Physician, researcher leads new state Health Equity Bureau

As a child in Richmond, Va., Dr. Brooke Cunningham noticed racial disparities early on.

In a predominantly white community, she and the handful of other Black students in her class were placed in the same reading group. Other Black students were bused home to other communities when the school day ended at 3:00. Cunningham wondered what these differences meant for people of color.

A lifetime of seeking answers has led Cunningham to the position of assistant commissioner in the Minnesota Department of Health (MDH) where she oversees the department's new Health Equity Bureau. Launched last month, the bureau will lead the department's health equity initiatives and solicit community input on those efforts.

The bureau also houses existing MDH equity units including the Center for Health Equity, the new Office of American Indian Health, the COVID-19 Health Equity team and Diversity, Equity and Inclusion.

"This is validation of the importance of equity to the core of public health and a reflection of the two years that we've come out of with the pandemic where people could not, with this at their doorstep, ignore the [health] disparities that we've been seeing," Cunningham said.

People of color experience higher rates of infant mortality, obesity, diabetes, hypertension, asthma and heart disease compared with their white counterparts. Some of Cunningham's patients can't afford insulin or other medications with high copays, while others experience homelessness.

As a primary care provider, sociologist and assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota, Cunningham has years of experience working with communities of color. She received her medical degree and a doctorate in sociology from the University of Pennsylvania. She has lived in Minneapolis since 2013 and moved to the city after completing postdoctoral fellowships in general internal medicine and bioethics/health policy at Johns Hopkins University. She's also a mom of one.

Her primary care practice at Community-University Health Care Center (CUHCC) in the Phillips neighborhood serves a diverse patient population. Cunningham's patients are lower-income uninsured or underinsured people who have difficulty getting time off work to visit a doctor.

"My patients, when we talk about racism as a fundamental cause of health inequities, have commented on the experiences of racism that have been impacting their health," she said.

Although Cunningham went into medicine to become a sociologist and researcher, working at the clinic has been the jewel of her career, she said.

Dr. Aarti Bhatt, who did part of her training at CUHCC, connected with Cunningham professionally around antiracism in medicine. They discussed how to talk to patients about race and how to acknowledge patients experience racism that affects their health.

"She's just incredibly committed to her patients; she's super attentive, and her patients love her. They always just want to see her," Bhatt said. "A lot of that comes from [her] having this real ability to sort of see people where they're at and to also acknowledge the multiple variables that are impacting people's lives."

Cunningham is the only Black female physician at the clinic and that is very meaningful for the Black women she cares for, said Bhatt, a founding member of Minnesota Doctors for Health Equity.

As a mentor, Cunningham pushed Bhatt to think about equity issues and how to get medical students to think about these topics. She brings that understanding to her research and work to create policies that will help people be healthier, Bhatt said.

Her years of groundbreaking work and research on how racism and structural racism affect health outcomes can really make a difference in Minnesotans' health care, said Dr. James T. Pacala, a University of Minnesota Medical School professor and head of the Department of Family Medicine and Community Health.

"This has really been something that she recognizes is an important factor in medical care, and she has really led in that area for quite some time," Pacala said.

While Minnesota was one of the first states to push for statewide recognition of these inequities, and the department has worked to raise awareness, there is still work to be done, state Health Commissioner Jan Malcolm said.

"We've written these great reports, and yet we don't see the needle moving very quickly," Malcolm said. "There was just a really powerful call for more, we have to organize the work differently … to really live up to the aspirations that we hold. This was really behind the creation of this new bureau."

Malcolm is thrilled to have a leader like Cunningham, who in just a few weeks has brought energy and inspiration to the department.

"She's already just such a wonderful addition to our leadership team and is going to really help us capitalize on the commitment that we've always had, and the commitment that only deepened during the pandemic," Malcolm said.

Cunningham is confidant her public health and health care peers care deeply about inequities in health care that can be an overwhelming challenge. But the past two years have shown her the medical profession can meet the challenge, she said.

"I'm just very excited about the potential for impact that the bureau brings, the potential for dialogue and partnership and ultimately, the opportunity to be in relationship with communities in a different way, in a deeper way," she said.