COVID-19 has put the health care system in the spotlight. Dr. MayKao Hang, vice president and founding dean of the Morrison Family College of Health, has been following the pandemic closely as she brings her vision for the college to life. Hang, former president and CEO of the Amherst H. Wilder Foundation, joined the St. Thomas community in November, bringing with her a lifelong passion for caring about the well-being of underserved communities and for addressing disparities.
Informed by Catholic social teaching, the Morrison Family College of Health is focused on educating leaders to work in service to the whole person (social, mental, physical and spiritual) in the context of family and community. It includes the Graduate School of Professional Psychology, the School of Social Work, Health and Exercise Science and will also house a new School of Nursing.
Hang said the pandemic has brought to light the weaknesses and strengths in our health delivery systems, proving it’s an opportune time to reevaluate how we think about health in general. She shared her thoughts with us on everything from holistic wellness to educating culturally competent health professionals.
Editor’s note: This interview has been edited and shortened for clarity.
The Morrison Family College of Health is committed to addressing the whole person when looking at someone’s health. Why is this so important?
When [people] get sick, they usually go to a medical facility. But what promotes good health and keeps people healthy depends on the social supports people have spiritually, physically and mentally. Their social emotional health. We’re seeing this now with how COVID-19 is impacting people. You can be physically fine but mentally distressed and taxed. Oftentimes, even in the medical professions, we’re not addressing the whole person. People always ask, ‘Does social, emotional or physical well-being come first?’ It doesn’t matter – it’s the same reinforcing cycle. These are factors that are always linked. In terms of delivery of service, it’s important to think about the conditions in which people are living, healing, learning and working.
What’s happened in society and how we conceive of health in American culture is sick care and not holistic health. It’s not health for the whole person. There are whole societies and health delivery systems across the world built around keeping people well, not just intervening when they’re sick. We need to reframe how we think about health, which is one of the reasons why in the Morrison College of Health we have the Social Work Department, the Graduate School of Psychology, and academic programs that can help reframe how we think of health and well-being, alongside more traditional health delivery programs, which includes creating a new School of Nursing.
In what ways does a person’s place in society affect the health care they received? And how are you seeing this play out during the COVID-19 pandemic?
What COVID-19 has highlighted is vulnerable populations, low-income populations, populations where there are ‘health’ deserts – there are stacked-up disadvantages occurring in those communities where the delivery of testing isn’t adequate, resource access isn’t adequate. People are lacking things like transportation to get to a place where they can be tested.
Often people are relying on systems that already exist for the distribution of relief and support funds. Those nonprofits serving the most needy in society and the most affected by COVID-19, in some cases, are not getting the resources they need. In other words, society has set up systems of helping that don’t reach the neighborhoods and people who truly need help. The reality is there is still a racial and socioeconomic bias in who gets tested and who doesn’t. You’re seeing health disparities with the elderly, African American populations, populations in the United States for whom it might not be safe to go get a test.
What other health care issues is this pandemic bringing to the forefront?
Ethics and globalization. They are really impacting how we think about health and how pandemics occur. The COVID-19 pandemic is happening throughout the world. For the first time international health organizations, travel mobilization, national chains of command, even organizations like cities in a very local context are taking action to respond.
The ethics of where the boundaries of life are from both a spiritual and a moral perspective … It’s a little like the Titanic effect, right? You only have so much protective equipment. We must ration our testing, which is one reason why we’re seeing some health disparities. You’ve got governors who have more resources and connections, so they’re getting more tests. We only have so many goods to ration to protect our social workers, medical professionals, even psychologists or others in the helping field. Whose life do we save? Those are big dilemmas.
The dilemma for Minnesota, in terms of the economic consequences of the stay-at-home order, is ethically balancing costs to life with equipment and resources. I’m on the board of Allied Health, and then I’m also part of a small group of business and community leaders advising Steve Grove, the commissioner of the Minnesota Department of Employment and Economic Development. We’ve been talking about the ethical considerations and concerns about returning to work, because people may not feel psychologically safe. The ethical dilemmas are around economic security, equipment, the balance of life and feelings of psychological safety and comfort – the social importance of some of the things we’re doing are all coming to light because of COVID-19. Decisions that policymakers and leaders throughout the realm have never had to consider before on this magnitude because we are more interconnected and global with commerce, health, knowledge.
In some communities there’s a lack of trust in the health care system. How will the Morrison Family College of Health teach students how to connect with people who might not trust them?
People tend to trust people who look like them and people from their own communities. Demographically, we have a mismatch of who’s living in society now, and the professionals that are trained to go out into the world. Getting more students in who look like the people we’re going to be serving will make a difference. That’s not always necessary in terms of building a trusting relationship for health and service, but it helps. Trust is earned in these contexts when professionals care deeply about the populations they are serving and taking care of.
The Morrison Family College of Health will be building into its core curriculum cultural competency as a skill. And cultural competency is a pathway to racial equity in terms of eliminating bias, because it’s possible to develop cultural competency skills to serve across difference so we can suspend judgment and bias in order to serve individuals, families and communities effectively. We’re working in professions where you can make that change at the individual level. And the individual level does start impacting policy if we equip them with the right skills to advocate.
It is really about educating leaders who are going to go out into the world to have the moral courage and the cultural competency to deliver services in a way that they’re not just bearing witness as providers who help improve the community, but can also advocate to highlight and remove the barriers for those who are underserved.
How will the Morrison College of Health help shape a more equitable approach to health care?
Equity is about outcomes. It’s about, regardless of where you’re coming from, you will receive the care and support you need to be and stay healthy. The approach, in terms of the educational process to get there, is to teach students how to identify and think critically about when they notice health outcomes are disparate and unjust, and then devising answers and new solutions to do whatever they can to shift the odds in favor of better health outcomes for everyone. If you’re in a delivery context, which is where I’ve worked all my life, you’re seeing patterns of inequity in terms of who’s getting better and who’s getting worse. It’s about teaching people to identify this inequity in the evaluation process and then teaching them how they can make those systemic changes to avoid what’s unjust for certain populations.
Nurses or physicians enter those fields because they want to help people and society. But they learn the system wasn’t set up to promote health for everyone in the same ways, and they can become disillusioned. Instead of becoming disillusioned, get up and fight. Get up and advocate, and do it based on quality outcomes. If something is both avoidable and unjust, then it’s your opportunity to act as the critical person who is there for that family or that system in whatever leadership role that you’re in.
Has this pandemic changed or enhanced any of your beliefs on educating health providers and future leaders?
The biggest insight during this time is how, as human beings, we resist change too much and how fast we can change. In academic programs, and just compliance generally, standards exist to safeguard quality in some way or keep us ethically moving in the right direction. There have been a lot of debates in psychology and in other fields, even nursing, about whether the remote delivery of health services, assessments and clinical supervision is possible and should be allowed. If so, to what extent? Look what COVID-19 did to that. Everybody has had to move to remote learning. When I first started at St. Thomas, the chair of the Graduate School of Psychology Department and I talked about if we could ever go to clinical supervision remotely. Well, guess what? We did it and it took less than a week. That resistance was based on some fears that it wouldn’t be as high quality as it would be in person. What COVID-19 did was take away that argument, because we had to do it. We can change faster than we think we can. That’s a big lesson, which has given me a lot to think about in terms of, ‘What are the self-imposed barriers that we in academia have placed on the learning process?’ For example, how do we support transitions and revisions in pedagogy to use technology for enhanced and more learning, versus resisting it? The Morrison Family College of Health is brand new, so we can design this with the future in mind because we’re not living with any legacies, which is a wonderful place to be. That means being far more globally, ethically and technology oriented. I had my hunches when I started at St. Thomas that these are big drivers, but now they’re even bigger than we thought.