John A. Rich, MD'84, HS'84, MPH

by Jim Rogalski

John A. Rich, MD'84, HS'84, MPH was a second-year Duke medical student doing clinical rotations when he made a friendly visit to the home of one of the patients he was helping to treat.

The young patient—an African-American man—was suffering from leukemia andresigned to the fact that his life would end soon. He told Rich that day that he was not interested in pursuing aggressive chemotherapy treatment.

“I remember his ambivalence about being involved in health care,” Rich says, “and began to wonder why young men of color might feel isolated from the health care system.”

Over the next 20 years Rich would secure more than $16 million in grants to research and address the health care needs of inner city African-American men, mainly in Boston, where he most recently was Medical Director for the Boston Public Health Commission.

He currently is chair of the Department of Health Management and Policy at DrexelUniversity in Philadelphia , and is a national leader on health issues facing inner-city African-American men.

In September, Rich, 47, received a coveted phone call: The MacArthur Foundation is awarding him $500,000 with no strings attached to either perform whatever research he feels inclined to conduct, to advance his level of expertise, or even to help him change fields. The stipend is paid out quarterly over five years.

This generous act of faith took Rich by complete surprise, as all MacArthur fellows do not apply for these special grants, but are instead singled out by a board of nominators.

“It's an honor, an amazing blessing, and an amazing gift,” Rich says.

He says he most likely will use the grant to continue support of issues surrounding trauma and health of inner city black men.

“Because of poverty, historical racism, and stereotyping, young men of color are in somewhat of a desperate situation across the board,” he says. “It is an incredible loss of potential if we have any segment in society cut off from the usual opportunities that help to bring people up.”

Some of Rich's previous successes in Boston include creating the Young Men's Health Clinic at Boston City Hospital in 1993. The primary care clinic provides intensive health education, access to dental care, nutritional and fitness advice, and mental health interventions to young inner-city men.

In 1995 he designed the Boston Health CREW, a program that trains four to six young, African-American men a year to conduct peer outreach in general health education and men's reproductive health. They are placed in community clinics and connect with patients, Rich says, in ways that physicians can't.

“It's an honor, an amazing blessing, and an amazing gift.” John A. Rich, MD'84, HS'84, MPH

“He would see the patients before I would and empower them to bring issues up when they saw me,” Rich says of the graduate of the nine-month program who was placed in his office. “It was a very powerful intervention.”

So far, about 40 men have gone through the program and are serving communities in and around Boston . Some have gone on to become nurses and emergency medical technicians.

“By linking economic health, mental health, and educational and employment opportunities to physical well-being, Rich's work on black men's health is influencing policy discussions and health practice throughout the United States ,” the MacArthur Foundation states.

In 1997 he received a five-year award from the National Institute of Mental Health to study the experience of violence among young African-American men. What he found was that trauma symptoms were a disruptive force in their lives. Many feared for their own safety, had a strong distrust of police, and carried the belief that they must retaliate or be viewed as weak and easy to victimize.

“The argument we were trying to make,” Rich says, “is the medical setting can intervene by treating their medical conditions and not lecturing them or dismissing them. We need to understand the forces that act upon their lives.”

In men's health, he adds, masculinity itself can be a barrier. “There's something about engaging in the health care system that threatens their masculinity,” he says. “Men are raised to be self-sufficient and not demonstrate any issues of weakness.”

Rich says that with this grant comes great responsibility “and my responsibility is totake the time to think about the best use.” He says it may be a year or more before he formalizes a plan for using the grant. “The nature of it is that it allows a researcher in my position to pursue things that might not get funded elsewhere,” he says.

Rich lives in Philadelphia.

The John D. and Catherine T. MacArthur Foundation is a private, independent grantmaking institution dedicated to helping groups and individuals foster lasting improvement in the human condition. For more information visit www.macfound.org.