A recent graduate of the Mass General Brigham Neurology Residency, Dr. Joshua Budhu is a clinical fellow in neuro-oncology at Massachusetts General Hospital, the Dana-Farber Cancer Institute, and Brigham and Women’s Hospital in Boston MA. In addition to his clinical duties, he is a Commonwealth Fund Fellow in Minority Health Policy at Harvard University, as well as the editor for Neurology’s® Inclusion, Diversity, Equity, & Social Justice (IDEAS) section.
I had the chance to sit down with Josh to get his ideas about IDEAS as it has informed his life, practice, and policy work.
STANLEY:
What formative experiences shaped your perspective on what DEI means and how the work should be approached?
BUDHU: Two formative experiences that have influenced my views on equity: my upbringing as a child of Guyanese immigrants in Queens, New York, and my brother’s death from pulmonary emboli while in police custody. Growing up, I struggled to make sense of his death. As I went through medical training, I became aware of the structural and social determinants of health. This helped me to conceptualize the incident and look at the bigger picture: he was set up to fail. Our immigrant status, economic situation, his untreated substance use disorder, untreated depression, low health literacy, and environment created the perfect storm for his death. This understanding helped me to continue looking at the bigger picture for my patients. Instead of assuming that a condition like diabetes is due to poor eating habits and medication nonadherence, I take a full assessment of the situation. Does this patient have access to healthy food? Can they afford their insulin? Do they have access to a gym or fitness? These are the questions we need to be asking. We need to be looking at health with an equity lens: an intentional and deliberate assessment to determine structural barriers in order to address them to promote inclusivity, diversity, and equity.
STANLEY:
What are your goals for the new IDEAS section of Neurology®? What is the role of such a section in the discourse of an academic journal like Neurology®?
BUDHU: I am very proud of Neurology’s® commitment to IDEAS. This section aims to highlight the importance of IDEAS in neurology and medicine. Medical care is only responsible for 15-20% of health outcomes. This means that 80-85% of overall health is determined by the social, structural, and political determinants of health. We can come up with the best plan for secondary stroke prophylaxis for a patient and prescribe the right medication, but that is only a small part. What happens if they can’t receive their medication because of prohibitive costs or lack of insurance? If they can’t make it to their visits because of transportation issues or the inability to take off from work? If they lack broadband or suitable devices to conduct a televisit? If they live in a food desert without adequate access to health foods to control hypertension or hyperlipidemia? If they have a limited budget and must choose between rent, medications, or food? The list goes on and on. The IDEAS section is recognition that medicine doesn’t stop at the bedside. We must be cognizant of all the other factors that make up health. This is just not on the patient side. Bias, discrimination, and racism affects a large proportion of our neurology community. This section also highlights our diverse lived experiences, struggles, and triumphs.
STANLEY:
What advice would you give to residents and fellows interested in IDEAS but not knowing where or how to start? What are the types of article content you are looking for in your section of Neurology®?
BUDHU:
One point that I would like to make is that you do not need to be part of a marginalized or minority group to support IDEAS. We need allies from every background. Achieving health equity improves health and health outcomes for every single person. Promoting IDEAS is not limited to large projects or policy, IDEAS is also about everyday life. This means working with an “equity lens,” promoting inclusivity, and recognizing the diverse circumstances of your communities, local and national. Students, residents, fellows, and attendings who are interested in IDEAS should start first within their own departments to make it a safe, comfortable, environment for all. Looking holistically at a patient and recognizing limitations and the importance of social determinants of health is a must. For those interested in formal projects, many of the Boston institutions now have diversity offices/departments.
For neurology, the AAN also has many opportunities:
In terms of content, I want to highlight lived experiences of the neurology community. This is open to healthcare workers, trainees and students, patients, families, and staff. These pieces are meant to be descriptions of personal experiences that shaped one’s views of IDEAS, as well as reflections on the intersection between personal identity and career. We will also be starting a section devoted to the discussions of the intersection of IDEAS and neurology patient care, research, education, or policy.
STANLEY:
And because this is an interview for the Boston Society...what ideas do you have on IDEAS in our communities of Boston?
BUDHU: Boston has had a long and complicated history with diversity, equity, and inclusion. On one end of the spectrum, it has an incredibly progressive history as the antislavery hub in pre-Civil War America and the first state to legally recognize same-sex marriages in 2004. On the other hand, it’s one of the most segregated cities in the United States, a product of redlining and systemic racism. Many Bostonians remember the desegregation of Boston public schools in the 1970s and 1980s, the associated race riots, and the white flight into the suburbs. This has ultimately affected health outcomes. For example, on average residents of Roxbury live a quarter of a century less than residents of Back Bay. We must come to terms with our own history as we also simultaneously address these systemic injustices. This means we need to prioritize resources and support for our most marginalized communities, those that have been disproportionally impacted by our current and historical practices. An example of this is COVID-19, the disparities in mortality and morbidity between races is not a novel concept, they are just another example of how inequity is embedded into our society. As we look to improve health and health outcomes, we need to draw upon the resources that are unique to our Boston community. This means continued commitment and investment by Boston’s storied hospitals and medical schools to the communities that need it the most.
For more about Dr. Budhu, check out his profile in Neurology®: https://www.neurology.org/ideas-editor, and please follow him on Twitter @JoshuaBudhu
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