Dr. Tracy Downs – A Catalyst for Change

Tracy M. Downs, M.D., FACS, joined UVA Health in July 2021 as the inaugural Chief Diversity & Community Engagement Officer. In this vital role, Downs serves as the institution's leading voice on diversity, equity, and inclusion and focuses on initiatives across the health system and the local community. He focuses on developing, supporting, and guiding efforts to ensure an inclusive, and respectful learning, training and working environment. He also works collaboratively to improve community health and well-being in underserved communities across the region. We talked with Dr. Downs about his background and vision for building a more diverse, equitable, and inclusive institution. 

Dr. Downs, please tell us about your background in medicine, urology, diversity, and multicultural affairs. And what brought you to UVA?

I've been a urologist for 19 years, and I chose this field for a few reasons—one is based on the people I work with and for balance in life, which includes family and providing high-quality healthcare. Another is the patients I serve, and though there are many serious challenges in urology, they are often solvable; and I get to work with some of the nicest individuals.

I began to tackle health disparities in 2000 during my fifth year of residency. The disparities in healthcare outcomes between black men and white men diagnosed with prostate cancer began to resonate with me, and I recognized this was a significant public health concern. Furthermore, I didn't feel satisfied with the answers I was receiving as to why those differences exist. That's why I decided to pursue academic medicine and be involved in these critical conversations.

Before I came to UVA, I was very fortunate to hold the position of Associate Dean of Diversity and Multicultural Affairs at the University of Wisconsin School of Medicine and Public Health (UW SMPH). In that role, I was responsible for recruiting and retaining medical students from a diverse population underrepresented in medicine (URiM). In healthcare, URiM represents individuals from the following backgrounds: African-American, Native American, Hispanic/LatinX, and Southeast Asian/Pacific Islander. At UW SMPH, I also was the director of the faculty URiM mentorship and faculty development program.

The center of my work outside of urology is focused on increasing the diversity of our healthcare workforce—representation at all levels of diversity matters. As an African-American physician, I have always been aware of the challenges faced by many individuals like me who don't have visible role models. So with that in mind, I have actively collaborated with others to use holistic approaches to evaluate each student, resident applicant, and faculty member for the intangibles that lead to success that might be missed if we solely focused on GPA, test scores, or the prestige of where they received their educational training and/or degrees.

While we embrace the challenge of providing healthcare for the most complex and complicated patients, I believe that we should also have that same determination to help a student who comes from a more disadvantaged background academically succeed in medical school and residency training.

As the inaugural Chief Diversity and Community Engagement Officer, you have an opportunity to implement your vision in this area for UVA Health. Please tell us about this vision and how you see helping the internal and external communities we serve.

For our external communities, I take inspiration from other healthcare systems that started before us in their journey toward advancing health equity. I strategically evaluate our approach to addressing health disparities in our patient service areas at UVA and UVA Community Health.

As part of our UVA Health Strategic Plan, we have added a fourth pillar to the core mission and vision, which centers on Health Equity and Community. In the Charlottesville/Albermarle County area, much of our work in advancing health equity will be in conjunction with our partners at Blue Ridge Health District, the Free Clinic of Charlottesville, and Sentara Martha Jefferson as we complete our community needs assessment called MAPP2Health. In addition, we are using the data analytic skills and resources at UVA Health to identify which communities have the highest needs around the social determinants of health using the area deprivation index (ADI).

For our internal communities, represented by all of our students, medical center staff, and nursing and medical school faculty, our mission and vision are aligned around creating a respectful and inclusive environment. We are actively working to reduce micro- and macroaggressions that lead to individuals from minority backgrounds and women feeling unwelcome and undervalued. Our Stepping in 4 Respect program has gained national attention and is a core diversity, equity, and inclusion training program to help when discriminatory behavior is observed from both patients and peers.   

Regarding patient safety and quality outcomes, we are expanding our internal capacity to monitor health outcomes for patients from different racial/ethnic backgrounds with the goal for patients to have equitable outcomes in their healthcare. Areas we are beginning to analyze include congestive heart failure outcomes in African-American and Hispanic/Latinx patients treated at UVA Health. We are also exploring ways to engage in regional and national efforts to reduce the poor health outcomes for African-American women around maternal mortality.

Change is challenging and not for the fainthearted. Hopefully, working alongside so many outstanding individuals at UVA Health, I can also be a catalyst for our goals of building an inclusive environment and advancing health equity.   

During the pandemic, evidence of inequities came to light, including disproportionately higher rates of COVID-19 infections, hospitalizations, and mortality among people of color. What work is being done to address those inequities?

The UVA Latino Health Initiative (LHI) in Central Virginia is led by Dr. Max Luna, an associate professor of medicine and cardiologist at UVA Health. Under Dr. Luna's leadership, the LHI has improved health outcomes in the Hispanic/Latinx community. We had the highest vaccination rates among all Latino communities across the commonwealth, which is a direct result of the strong partnerships LHI has built over the years with the Latino community here in Charlottesville and Albermarle County.   

At UVA Health, we also invested in two faith-based organizations for testing and immunization. Those sites include Mount Zion First African Baptist Church, a traditionally African-American church, and the Church of the Incarnation, which has a more diverse, Spanish-speaking Latino community. Early in the pandemic, we struggled to meet the needs of our communities of color around COVID-19. Over time, and by showing up weekly at our community testing and immunization sites, we are rebuilding the essential trust between UVA Health and the Charlottesville communities and neighborhoods we serve.

How does your work tie into the inclusive excellence framework in UVA’s strategic plan?

Much of that effort is led by my friend and colleague Kevin McDonald, J.D., Ed.D, who is the Vice President for Diversity, Equity, Inclusion, and Community Partnerships in the Division for Diversity, Equity, and Inclusion across Grounds at UVA. The inclusive excellence framework forms an effective platform for developing an inclusive environment and valuing excellence in multiple domains. We all need to ask ourselves: Are you really excellent if you are not recruiting and growing the talent of all individuals within your organization who come from different diverse backgrounds and provide new insights and perspectives that lead to innovation?

As we begin our journey toward advancing health equity and being strategic around our fourth pillar of the community, we have to be realistic in acknowledging that we won't be able to solve every health problem. But, we can make significant strides in addressing social determinants of health (SDOH), reducing health disparities, and improving the patient experience by holding ourselves accountable as we chart our UVA Health Strategic Plan: One Future Together both inside UVA Health and outside in our local and regional communities and neighborhoods.    

How does philanthropy intersect with the vital work that you're doing?

The pandemic has given us a sense of urgency to reverse long-standing patterns and policies that have led to health inequities in our disadvantaged communities and neighborhoods. Philanthropy can provide financial resources to recruit more diverse students through scholarships, support endowments for faculty work, expand community health worker programs, and strengthen initiatives for LGBTQ+ patient care and gender-affirming healthcare.

This article was authored by Rick Kessel.