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Host: Welcome Dr. Baskin. I'm honored to have you on our October episode of The Checkup, a podcast that we originate out of the school of medicine to hopefully keep people up-to-date of the issues around healthcare in particularly around COVID-19. We have a diverse audience that really spans around many areas in our area and hopefully broader than that. So I want to make sure people get to know a little bit about you. So tell us your title and department and where you currently serve, and so people can get that part.

Dr. Baskin: Sure. So first I'm delighted to have been selected to talk with you today. And I am a professor of preventive medicine and the department of medicine, and it also serve as the vice chair for culture and diversity in the department. Another hat of mine is as the associate director for community outreach and engagement for our O'Neil Comprehensive Cancer Center.

Host: So, you're an academic scientist working on disparities with an area focusing cancer it sounds like, can you maybe share a little bit of your journey into the academic medicine, how you get started and what was your pathway to get here?

Dr. Baskin: So, my pathway was actually not a linear path and it actually wasn't one that I started off in this direction. So when I was an undergraduate at Emory University, I focused on psychology and sociology and thought that I would become a psychologist focusing on clinical work, primarily in African-American communities. And by and large, that's where my career took me. I completed my graduate degree at Georgia State University became licensed. And then I was in the middle of my postdoctoral training when my training director talked to us about finding individuals in the community that were doing things that we were interested in. And so that path led me to someone I didn't know, it was a cold email to someone who was a faculty member in the School of Public Health at Emory and walked in. And he told me about public health and how that was a perfect match for my interests to focus on vulnerable populations, but to be able to do that to as many people as possible. So I started working with him in public health, on projects related to obesity and African-American girls, and that spawned into a total interest in health disparities and obesity research, and eventually about how that would lead into cancer disparities. And, you know, from there, I came over to UAB 16 years ago and the rest is history.

Host: Are you the only one in your family, sort of in the medical world or are there others?

Dr. Baskin: I have others. So my older sister is actually a nurse in Atlanta and her daughter is also a nurse and I come from a long lineage of nurses. So my grandmother, my maternal grandmother was for all practical purposes a nurse in her small, rural town in Georgia. And she helped to pretty much all the babies that were born in that particular area. So I think that's been certainly an interest in my family and I welcome the opportunity to be able to extend that.

Host: That's a great story. Monica, let's talk about this subject of disparities from your perspective, what are the disparities or what is disparities in healthcare that we need to be aware of? Number two, why do you think it is, or is it driven by systemic issues? And then maybe on the end, how has this, if you would this coming together of the deaths of George Floyd Ahmaud Arbery, Brianna Taylor, and COVID-19 created a crisis that we see now?

Dr. Baskin: Yeah. So great questions. A lot to unpack there. I think that when it comes to disparities or health disparities in particular, there are a number of things that we should be aware of and cognizant of. So we know that for all the major chronic health conditions, cancer, diabetes, cardiovascular disease, and others, that there are systemic differences between those individuals who are more likely at greater risk of having those diseases and then also of dying from those conditions. And what we also know is that a lot of that has nothing to do with biology. A great deal of that has to do with the social determinants of health. So where people live, where they grew up in play and go to school. Those things have a major role in terms of who gets sick and who remains healthy and who lives longer or shorter.

And some of those issues have to do with, you know, having appropriate housing, economic stability education, a small part of that is access to high quality care. But the other factors are really have been found to have a profound impact on who's healthy and the disparities. And so when you think about the events that have happened over this year, that are specifically rated related to systemic racism, we know that there are things that are structurally in place that help to determine which individuals are going to have a healthier outlook than others. And so when we see things like the policies and practices that have happened in our country over time from slavery to legal segregation, to, you know, the old version of Jim Crow or what some people call the new version of Jim Crow, we see that there are systems in place that continue to either create or perpetuate the differences that we see in health.

Host: Great answer. Let me ask you this. Probably even harder question. Why does it matter?

Dr. Baskin: Yeah, I get that one a lot. You know, besides the fact that I am an African-American woman from the deep South, and I have seen firsthand the devastation in my own family, having lost my father at the age of 51 to colorectal cancer, as well as other family members. So besides the personal part about why this matters, it matters because, you know, collectively we spend, you know, a lot of money in terms of trying to care for individuals at the later stages of their conditions and diseases. And that should not be the case. We could save a lot of money by making sure that people have great access to care that they have wonderful environments to grow up in and to help to prevent some of those issues before they get there. And that's the economic reason. So obviously there are other reasons about caring for one another and making sure that everyone leads a healthy life and have a fair opportunity to lead a healthy life for as long as possible. But I think it matters both from the standpoint of the heart matter and also the educational head matter in terms of what we can do and how we can improve lives. But it also impacts our bottom line.

Host: Yeah, I think you're absolutely right. It economically makes sense, but from a lives lost, it also makes sense that if people could have a chance to live their full potential and contribute, it would be a massive infusion of talent for our country that we've lost so many so early. I think your point well taken about the confluence of these things are really galvanized our country. Specifically, what do you think COVID 19 unearth about health disparities and what it has brought sort of a little more visual look of what that impact is?

Dr. Baskin: So, I think COVID 19 really just put a spotlight on what was always there. So these disparities that I mentioned before and the social determinants, they were there before COVID-19 and will be there after we address this pandemic. And I think that because the virus itself, it doesn't have any different preferences in terms of race or gender and location. This was an area where we saw that, despite that there are those who are disproportionately impacted in terms of severe morbidity as a result of the pandemic or the higher rates of death in some of these areas. So I think COVID-19 showed us even more, how there are resources that are missing in communities of color. There are resources that are missing in rural areas, and that we have to actually do something about that if we want to address the next pandemic or even address just underlying health issues that we see outside of an emergency situation like now.

Host: Yeah. I echo that in that I think we certainly had become used to tolerating health disparities, and COVID-19 brought to our attention that it's not a chronic problem, but it can lead to massive death. And as you talked about systemic issues, it plays out in the sense that if you're poor and often color, you're living in high density areas, you're taking public transportation, you're working on the front line when everybody else might be able to work from home remotely. And then thirdly, you're living with diabetes, heart disease, or kidney disease. All of those things added together are systemic problems that won't be going away with a pill or a vaccine. I think you're spot on. They'll be there if we don't choose to do something different and better. So you obviously have had a productive and successful academic career to be full professor. Tell me in the context of your own research prior, and we can talk about what you're doing now, what are the things that you found most compelling from some of the research you've done in the past?

Dr. Baskin: So, I think a few things, one is that it is painfully clear as we started mapping some of the health conditions, the social determinants and the health outcomes. We literally were able to map that in regions of our County to, you know, color code, that there are areas that were quite predictive in terms of having lower resources and poor health outcomes, just simply by the census track that someone lived in. And so it was really critical to help to have that evidence in front of people, not only just for scientists and researchers that do the work like I do, which that was not surprising, certainly it was not surprising to the community members that we were working in. They could tell you that without all the data. But it was really critical to be able to put that information in the hands of policy makers and other leaders so that they could see firsthand that it wasn't just some of the other issues that we bring up, but literally the resources that were missing in these communities, were disadvantaging those groups.

So, I think that was really important or that has been really important about my work. The second major area I think, is in demonstrating that you can reach those quote unquote, hard to reach populations. So the vast majority of my research has been community engaged or community-based participatory research in which we engage members of the community to help us to create the research questions, develop the design, deliver the interventions, and then analyze the results. And we've been able to show over, you know, a variety of different funding agencies and research projects that we can reach those populations. We can intervene. And we actually can have both statistically and clinically meaningful outcomes as a result of those projects.

Host: Outstanding. I think you highlight the issue of getting true data in people's hands with actionable information, and then destroying the myth that there are groups that you simply can't get to and you can't get them to respond. So tell me what excites you now about your role in the cancer center. You have a big role that has grown in its importance in our caner center core renewal grant. What are the things that you are doing and what do you, things you propose that you would do that really excites you and that our community would want to know about?

Dr. Baskin: Yeah, so the position itself, I think on the personal level, again, it's meaningful to me because of the circumstances, as I mentioned before. So, you know, being a young teenager and losing my father at such a young age, and from a cancer that is totally preventable is one that fuels me to get out and to make sure that people understand what they can do to prevent cancer, how they can get screened for that, and how they can get into clinical trials and other areas of care for that disease. So I'm really excited about extending the work that started under the leadership of Dr. Edward Partridge and Claudia Hardy from many years ago, where they created an academic community partnership and multiple areas throughout our state and in Mississippi as well. So expanding on that work, we are going into new counties that our cancer center has not targeted in the past.

And we are building up an infrastructure of lay individuals that are spreading the messages so that it's not humanly possible for us to go to every single County that's in our state, but we are training those local individuals to spread the message and to link people into care. So that's very exciting that we've expanded from 12 counties to now targeting 26 counties in our State. I'm also excited about the fact that, you know, whereas community outreach is an engagement. Usually it's just sort of tucked away in a corner. I'm really excited that the National Cancer Institute in its new requirements for comprehensive cancer centers is really mandating that community outreach and engagement, you know, goes throughout the cancer center. So not just in terms of recruiting to clinical trials, but in everything that we do, as we think about our research and discoveries, as we think about clinical care, that I'm really excited that, you know, we're able to do that now and that our leadership, our senior leaders are really excited about that.

Host: Monica, that's impressive. And I think that has a chance to truly be powerful. What seminal data will you be looking at to know whether you're having an impact that's making a difference?

Dr. Baskin: Yeah, so we have probably a five-page logic model. Whenever you have time, I'm happy to share it with you, but I think there are some components of that. So first and foremost, we want to track how many individuals we are reaching. We want to expand and reach more people than ever before. We also want to make sure that we are getting people in to be screened, and we want to reduce those disparities that we see in terms of who's being screened for our primary cancers or not. So we're tracking that number. We also want to see an increase in the number of individuals, particularly who are underrepresented in biomedical research to be enrolled in clinical trials. We understand that we have treatments for those who have lost hope about the traditional treatments. We have some opportunities for them to enroll and have benefits from that area. So we want it, we're looking at those increases as well. Ultimately, our long-term goal is pretty obvious. We want to reduce the number of people who have cancer, and we certainly want to reduce the number of people who die from cancer at an earlier than expected age.

Host: You're so right. That another disparity within the disparity of cancer care is not only those outcomes and access to just current standard therapy. There is a disparity of those people who are in clinical trials. So few, almost a tenfold difference in their participation in clinical trials, which is another huge factor that we know further expands disparities, because we understand that the best clinical care that you can get is most likely on a clinical trial. And we are the least of those who participate in doing so. So Monica, I appreciate to you sharing the fact that the NCI has now stepped up to say, this is not peripheral. It's more central to who we are as a cancer center. How might an academic institution, a cancer center be a active and vital participant in dealing with the current ills in our society beyond healthcare?

Dr. Baskin: Great question. I think that academic medical centers, particularly those that are as large as ours and has such a major impact economically not only in the City of Birmingham, but also in the State. I think that we can and should be better partners in our communities. So some of that has to do with, you know, making sure that we can employ individuals in our area, that we are doing our best to educate and train those individuals as well. And that we are taking a critical look at the diversity within our own workforce. So the, we don't, in my opinion, we don't get to tackle the new discoveries and figure out ways to eliminate or reduce health disparities until we have a workforce that is appropriate and representative of those individuals that we're trying to treat. So I think we can and should do all of that. We also have a pretty powerful voice when it comes to influencing policy. And I think we have to provide our policy makers with the evidence, the information, as I mentioned before, put that in front of them, as well as the personal stories about our patients, about our community residents, so that they are empowered to do the right thing, to ensure that everyone does have that fair opportunity to live a long and healthy life.

Host: So, Monica, a little bit on the external impact that we could have on these systemic issues that have affected the racial injustice platform we've seen across our country. Can you speak to what we internally need to do to be models of addressing unaddressed issues related to this topic of racial injustice?

Dr. Baskin: Yeah. I think that the critical thing is to first acknowledge the history of medicine and how it has played a major role in some of the systemic racism that exists. So we need to just simply say it's so, so for many individuals of color, we are led to believe that these are individual issues, that these are issues around competency or not being the appropriate person, but there are things that are put in place systemically and historically that have paved the way for there to be doubt about people of color being in leadership roles or being in medicine in general. So I think we have to acknowledge that history. We also have to actively put that spotlight back on us to see what's happening right now. We have to have transparency. We have to look at the numbers. We have to take a deeper dive into our diversity or lack thereof.

And then we have to act. I've had several conversations, particularly over the last few months about people who are interested in learning and I'm an educator. So I love the idea of learning, but I am really at the point and several of my colleagues are of, we've got to move past learning and educating, and we've got to move towards action. There are things that we can do right now and the things that we should do right now, certainly there are things outside of our organization that we have very little control over, but within the organization, we have to seize the day to dismantle the things that are within our institution that are keeping individuals from achieving their best in terms of their training, in terms of their clinical care, we can do more and we should.

Host: Monica, what partnerships are necessary in order to make these changes that you've spoken about internally and to have them to be effective and lasting?

Dr. Baskin: So, I think, you know, diversity and inclusion to me are essential for each of our core missions. So we have to bring together those individuals across the missions and with diverse backgrounds, into safe spaces to have real talk. So we have to sit down and have conversations that again, acknowledge what's been in the past, acknowledge what's going on currently, and have it and come up with a shared vision for how we want, you know, how we want this system to be as we look forward. And I think that's possible, but it is going to be challenging. There will be a need to basically do away with some of the hierarchy that exists within an academic institution. People have to let down their guards, people have to be open and honest and transparent, and I think that's possible.

Host: I agree. And I think that, you know, we have to get leaders step up from all walks of life and backgrounds to value this. I've often said that this issue of diversity is really about excellence. I think there is certainly a huge component of it related to equity, but it's about us being our best and having an environment for everybody to be able to achieve their goals and their dreams. So what's in the next days for you, what do you want to see yourself doing in the future?

Dr. Baskin: I love a vacation and I'm not sure. I mean, honestly, I'm not sure. There have been a couple of pathways that I've thought about over the last few years, but one of the things that the pandemic has certainly led to for me is just some time to be more reflective, to sit back and think about the things that I have accomplished and quite proud of the things that have been able to do, but also think about the future. And I'm honestly not quite sure what that is, but I do know that it will always involve connecting with communities, putting, you know, more than a hundred percent of my effort into making sure that people feel valued and respected for their contributions to advancing health of everyone. And so wherever that takes me, I'm open to the possibility

Host: Outstanding. Well, I want to thank you, Dr. Baskin for joining us today, it's been enlightening and your comments are terribly insightful. I think the audience of our Checkup will really appreciate it, this conversation. And thank you again for what you do and what you've done for UAB.

Dr. Baskin: Thank you very much.