Community Spotlight: Changemakers is a series of conversations with thought leaders, community members, and healthcare industry experts.

The series shines a spotlight on community leaders and members who know the burden of social and racial inequities, and health disparities, and are taking steps to change it. As we expand the conversation beyond simply addressing social determinants of health, we hope to draw inspiration from them and deepen our understanding of what diversity, inclusion, and equity in healthcare really mean.

We invite you to join us, follow the Health Equity Research blog, and read about the Changemakers who realize the immense potential of community-based solutions to achieve health equity. If you would like to recommend someone who's making a positive impact in your community, contact us at pereira.kanaaz@mayo.edu

George Maxey–Empowering From Within

George Maxey is an experienced educator (over 25 years), community change leader, and the Executive Director of 2nd Mile Ministries–a Christian community development organization empowering the people of Brentwood to elevate the neighborhood and surrounding communities through the Gospel and wholistic transformation.

Tell me a little bit about yourself–how did you become involved with 2nd Mile ministries? What is your role as executive director?

I became executive director of 2nd Mile Ministries just before the pandemic in 2019. I’m in the Brentwood community (north of downtown Jacksonville, helping kids and trying to develop leadership amongst young adults and children in the community–helping them realize that they don't have to leave their community to find a level of prosperity.

The whole purpose behind 2nd Mile is youth development, in areas of health, education, economics, and trying to build a platform where they can take leadership within the community–to help grow their community from within.

Why is it important for communities to engage and partner with institutions like Mayo Clinic? What are the benefits of doing so?

The benefit of partnering with Mayo Clinic is that the Clinic has a reach that we would never have, as an all-black nonprofit in Brentwood. Engaging with larger institutions creates a level of accountability, and publicity, and increases the level of discussion. Mayo Clinic may not be able to solve every problem, but it can be an advocate for communities, and bring people to the table so we can have discussions for potential solutions.

Are there any barriers to engaging with larger institutions like Mayo Clinic?

The flip side of partnering with non-profits like Mayo Clinic is making sure that they're being intentional and hearing the voices of the people they are trying to serve. It has to be a relationship–a two-sided conversation, and not just telling people what they need to do.

Take obesity, for example. Historically, we know that African Americans are overweight, leading to hypertension, high blood pressure, and diabetes. Large healthcare institutions talk about data that shows the benefits of a Mediterranean diet, eating more greens, more protein, exercise, etc. But it's important to take the time to listen to the people in the community because then you will hear them say–

• "We live in a food desert"
• "Our grocery stores don't provide these organic foods"
• "I know I need to drink and eat healthily, but I can't afford it"
• "You tell me to exercise, but it's kind of dangerous. We don't have sidewalks, there is a lot of crime, and I don't feel safe walking around my neighborhood"
• "We don't have a gym, and even if we did, I can't afford the gym"

Larger organizations need to take the time to see life through the community's lenses so as to find solutions to problems that are rooted in poverty and racism.

Phrases like "health disparities" and "social determinants of health" can become jargony at times, and are not always well understood. How would you explain the distinction between ending racial and ethnic health care disparities and the goal of achieving health equity?

I think the goal of achieving health equity must start with really understanding it. What started in 1694 (slavery), and what is taking place in our country right now, has been transferred–not just mentally but via DNA!  Certain habits and certain mindsets are generational.

We have to start by acknowledging that racism does exist, poverty does exist, but not just talk about it–we must ask why people feel like they're not part of the process or why they’re excluded from the process. Why do certain biases still exist within the process?

Solutions can't be just program-based; they have to be movement-based–something that takes place over an extended period. It’s about doing a deep dive and realizing what my (individual) role is; what are some of the things I can do as an agency, or as a policymaker to create the change I want to see.

How can we, as individual members of a clinical research community/healthcare institution, take steps towards achieving cultural competence that leads to diversity–more so in clinical trials?

A lot of underserved populations don't have access to resources that institutions like Mayo Clinic offer. The first step (in my humble opinion), is making sure there is money in a clinical research budget for marketing and networking.

Monica Albertie (Mayo Clinic) realized this very early on–budgeting for clinical research should include paying people (participants) for their time. That’s called networking! She also realized the significance of marketing, like identifying community leaders or connecting in a hair salon, barbershop, or maybe in a black church–utilizing your marketing campaign to identify key stakeholders within an area, and identifying the target audience.

For example, let's say the target audience is 18- to 35-year-old black males. How do we get the information to them and get them to participate in research studies? You might find them at the local barber shops; or, depending on the time of year, what’s the biggest thing that happens on Saturday mornings? Pop Warner football! That's where the kids will be. So, it’s taking the time to identify key stakeholders who can offer rich ideas on how to reach individuals within a community to get them to participate.

Disparities in healthcare for people of color have been longstanding challenges and have existed for decades. What would it take for the next 15-20 years to tell a different story?

This is where socio-economic issues play a role. Very often, especially in impoverished black communities, there's no trust in doctors. Why? Because the medical profession is not something they utilize. For most inner-city black communities the doctor’s office is the hospital or the emergency room. But you can't develop a relationship in emergency medicine–you’re there to triage! And, since there’s no building of relationship, there’s no creation of that trust.

The problem we are running into is trying to get people past their inability to trust and form relationships–which are formed over time and need a level of consistency. Most individuals in our community don't have doctors’ offices or don’t have proper medical insurance, anyway. They don't have a primary care physician. Well, you can't create consistency, especially with the state of healthcare today. We no longer have “down-home” doctors; now we have Walmart clinics, Walgreens clinics, etc.

For example, a person goes to one of these clinics and starts developing a relationship with the doctor. But they (doctors) will likely have moved on to bigger and better jobs–which leaves the patient feeling like he/she has to start all over again with a new doctor!  "Are they going to prescribe totally different medication?" "Will I have to repeat tests?" All these uncertainties lead to a lot of frustration for the individual. But they are not frustrated with the Walmart or Walgreens clinic–they are frustrated with the medical profession.

Are there certain issues that most affect the health of your community?

I think the primary issues are the same–obesity, hypertension, cholesterol, diabetes. The challenge is that although there's a lot of research being done about these problems, there's very little research done on finding practical solutions from a poverty perspective.

For example, when we provide information, brochures, pamphlets about a healthy diet, we are talking from the prism of the middle class. But what is healthy eating for a community where the grocery stores are Family Dollar or Dollar Tree? We know it's healthier to grow your own vegetables and fruits. But (we) live in a small apartment; there's no room!

Instead of trying to find solutions based on what we know, we need to do things based on what they (community) know–what is it that they know and how can we do it better? There has to be a paradigm shift in how we come up with solutions.

Here are some highlights from our conversation:

• Developing leadership amongst young adults in the community–helping them realize that they don't have to leave their community to find a level of prosperity.
• Inspiration can come through collaboration–engaging with larger institutions increases level of discussion.
• Data about disparities alone cannot advance health equity.
• Larger institutions need to ingrain equity in their actions and processes–get a seat at the community table and see life through the community's lenses to find effective solutions for problems rooted in poverty and racism.
• Developing relationships and building trust are at the core of community engagement.
• View health equity as a movement.