Celebrating Black History Month: Historically Black Colleges, Universities Are Essential to Improving Diversity in Pharmacy

In a conversation with Pharmacy Times, Earl Ettienne, BSc Pharm, MBA, LP.D., assistant dean of Graduate Programs and Industrial Partnerships at the Howard University College of Pharmacy, discussed the future of pharmacy and how pharmacists of color have been crucial to its history and development. In addition to vital historical contributions, pharmacists of color are crucial in reaching marginalized communities and providing culturally competent care.

Q: Can you discuss the contributions that pharmacists of color have made to the development and history of pharmacy?

Earl Ettienne, BSc Pharm, MBA, LP.D.: Indeed, pharmacists, Black pharmacists, in particular, have been really instrumental in the whole practice of pharmacy. We've made significant contributions to the development and history. You know, despite facing many challenges such as racism and discrimination, we have persevered, and we've made really meaningful impacts on the field.

I would say one notable pharmacist of color that I would bring forth is Frederick McKinley Jones. He's an African American inventor and entrepreneur, and he was awarded about 60 patents in his life, and he made some significant contributions. He actually revolutionized the system for those refrigerated trucks. Another person that sometimes we don't really hear a lot about is James McCune Smith. He was born into slavery 50 years before the American Civil War. He was determined to rise above his situation. And he made sure that he indeed left an indelible mark on society. He has been widely credited as the first African American to earn a medical degree, as well as the first African American to own and operate his own pharmacy. He was barred from attending college, by the way, in the United States due to the color of his skin, and he crossed the ocean, he became a student at the University of Glasgow in Scotland, after which he returned to the United States. After doing a brief internship, I believe it's in Paris, where he served and developed further skills, secondary education, and then he came back to New York City, and at 55 West Broadway in New York, he served patients of all walks of life, all races. Yes, he was a Black pharmacist, but he had no care about whether you were Black, White, green, or otherwise. You know, he parlayed his reputation in the medical field into becoming a prominent abolitionist and activist. He called on his medical writing and his scientific training to write papers and to be scholarly.

Another individual that I would want to really bring up during the spirit of time of Black History Month is in our own university. We had Chauncey Ira Cooper, who was a preeminent scholar, he led the College of Pharmacy, and he actually created the National Pharmacist Association, NPhA. It was the Black alternative to the APhA because back in those days, Black pharmacists were not allowed to be part of APhA. And Chauncey Cooper founded the NPhA, and he was indeed quite phenomenal in terms of his contributions to pharmacy practice. It's interesting to note, as well, that the first graduate of Howard University was indeed a pharmacist. His name was James Wormley. And when we look at more modern times today, our provost, Dr. Anthony Wutoh, is indeed a pharmacist. So, we have individuals, and we have a long history of really leading the charge in pharmacy in a way that is meaningful and leads to societal change.

Q: How have Black pharmacists been essential in tackling social determinants of health and reaching marginalized communities?

Earl Ettienne, BSc Pharm, MBA, LP.D.: You know, this is a really important question. To date, really, Black Americans are twice as likely to be hospitalized due to things like COVID. When compared to our White counterparts, the disparities heavily attributed to the interrelationship of structural racism and equalities and social determinants of health. These equities include the occupancy of essential worker roles. You know, you saw with the advent of COVID-19 how so many people of color, who are typically on the front lines of care, were the most impacted. The inequities include not just the essential worker roles, but we have had for a long time systemic, oppressive housing policies that result in high density living arrangements. And those circumstances really placed Black individuals at an increased risk of transmitting and contracting things like COVID-19.

So, when we looked at the availability of COVID-19 vaccines, that also served as a beacon of hope. However, there are centuries of mistreatment of Black individuals at the hands of the health system [which] created mistrust in the whole vaccine process. While, you know, we didn't quite trust the messaging and all of that type of stuff, there were also other things that were built onto that. Of the greater than 500 million COVID-19 vaccines that were distributed in the US, 10% were administered to Black Americans. This is really disproportionate to the representation when you're looking at the mortalities, because if I remember the numbers in February last year, I haven't looked at them recently, the mortality rate was at 14%. Okay, that's a significant number. The other thing was that when the vaccines were being put in place, the CDC Advisory Committee on Immunization Practices suggested that vaccines be prioritized to older adults. So, it simplifies that as older [Americans]. However, based on the history of maltreatment and so on, our reported age within our community was 72. So, therefore, we had a little gap there with that. So, therefore, there were a group of individuals initially, based on policy, that were being excluded from getting treatment.

And, you know, some of these things are not necessarily deliberate. It may just be from a lack of exposure or not really understanding the other side of the aisle. And these are some of the things that we've got to really change. You know, we as Black pharmacists have been essential in addressing the social determinants of health in marginalized communities. But particularly, you've seen recently with COVID-19 some of the ways that we provide culturally competent care. We addressed health disparities by being well positioned to provide communities that have historically been underserved and marginalized. We increased vaccine access and education through our community pharmacies and through other efforts by colleges of pharmacy, faith groups, local community groups, and so on, that really took the message to the people. You know, we've bridged the gap in communities with health care providers. Pharmacy has always been America's most accessible health care profession, and pharmacists the most accessible health care provider. So, we have been there. We were there during the pandemic, and we will continue to be there.

You know, also on the policy side, Black pharmacists advocate for change. They've been vocal advocates of policy changes to address health disparities and improve access to care in marginalized communities. That has been the hallmark of many individuals. I can speak very comfortably today, when I think of some of my colleagues. I didn't get permission to mention them, but I'll mention a couple of them. Dr. Edwin Chapman is a provider to the community here in Washington, DC, and he is a specialist on opioid use disorder. That is an area where we have seen tremendous health disparities and issues surrounding policy and care. You know, we produced a paper looking at the treatment guidelines, based on this particular cohort in Northeast Washington, DC, and racial issues that impacted genomics and drug selection. So, that's one area I know of. Also, Tamara McCants, one of our faculty members. She sits on the board of pharmacy in Washington, DC, and she went out there to the community and created a whole vaccine effort during this whole pandemic. So, Black pharmacists are at the front line of really driving care and wanting to address the disparities that we face from time to time with many of the conditions that we see.

Q: Historically Black Colleges and Universities (HBCUs) are playing an essential role in efforts to increase diversity in pharmacy. Can you discuss the value of these institutions for students of color who are interested in pursuing pharmacy?

Earl Ettienne, BSc Pharm, MBA, LP.D.: You know, HBCUs have been essential, Howard being, we call it the Mecca. It's one of the most important HBCUs in the United States, and I would say globally, and we've been essential in providing education and training to Black students, in particular. We don't ever limit our population to only students of color, but our mission dictates that we ensure that students of color who may not have had an opportunity to do some of these things do have access. So, we have been providing education and training to Black students who are interested in pursuing careers in pharmacy, in medicine. HBCUs, in general, offer a supportive and inclusive environment that helps to foster the success of students of color. Some of the benefits that we can talk about are cultural competence—who better to really train a person than that individual who has walked that walk and understands what they may go through? Networking opportunities. We have the ability to truly network when we have gone through, and we have broken through barriers.

We historically take those who are less fortunate and pull them forward, I can comfortably say that, as an institution, we don't ever think that what we do is just for Howard University. We move and take others along with us. Usually, you would see nationally, when there really major programs happening, we would bring in some of our partner HBCU schools to be part of this process. Feeder schools tend to also be in that network. So, when we have resources, we share those resources, we provide a supportive community. We ensure, as well, that the price of that education is also critical, because you're dealing with a group of individuals who may not be first because they did not have the economic means initially. Not everyone, but there's a cadre of individuals who may not have that economic means. And the price of the education that an individual gets at an HBCU—and I could speak for how that, in particular, is far superior to what is expended in terms of dollars—you know, HBCUs provide valuable opportunities for Black students who are interested in pursuing careers across the board. And we offer a supportive environment that is unmatched anyplace else.

Q: Although HBCU pharmacy schools account for approximately 4% of total pharmacy schools, they accounted for an average of 22.8% of the total African American student enrollment in pharmacy schools between 2015 and 2019.1 Do you have any insights into why this is?

Earl Ettienne, BSc Pharm, MBA, LP.D.: You know, people go where they think they are wanted, where they feel they belong, where they can ensure that they have the ability to really [succeed]. Iron sharpens iron, OK? So, culturally, they fit in the HBCU environment. That fit includes a supportive community of peers and mentors, as well as understanding the unique perspective and experiences of those individuals who are like themselves. Accessibility—HBCUs are often more accessible and affordable than other institutions, and they make higher education more attainable for some students. If you look at some of the data from the United Negro College Fund and some of the other studies that have been put out there, you will see that HBCUs move individuals from a state of poverty, onward, much faster and much more aggressively than any other institutions do. You know, HBCUs also have a strong commitment to diversity and inclusion. We have no choice, really, because we believe in the total human. So, we accept individuals from all walks of life, whether you are Black, whether you're Hispanic; wherever it is you're from, we welcome you into the HBCU setting. And you will see that people have found out that this is one of the best kept secrets.

Over time, our society is changing, the world is changing. And what is delivered at an HBCU is really critical for the advancement of society. That whole emphasis on community outreach, that the emphasis on a legacy of excellence, iron sharpens iron, causes students to want to feel like, “Hey, listen, you know what, I can really do this.” They don't feel isolated. And as such, they get time to really grow and develop. And then once they have gone through that process, they can compete with the very best, no matter where those individuals may have come from.

You know, I coined the term, “We can take an individual from the worst state, and we can bring them to first state.” So, I have total confidence in what an HBCU can indeed provide. And I've been to, you know, majority institutions, and I have nothing against majority institutions at all. I think everybody has its place. But when we are advancing society here, you know, our efforts to pull individuals together in that collective space is really necessary. Because, you know what? You're going to fall along the way and not everybody will be willing to reach that hand out, to pick you up. Now, in an HBCU setting, we will pick you up because we understand why you fell.

Q: Researchers have also found that attending pharmacy school at an HBCU can positively impact well-being for students of color, both while they’re in school and after graduation. Can you discuss the importance of having the social connections and support that an HBCU provides?

Earl Ettienne, BSc Pharm, MBA, LP.D.: Indeed, you know, an HBCU provides a network that is so, for lack of a better term, is so life enriching and life changing, that sometimes you really can't always justly describe it. You know, I did my undergraduate and pharmacy work at Howard University, and individuals who I was in my freshman year, was on campus with those individuals, I'm still connected to today. I can pick up the phone and call those individuals, even after many years to say, “Hey, what's up, I got this issue to deal with, can you give me some insight?” And it's not a problem. So, that sense of belonging that exists, I feel most tied to the HBCU, most tied to Howard University in this case, because that's what my experience has been.

You know, the mentorship. The mentorship is also a really big thing. I mentioned it before, but, you know, when somebody corrects you who understands where you have been, or who has walked the walk that you have walked, it sometimes feels a little bit more palatable. There's less room for extemporaneous feelings about well, “Do they really like me or not? Is there some other thing at play here?” You know, so that it levels the playing field.

In community engagement, we have such a strong emphasis on being part of the community that we build relationships that are so long lasting, that people absolutely believe and trust us. We can't take that for granted. Let me give you an example. I practice as a pharmacist because I believe that I need to practice what I preach. So, I continue to practice. I had a patient who was in the emergency room and wouldn't take her medication. This is an elderly lady, she wouldn't take the medication, and her blood pressure was going sky high. And she refused to take the medication. The physician, you know, said as we as we were walking down the aisle, said, “Hey, you know what, we have this patient here, this patient would not take the medication, they don't believe [in it], can you say anything to this person?” You know, I went, and I sat on her bed. And I said, “Tell me why you're not taking this medication. It can help you. Right now your blood pressure is out of control. What's the matter? Talk to me.” And we had a conversation for about 7 to 10 minutes. And then she said, “You know what? Nobody has ever really spoken to me in that fashion before. All right.” she reached into her purse, and she took out the medicine that she said she didn't have, and she took a dose. To me, that was just so life altering. I felt great. She felt great. I got her back on her prescription, just with a 7- to 10-minute conversation and showing some compassion. So, you know, to me, you can't beat this type of thing.

And this is what we get from an HBCU type of environment. We live it, we know it, and we love it. But we have to also ensure that we have the necessary resources come in into HBCUs. Because when you think of this nationally, what we deliver to society far outpaces what the resources are that are poured in, so we need equity in terms of some of those resources. And I've made those comments to, you know, administrations prior, that these are things that need to be considered. And I believe—I tend to be an eternal optimist—I believe that people are indeed listening. I think we're seeing change.

Q: We’ve spoken before about the value of partnerships. Can you discuss the partnerships that Howard University has forged and their value?

Earl Ettienne, BSc Pharm, MBA, LP.D.: Oh, yes, partnerships. You know, when I came to Howard University, really looking at the landscape for the future, I said, “Hey, we have very strong engagements and community practice.” But we were at that point where the growth may be slowing. And when I looked at the landscape of pharmacy itself, I said, you know, there's an opportunity here to grow—opportunities for pharmacists in the pharmaceutical industry side of things. And I pursued opportunities in the pharmaceutical industry side of things to say, “Hey, the pharmacist can indeed do a number of things that may not be considered today.” And those things have worked. We went from having a single relationship and having one pre-doctoral fellow, to this year, I'm going to have in excess of 60 postdoctoral fellows in conjunction with pharmaceutical companies, in conjunction with the FDA, and having PhDs in conjunction with NIH. So, working the entire gamut looking at these symbiotic relationships. We're not asking for a handout; we're asking for an opportunity to show you how we can improve your bottom line. And that is what we have done by creating these partnerships.

Pharmaceutical industry in general, and the larger population has been historically underrepresented in terms of people of color. So, this effort, these initiatives that we've done at the University have improved significantly some of those. And, you know, I'm open. I'm open to having as many partnerships as we possibly can. And one thing that I told many of my partners, I said, “Look, we are Howard University, but we have a responsibility to ensure that individuals who we would normally serve, who may not have access to us, we can still have access to our programs at graduation.” So, all of our Fellowships are opened up to individuals across the country. We're getting applicants today from, you know, the Midwest, the South, wherever it is in the country, the West. We screen those candidates, and we select the very best, because we want our partners to know that one, they're getting quality. Two: there is a trust factor that we're going to say that we're going to do something, we're going to do it, and we're going to revisit it to ensure we did it and we did it well, and then we're going to look for how we improve it from then on. So, my view on partnerships is that we cannot exist as an organization, we cannot exist as a society if we don't partner, because neither of us is as smart as all of us collectively thinking.

Q: Why is it so important that there are more Black pharmacists and pharmacists of color in general?

Earl Ettienne, BSc Pharm, MBA, LP.D.: You know, it is more important to have Black pharmacists and pharmacists of color in general for a number of reasons. One, representation matters. The Black population in the United States, depending on whose statistics you look at, is approximately 14%. So, having more pharmacists of color can provide those patients with a sense of comfort, with a sense of trust, that they're more likely to feel understood and respected by their health care providers. Those who share their cultural background will provide experiences that, you know, the average person may not necessarily understand. Just looking at the COVID-19 pandemic alone, that's just one example. This can increase the likelihood that those patients will comply with their medication regimens and seek out care when they need it, because they trust their providers.

Secondly, Black and other communities of color experience higher rates of chronic conditions, such as heart disease, diabetes, hypertension, when compared to the majority populations. Having more pharmacists of color can help really address that issue head on by increasing access to culturally competent care and improving health outcomes for marginalized populations. We've joked that we've got to go there [when] improving patient care. You know, sometimes we have a situation in this country where sometimes health care providers get pitted against each other. We have to eliminate that, and pharmacists of color in communities of color working with physicians, nurses, and so on in the medical home, can truly bridge that gap, remove the barriers. As a pharmacist, we play a critical role in managing medications. We are medication experts, right? We prevent adverse events. We bring unique perspective to the provider-patient relationship. A lot of times, a patient in the pharmacy may tell us things that they did not tell the physician because, you know, it's not that the physician is bad or anything—physicians are great. But somehow, because of that access factor, it breaks down a barrier. And if we're working consistently together, pharmacists with physicians and other health care providers, we can eliminate those barriers. We could ensure that our cultural and social factors that would normally impede care go away and [we can] enhance care.

As you know, increasing diversity in the pharmacy workforce can lead to more inclusive and equitable professional opportunities, or it can also ensure that the needs of the patients are met. In so doing, and we can have a society that represents the people who live and grow and work in that society. Remember, the ultimate goal is that people are people. However, some people will know each other better than some. As such, we need to provide those individuals who may know how to provide care in those communities. And it will work. I've seen it work, time and time again and there is no reason to change the model. We need to put more dollars, put more resources into those models, so that we improve communities of color. Because we know for a fact that when we look at diversity and inclusion, when we look at ensuring that individuals who are underrepresented get represented in corporations and in society, it moves the tide up. Many corporations for years left a lot of money on the table because of built-in, inbred nuances that they really were not aware of, because that's how they were. That's how they were socialized from early on. So, I said, we need to open this up. We need to have much more inclusion, but we need to have a much greater representation from our communities. You can't be at school with 3% and 4% when we have 14% of the population. It just it just doesn't necessarily work, so we've got to look at that.

REFERENCE

Moultry AM. The Evolving Role of Historically Black Pharmacy Schools in a Changing Environment. Am J Pharm Educ. 2021:85(9):8589. doi:10.5688/ajpe8589