Sanford Lecture: Uché Blackstock Says Health Equity Begins With Love

“This work is actually about love.”

Dr. Uché Blackstock paused after she said it, letting the words settle across a packed Fleishman Commons at Sanford. 

“It’s about people being able to spend time with their family in the best health possible.”

That idea anchored Blackstock’s Terry Sanford Distinguished Lecture, an evening that blended personal history, policy analysis and an unmistakable sense of urgency. Throughout her keynote and a wide-ranging discussion with Duke faculty and students, Blackstock returned to a central theme: health equity is rooted in community, mentorship and the shared humanity of patients and clinicians.

Endowed by the William R. Kenan, Jr. Charitable Trust, the Terry Sanford Distinguished Lecture is the school’s longest-running series. It brings leaders of the highest personal and professional stature to Duke to promote engaged and enlightened leadership in honor of the late Terry Sanford, who served as North Carolina governor, U.S. senator, president of Duke University and founder of the school.

Blackstock, a Harvard-trained emergency physician, bestselling author and founder and CEO of Advancing Health Equity, fit squarely within that tradition.

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She began with a story about her mother.

As a child in Brooklyn, Blackstock and her twin sister would walk through the hospital where their mother practiced medicine. “Oh, you’re the Blackstock girls,” staff would say. “Your mother is a …” The admiration was clear.

Her mother, Dr. Dale Blackstock, listened closely to her patients. She grew up in the same neighborhood many of them called home. “She understood where they were coming from,” Blackstock said. “She wanted to know her patients. And they loved her for it.”

As a child, Blackstock assumed that was simply what doctors did.

“But when I got older,” she said, “I realized that this was not the reality.”

Her mother had grown up in poverty in Brooklyn and had never seen a Black physician in real life. When she told a nun she planned to apply to medical school, the nun laughed. She went on to attend Harvard Medical School anyway.

At 19, Blackstock lost her mother to leukemia. Years later, she and her twin sister became the first Black mother-daughter legacy graduates of Harvard Medical School.

“Legacy is not just about practicing medicine or being from a family of doctors,” Blackstock said. “Legacy is about finding your purpose and being part of the change.”

Emergency medicine and upstream policy

Blackstock chose emergency medicine because she wanted to serve patients who lived on the margins of the health care system.

“I came to see the ER as a place where our country’s social problems come home to roost,” she said.

In Brooklyn’s public hospital system, she treated patients with hemorrhagic strokes from untreated high blood pressure and diabetic emergencies that could have been prevented with consistent primary care.

“I was seeing patients with long-standing complications that were all preventable,” she said. “We have a system that doesn’t focus on prevention.”

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When asked later about potential Medicaid cuts, she spoke from that experience.

“With Medicaid cuts, that’s what I think about,” she said. “We’re going to see more preventable emergencies. We’re going to see even more overburdened emergency departments.” Instead of investing in primary care and prevention, she said, the system spends more managing end-stage complications. “We actually spend more dealing with these complications than if we focused on prevention.”

The COVID-19 pandemic sharpened those realities. In the early weeks, Blackstock saw a steady stream of Black patients with severe illness.

During one shift, a young woman with shortness of breath looked up at her and asked, “Are you Black?” Blackstock, covered head to toe in protective equipment, said yes. “She said, ‘At least I know you’ll listen to me.’”

Blackstock described feeling both honored and unsettled.

“I was so happy to be that physician she needed in that moment,” she said. “But it also made me sad. Because there was a larger issue at hand.”

She began writing publicly about what she was seeing. Media interviews followed. Policymakers reached out. Her voice carried beyond the emergency department.

“I could never imagine my life would take this direction,” she said. “But every single person deserves equitable care. It’s up to each of us to create change.”

Asking “why”

Blackstock also urged the Sanford audience to interrogate history.

She highlighted the 1910 Flexner Report, which reformed medical education standards while recommending the closure of five of the seven medical schools training Black physicians at the time.

“When you say, ‘Why are only about 6 percent of physicians in this country Black?’” she said, “you always want to ask yourself, why?” Research estimates that between 25,000 and 35,000 more Black physicians might have been practicing had those schools remained open. “Think about the loss of potential,” she said. “The loss of mentorship. The loss of clinicians. The loss of impact on communities.”

“I read those words and I cried,” she added.

Policy decisions reverberate for generations. For Blackstock, that truth reinforces the need for leaders who understand history and community context.

A leap of faith

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Following her keynote, Blackstock joined Professor Kate Whetten and two Sanford students on stage for a moderated discussion: Aja Bullock, a second-year Master of Public Policy student and Vice President of the Black Policy Student Association, and Pauline Wakudumo, a second-year MPP student, Communications Chair for BPSA and President of the MPP Student Council.

Wakudumo asked about the decision to leave academic medicine and found Advancing Health Equity.

“I was on autopilot,” Blackstock said of her earlier career. “You do four years of medical school, residency, maybe fellowship. I was just moving along that predetermined road.”

She had been appointed to a leadership role focused on recruitment and retention of faculty and students of color. “I was really excited about it,” she said. “But unfortunately that role was just a figurehead.” She felt she could not fully pursue the work she believed institutions needed.

“I wanted to be true to myself,” she said. “I wanted to be an example for our students.” So she left. “Being brave does not mean that you’re not scared,” she told the audience. “There were many times where I asked, ‘Did I make the right decision?’”

The events of 2020 confirmed for her that the work was urgent. Demand surged. Then the political landscape shifted.

“We’re just trying to figure out how do we still do the work,” she said. “The language might sound different, but the mission is still the same.” For Blackstock, that mission centers on quality, safety and trust.

“This is about having a competent workforce,” she said. “This is something that everyone should want.”

Listening, data and accountability

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Bullock and Wakudumo guided questions on implicit bias, rural health access, maternal health and artificial intelligence.

“There is space for reflection,” Blackstock said when asked about mitigating bias. “Opportunities like grand rounds, debriefing after events. What happened? What could have been done differently?”

But she emphasized institutional responsibility.

“There need to be mechanisms in place within systems,” she said. “Disaggregate the data. Look at prescription patterns. Hold institutions accountable.”

On artificial intelligence, she warned that algorithms can replicate bias if developers fail to account for structural barriers.

“How accurate is this data set to what the needs are of the patient?” she asked. “We need transparency. Patients need to know who is making decisions about their care.”

Audience members submitted additional questions on note cards, prompting exchanges on birthing options, faculty development and community partnerships.

“We need more granularity in the data,” Blackstock said. “And we need to work with community-based organizations. Is the data collection meaningful to the community?”

Throughout the evening, she returned to the importance of voice.

“You want to be somewhere where your voice is valid and appreciated,” she told students. As they prepare for careers in policy and health, she urged them to seek environments aligned with their values. For those early in their careers, she offered a final reminder about sustainability. “You cannot be the martyr,” she said. “We want this work to be for the long run.”

She spoke about returning to the violin after years away. “We’re always finding things that feed our soul,” she said.

At its core, she reminded the audience, health equity aims to protect ordinary moments.

“When people die prematurely from preventable death,” she said, “it’s missed birthdays. Missed retirement parties. Missed family gatherings.”

Then she returned to the words that opened the night.

“This work is actually toward love.”

Inside Sanford, surrounded by students preparing to shape public policy, the message resonated clearly: build systems that honor the dignity of every community.