As a population health disparities research scientist, clinical psychologist, and tenured professor, Wizdom Powell, PhD, MPH, CMHC, has emerged as one of the nation’s foremost experts on racial trauma, healing and health equity. A one-time White House Fellow and Special Advisor on military mental health in the Obama administration, Dr. Powell joined us in person during HLTH in Las Vegas to talk about her groundbreaking work addressing mental health disparities among men and boys of color, and how health equity, once truly realized, can benefit everyone.
Watch the video of this podcast episode on the Nemours YouTube channel.
Guest:
Wizdom Powell, PhD, MPH, CMHC, Tech Advisor, The Evidencewatch Collective and former Chief Purpose Officer, Headspace
Host/Producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’re joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
MUSIC:
Let’s go, oh, oh, Well Beyond Medicine.
Dr. Wizdom Powell:
Equity is not a zero-sum game, and so I would caution and advise us to make those investments because when we do, when we lift the tide for those populations, everyone else gets better.
Carol Vassar, podcast host/producer:
That’s Dr. Wizdom Powell, who until recently was the chief purpose officer at the online mental health coaching therapy and mindfulness service Headspace. As a population health disparities research scientist, clinical psychologist, and tenured professor, Dr. Powell has emerged as one of the nation’s foremost experts on racial trauma, healing, and health equity, A one-time White House fellow and special advisor on military mental health in the Obama administration, Dr. Powell joined us in person at the recent HLTH event in Las Vegas to talk about her groundbreaking work addressing mental health disparities among men and boys of color, starting with the way in which the societal norms of masculinity affect their mental health.
Dr. Wizdom Powell:
When I started this work, it was very apparent to me and many others in the field that men, despite having lower rates of depression or diagnosed depression, were committing suicide at higher rates. They had higher suicide completion rates. And we talk about this in the field as the gender paradox in mental health, and I think I came to the space wanting to unpack and understand what was at the root cause of that gender paradox. Obviously, men tend to use more lethal means for suicide completion, which contributes to that higher rate, but it was clear to me that there was something a bit more driving men towards those outcomes.
And what we wanted to do in the field, those of us who at the time were interested in masculinities and their connection to mental health was to better understand what were the social or cultural components of men’s lived experiences that were giving rise to those outcomes. And so, for me, understanding the link between masculinities and mental health is about understanding how societies and systems prepare men and boys for engaging health systems and what are the rules and the norms of engagement around emotional expressivity that can keep some men trapped in the so-called man box.
And what we’ve come to understand is, first, that masculinities are not all bad for men’s health. There are some really important components of being a man in the ways that we typically think about it that can contribute to better health outcomes, but there are some norms that require men or instruct them to be strong, stoic and silent that militate against their capacities to seek help and create a really wicked problem around mental health seeking that can drive some of those more detrimental health outcomes. And I think that taking a look at masculinities from that perspective allows us to not only uncover where we might be able to intervene to improve but that we don’t throw the baby out with the bath water, that we actually start to examine men’s masculinities from a positive point of view as well as understanding how those norms and rules of engagement can detrimentally impact men and boys.
Carol Vassar, podcast host/producer:
You’re talking about cultural change, the way that men perceive themselves. Have we made progress?
Dr. Wizdom Powell:
I think we have. And you asked the question a moment ago about men of color in particular. I think we talk a lot about the role of intersectional lens and population health and I think in this instance, it really is important to lift up, that while men and boys hold pretty similar views about masculinities across race, gender, sexual orientation, there are some unique ways in which men of color have to navigate systems that can make the impact of masculinities on their mental health more detrimental in some instances than others. When you think about it masculinity in the ways that men express, deploy it is all about maintaining or sustaining a degree of agency or control over one’s life.
And if you live in a society or a system or community where your access to that power and control is more limited because of all of the historical structural issues, then your desire to man up in ways that allow you to recoup that masculine role identity is even more pronounced and felt. And so for men of color, not seeking healthcare isn’t just about wanting to be a man about it, but really wanting to reclaim the power, autonomy, and control that systematic and systemic oppression and disadvantage can bring to bear on their lives and their access to the opportunity structure. So I think it’s important to understand how those things interdigitate.
So yes, we have made progress, and I think men and boys are constantly redefining, particularly now as Gen Z and X, we all sort of interdigitate and talk about the rules of engagement in different ways, both in the public space but also with one another that men feel more radical permission to step outside of that man box and are taking back those definitions of masculinity and pushing back on this all-or-none, one-size-fit-all way of being a man and wanting to reclaim that for themselves and I think that’s absolutely a step in the right direction. We are making some progress.
I do think that we have a long way to go before we truly create the kinds of systemic approaches to intervening upon men’s mental health in ways that can drive structural change. That I think we’re still lacking because we’re still relying on the same care delivery modalities that really don’t speak up to men and boys. We haven’t yet redefined and transformed systems in ways that meet men at their highest intentions to be well.
Carol Vassar, podcast host/producer:
In your research, you talk a lot about structural racism and its effects on men, boys, people in general and how it shapes health disparities. You gave a great example just a moment ago. Talk about the history of structural racism as it relates to mental health and what healthcare systems and public health officials can do to combat the issue in practical ways.
Dr. Wizdom Powell:
Yeah, I think that we are in a moment in our history and time, particularly in this country, we’re talking about structural racism and systemic racism is more difficult. We are in a period where we’re rolling back investments on DEI, and we’re having a real come-to-the-fountain moment around what we’re going to do as a nation to rise up to meet the challenges that systemic racism has produced for all of us. And with that in mind, I think we all understand the science behind discrimination and health outcomes that actually when people are exposed chronically or acutely to experiences of racism, they have higher rates of depression, anxiety, and also PTSD symptoms.
And what we saw uniquely during COVID in the period of racial arrest in our nation, we saw adolescents from Hispanic and Latino, and Black communities actually displaying more post-traumatic stress disorder symptomatology just from having viewed incidents of racism online. So, we do embody the racism that we are exposed to. Our bodies keep score, and societies pay a high price for that. We know for sure that the instances of racism that we’re talking about that happen in everyday life also get baked into the policies and procedures and the way that we deliver care. We still have an unequal caste system in our healthcare delivery modalities, and so not everyone gets the same care or the same quality of care despite all of our advancements and efforts towards progress.
So, to me, the bottom line, the take-home message, is to stay vigilant around these things and recognize that racism is a wicked problem. It mutates, it takes on new hosts, and we’re going to have to constantly keep our eye on that ball if we’re really going to mitigate the inequities that really produce broad-scale societal impacts. When you look at our gross GDP and what we spend to address mental healthcare inequities at the root of those inequities, often our experience is of disadvantage and unfair treatment. And until we resolve that challenge, we’re going to continue to see the fallout, and it’s not just going to affect people of color.
So I think, if I had something to say to the audience, it would be that addressing systemic racism isn’t just a challenge that for people of color or minoritized populations to solve. It’s a problem for all of us to solve because it militates against national security. It creates a vacuum of care that produces an unwell population. And when you have an unwell population, you can’t innovate, you can’t advance, and you surely can’t meet the demands of a modernizing democracy. So I think there’s a real high price to pay.
And so when we look at discrimination and its impact on Black men’s mental health, what we’ve been seeing over time is that Black men don’t experience racism and then suddenly have a poor mental health outcome. There are mechanisms that make that connection between discrimination and poor mental and physical health more robust. And what we know from a study that I published in the American Journal of Public Health that’s entitled Taking It Like a Man, we realized that when men, Black men, were exposed to racism every day in their lives with more frequency and more intensity, that those men who believed that they should keep that experience or those experiences close to their best had the most detrimental outcome.
So in other words, it’s not just experiencing those stressors in your daily life, it’s believing that you shouldn’t tell anyone about it, that you should be able to soldier on, push through or take those experiences like a man. And I think, when we have systems in place that one encourage men to get support, create navigation to care that is gendered, we call this gender-responsive care delivered in a gender-responsive way, then we’re able to help men get to the care that they need and also lower those barriers that are often produced when men believe that they should be able to navigate or negotiate those experiences by themselves.
Carol Vassar, podcast host/producer:
I’m curious: what role policy can play in all of this, in dismantling this structural racism and making sure that we can get rid of, ultimately, in my dream space world, the inequities that affect people of color, especially in men of color in the mental health space?
Dr. Wizdom Powell:
Well, I think we have a tremendous opportunity, one, to lower the cost and accessibility barriers to care that sometimes can prevent men and boys and humans from getting. People want care that is affordable and that speaks to their wounds. So that care has to be culturally responsive and really rise up to meet men at the level of unmet need that they’re presenting. So any policies that can support us with creating better reimbursement pathways, the Mental Health Equity and Parity Act, which is now requiring us to treat, to pay for, rather, mental and physical health conditions on par with each other. Those kinds of policies actually help us to eliminate some of the structural barriers to mental health care that we see in our world and, by extension, address some of the challenges that are produced when systems are unequal.
I think we also have to think about policies, with a small P, that are related to provider care and the quality of that care. We have had a movement in our nation for a long time to focus on culturally responsive or competent care. I think we need a 2.0 and a 3.0 version of that because it isn’t just enough to match people on demographics. We’ve seen from the research of Dr. Lisa Cooper and others that racial concordance and healthcare doesn’t solve the problem. You just having a person who looks like you from, sitting across from you isn’t the only thing that you need to resolve to deliver culturally responsive care. It’s also knowing people’s values, appreciating those values, incorporating that lens into the way that you deliver care and the way you treat a person.
I think that policies that help us implement those kinds of guidelines and requirements for providers I think are a good way to go in terms of addressing some of the challenges that we see. But ultimately, it’s going to require us to look at the bones in our basements, to really excavate those root causes that lie at the foundation of our healthcare systems that will really ultimately drive the changes that we know can happen when we make a commitment to resolving them. And I do think, where there’s political will, there’s a legislative way. So if we can culminate that will and make it actionable, and I don’t think this just has to happen at the federal level, I think there are lots of local and state policies, policies within health systems, payment reform policies and reimbursement that could actually help us chart a path forward.
Carol Vassar, podcast host/producer:
You talked about parity early in your answer there and I’m wondering, from your perspective, have we reached parity between mental health and physical health despite the fact that the laws are in place, the policies are in place?
Dr. Wizdom Powell:
I’m going to say resoundingly no. And it reminds me: I had the great fortune, as you probably are aware, of working with Secretary Leon Panetta when I was working in the Obama administration. What I learned in working with this incredible leader was, at his time, trying to implement or enforce all of the requirements associated with Brown versus Board. And he talked about how they had Brown versus Board in place and it was understood that this was the rule of the day, the law of the day, but implementation was very slow. And so literally, he had to go around state by state and ensure that folks were enforcing the law or the regulations that were a part of this really monumental civil rights legislation.
And what I know for sure is that the Mental Health Equity and Parity Act is not a new one, and we have proclaimed our investment in ensuring that, but implementation has been slow. So I think we have a long way to go before we get everyone on board and we’re truly living the values that are expressed in that law. And I think to get there, we have to have people unified and committed to ensuring that that happens. We have to align payers and plans, and consumers all together to ensure that we have the right leverage to ensure that we have successful implementation over time.
Carol Vassar, podcast host/producer:
I want to get back to the young men that we have been talking about, the young men of color. Are there best practices that perhaps pediatrics can deploy pediatricians in their healthcare settings in identifying and intervening with young Black male youth and young adults?
Dr. Wizdom Powell:
Well, I think we have to have better screening and detection all around. Often, in my own clinical practice, what I’ve noticed is that men and boys don’t express their symptomatology in the same ways that we might see women and girls express them. And, of course, this is a generalization. There’s individual differences along the way, and not every boy or man responds in the same way, but on average, we see big differences in symptom expression, and often, particularly among boys and men of color, what happens is that their expression of symptomatology gets pathologized or treated as if it’s a behavioral problem. It’s the reason why we have school pushouts and higher rates of suspension among Black and Brown, and Indigenous boys in school settings because we fail to recognize or see their wounds very clearly.
So I think, as a first step, some of the advancements we’re making around integrating depression screening into primary care, we don’t yet have a mechanism for well-boy visits, but we need them. Girls get introduced to the healthcare system very early in their life course because of reproductive changes. There isn’t a corollary for boys, so they don’t have that early-life healthcare socialization that would cement their own investment in taking care of their health or treating it not just when they have a problem but using preventative screening as a way to create better lifelong physical and mental health. We don’t have those mechanisms.
So, I think a best practice would be to think about how can we structuralize well-boy visits. I know some of my colleagues at Johns Hopkins are working on some of these very measures when I was leading the American Psychological Association’s task force on racial and ethnic minorities, boys and men. That’s one of the things that we lifted up as a recommendation, like make sure that we can create standards around what those visits should entail and a checklist for boys and their parents and families to help them understand what is age-appropriate for their young males as they’re becoming throughout their life course. So that’s one way.
And then the other I think is that we have to, for boys and men of color, start to ask about the social determinants of their health in those healthcare visits. So, having electronic health records that actually have a place where you can actually check off, “Does this child have proper nutrition, food security, housing, transportation, and what are the conditions of their lived environments?” Like screening for community violence exposure is one of the things that we’ve been recommending through the National Child Traumatic Stress Network. We created a trauma screen time, set up recommendations for pediatric settings and for schools so that we could have instruments that are available for assessment.
Because what gets measured gets done, what gets measured gets attended to, and we’re just not measuring enough. We’re not screening enough. And I think, if we had that, even as a first step, some standardization around how we ask boys about their health, their whole health in primary care settings, in school settings where there are the highest touch points, I think we could actually start to see some movement at least towards normalizing health help-seeking, which would be a boon for men’s health equity across the world.
Carol Vassar, podcast host/producer:
We are here, Dr. Powell, at a health technology innovation conference called HLTH. Are there any technological advancements that you have seen, that you know of, that are coming down the pike in the digital mental health realm that you think might support these efforts, making sure that this is made note of in the EMR, for example, and help to reduce disparities?
Dr. Wizdom Powell:
I love this question because my mind is on fire with so many thoughts, but here’s what I would say. I think technology is only as good as the inputs that we build into them. And so I’m very excited about generative AI and the possibilities for AI to, one, be a complement to mental healthcare delivery and physical healthcare delivery, screening, and detection built into an AI model. Having AI systems that actually recommend services and supports in real time for boys and men could be really helpful. It’s something that we are taking on at Headspace as we rolled out Ebb, which is our generative AI companion that actually recommends content to folks on our platform. So you can actually interface, have a real empathy-centered conversation with an AI support system.
I think those are really promising practices, but my caveat to all of this is that whatever we build for communities must be built with them, not for them. And using human-centered design approaches that invite young boys and men of color and boys and men in general to the tables where those designs are being cultivated is critical to ensuring that they’re done with integrity. And, of course, we need guardrails because we know that a lot of the evidence base that exists for minoritized populations is wrought with bias. We’re working hard as scientists to undo that and to put in mechanisms for control, but we still need systems of checks and balances.
So there is the danger that all of the biases that we hold in our human intelligence gets infiltrated and interdigitated into the digital investments or digital technologies, emerging technologies that we build. So, we must be vigilant. Other ways I think that technology can really serve us in this regard is by making sure that we build ways through solving the data interoperability challenges that we all face for systems to talk to each other so that a boy who’s getting treatment in a pediatric setting has those records tied to some degree to his school records so that we can better understand the whole child. Those types of innovations that allow systems to talk to each other and deliver in rapid real-time recommendations for treatment referrals, care services, and life services are going to be, I think, the things that are going to tip us towards better outcomes for men and boys.
There’s tremendous promise for ecological momentary assessments, something that I’ve used in my own science to help us better understand immediate need states. Because what I know for sure is that men are watchful waiters. Boys are taught to wait and see; to go to the doctor when things are reaching a critical crisis. My own husband, it’s like blood must be showing for there to be a reason for him to go to the doctor. But if we could help nudge people along with generative AI, with actual machine learning and algorithmic configurations that actually help people get to the care when they need that care the most, I think we could really leverage the best that is coming online for us with respect to emerging technologies.
And we could also create the kind of digital community integration that I think we need to really ensure that the social determinants of health needs are also met alongside those others.
Carol Vassar, podcast host/producer:
You talked about possible bias in generative AI. You also talked about interoperability issues. What other issues do you see as potential unintended consequences of generative AI in your estimation?
Dr. Wizdom Powell:
Well, I think it gets back to something that we were just talking about with respect to putting bias on steroids. There is the possibility if the inputs for the AI infrastructures that we’re building are based on the flawed science and evidence base that we find ourselves grappling with and we’re not checking that science against emerging knowledge, we could actually have that infrastructure amplify some of the disparities and inequities that we’re seeing. We back … I can’t remember, I’m going to date myself back in the 1990s, you might remember that cardiac catheterization study, the famous study where they sent two patients into see a cardiovascular disease physician and they came with the same symptomatology, same record. One male was recommended for cardiac catheterization, and the other Black male wasn’t, right? So what’s going to fix that, right? That’s not going to be … If you’re baking in those same algorithms into, you’re going to find the same thing.
Carol Vassar, podcast host/producer:
The same outcome.
Dr. Wizdom Powell:
Now it’s going to be done with speed and rapidity, and with more intensity and global implications. So I think we have to just make sure that we are, as we’re doing a Headspace, building in advisory councils and systems of checks and balances to make sure that what you’re building actually represents the need states, the cultural values and the true lived experiences of the populations that you say you’re building them for. You’re not going to be able to retrofit a one-size-fit-all generative AI database onto populations of color. It will not work long-term. And that’s the thing I think that we are … Even at this conference, I’ve heard lots of conversations about people are paying attention to the biases that could be produced.
And I think if we work together smartly building the regulatory guardrails that we have councils to oversee, and also, as my nephew would say, “Chin check us,” when we don’t get it right, I think we have to be open to that way of moving ourselves through what is a really exciting time for us, but also one that could lead us towards a path of outcomes that I don’t think we want to achieve. So it’s about vigilance, careful co-designing, and making sure that you are aware of the most cutting-edge science possible to be the foundation of these databases that we’re building for AI.
I love this idea that we’re now at the critical precipice of where technology, health outcomes, and minoritized populations meet. The one thing I would say is that, even in this period of time where there’s still a lot of questions about what we can do to resolve mental health inequities, I think we have enough data and science now to know how to act. And what I would say to colleagues that are listening to this podcast and the colleagues that are attending this conference is that making the investments and resolving mental health inequities shouldn’t be an afterthought.
Because what I’m talking about now in terms of population improvement for men and boys actually has implications for our whole society. It’s one of the things that became really clear to me in my own family when the male patriarch in our family passed away prematurely from a disease that we could have prevented. The ripple effects, the fallout on society are enormous. This is not a zero-sum game. Equity is not a zero-sum game. And so I would caution and advise us to make those investments. Because when we do lift the tide for those populations, everyone else gets better.
Carol Vassar, podcast host/producer:
Dr. Wizdom Powell is the former chief purpose officer for Headspace. She’s currently a tech advisor at The Evidencewatch Collective, a consulting collective with expertise in brand equity, antiracism, healing justice, and strategic planning for organizational change well beyond medicine.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Dr. Powell for sharing her time and expertise with us, and thanks, as always, to you for listening. In recent episodes, we’ve talked with leading healthcare experts about digital dark design, firearms safety, children’s health equity, workforce diversity,y and the prevention of bullying. Coming up, we’ll delve into the meaning and importance of whole child health and the debate on the use of medication to control obesity in children. Is there a topic you think we should be working on? Let us know by leaving a voicemail at nemourswellbeyond.org. That’s where you’ll find all of our previous podcast episodes and links to the video podcasts we’ve produced, including this episode with Dr. Wizdom Powell. That’s nemourswellbeyond.org. You can also email our team at [email protected].
Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Sebastian Riella. I’m Carol Vassar. Until next time, remember, we can change children’s health for good, well beyond medicine.
MUSIC:
Let’s go, oh, oh, Well Beyond Medicine.
