YSPH alums explore issues of race at film screening

Human-centered storytelling conveys emotions that can transform moments into movies and movies about health disparities into a form of medical advocacy. Yale School of Public Health (YSPH) alums, inspired by two new documentary films, gathered for a night of storytelling and reflection on October 9.

In collaboration with NOVA, YSPH screened clips from the recently released documentary films “Critical Condition: Health in Black America" and “When Machines Prescribe." The Emerging Majority Affairs Committee (EMAC), a planning organization of YSPH alumni, organized the screening.

Alicia Whittington, PhD, MPH ’06, MS, attended a NOVA screening at Harvard Medical School and was inspired by the films. She collaborated with the NOVA team to bring them to Yale. “Critical Condition” investigates dramatic health disparities, revealing the factors behind the health crisis facing Black people in the U.S., while “When Machines Prescribe” examines the use of race in clinical algorithms.

Dr. Mayur Desai, PhD ’97, MPH ’94, professor of epidemiology (chronic diseases), described the films as “cross-disciplinary.” They bring “real expertise and perspective” to the topic, he said. “We have public health colleagues with medical school perspectives building this large community.”

Whittington was pleased to see her former instructors at the screening. “As an alum, it was heartwarming to see that some of my professors that taught me the fundamentals of public health were there to support me. It was a reminder that I chose a great school and career path,” said Whittington, assistant director of Engagement and Health Equity Research at The Football Players Health Study at Harvard University.

The screening was accompanied by a panel of Yale experts and one of the filmmakers. Dr. Trace Kershaw, PhD, department chair and Susan Dwight Bliss Professor of Public Health (social and behavioral sciences), moderated a discussion with Dr. Aba Black, MD, MHS, associate professor of medicine (general medicine) at Yale School of Medicine, Ashley Nurse, a PhD student at YSPH, and Llewellyn (Llew) Smith, director of “When Machines Prescribe,” Zooming in from his home in Boston.

For Black, “The educational initiative is so important, because it contextualizes why we talk about patients who are mistrustful of the health care system, as opposed to a health care system that is untrustworthy.”

The sample clip from “Critical Condition” emphasized the impact of residential segregation, when racially steeped factors such as living conditions, diet, and stress can have detrimental health effects. Narrators included Martin Luther King Jr., who spoke out about the difficulties African Americans faced in obtaining housing.

After viewing the clip, Black commended the film. “I think it's incredibly important that, as we center these stories, we don't create a narrative of victimization, like, ‘Look at these poor people who have these terrible statistics,’” Black said. “[Rather] still tell stories in a way that allows people to share their stories authentically and in an empowering light, as opposed to kind of reinforcing some negative stereotypes about poverty or disadvantages.”

Nurse also appreciated the film’s narrative approach. “Storytelling is important because it provides a lot more context and details to the statistical-like representation and data,” Nurse said.

The second film, produced by Llew Smith and Kelly Thomson, investigates the use of race in clinical algorithms. The main storyline followed the push to remove race as one of the criteria for organ eligibility, including in the estimated Glomerular Filtration Rate (eGFR), a calculation that measures kidney function. The formula considers age, sex, creatine levels, and historically, race.

Previously, the “Black/Not Black” checkbox fed an algorithm that made Black kidney failure patients seem healthier than they were. While gaining a few points seems inconsequential, the implications were broad; patients who had higher eGFR on paper were pushed down on the priority list for a kidney transplant. With Black Americans deemed “healthier” by the algorithm, many received delayed transplant care.

Black reacted strongly to the clip, citing her own experiences as a Black woman in medicine. “I graduated from med school in 2013. I remember learning about eGFR, and I never questioned it, as a black person,” Black said. “I trusted the people who were teaching me, even though, you know, I didn't really stop to think about it until I got here, and I was reading some of these papers. As a sociology major, I know that race is a social construct, but I never connected it because I just accepted what was being taught.”

Smith said in making the film, it was important to find a patient willing to open up. “The eGFR can sound like an abstract concept until you realize that this is about someone's life or death,” Smith said. “So, it's wonderful to take a human story and open up questions around how the medical field can often continue these racist ideas without knowing it.”