Q&A with Dr. Anne C. Beal

Dr. Anne C. Beal, MPH ’93
CEO and Founder, AbsoluteJOI Skincare
GSK Board of Directors, Chair Corporate Responsibility Committee
Prolacta Bioscience Board of Directors
Academy Health Board of Directors and Former Board Chair

 

Dr. Anne C. Beal, MPH ’93 is based in Washington DC. Over the course of her impressive career, she has been a practicing physician, researcher, director of philanthropic foundations, healthcare consultant, and has served on pharmaceutical boards. Most recently, Dr. Beal founded the skincare company, AbsoluteJOI.

Tell us about the journey you’ve taken to arrive at the work that you are doing now.

The trajectory is nowhere close to what I imagined it would be! For a kid like me, growing up in Jamaica, Queens, places like Columbia University were the magic palaces on the hill. My goal at the beginning was simply to become a physician and be a community provider.

Over time, I realized I had an interest in doing more than working with individual patients; I also wanted to work on a community and population-based level. That led me to complete a research fellowship that emphasized health services and pursue my MPH at Columbia Mailman. My master’s gave me an understanding that was so different from my clinical training. Rather than focusing on individual patients, public health focuses on populations, which requires a different approach to understanding how to improve health.

When I finished my fellowship, I went to work in the mobile medical units in New York City to help provide healthcare to individuals experiencing homelessness. At the time, cocaine was running rampant throughout New York, which was destabilizing communities of color and causing the number of women and children going through the homeless system to escalate significantly. Being able to work on these mobile medical units and provide care to a population in need really resonated with me. However, I quickly saw that while I could take care of my individual patients, what we were doing was just a band-aid on a much bigger issue. Of course, the needs of families experiencing homelessness needed to be met, but what more could we do to slow the rise of homelessness and how could we prevent it altogether? This made me want to act more holistically—I wanted to work towards allocating resources so mobile medical units weren’t needed in the first place.

From there, I decided to focus more on health policy. Health policy is all about the decisions that are made to determine who gets what healthcare and when, and the resource allocation to make that happen. When trying to figure out how to move into this new space, I looked at clinicians 10–15 years older than me working in health policy. I saw that many established their expertise in academic and research settings, rather than clinical settings, and I decided to do the same.

That was what led me to take a research faculty position at Harvard University where my work focused on health disparities. At that time, “health disparities” was a newly emerging concept. Before that, we were talking about “minority health” and it was just accepted that people of color had different health outcomes compared to everyone else. The language of “disparities” came out of Dr. David Satcher’s work with President Clinton’s Initiative on Race. This new framing of minority health as disparities in health was important because it recast the issue as there being a “gap” in health that needed to be closed.

A lot of my research at Harvard, and later the work I funded at the Commonwealth Fund, was descriptive. At the time, most health professionals denied there were disparities in their practices or health systems and said, “I treat everyone the same.” Although the early work was descriptive, it was important to show—and prove—that health disparities were rampant throughout healthcare. I felt it was important to describe the problem in what I called “units of accountability.” Everyone could see reports indicating that people of color had worse outcomes but would explain it away as “personal choice” or “social factors” and then everyone could shrug their shoulders and say, “what a shame.” But if the data shows that it’s your health plan (where everyone has the same financial access), or your hospital (a place where you have control and responsibility), it’s something you cannot ignore and explain away. This also dovetailed nicely with a lot of the discussions at the time about defining and improving the quality of healthcare in the United States. Our research not only described health disparities but framed it as disparities in quality of health care and reported it in a way that people couldn’t ignore, because they were responsible for the quality of care in their respective settings.

Over time, as a health professional of color, I was being pigeonholed and only tapped to address issues of disparities, but I had the training and expertise to do more. This led me to leave the Commonwealth Fund to take on the role of president of the Aetna Foundation. Earlier in my career, I never could have imagined working at a health plan, but it’s where I learned a lot about the business of medicine and realized every stakeholder has a role to play and must add value to remain in business. In the case of health plans, I realized they do a lot to hold down the cost of care and make it an affordable offering from employers to their employees. In other countries, the national payers negotiate prices with hospitals, physicians, and pharma. But in the US, our federal purchasers do not play that price negotiation role. As a result, the pushback on prices falls to the private sector and to the health plans who negotiate with pharma, hospitals, and others. The cost of healthcare in the US is skyrocketing unsustainably and someone needs to push back on that growth. As a physician who was not a fan of health insurers, this was an important lesson. Everyone is playing a role that is an important part of the healthcare dialogue.

At the time, President Obama was implementing the Affordable Care Act to address many of the quality and access challenges in health care. One of the organizations created from that legislation was the Patient-Centered Outcomes Research Institute. I was recruited by the executive director, who was employee #1, to become employee #2 to help build the organization. I knew I could contribute because I had led a funding organization, and knew how to navigate the Washington, DC policy and political landscape to make it successful. This challenge was exciting because I really liked the thought of a research agenda that was patient-centered and genuinely responsive to patients’ needs, not just the researchers’ interests. We spent a lot of time defining patient-centricity in research, how to implement it, and how to evaluate its impact. This was challenging because no one had operationalized patient-centered research before, but that also meant no one could tell us we were doing it wrong!

I was really enjoying this work, but as my interest in patient-centeredness grew, I got another call, this time to be the first chief patient officer in a top 10 biopharmaceutical company based in France. Again, I never imagined I would work with a pharmaceutical company, but it was my patient advocacy colleagues who encouraged me to consider it because they reminded me that pharma is the only source of financial support for patient advocacy efforts, and I could contribute to creating a meaningful engagement with patient groups. I also wanted to understand how pharma conducts research and then puts it into practice so quickly. My goal was to help ensure the patient voice was brought into this work. It also provided a new level of challenge because this company worked on six continents, which required me to think about patient-centricity in both a cross-cultural context and a cross-market context. We were trying to understand all those different factors and come up with an agenda around the patient that could be implemented in a global context.

After five years, I was reflecting on my career and felt that it was time for me to take a different approach. In the decades since I’d trained as a doctor in the Bronx, I saw that healthcare disparities hadn’t gotten better despite all the work and effort of many, many people. Even the numbers of under-represented minority physicians—particularly African American—hadn’t increased since I’d been in school. COVID-19 really emphasized the ongoing disparities in health care for me. I was at a conference and Dr. Rob Ross, president of the California Endowment, was giving a talk where he said something we all know in public health: “Your ZIP code is more important than your genetic code for health outcomes.” This gave me pause to think about what else could be done to improve resources and infrastructure in communities of color that ultimately impact health.

Much of Europe claims to be open and secular, but living in France, I saw there is xenophobia and real discomfort with people who are not from Christian-based faiths. There is Islamophobia against émigrés from their former colonies, and I was very surprised to see the level of anti-Semitism that still exists in Europe. However, it helped me understand why those communities had worked for millenia in Europe to build their own infrastructure to survive in hostile environments. On top of that, the 2016 election results shattered any belief I had about America being a meritocracy. All politics and policies aside, we had the most qualified modern candidate lose to the least qualified candidate and it had nothing to do with merit. Together, this drove me to shift my focus to economic empowerment as a path to improving health outcomes in communities of color. Rather than working in institutions not fundamentally designed to improve health in communities of color, I wanted to take my business experience and shift to building infrastructures in our communities for financial empowerment so communities can advocate for themselves.

Just like in healthcare, there are disparities in the entrepreneurship space, and only 3-percent of venture capital goes to women of color in the United States. I decided that whatever I did would have to be a high-margin business to grow profitably. Skincare is one of those businesses, and this resonated because I was coming from pharma, so I knew a lot about formulations, approval processes, and product development.

Skincare had also always been a personal interest of mine because I struggled to find products that addressed my anti-aging skincare needs. This was backed up by the market research: 70 percent of women of color say that the products on the market don’t work for them. I had been making my own products at home for a long time, so while I was living in Paris, I went to a DIY skincare store to get more ingredients and was struck by the disproportionate number of Black and Brown women in this store.

There is a professor at Harvard Business School who says that if you see people creating a work-around to a problem, there’s a business opportunity in bringing a solution for that problem to market. Seeing all these women of color making skincare products for themselves made me realize it wasn’t just me who was creating a solution for myself, but there were others, and this was a business opportunity as the solution wasn’t on the market yet.

I knew I wanted my products to be “clean beauty,” and that I would manufacture them in Europe because the manufacturing standards are higher than in the US. Then, a study came out that said over 75-percent of products marketed to women of color contain problematic and potentially harmful ingredients. This mostly comes from hair products and skin bleaching ingredients, but also includes universally used chemicals in beauty such as phthalates and parabens, which are banned in the EU.

I looked further into parabens and that found they are classified as hormone disruptors, act as estrogen in the body, and are concentrated in estrogen-sensitive tumors. There have been epidemiological studies in New York that found the paraben levels in Black and Latinx women are 4–8 times higher than the general population. That set off alarms for me because many disparities in women’s health seem to be related to excess estrogen, such as the prevalence of uterine fibroids, and no one knew why. I could not find research that showed parabens cause estrogen sensitive tumors, so I am careful about the language I use to describe the paraben risk for women of color. And while correlation is not causation, I do know there’s no downside to eliminating parabens from our products—especially for Black and Latinx women who use twice as much skin care per person as the general population.

Now my mission isn’t just about economic empowerment, but also about clean beauty and the role it plays in disparate health outcomes. As a result, AbsoluteJOI Skincare is about a non-toxic lifestyle holistically. Today, I am building a company that is about skincare, but also about working with other      black, Indigenous, and people of color (BIPOC), women-founded companies. My goal is to be in a position where we can invest in and support other women-led companies to create products and services that meet our needs while building familial and community wealth and empowerment. It is a health mission, a social justice mission, and an equity mission.

What accomplishments are you most proud of?

On the professional side, it was the contribution to mainstreaming health disparities— helping to shift that dialogue, helping fund others, and supporting the careers of others so that it was no longer the “minority health thing,” but instead a gap in health care quality that was everyone’s responsibility to close. We made some good progress in giving people the language and the comfort to be able to look at quality measures, stratified by race and ethnicity, and to be able to start to ask within their own settings how they could begin to eliminate existing disparities. On the personal side, I am absolutely proud of my three daughters. They are all young adults and out in the world making an impact. I am so proud of the women they’ve become and I am happy to have played a small role in their development.

How did your time at Columbia Mailman influence your career?

At that time, I was completing my research fellowship, had two of my babies in two years, worked extra ER shifts to make ends meet and was taking my classes full-time. First, it taught me how to manage and balance my time as a professional and working mother. In terms of my training, my biggest learning was the shift from thinking that excellence in health outcomes was based on the individual efforts of patients and their doctors, to health being based on a collective effort to promote systems that support population health. I learned that there are forces outside of your individual health behaviors that impact your health outcomes and learned to appreciate all of the factors outside of the clinician’s office that are important. Beyond social determinants of health, it’s about resources and who has access to what. For example, food deserts are a real and major problem in low-income communities. It’s no wonder there’s an obesity epidemic that disproportionately impacts those communities. Columbia Mailman also gave me the space to begin to understand health policy and how important it is to health outcomes. A lot of doctors don’t even know the basics of health policy. I’ve given talks to medical students who don’t know the difference between Medicaid and Medicare. It was a place that really shifted my thinking from just being a clinician to being a health advocate.

Reflecting on Columbia Mailman’s Centennial: What do you see as the biggest opportunities for public health in the next 100 years?

Well, in the last 100 years, I’d say the biggest advance we’ve had in public health was indoor plumbing to reduce transmission of many communicable diseases, and generally improving what I call “the passive areas” in health for patients like environmental health and clean water. I’ve also gone through the exercise of looking through the morbidity and mortality reports of the last century, and the number one cause of death and illness 100 years ago was different types of infectious disease. We’ve mastered many infectious diseases through vaccinations, hygiene, plumbing, and antibiotics, but we now have an infectious disease healthcare system that is managing a new chronic disease epidemiology.

As a patient, your lifestyle, diet, where you live, and so on, are so much more important than the treatments I can give you as a clinician. As we look towards the next 100 years, the question is: can public health and clinical health shift from the acute, infectious disease model to the chronic disease model? That will be our biggest challenge as a field.

What do you think the field of public health needs to do differently to effectively tackle those challenges? 

I think the kind of innovation we’ll see in drugs will not have the same kind of major impact that innovations like insulin and penicillin have had in the past 100 years. I’m very excited about monoclonal antibodies, and I think cancer will become the next chronic disease to be managed over time. But then, how do we manage that? How do we engage patients and maintain the long-term relationships that chronic disease management requires?

On top of that, how do we do it in places and spaces that are virtual? I don’t think we have a good handle on that right now. We also need to get better at communicating and going where people are, in the same way that businesses do with their sophisticated marketing techniques. If you want to be found, you must speak in the language that your target audience uses. We must establish thought leadership on this, not only for communicating information with the public but with each other. Relying on academic journals is too slow and inaccessible.

COVID has shown us the importance of communication, meeting people where they are, and what happens when you don’t get it right. We also need to stay cognizant that knowledge and communication are not enough to change behavior. One of the things I think is useful for this is the field of behavioral science. When I was at Sanofi, I started their behavioral science advisory group to focus on methods to improve patient self-management to improve health outcomes. At the end of the day, patient-centricity is about improving patient outcomes, and within the context of chronic disease, I think patient empowerment for self-management is a critical factor.

What advice would you give current Columbia Mailman students starting their own careers? 

You can do anything with an MPH—what isn’t related to health and wellness at some point? My advice is to recognize that the MPH is just the beginning of the journey. I don’t know anyone who 100-percent ended up doing what they thought they were going to do with their career, myself included. Health and healthcare as we know it now won’t be recognizable in 10–15 years, so you need to be able to evolve and stay relevant. The biggest skills you should take away are learning how to think on a population basis and learning how to learn because new knowledge will come at you throughout your entire career. If you have those skills, you’ll be a fine contributor to public health.

– Suzanne Kirkendall, MPH ’18