Community recurs as a theme in the life of Herman Taylor, MD ’80. Early on, it came to him by chance, for he was part of a family and a church that were close and supportive. Later, as a first-year student at HMS, it came to him by circumstance in the form of life-long friendships, forged during anatomy classes, with three Black classmates. Still later, it came to Taylor by choice, drawn from his commitment to being a physician, cardiologist, researcher, and advocate who seeks to improve health and research equity for Black people.
This chosen path led him into established communities where he worked to become a trusted member by involving community members in health intervention studies and educating them on cardiovascular risk factors, all the while partnering with governmental, academic, and philanthropic institutions to ensure that the fruits of U.S. medical research and clinical advances would be available to all people.
The clinical foundation for Taylor’s career began with an internship at Mount Auburn Hospital in Cambridge, Massachusetts. A subsequent three-year tour with the National Health Service Corps in Miami’s Liberty City enclave brought Taylor face-to-face with myriad health issues of both the area’s Black residents and members of its Haitian and Cuban refugee communities. After Liberty City, Taylor began an internal medicine residency at the University of North Carolina at Chapel Hill, then pursued an interventional cardiology fellowship at the University of Alabama at Birmingham, where he became a member of the faculty and the founding medical director of the UAB Hospital Cardio-Pulmonary Rehabilitation Service.
In 1998, Taylor joined the Jackson Heart Study as its principal investigator and founding director while also holding professorships at the University of Mississippi Medical Center (UMMC), Jackson State University, and Tougaloo College, each affiliated with the study. The study remains the most significant epidemiological study of cardiovascular disease in Black people. In 2014, Taylor became the endowed professor and director of the Cardiovascular Research Institute at Morehouse School of Medicine, where he continues to be a lead investigator on several cardiovascular studies supported by the National Institutes of Health.
Taylor has received numerous awards and recognitions for his work as a clinician, researcher, and mentor. He also has testified about cardiovascular disease prevention and health equity in hearings convened by the U.S. House and Senate and in meetings of the U.S. Civil Rights Commission.
Taylor spoke with Harvard Medicine magazine about his career. An edited version of that conversation follows.
Let’s start with Princeton and HMS. Why did you choose those two schools?
My path to Princeton began with my sincere wish to leave the South and see what was out there. Now, my father had asked me to apply to the University of Alabama. He said that since we had to pry George Wallace out of the doors of UA so that we could attend, I needed to apply. I did, but I also applied to Princeton. Although I wanted to leave Alabama, I did want to return, and I said so in my application: I wanted to get the best credentials possible to work in the South in medicine and to do whatever good I could there. When Princeton said yes and provided me the means to attend, I accepted.
When applying to medical schools, I set my sights on HMS because I knew the best preparation in medicine would be found there. I applied to a robust list of medical schools, but Harvard was the obvious choice in my mind.
When you arrived, did you feel you had made the right decision?
I did! From the first day, the excitement was just incredible. Some of the brightest people you’d ever hope to meet were in your classes. If we go down a list of what they’re doing now, that would prove true. And the lecturers, particularly in the first couple of years, were incredible. They were inspiring to be around. The best of them integrated humanity into the clinical question at hand and showed how the science of the day could be brought to bear in resolving a human problem. These were important, informative experiences for me. My journey is an incredible odyssey, from growing up in the shadow of the steel mills in Bessemer, Alabama, and breathing air polluted by iron ore to walking the Quadrangle at HMS. Incredible.
So tell me, why medicine, why cardiology?
Well, those decisions have interesting stories. The decision to pursue cardiology grew out of a summer research experience I had during my undergraduate years. This summer research fellowship program, held at what is now the Weill Cornell Medical College in New York City, was designed for minority students who were thinking about attending medical school. It was highly competitive. One of its courses was a medical school-level course in cardiovascular physiology. I took it, and I immediately fell in love with the discipline. I said, ‘I’m going to be a cardiologist.’ And when I became aware of the great disparities in cardiovascular health between Black and white populations, my interest was further fueled.
I wanted to get the best credentials possible to work in the South in medicine and to do whatever good I could there.
But I was in college, and, like many college students, my intentions would waver. Even though I had declared my interest in medicine and cardiology, I also liked architecture, or thought I liked it. I was wondering which career would satisfy me over a lifetime. One Sunday after church, I was sitting on my grandmother’s porch and talking to her about my indecision. She was rocking back and forth, but she stopped rocking and said, ‘Junior’ — that’s me — ‘you know health is the first blessing.’ That brought it all together.
One of the activities you were involved in early in your career brought together cardiology and the power of the Black church, right? Heart to Heart?
That program was a not-for-profit I founded in the early 1990s. I had completed my cardiology fellowship at the University of Alabama at Birmingham, and had started as an instructor on the cardiology faculty there, when I traveled to Kenya to attend an annual conference of the former International Society on Hypertension in Blacks.
When these conferences ended, attendees had a tradition of performing a day of community work, so this time we went to a rural clinic outside Nairobi. At the end of the day, a woman came to us with her 10-year-old daughter who she said was having a hard time getting around. We determined the girl had a congenital heart condition. Her mother asked us for help, and I found myself saying yes. Six months later, with help from the president of UAB and Al Pacifico, then the director of the Division of Cardiothoracic Surgery at the university, the girl, her mother, and a local medical care provider flew to Alabama so she could have surgery.
The plane fare was arranged by my mother, who was then the president of the AME Missionary Society in our Episcopal district. She marshaled all the women in the group and took care of the social side of things, including securing a donation for the plane ticket.
The intervention for that young girl — her name was Faith — was the beginning of Heart to Heart. During the decade or so that I led the organization, we performed more than one hundred surgeries on kids from five different continents. Each time, we involved a local medical care provider and provided them with intensive medical education that they could take back home and pass along. We considered it the ripple effect of good.
When I left to take the helm of the Jackson Heart Study, the leadership of the Heart to Heart program went to people at Children’s Hospital in Birmingham.
The Jackson Heart Study also relies on community involvement and trains doctors and health care workers, doesn’t it?
It does. This was to be a holistic approach to improving health through community interventions that would make a difference for Black people for generations to come.
You need to remember that in the final half of the twentieth century, there was a 40 percent or so drop in deaths from cardiovascular disease across the U.S. Unfortunately, that promising statistic failed to capture what was happening in Black communities. If you looked at data from Mississippi anytime between 1970 and 2000, there was pretty much a flat line in terms of change in cardiovascular deaths among Black people. It was a disparity that was increasing but was not being explained. This study offered the chance to take a hard look at the cardiovascular epidemic among Black Americans in what was pretty much its epicenter, Mississippi.
Although I hadn’t been thinking of leaving my faculty position at UAB, the notion that this study focused on Black people, not as an afterthought or as an addition to another study, appealed to me. I also realized this was really kind of a dream job for me: I could continue my cardiology practice and be a part of the founding of a study that would be comparable to the Framingham Heart Study; in fact, people were already calling it the Black Framingham. It was largely an epidemiological study, of course. But by the very nature of studying a problem, you change it. Then they said they hoped to involve UMMC, Jackson State, and Tougaloo, and I said ‘tell me more.’
Was it important to you to have affiliations with academic institutions and their students?
Very much so. Especially since two of the schools were historically Black schools — HBCUs. The mission of the study was to build a legacy of health. This meant that we felt it was vital to establish a pipeline of trainees who would have a transgenerational impact on health, an impact that would continue long after our time was done. This priority was equal to our work to advance scientific knowledge.
You’ve written about how important it was to secure the trust of community members because the history of medicine is filled with atrocities perpetrated on Black people. How did the Jackson Study work to establish trust?
We began by bringing community members into the process of helping us decide how we were going to build the study. This was critical. But even before we talked with people about how we should do the study, we did everything we could to show people that we cared about them. We held information sessions, town hall-type meetings, and presentations in churches and schools and at sporting events and political venues. We talked about why the study was necessary, why people should be concerned about cardiovascular disease and its risk factors. Community engagement became community mobilization. We trained residents to understand traditional cardiovascular disease risk factors and behavioral interventions to mitigate or minimize those risks. We involved high school students in summer science, language, and math enrichment programs; we took young scholars who were studying ethics, research design, and epidemiology at Tougaloo and had them shadow physicians and other investigators, so they could learn the practical side of the academics; and we trained graduate students at Jackson State who were working on degrees in public health and epidemiology. We even involved residents and cardiology fellows from UMMC.
Between 1970 and 2000, there was pretty much a flat line in terms of change in cardiovascular deaths among Black people.
We also reached beyond Jackson. We sensitized members of Mississippi’s congressional delegation to the work of the study. Some of those people got to be very senior in Congress, and they knew about us, our activities, and our challenges.
I think the Jackson study educated our populace and our power structure. And because of the study’s collaborations with the NIH, the data it gathers is incrementally expanding and diversifying the database that will train precision medicine algorithms.
Your move to Morehouse’s Cardiovascular Research Institute expands efforts at data gathering to include genetic, epigenetic, and bioinformatic investigations. Is there an effort that you find especially promising or groundbreaking?
That’s hard because they are all so promising. But I am excited by what members of our multidisciplinary team have found in their analysis of data from our MECA study, an investigation of the role of resilience in health and well-being. The initial work on this was funded by the American Heart Association, and the investigation is now expanding, thanks to support from NIH. The study asks why so many Black people in the United States — people who continually face so many challenges because of race and who statistically face higher risks for cardiovascular disease — survive so well in the face of adversity, or even thrive. There is growing evidence that individual and communal resilience may play a role, possibly a big role, in this seeming contradiction. In addition to contextual factors, the study will look for genetic, metabolomic, and other “omic” signatures of resilience that may help explain this phenomenon. If such signatures are found, they could be used to design new approaches to resolving disparities and to assess interventions.
Is there any advice you would offer physicians who care for Black patients? Is there a tenet you follow in your practice?
In terms of heart health, of course it’s crucial to follow the guideline-directed approaches that we follow with any patient. But communication and trust are the cornerstones of an effective therapeutic relationship. As a profession, we have not consistently been trustworthy or communicative with Black patients. To break that barrier, the most powerful attribute a physician can bring to a patient encounter is humility. By humility I mean keeping the patient central to the encounter, assuming nothing but that the human being before you has deep concerns, legitimate perceptions and feelings, people who love them, and a story to tell in their own words.
Ann Marie Menting is the editor of Harvard Medicine magazine.
Image: Gregory Miller