Rocking the Boat: How Dr. Kendra McDow Imbues Public Health with Racial Justice

Image courtesy of McDow.

As I pored over LinkedIn, Twitter, and various healthcare websites in preparation for my interview with Dr. Kendra McDow, a clear portrait of the formidable female data scientist and epidemiologist took shape in my mind. Her resume is impressive. She holds an undergraduate degree in biology and religion from Swarthmore, a master’s in public health (M.P.H.) from Columbia, and an M.D. from Mount Sinai. She currently serves as a medical epidemiologist at the Centers for Disease Control and Prevention (CDC), where she has spent the past few months promoting telehealth in the COVID-19 pandemic. As I understand firsthand the sacrifices Black women must make in order to succeed in male-dominated STEM fields, my invented Dr. Kendra McDow was an amalgamation of all the top-notch Black career women I had encountered in the media—irreproachable and a bit austere à la Annalise Keating of How to Get Away with Murder or Olivia Pope of Scandal. Yet, on the late summer morning of our interview, McDow’s sunny voice sliced through the hazy monotony of quarantine. She barely introduced herself. The moment our phone lines connected, McDow dissolved the stuffy formality of interview etiquette and conversed with me in the approachable, conspiratorial manner of an aunt or beloved neighbor.

Despite the years she spent training with the National Center for Health Statistics as an Epidemic Intelligence Service (EIS) fellow, McDow doesn’t think of herself as a data scientist. Most of her formal education prepared her to be a pediatrician, and she often finds herself missing the routine of seeing patients and bonding with children and their families. McDow’s pursuit of data science has little to do with any particular love for numbers and everything to do with the socio-political influence of data in the technological age. Her truest passion is, and has always been, affecting material social change. Data science provides a way for her to do so. “To sway public opinion, to sway the opinion of [policy makers], you have to be able to collect data, you have to be able to analyze data… and you have to be able to translate it into a message that is cohesive, into a message that multiple audiences understand and can take action based off of,” McDow said.            

Setting Sail

Although she didn’t always see herself at the CDC, McDow had long known that she would never be quite satisfied by the typical duties of a physician, constrained by a laser-focus on individual patients. She went into her medical training conscious of the fact that she eventually wanted to improve health at the population level and to rectify the systemic injustices perpetrated against the African American community. As an undergraduate student, McDow had spent time in New Orleans rebuilding after Hurricane Katrina as a member of Common Ground, an anti-racism organization. She witnessed how Common Ground’s efforts to address structural inequality were still able to help survivors in a personal way.

In time, her curiosity about the intersection of healthcare and social justice inspired her to get a Master of Public Health degree between her third and fourth year of medical school, if only to have a broader knowledge base to draw on during patient interactions. When confronted with racial health disparities, having a public health background allowed her to understand that historical trauma manifests itself in the very beings of marginalized people, both today and tomorrow. “We are learning that chronic stress, the weathering that occurs, causes epigenetic changes and may result in generational inheritance of disease.” McDow said. “So, this is not just having an impact at one person’s level, but it’s also affecting generations. It’s affecting generations.”

The sentiment could just as easily be applied to McDow’s own family history. She was born and raised in Washington, D.C., but both sides of her family are originally from South Carolina. Her mother and paternal grandparents were all part of the Great Migration, joining thousands of other Black Americans in escaping segregation and terrorism in the South. They left in search of a setting where they could realize their potential, where their worth would be judged on merit rather than on a part of their identity over which they had no control. D.C. was far from a utopia, but it provided at least some relief from oppressive Jim Crow laws in the South. Her family’s willingness to uproot for better opportunities would never be forgotten. “It’s something that’s always stayed with us, and that we have drawn strength from,” McDow remarked.

So, McDow’s parents pushed her to excel in her education, knowing that her credentials would grant her access to the influence necessary to help her community. She grew up keenly aware of her history and her obligation to improve the lives of others, and this personal stake in social justice drove her later career choices. The same historic subjugation that has left its ghostly fingerprints in Black Americans’ DNA generated one of its most devoted assailants. One could say McDow’s hunger for righteousness was baked into her very being.

Doing so, however, would disregard the work that McDow has done to unlearn her own unconscious biases. When she attended medical school in the early-2000s, she and the other medical students were trained to diagnose patients based on pattern recognition—a sanitized term for stereotypes. In an exam, when given a patient vignette that began with “young African-American,” the medical students could safely assume that the fictional patient had sickle cell disease and know that they’d be marked correct. Several years later, when Central American patients tested positive for the sickle cell trait at the community health center where she worked, McDow was puzzled. She told herself that they must have had some Black ancestry. Eventually, one of her mentors, a Guyanese doctor who graduated from Howard University’s College of Medicine in the ’50s, explained to her that sickle cell disease was a genetic mutation, not something caused by one’s race or ethnicity. That conversation forced McDow to separate the socially constructed theory of race from the biological reality of genetics, a fine distinction that she still struggles to grasp fully. “It’s still difficult for me to conceptualize that. It’s an unlearning; it’s an unlearning that has to take place,” she admitted. Despite her prior activism and personal experiences, she was not immune to the harmful mythos of race.

Shifting Course

McDow’s shortcomings only strengthened her resolve to dismantle racial disparities in healthcare. As a medical resident, she questioned the leading theory that African-Americans’ poor health outcomes were caused by soul food diets. Later, as a pediatrician, she personally called school nurses, psychologists, and guidance counselors to make sure that ill children had the proper accommodations because she knew that strong academic performance leads to better economic status, which then leads to better health as an adult.

Eventually, McDow became frustrated by the limits of her reach as a lone physician. “I felt like my hands were tied… I wanted to be able to say that this child needs to connect to [this specialist], but, for some reason, I can’t even get them an appointment,” McDow said. “Why is that? Why are the resources so lacking that my patients cannot be connected to the services they need, not because of any fault of their own, but because the economic resources are not there in the community because of structural inequality, because of racism?”

The more time McDow spent as a pediatrician, the more obvious it became that medicine was too siloed for her ambitions. As a public health professional, she could work directly with the board of education. She could focus exclusively on a given community’s historical relationship with government and healthcare systems and develop far-reaching interventions to address the modern repercussions of those relationships. So, after a decade, McDow applied to the EIS, leaving medicine behind to enter public health. “I wanted to know how I could join the community of people who are thinking like that,” McDow said.

Rough Seas

In public health, Kendra McDow found a community that, like her, was still grappling with the mythos of race. For all its analysis about the intersections of history and collective wellness, public health still has many blind spots with regards to race. Although public health professionals have supported emerging research detailing the origin and mechanism of healthcare disparity, there is a difference between extensively describing a problem and fixing it. That, McDow believes, is the current frontier of race and public health: we understand how racism, not race, acts as a social determinant of health, but we are paralyzed by inexperience. “The issue now is with the science that we have, with the evidence that we have, how do we craft interventions based on this?” McDow said. “How do we evaluate those interventions?”

The challenge is partly caused by the lack of diversity at the upper echelons of health institutions. Black scientists, physicians, and public health professionals are underrepresented in leadership positions. As a result, McDow opined, efforts to alleviate the burden of disease on marginalized communities have been reactionary instead of proactive. “[Race] isn’t a priority because no one’s thinking about it. And the people that would think about it are not at the table,” McDow elaborated. If our society ever wants to be free of the multi-headed beast of white supremacy, we must begin by investigating who has access to the platforms that could ameliorate racial inequality in the first place. And then we must ask ourselves the question that shifted the course of Kendra McDow’s life: Why is that?