Alumni Spotlight: Moses Mansu (MPA 2000)

In February 2023, Moses Mansu moderated a conversation on health equity with NYU Wagner students, alumni, as well as NYC Mayor and 2023 NYU Marnold Fellow, Bill de Blasio.

What motivated you to attend the Wagner School of Public Service and how did it impact your understanding of health and healthcare?

I relocated from Ghana to the United States and went to work for the NYC Department of Health and Mental Hygiene’s Bureau of Operations on an archiving project. The Bureau of Operations provides support to other Divisions of the agency for their daily operations. It was during that time that I developed an interest in the operations and management side of public health.

In a casual conversation with the then Director of the Bureau, he indicated to me that if I were considering a career in public service, he would recommend the Robert F. Wagner School of Public Service at NYU. I attended an open house and immediately thereafter, I made the decision to join the Wagner family. It was one of the best decisions I ever made.

A course on the history of healthcare policy in the United States course had the most impact on my understanding of the racist roots of health and healthcare and how they are ubiquitously perpetuated and recreated—and yet very meticulously hidden—across systems, policies, and environments to this day. Whether it was the collection of blood samples from Black youth in Baltimore to test for anemia when in fact they were looking for signs of genetic predisposition to criminal activity or studying the course of syphilis in Black men in Tuskegee without their knowledge and permission, I came away with an understanding of why racial health inequities and disparities exist. Incidentally, I was appointed to the Office of Minority Health in the NYC Department of Health after graduating from Wagner where I was responsible for helping to lead the agency’s efforts at reducing health disparities. The historical context of healthcare policy in the U.S. helped me appreciate that, in order to right the historical and contemporary wrongs, every program we implemented in minoritized communities had to have an equity lens—including centering those communities as well as recognizing, honoring, and yielding to their collective wisdom, power, voice, and lived experience. This is how my journey in the health equity space began.

You’re currently the Program Director of NYU Langone’s Institute for Excellence in Health Equity which advocates for individuals who are underrepresented in medicine and works to mentor clinicians and trainees of color, contribute to national policy on health equity, educate medical students on this topic, and conduct health research. Can you tell us about an initiative you are currently working on that either excites or challenges you?

Of the many social determinants of health, one of the key drivers of inequity is education. A good education can lead to well-paying employment, which in turn can improve outcomes across the other social determinants such as housing, food security, access to healthcare, and lead eventually to intergenerational wealth capture and accumulation—the very thing that racist policies and practices have sought to deny Black people and other racially minoritized communities for centuries.

All too often hearing loss goes undetected in children yet, even mild impairment can cause a child to miss as much as half of all classroom content. Moreover, when children are found to be struggling, often, they are misdiagnosed and treated for conditions they do not have. At the same time, despite these setbacks, they are often moved along in the educational system until they graduate despite being poorly equipped for a successful post-secondary education life—and many drop out without completing high school thereby lacking any widely acceptable educational credentials required for well-paying employment. For many of these children and their families, this represents a painfully missed opportunity for upward socioeconomic mobility and may result in another generation trapped in the cycle of poverty—particularly if they live in neighborhoods already bearing the brunt of disinvestment and marginalization due to racially discriminatory policies and practices. In a nutshell, therein lies the potential impact of hearing loss on a child’s education and their family’s opportunity to escape poverty.

Immigrant children, many of whom did not have hearing loss screenings at birth, carry a greater burden of this condition. Here in the Institute, we recognize the long-term health equity ramifications of this condition in children and partnered with communities to co-create a community-led program to raise awareness of the problem and to offer opportunity for immigrant children to be screened for hearing loss.

Soon after our program launched, a Bill H.R. 5561,“Early Hearing Detection and Intervention Act of 2021” was introduced in the United States Congress, aimed at supporting hearing loss screening and early intervention services for newborns, infants, and young children. Some people will call it coincidence, right? But I believe opportunity and favor often follow in the path of preparation!

The NYU Langone Office of Government Affairs is working together with the Institute for Excellence in Health Equity, and the Ear, Nose and Throat (ENT) Department. They have also enlisted the support of the NYC Congressional delegation of leaders for the bill, highlighting the health equity implication of undetected hearing loss. The bill is currently before the U.S. Senate Committee on Health, Education, Labor, and Pensions, after passing the House of Representatives.

What is even more exciting for me, from the local policy angle, is the fact that advocacy groups such as the NYC Chapter of the Hearing Loss Association of America have found the Institute as a preferred partner to support their effort at getting New York City Council to restore hearing loss screening in schools. It is interesting to know that NYC is the only locality in the State of New York that does not mandate hearing loss screening in schools. We will be making data available to the group and to help identify families in our program whose children have hearing loss so that they can testify before the Health Committee of the City Council. You can see that, not only is the Institute working to impact national policy, we are also hard at work to impact local health policy as well.

In addition to your role with NYU Langone, you have been a long-time health advocate in New York City with work across faith-based organizations, immigrants, and accessibility advocates. What policy trends do you see emerging in health equity that you hope will gain more momentum? How might new health professionals be more effective allies and advocates in support of this work?

My work has primarily been in communities of color, trying to address issues of health disparities and inequities. Race and racism have always determined access to healthcare as well as the quality of care and health outcomes overall in the United States. But what is often less known is how race-based medicine, which has characterized the practice of medicine in America for centuries, has contributed immensely to a deadly two-tier system of care and the differential health outcomes we see today. This has also contributed to the kind of distrust and mistrust of the healthcare delivery system, public health, and medicine among impacted communities—something that was magnified during the recent roll out of COVID-19 vaccinations.

One well discussed example of this is the use of a racial quotient in the calculation of kidney function by modifying the calculation for Black Americans. The modified calculation falsely indicates better kidney function for African Americans, resulting in delayed diagnosis and treatment of kidney disease in Black people and having the effect of forcing them to “the back of the line” for kidney transplantation despite having more advanced kidney disease. This has prompted the U.S. Organ Procurement and Transplantation Network, the National Kidney Foundation, the American Society of Nephrologists, the American Medical Association and others to recommend an end to race-based calculations of kidney function and implement a new policy that is accurate, equitable, inclusive and standardized in every laboratory across the country.

The recognition by organizations such as the U.S. Organizations Procurement and Transplantation Network that race has no place in the practice of medicine indicates to me that the longstanding use of race-based medicine in the U.S. is under immense pressure to change. To use race, which is a social construct, as a proxy to explain biological differences and to base treatment decisions is purely racist and tantamount to malpractice and bad medicine in my opinion. It will come as no surprise to me, when guidelines on other current race-based practice of medicine such as the use of race in making clinical decisions about the success of vaginal birth after cesarean section in Black women, are revised. That is the direction and momentum of the wind now and we must all play our part, individually and collaboratively, in advancing those unstoppable winds of change.

For new health professionals who choose to work in the health equity space in the healthcare system, they must be unafraid to call out any injustices that promote health inequities in the workplace—at the internalized, interpersonal, institutional, and structural levels of racism and other forms of discrimination. We know race as a social construct has been largely responsible for the unequal health outcomes among racialized groups today, yet, the subject matter of racism can be difficult to discuss. They must be unafraid in their approach and resolute in their support for all efforts at achieving diversity and inclusion in the workplace. It will be uncomfortable and challenging at times, but that is to be expected when bending the long arc of the moral universe towards justice as Dr. Martin Luther King, Jr., taught us. Volunteer to serve on the workplace internal reform committees that are set up to promote diversity, equity, and inclusion and take every opportunity to learn and sharpen your understanding of the issues so that your contribution can be as meaningful as possible.

Do not work not in isolation, but with like-minded people who want to see equity achieved, including those from other sectors like housing, law, food access, education, immigration, and the like. Be a leading voice for your organization to be a part of the network of like-minded people and organizations that are looking to break down the barriers to achieve health equity and ultimately justice. Do the honest and hard work of understanding your own biases and keeping them in check while you work to unlearn them. Most importantly, always center and amplify the voices of those who live the inequities and injustices—our communities can always tell when an individual or organization is actually listening to, and valuing, their wisdom and voice, or coming in with a “savior complex.” Make sure you are part of the former and never the latter.