2023 NIMH James S. Jackson Memorial Award Lecture: The Critical Health Equity Imperative: Five Insights About Reducing Health Inequities From My Research With U.S. Black LGB People and Heterosexual Men
MAURICIO RANGEL-GOMEZ: Hello everyone here in the room and on Zoom in our virtual world. Thank you very much for being here at this 2023 James S. Jackson Memorial Award. Thank you so much for all the people from outside that came to support our awardee, Dr. Lisa Bowleg, and everyone in the virtual world. We had tons of registrants and I hope everyone that registered is here and thank you very much for being in this event.
I want to acknowledge the people that worked tirelessly to organize this event with me during almost 7 or 8 months that we were working on coming to this moment. It’s very exciting for all of us to welcome you here and to see this finally getting to fruition and to see we are here celebrating Dr. Lisa Bowleg. Thank you very much for submitting your application. We were mesmerized by it, so thank you so much. And thank you to our leadership, Josh, Shelli, thank you for being here. And, Dr. Enrique Neblett Jr., thank you for being here.
I want to give you context as to why Enrique Neblett Jr. is here. This is the first time we are doing this in person. The first two times we were in the middle of the pandemic, we couldn't host anyone in person here. This is the first time we can see you in 3D and we decided it would be great to have the previous awardees coming to meet us in person as well. Unfortunately, Dr. Karen Lincoln couldn't be here with us. However, she is on the West Coast, and she woke up at 5:30, just to be with us, and she is in the Zoom universe listening to us and she will be graciously introducing Dr. Lisa Bowleg when the moment comes.
To give you some context, the James S. Jackson Memorial Award started in 2021. We started the award with the idea of honoring the late James S. Jackson, who was a renown social psychologist at the University of Michigan and was researching race, ethnicity, racism, health, mental health and pushed the boundaries and advanced the field of mental health disparities and minority mental health. That's the reason why NIMH really wants to honor his memory and all the legacy that Dr. James Jackson gave us.
This is a joint effort between the Office for Disparities Research and Workforce Diversity and the Mental Health Disparities Team. The Office basically has two ideas or two priorities, which is promote research to reduce mental health disparities and to support programs to diversify the mental health research workforce. This Office belongs to the Office of the Director of NIMH and is one of these initiatives that wants to really underscore the commitment of NIMH to mental health disparities. It is supported by the Mental Health Disparities Team, which is an amazing team, and was just honored by the Office of Grants at the Department of Health and Human Services for their great impact in supporting research in mental health disparities. And across NIMH and basic neurosciences, you may wonder why this guy is here, because the team really brings together people from all over NIMH, intramural and extramural. So, with that, I introduce the award and I bring you, Dr. Karen Lincoln to introduce Dr. Lisa Bowleg.
KAREN LINCOLN: Good morning, everyone. I'd like to start off, before I Introduce our distinguished awardee, just to talk a little bit about what this award means to me in receiving it last year. I’m Karen Lincoln, a Professor at UC Irvine in the Department of Environmental and Occupational Health in Public Health. When I received this award last year it was an extreme honor. It was quite surreal because I worked with James for many years at Michigan and the Program for Research on Black Americans, and that's my family. It was such an honor to be acknowledged with this award. I just like to say very briefly, in addition to still marveling at the fact that my name and James's name are mentioned as part of this award, I think it's really important to acknowledge what it means to NIMH.
I think the recognition of not just James but the scholars who do research that interrogate the social structures, rather than the individuals, is very important. This work that we do, it recognizes the complex and historical - contemporary and historical- political, economic, and social factors that shape the context that determine the health of Black people. It also recognizes the heterogeneity of Black people in this country and in the world, and finally in addition to recognizing James' legacy, it also acknowledges the work that still needs to be done to achieve health equity.
Our esteemed awardee, Dr. Lisa Bowleg, is an example, a prime example, of the wonderful work that honors James and also the work that still needs to be done to achieve health equity. Our awardee is a professor of Applied Social Psychology in the Department of Psychological and Brain Sciences at The George Washington University and a co-director of the Social and Basic Sciences Core of the DC Center for AIDS Research. She is also the Founder and President of the Intersectionality Training Institute and a leading scholar of the application of intersectionality and other critical theoretical frameworks to social and behavioral sciences health research. Her mixed methods research examines the effects of social structural stressors, like unemployment, incarceration and police brutality, intersectional stigma, and discrimination as well as protective factors on the mental, substance use, HIV, and physical health outcomes of Black men in the United States, at diverse intersections of socioeconomic status and sexuality and her work also examines Black lesbian, gay, and bisexual people in the United States. She served as principal investigator or joint PI of several NIH-funded projects, including a T32 grant, which is very important to mention because mentorship is one of the key features of James' work and also one of the key features of Dr. Bowleg's work. She’s also published widely in high-impact journals, such as American Psychologist, the American Journal of Public Health (AJPH), and Health Psychology. She is an associate editor at AJPH and the editor of AJPH’s “Perspectives from the Social Sciences” section and an editorial board member or consulting editor of numerous journals highly relevant to her areas of expertise.
In 2021, her institution awarded her its Oscar and Shoshana Trachtenberg Prize for Scholarship in recognition of her outstanding research accomplishments. In 2022, she received the 2021 Lawrence W. Green Paper of the Year Award in honor of her article, “The Master’s Tools Will Never Dismantle the Master’s House: Ten Critical Lessons for Black and Other Health Equity Researchers of Color” from the journal Health Education and Behavior.
It is indeed my honor to introduce the 2023 NIMH James Jackson Memorial Award recipient, Dr. Lisa Bowleg.
LISA BOWLEG: Good morning. Wow. This is quite an honor. I feel a bit overwhelmed. I always say of my talks that I’ve never met a short title I liked and so I’m continuing that tradition with what I’m calling “the critical health equity imperative” and I’m going to talk about what that is at the end and it’s really informed from insights from my research with Black heterosexual men in the domain of HIV prevention and also Black LGB people but I’m going to focus mostly on the NIH focused work.
I am honored to have this award. It feels for me that my trajectory has been so unconventional, so to be standing here with this recognition is so meaningful. I’m going to talk to you about my trajectory but first what I’m going to do is to do a few thank yous. Of course, the selection committee who selected me, it was just a thrill. I remember being in the Bahamas and getting the notice. My nominating committee, some members who are here. Dr. Allen Greenberg along with Dr. Shawnika Jull, Jesus Ramirez-Valles, Maria Cecila Zea, Riko Boone, and Janné Massie. You’ll see her name all over this and there is a reason for that. She just walked in. My GW family who is in attendance. My intersectionality training is with a team and my mentors. I had the great privilege of being mentored by Dr. Faye Bellgrave when I was a doctoral student at GW. Margret Stepz who you'll hear about in a little bit and Jeanne Tschann. The Center for AIDS Prevention Studies Visiting Professor's Program is one of the chief reasons I'm standing here. And that was initially an NICHD-funded program. But having the opportunity to learn about the NIH process, something I knew nothing about when I got my doctorate, has been absolutely instrumental to everything that happened to me. My academic friends plug, Scarlett Bellamy and Kali Gross, these are the friends that I call, and we talk about and get support about all things crazy academic. And then the supreme commander. If you wonder who that is, this is my husband, Joseph Smith, who is watching. And how he gets that name is, he retired a few years ago and decided he would help me out with all—my life is crazy and hectic and help me out with these administrative things. So I said you want a title? He said, my title is Supreme Commander. So, he is such a love and support of my life. He is incredible. And also, I should tell you, he is threatening to write a book. The book is going to be titled “Beyond the Brilliance” and it’s going to be all of the things you don’t know about me about things like putting batteries in smoke detectors backwards and that kind of thing. But Joseph, I love you and thank you. I know you’re watching.
So, what I’m going to talk about, an overview. I want to just give you a where and when I got here. And then I want to talk about my educational and professional path and then I want to talk about specifically Dr. Jackson's foundation. He has given me such a solid groundwork. And as I was preparing this talk, I wanted to lay it in the work that he has done and I was just so mesmerized about how solidly I’m standing on the shoulders, metaphorically of course, and I hope he would be proud of me getting this award.
I'm going to give you a basic overview of my work and then I’m going to talk about the insights from that work that informed what I’m calling critical health equity imperative. So, this is where it starts for me. I'm from the Bahamas. This is really important to me. I'm a descendant of the Black Seminoles, formerly enslaved people in Florida who around 1821, said we had it here with you European Americans during the First Seminole war. They, along with Seminole Indians, made their way to Andros, 200 of them. They are able to stay on the Island of Andros, the largest Island in the Bahamas for 150 years. And so, this is a real important story for me. And so, in the U.S., where I can't tell you how many times people are like, “you have an interesting name.” If you're in the Bahamas, Bowlegs everywhere because of this Black Seminole tradition. And our flag is represented so much of what is important to me.
So aquamarine for the water, turquoise, the beaches—I feed my soul by going home often. Yellow for the sun and Black for the people. And that Black is really important because I think growing up in a place where all of the people that I admired, all of my respected leaders, all the people who are really smart, look like me. And so that gave me a foundation where I feel very comfortable talking explicitly and candidly about structural racism and interlocking oppression. So it's important you know this part because even though as the Supreme Commander likes to remind me, I have lived here more than half of my life. This is true. Being Bahamian is important to me and shapes my world view. And then there is a story of how I became a social psychologist. This is my mom. This is the scientist in the family. She is a hematologist. And my father was in business. And my father is a well-read, in fact the most well-read person I know. Multiple books at the same time. So my love of learning comes from my family. I grew up in an upper middle-class family in the Bahamas. I want you to look, in particular, at he woman sitting to my left in the picture in the white jacket. That is my grandmother who we called Mummy Rosie. Had you met her, you would have called her Mummy Rosie. I loved her so much, I thought I had two moms. So she was this really respected English teacher in the Bahamas and so those of you who had the horror of being—my team calls it being bow legged—my detailed edits and I’m a grammarian and I really love it. She is the one who was encouraging me to submit writing to different contests when I was a little girl. So then so 1983, I graduated—I wasn't sure what I wanted to do. But working at a bank for a year was not for me. Okay, time to go. We have to go to college. But, when I get my first academic job, my mother is going through my scrapbook. I always kept scrapbooks. And she found my college board PSAT. I don't know when you take it, But it's grade 9 or 10. And you had to name an occupation, an aspiration. On it I written I wanted to be a social psychologist and I assure you I had no idea what that meant. Here is my path. I got my bachelor's degree from Psychology in Georgetown and did a Master’s in Public Policy with a concentration in Women's Studies at George Washington and then a Doctorate in Applied Social Psychology at George Washington.
And here I am back years later as a professor. But this path has been so pivotal in everything that happened since. So enter Margaret Stetz. She was my first Women's Studies professor at Georgetown. And this is why I think women's studies is so important is because we learn how to think critically. We learn how to sort of challenge the status quo. Think about power. And so there was that class, which was just transformative, but then she says, are you familiar with Black feminist literature? I said not really. Okay, we're going to do an independent study and you're going to read all these books. So this is circa ‘86 this is happening. So from then on, and I’m just going to go through this really quickly, I had this professional path that to me, seemed nonlinear and curvy and not connected. And it's only now at this stage that I understand that this was all connected. Doing the HIV policy work that I'll talk to you about in a bit.
Doing policy work as an HIV analyst at the Center for Women Policy Studies. Then going into the academy, my first job was at the University of Rhode Island in a very quantitative psychology department that I very much loved. Moving to Drexel, the School of Public Health, and then going to GW and then founding the Intersectionality Training Institute.
But first, how I got into HIV work. So I’m an undergraduate at Georgetown as a psych major. And I hear somewhere that if you want a Ph.D., you need research experience. This is in the old days where you wrote a letter. So Caitlyn Ryan was doing the National Lesbian Health Study. I write her and say, I will be graduating soon and I’d like to get research experience. And this was my first lesson in soft money. She said that's really cool but that study is no longer funded. But I’m doing work at the AIDS Policy Center, which is at The George Washington University, And by the way, there are tuition benefits. And this job would also be state HIV legislation and policy but also part of it is an administrative assistant part. That photo of me is the administrative assistant part. That was brutal. Answering phone calls, all that stuff. I hated it. But it was such an important springboard into HIV work for me.
And the timing was especially important because to be in DC in 1988, the surge of HIV and AIDS, a totally different world. And it was a world in which I could walk—my office was 21st and K—I could walk a few blocks to the White House and see active—I was at an HIV meeting where a group of women living with HIV, took over the platform for which Dr. Fauci was speaking, to advocate for their needs. It instilled in me this need for advocacy, action. But that was complicated by the fact that the position of the AIDS Policy Center was that we were not to take positions. We just recorded what the states were doing in terms of legislation and policy and we were not supposed to opine on this. There was a lot I wanted to critique. And so, while working full-time at the AIDS Policy Center and doing my master’s work and later my doctoral work, I’m also working as a consultant for the Center for Women and Policy Studies because they have a stance about inequity and how we needed to point to the structures that constrain opportunities for people to be healthy.
So as an example, the publication on the right, “Inaccessible Miracles?,” we did that after we had done research with mostly Black and Latina women in D.C. when people are just so excited about AZT and how important it is. And we are talking to women who don't have refrigerators. We are talking to women who don't have housing. And so it was very important for me to have this outlet to do this sort of critical work that really informs critical health equity imperative that I’m advancing now. I told you I had never met a short title I like. This is another example. Whereas I had to be very sort of stayed and neutral in presenting what the states were doing -and states were doing crazy stuff- I mean criminalizing and all of the things you might imagine. Margaret, who I showed you earlier, said, you know, I work for this journal, Women's Studies Journal, and you can write a different type of article. And so this was my first.
Pollutants, Criminals, and Incubators. I love long titles. So I’m proud of having this opportunity and also very proud of Margaret’s role in steering me into academic writing.
And so, GW. After the master’s program, I go to GW psych program where I get my doctorate and I always have been interested in context. I wanted to understand the role of power and gender roles and what are the things that constrained opportunities for women to protect themselves from HIV. And so I did that for my dissertation but then it became very clear to me after I did this, where are the men? Where are the HIV prevention research and programs and interventions for Black heterosexual men, particularly when we know that that is the mode by which HIV is more efficiently transmitted from men to women (during heterosexual exposure)? That was my interest in looking at men.
So back to the CAPS program. I am somebody who graduated with my doctorate not knowing anything about the NIH grant process. Nothing, nothing. I had a single publication from my dissertation, and I was very lucky to have two mentors, Faye Belgrade and Maria Cecilia Zea in the Department of Psychology at GW and they said you have to apply to this program designed to teach people how to write NIH grants and also how to devise more innovative strategies to try in the HIV epidemic.
I met Jeanne Tschann. I describe our relationship as love at first sight. She was assigned to be my CAPS mentor and somebody who really knew where I wanted to go and instrumental to my work.
So, this brings me to James Jackson and his legacy and his groundwork for mine. Isn't that a lovely picture? As I have been preparing this, I just love the sweetness of this photo. So, strong foundation and I want to show you how. One of the things that Dr. Jackson did in life was, the importance of prioritizing within group comparisons. We are focused on Black people and Black people's needs and we are not, not in terms of comparing them to other groups. This is something that has been central to the work I do as well.
I'm very much concerned in wanting to make sure I understand Black men's experiences or Black LGB people's experiences from their vantage point. So, as I said before, part of my research is focused on minority stress and resilience, also something I shared with Dr. Jackson. Also wanting to know the good stuff. And then the HIV work. This is my body of projects, that of course there are people who are—for me, this is a magical slide because it really shows my journey from getting a doctorate and not knowing anything about the NIH process to here. And so, the far right is our latest T32 grant that Dr. Deanna Carry are joint PIs on.
So, the other thing is that Dr. Jackson was really clearly a frustrated social psychologist, which is how I define myself often. Clearly. Because you see in his work this sort of critique of these biomedical psychosocial—I got the receipts, I’m going to show you—where he talks about the need to highlight what he called the structural empowerments. And so one of the problems with (traditional) psychology as a discipline is that individual is a primary unit of analysis, meaning we don't understand or look at factors beyond the level of individual that constrain opportunities to be healthy.
And so, what this has looked like in my work is, this is the conceptual model of the first grant that we did. And when I say we, Janné Massie, has been my project director for 14 years. When I say we, I’m talking about Janné getting the trains to move on time always. And so this conceptual model, we were interested in the social-structural, factors—the unemployment, the incarceration - and you'll see in this a whole bunch of psychosocial stuff: cognitive, self-efficacy, attitudes about condoms, and how they related to risk.
However, because all of our studies are mixed method studies, what we found is that these things which are the things that PIs are interested in, we want people to use condoms, we want people to take PrEP, we want them to increase their perceptions and awareness, and we want them to be tested. And these are the things that NIH is interested in. But when we talk to the black men in our studies, individual interviews with them as well as focus groups as well as quantitative measures, here is what they are talking about.
They are talking about the links between incarceration and unemployment and the notion that something you got arrested for and convicted for years ago is still very much with them, which is a considerable barrier to everything. And HIV is the last thing on their mind. So one of our papers, “It's an Uphill Battle Every Day” as a title, it captures what they told us about their experiences. The other thing, and I’ll just go in the interest of time In other study, the other thing that men talked about, and in fact this comes up in all of our studies, regardless of whether we ask direct questions about police violence or brutality or not: negative police encounters always comes up unprompted. In this study we wanted to understand neighborhood context for Black men and what that might tell us about HIV risk. And this is about where does HIV rank and it's kind of low on the list of 1 to 10. It's a number 9. And so then the respondent says, HIV prevention isn't even on it. So in this focus group, there was a whole dialogue about Saunders, who was a racist violent cop, and the notion that what I have to deal with, the most immediate thing that is right in front of me, is police brutality. And HIV is not on my list.
And so this was really helpful for helping us understand that, wait a minute, it's all about the social-structural—well, primarily about that. And these larger factors that shape what it means to be healthy for Black men. The other thing that we do in our research and that Dr. Jackson was adamant about, is centering. And centering is the notion of trying to understand something specifically from the perspective of that group of Black people. Noncomparative, not in comparison to other groups, particularly more privileged groups. And I show this to you as an example just a really excellent study that was done on PrEP from an awareness discussion and youth among Black Latino and White men who have sex with men in 2017. And surprise, surprise, White men were significantly more likely than Black and Latino men to know about PrEP, to talk about it with their health care providers, and to use it. Not surprising. But the point I'm showing this to you is that if you just focus on comparing, you really lose the specific nuances that you learn when you center a group.
And so to this end, one of our studies, current studies funded by the NIMH Intersectional Stigma RFA, is to develop measures of multi-level intersection stigma from the experiences of Black, gay and bisexual men in Jackson, Mississippi as well as Washington, D.C. And what we do when we develop any measure, because again we are centering their experiences, so we need to learn from them. We need to have them tell us what the issues are. These are snippets from the interviews we did. You see some of the participants are very much aware of issues of privilege, that White men have compared to them.
I didn't know where to get PrEP. So what we do is go through this painstaking—Janné and Meredith are in the room!—painstaking process, distilling these different folks—grouping them into sort of snippets, and developing quantitative measures. And I’m so excited to show you, just some preliminary data from—we collaborated with the HPTN study which is a study focused on prevention for Black GBMSM (gay and bisexual men who have sex with men) and they came to us and said you are developing this and rather than duplicate the wheel, maybe—it's not ready! It's not ready! But fine. We jumped at the opportunity to have them tested and what they did is, this shows eight of the 15 subscales we created, and they administered it to a sample of Black men, 422 in the South.
As you can see, by the way, I need to tell you because Anna Maria is in the room. This is just a tentative title and my acronym. When I showed it to Anna Maria, she's like really? This is really strong alpha. And so what these are, the different sub scales they used and what I wanted to point out to you is that it was very important to us that we took a multi-level focus. Not define intersectional stigma in terms of the men's negative experiences about themes as Black gay men. We wanted to understand the larger context. Of course, they are talking about racist health care providers. They are talking about heterosexism. They are talking about homophobia in their communities. And we integrated that into this measure and as you can see, the alphas were solid.
We are quite excited about this. Our next phase is, these are the different domains that the HPTN Team did not access but we are going to test these larger factors: heterosexism, racism and classism, this notion of you can't pull apart the racism part from the heterosexism part. I'm excited about this. So the other thing, this gift from Dr. Jackson, is this focus on strengths, not just deficits. What can be leveraged? What are the assets? This is something that shows up in all of our work. And this is Dr. Jackson's post from an interview in 2001 that I Iove. And this is more evidence about his frustration, that social science research is oftentimes problem focused. The questions tend to start from the perspective of asking, “What is wrong with Black people?” We (at the Program for Research on Black Americans) approach the issues form a very different perspective. Our question is, “Given the structural impediments that they face, why do Black people do so well?”
And indeed, this is the question that informs a lot of our work. To that end, we always have in our models, we are always asking about religiosity and spirituality. Always asking about social support, resilience, just, “tell me the good stuff.” It’s also very important to the participants, right? We bring them in to talk about all these horrible things, but they have the opportunity to talk about protective things we’ve found is something they really value. And this is an R01 informed by intersectionality, where we are seeking to understand social-structural stressors from men at different intersections of sexuality and socioeconomic status. So we have different hypotheses for men at each of these different positions. On the bottom left is an example of a publication we did based on the data about resilience and also the limits of resilience. That you can be as strong, and ‘I’m going to keep going,’ and no matter what, but in the face of persistent structural racism, for example, that resilience will get you only so far.
So there is always that caveat there. It was so exciting to see Dr. Jackson embrace critical frameworks in his later work. And this is an example of why I describe him as a frustrated psychologist—social psychologist. He was advocating for more critical race theory in this paper from 2018. This notion is advocacy for public health scholars to move beyond the conventional public health biomedical risk model and really focus on critical race theory. And why that is important is because by the way, intersectionality—comes out of critical race theory. So this notion is focused on power and hierarchy. Dr. James is very much in line with critical health equity imperative. And last, the other thing that I get from Dr. Jackson is, if the institution you need does not exist, you build it. So, as you all know, Dr. Jackson on was the founder of the Program for Research on Black Americans at the University of Michigan, 1976, which pioneered innovative sampling and recruitment techniques for Black people. And included all the things that I showed you already about the foundation's centering within the comparisons.
And then there is me. So two years ago, I started the Intersectionality Training Institute. This is borne out of a conversation where Joe is in my office and I’m probably doing emails and juggling lots of emails around intersectionality and I say, I should probably start an Intersectionality Training Institute. He said I think you should. I said, that's insane. And then here we are. But I'm so proud of this organization. It's a baby organization: just two years. And these are the two cohorts. This is one of our signature programs. We do trainings and seminars to different universities but we also have this event where we invite applications from people who are interested in learning about how to apply intersectionality to qualitative, quantitative, and mixed methods research with fidelity to the four principles of intersectionality. They spend a week with us in Philadelphia. It is intense. So these are a few pictures. You may recognize that fellow at the top left. That is Greg Greenwood of NIMH. For the last two years he has come up to the institute to talk to people about integrating intersectionality into NIH grants and to learn about that process, which we feel is so important. And I’m really thrilled to mention that we are now starting to see this trickle from that. We recently learned about an R-01, an intersectionality R-01, that was hatched at the intensive.
And I learned two days ago about a K01 from somebody in the first cohort. And so, this is yet another lesson I’ve learned. So don't worry, I’m landing this plane. The critical health equity imperative.
So, towards the title of my talk, the critical health equity imperative, this is just a word cloud of different critical health words. And what we talk about when we talk about critical frameworks: any framework focused on exposing power, challenging power, advocacy for transformation for change. So that is a general idea of what I mean when I talk about critical frameworks.
And in terms of the work that I have been doing, you'll see that critical shows—these are no my research articles— you see that critical shows up over and over and over again. I am really trying to push the field to go beyond, as Dr. Jackson said, these conventional biomedical frameworks, which I think frankly are inadequate for achieving health equity. I mean, look at the evidence. There has been—we made amazing roads in HIV prevention— and it's also true that Black people are disproportionately affected by HIV, and it's troubling in 2023. Do not have same access to PrEP, which suggests to me there is something else we need to look at. My most recent publication, almost killed me because I decided to do it while I was teaching is on the far right, the White Racial Frame of Public Health Discourses about Racialized Health Differences. Another long title! And disparities, what it reveals about power and how it supports health equity and trying to move the field to really engage in really explicit ways about—we're not calling it race—we're calling it racism. We are not using ‘health–disparities’ when we mean ‘health inequity’ and how and why language is so important when it comes to power.
This critical health movement, advocacy, whatever you want to call it, it's really not new. It's just not as salient in the U.S. So much of the work that is happening on the critical health work, the top names in critical health work come out of the U.K., Critical Health Ecology and Critical Public Health, which is a U.K.-based journal and the article on the right is 2022 article about what is critical about critical public health and what does that mean?
And it's basically the focus on inequalities, social justice, being aware of history and history's role in health inequities and so forth. So, five insights. I said it all along, get critical.
There is a need. My research tells me that just focusing on cognitive risk factors and individual level factors are not going to get you where you need to go. You need to expand critical frameworks. So I’m talking critical race theory, intersectionality, and queer theory, and disability theory. We need eco-social theory. We need to expand the number or the types of theories we research.
Get intersectional. Of course. The need to transcend single-axis approaches. Those are where we just present data in terms of one axis of one intersection like race. So for example, depression and African Americans. That's great, but that doesn't tell us anything about key intersections by socioeconomic status, for example, sexual minority status, disability status, and on and on. And also, by the way, I must take this opportunity to say when we are talking about intersectionality, it's not just about multiple identities. Think about it. Everybody has a multiple identity. Intersectionality is keenly focused on interlocking systems of structural oppression. So always bringing that to the forefront. And so I have been lucky in my journey to be mentored by Black feminist thinkers who have been talking about this stuff forever. This is the wonderful Audre Lorde. If you don’t know about Audre Lorde, you should.
This is a picture of me meeting Audrey Lord in 1989 after I graduated from Georgetown. And her work, particularly her work—this one essay on the master’s tools will not dismantle the master's house—has been with me all through my journey. And so, it was the title of the paper that I wrote to critical health equity researchers of color. And then more recently, this is as we call her at the Intersectionality Training Institute, the Patricia Hill Collins. We were honored to have her be our keynote just this summer. And her work, this book—and she has written many others—she has a 2019 book on critical social theory. She is 75 years old and rolling still in terms of productivity. You will not find intersectionality in this book, that word. What she was doing is laying out this framework where she sort of challenged the field to abandon this Eurocentric masculine thought and she advocated for this power dramatic shift about thinking of oppression through these different intersections and why that was so important to me was that I, reading Patricia Hill Collins’ work made me think, wait a minute, we don't need to just think about intersectionality in terms of its historic groups, historically Black women or Black Latino women. Intersectionality could be this really important framework for understanding other groups. This is how I started to think about applying it to, for example, experiences of Black men, because it so beautifully looks at how people's individual-level experiences reflect larger systems of interlocking social oppression.
Three. I think that we need to expand our epistemological reach and our lens. While we’re talking about epistemology, and I just love talking about philosophy of science. I’ve spared you all today.
What we're talking about is like the justification of knowledge. Whose knowledge matters? What is knowledge? And what is important? Who do we trust? And historically, it's been people who look like the Gentleman with the stethoscope, White men, doctors, mostly biomedical and we have not paid attention to indigenous knowledge, other ways of knowing. And I think that we, it's really important for us to expand who we think about as experts and the way we do that, I think, is through citizen science and community-led projects, not just the projects where the academics with the Ph.D.’s who are not members of the community don't know what is going on in the community, sort of swoop in and control everything. And so there is really a need for this more equitable community-based partnerships where they are paying for—they are getting a large share of indirect cost rate. They have a say in the design. They know their communities best. They know what works. They know what the priorities are and harness that wisdom. I feel very strongly that this is imperative for advancing health equity. We need to get structurally competent. This is a concept from Metzl and Hansen’s work and what this was doing was this article is focusing on medical trainees and how to give medical trainees more insight into structure. So that when, for example, a Black woman, she's late for her appointment, you're not going, “oh well they’re just always late,” or “she's not interested in her health”. But to understand, well, how does she get there? She got to take two buses, for example. What is the larger context? This the article is really important to me. What I have done is used it as a Springboard to talk about intersectional structural competencies because for those of us, and I’m speaking only about psychology now, public health is much better. We don't get training about anything beyond the level of the individual.
So structural measures. Okay, how do we do that? How do we design structural interventions? How do we test them? None of that. I think there is a need for the field to train the next generation about structural competency. And lastly, beyond documentation, I find myself at this point in my career, feeling very much like a frustrated researcher. I think to myself, do we really need another study to tell us that racism is harmful to health? Do we really need another study? And so this last question is like, when do we start eliminating health equities, not just doing another study and doing another study and building evidence. And for this, I also have given the last word to Dr. Jackson who, like I am, was very much influenced by this wonderful article on Critical Race Theory and public health towards anti-racism by Chandra Ford and Collins Airhihenbuwa.
And one of the things that strikes me about this article, it's always stuck out for me is, one objective of Critical Race Theory is to go beyond telling us what we already know. How do we dismantle it? And thus it was wonderful to see Dr. Jackson wrestling with this exact question in his last paper where this is the last paragraph. And so he talks about Chandra Ford’s work:
“We urge the field to reconstruct the knowledge around racial health inequalities so it can be used as a tool in the struggle to dismantle”—by the way, the astute listeners in the room will also notice the parallels between the words “tools” and “dismantle” in Audre Lord's work.
So to me, I saw this and I was like, “yes, it’s all linked”. And so, this is where I will close. I think that the time for critical health equity is now, now. One that is absolutely committed, absolutely committed to reducing and eliminating health inequities, not just documenting it. Thank you.
MAURICIO RANGEL-GOMEZ: Thank you, everyone. Thank you so much, Dr. Bowleg, for this. I have to be 100% honest. When I was setting up talking about this, I’m like, oh, my God, I’m having just like a revelation moment. I will reach out to you because we are very much interested in intersectionality and we’ve been talking about that a lot in the mental health disparities theme and in everything. So, yes, this is fantastic for us. I’m sure people in the back, Lauren and everyone, I see big smiles because—like they are like, yes! Thank you so much everyone. Now we will continue with a really great moment that Enrique had the opportunity to have in the past, so we are having this in person now. We'll have a moment of a conversation between Dr. Lisa Bowleg and our NIMH Director, Dr. Josh Gordon.
DR. JOSHUA GORDON: Thank you, Lisa, for that really outstanding talk. I love the arc of your career description as well as your engagement of the awardee—the person for whom the award is named after, Dr. Jackson, who is really clearly the foundation for much of the work that is being done. And I also appreciate that last piece. I’m going to come back to this, the challenge of moving from documentation to dismantling. But I do want to start with what you started with, which is mentorship and mentoring. You spoke eloquently about mentors that you had both early in life and later scientifically. And you didn't speak directly to it, but of course it was implied, certainly setting up The Training Institute, for example, that you yourself have been an outstanding mentor for many.
What makes a good mentor? You can use your own experience as a mentor or mentee in discussing this. In particular, I’d love to hear how more about how the mentoring relationship affected you from a personal growth standpoint because I think we’ve already talked about how it’s affected you from a scientific standpoint.
LISA BOWLEG: I think the first thing is that there are different types of mentors. That's important for people to know because I think often people want or expect everything in a mentor. It's kind of like your friends. You have the friend you tell the crazy stuff to but you don't tell that to the—you know? And so I think understanding whether there is a mentor—so one, or multiple mentors—whether there is a mentor you go to for emotional, psychological support, the mentor who is more instrumental because they can connect you, they’re connected, and so they can know. So I think, one, understanding the type of mentorship you need is important. But in my experience, what was so wonderful for me was having mentors who got me. They didn't want me—they didn't want to mold me into who they were, but they really understood that—how could they facilitate where I wanted to get?
A great example of that is Jeanne Tschann at the CAPS program. The CAPS program is designed to get people to write an R01. I'm coming in with the one publication from the dissertation. I don't have experience working on grants. And so, I’m really worried about the publications are going to need to get tenure and we’re being asked to write a specific grant. I'm like oh, my god. This doesn't make sense. And she said, don't worry about it. We're going to work this out with the CAPS. There are certain things you need to do but we're going to focus on what you need to do to get tenure. So it was always having a mentor who was just like, okay, I see where you're going to go and I just want to facilitate that.
DR. JOSHUA GORDON: Right, the mentor who considers your perspective much the same way you have talked about how the research needs to take a perspective of the people that the research is trying to help.
LISA BOWLEG: Exactly. So, you got to the get the specific aims and you really got to write this research approach, and you really got to do that because that’s how—that would have been disastrous. And it was a bar I couldn't meet. So that's really important, a mentor who gets you.
DR. JOSHUA GORDON: Now you described within your career, this back-and-forth between policy and research, and you can see that in the writing. You can see that in the different programs that you talked about, that you established in your career. But at some point, it seemed like there was a transition. You started out in this policy job. And more than that, also you added an advocacy component with your strong writing skills you gained from your early mentor. And then you went to study. Right? Then you went to academia to get your Ph.D. If that was a transition, maybe that's the wrong way to put it, but how did you conceive of that? Did you go into research because the advocacy work made you realize we didn't know enough? Did you go into research because it was an extension of that advocacy work? A little bit of both? What was that like? What was that transition for you, conceptually, in terms of what you wanted to achieve?
LISA BOWLEG: I think recognizing that I loved research and I wanted to do different types of research and also the public policy work and women studies foundation, because what we were doing is critiquing traditional methodological approaches all day long. So I figured, I can learn sort of the conventional quantitative approaches and then I can bring in critical thinking from my women studies and my policy and use research as a tool for advocacy and use research to ask new questions, particularly understudied groups and people who are intersectionally invisible, and I can do it in a new way. So I think it was the understanding I wanted to—that I could do—I didn't see it at that time but I see it now. That I could do it all in terms of using research as a vehicle for critical work and for advocacy as well.
DR. JOSHUA GORDON: I see it too from your arc. But when you first started that research, the questions you seemed to want to ask were really centered around HIV, right?
LISA BOWLEG: Yes.
DR. JOSHUA GORDON: And HIV in Black men if I'm recalling correctly. But as you go to study it, you end up instead, or in addition, studying incarceration, police brutality, depression, et cetera, these other factors. Speaking of mentorship, was that a challenge for you to be able to pivot in the context of a research program that you are entering as a student into these other areas? Or did you have the support that you needed from your mentors to allow you to branch out? And it wasn't a big deal?
LISA BOWLEG: I always had the support of my mentors. I think about my doctoral mentor. Dr. Faye Bellgrave. And I wanted to do this study on power and context in Black and Latino women. And because I’m an absolute masochist and overachiever, I decide I’m going to do these surveys on one of them in a language I don't speak. So Spanish and English and I’m going to collect the data from community clinics in D.C. and then Faye informs me she is leaving, so we have to do this in 6-8 months. And I got it done. And I got it done at the end with Faye just making it happen. So I always had mentors who they see where I want to go and they facilitate that.
And I think it's also, it goes back to me from being Bahamian. We just get it done—you know, the line in Hamilton—“immigrants, we get the job done”. So just this notion of like, no, I think this is important. I think this is important. And I want today to do it this way. And I think it's important to the communities that it be done this way. And these boxes are inadequate for where I think I want to go with this research. And so I’ve always been pushed and had mentors who were like, okay, okay, I see where you're going. That's been really instrumental in my growth.
Did I answer your question?
DR. JOSHUA GORDON: No. So I’ll ask it again. But you set it up very, very nicely. So you had the support. When you went to go study HIV in Black men, did you know that you were going to study incarceration, police brutality and oppression? Or did you go in and try to study other things and this pulled you away and—
LISA BOWLEG: Yes
DR. JOSHUA GORDON: That one. So now I heard, yes, you had the support of your mentors to be able to do that. What was that like for you? Was a challenge to be that flexible and say, no, I have to pivot. Or did it come naturally because of your education or something —
LISA BOWLEG: I think it comes naturally because it comes out of the women's studies world where we are critiquing that—these post-positivist approaches to research.
DR. JOSHUA GORDON: Stop. Post-positivist.
LISA BOWLEG: Yeah. We are not just positivists. This paradigm about the nature of say, the world. So a post-positive paradigm in science is that one, there is Ontology, the nature of Reality. This notion there is some reality out there we can capture. That’s an assumption. Axiology, another assumption. The role of values in research. The post-positive stance on that is that research and scientific Inquiry is objective. There is an objectivity that exists. There are other forms of knowledge, social constructivists, for example. This well, no no no, objectivity is a myth. So having this sense or epistemology that we—what we value, is what somebody in a white lab coat with a M.D. or Ph.D. behind their names. So I had a critical way of thinking about the research process. For me, it was not a barrier that okay, so we did have these hypotheses and we were going in with this framework, but this thing that these participants are telling us and by the way, they are telling us because we are using methods that elicit these—otherwise we wouldn't get them because we didn’t think about. This is really important. And so it was that. The confidence and comfort in that to just be flexible and say, we got to shift. We are going in a different direction.
DR. JOSHUA GORDON: Now, I’m going to come back now to this, don't just observe and document. But intervene. So what did we learn? What did you learn from those studies that allowed you to then try to attack the problem of HIV prevention in Black men?
LISA BOWLEG: I think what I learned is that the importance—that slide I showed where with the condom and all that. All that stuff is really, really important to investigators and funders. For many of the Black men who are in my research and these are mostly low-income men—mostly high school education, that HIV is really sort of low on their list of their day-to-day reality. And thus, we need to, in order to be effective, we need to have interventions that engage the things that they—that are most important to them. Jobs, jobs, jobs. For example, and then embed HIV prevention within job training programs, for example. This is where I started to go structural approaches.
DR. JOSHUA GORDON: Right. So the typical way of thinking about this is how do we raise the priority of condom use or PrEP use for other sort of more typical interventions? And you’re saying, no, that’s not the way to do it. The way to do it is build into the priorities that these men have, build into that, ways of accessing HIV prevention.
LISA BOWLEG: That's one route. The other one is to be really sort of cognizant of power and how that limits opportunities for men. So I’m thinking in the work we are doing now on the multi-level intersectional stigma. One of the things that I have been absolutely animated by in this work is the role of health care providers and their intersectional stigma as a barrier to PrEP. And we don't spend a lot of time on that side. We just spend a lot of time in the deficits. Why won't they use PrEP, they don’t know about PrEp—and then we're getting these narratives about intersectional stigma, whether it's about homophobic stuff, racist stuff, health care providers who, the men many of our participants deem incompetent.
So that says to me, wait a minute, the intervention is with the people who prescribe the PrEP as I often say you don't walk into the CVS and pull PrEP off the shelf. Somebody has to give it to you. Again, that's about power and the questions that we ask. And historically what we do is just focus on the deficits. “They just won't use it. We don't know why.” Rather than understanding the larger context that better explains why this is not happening in this population.
DR. JOSHUA GORDON: Got it. And the other piece which you are not quite at with this particular thread of conversation, but you are in your own work, and it’s that really dismantling. So, if work inequality, if income inequality, food inequality and all of these other things are underlying a lot of challenges that we have to achieving health equity, let's address those structural factors.
LISA BOWLEG: uh-huh.
DR. JOSHUA GORDON: Has your own research focused yet on that?
LISA BOWLEG: That's such a bigger question.
DR. JOSHUA GORDON: yes.
LISA BOWLEG: And it takes us into the mess of structural determinants ever health but also the political determinants of health.
DR. JOSHUA GORDON: Yes.
LISA BOWLEG: And what a hornet's mess that is. Right?
DR. JOSHUA GORDON: And frankly, it's one of the reasons, that hornet's nest is one of the reasons why the biomedical research establishment, including NIH or driven by NIH, has had a challenge in trying to address these determinants. So I’m going to come back there in a moment. I like the term, hornet's nest. I have been stung by a hornet, it is not fun. But I want to just take a step back a little bit because you talked about how one approach in this field and the one championed by Dr. Jackson, is to understand why Black people do so well despite these structural factors. And to me, that's one potential pathway to intervention. We can look at resilience factors and figure out how we can build them. So we are not dismantling yet but we are trying to look at the things that work within the context of the system and try to strengthen them. Is that an approach you think is worthwhile or is that—or you also said, but, there is only so much that gets you.
LISA BOWLEG: To me, that lacks the sort of moral urgency and imperative and it's a slippery slope. Like they are doing okay. Despite all of this, they are doing well. So we are just going to study what makes them strong in the midst of oppression rather than okay, wait a minute, something is—is very wrong. And that if we look at HIV and COVID and diabetes and hypertension, we could go down the list and see there are common threads that link all of these and what if we addressed some sort of—the structural things we know, the legacy of residential segregation, the incarceration? We know this. We have the evidence. We know this. Then that's not something we—we have not done that yet, not as effectively and not as assiduously as I’d like to see.
DR. JOSHUA GORDON: Right. So okay, now we're back to the hornet's nest, structural factors.
LISA BOWLEG: Oh, yes.
DR. JOSHUA GORDON: One approach you also talked about is the approach of engaging with community organizations, including ways that you said directly, give them the indirect costs, and this is as you're aware, this is one method that NIH is trying now to form the common fund program. For those who don't know, the Common fund program, called Compass, which will be testing interventions designed to ameliorate structural factors that create or exacerbate health disparities. And in this experiment that they're doing, about 40-50 different community organizations will be receiving the grants directly and then the subcontracts will be to investigators, exactly the opposite way from the way grants are usually given. We’re just awarding those first grants now so we don’t know how well it’s going to work. But I think it points to what you were saying, engaging with communities in a meaningful way is one way forward to addressing some of these structural factors. Can you think of some research now that has done this in HIV? And if not, how would you design something that would say, attack the problems you have been studying, say in men in HIV?
LISA BOWLEG: The programs that I’m thinking specifically about the community-based programs that were happening for Black men—there was in Philadelphia a program called, Straight Up. It was trying to engage Black men through a—I can't remember the name of the—Janné what was the—
JANNÉ MASSIE: [ off microphone ]
LISA BOWLEG: Yes, the National Center for Fatherhood. So when we were in Philadelphia, we found this organization that—we were just amazed. They were working mostly with men who had histories of incarceration. So for example, they had a closet where stores would donate clothing for the man who needs to go to court, for example. There was a barber on site, resume training, and then we were trying to integrate an HIV prevention program in there, in that program. And then we're calling them, calling them because they are going to partner with us on research and we can't find them and—I think the Supreme Commander went and found that the organization was closed. And so this is always the sort of constraints around capacity building of these organizations. And then there was another organization, again in Philadelphia, I can't remember the name of it. It was a women's organization that was doing HIV work and they tried to integrate a men's program and they found that it was really hard to engage Black heterosexual men around HIV prevention in just the program. So again, the need for programs like the national center for fatherhood but they didn't have the money to sustain the program.
So that's what I’m thinking about when I talk about the need for capacity building for community-based groups who are doing excellent work and how can we integrate our HIV work within that.
DR. JOSHUA GORDON: Okay. I want to turn towards intersectionality at the heart of this latest chapter where you're starting a center for training and intersectionality. I'm not sure you defined it for us.
LISA BOWLEG: I know. [laughs]
DR. JOSHUA GORDON: So that was intentional?
LISA BOWLEG: It was.
DR. JOSHUA GORDON: Because you want me to ask you?
LISA BOWLEG: Finally.
DR. JOSHUA GORDON: Because you can't?
LISA BOWLEG: Oh, no no. I can definitely define. I thought it will take me into a different tangent but I’m happy to explain.
DR. JOSHUA GORDON: Go ahead, why not.
LISA BOWLEG: So intersectionality is a critical theoretical framework, I want to talk a little bit about its origins because it comes out of experiences of Black women in the U.S. and so, you can find Anna Julia Cooper in 1892 talking about this unique space that Black women occupy. Or Henry Jacobs in “Narratives of the Slave Girl,” talking about slavery was really bad for men but for women—so there is that.
And it also comes out of Black feminist activism mostly through the Combahee River Collective. This is important to understand intersectionality because it's not one of these theories that comes out of the academy. It is not developed to be tested. So it's critical. It's exposing how the social health economic outcomes of people, who at specific intersections, historically marginalized groups, how that interlocking oppression sort of pretty much explains the health inequities we see. So intersectionality rejects the notion of single axis we can talk about just race, absent how it interlocks with say, sex and gender, you and I were just in Frankfurt. We were at the Ernst Strüngmann Forum in Frankfurt Institute talking about sex and gender about three weeks ago. And that these are interlocking. But also the systems of oppression, so that racism intersects with sexism and heterosexism and on and on. So that's it in a nutshell.
DR. JOSHUA GORDON: So, we in our field, are—I'm trying to figure out the right way to say it—are struggling with multidimensionality even within brain science or behavioral science or in psychiatry. This is an issue that we are challenged with. One of the challenges is when you have many dimensions that you're defining individual people on, you can end up very quickly with a collection of individuals. In science for better or for worse, science requires us to collect information in a way that will then be generalizable. The lessons we learn are generalizable to a large group of people. How is intersectionality both a barrier to, and a facilitator of generalizability, when we're thinking about issues that you're talking about?
LISA BOWLEG: In some ways, intersectionality just rejects the notion of a one-size-fits-all approach. That that is even possible. And also that Kimberly Crenshaw has this quote that is shown up in some of my NIH proposal grants where she talked about intersectionality, addressing the specific and particular concerns of these groups. So what has happened historically in the quest for generalization, is that certain groups, intersectionally invisible groups, they drop out. Because where is that—you mentioned a large group of people. Where is that large group of Black transwomen, for example? But we know that that is a particular intersection where racism and cisgenderrism and class exploitation, where those come together. And so if we're focusing just on generalizing to large group of people, they go missing. They fall through the cracks. And so intersectionality is laser focused on the groups who have historically fallen through the cracks even in biomedical work.
DR. JOSHUA GORDON: So Dr. Jackson, he advocated for studying and created a center for studying Black people as a group, number 1. And number 2, it's a little bit like that, it’s saying this is a group that has been historically marginalized and falls out of the data we normally collect about people in the United States. And you're pointing out now that it's beyond Black. It's Black transgender. It's Hispanic—
LISA BOWLEG: Native American with disability. All of those nuances.
DR. JOSHUA GORDON: So I'm the Director of the National Institute of Mental Health, and I have got a wonderful two billion dollars to spend on research. But I have to prioritize. So when we think about identifying ways to improve the mental health of the population in the United States, we simultaneously think about how do we increase the representation of these underrepresented—traditionally underrepresented groups— in our studies, in our big general studies. And also trying to identify at-risk populations. One of the reasons I think your work is so compelling to us is we recognize that these groups that you have studied, especially Black men, are at high risk for HIV and high risk for mental
illness. And so that is an area we know we need to study. How granular can we really get? So what is a better approach than either trying to do these very large studies to include quote/unquote, everybody, where you're still going to get drop out, versus trying to identify high-risk groups that might be smaller, but then how do you decide to cover the full landscape?
LISA BOWLEG: So I would say that you then you’re not focusing so much on the individuals, but you're focusing on the structure. What are the interlocking systems of structure? How is housing instability linked to incarceration, linked to unemployment, linked to the history of residential segregation that explains why people in this area have these outcomes across all of these different conditions? Whether it’s depression, HIV, COVID. It's flipping the question. It's flipping the script. So it's not just about the individuals but it's about the systems and interlocking systems that reflect and explain why individuals at these specific positions have these outcomes.
DR. JOSHUA GORDON: I'm smiling. Maybe not big here, but I’m smiling inside. The reason why I’m smiling, it's a little devious of a smile, is because that's actually the approach we try to take in another multidimensional space of the brain and behavior. In facing trying to understand another intersectional space, which is different mental illnesses which typically intersect in an individual. There is no individual that has pure one mental illness. There is tremendous co-morbidities but you can also think of it as an intersectional problem that each person has an individual illness. And rather than trying to study that, we have decided that we're going to try to study functions of the brain, mechanistic functions in the brain that can breakdown in different ways that result in different forms of mental Illness. So what you're suggesting is that we study the different mechanistic functions of our society— as a social psychologist—of our society that can breakdown and result in illnesses of our society that manifest in the form of health disparities, that will affect different people depending upon their intersectional —
LISA BOWLEG: Exactly. Which is why I didn't have an opportunity to talk about— or I chose not to take the time— to talk about the strength and stressors studied. What we were really interested in is recognizing black men are not a monolith. We want to understand the outcomes for that study are negative mental health and substance use. That grant is funded by NIDA. And we wanted to look at these distinct— because we don't know what are the stressors for an upper SES. I don’t know— maybe gay man working at a law firm compared with low SES black man who works in, I don't know—who is gay but also works in mechanics. There are so many different complexities. So research needs to be structured in ways to address those complexities and nuances and historically what we have done is looked at the group of individuals and we ended there and not look at structure.
DR. JOSHUA GORDON: This is a challenge for us but it's one in which we need to take on. I want to ask you one more question. And it's a mixture of the dismantling problem and other themes you have brought up. And it's the magic wand question. If you could wave your magic wand and do one thing to advance HIV and mental health disparities to reduce them, I should say. Or even to eliminate them, what would you do? And, because you're a researcher, what does that mean we should be studying?
LISA BOWLEG: I—well talk about being put on the spot. I would probably—I know I would go structural and wanting to understand. Like I think about, we don't talk about it in this way, but the Affordable Care Act, it’s a structural intervention.
DR. JOSHUA GORDON: Yes, it was. That's right.
LISA BOWLEG: Medicaid expansion means that people have access to PrEP, that they otherwise wouldn't have and other technologies. I would be interested in—and I don't know how we would go about doing it, but if could—my wand would be the structural wand that would encompass employment, education. All of these things and housing. All of that and then I would want to assess. I would want to test the effects of that and see what did that change in terms of improving people's lives in reducing health inequities? And because I always think intersectionally, it wouldn't just be HIV for me. I would also want to know about cancer and negative mental health and all of that because I think these are all linked. That's what I would do with my magic wand.
DR. JOSHUA GORDON: Thank you very much. Dr. Lisa Bowleg. Let's give her another round of applause.
[ applause ]
And now my distinct privilege to give you this award, the James Jackson Memorial Award. Stand up so everyone can see it.
[ applause ]
We have a bunch of photographers but apparently non-official ones. We'll have to figure out the best one. Thank you for joining us today. And I’m going to turn it over to Dr. Christina Borba, the Director of our Office of Disparities Research and Workforce Diversity, to close it out. Thank you.
CHRISTINA BORBA: Good morning. I wanted to thank everyone for coming this morning. I really wanted to thank Colleen and Mauricio for your unbelievable leadership in this and the steering committee of the Disparities Team for the James Jackson Memorial Award. I wanted to thank our contractor for all the logistics and then Jing who is not here, who is running up and down on all the different floors putting this event together.
It was such a pleasure having dinner with you both last night and I'm really excited to spend the day, and all of us are very excited to spend the day with you as well. So thank you everyone. You have the schedules— but the Disparities Team, we are having lunch at 11:45 up on the 8th floor. Thank you.