Anne Beal
Senior Program Officer
The Commonwealth Fund

I am a senior program officer for the Program on Quality of Care for Underserved Populations at the Commonwealth Fund. The program's goal is to improve health care quality and reduce disparities for low-income and racial/ethnic minority patients. I am dedicated to improving health care in the United States, particularly to vulnerable patient groups such as children and people of color.

I completed my undergraduate degree in the biological sciences at Brown University. I have always been interested in science, African-American studies, international policy, and history. When I was growing up, the Vietnam War was going on and it was the height of the feminist movement. I knew people who were drafted to go to Vietnam, and thought that, with the equality of women, there was a potential I could be drafted for a war in which I did not want to fight. I liked the movie MASH and decided I would become a doctor so that, if drafted, I would go as a field surgeon to save lives instead of taking them away.

In addition to wanting to become a doctor, I was also interested in public health and health policy. I realized that one doctor could care for a handful of patients, but could not cure the ills of the system to improve the health and health care of underserved populations. As someone who grew up without health insurance, I knew firsthand what it was like to not have access to high quality care.

Throughout my college and medical education, I was very politically and socially active. I spent the summer before medical school in Nicaragua as a volunteer. I saw the devastation of Contra attacks on rural schools and clinics. By cutting off people from education and health care, the Contras were limiting the future of their victims and destabilizing that society. My time there helped to crystallize for me how providing health care services can be a form of political activism.

While I was a medical student at Cornell, I spent three months in Tanzania studying community medicine and learned about the importance of public health, particularly for a very poor patient population. I also had a chance to observe another health system and learn how they were addressing the needs of that population. I was very impressed with the clinical expertise of my African student colleagues, and learned that their education was free but they had a service obligation and would serve as medical officers in the Tanzanian health system.

After medical school I completed a three-year pediatric residency at Albert Einstein/Montefiore Medical Center. At the end of my residency, I was planning to work at a community health center. However, Dr. Ruth Stein, one of my mentors, suggested that, with my interests in public health and health policy, I should do a primary care research fellowship with her instead. (Of note, pediatric health services research fellowships did not exist at that time.) The program would pay for my Masters in Public Health, and I could learn how to conduct as well as evaluate research related to health policy.

My research focused on the impact of managed care mandates for Medicaid recipients. Although we called this primary care research, it was not quite a fit because of my focus on policy and systems-level issues. I then came across a meeting brochure from the Association of Health Services Research (AHSR-one of AcademyHealth's predecessor organizations). Every other session was focused on something that interested me! I attended AHSR's Annual Research Meeting, and realized that I had found a research home. The work I was doing had a name (health services) and I found a group of colleagues outside my clinical area who shared my research interests.

At the end of my fellowship, I went to talk with my department chairman, Dr. Michael Cohen, about employment opportunities. When he asked me what I wanted to do, my lack of focus was evident, as my list of desired activities included: patient care, research, policy, advocacy, and public health. He advised me: "You have a 30- to 40-year career ahead of you. You can do all that you want, but my advice is to do one thing at a time, and to do each one well."

I decided to focus on clinical care for underserved patients and went to work for the New York Children's Health Project, which was a mobile medical unit project that provided health care to children living in New York City homeless shelters. My clinical responsibilities left little time for research or policy but I was accepted to a health services minority faculty development fellowship with the Association of American Medical Colleges, which met three to four times per year.

The fellowship gave me great insight into what was needed for an academic career, and what kind of work environment was necessary to promote my career. Although I enjoyed working with my patients, their needs highlighted the importance of health policy for the underserved, and raised several research questions for me. I decided to focus on building a strong foundation and reputation in academia through research so that I could later move into a policy position.

I joined the faculty at the Massachusetts General Hospital Center for Child and Adolescent Health Policy. In addition, I was Associate Director of the Multicultural Affairs Office of Massachusetts General Hospital, and held faculty positions both within Harvard Medical School and the Harvard School of Public Health. I spent approximately 20 to 30 percent of my time on clinical work, 10 percent on teaching/mentoring, and the rest on research.

My research focused on social influences on preventive health behaviors for minorities, breastfeeding promotion for women of color, racial disparities in health care, and quality of care for child health. I enjoyed academics, but felt that I wanted to work more in policy, and to do work that would lead to positive changes in the health care system.

After six years at Harvard, I joined The Commonwealth Fund where my job has forced me to think not only of publications as a measure of success, but to think about how the work we are supporting has an impact on health and health care. I have the opportunity to respond to needs in the field, as well as to set directions for where the field needs to go. Supporting a number of projects also allows me to develop a body of work that is larger than what I could accomplish as an individual. Lastly, I really enjoy working with researchers and policy analysts, and promoting the careers and efforts of professionals who are working to improve care for the underserved.