As a young girl, Shaunessey Burks remembers walking up to the plant where her grandfather worked. Pierced in her memory were the fumes radiating from inside the building, where no one was wearing protective equipment. There was no barrier between her grandfather and the hazardous chemicals floating in the air he was breathing.

Years later, Burks began to piece it all together.

Her grandfather had developed asthma, the eventual cause of his death. Her mom had heard comments from his co-workers, and a manager came to the family to say they should sue. The chemicals were to blame, Burks thought.

But by then, the family couldn’t prove the Memphis, Tennessee, plant was what caused his death. Now, she’s pursuing her master of public health degree at Brown University in Providence, Rhode Island, after getting a degree in biomedical engineering at Alcorn State University in Mississippi.

It wasn’t until her undergrad years when Burks discovered public health — the science and practice of disease prevention and protecting community health. She decided to pursue it after feeling called to act following her grandfather’s passing in 2014. A first-generation college graduate, the 24-year-old is focused on environmental and occupational health to advocate against the dangers that left her grandfather vulnerable.

Burks joined Brown’s program in the midst of a nationwide boom in interest among Black students in pursuing public health. One year into the pandemic, Brown received a record number of applications to its master of public health program. In 2021, the number of applications was double that of the year prior, increasing from under 440 applications to nearly 950. The largest spike was among Black applicants, with an increase of almost 200%.

The unexpected influx of applicants forced the program to close its application period early that year. The university points to its recruiting efforts as a major driver in the increase. Other factors, like an increased awareness of what public health means, may have also contributed.

The uptick in the number of Black students across the country who decided to pursue public health began during the coronavirus pandemic. While it is now starting to decline, it remains higher than pre-COVID levels. And as public health programs expand their reach to include Black folks, medical schools across the country are incorporating essay prompts related to diversity, equity, inclusion, and anti-racism into their application processes.

Is this increased attention by higher education institutions on how students’ racial identities and personal experiences affect health-related fields a step toward solving the health disparities that are so persistent across outcomes in the United States? Students like Burks hope so.

Black Americans face disproportionately high rates of diabetes, hypertension, heart disease, asthma, and maternal mortality. Their death rates for most cancers are higher than other racial groups, with lower survival rates. Black men have the highest rates of prostate and colorectal cancer, and the number of patients under age 50 is rising. And despite being diagnosed at similar rates, Black women are more likely than white women to die of breast cancer.

Read more: Why Race Matters So Much to Your Health

These outcomes are affected by many factors, from a disproportionate amount of toxic waste exposure to unequal access to quality health care. Black patients and health experts have also pointed to increasing the number of Black physicians and public health professionals as a way to combat the harms caused to Black people by the American health system.

That’s where medical schools and public health programs have come in.

Brown credits the unprecedented level of interest from Black students to recruitment measures like efforts to develop relationships with historically Black colleges and universities, as well as pandemic-inspired application fee waivers and suspension of its graduate record exam (GRE) requirement.

Levell Williams (back row, second from the left) and Shaunessey Burks (back row, third from the right) are part of the first cohort of Brown University's Health Equity Scholars program. (Ken Zirkel/Brown University)

They also launched a Health Equity Scholars program aimed at building up a diverse cohort of public health professionals who will be the future leaders in eliminating health disparities. The first cohort, which will graduate this May, is made up of 12 HBCU students. The program offers full tuition support and a paid research assistantship, along with formalized mentorship and coaching.

Burks came to Brown through the program.

“We are training these students on how to be those leaders to go out and make a change,” said Rosenny Taveras, the program’s director. “It’s going to give us results.”

What more Black applicants could mean

When COVID-19 hit, Brandon Bond’s interest in public health was solidified. He knew he wanted to enter the field a couple of years prior, but as the virus spread, disproportionately killing people who look like him, his thoughts, opinions, and desire to act strengthened.

At the University of Michigan, Bond began to see public health as everything from food, business, and architecture to transportation. It was a way to not feel boxed in, he said. The field felt like it encompassed everything.

“Growing up, I thought the health field was just made of doctors and nurses; that was initially the path I intended to follow,” said Bond, but after AP Biology in high school he decided to change routes. “I knew I wanted to have a wider impact, which drew me to public health.”

The 25-year-old was part of the university’s uptick in enrollment of Black students that came during the pandemic. The school saw a surge in the overall number of applications that they call the “Fauci effect,” a nod to Dr. Anthony Fauci, chief medical adviser to President Joe Biden, who quickly became one of the most recognizable faces in public health amid the COVID-19 pandemic.

The level of recognition and attention on public health during 2020 was unprecedented, said Emily Youatt, the assistant dean of student engagement and practice at the university’s School of Public Health.

“COVID really highlighted the inequities that exist in health and health outcomes, particularly for African Americans,” Youatt said. “In public health, there is a growing awareness around the role of racism and racism as a public health crisis. Some schools and universities have been quicker to name that.”

Read more: What Happens After Your Town Declares Racism a Public Health Crisis?

The pandemic was also a moment during which some higher education institutions evaluated their policies and practices to make their education more accessible. Eliminating the GRE requirement was a step many programs, including Michigan’s, took. Youatt said they have since made the change permanent as a way to reduce barriers to applying.

Many schools realized that without the GRE, they could still holistically review candidates and the burden on applicants was relieved, said Melody Goodman, whose research at the NYU School of Global Public Health focuses on risk factors for health disparities and workforce development and diversity. But others are returning to requiring the GRE, despite pushback, which might be a part of why the number of applications nationwide has started to level off. “The tide is turning the other way,” she said.

And the sharp decline in concern around COVID-19 may also be playing a role in the more recent dip. “We barely discuss the pandemic anymore,” Goodman said, “and if we do, we say it’s over.”

Harvard University’s T.H. Chan School of Public Health is among the schools that saw an uptick in the first two years of the pandemic, said Kerri Lyn Noonan, the director of admissions. But the last cycle had a sharp decline.

Still, the number of Black students enrolled in public health programs across the country is higher than years prior, according to the Association of Schools and Programs of Public Health. “Of all the health professions, public health and social work tend to be the most diverse,” Goodman said. Both field’s social justice core, she said, is often a major draw for Black students.

Columbia University’s Mailman School of Public Health has also seen a flood of applications for Black students, which has also been reflected in a higher number of Black students being accepted into the program and enrolling, said Vice Dean for Education Michael Joseph. “With the COVID-19 pandemic, many of our Black students were directly impacted. We see it in the personal statements,” he said. He hears from students whose mother or neighbor died, and others who talk about the pandemic of gun violence in their communities.

Read more: Why Gun Violence Is a Public Health Crisis

And in recent years, they have been working to expand the school’s pathway programs to connect students, who may not feel like an Ivy League education is attainable, to their courses. They are also focused on increasing financial aid and the number of Black faculty, Joseph said.

More awareness that lived experiences matter

At Brown, prospective health equity scholars go through the typical application process and indicate whether they’d like to be considered for the program. There are no additional admissions requirements, but the review committee evaluates applicants’ statements of purpose to make sure their goals align.

In her application, Burks dove into the meaning of “health equity,” outlining how, for her, it means people have a fair chance to be healthy regardless of various social factors, including race. Her grandfather had not had that chance.

After submitting the application, “everything kind of fell into place,” Burks said.

Medical schools are taking a different approach, incorporating explicit diversity, equity, and inclusion essay prompts into their application process.

Of the top medical schools whose application prompts were publicly available and those who responded to Worldacad’s requests, the types of questions range from explicitly asking about racism to prompting applicants to write about personal experiences.

Vanderbilt’s School of Medicine in Nashville, Tennessee, gives applicants 600 words to tell the admissions office about a time when they interacted with someone who is different from them. “What did you learn? What would you do differently?” it asks.

Baylor University’s College of Medicine uses the Texas Medical & Dental Schools Application Services, the common application for Texas medical schools, and among their prompts is one that says, “learning from others is enhanced in educational settings that include individuals from diverse backgrounds and experiences,” then asks prospective students to describe their personal characteristics, including background, talents, skills, or experiences that would add to the school’s educational experience.

But far more explicit are prompts like those from the University of Minnesota.

One of its prompts says, “describe a time when you personally experienced, observed, or acted with explicit bias. What did you learn about yourself and the experience?”

Another reads, “please share your reflections on, experiences with, and greatest lessons learned about systemic racism.” It asks applicants to consider the country’s history of anti-Black racism and the impact of George Floyd’s murder on the community.

Another one of its prompts focuses on fighting for equity. “As you think about being a future physician and advocate for patients, describe a time when you advocated for someone or something,” it asks. “What did you learn from this situation?”

The movement toward integrating questions about racial identity, bias, and advocacy into the application process reflects a growing awareness within the medical field that life experiences affect health outcomes and patient-provider interactions. A majority of Black adults have had at least one negative experience with a health care provider, according to a report published by the Pew Research Center last year. And young Black women are even more likely to experience a negative interaction. As a result, they are most likely to prefer seeing a Black physician who looks like them and comes from a similar background.

There is some evidence that having a Black doctor also results in better outcomes for Black patients. For example, a 2020 study published in the journal Proceedings of the National Academy of Sciences of the United States of America concluded that Black babies were more likely to survive birth when cared for by Black doctors as opposed to white doctors.

The essay prompts seem to acknowledge the implicit and explicit bias that bleeds into how Black patients are treated when they interact with the American health care system.

“We take seriously the responsibility in terms of the structural transformation and change that’s needed in medicine,” said Ana Nuñez, the vice dean of Diversity, Equity and Inclusion at the University of Minnesota’s Medical School. They’re looking for students who are ready to come into the classroom knowing disparities in health care exist.

“Having that insight and having that awareness ... that’s important for us in terms of how we’d like to help them in their journey to become a well-rounded physician,” Nuñez said.

At Case Western Reserve University in Ohio, the school writes, “We are deeply committed to anti-racism and promoting diversity, equity, and inclusion in education, healthcare, and our communities. We invite you to share a specific life or work experience that aligns with and will allow you to uniquely contribute to the DEI initiatives at [Cleveland Clinic Lerner College of Medicine].”

From medical schools to master of public health programs, university administrators believe their increased diversity and inclusion efforts can trickle into improved health outcomes as the students they train become the next generation of physicians or decision-makers in health departments.

Back at Brown, Levell Williams is wrapping up his final semester of his master of public health program. His thesis is on substance abuse disorder and harm reduction, though he is still thinking through what health issues he wants to dedicate his career to. Williams is looking for ways to merge his public health knowledge with his undergraduate degree in mass communication from Mississippi’s Tougaloo College.

“The field of public health, it allows you to solve problems in a lot of different and creative ways,” he said. “I want my work to have value by helping people.”

This story was published with the support of the Solutions Journalism Network through the Health Equity Initiative.

Margo Snipe is a health reporter at Worldacad. Twitter @margoasnipe