Pozen-Commonwealth Fund Fellows Explore Health Equity Solutions in Capstone Projects

By Karen Guzman

Kennetha Gaines ’21 enrolled at the Yale School of Management in 2019, a member of the first student cohort of the school’s Pozen-Commonwealth Fund Fellowship in Health Equity Leadership. She knew that her MBA experience would culminate in a capstone project of her own choosing and had already identified the real-world problem that she wanted to tackle: infant mortality in the African American community.

“This is an issue I’ve been working on for a while, so I knew I wanted to focus on it at Yale with the goal of arriving at real, proactive solutions,” Gaines says. “The capstone let me dive deeper to get at the root causes. How can we prevent these negative outcomes before they happen? How do we create a more integrated health system for the African American community?”

A graduate of the Yale School of Nursing, Gaines is now director of nursing for the University of California Los Angeles Health system. She was one of Yale SOM’s three inaugural Pozen-Commonwealth Fund Fellows, all of whom graduated in 2021.

The fellowship gives healthcare practitioners the leadership and business skills to tackle major inequities in the U.S. healthcare system. Fellows attend Yale SOM’s MBA for Executives program in the healthcare area of focus while receiving specialized training and mentoring from experts in healthcare disparities, including the prominent practitioners and administrators who serve on the program’s National Advisory Council.

“The capstone project allows the students to bring together many key elements of the fellowship,” says Wendy Tsung, assistant dean for the Executive MBA program. “Students identify a pressing healthcare disparity issue they want to address, and they utilize the business knowledge gained from the program, along with mentoring from faculty directors and the health equity leadership network, to deliver an impactful proposal.”

Gaines’ fellowship classmates, Dr. Cecelia Calhoun ’21 and Crystal Yates ’21, each undertook their own capstone projects focused on a professional goal. Calhoun, an expert on sickle cell disease, undertook a financial evaluation associated with a proposal to improve outcomes for patients with the disease. Yates, the deputy commissioner of the Philadelphia fire department, drafted a policy brief exploring the need for employers to provide paid maternal leave for new mothers.

“The Pozen-Commonwealth fellows are incredible leaders and advocates for health equity who, with their newfound skills obtained at SOM, have an opportunity to further advance their visions for a healthier and safer world for all,” says Dr. Howard Forman, a physician, management professor, and public health expert who serves as director of the MBA for Executives healthcare curriculum. “The capstone project offers the fellows one tangible and additional way to do this before graduation.”

Dr. Marcella Nunez-Smith, who directs the Pozen-Commonwealth Fund Fellowship, is a national authority on healthcare equity. In addition to serving as the C.N.H. Long Professor of Medicine and Public Health and Professor Management at Yale, she serves as senior advisor to the White House COVID-19 Response Team and chair of the Presidential COVID-19 Health Equity Task Force.

“Kennetha’s project is a great example of the type of work we want students to take on in their capstone,” Nunez-Smith says. “She identified infant mortality as an equity issue and developed a project to evaluate early interventions and improve infant survival.”

Gaines points out that although infant mortality has decreased in the U.S. over the last 30 years, the risk is not evenly distributed. African Americans infants are twice as likely to die compared to non-Hispanic White infants. African American women are also three to four times more likely to die from adverse birth outcomes. “Even controlling for education, socioeconomic status, and personal risk factors, African American women still lag behind,” Gaines says.

Her project was based on a growing body of empirical knowledge that suggests a relationship between maternal experiences of racial discrimination and birth outcomes.

Gaines examined the efficacy of an early intervention strategy that calls for racial trauma screening given every six months to African American women aged 13 to 21. Targeted interventions, such as therapy, peer-to-peer support groups, education, and home-based nurses, would immediately follow screening for those at risk.

Current CDC initiatives to address adverse childhood experiences such as discrimination, child abuse, and neglect through screening have gained attention, but too many states have failed to add racial trauma screening, Gaines says.

She says that several courses in the curriculum were especially helpful in her research. “They aided me with the critical thinking, observations, research, and strategy needed to approach a difficult problem,” she explains.

The Global Health course, for example, introduced Gaines to in-depth analysis of infant and maternal mortality the world over, while Population Health and Health Equity explored solutions to inequities and actionable tasks.

In Healthcare Economics, Gaines was introduced to the monetary costs of not intervening early in healthcare issues, and through visiting colloquium speakers she connected and shared ideas with various experts.

“I was also able to connect with the Yale School of Medicine psychiatry department and speak with Dr. Carmen Black, who studies the effect of racial discrimination on patient care,” Gaines says. “She had great insights on how to approach my project and make sure that I took full ownership of the process.”

Gaines is now advocating for policy changes based on her research, including writing an op-ed about the benefits of proactive intervention and lobbying California’s surgeon general to adopt racial trauma screening for African American women.

“The capstone project allowed me to start a discussion aimed at making actionable change,” Gaines says. “And I’m now pushing through to the next level. I’m grateful to have had the opportunity to focus on an issue that’s really at the heart of what I’ve been working on all these years.”