A 40-year battle against racism and health inequities

Jan 25, 2021

Paul Underwood, M.D., medical director at Boston Scientific, looks like a kindly college professor. But beneath his unassuming demeanor lies a battle-tested warrior in the fight for racial justice and health equity.

When Dr. Underwood was training at the Mayo Medical School 40 years ago, apartheid in South Africa was collapsing. Many Afrikaners fled to the United States, and a few of the physicians landed at Mayo; some of them were his instructors.

“Their ingrained beliefs about black people didn’t change after they came here,” says Dr. Underwood. “Things are very different now, but I learned from those early experiences that if you don’t have the power to say, ‘this is how it should be,’ then you have to find ways to influence others. Later, when I became Chief Fellow in cardiology at the Cleveland Clinic, I learned how to build consensus among small teams by collaborating to reach a common goal, which is a skill I’ve carried forward.”

Leveling the Playing Field

Dr. Underwood has been working to reduce health disparities for women and minorities since joining the Association of Black Cardiologists in 1990. He also founded the Center for African American Health in Arizona and was an advocate for the American Heart Association’s community health initiatives in Phoenix.

In 2009 he left clinical practice to join Boston Scientific as medical director for Interventional Cardiology. In 2011 he connected with the Close the Gap initiative to help expand its impact on the root causes of health inequities.

Close the Gap focuses on educating and empowering healthcare providers and consumers to reduce health inequities among underserved populations. One area of focus for Close the Gap includes improving diverse representation in clinical trials. Dr. Underwood was the Medical Director for the groundbreaking  PLATINUM Diversity trial, which evaluated the impact of ethnicity, gender and income on cardiovascular outcomes. One of the first clinical studies of its kind, it provided a benchmark to help physicians create treatment plans tailored to patients’ individual demographic and socioeconomic situations.

“The data shows that the most vulnerable populations have the greatest risk of heart disease but are the least studied in large-scale clinical trials,” said Dr. Underwood. “Close the Gap partners with hospital systems to help reduce systemic inequities by using zip code level data that highlights the disparities in treatment between white and non-white patients in their communities. The opportunities to make an impact are fantastic when we use objective data to guide the way. What brings me the most pride is watching the progression and growth of our efforts as teams across the company adopt our approach.”

A Defining Moment

Dr. Underwood is especially grateful to be part of a company that has been a leader in advancing the causes he values.  In the social unrest that followed the death of George Floyd, our Boston Scientific leadership published an open letter signed by CEO Mike Mahoney, which pledged a commitment to stand up against acts of intolerance and racism.

“George Floyd’s death hits very close to home because I have 9,000 colleagues in the Minneapolis area. I am so proud to be working for one of the first companies to step out and take tangible actions to battle systemic racism. The fight against disparities comes from the leadership level and passes through the entire organization.”

Two weeks later, Boston Scientific announced its actions to confront racism and advance social justice, which included investing $2.5 million to support a multi-faceted strategy to combat racism, inequity and injustice in the workplace and surrounding communities.  These actions build on existing global inclusion and engagement programs at Boston Scientific, including our Close the Gap initiative.

Bring Your Whole Self to Work

Dr. Underwood joined Boston Scientific before inclusivity, or the ability to bring one’s whole self to work was common vernacular. Still, “I was empowered to combine what I’ve learned as a cardiologist and as an advocate for social justice to advance equitable healthcare for people across the globe,” he says. Today, inclusivity remains central to the company’s culture and core values.  “Our workforce is much more diverse than it was five years ago, and people are encouraged to share their backgrounds, express their personal experiences and try new things not directly linked to their job function.”

Dr. Underwood believes everyone should participate in unconscious bias training, join an Employee Resource Group and become advocates to raise awareness for health inequities.

“I know what it’s like to feel you’re working uphill, and no one is on your side. Overcoming the harms created by injustices and biases will take time. Still, I believe we have the leadership and talent to create unfettered pathways for all people regardless of race, creed, color or gender to achieve success.”