As a child growing up in Queens, John Rich, MD, MPH, learned how poverty and racism affected the health of patients treated in his father’s dental practice. Decades later, those inequities are still entrenched in our national health care system, and Rich is eager to continue confronting these disparities in his role as the Harrison I. Steans Director of the RUSH BMO Institute for Health Equity.
We had a conversation with the physician, researcher and MacArthur “Genius Grant” winner on why he has focused his efforts on improving health equity, particularly for young men of color. In this interview, he also presented his vision for the Institute, which was launched in 2021 to coordinate the broad range of health equity initiatives across RUSH and the communities it serves.
What early experiences growing up in Queens helped you understand the nature of health disparities?
My mother was an elementary school teacher, and my father was a dentist who practiced in Corona, an economically stressed neighborhood in Queens. Most of his patients were people of color, often members of the Ebenezer Baptist Church where we went on Sundays, and many from the community. Many of his patients were also poor or working class, without insurance. Still, he cared for them, though he wasn’t always sure when or how he was going to get paid.
Even though my father had achieved a high level of education, he was practicing in a world that was rife with not only structural racism but also the day-to-day stress of delivering needed care in a system that was not really built for the patients that he was seeing.
Did you know at a young age that you wanted to be a physician?
Not at first, although my father’s dedication to his patients was always in the back of my mind. In college, I thought I wanted to be a psychologist or a psychiatrist. When I went to medical school at Duke, I was drawn to internal medicine, especially primary care. In the South, I was reminded that poor people and people of color didn’t have access to health care in the same way that I did growing up. And it was not much different in Boston, where I went for my internship and residency at Mass General. There, too, I found communities where families had lived for generations and yet were cut off from the city’s resources.
What came next in your early career as a physician?
After I finished my residency, I completed a fellowship in general internal medicine and earned my master’s degree in public health at Harvard. I took my first job at Boston City Hospital, now Boston Medical Center, in 1989, during the HIV/AIDS epidemic, which was disproportionately affecting people of color and poor people. I cared for patients in the HIV/AIDS clinic at a time when we had no effective treatment. I also worked in primary care.
During this period, there was also an epidemic of violence in Boston and in most cities across the country. I wanted to better understand what it was about violent injury that made it a recurrent cycle. I began interviewing young patients who had been victims of violence to understand not only how they came to encounter violence but also how they moved on from it and healed.
What did you learn from talking with young victims of violence?
It really enlightened me about the biases against these young people. Young people of color who are victims of violence are often treated as though they are perpetrators. In medicine, providers still make distinctions between people they think are virtuous and people they think are not, which is the basis of many other disparities.
What I learned became the basis of my book, Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men. I wanted to share their stories but also how their stories changed me.
How did their stories change you?
They helped me see more complexity in many issues. Many young people have suffered physical and emotional trauma, having lost friends and family to violence or suffered brutality at the hands of the police. And young people of color have suffered from significant racial trauma. I believe that trauma drives the cycle of violence, and that many young people who have weapons take up those weapons because they feel both physically and psychologically unsafe. They also live in a world where they don’t believe that the police will protect them. This becomes a cycle.
How does this cycle of violence relate to health equity?
When young people don’t have access to primary care, they turn to whatever is in their environment to ease their pain and distress. In many cases, that’s cannabis. This can cut them off from legitimate employment if they have drug tests, so they find some other way to make money, which may include illicit activities. If they get arrested, they are further cut off from opportunity.
We need to change how we think about these issues. Until these young people are safe, none of this is going to change.
When I was in Boston, one of the programs I built to help address this problem was the Young Men’s Health Clinic. To this day, the clinic offers a place for young men who have been victims of violence to receive primary care, including treatment for the psychological wounds of trauma.
Do you see any parallels to the violence that is happening now in American cities and the epidemic of violence in Boston when you first began your career?
I do. Back then, much of the violence was related to crack cocaine, but it was not the only factor. It also had to do with social policy.
We know that social determinants are responsible not only for violence but also for chronic disease and early death. Ultimately, we need to partner with communities to not only address violence but also the root causes that include structural racism, discrimination in education and in the workplace, lack of opportunity and poverty.
For years, RUSH has been a model for this type of partnership through initiatives like West Side United, a network of community-based organizations, religious institutions, social service groups, government agencies and residents, that aims to improve the health of West Side neighborhoods.
Throughout your career, you have addressed health inequities by building programs that engage young men of color, such as by training them to work as community health workers. Why focus on them?
These young men possessed tremendous wisdom, compassion and a desire to create change. It made sense to provide career paths for these young men so they could avoid the cycle of poverty by having a path into health careers. We trained them to help others navigate the health care system. But they also began to identify issues in their neighborhoods that could be addressed in positive ways. They understood that health wasn’t only about care, it was also about the environment.
Rather than thinking about these young people as problems, we ought to be thinking about them as our greatest asset in addressing many of the health equity problems that we’re facing.
That work helped you earn a prestigious fellowship, more commonly known as a “Genius Grant,” from the John D. and Catherine T. MacArthur Foundation in 2006. Can you talk about that?
A year before, I had relocated to Philadelphia and joined the faculty at Drexel University. I was tremendously humbled to learn about the MacArthur Fellowship because it isn’t really about what you’ve done — it’s equipping you for what they believe you can do.
A year after receiving the award, I founded the Center for Nonviolence and Social Justice at Drexel University. One of the first programs we created for survivors of violence was Healing Hurt People, a hospital-based intervention to help survivors heal from the wounds of physical, emotional and racial trauma. Healing Hurt People expanded to Chicago several years ago. We also conducted research around violence and trauma and built an academy to train young people to serve as community health workers with support from the U.S. Department of Justice.
Our goal has always been to shift the conversation away from punishment through a criminal justice lens toward one about healing through a public health lens. One way we did that was through a social media campaign called #OurWordsHeal. We wanted to give voice to not only the problem but also to the healing and the reality that despite trauma, communities of color have been healing for generations. This is healing that is not only clinical but also cultural, social and spiritual. This culturally responsive healing helps us to find hope and to see ourselves as part of something larger.
How do you plan to apply your experience working with victims of violence now that you are in Chicago, which, like many large cities, has seen an uptick in violent crimes in recent years?
My hope is that my relationships in Boston and Philadelphia will allow me to continue to learn from that work but also to learn from the communities in Chicago who contribute to the expertise on these issues at RUSH. I’m particularly interested in building broad partnerships that address not only the immediate loss of life because of violence but also address the holistic health and well-being of young people in communities. It’s important to view issues of violence and trauma as health equity issues and recognize that disparities are related not only to structural racism, but also to racial trauma.
What attracted you to the role at RUSH?
RUSH was one of the first academic health systems to make health equity a strategic priority before it was on the main stage. Leaders like Omar Lateef, Sue Freeman and David Ansell, to name a few, have clearly articulated their commitment to addressing these disparities. This includes RUSH’s vision to reduce the 16-year life expectancy gap between Chicago’s Loop and the West Side by 50% by 2030. It’s quite bold and unique, at least among organizations that I’ve seen.
Another example is RUSH’s Anchor Mission strategy, a long-range plan to boost economic vitality through local hiring and purchasing to create healthier West Side communities.
We also saw RUSH’s commitment to health equity during the worst periods of the COVID-19 pandemic. When patients couldn’t receive care at safety-net hospitals, RUSH accepted transfer patients while many health systems around the country closed their doors to people outside of their own systems because of the overload and financial burden.
Beyond RUSH’s commitment to these issues, I was also attracted to the collaborative and interdisciplinary mission of the Institute. No single discipline alone can fully meet the public health and health equity challenges that we face. To address these complex and persistent problems, we must prepare students and faculty to work across disciplines while upholding strong partnerships with the community.
What is your vision for the RUSH BMO Institute for Health Equity?
I see the institute as an accelerator and amplifier of the incredible research, interprofessional education, community-based care, policy work and community partnerships that are already happening at RUSH.
What’s most powerful about the institute is that we are all coming together around the “why.” The reason why we are doing this is to reduce gaps in life expectancy and improve the well-being of communities. We need institutions like RUSH and others that are committed to equity to take on these problems. We may not all approach them the same way, but if we share that single “why,” we’ll find more partners who are in it for the long term.
Although we won’t solve these problems in a few years, we can equip future generations to undo the structural racism that affects the health and well-being of so many communities.
The institute has secured extremely generous support from the business and philanthropic communities. Why is this support so important for the mission?
We have an incredible base of support, thanks to the ability of RUSH leaders to clearly articulate their mission and values over time.
Companies like BMO Financial Group understand what the private sector can do to promote health equity. Beyond investing in the Institute, they are investing in health through workforce development and economic development in communities.
At the same time, our philanthropic partners like the Steans Family Foundation, the Morrison Family Foundation and the Hunter Family Foundation are essential to helping us address a complex issue like health equity. Their commitment gives me tremendous hope that we’re going to address the fundamental causes of disparities while also supporting innovative programs, research and education.
I’m excited about the synergies and innovation that can come from the private sector and from private foundations, as well as from partnerships with the city and the community. These relationships will be essential to address health equity in the long run.