It’s the story of a Black man in Dr. Marcella Nunez-Smith’s own community of New Haven, Connecticut, that illustrates why she is so determined to bridge racial health disparities.
The man had been living with chronic diseases, including diabetes, and was on dialysis. He used a wheelchair to get around.
When he developed a fever and shortness of breath last April, he tried to get tested for Covid-19, Nunez-Smith said, without success.
Within 24 hours, he was dead. Tests later confirmed he did, in fact, have SARS-CoV-2, the virus that causes Covid-19.
“It struck me very deeply,” Nunez-Smith said. The image of the man and his loved ones trying to get help for him has stayed with her.
“If you think through the steps of getting to an emergency department, for someone who needs a wheelchair for mobility, to say, ‘We think he’s really sick,’ and then not get care,” Nunez-Smith said, her voice falling. “How did the system fail him?”
It is now Nunez-Smith’s job to fix the system for disadvantaged communities in America. She’s taken on the challenge as the director of the White House’s Covid-19 Health Equity Task Force.
“A system under pressure or under stress,” she said, “will fail faster for some than for others.”
“A God-given gift”
Nunez-Smith grew up in the U.S. Virgin Islands, a place that she said had an inordinate number of people affected by preventable conditions.
Her father was one of those people: He had uncontrolled high blood pressure, which caused a stroke in his 40s. He was left paralyzed.
Nunez-Smith lived with her mother and maternal grandmother on the island of St. Thomas. She was highly influenced in particular by her mother, Maxine Nunez, a registered nurse who graduated from Johns Hopkins University with a doctorate in public health.
While raising her only child, Nunez taught at the University of the Virgin Islands. As a kid, Nunez-Smith would read the health-related textbooks her mother used to teach her university students.
The pair traveled widely, particularly in Europe, to explore the islands’ Danish history, Nunez recalled.
“I remember one time we were on a bus, traveling from country to country, laughing and having a good time,” Nunez said. “People would actually come up to us and say, ‘I have to visit you for a while because you are having too much fun.'”
Nunez describes her daughter as outgoing and passionate about others. “She just has a way with people, a level of understanding and empathy.”
“She can go into any circle and feel comfortable,” Nunez said. “It’s a God-given gift.”
“You have to show up”
Nunez-Smith left the Virgin Islands after high school. She attended Swarthmore College in Pennsylvania, then Jefferson Medical College in Philadelphia, now Sidney Kimmel Medical College, where she earned her medical degree.
It was around this time that she saw first-hand the racial and ethnic disparities in the health care system.
Nunez-Smith focuses her research on “promoting health and health care equity for structurally marginalized populations,” according to her biography at Yale University, where she’s an associate professor of internal medicine, public health and management.
This does not mean Nunez-Smith sits in an office at Yale doing research — far from it. She collaborates directly with communities.
“You have to show up. You have to listen. You have to learn. And you have to be humble with equity work,” Nunez-Smith said. “Communities are the experts in what they need.”
Dr. Julie Morita, executive vice president for the Robert Wood Johnson Foundation, worked with Nunez-Smith as part of the Biden administration’s transition team. She said she is “thrilled” about Nunez-Smith’s appointment as head of the administration’s health equity task force.
“Her presence in the White House right now is a clear indication of how health equity is being prioritized.”
“We’re losing our neighbors”
Covid-19 tops Nunez-Smith and her team’s agenda. The pandemic has hit communities of color particularly hard. The Kaiser Family Foundation reported that Covid-19 death rates among Blacks were double those of white Americans.
“We can easily get so blind to the numbers, but we’re losing our neighbors,” she said. “We’re losing loved ones, and we’re losing potential in our communities.”
Her approach is two-pronged. First, a reckoning. “Why is this so predictable? Why weren’t my colleagues able to predict the disparate impacts that we now see in the pandemic?”
The second, she said, is disruption. “How do you then go about disrupting the predictability of who is always going to get hardest hit?”
The task for her team is monumental. “We have a complicated intersectional web that we are now coming to understand better. Structural racism is real.”
Still, Nunez-Smith said she feels optimism and hope when she looks at her three young children.
“I imagine a future for our children and their peers, where they look back at this time with historical interest, like: ‘Oh my goodness, can you believe the pandemic ravaged communities differently? That would never happen now!'”
“That’s what I want them to inherit,” Nunez-Smith said. “I want our task force to work ourselves out of a job.”