BOSTON, MA – Benjamin Perkins recalls his father taking a stress test and collapsing on a treadmill in Los Angeles in 1995. His dad, also Benjamin, had suffered symptoms pointing to heart trouble, but doctors repeatedly insisted everything was fine. Three days after the heart attack on the treadmill, he was being transferred to another hospital, one with better cardiology care, when the 56-year-old went into cardiac arrest in the ambulance and died.
Fast forward to today. His son is a prominent social-justice and health equity advocate who has spent more than two decades in the public health field, including as Vice President of Health Strategies for the region’s American Heart Association/American Stroke Association. He was CEO of Wholesome Wave, a national nonprofit that enables under-resourced communities to make healthier food choices. Currently, he leads their equity-centered work as the creator of the FED (Fidelity, Equity, and Dignity) Principle and chairs the board’s FED Committee.
Perkins has learned that racism in medicine creates environments where patients of color too often, like his dad, do not receive the best medical care and the patients, and their families, suffer because of it. For Perkins, a recent civic engagement resonates even more, reminding him of the pain of losing a father – when it just shouldn’t have happened.
Perkins is on the “Wisdom Council” at Brigham and Women’s Hospital (BWH), where the group plays a critical role in channeling community insights and recommendations to the hospital’s Healing ARC initiative. Why is it needed? In 2015, a study by BWH physicians found, on average, that fewer Black and Hispanic patients diagnosed with heart failure in the emergency department were admitted to the specialty cardiology unit. More frequently, patients of color were sent to general admissions, where outcomes weren’t as positive. In response to this blatant pattern of structural racism, the Healing ARC framework was created to develop a practical care delivery model that can save lives and has already paved the way for better treatment for Black and Hispanic heart failure patients.
“My father’s story is certainly something that I think a lot about in relationship to the work of the Wisdom Council and understanding that there’s a differential in patient care,” Perkins says, noting that what happened to his father is the precise situation that the BWH Healing ARC intervention seeks to prevent. “Healthcare systems produce disparate health outcomes. I am very interested in supporting work that engages residents in addressing issues related to health inequities. For me, this is a very personal story.”
Perkins continues: “We felt my father didn’t get the best treatment. But this was 1995, we didn’t necessarily connect it to race, disparities, or inequities. But it just felt like this shouldn’t have happened. It was two years ago when that was really hammered home. I was on a panel at Harvard Medical School with a Latino friend who is a doctor. And when I told him my father’s story, he said every indication suggested my father should have immediately been triaged into cardiology. They shouldn’t have waited so long before doing something. And that was the first time anybody put it to me that bluntly. He was a victim of racism in medicine.”
In some ways, Perkins sees himself a child of the struggle for racial equity. He was born in Los Angeles in 1965, the year of the Watts riots. He graduated from UCLA with a degree in geography and the scholar has advanced degrees from Harvard Divinity School and Antioch University in Los Angeles. While working in public health, he has been a leader in disease prevention and working on preventing HIV infections. Along the way, he has led a community advisory board, directed a CDC-funded HIV-prevention and wellness center, led an NIH-funded HIV-prevention feasibility study. Perkins is an ordained minister in the Christian Church (Disciples of Christ) and serves a congregation in the Boston area. By 2014, his focus turned to issues closer to home – health disparities and inequities in cardiovascular disease and stroke rates among communities of color and other under resourced populations. Not only did Perkins lose his father, but he had two uncles also die of heart-related causes.
Perkins believes that racist systems and structures bare the fault for inequities in patient care. “Some people may have ill will, don’t get me wrong,” he says. “But I think the systems produce these outcomes independent of bad actors. It’s absolutely essential to have these kinds of initiatives, like the Healing ARC, that work at the systems level. That is so foundational. If you don’t do the systems level work, bad outcomes will continue to be produced.”
In accenting that point, Perkins compares systems-level interventions in healthcare to the Boston Globe’s award-winning investigation of sex abuse in the Catholic church. In the movie, “Spotlight,” which focuses on the Spotlight Team investigation, Perkins recalls that the editor tells the team’s leader not to focus on the individual priests, but on the system that tolerated their behavior. “It was really fascinating because in talking about their approach, the editor said there had to be a laser-like focus. He understood that it was much more about the system than ‘individual bad actors.’ That just confirms that systems must be the target if you want real change.”
Perkins expanded on that reasoning, saying that he has spent decades in public health and engaging both individual and system level initiatives. “But if you don’t understand that it’s the structural weakness causing the problem, and that is where you must intervene, your resources and time will just be squandered.”
He notes the role that the Wisdom Council plays in the Healing ARC framework, as the intervention addresses the structural racism that facilitated Black and Hispanic patients not receiving the best available treatment for serious heart ailments at BWH. The “ARC “stands for acknowledge, redress and closure. In Healing ARC models, stage one requires providers and institutions to acknowledge that racism contributes to inequitable health outcomes. Stage two must redress the harm by providing restitution to the harmed population, including opening access to services and care historically denied. Stage three is to facilitate closure through reconciliation and agreement that the harm has been redressed.
When Drs. Michelle E. Morse and Bram P. Wispelwey led the development of the Healing ARC, they created a more equitable process at the hospital. Today, if an emergency physician selects admission to the general medical service, rather than cardiology, for a patient of color suffering heart failure, the clinician receives a “Best Practice Advisory” through an electronic health record system. It reminds physicians that patients of color have fewer admissions to the cardiology unit. The physician then can either change their decision and admit to cardiology or override the advisory and continue admission to general medicine. Regardless, there is now accountability for what can be life altering decisions.
Perkins sees the Healing ARC approach as a branch of Truth and Reconciliation Commissions (TRCs), which have been instrumental in resolving deeply rooted conflicts around the world. The TRCs identify human rights violations, impacts of racism and tragedies, and then lead populations on a healing process that restores dignity and respect, paving the way for the transformation of societies. The approach has been deployed to address historic wrongs in Australia, Canada and a few communities in the United States.
“My fond hope and desire is that the Healing ARC can become a success similar to those derived from truth and reconciliation frameworks,” Perkins says, noting the reluctance of America to provide reparations for the racist policies and practices that have harmed people of color since the birth of the nation. “It’s like the story we hear all the time about the only reparations ever given went to slave owners, who lost their slaves after emancipation.”
Yet, Perkins sees real progress, especially in what the Healing ARC has accomplished.
“As an individual who has experienced losing family members because of inequities in healthcare, I see real power in the hospital acknowledging their wrong. It’s like the first step in an exorcism is to name the demon, ‘What’s your name?’ “Perkins says. “In this case, the hospital has acknowledged the wrong. The study documented that Black and Hispanic patients were mistreated for at least 10 years, and we know it was longer. The hospital did not run from it. Like with my father, he didn’t have to die. And we all know it. There is a power that comes with the validation of your claim. What was suspected, is what actually happening. There’s something really powerful about the hospital acknowledgement of what happened.”
Moreover, Perkins says that African Americans aren’t used to unconditional acknowledgements of wrongs, and committed efforts to redress the harms. “The hospital says they are committed to doing things differently, the redress,” he adds, noting the Healing ARC intervention has been implemented as pilot program since earlier this year. Still, he cautioned, “the harmed community must help set the terms of what the redress and closure look like.”
That is where the importance of the Wisdom Council emerges.
“The offending institution’s role is to acknowledge and then listen,” Perkins says. “If this is done well, the community voices will be in the forefront for the final stages. We want to be in a relationship where the community and the hospital mutually agreed to the course of redress and we need to define together what closure is.”
This experience demonstrates the true power of structural interventions, Perkins says. “We are changing ingrained habits that privileged a specific group of patients. It was built into the system. But now that system has changed, it’s fairer, it’s more equitable. I often think about my father and what would have happened if he showed up at Brigham’s emergency room with the same symptoms. The way this system now works, he would have been sent to cardiology and not had to wait three days for the proper care. He could have lived more of his life.”
