Under Dr. Bisola Ojikutu’s leadership, equity and community take center stage

From the top floor of 1010 Massachusetts Ave., where she heads the Boston Public Health Commission, Dr. Bisola Ojikutu is a long way from the South Side of Chicago, where she grew up surrounded by a distrust of the medical system.

There, she watched her community consider hospitals as a place to be avoided, somewhere that people like her went in but didn’t come out. Now, as executive director of BPHC, she leads the city’s population health effort that aims to bring better — and more equitable — care to all of the city’s communities.

“We know that here in Boston, we have significant challenges ahead in regards to health outcomes … however, I’m hopeful, because I think we’re talking about the right aspects of this,” Ojikutu said. “We’re not just talking about the individual-level or even household-level interventions, we’re thinking systems change.”

She took over the role in 2021, as the city was grappling with the surging Delta variant of COVID-19. For her, it was a relatively small jump from a career that had largely focused on infectious disease and access to treatment.

Prior to the pandemic, much of her work had involved looking at HIV, following work in an AIDS ward at Johns Hopkins University, where she earned her medical degree. There, she saw the impact the disease had on Black and brown patients who often couldn’t or didn’t get existing therapies due to stigma, poverty and poor access to health care.

Her work in the field took her to South Africa, where she worked with the U.S. President’s Emergency Plan For AIDS Relief, which was launched in 2004 by the George W. Bush Administration.

There, she saw the difficulties of rolling out a public health initiative — especially translating policy to people — and the on-the-ground impact of a disease like AIDS. The lessons she learned there eventually brought her back to the United States.

“I ended up back in the U.S. largely because there’s so much inequity here,” she said. “I said, ‘Well, let me translate some of what I’ve seen overseas into what I could do here.’”

She went on to pursue work as an academic, still focused on HIV and AIDS, until the COVID-19 pandemic brought many of the same challenges around trust and treatment to the forefront nationwide and her scope of research expanded to the new virus.

That work was one of the factors that set up her appointment as executive director of BPHC.

A ‘remarkable leader’

When she did take over, her reputation preceded her. Carlene Pavlos, executive director of the Massachusetts Public Health Association — a statewide nonprofit focused on public health and health equity — said a member of her association’s board knew Ojikutu and said, with excitement, to keep an eye on what she would do in the role.

Peers and colleagues say that reputation is well-deserved. Pavlos called Ojikutu a “remarkable leader,” and Dr. Sandro Galea, who chairs the city’s Board of Health that oversees BPHC, called Ojikutu’s work “transformational leadership.”

To those in public health spheres, Ojikutu’s focus on health equity stands out.

Galea said that working to close disparities is a not-yet-universal — though increasingly common —understanding of how to approach the field.

“She has made health equity a core part of the vision, if not the central vision, of the health department, and I think that is unusual and inspiring,” said Galea, who also serves as dean of Boston University’s School of Public Health.

Galea said an equity lens is key to addressing many of the public health challenges the city is facing, like the opioid crisis, unhoused populations and, in recent years, the COVID-19 pandemic.

“I think it is central to everything that’s going on,” he said. “These epidemics affect populations unevenly and they are inextricable from thinking about health equity.”

Dr. Thea James, vice president of mission at Boston Medical Center, said it’s refreshing to have someone at the top of the health commission who deeply gets the inequities the city faces — an understanding that she said is important to addressing them.

“She is one of those humans who has always seen the inequities, and when you recognize what the inequities are, then you have every opportunity to operationalize equity and change those outcomes,” James said.

A keen sense of collaboration and a reliance on breaking down silos is another aspect of that effort that James said is important to Ojikutu’s leadership.

A focus on communities

For Ojikutu, an important piece of the health equity work is bringing efforts to address public health issues out from BPHC’s office and into the city’s neighborhoods.

In December, the city launched a first round of funding through its Community Health Equity Empowerment grant, with $1.2 million in financial support going to community groups already doing work in things like mental health, food access and wraparound health services in Dorchester, East Boston, Hyde Park, Roxbury and Mattapan — the neighborhoods in the city that saw the highest inequities in health outcomes in the commission’s Health of Boston reports released over the past year or so.

In May, the commission announced a new grant, funded by settlements the city reached with opioid companies, to address overdose deaths in Boston. That program, too, will provide funding to community-based organizations in an attempt to engage with people who have the lived experience to identify what does and doesn’t work, Ojikutu said, speaking shortly after the program’s announcement.

Even in research and publications, that focus shines through. In an article published this month in the journal Health Affairs, Ojikutu, alongside John Auerbach — who formerly led the city’s health commission — and other public health leaders wrote about the need to engage and center communities not just in what work is done but how that work is developed.

That article centered the use of surveys with local organizations from communities that are often left out of public health work, a move that Pavlos said normally doesn’t happen.

Outreach like that can be key to encouraging communities to respond to the guidance a public health department offers, Auerbach said.

“Public health officials can make lots of recommendations about what needs to be done, but unless the public believes that those recommendations are in their best interest, they won’t follow them,” said Auerbach, who led the department from 1998 until 2007.

That sentiment of relying on communities’ lived experience continues to shape how Ojikutu considers the work she and the commission do.

“If we want to effect change and advance health equity, communities need to lead,” she said. “It’s not just that they have to be at the table, because I think that has become a little trite; I think that they need to have the power to do the work.”

She added, “Oftentimes, we have interventions where we say what the intervention should be, and we keep the money and it trickles into communities, and that’s a mistake.”

Auerbach said Ojikutu’s work in creating such connections has “broken new ground” to demonstrate how public health should move forward.

The work is also important in building bridges; other health leaders said that building connections with communities that historically have had limited trust in city health entities is a challenge Ojikutu doesn’t shy away from.

“So many public health practitioners across this country, and even in this state, use language like ‘hard-to-reach’ populations,” Pavlos said. “You will never hear that coming out of Dr. Ojikutu’s mouth because people aren’t hard to reach. They don’t trust governmental public health — in many cases, for good reason; governmental public health has not always been trustworthy.”

Ojikutu’s job involves toeing the line between the science of health work and the political instinct to look for tomorrow’s improvement or change.

“You have to think about the politics and the electoral cycle and the fact that you have to announce things,” Ojikutu said at a Health Equity Trends Summit on June 6. “When you’re talking about things like life expectancy, that’s going to take years, if not decades, to change, when you’re talking about inequities that have been persisted for decades. It’s difficult oftentimes, when you have elected officials — who are part of the process — to really think to themselves that this is what we need to invest in.”

But Ojikutu said that balance is inherently part of the field — a truth that has come into the spotlight as political fights over vaccination and masking swept the country during the COVID-19 pandemic.

“We all, in public health, have to manage this,” Ojikutu said. “Public health is political in and of itself.”

Cabinet-level access

Under the current city administration, public health has been given an elevated podium with a seat on the mayor’s cabinet — something that hasn’t always been the case over the past decade.

When that cabinet seat exists, it means the mayor has direct access to the top public health expert, while the head of BPHC has a clearer line in trying to address health efforts in the city, Auerbach said.

“You can develop a very close working relationship with the mayor, which is extremely important in terms of getting work done,” he said.

For example, he pointed to the fight he led during his time in the commission to ban cigarette-smoking in restaurants. It was a controversial effort that he said only made real progress after then-Mayor Thomas Menino signed onto the proposal.

As in the current administration, Menino — whom Mayor Michelle Wu interned for while in law school — included Auerbach’s Public Health Commission role in his cabinet. Auerbach said that seat was key to getting results like the cigarette ban in place.

Ojikutu said that seat indicates the emphasis Wu has placed on advancing health efforts in the city.

“It’s not that that just happened, it was more like, ‘OK, this is really a priority; health in our city is very important,’” she said. “I think the mayor recognizes that.”

While balance between the two spheres can tip in either direction, Pavlos said that she thinks what is best for the communities — and not necessarily what is politically expedient — is central for Ojikutu.

“The public’s health and creating more equity and justice in the design of public health strategies is at the core. It’s a point of reference for her, and that takes courage,” Pavlos said.

Walking the line between those worlds means considering both how to support specific individuals and families and looking to effect broader changes — considering both what people need in the moment and how systems can be shifted to address the issue in the long run, Ojikutu said.

Looking upstream

BMC’s James said that public health efforts sometimes don’t go “upstream” enough to identify the causes, rather than just treat effects, and that’s a trap Ojikutu avoids.

“There are a lot of people who would say, ‘Well, let’s give them this and give them that. Let’s make sure they have access to food, access to some kind of housing,’ but they are never upstream enough to make it so that these people will have agency and self-determination,” James said. “She’s forward-thinking, she has clear insight into the root causes of the data, and absolutely thinks upstream in terms of how to address them.”

As an example, Ojikutu pointed to concerns around food access, where connecting residents with programs like the Supplemental Nutrition Assistance Program — SNAP, formerly known as food stamps — or services at a food pantry are important to keep food on tables, but can’t supplant longer-term, farther-reaching efforts that would help provide better community access to food or teach residents how to prepare more nutritious meals.

“We have to figure out a way to meet immediate needs, but yet be visionary and have longer-term goals,” Ojikutu said. “I think it’s balancing that, it’s not one or the other.”