Building a Healthy and Just World From the Inside Out

When the guilty verdict in the trial of George Floyd’s killer came down on the afternoon of April 20 earlier this year, Robert Fullilove, EdD, was right where he wanted to be: on 169th Street between Broadway and Fort Washington Avenue, at the heart of the institution and community where he has worked for 30 years. For longtime activist Fullilove, the Columbia Mailman School of Public Health’s associate dean of community and minority affairs, the verdict brought other trials to mind, trials with less just endings. “I was in Mississippi in 1964 when three civil rights workers were murdered,” he says. “But seeing everything that has happened as a result of George Floyd’s murder—that gives me hope for a world not dominated by white supremacy, hope that we know the difference between right and wrong.”

Fullilove’s optimism extends to the School, where change is afoot, rooted in the long-standing commitment of students, faculty, and staff to ensuring health equity and dismantling structural racism. At issue is the very question of what public health should be, what health equity means, how it is hampered by structural racism, and why it is so crucial to educate students in the principles of anti-racism. “In many schools, public health is viewed as a purely technical exercise. That’s not true here,” says Merlin Chowkwanyun, PhD, MPH, Donald H. Gemson Assistant Professor of Sociomedical Sciences (SMS). “As we’ve seen with COVID-19, you can’t separate politics from health. Public health is a political exercise.”

Columbia Mailman School leadership, faculty, staff, alumni, and, especially, students, are all in, helping to drive change, making the school more equitable while also actively battling inequities in the Washington Heights and Harlem communities and beyond. Yvonne Hou (’22), an MPH student in the Department of Epidemiology and the diversity and inclusion chair for the Graduate Student Association, says her interest in public health and medicine was sparked by volunteering in the emergency room at Bellevue Hospital, where most patients were people of color. “That’s where you truly see that there is a gap in healthcare, and when I began to understand what systemic racism really is,” she says.

That understanding deepened at the School. “A lot of students know racism exists. We want to change the world, but we don’t know how to do it, because we don’t have the context,” says Hou. The School, she says, provides that context. “As part of the Core program for a master’s in public health, we learned about the history of the field of public health, especially as it relates to racism,” says Hou. “That’s one way the School is equipping students with the tools we need to implement change.”

Besides attracting students interested in looking beyond the traditional boundaries of public health, Columbia Mailman School is known for faculty who take a broader view of the field, not focusing solely on numbers and analyses. “We are as much imbued with a passion about using public health to remedy the inequalities that exist in the culture as we are about sophisticated cohort studies,” says David Rosner, PhD, Ronald H. Lauterstein Professor of SMS and co-director of the Center for the History and Ethics of Public Health. “We are meant to be talking to the world, not just to each other.

Among the instruments of change are Columbia Mailman School’s Office of Diversity, Culture, and Inclusion (ODCI) and the School’s FORWARD (Fighting Oppression, Racism, and White supremacy through Action, Research, and Discourse) anti-racism initiative. Both are helping to train students like Hou to consider health equity from the get-go. “I’m involved in FORWARD’s Curriculum Corps,” says Hou. The Corps has recommended changes to teaching and the curriculum. “The School has given me a chance to be a leader. Racism is systemic. There’s no quick fix, but the School is trying to implement a sustainable approach.”

Indeed, as alumni, students like Hou go on to redress health inequities and consider social determinants of health in their careers at nongovernmental organizations (NGOs), government entities, the Centers for Disease Control and Prevention, and health departments at national and local levels. “In a sense, it doesn’t matter where you end up working—whether for an NGO or in consulting—so long as you bring a certain spirit and an equity-and-social-justice lens to what you do,” says Chowkwanyun. “Our students tend to graduate with a greater sense of commitment to these principles.”

Pipelines to a more inclusive world

Many Columbia Mailman School students and alumni have experienced inequities themselves. Some came to the School through the Biostatistics Department’s BEST program and the Environmental Health Sciences Department’s PrIMER pipeline program, both of which help to educate populations that are historically and presently marginalized. The BEST program, which stands for Biostatistics Epidemiology Summer Training, is expressly meant to “create a pipeline to public health” for undergraduate students who may not have even heard of biostatistics, much less dream of going into the field. “BEST was started in 2008 by two DrPH students who didn’t see anyone in the department who looked like them,” says program director Justine Herrera. Now, every summer, the Columbia Mailman School trains 12 to 14 students for eight weeks, including students of color, or those who are from economically challenged backgrounds, or who may have disabilities, or who are the first in their family to go to college. During the program, each student is closely mentored by a faculty member from Columbia Mailman School or Columbia University Irving Medical Center. The goal, says Herrera, is to encourage these students to go into public health, ideally at Columbia Mailman School.

According to BEST founder Melissa D. Begg, ScD, now dean of the Columbia School of Social Work, of the 110 students who have attended BEST since 2008, 75 percent pursued graduate school or are working in the quantitative sciences and related areas. Out of those students, 25 percent have received or will receive their degrees from Columbia Mailman School. Those kinds of numbers will make a big impact on the field. “Extensive evidence reveals that as teams become more diverse, they also become more creative and effective,” says Begg. It stands to reason, then, that “a more diverse scientific workforce will lead to more relevant research and better population health outcomes.” The BEST program and its sister PrIMER program in the Department of Environmental Health Sciences (a two-year paid research internship for marginalized New York City high school juniors and seniors) are also focused on dismantling barriers, particularly the financial impediments that come with the cost of attending a private institution like Columbia. All students who finish the BEST program and matriculate in the MPH or MS program at Columbia Mailman School are eligible for a special scholarship, currently $10,000 per year. “This is a sign of how much the school supports the program and wants these students to be and feel part of our community,” says Herrera.

Adds Fullilove, “Columbia Mailman School has been open to reengaging populations that used to be rejected. We no longer regard these people as automatically excluded.” Case in point: the School’s collaboration with the Bard Prison Initiative (BPI), which offers incarcerated individuals the chance to earn an undergraduate degree from Bard College. Fullilove is a senior advisor to BPI where he teaches public health, and he likes what he sees. “Six formerly incarcerated individuals are now in a public health graduate program or are working in the field or in the community, doing great things,” says Fullilove.

And the pipeline will continue to broaden. “There are opportunities to start identifying middle school students for pipeline programs,” says Charles Branas, PhD, Gelman Endowed Professor of Epidemiology and chair of the Department of Epidemiology. “When you look at the challenges facing underserved communities with COVID-19, it’s clear that pipeline programs for younger kids could eventually contribute to solutions.” Programs for students at community colleges are another possibility. “There is a huge opportunity to find the best and the brightest who would otherwise not have considered a career in public health,” he says.

These initiatives add up, shaping into what Dean Linda P. Fried, MD, MPH, calls one of the roles of great universities: “to educate the future leaders who will build a thriving society with a foundation of health for all.”

a new definition of diversity

That's also a key goal of Raygine DiAquoi, EdD, assistant dean of ODCI and assistant professor of SMS. ODCI was established in 2016 to help build a culture of inclusion and equity at the school. “That means analyzing and making changes to our long-term practices, such as requirements for entry that may be denying students opportunities,” says DiAquoi. “We are the gatekeepers, and we don’t want to replicate the structures that have been purposefully keeping students out.”

DiAquoi is thinking about everything from how to define the word “diversity” to how the School continues to take specific actions to become an anti-racist institution. “Diversity to me is not just about numbers around race and income,” she says. “Diversity also speaks to the climate and culture of a place. When I see students who are not the ‘onlys’ in classrooms, seminars, and study groups and those students are thriving, are feeling truly mentored, connected, valued, respected, and welcomed here, then I’ll know we are moving toward where we need to be.”

And things are moving. Soon after ODCI was established, the office, jointly with Fried and the Office of Education, invited students, staff, and faculty to be part of a task force to develop recommendations for faculty and student recruitment and retention efforts, as well as community engagement and curriculum. In 2017, ODCI, in partnership with the Office of Education, launched the Faculty Inclusive Institute for faculty members to explore inclusive pedagogy. Then, in 2018, the office debuted the RISE (Resilience, Inclusion, Solidarity, and Empowerment) Peer Mentor Program, in which incoming students of color and first-generation graduate students are paired with second-year student mentors of similar backgrounds. Since then, ODCI has led trainings and workshops for departments, centers, and hiring committees. And it has partnered with departments to closely examine and revise practices that contribute to the maintenance of structural inequality at the School.

In 2019 and 2020, Fried, in collaboration with Fullilove, ODCI, and others throughout the School, led a yearlong effort, via guest speakers and special lectures, to explore how threads of this country’s history of slavery and racism are woven in and through every aspect of our present and to use that understanding to identify more effective solutions. Chowkwanyun is proud of the speakers he brought this past year to the Sophie and Alex Rosner seminar series, including labor leader Sara Nelson, who is the international president of the Association of Flight Attendants, and New York state Sen. Julia Salazar, who has been instrumental in pushing for tenant protections. “It was important to me that the series reflect the student body, which is mostly women and people of color,” says Chowkwanyun.

This fall, the School is offering a series of seminars on anti-racism public health practice that were suggested by a committee of faculty, staff, and students. This series is situated within the MPH Core Curriculum, taken by all 500+ first-year MPH students, and is also open to the larger school community.

looking forward

Columbia Mailman School students are doing extraordinary things themselves, including during the summer of 2020, when the School’s Black and Latinx Student Caucus advocated for greater focus and investment in anti-racism efforts through FORWARD. FORWARD is no temporary task force charged with writing a report, then calling it a day. It’s a permanent advisory board to the dean, powered by 120 students, faculty, staff, and alumni, working to create real change within the School—and to continue creating it, in successive waves.

How it works: Ideas are generated by four all-volunteer Action Corps, then shared with an Accountability Cabinet led by co-chairs DiAquoi and Branas. The Cabinet then makes recommendations to the dean to implement the ideas that will have the most impact toward helping Columbia Mailman School become an anti-racist community, working in an ongoing, focused way to develop solutions, measure success, and be accountable for progress.

Already, initiatives born of FORWARD are underway, including the Curriculum Corps, which is conducting a review to ensure the curriculum is grounded in equity principles and anti-racism. And the School has provided stipends for financially deserving students to take otherwise unpaid summer practica (essentially internships) in the community. The anti-racism workshop series will be required for all incoming students starting this fall. Notes DiAquoi, “It’s been amazing to see how we now speak to each other as an institution about inequities instead of all of us being separated in our own silos and departments. There is now a shared lexicon and thinking around anti-racism.”

The ethos of activism and science

Of course, Columbia Mailman School also has a long history of activism around health and health inequities that started long before the summer of 2020. That history is part of what drew Chowkwanyun to the School in 2015 to work at its innovative Center for the History and Ethics of Public Health. “The heart of public health tends to be very quantitative,” Chowkwanyun says. “But one thing our Center does is to put those numbers into a larger political context. A lot of today’s racial inequality has long roots, and decisions made nearly a century ago have consequences we feel today,” he says. “That’s why it’s so important to understand policies that reduce or create racial inequality.” 

Rosner points to the Black Lives Matter movement, which has forced us to acknowledge the problems we’ve had in the past, as well as to continue to ask questions and define what public health is and what it should be. “For instance, should public health protect or advocate for the public or just do good studies?” he asks. In the end, Rosner says, it comes down to “the social structures built around racist assumptions like ‘poor people don’t need the same doctors as the rich do.’ These are relics of an unequal society, and that’s what we in public health—and at Columbia Mailman School—are wanting to address.”

Adds Kathleen Sikkema, PhD, chair of the Department of SMS and Stephen Smith Professor of SMS: “We are guided by science-based advocacy. That’s potentially the most effective kind of advocacy—using science to move beyond a belief or a mission to action.” She says, “What we do in SMS, what we’ve always done, is address social influences in public health that contribute to health disparities.”

The roots of this approach at Columbia Mailman School, explains Rosner, go back to the late 1920s and 1930s, when social reformers and activists like Adelaide Ross Smith, MD, who published a study in 1929 with Columbia’s School of Public Health on the lung disease silicosis, began to notice that people were starting to die of “working class diseases” from the factory. Smith was followed by people like Jack Elinson, PhD, a pioneering sociomedical scientist and statistician who established the SMS Division of in 1968, amidst the tumult of the Vietnam War and the assassination of Martin Luther King Jr. “Social issues such as socioeconomic status and race had not been applied to health before,” says Sikkema.

from within to the world beyond

Part of the School’s history also includes the sometimes fraught relationship of Columbia University to Harlem and Washington Heights. “There are great ideas in the community about how to make things better for people’s health and safety,” says Branas. “Academics often think they know best, but things often emerge at the grassroots, community level without us, and we need to be shoulder-to-shoulder with the folks who are living and working nearby.”

Ideally, that tension can also lead to good things. “Washington Heights and Harlem have long been hotbeds of social reform, civil and immigrant rights, and tenant activism,” says Chowkwanyun. “That energy flows over into the school.”

Adds Fullilove: “We are turning our talented students on to what’s going on in the community, and they and our faculty are actively engaged.” Like Fullilove and many other Columbia Mailman School faculty, along with the school’s leadership, Chowkwanyun welcomes students’ political engagement. “Our students are not only here to learn things in the classroom and in textbooks,” says Chowkwanyun. “They have their ears to the ground. That’s a great thing.”

Because, ultimately, it’s the students who will go out into the community and the world, shaped by the turmoil of these past few years—as well as by Columbia Mailman School’s long-standing mission of science-backed health advocacy. One of them is Ibrahim (Bryan) Konaté, MPH ’20. Konaté was active in student-government leadership during his final year at the School and is now a clinical research coordinator at a New York City hospital system. “I’m hopeful that in 100 years, when the School is reflecting on its bicentennial, that we’ll say that the past year really did change a lot of things,” he says. Going forward, “we’re going to make the leadership of public health look a lot like the communities we’re working in.”

Paula Derrow has worked and written for national magazines, nonprofits, and academic institutions. Her work has been published by The New York Times, Real Simple, Tablet, and Refinery29.