From Black History Month to Policy Reform: Reimagining Equity in Neuroscience

Black History Month offers an opportunity to reflect on progress, confront ongoing inequities, and recommit to systemic change across medicine. In neurology, where disparities in stroke, dementia, and other neurologic conditions remain persistent and measurable, the month carries particular weight for clinicians, researchers, and policy leaders working to advance equitable brain health.

Bruce Ovbiagele, MD, MSc, MAS, MBA, serves as the Founding President of the Society for Equity Neuroscience (SEQUINS), the only global organization dedicated primarily to advancing brain health equity through science. He also serves as Editor-in-Chief of the Journal of the American Heart Association, one of the leading open-access cardiovascular and cerebrovascular journals worldwide. Through SEQUINS initiatives such as TRANSCENDS, TALENTS, and the HEADS-UP Symposium, Ovbiagele has helped shape workforce development, research capacity, and policy discussions centered on reducing neurologic disparities.

As part of Black History Month, NeurologyLive spoke with Ovbiagele about the meaning of the month in his professional life, the evolution of equity-focused neuroscience, how clinical guidelines and quality measures can better account for social determinants of health, and what structural reforms are needed to accelerate equitable outcomes in neurology training and care delivery.

Describe what Black History Month means to you, as a clinician and the founding president of an organization like SEQUINS?

Bruce Ovbiagele, MD, MSc, MAS, MBA: A yearly opportunity, to join others over a period of a month, in reflecting on the journeys of people of African ancestry in the United States, as patients, clinicians, educators, research subjects, researchers, and leaders; and to recommit my professional efforts toward achieving more justice and equity for all. It serves as a moment to celebrate pioneers in medicine, commemorate resilience against systemic barriers, encourage the next generation, advocate for brain health equity, and highlight ongoing work to eliminate neurological disparities.

In 2026, how can we continue to promote equity in neuroscience? Talk about how we can continue to make positive change from all levels of medicine.

We can continue to promote equity in neuroscience by embedding structural, technological, and educational changes into the care, education, and research of neurologically disparate populations. Key strategies would include implementing inclusive, AI-driven, and culturally humble care; diversifying the workforce through intentional mentoring, recruitment, and leadership development; increasing inclusion in clinical research studies; utilizing innovative, multi-community, multi-stakeholder models for collaboration and education; and advocating for policies that improve care access, such as telehealth expansion and reduced cost barriers.

In your view, how should clinical guidelines and quality measures evolve to better address social determinants of health that contribute to disparities in neurological outcomes?

First, membership of clinical guideline writing panels should include individuals who have expertise or experience in studying or addressing the social drivers of brain health. Second, within the healthcare system, guidelines should empathize the need for a welcoming and culturally safe environment, including provider cultural competency training, documentation of patient language preferences and use of interpreter services to reduce barriers to care. Third, guidelines should cover the screening of neurological patients for social risk factors (e.g., food insecurity, housing instability, transportation issues, community and social context) as a standard part of clinical assessment. For instance, they could incorporate specific, validated screening tools (like the Accountable Health Communities Health-Related Social Needs tool) that are tailored to the unique needs of patients with cognitive decline, chronic neuro-degenerative conditions, or acute stroke.

Fourth, beyond identifying social needs, guidelines should highlight evidence-based protocols for connecting patients to resources (e.g., social work referrals, transportation assistance, or nutritional support). Fifth, the perspectives of patients and patient support groups, especially from communities disproportionately affected by neurological disease, could be incorporated along with those of experts into implementation sections of the guideline, corresponding to the major diagnostic or therapeutic recommendations being made. Finally, a lay and concise summary of the finalized guideline could be made available to patients, caregivers, and support groups, with an invitation for feedback to improve future iterations of the guideline.

Regarding quality measures, these should ideally shift to reward systems that successfully manage patients with high social risk, rather than penalizing them for poor outcomes driven by external factors. Key approaches would include broader incorporation of standardized social driver metrics into quality measures; adjusting quality measures for social drivers of brain health to ensure that providers treating vulnerable populations with lower socioeconomic status are not penalized for lower adherence rates or worse outcomes, which are often caused by resource scarcity; tracking the effectiveness of quality interventions, not just screening rates; and including data on neighborhood-level deprivation (e.g., area deprivation index) rather than only patient-level data, recognizing that location shapes risk.

Can you share examples of how SEQUINS initiatives — like TRANSCENDS or TALENTS — have influenced workforce diversity in neuroscience research and what barriers still remain?

The Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars (TRANSCENDS) is a 2-year program that exposes individuals from under-represented communities in neuroscience to educational and mentoring opportunities. Senior academicians from around the United Sates, roughly one-quarter of whom are from under-represented communities in neuroscience, themselves, serve as mentors. TRANSCENDS scholars develop and present research projects and receive a Master of Science in Clinical Research degree by the time of graduation.

Over 40 people have graduated from TRANSCENDS. The Training Africans to Lead and Execute Neurological Trials & Studies (TALENTS) program aims to build capacity to conduct neurological research in Africa by providing comprehensive training in the design and conduct of high-quality neurological research. TALENTS scholars are paired with one mentor from a low-income country and one mentor from a high-income country. TALENTS scholars receive a Certificate in Clinical Research credential by the time of graduation. Over 20 people have graduated from TALENTS.

The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving (HEADS-UP) Symposium is an annual multidisciplinary scientific and educational forum covering stroke care and outcome disparities, with the goal of translating scientific results into routine clinical practice for the benefit of disparate populations. Each year, travel scholarships are awarded to 20 early career researchers (roughly a third of whom are from under-represented communities in neuroscience), enabling them to present posters at professor-moderated events, learn about contemporary stroke science, join several career development activities and engage in networking opportunities. Over 130 early career scholars have participated in HEADS-UP.

Graduates of and participants in all these programs are getting competitive grants as principal investigators and research prizes from major professional societies and are occupying key leadership roles in academic departments, professional organizations, and journals. There is clearly still a lot to be done and more people to be developed. Recent targeting and termination of relevant training grants, changing funding priorities of funding agencies, and departure of knowledgeable funding agency staff have made things even more challenging.

Looking ahead, what specific policy or system-level changes within neurology training programs would accelerate equitable brain health outcomes across under-represented populations?

First, implementing holistic recruitment processes to increase the representation of individuals from under-represented communities in neuroscience among trainees and faculty. Second, integrating mandatory, comprehensive health equity and health disparities curricula for neurology residents and fellows, including training in social determinants of health, structural competency, cultural humility learnings, and anti-bias education. Third, developing structured, longitudinal mentorship programs designed to support trainees and faculty interested in pursuing equity neuroscience research.

Fourth, incentivizing neurology program trainees to conduct research on the social drivers of brain health and community-based participatory research to understand lived experiences. Fifth, incorporating competency-based education about diagnostic or therapeutic modalities that have the potential to bridge care equity gaps into graduate medical education in neurology would provide trainees with the acumen to apply these modalities in practice. For instance, including training on performing and interpreting ultrasound techniques into the vascular neurology fellowship training curriculum might augment diagnostic capacity in settings constrained by geography, infrastructure, or workforce limitations, since ultrasound machines rea relatively cheaper and more portable than most other neuroimaging diagnostic modalities.

Sixth, more academic departments and institutions around the country could apply for funding to host programs aimed at specifically train interested individuals beyond the resident/fellow/post-doc stage in rigorous neurological disparities research methodology. For example, the ENgaging Leaders In Global and local HealTh Equity in Neurology (ENLIGHTEN) program is a relatively new two-year initiative housed at the University of California, San Francisco, funded by the National Institutes of Health, which seeks to train academic clinicians and PhD scientists to become adept at conducting high-quality neurological disparities. Finally, increasing awareness about the need for more training in equitable brain health research with policy makers and stakeholders at all levels would be helpful.