In July 2022 I attended Mayo Clinic’s Rise for Equity conference in Chicago, where I had the opportunity to interview some of the nation’s best and brightest experts from across the field of medicine for a podcast about what an equitable, inclusive, and diverse approach to healthcare could look like. As these physicians, researchers, administrators, and students shared their work with me, conversation often turned to their family histories, and those of the patients they serve. Like me, most of them were people of color, and their stories about family members and patients who died horrifically young brought back painful memories.
On November 10, 2019, when I was still a reporter for The Wall Street Journal, a breaking story triggered a flood of haunting childhood memories: “The first African American CEO of Kaiser Permanente, Bernard Tyson, has died at the age of 60.”
Though early details of his mysterious death were scant, the fact that he passed away while sleeping felt all-too familiar. My mind filled with images of the teary-eyed younger versions of my childhood friends — Jimmy, Latarsha, Tenisha, Christopher, Johnny Jr. — who are just some of the many kids I knew who had been devastated by the unexpected deaths of their 40-and-50-something-year-old Black fathers.
Nearly every time this happened, my mother’s explanations of how these men died were somber and eerily unchanging: “He died in his sleep.” As a Black boy, I came to recognize that phrase as code. These Black men had not just slipped away with no rhyme or reason. They had died from heart attacks or strokes.
I felt the sting of losing Bernard Tyson directly. As a Black man, I fight a daily battle to resist the temptation of eating sugar to avoid developing type-2 diabetes. It’s a disease that seized my father and too many family members and friends. Tyson openly discussed his own battle with food and diet, as he committed to sharing his “personal health journey” on Twitter in 2015. His words inspired me and so many others:
“I have to walk my talk,” Tyson said. “I have two major challenges to continue to work on: my food, which I am on this journey and doing much better, but I still need to continue to work on portion control and snacks that aren’t healthy. Everyone in the company knows my snack habits.”
Tyson rose from an entry-level job to the helm of Kaiser Permanente over his 34-year career there. He was a personal hero to me and so many others in corporate America and beyond. In addition to being one of the highest-ranking Black CEOs in the world — earning more than $16 million in 2017 — his fantastic success in a predominantly White industry never kept him from speaking out on controversial issues, such as racial and social justice, workplace diversity, and equal access to healthcare.
At the height of his influence, he used his platform to address the racism he experienced throughout his life. That honesty only added to his thousands of fans, especially among those in circles that paid extra attention to promoting diversity, equity, and inclusion initiatives.
According to a 2020 Brookings Institution study, the life expectancy of Black men trails White men by four years. Tyson — despite being one of the wealthiest, highest-ranking executives in the health care industry — was no exception. This trend has been even further exacerbated in the wake of the COVID-19 epidemic, where for every death of a White person, nearly two Black people have died.
Tyson’s cause of death was never officially revealed by Kaiser Permanent or his family, but regardless of the cause, his passing at 60 made him a hyper-visible example of the ongoing crisis of African Americans dying while still very much in their prime.
Personal toll, public outreach
As the host of Mayo Clinic’s RISE for Equity podcast, I was most fascinated — yet saddened — by two key conversation topics. One was how the heightened stress of experiencing racism, bigotry and bias can contribute to “accelerated aging” and the early death of patients from marginalized groups. The other was how historical inequities and unconscious bias in research and patient care help to fuel and keep those trends alive.
While taping the episodes, I reflected on the plight of Tyson, my friends’ fathers, and the Black men and women I have known of who also suffered early deaths. Many of their early deaths could have probably been avoided. The diseases and situations they died of — such as prostate cancer, heart disease, stroke, pregnancy, giving birth, late-stage breast cancer — are often preventable, treatable or manageable. But the odds of surviving these common situations drops dramatically when there is racial bias in care — and a lack of research facilitated without a racial bias.
Our guests were people who have dedicated themselves to the same type of social justice efforts that Tyson trumpeted. I felt the same admiration for them that I had for Tyson — along with a sense of concern for their health and well-being. Some bravely discussed their frustration as medical professionals of color — feeling isolated across a health care industry where minorities are vastly underrepresented and racial disparities and inequities still rage.
This “minority tax” can take a personal toll, but they remain committed to fostering diversity and inclusion — in addition to their responsibilities as some of the top-ranking experts in their fields and specialties. Their commitment and presence has helped make a difference: In 2020, Mayo Clinic vowed to invest $100 million over a 10-year period, to address health disparities and to ‘eliminate racism’ and advance equity and inclusion across its campuses. Now, with the backing of Mayo, many of them are working to have even more impact nationally and globally.
Dr. Alyx Porter, Medical Director for the Outpatient Practice at Mayo Clinic in Phoenix, Ariz., is also one of only four Black female oncologists in the United States. She insists that diversifying the physician workforce is a crucial step. “We all should seek an ideal where the workforce reflects the population cared for,” she says. “There are times when I’ve walked into a patient room and have been met with tears because the person has waited to see me or wanted to see me, someone who looks like them, who understands their disease and how impactful that was for them.”
Racism affects even people at the top
The RISE for Equity conference attracted a wildly impressive range of committed experts who are working on projects designed to address racial disparities in every specialty of the health care industry, also including projects on research, data collection, and clinical trials. Many of them have made this their life’s work, hoping to usher in changes and solutions that will benefit the health care industry and humankind long after they have left the profession and the world.
Like Tyson, many of these experts conceded that they have faced racism in their lives and careers, dating back to college and medical school. They credited their families, teachers and professors, diversity allies — and their own resilience — with helping them succeed.
One of the speakers who also joined me in the recording studio was Dr. Folakemi Odedina, deputy director of the Mayo Clinic’s Comprehensive Cancer Center, Community Outreach and Engagement in Jacksonville, Fla. She has helped establish an ambassador program at American Legion halls, tapping Black veterans who have survived prostate cancer to educate other Black veterans about the disease. The program includes sharing research on how cumulative stress and lower rates of screening can drive racial disparities in diagnosis and treatment of prostate cancer in Black men.
In her podcast episode, Odedina discussed her firsthand experience with the alienation that can sometimes make a person of color feel distrustful of medical institutions or reluctant to submit to testing or consult a doctor.
“We know about how people are perceived when they go into a health care system, how they are treated. I’m an educated Black woman, and I’ve faced it, and I’ve experienced it,” she said. “And it’s just unfortunate that sometimes I have to throw out my doctor title to be able to get what I need.”
Odedina said that unconscious bias in health care is not just a part of history, “it’s about what people are experiencing right now.” She recalled an experience she had as a new patient at a provider’s office. “I walked into the door and the person said, ‘Oh, we stopped taking Medicaid,’” she recalled. “True story.., how do you even know if I’m on Medicaid?”
The effects of bias have also made her husband reluctant to visit doctors. “He does not feel very comfortable going into a health care system without me going with him,” she said. “This is somebody with two college/advanced degrees. There is a bit of a trust issue.”
The anxiety that Odedina’s husband feels about visiting a doctor’s office, when pulled over by a police officer — or when he’s one of the few people of color in an unfamiliar setting — are just a few types of toxic stresses that, some of our podcast guests say, have been understudied.
In the days after the announcement of Tyson’s death, the Internet was set ablaze with dialogue about the loneliness and pressure than can accompany being Black in corporate America. Esther Choo, a medical doctor and professor of emergency medicine, challenged the assumption that the shorter life expectancy of Black men can be blamed entirely on factors such as poor nutrition, increased risk for violence and poverty in an article she wrote for Medium titled “Racism is Killing Black Men, Even in Health Care.”
“Deaths like Tyson’s challenge this idea and run in parallel with increasing data on how socioeconomic status does not protect against the direct, toxic impact of racism itself,” she wrote. She noted that the experiences of racial discrimination and internalized racism are associated with DNA-level signs of accelerated aging, and should therefore not be discounted.
“Imagine the many insults one must have to endure on the path to becoming Kaiser Permanente’s first Black CEO,” she wrote. “It’s bearing the weight of ‘first’ and ‘only’ at every step along the way; it’s facing both the subtle and overt racism that never turns off, no matter how powerful the role one inhabits.”
Racism Can Kill, So How Can We Help?
Felicity Enders, Ph.D., a Black woman and a professor of biostatistics at Mayo Clinic, hopes to change these perceptions about racism. She is pushing the health care industry to examine patient data to determine how factors such as racism can impact their health in real-time.
She agrees that cumulative stress over a lifetime can age a person at a biologically swifter pace. “That means that their bodies at the cellular level are aging faster,” she said. “Over the past year, I’ve been trying to develop survey measures to estimate someone’s accelerated biological aging by estimating how much stress they have been under over the course of their life.”
Dr. Enders is part of a growing number of researchers examining the “weathering hypothesis.” The term was used in Columbia University study that demonstrated that “chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes and could partially explain disparities in a wide array of health conditions.”
To that end, Enders’ work includes educating researchers on how to collect data, stressing that diversity and inclusion should always be a part of the process. She said that experiences such as growing up Black under Jim Crow segregation or being one of the few people of color in a professional or educational setting are examples of potential “stressors” that might encourage medical professionals to examine patients for risk factors such as stroke or heart conditions — examples that have been overlooked until now.
“We should think about doing extra testing. We don’t know what those are yet, but testing for heart damage is certainly one of them. That would change the way [a doctor] thinks about treating and testing [a patient] to look for problems. That’s where we want to go with this.”
After the police shooting death of Michael Brown in 2014, Tyson published “It’s Time to Revolutionize Race Relations” on LinkedIn. It was a devastatingly insightful commentary recounting some his experiences as a Black man in America. Rather than holding it inside, he addressed a controversial issue that could very well have alienated him from some colleagues and associates.
He compared moments from his own day-to-day experiences to those of Black men like Eric Garner and Brown, focusing on the instructions his father had to give him about how to conduct himself during police stops.
“I experienced being disrespected in my early twenties by someone who was supposed to protect my rights. I hold to this day that the biggest battle within me was the rage at how I was being treated while having to do what my father told me,” Tyson wrote. “If I acted out how I was feeling at the time, I might not be here today.”
The road to confronting life stress can be littered with all kinds of soothing tactics. People from all races and levels of society have been known to turn to drugs and alcohol as an attempt at coping. Still, we hear a lot less about the trials and tribulations of food addiction, and how its manifestation as a temporary escape can ultimately make us sick.
In 2015, as Tyson shared his personal battles with trying to change his eating habits, manage his C-suite-caliber stress level, and re-commit himself to walking and exercising as part of his New Year’s resolution, Tyson selflessly showed sides of himself that high-profile CEOs rarely show. All of this made him more relatable and inspired droves of people to engage deeply with issues that they may not have otherwise considered.
In short, Bernard Tyson died trying to help people live. We can honor his memory by doing the same — by digging deeper into how racism and stress can impact health and shorten life expectancy, and by telling the stories both of the data and the people behind it. As a journalist and storyteller, that’s my commitment to ending racism and unconscious bias in health care. Each of the guests I had the honor of interviewing for the RISE for Equity podcast has made their commitment as well. My hope is that by hearing their stories, you will be inspired to find your own.