Aaron Pinkett, a 2019 graduate of the MPH program, took to heart the advice former Dean Sandro Galea shared with him and his soon-to-be classmates at their new student orientation.

Galea, Pinkett says, encouraged the crowd of matriculating students to use their time at the school to discover what was most important to them and to concentrate their efforts on confronting only those challenges they truly cared about. Bringing that kind of motivation to their work, Galea said, would make them the most effective.

The advice rang true for Pinkett, now a law student in his final year at Northwestern University. He is on track to graduate this spring and take the next step towards his dream of becoming a civil rights lawyer. Earlier in the year, Pinkett published a note in the Northwestern University Law Review titled “Challenging Race-based Health Care Discrimination: A New Private Right of Action,” which examines racial disparities in healthcare and suggests a potential legal mechanism for civil rights plaintiffs looking to hold hospitals accountable. Pinkett provides the legal basis for legal actions that he believes could catalyze real changes in healthcare practices and disrupt some inherent biases that have long led to health inequities among people of color. It is exactly the type of case he could imagine taking on one day.

Pinkett wrote the piece, which he views as the culmination of his public health and law school educations, for deeply personal reasons. In 1997, at just 40 years old, Pinkett’s mother, Barbara Bunkley Pinkett (CAS‘78), died of breast cancer. She sought treatment for her symptoms about a year prior but was dismissed and later misdiagnosed. Pinkett, who was a child at the time, would later realize that a version of his mother’s story tragically plays out in families across the country every year.

At first, the loss of his mother motivated Pinkett to consider attending medical school. However, after graduating with his bachelor’s degree in psychology from Pennsylvania State University, he took a job in clinical research that led him to change his mind. While investigating the genetic characteristics of opioid addiction among people with chronic pain disorders, he noticed a familiar and troubling pattern. The participants recruited for his study, and many others like it, were exclusively people of European descent. Researchers often limit preliminary studies to a single racial group to reduce confounding variables with the intention of later expanding the investigation to other groups, he says. However, due to the challenging landscape for funding scientific research, oftentimes the researchers never get approval to do further studies. This gap in literature may perpetuate inequities in the information available to inform decision-making in healthcare.

“People of color, especially Black women (of any socioeconomic status)—are consistently misdiagnosed, undertreated, and discredited when seeking medical care,” writes Pinkett in his note. “Seeing those kinds of inequities at work really motivated me to want to pursue the MPH,” he says. “That’s how I ended up at applying to the program [at BUSPH].”

Pinkett enrolled at SPH eager to better understand the underpinnings of the healthcare system that so devastatingly failed his family and continues to fall short for so many others. “I thought that my time might be better spent looking at larger systems, larger types of interventions, as opposed to one-on-one clinical interventions,” he says. “That was something that excited me and I really enjoyed [about] the health policy and law concentration.”

You are set to graduate this spring—congratulations! What are some of your aspirations for your career after you graduate?

I’m going to a law firm in D.C., but the long-term goal is […] civil rights work. I spent half of this past summer with the NAACP [National Association for the Advancement of Colored People] Legal Defense Fund [and] I spent my first summer of law school at a small civil rights firm in New York. I work for [that firm] right now as a contract law clerk, and they do some work on gender affirming care litigation where if a hospital or an insurance company is denying care based on sexual [or] gender identity, sexual orientation, those kinds of things, the firm that I work for has brought suit against. There’s a lot of intersection between civil rights work and healthcare. I think police misconduct, voting rights, economic equity, access to higher education—all of those are civil rights problems and all of those are related to social determinants of health. That is work that I really see myself doing and am excited to pursue after I finished law school.

I was going to ask about skills or knowledge you gained during your MPH studies that you still use today—it sounds like the social determinants of health is one. Do you think that all law students could benefit from a background in public health?

Absolutely. I think that that’s something that I see constantly in the law. We are talking about communities that are over-policed, that are under-resourced, and then you see more problems in those underserved communities, so that is where you see some of that intersection with the law and with public health. I personally think that everybody could benefit from some of these conversations, and that is not limited to JD students. There were so many things that I take from my MPH education that I think that everybody needs to know.

In your note, you write about how the court system’s interpretation of the Civil Rights Act of 1964 has not addressed disparities in health outcomes stemming from racial discrimination in healthcare and you suggest the Affordable Care Act offers a better avenue for civil rights plaintiffs to effect change. Could you break down your argument in terms that those of us without formal legal training might understand?

The zoomed-out view here is that when you bring suit for medical malpractice, you are typically bringing suit against one individual clinician. The problem with that is […] if you can prove that there has been some sort of medical malpractice, which is already difficult to do, then you are going to get a remedy from that one individual clinician, and usually that’s going to be some sort of money damages. I would never discount the fact that it is important that people are getting compensated, but that doesn’t replace somebody that’s been lost or received some sort of inadequate treatment that led to further injury—[monetary compensation] is incredibly important for people’s livelihood.

However, it doesn’t solve the systemic problem, because at the end of the day, in a lot of those cases, that clinician is just going to be able to go back and keep practicing. You can’t get the kinds of compensatory damages which are going to be able to [effect] systemic change. The reason that I said the ACA might be a more effective avenue is because you could bring suit against, for example, an entire hospital system. You could say, ‘Okay, we are seeing that your practices, across the board, across all of your clinicians, [result in] patients of color receiving lesser care, more inadequate care compared to white patients at your hospital,’ and as such, not only can you in that case potentially ask for economic damages, but then you can also ask for injunctive relief—they would need to make certain changes.

If it’s a large hospital system, we’re talking about a hundred million dollars plus [in damages]. Then, we’re requiring that you add all these different implicit biases trainings. We’re requiring that you do internal audits of how you are treating your patients to make sure there aren’t these disparities across race lines. I talked about the ACA as a more effective intervention because, on top of money damages, you can also impact institutions and force these institutions to change.

If somebody were to successfully bring suit, something that we often see in the legal field is that if one of these large hospitals were to get sued and to lose and to lose big, there is potential that other institutions would see that and say, ‘Okay, we really need to reevaluate our practices because we don’t want that kind of liability.’ There’s the domino effect, and then there’s the opportunity for systemic change. There’s a lot of Supreme Court cases and other cases that would suggest that, given how the statute [in the ACA] was written, it was intended to let private citizens bring claims against hospitals.

You draw heavily on research findings from the field of public health to support this argument, and when the piece published, you shared it with your former SPH professor Sophie Godley in the Department of Community Health Sciences. Could you talk more about the influence of your SPH professors on your career trajectory?

I took [Godley’s course] Women, Children and Adolescents: A Public Health Approach, and I TA’d with her as well. If I was going to give a piece of advice to students at BUSPH, it would be to make sure to take a class with Professor Godley. Not only was she an incredible professor, an incredible mentor, wrote letters of recommendation for me for law school, she’s just an incredible human being [whom] BUSPH is incredibly lucky to have. I emailed her when I published the piece because I want to thank her. She motivated and taught me about a lot of the things that I wanted to write about. And there are other people at BUSPH too, who helped. Professor Trish Elliott, I took ICPH [Individual, Community, and Population Health] with her and then TA’d her ICPH class. Also, Associate Dean Yvette Cozier—I called her in the early stages of writing this to talk about some of the statistics that I was going to use.

I’ll never forget, I was working at the Massachusetts State House with another classmate of mine from BUSPH, and we ran into Professor [Michael] Ulrich and the late Professor [David] Jones, whom I would be remiss not to mention—he was my direct health policy and law mentor. We went up them and we asked them, “Hey, we’ve been working at the State House for a couple of months now, and we [realized] we never read a single statute in your health policy and law classes.” And Professor Ulrich made a joke and said, “That’s what law school is for!” I think that stuck with me, and a couple years later I was applying to law school. Professor Jones and Professor Ulrich were huge inspirations. There were a lot of incredible people at BUSPH who motivated me [and] inspired me to write this note, for sure. I’m excited to share this with the BUSPH community. I’m constantly impressed by the things that my former classmates are doing. To be a part of this alumni group is really special.