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When Dr. Brooke Cunningham meets a new patient, the first thing she says is that she’s happy to be their doctor.
The second thing she says is that she’s usually running late.
“I tell them to bring a book, or if they’ve got to be someplace, get the first appointment of the day,” she says.
Dr. Cunningham became Commissioner of Health last month, succeeding Jan Malcolm’s nine-year tenure at the Minnesota Department of Health. Yet while she fills this new role, she will still make periodic visits to her patients at Community University Health Care Clinic, the medical facility in the Phillips neighborhood of Minneapolis that she calls the “gem” of her professional career.
Commissioner Cunningham’s colleagues at CUHCC are well aware of the reasons behind the tardiness.
“She’ll sit and talk and listen, and her patients really appreciate that,” said Dr. Aarti Bhatt, who has worked with Cunningham since 2015. “She’s always just grounded in human connection and understanding. But also evidence: making sure her patients are getting the most up-to-date standard of care. To have a doctor that just wraps around you in such a way is sadly unusual.”
In a conference room at MDH headquarters, six weeks into her new role, Cunningham talked about her journey into medicine and her mission to establish health equity for all Minnesotans. When she talks, she looks you in the eye and gives you her complete attention. It’s easy to see why patients feel comfortable with her, and how she usually falls behind schedule.
As the first Black woman health commissioner of Minnesota, she’s eager to address the inequities highlighted by the pandemic, such as the impacts of staffing shortages on different patient populations. The whiteboard in the room shows scribbles from a recent meeting that include the word “equity” several times.
The health commissioner is responsible for overseeing the work of the department of health, which has a broad mission of improving the health of Minnesotans. The agency employs 1,400 people in the Twin Cities and throughout Minnesota.
Since February 2022, Cunningham has held a role leading the Health Equity Bureau, a new venture at the health department that houses the Center for Health Equity and the Office of American Indian Health, and oversees all diversity and inclusion efforts. (Malcolm, the previous commissioner, named her to this role.) By appointing Dr. Cunningham to head the whole department, Walz seems to be putting equity front and center. That’s also what Cunningham has done throughout her career as a researcher and physician.
Cunningham’s first priority is helping to pass the governor’s budget proposal, which includes $1.5 billion for health and public safety. This is a moment, she said, when officials can capitalize on the “new appreciation for the importance of public health” to think about innovative ways to improve public health and health equity.
Cunningham also plans to prioritize technology to make public health data more useful. For example, data that now lumps many ethnicities together could be disaggregated to reveal differences based on different community backgrounds. COVID hospitalization rates, for instance, could be broken down into numbers for Hmong people and Somali people, rather than grouping all Asian people together and all Black people together. The same could be done for gender and sexual orientation.
Cunningham recently finished a three-year grant from the National Heart, Blood, and Lung Institute to determine the most effective approaches to discussing race and racism with patients in order to improve their care. “That work affects dozens of physicians,” she said. “But are there ways to effect change in a more immediate, timely, relevant way today?”
To Cunningham, an experienced clinician who is in her late 40s, this new and powerful role offers the chance to scale up that kind of health equity research.
“I did not have commissioner of health on my radar,” she said. “For me the thing that’s been important is to move into those spaces that are just an opportunity for me to have a greater positive impact.”
Becoming a doctor
As a teenager in Richmond, Virginia, in the early ‘90s, Cunningham worried about the high homicide rate and racial disparities near her home. She aspired to a career that would enable her to effect change. But she didn’t see doctors caring about gun violence.
“I just thought, ‘What are the doctors doing? People who are getting shot are showing up at the hospital doorstep and the doctors are just getting paid,’” she said.
Her high school chemistry and anatomy teacher, however, planted a different seed in her mind: Physicians have power. “And I just always held that with me,” said Cunningham.
In college at the University of Virginia, Cunningham did pre-med “on the side” while double-majoring in history and African American studies.
Then, during a summer program at New York University’s medical school, she got paired with a primary care doctor doing research on how Black physicians forge a career path to medicine.
“That showed me there was space in medicine for the work I wanted to do, because he was doing it,” Cunningham said.
The type of work she wanted to do on health equity would require both an MD and a Ph.D. in sociology. She enrolled at the University of Pennsylvania, crossing the street between classes at the social sciences building and the med school.
While there, she realized that primary care would best fit her goals to help dismantle racism through patient care. She knew it would mean taking a status hit: In the medical field primary care doctors are paid less than many specialties, such as orthopedics, surgery, or dermatology.
“I remember walking home with a classmate saying, ‘I think I’m going to do primary care,’ and he said, ‘Oh, you’re too smart for primary care,’” Cunningham remembered.
(These days, when young people ask her to advise them on career choices, she has a ready answer: “‘Pay attention to what your spirit is telling you about a decision. There’s a lot of pressure to do things the ways that are most esteemed and traditional, but really, when you’re bright you can do a lot of things.”)
She completed her residency in internal medicine at Duke University in 2010 and completed fellowships in health services research, health policy, and bioethics at Johns Hopkins University in 2013.
She landed in Minnesota in the summer of 2013, intent on pursuing work in health equity at Medica Research Institute. She had no ties to Minnesota, but she was impressed by the fact that health care systems in the Twin Cities were sending their executives to Harvard to do health equity training. Other factors helped her feel like she’d found the right place. When she heard discussions about health equity on Minnesota Public Radio, and noted banners at the local YWCAs promoting the mission to eliminate racism, she thought “Ok, maybe I want to stay.”
No one prescription for diverse patient care
In 2014, Cunningham landed at the University of Minnesota where she works in its Department of Family Medicine and Community Health. She taught a class on race to first-year medical students and continued her health equity research. In 2015, she joined the University’s program with CUHCC, which is housed in a one-story brick building across the street from the Little Earth housing complex. The side of the building facing the parking lot features a brightly painted mural depicting diverse health care workers alongside patients, along with the words “We all need help in some form or another.”
CUHCC is a federally qualified clinic, meaning that it serves everyone, regardless of the patient’s insurance status or ability to pay. It serves a diverse array of patients from the surrounding community; interpreters on site speak Hmong, Lao, Somali, Spanish, and Vietnamese. It’s where Cunningham knows she’s on the right path, where she embraces the everyday challenges of working with a lower-income patient population.
She lights up whenever she talks about her patients at CUHCC. Many of them don’t have insurance, so on any given day, she might be faced with figuring out how to get eyeglasses for a patient who can’t afford them. Or she might spend time revising the clinic’s policy on “no-show” patients (that is, patients who show up very late or who miss their appointments). Cunningham sees these tasks as essential: If you operate from the assumption that people want to get to their appointments, you can actually start to help them.
In other words, it’s where she turns her research on health equity into action.
“The real challenge with any kind of evidence is what does that mean for the person in front of me?” said Cunningham’s longtime CUHCC colleague Dr. Chris Reif. “Brooke gets that. She got that maybe even before she became a doctor. And she’s able to help people as a helper and a partner, not as a critiquer.”
For example, Cunningham led an effort to teach doctors, especially white doctors, on how to talk to their Black and brown patients about racism in health care.
“Her work around antiracism has given me a lot of courage,” said Dr. Roli Dwivedi,
CEO and chief clinical officer at CUHCC. “I feel very comfortable in having conversations about race with patients now.”
In the exam room, she’ll ask straightforwardly whether a patient has experienced racism in the health care system. The patients appreciate it, Dwivedi said.
On a personal level, Cunningham is motivated to advocate for her patients, Reif said. She’s the kind of person, he said, that you really appreciate having at your clinic, or on the PTA of your school—or at your state health department.
Connecting with colleagues and patients “is part of joy at work,” Cunningham said. “And I have fun there.”
Meanwhile, her CUHCC colleagues are still basking in the appointment to the office of health commissioner.
“I can’t think of anybody I know of who is better suited to bring that personal clinical compassion to the policy level, the institutional level,” Reif said.
She is the perfect fit, agreed Dwivedi. “She is a strong force and so committed to improving the health of communities that have been ignored and that have suffered for so long.”
In her first six weeks, Cunningham has grown accustomed to a new work pace including days filled with back-to-back meetings. Research can feel isolating at times, she said, and her new job does not.
But she smiled when she mentioned that she’d be leaving the office early on a recent Friday to drive to CUHCC and care for a round of patients. “Everybody was happy to see me and I was happy to see people,” she said.
By the end of the day, Cunningham recalled, she’d stayed well past closing time.
*Correction: Due to an editing error, an earlier version of this article misstated how often Dr. Cunningham treats patients at Community University Health Care Clinic.