Keishi Foecke
As part of a long line of Haitian educators, physicians, and activists, Dr. Rachel Villanueva always knew she wanted to follow in her family’s footsteps. She quickly gravitated toward medicine and became a practicing OB-GYN and then expanded into education as a Clinical Assistant professor at NYU Grossman School of Medicine.
In 2021-2022, Dr. Villanueva served as the 122nd president of the National Medical Association, the country’s oldest and largest professional organization representing more than 50,000 Black physicians and their patients. Through her clinical practice and service as a physician-advocate, Dr. Villanueva works to create meaningful change at both the patient and population levels.
As our nation observes Black History Month, we sat down with Dr. Villanueva to discuss health disparities, health equity, and Black women’s health.
Please note: This interview has been edited for brevity.
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Reservoir: As a physician-advocate, you’ve dedicated your career to promoting health equity. What does that look like in your day-to-day practice as an OB-GYN?
RV: I’m a full-time clinician seeing patients from all different ethnicities and backgrounds, so I’m a very strong advocate for women’s health and rights on both the micro and macro levels. On the micro level, I see patients full-time, taking care of the preventive and reproductive health needs of women across their lifespan. Many women are coming to me because they feel unheard and undervalued, which makes sense given the history of treatment of Black women in our health care system. Currently, the U.S. has the worst maternal health outcomes of any industrialized nation; socioeconomic status and education do not protect Black women from these outcomes. As a result, many women are looking for a provider who looks like them, and research shows that patients do better – they’re more compliant with treatment plans, have better interactions with providers and have better health outcomes – when they see a provider with similar identities to their own.
More broadly, I believe that we must center health equity on the macro level through policy and advocacy. This can look like many different things, from supporting legislature like the Momnibus Act, promoting fibroid research and education, and amplifying the need for the diversification of not only the physician workforce, but also the overall health care workforce.
Reservoir: Black women in the U.S. continue to face disproportionately poor health outcomes, including around reproductive health. What are some of the roots of these disparities, and what steps can we take to remedy them?
RV: For Black people in the U.S., even if you do everything “right” in terms of your health, you’ll likely still have worse health outcomes, and that’s not by happenstance. Rather, it’s due to longstanding systemic and structural inequities and factors that are entirely outside your control. Policies that have historically disadvantaged minoritized communities influence the social determinants of health (where people live, work, and play), such as individuals’ access to green spaces and exercise, to nutritious foods, their home environment, their stress level, and their hospital access.
To remedy these disparities, we must remember that these systems are entrenched in society, in politics, how laws are made, in health care, in education, how and where we train physicians, and how patients are treated. We must bring health care back to respecting our patients, doing no harm, and doing what’s best for the patient given their unique situation. Equity must be valued in terms of quality. Unfortunately, our current health care system is one that prioritizes taking care of illness, rather than focusing on preventive care. We must incorporate individual patient needs and their own social determinants of health, and endeavor to improve their health outcomes. People need to be able to trust in our health care system and more importantly in their individual provider. An important piece of this is having a health home, a provider who knows you, your family history and individual risks, and works to create a preventive plan for your best health.
Reservoir: As the past president of the National Medical Association (NMA), you led the largest national organization representing Black physicians. What are some of your key takeaways from your experience leading NMA?
RV: Being the president of the NMA was an incredible experience, and I’m continuing much of my work, especially in health equity and diversity. The overarching theme of my year was that organizations like the NMA are still relevant and matter. Black organizations still very much need to exist. NMA started when Jim Crow laws were still in place, and individuals of color got “separate but equal” care, which was not equal and often substandard. NMA was founded so that patients could be treated and get good care, and Black physicians could practice and thrive in their communities. Those goals remain true today.
Diversifying our workforce is a big part of that, and NMA strongly supports that vision. Only 5% of physicians in the U.S. are Black, while Black people represent nearly 15% of the population. Over the last 40 years, we’ve increased the amount of overall minority physicians by only about 2%, even though minoritized populations will make up more than half of the U.S. population in a few decades. We need organizations whose core mission and foundation are diversity to remain viable. NMA’s work to promote diversity in research, clinical trials, and leadership is crucial, and NMA continues to play a critical role in supporting Black physicians and patients.
Reservoir: What does Black History Month mean to you, and what should it mean to the health care industry?
RV: Black History Month is always a great time to celebrate accomplishments, the diversity within the Black diaspora, and how united we are even though we come from many different backgrounds even within the U.S. There’s such richness in that diversity, but so much commonality as well.
Black History Month is a special time for us to highlight positivity within our community, but it’s also important to remember our struggles and adversity that continue to fuel the work that remains for us to do. Black history is American history. We must continue to elevate, educate and promote our contributions, and protect them from being erased from our country's history. While some aspects may be difficult to acknowledge, we can't minimize or ignore their impact on our culture or society. It's a time to recognize and value the power in unity and re-energize for the future.
Reservoir: How do you stay motivated to do this work?
RV: Racial health disparities are not only persisting but are even widening. Most recently, COVID highlighted this fact, and the worsening Black maternal mortality crisis continues to be a painfully a glaring example. I stay motivated by the basic reason I chose to become a physician, to help people. I stay motivated because I believe that it’s unacceptable to allow people to suffer from preventable issues, and to die preventable deaths. I stay motivated because these are not just statistics of poor health outcomes, these are my friends, my family and my community. We need to come together as a society to address health inequities.
I’m very encouraged that there are so many groups addressing these problems from so many different angles nowadays. Many organizations are looking to address social determinants, policy, and holistic care. There’s a groundswell of groups and individuals, from tech to payors and providers, attempting to address health equity in a meaningful way, so hopefully that continues and isn’t just of the moment. I’m excited that we’re moving the needle in the right direction.