In 2013, years before she became a household name in Philadelphia for her work during Covid, Dr. Ala Stanford found herself fighting for her life. The then-pediatric surgeon had gone to the hospital to address the uterine bleeding she’d been experiencing for nearly a year after the birth of her twin sons. What should have been a simple, same-day procedure ended up as near fatal sepsis.
As Stanford fought the infection, self doubt set in. Had she failed to advocate enough for herself? Was there something she should have done differently?
By that time, Stanford, the first Black woman to complete her entire pediatric surgery education in the U.S., had become very familiar with systemic racism in the medical system. As a patient herself, she knew she was among the horrifying numbers of Black women in the U.S. who suffer from maternal morbidity, any of a number of illnesses associated with childbirth. As a doctor, she knew it wasn’t just patients who experienced racism.
“You’re in the operating room, and your face is less than a half a foot away from your operating surgeon, whispering things in your ear like, So why would you choose something like surgery? There’s so many other things you could have done in medicine. This is hard and I don’t know if you’re going to get any better,” she recalls. “You start to feel like everyone’s looking at you, waiting for you to fail. It’s not a place where you want to get up and go to work every day.
“If I could be treated a certain way by my attendings, my superiors, as a supposed colleague, then I wondered how the patients who looked like me were faring.”
If I could sum up everything: Wealth is linked to homeownership. Homeownership is linked to education. Education is linked to best health outcomes. And health outcomes are exacerbated by racial injustice.
During Covid, Stanford — whose concierge medicine practice counts Will Smith among its patients — founded the Black Doctors Covid Consortium, a group that aimed to make sure Black Philadelphians, especially those living in poverty, had access to testing and vaccines. Soon after, she was named a regional director for the U.S. Department of Health and Human Services, where she worked closely with the Biden Administration to increase access and improve equity across the six regions she oversaw, which included Pennsylvania, Delaware, Maryland Virginia, West Virginia, and Washington, D.C.. . She left that role in 2023 to focus on the Dr. Ala Stanford Center for Health Equity, an ambulatory care facility in North Philadelphia, and recently joined the University of Pennsylvania as a professor across multiple programs.
Today, Stanford is tackling ingrained health disparities, with a focus on Black women. The celebrated M.D. details her trajectory in her new memoir, Take Care of Them Like My Own: Faith, Fortitude, and a Surgeon’s Fight for Health Justice, released earlier this month.
The Citizen caught up with Stanford to discuss how her personal and professional experiences shape her work, her hopes for health policy to come — and why she thinks a Harris presidency is the way forward for health equity. This interview has been condensed and edited for clarity.
Courtney DuChene: How did some of the biases you encountered in your own life shape your thinking about health disparities Black people faced at the onset of the Covid-19 pandemic?
Ala Stanford: When I was in med school, I clearly remember hearing how Black Americans had poor health outcomes with regard to cancer, hypertension, diabetes, obesity, mental health. It [was said] one of the larger reasons for this was a lack of self-responsibility, but that had not been my experience as a young Black person growing up in Philadelphia. If we weren’t making appointments, it might be because the doctor’s office was closed when my mom got off work and there were no office hours on weekends.
Plus, Black Americans that were affluent had similar outcomes. How do you explain how an educated, affluent Black woman is more likely to lose her baby or her own life during childbirth and the postpartum period, but a poor White woman is more likely to carry her babies and [still have] her life when all things are equal?
When Dr. Fauci said, Black people are not going to do well from this because of the health disparities. They haven’t done well for years and they’re going to have the short end of the stick, that’s the way it’s always been, I had a flashback to medical school. Wow, here we are again. Except I wasn’t the helpless 20-year-old anymore. I had been a doctor for 20 years. I was at a point professionally — being an entrepreneur, owning my own practice — that I could go out there and save lives and make a difference.
What do you think a Kamala Harris presidency could mean for addressing health disparities in Black communities and other communities of color?
When I was appointed by President Biden and the Biden-Harris Administration to the U.S. Department of Health and Human Services, I oversaw Delaware, Maryland, Virginia, West Virginia, and D.C.. We worked on Covid recovery and response, casualties from suicide and homicide, cancer, cardiac disease, maternal health and, obviously, a woman’s rights to choose.
Vice President Harris was one of the biggest proponents for the postpartum coverage extension (which offers a full year of coverage to women on Medicaid after their pregnancy ends). Most of the death and disease that happened, especially in Black women, happened in that postpartum period from hypertension, from infection, from postpartum depression. During my time at the administration, to watch postpartum coverage go from 30 or 60 days to a year was paramount.
If I could be treated a certain way by my attendings, my superiors, as a supposed colleague, then I wondered how the patients who looked like me were faring.
During Biden-Harris, we watched prescription drug costs come down, we watched hearing aids be available, the cost of insulin drop. They worked tirelessly so that people don’t have to decide between am I going to buy food or am I going to get my medicine?
Right here in Philadelphia, we unveiled 988 as the number to call [for mental health emergencies]. Every time I say that now, I’m envisioning Sonya Massey standing at a stove with boiling hot water and being shot and killed because her mother, concerned about her mental and emotional health, called 911. If anyone has heard the tape, she’s saying, “Please don’t hurt my child. Please don’t hurt her.”
What does it look like for eradicating health disparities? It looks like a brighter day that these things can continue and that Harris will have more power to make things happen.
If Kamala Harris is elected, what policies would you like to see her administration enact to help address health disparities Black women face?
This isn’t just for Black women, but for all of health and equity: You have to really get to the root cause of why [health disparities] exist in the first place. Some of it has to do with trust, or lack thereof, between the medical establishment and the patient. The healthcare system has been untrustworthy, and you have to work to earn the trust of people. It’s not like anybody woke up and said, I’m Black. You’re White. I think I’m not going to trust you. There were some pretty horrific things that happened to Black people without their consent.
If I could sum up everything: Wealth is linked to homeownership. Homeownership is linked to education. Education is linked to best health outcomes. And health outcomes are exacerbated by racial injustice.
When I have a home, I pay real estate taxes; I pay education taxes that go to the school district. If you live in a community where everyone rents, where people are in high-rises or HUD housing, there are no taxes being reinvested into the school system. The reason why you see this in areas where so many Black people live is because of redlining. When I say education is leading to health outcomes, specifically, if you can advocate for yourself when you know you’ve been mistreated, that’s going to portend to a better outcome for you. Even when you have the education that leads to the best health outcomes, the last thing is that the health outcomes are exacerbated by racial injustice. In my book, I talk about the fact that even as an educated Black woman, bias was directed towards me that led to me having poor health outcomes and certainly poor health experiences.
You have to work on that entire cycle because it’s all interconnected. So that means better housing; it means better jobs; it means a better environment; and it means an acknowledgement from those making the decisions that the way we are today is because of poor decisions that were made before us.
And, I hope that she chooses people in leadership roles that are close to the pain, meaning they have worked with people who received their insurance from the Affordable Care Act. I don’t believe that healthcare should be capitalist and driven by revenue. It should be driven by the best care that can be afforded to a person.
Quite recently Vice President Harris proposed a policy to offer $25,000 to first-time home buyers who have paid their rent on time for two years. Could that have ripple effects for people’s health?
It could absolutely have ripple effects. For example, where I live, there are specialty care centers everywhere. I don’t have to go to Center City and navigate my way around, looking for parking. I can be in Montgomery County or Bucks County, on beautiful tree-lined streets with ample parking that’s free and get the care that I need. People in urban communities don’t have that. With that $25,000, not only does it mean that you can move to a place where your access to care is improved, you’re also in a place where the education for your children can be better, and that leads to better health outcomes for people.
You have mentioned that cities can look to one another for ideas on improving public health. Are there any ideas Philly or PA should steal around addressing maternal mortality rates, which are higher for Black women than any other group, or other issues?
Reimbursement from Medicare for doula services [like they do in California, Minnesota, New Jersey and several other states] would go a long way. A doula is an adjunct or ancillary service afforded to the mother during prenatal and postpartum and delivery. You basically have a second care person that you trust through labor, that is going to help you with breastfeeding and get to your appointments in the postpartum period, not only for your child, but for yourself.
And having more doctors that reflect the patients that they serve would go a long way. Having just one Black doctor in the county can improve health outcomes [for] Black Americans. Representation matters.
Your book talks about your experience struggling with period poverty, unable to afford pads and tampons when you were a middle schooler. Today, one in four teens and one in four women in the U.S. struggle in the same way. What could we do to address that issue?
Women are not going to school during their period because of leakage or a foul smell that comes from having excess bleeding. You should be able to get menstrual products with public assistance. Being able to be covered just like formula for your baby would be a first step.
In 2023, you left the Department of Health and Human Services and recently accepted a new role at Penn. What’s next for you?
At the top of my list is an endowment for the Center for Health Equity to the tune of $50 million, because then we could be operational off the interest and annual budget of $2.5 million a year. So it’s about making sure that that building outlives me, that we are providing care when I’m in my 70s and 80s.
At the University of Pennsylvania, I’m with thought leaders that are working on world problems — not just local and national, but world problems. I’m loving that — not to mention that I am actually teaching, which also allows me to pass the baton to the next generation of healthcare workers, but also policymakers and entrepreneurs. I can teach what I’ve done, so hopefully the next generation will do it even better than I have.
This piece is part of a year-long editorial series looking at innovations to address inequities in women’s healthcare, sponsored by Independence Blue Cross.
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