Transforming Health Care at Johns Hopkins Health System

Womanly Chats
Special Issue: High Blood Pressure
Words - Attia Taylor
Illustration - Singha Hon

Sherita Hill Golden, M.D., M.H.S is an esteemed doctor, scientist, and administrator at Johns Hopkins Medicine, dedicated to serving her community and addressing systemic racism in health care. Her contributions to the field of diabetes research and to inclusive hiring practices have made a lasting impact on her community.

Attia Taylor: You've been at the intersection of so many issues related to equity and preventive health. I'd love to hear about your passion for this work and what drives you to really ensure people, especially folks who live in Baltimore, receive quality and equitable care.

Dr. Sherita Hill Golden: You know, I think a lot of it stems from my upbringing. I was born in 1968, right before Martin Luther King Jr. was assassinated. There was a lot of transition occurring in our country and I was a child of those additional integration efforts in the 1970s. My parents always instilled in me the importance of pride in my African-American history and my Christian faith. I think that those are the two things that have really inspired me to use medicine as a service and a ministry.

I decided I wanted to become a doctor when I was in the fifth grade because I liked studying the human body in Science class. My teacher was one of the few African-American teachers in the school, and she really instilled in me the confidence that I could actually become a doctor. I also pledged Delta Sigma Theta Sorority, Inc. where the principles of service to the community and social action are really embedded in the core values of our organization. So I knew that whatever I ultimately did in medicine, there would need to be a service component in order for me to combine my value system with my passion for medicine.

When I was in medical school, I developed an interest in diabetes because at the time it particularly impacted underserved communities—Black and Brown communities and individuals with lower socioeconomic status. It was a growing epidemic at the time, so I knew that I wanted to be a part of giving patients access to all of the new technologies and medications that were emerging. I would also be able to deliver the care in a way that accounted for the context in which they live and the challenges that they faced. Heart disease is the leading cause of death in people with diabetes, so a lot of my research and clinical care intersected. I focused not only on the management of glucose and diabetes, but also, the management of cholesterol and blood pressure.

When I graduated from the University of Virginia School of Medicine, I did my internal medicine residency at Johns Hopkins Hospital. I grew up in the Washington, D.C. area, but I've been in Baltimore over half my life now. So this is really like a second home to me. And that really inspires my passion around making sure that the people of Baltimore city get the health care access that they deserve, and to address the structural inequities that have kept that from happening. 

Attia: That's amazing. Health care providers should have this understanding of where people are coming from and what their barriers are to accessing care. What are some of the barriers that Black and Brown communities face to receiving care, particularly around cardiovascular health, diabetes, and hypertension? 

Dr. Golden: I think there's a few things. I put them in two buckets. First, what are the medical and health care context barriers? And then what are some of the social needs and policy barriers? 

People have to be adequately insured. People can lack any insurance or they can be under-insured, where you have health insurance but it doesn't cover, for example, seeing a specialist like a cardiologist or an endocrinologist.

The Affordable Care Act and expansion of Medicaid enabled more people to have health care coverage, which is really critical. So much of our health insurance is linked to employment. For some workers, this was a particular challenge during the pandemic. For example, immigrants in our Latinx community are working as day laborers or migrant workers and there’s no health insurance with those kinds of jobs.

If you can access the health care system, certain populations have experienced biases from health care providers. Some of that is residual bias from historical practices of experimenting on marginalized communities without their consent, which goes back to slavery and continued into the post-Civil War era. There are studies that show many clinicians presume African-American patients are less likely to understand and adhere to medical treatment, regardless of their education level. So if you come into the health care system and have experiences where your complaints are not heard or taken seriously, that can affect the treatment you receive and influence whether you return. 

And then there are social contributors and policies. People may live in an environment where there are no sidewalks or open green spaces to exercise safely. There's corner stores that have a lot of calorie-dense, highly processed food, but don't have fresh fruits and vegetables, which makes it very hard for people to practice preventive health care with proper nutrition. That became clear to me when my father had a heart attack and had to have a five-vessel bypass. A nutritionist came in right before we went home and said, “What do you like to eat, Mr. Hill?” She wrote down all the healthy substitutes, and my mom and I went to the grocery store to replace the food in the kitchen with new ones. We spent twice as much money as they'd ever spent on groceries. How are my patients in Baltimore, who may be working two or three jobs just to survive, going to be able to afford to implement a recommendation like that?

Attia: You’re the Chief Diversity Officer at Johns Hopkins Medicine. How has your work combatted some of these aforementioned barriers and helped underserved communities? 

Dr. Golden: I oversee the workforce diversity and inclusion efforts for the school of medicine at Johns Hopkins University, as well as Johns Hopkins Health System. We're focused on recruitment and retention of those underrepresented in medicine, science, nursing, and health care administration, employee engagement, as well as changing the culture and dismantling structural racism. We examine our policies and practices to see if they inadvertently reinforce structural racism and then change them accordingly.

We are on a campaign now to make sure we have accurate race, ethnicity, and language data recorded for our patients. We’re stressing the importance of self identification, allowing patients to select more than one race and indicate their preferred language for health care. Before we can accurately say, for example, we see disparities in hypertension in one demographic group versus another, we have to ensure we have accurate data. Then we can look at outcomes not only based on race, ethnicity, and language, but sexual orientation and gender identity, disability status, and other parameters. 

We've done a lot of work around COVID to address health inequities. We're working with our city to make sure that we can reach vulnerable communities, doing a lot around community vaccine education. We've done a lot to make sure our own internal employees who are high risk have had access to the COVID vaccine.

Attia: Knowing what they know and considering the mistrust that they may feel based on our history, how can patients advocate for themselves and feel confident in the system? 

Dr. Golden: What I tell patients is, you know your body better than anyone. You know your body better than your physician. And even if your physician says, “I don't think this is anything,” but you feel like it is, then you should number one, get a second opinion. Number two, exercise your right to go to the emergency department or urgent care and insist on getting the care that you deserve, even if you get called an angry Black woman or man. Take a family member with you who can help you advocate, particularly if you're feeling really ill. 

You have a right to question the doctor. It's not a paternalistic relationship, it is a partnership. Ask questions to get clarity. Ask, “Help me understand again, why are you giving me this new medicine?” If a physician feels like you’re questioning [their] judgment, it's probably not the right doctor. That's not questioning judgment, it's helping you to make the right decision for yourself and to understand what you're taking, why you're taking it. 

Attia: You've been in medicine for a long time. What changes have you seen in terms of equity within the health care system? Do you think it's getting better? 

Dr. Golden: I think it is. No matter how much work you do in this space, people think we aren't doing enough and we need to be doing 15 other things. I've been in medicine for almost 27 years and I've been at Hopkins almost that long. The organization looks completely different than when I first arrived.  There were very few women professors of any race when I first got to Hopkins. Now we’re approaching 350 women professors. So, it has evolved and we have more diversity.

We need more race and ethnic diversity but we are making progress. I think the thing that I've noticed in the last five years, particularly since the Freddie Gray unrest, is that the staff speak up more when something is not appropriate and even more so since the protests last June. When Freddie Gray was murdered, my son was 15 and just learning to drive. I'm the wife of a Black man who is a doctor that drives back to the hospital in the middle of the night to take care of other people's children. And I'm petrified. I talked about it to my department and then our department started a whole dialogue series about these issues, called “Journeys in Medicine.” And now we're talking about it across the organization. Now our executive leadership wants to hear and is willing to begin to make culture changes. There are some people that still feel like, “We're in health care, why are we talking about race at work? We treat everybody the same.” But if you treat everybody the same, that's where you get inequity because everybody needs something different. We aren't all starting at the same place. And I think that getting people to understand [that is important].

Attia: I like to end my interviews with a few personal questions. Where is your favorite place to eat in Baltimore?

Dr. Golden: [Laughs] The Lebanese Taverna. I just love Middle Eastern food. I'm having withdrawal over the last year because my husband and I are trying to be cautious.

Attia: What do you like to do to relieve stress?

Dr. Golden: My favorite thing is sleeping and reading a book. I'm always so busy, but Friday evening around seven comes and I can snuggle up on the sofa with my book. I also love listening to gospel. If I'm on the elliptical, I have gospel music on. If I'm getting dressed in the morning, I have it on. It's on in the car. So I would say it's a combination of gospel music and some form of reclining on the sofa with a book.