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Q&A: UNC Health's newest equity director talks about how to drive systemic change

Dr. Nicole Mushonga is the UNC Health executive director for Health Equity.
UNC Health
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Dr. Nicole Mushonga is the UNC Health executive director for Health Equity.

Earlier this month, UNC Health announced Dr. Nicole Mushonga as its executive director for health equity.

She came to UNC from Wake County Health & Human Services, where she led their public health division as the interim medical director of public health & epidemiology director. In her role, she will lead health equity efforts across the system, and aim to help create a more equitable experience for all patients.

Dr. Mushonga sat down with WUNC health reporter Jason deBruyn. The interview has been edited for length and clarity.

Health equity. What does it mean for UNC? What does it mean for you?

It's ensuring that everyone regardless of your background, regardless of your location, your accessibility status, that you are able to truly access the quality care that you need, when you need it.

I think it's pretty well established that hasn't always been the case in the health care system, even at UNC. Talk about some places where both the health system in general, or even UNC specifically, has fallen short of those equity goals.

I would say that we've seen this nationally, and more so through the pandemic, really having a spotlight on a lot of the inequities that are faced by certain members of our population. But there's an opportunity here. We've seen through the pandemic we can build collaboration and partnerships to really have an impact. Consider mobile vaccination. Over 67% of the population that was vaccinated through mobile vaccination events were African American or Latinx populations.

But on vaccinations, especially early on, it was the white populations that were vaccinated before Black and Latino populations. Even in 2022, we're still seeing some of these inequities, right?

So you use the data. And it's important that when you see that there are those inequities, you course correct, you find ways to address those needs. So if you're using one particular method, and it doesn't seem to be working, and we're seeing that there's another population that's being left behind, how do we improve that? And that's where you have those strategic sessions to find ways to really focus on those populations.

Among populations of color, there's been a historic distrust in healthcare writ large, and much of that is frankly warranted. How can you — specifically in your role — try to alleviate some of those long standing and very accurate concerns that people of color have about the health care system in general?

Firstly, listening. Listening, understanding where people are coming from, why they have those concerns, and sharing educational information resources. And connecting with people where they are, and connecting with them in places that they feel safe and that they feel are trusted places. And sharing evidence-based information and resources, based on the needs that they've identified.

Addressing the needs part is what I really want to focus on. I think people of color would say, "Listening is great. We're glad you're listening. But it's that action part where it feels that the health system falls short." There are historic examples, but even today, women of color face worse outcomes during pregnancy and childbirth. How can you go from listening to actually following through and actually making a change?

That's what our department is here for and supporting the entire system. I'd like to share for a moment that I'm a Black woman. I have a four-year-old daughter, and I can remember almost five years ago, being afraid. Knowing the statistics that as an African-American woman, regardless of my education, my background, my knowledge, even being a physician, I still had a higher likelihood and a higher chance of having either complications or — potentially — death from delivering my child. I knew that there were ways that I could try to help prevent that by finding a physician that that looked like me. But women shouldn't have to live in that fear. They should not have to go through that and make those types of decisions.

I'd say that one of the things that really stands out about UNC Health is that they have provided the support to develop a department of equity and inclusion that is addressing health equity across the entire system. To implement things that actually help drive that needle and decrease the disparities from what we're seeing between our African American or Latinx populations, when compared to our white populations in the community.

I'm not going to guess your age, but you said that you have a four-year-old child. So you're still relatively young. I'm curious if you've seen perhaps any generational differences in mistrust in the health system? Perhaps people of color who are a little bit older have a higher level of distrust?

I can't say that for sure that that I know of any specific differences between generations. But I think what's important is that we continue to look at the needs of our community and the needs of our patients, and really work to address those as we see them. I've said that this is a prime opportunity for us. Unfortunately, the pandemic has shone a light on these needs, that for years, people have been talking about. Talking about diabetes, talking about hypertension, talking about the increasing needs of some individuals with food insecurity, economic insecurity. And how do we as a health system address that? Part of that is thinking strategically, and finding ways for us to partner and collaborate with community partnerships, community based organization, public health departments. Really working together. This is not a problem that can be solved by a single institution. It's going to take lots of collaboration and lots of partnership.

But certainly one institution, particularly the size of UNC, can help to drive that conversation.

Absolutely. What really stood out to me about UNC, and particularly this opportunity, is the ability to be able to have those resources to connect with the community across the entire state of North Carolina. We're going from rural areas to urban areas, and everywhere in between. There's an opportunity there for us to truly make an impact.

The COVID-19 pandemic exposed inequities. And it occurs to me that if the provider community had done a better job building trust with patients over the past two decades, then some of the important information about fighting COVID-19 would have worked its way through these communities better. How can you improve that trust so that when the next major public health crisis happens, the outcomes are more equitable?

Part of that is looking at the method in which some of that information flows. We had to use various channels to communicate and especially use trusted messengers. Really educating those individuals in the community that are trusted to share that message with other community members.

UNC is a big institution, and as you said, you're just one person, your department is just one department. How can you and your department affect change? Not just in the long term, but really in the near term? What are some of your goals that you're setting for even just six months or 12 months from now?

So we are definitely developing that plan. Because it's so important for us that we are able to really infuse equity and inclusion across the system. Part of that includes growing up our department and growing in more positions, and also being strategic about the work that we're doing. And it also requires collaboration. That's really the key. We're one department, but what we're able to do is provide resources, provide guidance, provide education that can then be spread throughout the system, and allow that to be able to support that work and continue that work across the system.

What sorts of assurances or support have you felt from top leadership that if you make proposals, or even shine a light back on them and say, 'Here's maybe something leadership needs to change,' that it will be received with open ears?

Our leader for our department, Dr. Audrea Caesar, reports to (UNC Health CEO) Dr. Wesley Burks. That's important. Having leadership from the top that supports the work that we are doing, and supports the efforts that we are taking is important. There's a leadership that understands this is a priority for the system. This is the foundation upon which we are building the work and it has it has felt very much supported.

Nothing in life is without roadblocks. What sorts of roadblocks do you anticipate, or perhaps are you already seeing, as you're trying to implement some of your work?

What's important is that we take a very strategic approach into how we address the needs. And really, how we address equity across the system. I can't say that I've run into any roadblocks. Everyone has been really supportive, very interested and engaged. And it's going to take partnership, it's going to take partnership across the system,

If not roadblocks, what do you anticipate might be some of the hardest parts of your job or implementing what you would like to see happen?

I can't say that I have anything right now. But I want to say that across the system, each location will have their own needs. There might be rural areas, there might be urban areas, specific needs that are different. And so really, I think it's going to be important for us to be able to have a plan that's adaptable to the needs of each of those hospitals within our system.

Jason deBruyn is the WUNC health reporter, a beat he took in 2020. He has been in the WUNC newsroom since 2016.
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