Understanding deficiencies of leadership in advancing health equity: a case of pit bulls, public health, and pimps.

Market- and legislation-driven health reforms are being implemented across the United States. Within this time of great change for health care delivery systems and medical schools lie opportunities to address the country's long-standing health inequities by using community needs assessments, health information technologies, and new models for care and payment. In this Commentary, the author, a university regional campus leader, shares several difficult personal experiences to demonstrate that health equity work undertaken by academic institutions also requires institutional leaders to pay attention to and gain an understanding of issues that go beyond public health data. The author reflects on lessons learned and offers recommendations that may help academic health center and university leaders be more effective as they take on the complex tasks involved in improving health inequities. These include reflection on personal strengths and deficiencies, engagement with the community, recognition of the historical roots of health disparities, and the development of trusting relationships between the institution and the community.