Dr. Hannah Valantine — At the Heart of Diversity

>> Diego (narration): Time and again, diversity and inclusion initiatives have proven to be a surefire way to improve productivity and wellbeing in the workplace. Not only do they make for happier, more fulfilled employees, they also boost innovation and overall performance in the team as a whole. Companies that make it a point to employ individuals of different backgrounds report seeing a 60% improvement in overall decision-making abilities. Why is that? Well, it’s like solving any complex puzzle. When you have folks at table from various races, cultures, ethnicities, you name it, you gather multiple perspectives that can attack the same problem from different angles and come up with more than one solution.

The list of benefits goes on. Companies that champion diversity are also more resilient to economic down turns. During the recession of 2008, when the S%P 500 saw a 35% decline, companies that remained highly diverse and inclusive experienced a 14.4% gain.

There are countless studies and the results are incontrovertible; diversity in the workplace is a competitive advantage. But despite the numbers and although there have been significant strides, especially in the last decade, the struggle to recruit and ensure equal-opportunity persists.

Take STEM fields for example. A 2017 study showed that black workers make up 11% of the U.S. workforce but only represent 9% of all STEM workers. Similarly Hispanics comprise 16% of the U.S. workforce but only 7% of all STEM workers.

That’s why today, many groups in the private and public sectors make it a priority to cultivate diversity and inclusion. Cue the Scientific Workforce Diversity Office here at the NIH. The office leads the NIH’s effort to diversify the national scientific workforce. They are expanding recruitment and retention the best way they know how, through science. Dr. Hannah Valantine, the first Chief Officer of Scientific Workforce Diversity at the NIH says that it is key for these strategies to be evidence-based. She has been working to capture and spread the value of diversity for years.

Dr. Valantine is a cardiologist by trade. Before coming to the NIH, she was a Professor of Medicine in the Division of Cardiovascular Medicine and Director of Heart Transplantation Research at Stanford University. In 2014 she was recruited to the NIH to head the Scientific Diversity Workforce Office and continue her research in the Laboratory of Transplantation Genomics in the National Heart Blood, and Lung Institute.

When I spoke to Dr. Valantine about the importance of diversifying the biomedical sciences, she emphasized how proper resources, mentorship, and community are essential in the process.

>> Diego (interview): Thank you so much Dr. Valentine for taking the time to talk with me today.

>> Dr. Valantine: It's my pleasure.

>> Diego: I think it's pretty safe to say that the topic of diversity has been at the forefront of a lot of our minds given the civil unrest that we see in the last several weeks. I think it's really shaken people into a new or a renewed awareness about the injustices that are so deeply rooted in our society. And as part of that, it's clear that the workforce in the US has a diversity problem, and biomedical research is no exception. So, can you give me a sense of what the biomedical landscape looks like in terms of representation as it is and perhaps how it kind of compares to other industries?

>> Dr. Valantine: Yes. Yes, you're absolutely right. The workforce mirrors that of the workforce in other fields in terms of lack of diversity. And what we see is a very typical pattern that earlier on in a career path of biomedical researchers, we see reasonable amount of representation and as we move across through the higher levels of the training, into the actual independent investigator and then into leadership, we see a diminishing representation of all racial and ethnic groups, as well as for women. So, for example, women make up more than 50% of Ph.D.s in sciences that are relevant to NIH research, and yet if you look at the representation as independent investigators or as assistant professors it's only about 44% women. And then when you go into more senior investigators only about 25%. And then when you go into the leadership of these institutions, less than 20% of department chairs are women. And you see the same pattern for racial and ethnic groups but it's even more severe.

When you look at the Ph.D. recipient pool, only about 15% of the Ph.D. recipient pool in biological sciences is made up of people from racial underrepresented groups. That is to say African American, Hispanic, Native American, Native Hawaiian, Pacific Islander. But it gets even worst when you look at their representation in faculty position. It's less than 7%. And for African Americans, it's actually about 2 to 3%.

In fact, if you look at applications for NIH research grants, that pool has only about 2%, in fact less than 2% is African American. It's a devastating disparity.

>> Diego (interview): That’s tiny.

>> Dr. Valantine: It is. It's very important because we know that when you have a concordance of race between a patient and a physician or a healthcare deliverer, the quality of the care is better. When you look at ability to recruit into clinical trials and clinical research, when the person approaching the potential participant is of the same race, then you're more likely to have that trust that will go into and make that person more likely to participate. The numbers matter.

>> Diego (interview): Right. So yeah, it’s clear that the numbers definitely don't lie, and I really want to pull the curtain back for folks who maybe haven't personally experienced these hardships or feel that it's not really a problem. So, can you tell me about some of those obstacles that people face in these underrepresented groups as they're entering the field?

>> Dr. Valantine: So first of all, there are stereotypes of who is a scientist that begins even in childhood. And there have been these beautiful experiments done where if you go to a kindergarten class and ask them to draw a scientists, about 50% of them at least will draw the picture of a stereotypic white male scientist, and when you go to higher grades that percentage increases. So, there's that already in the back of their mind that sends a message to these groups that they don't belong in science. And once they get over it and they get into the sciences, then there are other barriers. There' are so few of their professors, their teachers from the same racial ethnic groups, and so, they don't see role models, and that's another message suggesting that even if they get into this career path that they will not be successful.

And then there's the fact that this internalization of those stereotypes occurs so that the individual now because they don't see others like themselves successful feel a fear. They feel a fear of succumbing to the negative stereotype associated with their group, and that phenomena is called stereotype threat. And that threat actually could make their performance go down because there's this fear of failure. Another version of that is the imposter syndrome whereby people who have made it worry that they've made it not by merit but by chance, and so, for every time they are asked to do something they feel a fear of failure. That's the imposter syndrome.

>> Diego (interview): That sounds a lot like the self-fulfilling prophecy that kind of like assume that you're not going to do well so then you fall into these traps where you fulfill essentially that stereotype, or not the stereotype, but the role you had kind of set up for yourself before you even started. And even when people break through, the problem is retention, right? So, what makes it so difficult for minority groups to climb the professional ladder and stay at the top?

>> Dr. Valantine: Yeah. It's partly to do with the social and cultural barriers that persist. You feel a sense of hyper scrutiny of your abilities and your successes, and you feel that you are being often held to a much higher standard than others. And that is a reality. You've got to be twice as good to be successful. And so, that constant struggle leaves people tired. There is a revolving door phenomenon for faculty who are from racial and ethnic underrepresented groups. Where they get in, they realize that the culture is not supportive, and they leave. So, this is a deep cultural issue that you are talking about that results in this lack of retention.

>> Diego (interview): And have you personally felt this way?

>> Dr. Valantine: Yes. I've had this feeling constantly, even today. Many of the rooms where I sit, I'm the only woman of color. When I went into cardiology training in the early 80s, this was in London, there were two women cardiologists. And certainly, no cardiologists of color. And so, I actually felt this but one of the ways around it is to have really good mentorship that goes actually beyond mentorship into that arena of sponsorship.

My mentors were white male, but they were very supportive and advocated for me for my various positions as I went on. And in particular, Dr. Norman Shumway, who was the pioneer of cardiac transplantation in the United States. When I went to Stanford he was still the chair of the department and he supported me through my appointments and advocated very strongly for my career advancement. So, while we wait to correct the numbers, sponsorship and mentorship is key from the majority group, from those people who are already successful and in those networks that guarantee success.

>> Diego (interview): Right. It's up to the people who are in those positions. And it’s definitely not kind of like stay in your own lane. You can cross the bridge and help someone who isn't in your per se group or whatever. Just like your mentors did for you.

>> Dr. Valantine: Yeah. And I think there should be a systematic approach to that mentoring and sponsorship. It shouldn't be left to chance because often, well-meaning professors from the majority group want to help but they don't know how to. They don't know how to mentor using a culturally aware lens. So, institutions have to put those tools, those resources in place to help people.

>> Diego (interview): Yes. Well, now that we've kind of set the stage for the problem, I want to get into the work you're doing to counteract that. So, as the first Chief Officer of Scientific Workforce Diversity at the NIH, you're dedicated to promoting inclusiveness and equity here. So, can you tell me how the Office of Scientific Workforce came about and the kind of work it does?

>> Dr. Valantine: Yes. So, this came about in the wake of a very famous study that was published in 2011 called the Ginther Report, and what that study showed definitively was that African American applicants for a research grant, the RO1, were significantly less likely to get that grant funded compared to any other racial groups as a matter of fact, and certainly compared to white applicants. So, Dr. Collins, to his credit, summoned a working group to give advice as to what should be done not only about that specific problem, but also about diversity in the scientific workforce in general. That working group came up with 13 recommendations, one of which was to create the Office of Scientific Workforce Diversity. And the mission here is to enhance the diversity in the scientific workforce through the different career stages and to make sure that we create these cultures of inclusiveness that are more likely to have people stay once they are recruited into the scientific workforce.

And a key element of this work is that it should be coordinated, integrated, and evidence-based. We have 27 institutions and centers. Each of them have always had some effort in scientific workforce diversity. This idea is not new, but my office was put in place so that we could have a coordinated effort, evaluate those efforts and know what works for whom and in what context.

>> Diego (interview): I see. You kind of mentioned this, and you've even quoted as saying that, "we must approach workforce diversity with the same level of rigor that we employ in the conduct of biomedical research,” which is an interesting idea. I mean after all we are the NIH where science kind of reigns supreme. So, how have you been using science or the scientific approach in your efforts to improve diversity?

>> Dr. Valantine: Yes. That's a great question there. So, the first flagship program for NIH that was launched in 2014 when I established this office is called the Diversity Consortium Program. And that is a program that is entirely based on the scientific method. It has three components. The first component is a set of interventions situated in 10 different institutions, the goal of which is to increase the recruitment and retention of students and advance them into Ph.D. programs in biomedical research.

But it is not just a program. Each of these institutions had to structure their interventions around a particular theoretical framework, and they do their work by comparing a group of patients that gets the intervention with a control group—a bit like a clinical trial. Control group, an intervention group, so that we could see the extent to which interventions are working. Some of those interventions, I can give you some examples, are addressing stereotype threat. So, half the students get the belonging intervention, half not, and then there are defined metrics that are measured. A key one is science identity. Did this intervention make any difference in science identity? So, we're getting that data from each of those 10 institutions. And the beauty of it is, each institution has a slightly different cultural background. It has a slightly different context. So, we want to know what works in particular context. So, there are HBCU's are doing certain interventions, and you can imagine that the interventions needed for advancing their students might be not exactly the same as in other institutions, and we can look and see what the commonalities are.

I would say that what is mostly emerging is that there are certain key elements that are needed for the recruitment and advancement of trainees. Resources. They must have resources. A lot of these students are from backgrounds that are economically disadvantaged, and they have to have the resources to succeed. Second, mentoring. Very key. Mentoring, role models, culturally aware mentoring. Thirdly, having a community. Bringing them in together as a cohort so that they sustain each other. Very important. And then finally having a focus on the research that they do. Having it very clear what the implications might be for society as a whole. That grabs the attention and more likely to keep people engaged if they can see where this research is going.

>> Diego (interview): So, now that you're kind of talking about strategies, do those efforts include the Distinguished Scholars Program. That’s what I've read about. So it's supposed to bring together scientists from across the NIH and provide them with financial support and invested mentoring. So, it seems like the idea for a lot of these things is kind of to get someone who is underrepresented to the top and because of their presence and their influence, they can bring people like them with them.

>> Dr. Valantine: Absolutely. So, the Distinguished Scholars Program addresses exactly that gap of the transition from post-doc to faculty. The idea behind it is to bring in a cohort. Everybody is exhausted by the stresses of being the only one, you know. When you are the only one, often you are mistaken for support staff. I myself have been at a meeting asked to go get the coffee with the assumption that I was support staff and not a scientist. You look surprised but these are everyday experiences of scientists from underrepresented groups. So, we live with that. But in order to mitigate that, why not bring in a cohort? So, that once this cohort begins to be seen in the environment, their excellence appreciated, that is a way to changing the culture. So, the purpose of this Distinguished Scholars Program is really not only to change the numbers, but to change the culture. And to be part of the Distinguished Scholars, first of all you have to be excellent in your science. They go through the normal recruitment process. So, these aren't starting scientists. But in addition, they have to demonstrate a track record of commitment to diversity, inclusion, and mentoring.

And so, you can see immediately that not all of them will necessarily be from racial underrepresented groups, and in fact, that's a good thing because it creates a cohort that is itself diverse and that makes you less likely to be subject to stigma. There is this tendency to think, “oh you only got hired as an affirmative action effort.” No, the group is itself diverse. So, we saw that after only two rounds of this, each round hiring 15 new tenure track investigators, the actual representation of African Americans in the tenure track and Hispanic in the tenure track just took a complete inflection point. So that now at NIH, the tenure track investigators—if you look at the demographic characteristics over the last two years—it’s actually 45% women which is really higher than the national average of 42%, and for the underrepresented racial ethnic groups it's close to 13%. And nowhere in any university, tier one university, would you find that representation.

So, because that was so successful, we worked on an idea of whether or not this could be used in our NIH-funded universities out there that get the bulk really of the NIH budget to do research. So, we've developed a program which we are calling FIRST and that will create a similar program at any NIH-funded institution; this cohort of assistant professors with an interest in diversity and inclusion. And I think with that, we are going to see not only an improvement in the numbers but actually a change in the culture which is ultimately what we want to see.

>> Diego (interview): Of course. Well, you kind of you touched on this, but some people might say that this is all kind of in the vein of affirmative action, which can be quite controversial. What do you say to critics of these programs?

>> Dr. Valantine: I think it's rather different from affirmative action. I think what it's doing is trying to get a broader perspective into the scientific arena. And with that broader perspective, we actually will make the science better, and we'll be able to make more rapid improvements in the care of our entire nation in terms of better health and the elimination of illness and disease. And that's what the NIH mission is all about. So, I would say it's beyond affirmative action. Really, the focus is a ways to really achieve the NIH mission of discovery and translating that discovery to the betterment of human health.

>> Diego (interview): Right, and I mean just as you’ve said, and I'm paraphrasing, to ensure diversity means to ensure basically the best science. So, is there kind of an example that sticks out in your mind of something you've seen that illustrates this?

>> Dr. Valantine: Yeah. So, the classic example is out of my own field in cardiology. When women started going into cardiology the questions about heart disease became different. New questions were asked about the nature of heart attack. Heart attack was typically described—you have chest pain, and well, it turns out that women have a heart attack without those classic symptoms. And so, that spawned a whole new research field about coronary artery disease and this idea that women might be presenting with a different pattern of symptoms and then what is the biology behind that. And so, there's a lot of vascular biology work that has now gone into this simply by asking new questions.

When you ask new questions about a research, you broaden the scope of the research and this is what we saw in cardiology. For myself in the area of transplantation, I am asking the question why is it that African American patients who receive a heart transplant or a lung transplant or a kidney transplant, why is it that they reject their organs more? And they actually die earlier. They have a shorter lifespan. Very important question to ask. The phenomena has been known for the longest time, but there's very little research in this space. So, in my laboratory we are trying to address that question. Sure, there is the access to healthcare and perhaps unequal treatments, the discordance, race between the transplant recipient and the people giving the care. We don't know, but there might also be some biology, some epigenetics around this that we are studying as well.

>> Diego (interview): Interesting. Well, I'm very curious about your personal story and kind of what inspired you to both go into cardiology and along the way, kind of make diversity such a priority in your career.

>> Dr. Valantine: Yeah, that's very interesting. I was first drawn to the cardiovascular system in an art class actually. I think it was second grade or so. I was terrible. It was my worst subject. And we were given this assignment that was okay to copy a drawing from a book, and I found somewhere the circulation of the blood as depicted by William Harvey showing the blue blood and the red blood, and I copied that meticulously. It was the first time and probably the only time that I ever got an A in an art class.

I continued to be fascinated by the circulation, the pump, how that happens, and then I did an undergraduate degree in biochemistry, and that was in, longer than I wish to admit. It was at the time when Brown and Goldstein had just reported about the LDL receptor. And suddenly, it became clear to me all of this recitation and memorization of the cholesterol pathway had some meaning to health. And in particular, cardiology. So, I moved into that space and then I got absolutely in awe of the idea that you can take an organ from a person that is dead and put it into a person and that it still works. And quite frankly, I'm still in awe of that. It is so thrilling. I cannot even explain to you. When you have a patient who is so ill with heart failure, they can't breathe. They're sitting up in their bed, and you do a transplant and literally the morning after the transplant, they actually are up in bed, walking around and within a week they're on their bike, doing things that they couldn't do for 20 years.

>> Diego (interview): I mean to save a life in any capacity is always something very inspiring. But talking about diversity, what was the inspiration—just like the art class was inspiration for your cardiology career—was there a moment, or I guess it was maybe a lifetime of moments that really inspired you to, as we've been talking, bring more representation to the field?

>> Dr. Valantine: Yeah. You're absolutely right. I observed this lack of representation, but I will say that I blocked it out of my mind realizing that in order to be successful I just had to keep going. It was almost like wearing blinders. I was only mildly involved as a student in a diversity work, and in my early career as a faculty member at Stanford. It wasn't until I was tenured that I was asked by the dean of the medical school of Stanford to set up the first office there of diversity and inclusion at the medical school at Stanford. And then I felt ready to really get involved and do the necessary work.

It's really quite distracting before that. And it shows up in a phenomena called the diversity tax whereby most of the students of color, the faculty of color, they are asked to do more and more work in this diversity space. And it saps away from your time. So, at the end of the day you are then –and it doesn't count in the promotions process—so at the end of the day you're looked at and say, "Well, you've not been productive enough." And so, when students ask me how they can get involved, I say yes get involved but be very careful about over commitment because the best thing that you can do is to get your degree, your graduate degree in this biological science and move into a career space, and then begin to be involved in what it takes to make a change.

>> Diego (interview): Right. That's so interesting to think about that in the sense that you have an additional stressor, this expectation that you need to be a voice for diversity, but that stress obviously also hinders you from doing the work that you need to do, and so then there’s that vicious cycle that you were talking about. It seems like being able to share the stressor is the best way to do it. So, it's not about taking it all on yourself and carrying it through your entire career, but finding the space where you've succeeded and you can then kind of look back to your community and then pull them up.

>> Dr. Valantine: Yes. Absolutely. And the other component to that is engaging allies. So, the majority group there, they really -- find ways of engaging them in this effort. I often say to students it would be wonderful to have a role model of the same race, but in fact, there are so few, and quite frankly, there are a lot of people from the majority group who are willing and ready to mentor. Plus, they have access to those super networks of what it takes to be successful. Reach out to them. And you will be surprised how often they will be welcoming.

>> Diego (interview): Great. Is there anything that I didn't cover that you definitely want to include?

>> Dr. Valantine: We talked on the issue of structural racism. I think that is important to highlight and to make the case that that is an issue that is beyond the concept of diversity. It lies in the history of this country and it's to do with being black in America. And we must face it up front and focus on how we're going to address this and make sure that those barriers are removed.

>> Diego (interview): You know, it's really important to have these conversations. So, I just thank you so much for all the work you're doing and for joining me today.

>> Dr. Valantine: Thank you very much.

>> Diego (narration): That was Dr. Hannah Valantine. To get more information about the Scientific Diversity Workforce Office go to diversity.nih.gov. And to learn more about intramural research, go to nih.irp.gov. While you’re at it, make sure to subscribe to our weekly newsletter for updates on all the science coming out of the NIH.

Thanks for tuning in and I’ll speak to you next time.

Music by APM Music