Diversity and Inclusion | Mount Sinai Today

Structural Racism and Coronavirus in NYC—What Will be the Toll on Maternal Health Equity?

May 8, 2020 | BFWHRI, Diversity and Inclusion, Women's Health

Racial-economic spatial polarization in NYC zip codes using data from the American Community Survey

In our study recently published in Health Affairs, we found stark differences between neighborhoods in New York City in incidence of severe complications during childbirth.

Twice as many women from poor black neighborhoods experienced a life-threatening complication during childbirth as women from wealthy white neighborhoods. Further, the harmful effect of living in a racially and economically segregated neighborhood was greatest among Black and Latina women. This disparity landscape is a feature of structural racism, shaping societal privilege and advantage, and we know now, maternal health.

Geographic disparities in positive COVID-19 tests in New York City were apparent in a map released by the New York City Department of Mental Health and Hygiene (NYCDOMH).

I was struck by the similarity of the COVID-19 map to the map of the measure of racial-ethnic spatial polarization I used in the recent Health Affairs study shown here. In the map pictured here, we display levels of extreme racial and economic segregation using a measure called the Index of Concentration at the Extremes (ICE), which is the proportion of poor black households relative to wealthy white households in a zip code. I did some quick data crunching, and found that the percent of positive COVID-19 tests in zip codes with the highest relative concentration of poor black residents was 50 percent (dark red zip codes), compared to only 34 percent in zip codes with the highest relative concentration of wealthy whites (dark blue zip codes).

As we connect the dots between structural racism, our severe maternal morbidity research, and the current coronavirus pandemic, the concern shared by many passionate about maternal health equity is, how might the current coronavirus crisis exacerbate these inequities?

In our analysis, we found that about half of the disparity between poor-black and wealthy-white neighborhoods was due to pre-existing health conditions, such as obesity, asthma, and hypertension, and that an additional third was due to the hospital where women delivered.

Over a decade ago, Philip Blumenshine and co-authors wrote that racial and economic disparities are likely to occur during an influenza pandemic because of differences in exposure to the virus, differences in susceptibility to severe disease, and disparities in treatment once the disease has developed.

Our study suggests that the excess chronic disease and lack of access to quality health care result in higher risk of severe maternal morbidity in racial and economically segregated neighborhoods. To the extent that these same mechanisms fuel the negative effects of the coronavirus or the economic and social impact of the epidemic, health care providers and policy-makers should be on high alert to support birthing women of color as the coronavirus pandemic moves into the next stage.

Teresa Janevic, PhD is an epidemiologist and a member of the Blavatnik Family Women’s Health Research Institute

Diversity Innovation Hub Is Launched With a Mission

Updated on Sep 1, 2023 | Community, Diversity and Inclusion, Featured

At the launch of the Diversity Innovation Hub: Dennis Charney, MD, center, and co-founders, from left, William Brown, Mary Sun, Ted Obi, Gary C. Butts, MD; Isaac Faith, Omar Njie, and Ann-Gel Palermo DrPH, MPH.

The Diversity Innovation Hub (DIH), a groundbreaking initiative of the Icahn School of Medicine at Mount Sinai, was launched with a symposium on entrepreneurship on Monday, October 14, at Davis Auditorium. The aim of DIH is “to connect the dots between innovation work and diversity and inclusion,” said Gary C. Butts, MD, Chief Diversity and Inclusion Officer, Mount Sinai Health System, and Dean for Diversity Programs, Policy and Community Affairs, Icahn School of Medicine at Mount Sinai.

“Our mission is, No. 1, to address the lack of inclusion of people of color and women in health care innovation,” said Dr. Butts, who developed DIH with a co-founding design team. “No. 2 is to figure out how best to use innovation and technology to address social determinants of health, especially in our surrounding community; and No. 3 is to accelerate our work in diversity and inclusion through innovation, through technology, and through design thinking.”

Dr. Butts thanked the founding team of DIH “for your curiosity, your creativity, and your boldness in all we intend to do.” They are Ann-Gel S. Palermo, DrPH, MPH, Associate Dean for Diversity and Inclusion in Biomedical Education, and Chief Program Officer, Office for Diversity and Inclusion; William Brown, Associate Director, Information Technology; Tanvir Islam, CEO and Co-Founder of the start-up Errunds; Icahn School of Medicine students Omar Njie, Ted Obi, and Mary Sun; Isaac Faith, a graduate student in Biomedical Science; and Kenechi G. Ejebe, MD, a 2019 graduate of the Icahn School of Medicine who is now Associate Medical Director of Wave Life Sciences in Cambridge, Massachusetts.

Keynote speaker Dhaval Bhanusali, MD, told attendees that as physicians and scientists they were well-equipped to find new solutions in patient care, saying,”If it doesn’t exist, build it.”

The keynote speaker of the launch event, Dhaval Bhanusali, MD, exemplifies the goals of DIH. Even as he was completing his residency in dermatology at the Icahn School of Medicine, Dr. Bhanusali was creating a digital health start-up. Later, as a clinician, he noticed that prices for some basic medications had skyrocketed and helped create Skin Medicinals, which allows physicians to prescribe personalized therapies at a low cost to patients. “If it doesn’t exist, build it. Sometimes there is no blueprint, so you must create it,” he told the nearly 200 attendees, who included faculty, staff and community members. He called their knowledge of science and medicine a “super-power” that they could use—if necessary with partners in business and technology—to have a great impact on patient health.

The event also featured women and minority entrepreneurs who discussed their solutions to health care disparities in a panel moderated by Mr. Brown. The panelists were:

Gil Addo, MBA, Co-Founder and CEO of RubiconMD, a telemedicine platform that allows specialists to consult with primary care physicians in underserved areas.
Ivelyse Andino, Founder and CEO of Radical Health, a local startup that helps patients in under-resourced communities negotiate the health care system.
Clayton Banks, Co-Founder and CEO of Silicon Harlem, a hub for start-ups that has attracted $50 million in investment to Upper Manhattan.
Tanvir Islam, Co-Founder and CEO of Errunds, a platform that addresses the issue of “food deserts” by using artificial intelligence to connect shoppers in under-resourced neighborhoods with brick-and-mortar businesses.
Sarah Pesce, ANP-BC, MSHCDL, Chief Operation Officer of Mount Sinai Lab 100, a clinic and research laboratory that provides patients with personalized health data that empowers them in staying well.

In the first phase of its efforts, DIH is providing mentorship, training, and networking opportunities for students and staff. On Wednesday, January 22, 2020, it will hold its first Pitch Day, in which participants will be invited to develop solutions addressing social determinants of health. In the spring, DIH will launch a fellowship program in entrepreneurship and technology for Mount Sinai medical and graduate students who are women or in underrepresented minority groups. In a second phase, the most promising ideas developed by DIH members will come to fruition through pilot projects.

DIH is partnering with national leaders in innovation and technology, as well as business and entrepreneurial leaders in East and Central Harlem, including One Hundred Black Men, Inc. of New York and Silicon Harlem. “To close long-standing gaps in health care, we all need to innovate—and we need to engage local stakeholders in the process,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System.

View more information on the Diversity Innovation Hub.

From left, panelists Clayton Banks, Chief Executive Officer, Silicon Harlem; Sarah Pesce, ANP-BC, MSHCDL, Chief Operating Officer, Mount Sinai Lab 100; Tanvir Islam, Chief Executive Officer, Errunds; Ivelyse Andino, Chief Executive Officer, Radical Health; and Gil Addo, MBA, Chief Executive Officer, RubiconMD, and keynote speaker Dhaval Bhanusali, MD.

Ted Obi, right, a student at the Icahn School of Medicine at Mount Sinai and a co-founder of DIH, with Scott L. Friedman, MD, Dean for Therapeutic Discovery and Chief of the Division of Liver Diseases, Icahn School of Medicine, and leader of the SinaInnovations conference.

Mount Sinai faculty, staff, and, and students networked with local entrepreneurs and business leaders.

The mission of DIH is to “connect the dots” between innovation and diversity and inclusion, says Gary C. Butts, MD, Chief Diversity and Inclusion Officer, Mount Sinai Health System, and Dean for Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine.

Partnership Supports Veterans in Civilian Careers

Nov 5, 2019 | Community, Diversity and Inclusion, Featured

Roger Braman, RN, BSN, second from right, with veterans, from left, Anit Shrestha, Jonathan Duchnowski, and Kevin Lama.

The Mount Sinai Health System recently partnered with Workforce Opportunity Services (WOS), a leading nonprofit that is dedicated to recruiting, training, and placing underserved and veteran job seekers into long-lasting civilian careers. Through the organization’s WOS On Demand program, veterans Jonathan Duchnowski, Kevin Lama, and Anit Shrestha were recruited and placed in various roles within Mount Sinai’s Department of Information Technology (IT). Prior to joining this program, they struggled to find gainful employment opportunities as they transitioned from the military to civilian life.

“The Workforce program gives us a great opportunity to give back to those who have served in the military protecting our country,” says Roger Braman, RN, BSN, Senior IT Director of Infrastructure Project Management, who leads the partnership at Mount Sinai.

Using a scientifically based model derived from research conducted at Columbia University, the program recruits, educates, trains, and then places high-potential candidates at leading organizations around the world that are committed to diversifying their workforces. Key to the effort’s success, says Mr. Braman, is “the additional support and training that the candidates receive, both from the WOS program and Mount Sinai, to allow them to build on the valuable skills they learned in the military and help them to transition to the civilian workforce.”

For example, Mr. Duchnowski, who served in the military from 2000 to 2006 as a Nuclear Propulsion Plant Machinist’s Mate and Engineering Laboratory Technician, completed his BA in 2018 and was looking for work in health care or in a biological lab when he found a position at Mount Sinai through WOS. He says, “I was contacted by one of their team members who also happened to be a Marine. He explained what WOS was all about, and I was immediately hooked.”

Mr. Duchnowski, who currently works in Infrastructure Project Management as the Infrastructure Project Coordinator, spent three weeks in general business professional development, as well as in focused Project Management training modules as part of the WOS program to prepare him for the Mount Sinai job. “I wanted to work for an organization trying to heal and help people, and I always wanted to work with IT, as well, so this fits both of those desires,” Mr. Duchnowski says.

Mr. Braman says, “All of the participants are really motivated and eager to learn and have quickly been able to integrate themselves into the teams to which they have been assigned.”

Interns Introduced to Health Administration Careers

Oct 21, 2019 | Diversity and Inclusion, School

More than 50 high school, college, and graduate students from underrepresented backgrounds gained valuable exposure to careers in health care and medicine this summer in administrative internships spearheaded by the Mount Sinai Office for Diversity and Inclusion (ODI). Departments across the Health System sponsored a wide range of experiences in fields including ambulatory care, hospital administration and operations, supply chain management, finance, development, digital and social media, information technology, and real estate services and facilities.

ODI supported the internships through partnerships with organizations including America Needs You; the All Stars Project, Inc.; CUNY Summer Corps; the Greater New York Hospital Association; the Institute for Diversity and Health Equity; the New York City Department of Education’s Career and Technical Education Industry Scholars Program; and Prep for Prep. “We are grateful for our internal sponsors and external partners, which allow us to expand opportunities for the next generation of health care leaders,” says Shana Dacon, MPH, MBA, Director, Corporate Health System Affairs, Office for Diversity and Inclusion.

ODI also introduced LGBT-identified youths to careers in health care in the second year of its Lesbian, Gay, Bisexual and Transgender Young Queer Urban Teens for Health in Medicine program. “In addition to year-round outreach events, we were able to welcome 18 LGBT students and allies to this year’s ‘Saturday at Sinai’ event on April 27,” says Edgar Vargas, MPH, LMSW, LGBT Program Manager, Office for Diversity and Inclusion.

Ive Chowdhury, a Bard High School student, participated in the one-day program and completed a summer internship with ODI. “This has been such a rewarding experience,” she says. “I enjoyed speaking to medical students, meeting new people, and seeing health care from a different perspective.”

Learn more about Diversity at Mount Sinai

Mount Sinai Is Taking the Lead in Transgender Medicine

Oct 7, 2019 | Diversity and Inclusion, Featured

In “Born to Be,” a documentary about the Mount Sinai Center for Transgender Medicine and Surgery, its Director of Surgery, Jess Ting, MD, center, headed for an operating room with Adriana Macias, RN, and patient Mahogany Phillips.

The Mount Sinai Center for Transgender Medicine and Surgery (CTMS) in three years has become a world leader in the care and support of transgender people, a journey that is the subject of Born to Be, a documentary that premiered on Saturday, September 28, at the 57th New York Film Festival.

“CTMS has treated 2,500 transgender patients since it was founded in 2016 and performed 1,200 ‘trans-related’ surgeries, such as facial feminization and genital reconstruction,” says Joshua Safer, MD, Executive Director of the Center for Transgender Medicine and Surgery, and Professor of Medicine (Endocrinology, Diabetes and Bone Disease), Icahn School of Medicine at Mount Sinai. The Center also offers services in primary care, physical therapy, endocrinology, behavioral health, and social work that are uniquely comprehensive.

Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery.

“The one thing that transgender people have in common is that their gender identity is not aligned with the physical anatomy that we see,” Dr. Safer says. “But there is great variability in what they want to do about that, and we think patients should have customized choices, just like treatment for any other medical circumstance.”

The new documentary, directed by Tania Cypriano and produced by Michelle Hayashi, focuses on five patients seeking to transform their lives with surgery performed by Jess Ting, MD, Director of Surgery, Center for Transgender Medicine and Surgery, and Assistant Professor of Surgery (Plastic and Reconstructive Surgery), Icahn School of Medicine at Mount Sinai. They were a varied group, including a self-described survivor of the 1980s drag ball culture, a young professional, and a former model. One patient seemed to speak for many in describing life before the surgery. “You are fighting every day,” he said. “You are fighting to be respected, you are fighting to be comfortable in your own skin.”

The film depicts CTMS in its early days, when Dr. Ting was just transitioning into his role. Since then, Dr. Ting created the nation’s first transgender surgery fellowship and hired the first two graduates of the program. “One new surgeon is coming out of this program every year,” Dr. Ting says. “Over time, we will be able to multiply our expertise and our ability to address health care disparities for transgender patients.”

CTMS has also added two luminaries in gender-affirming surgery: Marci Bowers, MD, a San Francisco-based pioneer in vaginoplasty, and Miroslav Djordjevic, MD, PhD, a specialist in female-to-male genital surgery who leads the Belgrade Center for Genital Reconstructive Surgery in Serbia. Both teach and practice at Mount Sinai several times a year. “These collaborations build upon an already strong program and make CTMS a world leader in gender-affirming surgery,” Dr. Ting says.

Miroslav Djordjevic, MD, PhD, left, and Marci Bowers, MD, two leaders in gender-affirming surgery, are collaborating with the innovative team at Mount Sinai.

In other innovations, CTMS created the first psychiatric fellowship in transgender medicine, and is now training its second fellow. In addition, all endocrine fellows and plastic surgery residents rotate through the transgender program, making Mount Sinai one of the only centers to incorporate the care of transgender and nonbinary patients into its physician training curriculum.

These fellowships are part of the larger mission of CTMS, to provide guidance in a field that is at a crucial “inflection point,” Dr. Safer says. “Until a few years ago, the universe of trans surgery has been really ad hoc,” he says. “The better-known surgeons in North America operated out of freestanding surgery centers, because conventional medical centers would not let them use their operating rooms.” Medicare specifically banned coverage for transgender procedures, and patients paid out of pocket. But in 2015 the government reversed its policy, leading many states—including New York—to obligate private insurers to provide coverage of transgender procedures. This has made such treatment affordable for many more patients, and transgender medicine is rapidly expanding to meet the demand.

Leveraging its resources as a large academic medical center, Mount Sinai is taking the lead in efforts to elevate and standardize important aspects of patient care, including the training of nurses, physical therapy for patients undergoing genital surgery, and the pre- and postsurgery process. To create a national conversation on best practices, CTMS held the first Live Surgery Conference for Gender Affirmation Procedures in spring 2018, co-sponsored by Mount Sinai and the World Professional Association for Transgender Health (WPATH), the leading professional and educational organization for transgender health care. The second such conference, in spring 2019, held panels on social and ethical issues in transgender care and featured live surgeries by experts, including Dr. Ting, Dr. Bowers, and Dr. Djordjevic.

CTMS plans another conference in spring 2020 focusing on medical issues such as perioperative care and adolescent health. “CTMS has become a national model for providing a full-service and integrated system of affirmative patient-centered care, accessible to all transgender and nonbinary patients,” says Barbara Warren, PsyD, Director, LGBT Programs and Policies, Office for Diversity and Inclusion, Mount Sinai Health System. “It also serves as a much-needed resource for educating the next generation of health care providers in culturally and clinically competent care.”

David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, who was a driving force in creating CTMS along with Dr. Warren, says: “In so many areas of medicine, we tend to be competitive. In gender affirmation surgery and transgender medicine, however, we need to think broadly to support a community that has for so long been underserved. Our mission and our vision is to bring the care of the community to the next level by sharing our expertise.”

At a screening of the documentary “Born to Be” at the 57th New York Film Festival, from left: the film’s producer, Michelle Hayashi; patients Garnet Rubio and Jordan Rubenstein; Jess Ting, MD, Director of Surgery, Mount Sinai Center for Transgender Medicine and Surgery; patient Mahogany Phillips; and the film’s director, Tania Cypriano.

Study Finds Distress Among Children in Immigrant Detention

Sep 24, 2019 | Diversity and Inclusion, Featured, Psychiatry, Research

The research team from the Icahn School of Medicine at Mount Sinai included, from left, Priscilla O. Agyeman, MPH, research coordinator, Division of Liver Diseases; Principal Investigator Craig L. Katz, MD; and Sarah MacLean, third-year medical student.

Mount Sinai researchers found that children being held in an immigration detention center experienced high levels of mental health distress, with 44 percent demonstrating at least one significant emotional or behavioral symptom. The report was the first large, empirical study examining the mental health of children in U.S. immigration detention, says the Principal Investigator, Craig L. Katz, MD, Clinical Professor of Psychiatry, Global Health, and Medical Education, Icahn School of Medicine at Mount Sinai.

“Perhaps our findings should not really be a surprise,” says Dr. Katz, who considers the study a valuable baseline for further research. “Kids who had been previously separated from their parents had higher rates of emotional problems, compared to those who were always detained with a parent. And the detained children overall had higher rates of distress compared to the general population in the U.S.”

The research team from Mount Sinai spent two months in summer 2018 at a detention center in the Southwestern United States. speaking to women and children, most of whom had fled Honduras, Guatemala, or El Salvador. The researchers were not allowed to use telephones or take photographs while interviewing the families in a visitation trailer. The study was published in June 2019 in the journal Social Science and Medicine.

The mothers told stories of escaping gang violence or domestic violence in their home countries, where government and police officials often turned a blind eye. The team interviewed 425 women about their eldest child, using the standard Parent-Report Strengths and Difficulties Questionnaire. Among those 425 children, 32 percent had elevated scores for emotional problems, and the rate was 49 percent for those who had previously been separated from their parent. A subset of 150 children who were age 9 or older also completed the UCLA Post-Traumatic Stress Disorder Reaction Index. Seventeen percent of those children had a probable diagnosis of PTSD, compared with 4.7 percent in the general population of U.S. children.

“Children with emotional distress showed symptoms like wanting to cry all the time; problems with conduct, such as fighting with other kids or having temper tantrums; and peer problems like not having a lot of friends or only wanting to interact with adults,” says Sarah MacLean, lead author of the study and a third-year medical student at the Icahn School of Medicine who was part of the field team. “The children with symptoms of PTSD reported having flashbacks or nightmares about a trauma, or feeling depressed or sad.”

The field research for the study was conducted by Kim A. Baranowski, PhD, Associate Director of the Mount Sinai Human Rights Program; Priscilla O. Agyeman, MPH, a research coordinator in the Division of Liver Diseases, Icahn School of Medicine; Ms. MacLean; and Joshua Walther, a fourth-year medical student at the University of Texas Health Science Center in San Antonio, Texas. Authors of the report were the field team; Dr. Katz; and Elizabeth K. Singer, MD, MPH, Assistant Professor of Emergency Medicine, and Medical Education, Icahn School of Medicine, and Director of the Mount Sinai Human Rights Program.

Dr. Katz hopes to expand on the research, which had certain limitations. The subjects were a “convenience sample,” meaning they were the families who were accessible for interviews in the center’s visitation trailer, as opposed to a randomly selected sample. Because of the setting, some mothers completed the forms in their child’s presence, which may have influenced their responses.

The study also could not pinpoint the cause of the children’s distress, whether it was detention, or the journey to the U.S. border, or the violence they faced in their home countries, says Dr. Katz, who is also an Associate Director of the Mount Sinai Human Rights Program. Regardless of the cause, the study concluded that the children “would benefit from culturally responsive and trauma-informed mental health care.” Dr. Katz says that ideally, the mothers and children would receive appropriate psychiatric support once they settle into a community. “But even if they don’t get psychiatric help, social support helps,” he says. “Making sure people have clothes, a backpack, a phone, know how to take a bus. That support is going to make an enormous different in the trajectory of their recovery.”

Despite their higher rates of emotional distress, 98 percent of the children studied had normal scores on the “prosocial” scale, which included being considerate of other’s feelings and volunteering to help others. The team found signs of hope and humanity at the center, a broad expanse of trailers surrounded by a barbed wire fence. One boy from Honduras drew a picture and shyly presented it to Ms. Agyeman, and she intends to keep it forever. “The picture gave me a bittersweet message,” she says, “that a little boy can do the things any other kid would do, laughing and playing, even in an otherwise very sad environment.”

Listen to a Road to Resilience podcast on the Immigrant Detention study.

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