Joanne A. P. Wilson, MD: Still Blazing Trails
When Joanne A.P. Wilson, MD, was growing up in Raleigh, everybody in her family worked, partly to help pay for the parochial school education her parents were determined their children would receive. Wilson was 11 when she came across her first job opportunity, selling copies of The Carolinian newspaper at the A&P grocery store in Moore Square.
There was just one hitch: at the time, girls didn’t do that.
“I thought, ‘What does that have to do with anything?’” recalled Wilson, now emeritus professor of medicine in the Duke University Department of Medicine’s Division of Gastroenterology. “So, I just did it. I’d wear pants and a hat, and since nobody was expecting anything different, for a long time nobody knew I was a girl. Ten years later there were lots of girls selling papers.”
Paving the Way
Wilson has been ahead of the pack her whole life. She was the valedictorian at Cardinal Gibbons High School and graduated with highest honors from the University of North Carolina at Chapel Hill. When she enrolled at Duke University School of Medicine in 1969, she was the only Black student, and one of only three women, in her class. She was elected to AOA in her third year, graduated first in her class, and was elected president of the Medical Student Body — accomplishments applauded by the School of Medicine’s founding dean, Wilburt C. Davison, MD, in a 1972 letter to her.
When she graduated in 1973, she was just the second African American woman to earn a medical degree from Duke. After house staff training at Harvard and in Washington, D.C., and several years on the faculty at the University of Michigan (where she was the first medical faculty member to receive maternity leave), she returned to Duke in 1986 and became the first Black woman in the School of Medicine to receive tenure and the second woman of any race or ethnicity to attain the rank of full professor in the Department of Medicine.
She remained at Duke for the remainder of her professional career: 37 years as a leader, educator, and clinical gastroenterologist, earning myriad honors along the way, until she retired last June. (It wasn’t easy: her imminent departure triggered a frantic rush as her devoted patients tried to squeeze in one last visit.)
Retired or not, she’s still blazing trails. Last year she was elected the first Black president in the 140-year history of the American Clinical and Climatological Association (ACCA).
“That meant a lot to me,” she said. “It’s a fascinating organization.”
A Climate of Change
The ACCA was established as the American Climatological Association in 1884 by a group of physicians and scientists initially focused on the links between tuberculosis and climate. In the years since, the association has evolved, changed its name, and expanded its interests and membership to encompass all scientific and clinical aspects of medicine and specialties, including epidemiology, preventive, and environmental medicine.
The association had no female members for almost a century and no Black members until 1996.
“It wasn’t a policy,” Wilson said. “There were no restrictions on race or gender. For a long time, it was largely a reflection of society: you have to be at least an associate professor to become a member, and there weren’t many Black or women physicians or scientists in those positions. And then it was one of those things that happens in organizations where people nominate people they know and it becomes this self-perpetuating cycle until suddenly somebody looks around and says, “Oh my gosh, we need to fix this.’”
“I’ve done some things, but a lot of that is just a matter of living long enough and staying in one place long enough. You have to work hard, and you have to have some luck.”
- Joanne A.P. Wilson, MD
In recent years, as the effects of the climate crisis have become evident, the ACCA’s founding concern with the influence of climate on health and disease seems prescient. Wilson led the ACCA’s October meeting as its 135th president, and the speakers she invited addressed various aspects of climate change and health.
Two of them, in addition to Wilson herself, gave the proceedings a Duke Blue tint: Duke Chancellor Emeritus Victor Dzau, MD, now president of National Academy of Medicine, presented the Gordon Wilson Memorial Lecture on the impact of climate change on human health and equity, and former Duke neurobiologist Erich Jarvis, PhD, now at Rockefeller University, addressed evolution and species loss in the context of climate change.
For her presidential address, Wilson used the story of her own family as a lens through which to view the challenge of racial disparities in health, and maternal mortality in particular.
“My great-grandparents were among those who had great hopes after the Civil War and emancipation,” she said. “They ran a successful farm. Then they lost their farm to Jim Crow. They lost some of their children to the flight from farms to the cities, and the others became sharecroppers who, without access to good health care, developed diabetes, cardiovascular disease, and so on. They had a granddaughter who worked her way through college, and then she got married and pregnant and developed preeclampsia, hypertension, and ultimately seizure. When they took her to the St. Agnes Hospital for Negroes in Raleigh — the only hospital for Blacks between D.C. and Atlanta — she was comatose and in labor. And then I was born.”
Her mother was one of the lucky ones: she survived and went on to give birth to and raise six more children. But even now maternal mortality is more than three times higher in the U.S. than in most other high-income countries, and the rate among Black women is almost three times higher than among white women. And those trends are getting worse over time.
Worse still, Wilson said, those alarming numbers don’t even capture the actual reality. Maternal mortality is defined as the death of a woman while pregnant or within 42 days of the end of pregnancy. Those who die on day 43 or later aren’t reflected in the statistics.
“You have your six-week checkup after delivery, and they say, ‘The mother is fine,’ and everybody thinks she’s done,” Wilson said. “Well, she’s not done. There’s more mortality from 43 days to 365 days. Strokes, gestational diabetes, postpartum cardiomyopathy, all of these things can happen.”
Wilson called for providers and insurers to recognize that women need easy access to follow-up care for up to a year after they deliver. She said health care systems should coordinate care to make sure women see the appropriate specialists, and that a more diverse provider population is needed to treat a diverse patient population.
Society, and Duke, have changed, of course, in the 50 years since Wilson graduated from medical school, and certainly in the nearly 100 years since Duke Hospital and the School of Medicine opened in 1930. Still, some subtle traces of the old ways remain.
“I was with somebody in Duke South, and they asked me ‘Why are there so many bathrooms?’” Wilson recalled. “I said, ‘Why do you think?’ They had to think about it for a minute. It’s because when the hospital opened in the 1930s, during segregation, you had two sets of everything. Separate white and Black bathrooms, water fountains, patient wards. There are some people now whose offices used to be bathrooms. They wonder why there’s a sink in their office.”
She credits the late Brenda Armstrong, MD, and other leaders with opening doors at Duke to more non-white students and increasing the diversity of the faculty and workforce. She is encouraged by the rising numbers of people from underrepresented demographic groups pursuing careers in science and health care, but she said there is still progress to be made and she had hoped society in general would have gotten further by now.
All three of her children are Duke alumni, and her husband and both daughters are on the School of Medicine faculty: Kenneth Wilson, MD, is a professor emeritus of medicine, while Sarah M. Wilson, PhD, is an assistant professor, and Nora W. Dennis, MD, is an adjunct assistant professor, both in the Department of Psychiatry and Behavioral Sciences.
Although Wilson has been emeritus now for more than half a year, she’s been so busy with family and professional obligations like the ACCA that her retirement has barely had time to register. She misses her patients but enjoyed seeing her classmates at her 50th School of Medicine reunion last fall.
Wilson acknowledges that she has helped pave some paths that those behind her have followed, but she tends to downplay her role as a pioneer.
“I’ve done some things, but a lot of that is just a matter of living long enough and staying in one place long enough,” she said. “You have to work hard, and you have to have some luck. Some of the things I’ve done were a matter of having the opportunity. Some of them were things that I didn’t necessarily seek to do. When I became president of the medical student body, for example, I just thought, ‘Well, somebody needs to do this.’ I didn’t see anybody else stepping forward, so I did.”
Dave Hart is the editorial director for the Duke University School of Medicine's Office of Strategic Communications.
Photography by Kevin Seifert.