Date published: 1/18/2017

In 1985, a historical report was issued by Health Secretary Heckler on Black and Minority Health. While there was already decades of research demonstrating that the physical and mental health of racial/ethnic minorities particularly African Americans was worse than most others in the United States, there was not a coordinated effort to focus and improve the health of African Americans.

I have had a long interest in the identification and understanding of the ways in which social status disparities are significant factors in negative mental and physical health outcomes.  My initial training as a clinical psychologist provided me the skills to understand individual disorders.  It was my postdoctoral training in psychiatric epidemiology and my health policy training that equipped me to study psychopathology at the population health level and understand how to develop policy interventions at the system level to make health services for racial and ethnic minorities work better.

In my early work in HIV, I identified how prevention approaches needed to be tailored to the way in which women and sexual minorities experience risk and the risk consequences.  My work illustrated how gender, race and place in particular when viewed through a cumulative advantage and disadvantage (CAD) model conferred risk differently.  As an example, African American women in the U.S. experience higher rates of HIV infection not due to differences in the rate of sexual or drug related risk behaviors but because of a number of factors that come into play in the South such as the migration of male gang members and drug traffickers who as a result of successful police interdiction in other places reside in the South with families and as sexual partners of these women are likely to be HIV infected and infect these women.  My work examines risk clusters and how these clusters come together differently as they relate to societal issues of privilege, power and inequity.  Historical factors such as the years of discrimination in the types of separate and segregated schools in the South which often excluded women for any careers other than teachers which meant greater reliance on being in a relationship for either survival or moving up the social class ranks.  Identifying how to design prevention services that take these structural factors into play are the topic of my work.  In my recent work, I have focused on examining aspects of the health care system, particularly the primary care setting may not be meeting the mental health and health care needs of African Americans and Latinos.  In a recent study, we were able to demonstrate that experiences of race-based discrimination for African Americans in mental health or substance abuse treatment resulted in their dropping out of mental health care.  This is quite different than the belief that they were less interested in formal mental health sources.  During a time in which African American men with mental health problems are more likely to wind up in the legal system and may be shot or killed during policing efforts to deal with these problems fixing primary care settings rises in importance.  The third long term area of my research is in understanding the emotional, social neurocognitive, physiological and biological of experienced race-based discrimination.  As a part of the work of my NIH funded BRITE Center on Health Disparities, we are engaged in cognitive studies of how race-based discrimination impacts cognitive processing, how the stress of race-based discrimination contributes to early mortality and morbidity, and how African American men 18-24, 40-64 and 65+ cope and manage their lives in the face of race-based discrimination based on a model I have developed.

I grew up in Chicago, Illinois in a family that was a part of the Chicago migration from the South.  My education was predominantly in Catholic schools, having attended Catholic grammar school, high school and college in Chicago before heading to Massachusetts for my Ph.D.  I did postdoctoral work at the University of Michigan in psychiatric epidemiology at the Institute for Social Research.  Later in my career, I was a NRSA Fellow in the RAND Health Policy program specializing in Health Policy and Health Services and received a MSPH degree.  I took my first psychology course in high school and knew from there the name for what I wanted to be—a psychologist.

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