Diversity, Equity, Inclusion and Accessibility

Statement on Diversity, Equity, Inclusion, and Access

Context and understanding. As an immigrant and a foreign-medical graduate from a developing country, I have navigated my professional advancement in the US with a heightened awareness of the challenges encountered by individuals who might be perceived as belonging to a non-majority group. My experiences have sensitized me to the necessity of active, intentional, and ongoing engagement with the diversity of fellow humans and developing a deeper understanding of their lived experiences within institutions, systems, and society. I strive to understand, respect, and celebrate all cultural values and experiences, be authentic about sharing my vulnerabilities, and offer others a ‘safe and brave space’ to voice theirs. I believe that our overall human experiences are richer when we share, assimilate and integrate while maintaining our roots.

My initial medical training in India sensitized me to the critical role of social determinants of health in influencing health care access and disease risk. Working at a tertiary referral care hospital in New Delhi, I daily encountered impoverished patients presenting with very advanced stages of diseases because they could not afford medical care and they delayed seeking care until it was unavoidable. My subsequent work directing the first School of Public Health in Kerala re-emphasized the importance of social determinants of health and structural determinants of equity. Kerala is a beacon for ‘good health at low cost.’ The factors responsible for Kerala’s excellent public health metrics (such as very low infant and maternal mortality rates) include the high level of literacy, the empowerment of women, low levels of child poverty, and a robust network of community health centers that ensure easy access to preventive health care. Working in a developing country has strengthened my belief that diversity, equity, inclusion, and justice are foundational requirements for public health.

Service-related Contributions. As a mentor and a Section Chief, I have embraced mentoring of women, those with a different gender or sexual orientation, and those from a structurally disadvantaged and minoritized background. These experiences have enriched my growth as a mentor. As the Director and PI of two training programs (T32 and R38), I have built mentoring support groups for minoritized scholars within the Department of Medicine at BUSM. I have broadened my search and recruitment strategies of faculty, post-doctoral trainees, and resident scholars using a framework of an inclusive and diverse selection committee and a thoughtful process that prioritizes representation and weights life experiences in parallel with academic credentials. I am actively building relational connections with HBCUs and HSIs for this purpose. As part of an inclusive retention strategy, I advocate for the support, development, and advancement of staff, faculty, and trainees during their employment/training using a framework customized to their individual needs and expectations and informed by their background.

As the Principal Investigator of the Framingham Heart Study (FHS), I have ensured that participants from our modest-sized non-White cohorts are approached with respect, understanding, and recruitment staff who communicate with non-English speakers in their native language. Spanish versions of our consent forms and website facilitate this strategy. I have led efforts to ensure that all FHS data and biosamples requests include our non-White (Omni) cohorts. Researchers have to clarify explicitly if they deviate from our overarching policy of inclusivity. As a study-wide policy, we have assured the representation of biosamples from our non-White cohorts in TOPMed whole genome sequencing and omics-assays. The FHS team (staff and investigators) belong to a diverse group, and we have actively supported funding of diversity supplements.

Research-related Contributions. I have been working with NHLBI non-White cohorts for over two decades. I have co-authored twenty Publications using Jackson Heart Study data, which highlight the burden of cardiovascular disease in Black people. Seminal publications include the development of a cardiovascular disease (CVD) risk prediction score (PMC5115626) and an investigation of the natural history of preclinical heart failure in the cohort (PMC8200743); the latter underscored the substantial burden of preclinical cardiac remodeling in middle-aged Black adults. I am a multi-PI on an NIH grant (R01HL136266), collaborating with the Hispanic Community Health Study and mentoring junior investigators from this study. I am also a multi-PI on another NIH grant (R01HL143295) that returns genetic results (pathogenic variants) to participants in FHS and the Jackson Heart Study. I have advocated for building equitable approaches to returning genetic results to non-White people.

As a scientist, I have directly drawn attention to the importance of addressing health disparities and working towards health equity in my publications and national presentations. In a recent review in the journal Circulation on the future of cardiovascular epidemiology (PMID 34952676), I emphasized the critical need to evaluate and address social determinants of health as upstream mediators of race-related disparities in CVD. Earlier this year, I published a detailed in silico cohort study in a major medical journal (PMC4974092) that drew attention to substantial differences in predicted CVD risk for Black versus White adults with identical risk factor profiles using the AHA pooled cohort equations. I emphasized that these race-related differences in predicted risk were biologically implausible and raised the possibility that using these risk equations can result in racialized approaches to medical decision-making. I questioned the continued use of race as a term in the risk prediction algorithms because it can perpetuate race as a valid medical construct. I suggested (as a possible solution) that causal social determinants of health might be a reasonable substitute for the race term in these risk prediction equations. At a major BUSM CTSI symposium, I explicitly addressed the complex history of recruitment of non-White participants in FHS.

Recently, I designed and funded as the Principal Investigator a new cohort study called the Risk Underling Rural Areas Longitudinal Study (RURAL) to investigate cardiovascular health disparities in the rural Southeastern US. RURAL collaborates with sixteen institutions across the US led by a diverse team of investigators and funded by the NHLBI. RURAL has selected the most economically challenged rural counties in the Southern Appalachia, Mississippi delta, and the ‘Black belt’ to focus its research. One of the main research domains of RURAL is to evaluate structural urbanism in the rural South and investigate rural residence as a ‘meta’ social determinant of health. In its initial 3-year period, RURAL has obtained a diversity supplement and funding for two major ancillary studies led by non-White PIs.

In summary, I stand firmly committed to diversity, equity, inclusion, and justice as a core value of my professional and personal life.

• BU Research
• BMC Research
• NIH RePORTER Research

• List
• Timeline Graph
• Timeline Data