Everyone deserves to be healthy

Photo by Donn Jones

Consuelo Wilkins, MD, MSCI, Senior Vice President for Health Equity and Inclusive Excellence for Vanderbilt University Medical Center (VUMC) and Senior Associate Dean for Health Equity and Inclusive Excellence for Vanderbilt University School of Medicine, always knew she wanted to be a physician. Born and raised in the Mississippi Delta, she was drawn to the idea of becoming a doctor at the age of 7 and was asking for a Physician’s Desk Reference by her 9th birthday. Wilkins, now a renowned physician and researcher, recalls feeling similarly about her passion for health equity — it is something that has always been on her mind, frequently shining through in her work.

“Health equity was built into everything I did, even if I didn’t know it or recognize it at the time,” Wilkins said. “I have always learned and believed that people are the same — everyone deserves to be healthy, and everyone should have the best opportunities to take care of themselves and their families.”

In the small town where Wilkins grew up, poverty was prevalent and resources were limited. As a child, she did not realize that her small, local hospital was underresourced. There was nothing for her to compare that experience to until it was time for her to attend college.

Wilkins attended Howard University in Washington, D.C., a childhood dream of hers. “I grew up reading these stories about incredible African Americans, and all of them seemed to have gone to Howard. I knew that was where I needed to go,” she said.

Wilkins obtained her undergraduate degree in microbiology in three years and remained at Howard to complete medical school. From there, she attended Duke University for an internal medicine training program and Washington University for a geriatrics fellowship, where she later obtained her master’s degree in clinical investigation.

Eleven years later, Wilkins arrived at VUMC, taking on the role of executive director of the Meharry-Vanderbilt Alliance. Wilkins oversaw the partnership between these two institutions, with the mission of enriching learning and advancing clinical research by developing and supporting mutually beneficial partnerships between Meharry Medical College, VUMC and the communities they serve. In this role, Wilkins was primarily focused on expanding the partnership to meaningfully engage the broader community.

Wilkins served in this role for eight years before recruiting her successor, Karen Winkfield, MD, PhD, professor of Radiation Oncology at VUMC and professor of Medicine at Meharry Medical College, who came on board in fall 2020. Wilkins also spearheaded the Vanderbilt-Miami-Meharry Center of Excellence in Precision Medicine and Population Health, a grant-funded center with a focus on using precision medicine approaches to address health disparities among African Americans and Latinos.

“Although I trained in internal medicine and geriatrics in my early career, that thread of health equity and community engagement started to come out relatively early in my career,” Wilkins said. “It drives what I do — trying to make sure everyone has the best chance of being healthy.”

The most recent example of Wilkins’ advocacy for health equity came when she testified in a U.S. Senate hearing on “Examining Our COVID-19 Response: Improving Health Equity and Outcomes by Addressing Health Disparities.” There, she outlined her plan to prioritize building trust in communities during the pandemic.

Wilkins’ expertise in health equity and community engagement has uniquely positioned her to be a leader in a wide area of health-related fields, publishing research about diabetes, cardiovascular disease, breast cancer screening, cancer clinical trials and countless other areas, in addition to her initial expertise in geriatric topics such as Alzheimer’s and late-life depression.

Cancer care and cancer clinical trials are an area Wilkins is particularly passionate about. “Because health equity is a cross-cutting theme, we need to focus on social determinants of health when it comes to food, housing, transportation and access to care. These are foundational to health in general, but specifically cancer,” she said.

While patients may be able to manage some medical diagnoses on their own, such as changing diet and increasing exercise to manage mild hypertension or diabetes, cancer is a different ballgame. When a patient has cancer, it is vital to see a physician who can provide the best help possible and increase the chances of a full recovery. Wilkins sees access to cancer care as a major part of establishing and upholding equitable health care.

Part of her effort to increase access to cancer care comes in the form of a National Institutes of Health-funded grant for Meharry Medical College, Tennessee State University and VUMC, focused on cancer disparities. This grant is the longest running cancer disparity grant from the NIH.

“The grant certainly accelerated some of the work I’ve been doing around getting more people involved in cancer clinical trials,” she said. “There is such a huge disparity in cancer clinical trials, and we often end up with results and treatment strategies that are not informed by the people who carry a large part of the burden of the illness.”

This work led Wilkins to think of clinical trials differently, recognizing the long history of Black people and other marginalized populations shying away from trials as a result of historically poor treatment by the health care system and prior research abuses.

“In my mind, we have the right to participate in clinical trials,” she said. “I try to tell people to think about how we may not benefit from science, and our descendants may not benefit from science, if we stay out of clinical trials.”

On a patient-to-patient basis, Wilkins encourages physicians, clinicians and nurses to identify individual goals a patient with cancer and their family might have for their care. While most clinicians do this well, it can be tricky if a patient’s background differs from the clinician’s. “Sometimes we lack the cultural humility that is needed to connect with others,” Wilkins said. “If we get into situations when things are unfamiliar, and we don’t know a lot about an individual’s background, we sometimes divert to harmful stereotypes. Instead of having a conversation with that individual, we run the risk of thinking, ‘This group is more likely to do this.’ It requires a level of humility and willingness to ask about culture and beliefs around treatment or prevention and incorporate that into how cancer care is provided.”

A lack of cultural humility or willingness to learn can result in perpetuating the lack of trust between marginalized communities and the medical establishment. If patients do not believe they are being understood or prioritized, they may find the health system less worthy of trust. The effects of this can be extremely broad, Wilkins says, ranging from desertion of treatment plans and follow-up visits to less confidence in their medical care or even depression.

To reach the most patients possible, especially those with cancer who urgently need to seek medical care, Wilkins recognizes the unique abilities of telehealth which have become clearer since the COVID-19 pandemic. “It’s not the same as an in-person visit, but there are ways to have more connections with patients virtually. Part of that is being sure we have appointments available at a wide range of times of day for patients who might have to work or might have to go to the library or a community center to access high-speed internet.”

Wilkins believes in the power of talented providers who are not physicians or clinicians — such as peer navigators and community health workers — to assist and extend care for patients with cancer in more rural areas. She also recognizes the importance of working closely with local health care providers, collaborating and supporting them in their decision making.

Above all, Wilkins believes in equity. “Being a teacher is no more important than an environmental services tech; the cashier at the grocery store is not less important than the mayor, and we all equally deserve to be healthy.”