Make commitment to righting racial injustice in health, Jacobs School lecturer urges

The title of Maxine Hayes’ virtual talk last Tuesday as part of the Celebration of Inclusiveness in Medicine and Science Distinguished Lecture Series was “Righting the Wrong of Racial Injustice in Health.” It was a title she chose with care.

“I didn’t say ‘health care,’ ” she pointed out at the start of her talk, “I said ‘health.’ Health is one of our most precious attributes. If we don’t have health, there is very little we can do in this life. That’s why Martin Luther King Jr. said that of all the injustices, it is the worst.”

A nationally recognized expert in maternal and child health, Hayes is clinical professor emerita of pediatrics at the University of Washington School of Medicine and professor emerita of health services in the University of Washington School of Public Health.

A 1973 graduate of the Jacobs School of Medicine and Biomedical Sciences, she gave the talk at UB last week as the recipient of the Medical School Alumni Association’s 2021 Distinguished Alumna Award.

Hayes’ extraordinary career includes serving the Washington State Department of Health for 25 years, from 1988 to 2013, 16 of them as state health officer. As the state’s top public health doctor, her role included advising the governor and secretary of health on issues ranging from health promotion and chronic disease prevention to emergency response.

After graduation from UB, she did postgraduate training at Vanderbilt University Hospital and the Children’s Hospital Medical Center in Boston. She earned a Master of Public Health degree at Harvard University and took a teaching position at the University of Mississippi Medical Center. She joined the faculty of the University of Washington School of Medicine in 1985 and was medical director of the Odessa Crown Children’s Clinic, delivering primary care to underserved populations.

Hayes is the recipient of many awards and honors for her work in maternal and child health, including the American Medical Association’s Dr. Nathan Davis Award, the Heroes in Health Care Lifetime Achievement Award through the Washington Health Foundation, the American Public Health Association’s Helen Rodriguez-Trias Social Justice Award and the Martha May Eliot Award from the American Public Health Association.

She grew up in Mississippi in “the Jim Crow South,” she noted, and attended the Jacobs School after graduating with a degree in biology from Spelman College, an historically black college or university (HBCU). While an undergraduate, she spent 1968 in Vienna through a study abroad program. That was the year that Martin Luther King Jr. and Robert F. Kennedy were assassinated.

“I got into medical school on the quota system,” she said during her talk. “After the 1968 riots and the deaths of King and Bobby Kennedy, the country was in an uproar. If I had graduated from Spelman on time, I would not be here as a physician. Things had changed and doors were opened by force. The schools had to let us in.”

That year, Hayes was one of 10 women and five African Americans in her class in the UB medical school.

Coming to Buffalo from the south as a young African American woman meant Hayes had to deal with multiple challenges. “My biggest challenge in going to Buffalo was trying to find housing,” she recalled. “I would find places near the school and then when I showed up, they’d say ‘oh there must be some mistake.’”

So Hayes took a flat, as she put it, “in the ghetto” that required three buses to get to UB. She was also the only student from out of state. “I had lots of formidable types of challenges,” she said, “but I was very focused on my studies. I didn’t let any of that deter me.”

Originally interested in becoming a cancer scientist, Hayes chose to attend the Jacobs School over Harvard, where she was accepted, because of the proximity to the Roswell Park Cancer Institute. But her plans changed after her first year in medical school when she worked in the Mississippi delta, in Mt. Bayou, through a UB externship.

Even though she, too, had grown up in poverty in the same state, the experience served as a powerful wake-up call. “I saw the tremendous amount of suffering,” she said, adding that the community had none of the basic environmental protections that other communities took for granted.

“I was building privies to keep waste away from drinking water, we were putting screens on houses so mosquito bites didn’t lead to impetigo,” said Hayes. “I was learning about poverty and neglect.”

That experience changed Hayes’ mind about becoming a cancer scientist. “I had encounters with so many elderly people who had never seen a lady with a white jacket,” she said. “They knew I was a student and they said, ‘come back, we need our doctors to be people who really care about us,’ and that put a burning piece in my heart.”

The experience instilled in her the passion to be a physician for the underserved and to become an activist for public health, a passion that she works hard to instill in others.

“Community activism shines a light on what needs to be corrected and that’s what the Mt. Bayou experience did for me,” she said. “We didn’t have the vocabulary of the social determinants of health then, but in fact, that’s what we were practicing.”

During her talk, Hayes fielded questions from Jacobs School faculty, students and medical residents about how to recruit and retain more physicians of color, how to encourage physicians of color to serve their communities and about her switch from clinical care to public policy.

“I realized that there was a lot more that could be done working with communities and advocates on the policy side,” she said, “that there were a lot of things that affect health, not necessarily on the medical side.”

She considers legislation that afforded women safe and healthy obstetrical services and better care for children among her proudest achievements. She also helped “put Joe Camel to sleep,” referencing the child-friendly cartoon character that the R.J. Reynolds Tobacco Company featured in advertisements in the 1980s and 1990s until pressured by government agencies and public health advocates to retire him.

“The billboards came down,” said Hayes. “It was one of those moments in public health when you could see the impact, one of those things I definitely take pride in.”

Asked about the role of medical education, Hayes said the curriculum needs to reflect the contributions that African Americans have made in medicine.

“We don’t know a lot of our history,” she said. “There are a lot of hidden figures in our profession who have never been acclaimed, and that’s not right.”

She added that stereotypes about African American men, for example, are having a profound and detrimental effect on the profession. “We need to stop believing the lies we are told about African American men,” she said, “that they’re dangerous and they’re going to hurt you. The bias training has got to happen across all our systems.

“We have almost no African American men in medicine,” Hayes continued. “We are losing them. They’re not there because of bias and racism in institutions that don’t treat them fairly. They don’t want it and they don’t have to put up with it, so they go into other professions, but we need them.”

She noted that there are algorithms widely used in medicine that are based on racist assumptions and that perpetuate racism in health care.

“We need open spaces to talk about these things and not punish people for talking about these things, where people say, ‘This is a troublemaker.’ Well, I want to make trouble,” she said. “I want to make good trouble on the things that really matter. If our students don’t feel safe telling us what needs to change, then there’s resistance to change. Don’t think people aren’t going to resist. White privilege has existed for a very long time and to have it taken away I’m sure is very frightening. But what are we giving up in keeping it? It hurts all of us, these inequities.

“I ask you to honor me by making the commitment, so that we can say we have really righted the wrongs of racial injustice in health, so that we will no longer have that problem,” Hayes said. “It will take the next generation of health professionals. And I am so proud of you, my alma mater, for recognizing that you can do this, like the boldness of Buffalo. Be bold. Be creative. Take those steps.”

Jacobs School discussants who participated are Olumayowa “Mayowa” Adebiyi of the Class of 2024 and president of the UB chapter of the Student National Medical Association (SNMA); Fred Archer, clinical assistant professor of pediatrics; Tonya Lemonious, chief pediatric resident; and Joseph Lesh, Class of 2023 and president, Polity.  

The event was organized by the Office of Inclusion and Cultural Enhancement in the Jacobs School, the Medical Alumni Association, Polity and SNMA.