time when physicians used to regularly visit patients in their homes are key to improving patient outcomes through more convenient access to healthcare providers and treatment.

What specific steps can be taken to ensure that medical research and clinical trials are more inclusive of underrepresented groups, and why is this important for improving overall patient outcomes

When my husband was diagnosed with cancer, we were offered clinical trials and other treatment options, such as chemotherapy and oral treatments. However, these offerings were rare because many people I know said they knew nothing about them. I believe my proximity to healthcare education and providers made these treatment options more accessible to us. However, patients and their families proximity to healthcare education, and providers, knowledge and access to clinical trials ought to be universal.

Clinical trials are essential, and a shift needs to happen. Individuals who are often underserved, marginalized, and unvoiced do not prioritize their health. Most are considering obtaining an education, having enough food, and maintaining a home for themselves and their families, especially now. If a person gets sick, they know they cannot afford to take care of themselves and their family if they stop working.

We must create small educational hubs where medical providers show underrepresented groups that they are valuable and present them with a whole health model, which indicates everything that a person ingests, including medicine for a headache, has gone through a clinical trial that often does not include Black patients. Also, healthcare providers must educate underrepresented groups earlier. Many Black patients say that they learn about clinical trials near the end of their lives. This statement is partly true, but also, many of these patients delay seeing a doctor about their health or a diagnosis at a very late stage.

Healthcare systems must expand opportunities and knowledge in underserved communities. I regularly speak about health-related topics at my local church and annual family reunions. Black people are starting to recognize that doing better about our health, especially in natural settings such as Sunday dinner, is critical.

You are a person of great 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 can trigger. :-)

I would inspire a movement of health and social justice with an understanding for everyone to treat others how they want to be treated. Do for others as you would do for your loved ones. In my life, I have been involved in global and domestic research projects, such as a water treatment study in Nigeria and sexual infections in the Caribbean. I have also participated in environmental justice projects, where Black and brown communities were being displaced and proliferated for landfills, smelt and water, and paper factories, and the water quality was lesser in these communities. We are all in this human movement and journey together. I want the movement to link health, prosperity, wellness, and well-being globally and domestically.

How can our readers further follow your work online?

Readers can learn more about the work we are doing at the Satcher Health Leadership Institute online at GeorgiaThrives.org and SatcherInstitute.org. They can follow us on Facebook, Instagram, YouTube, and X at @satcherhealth and on LinkedIn at @SatcherHealthLeadershipInstitute.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.