COVID-19 Webinar Series Session 18 – Health Inequities: Addressing the Disease Burden in Black, Indigenous, and People of Color Communities

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

 

0:07

Good afternoon, everybody, and good morning to our friends on the West Coast. I am Sarah …, President and CEO of the Alliance for Health Policy, and I want to welcome you to the 12th week of our … webinar series. For those who are not familiar with the Alliance, welcome, we are a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues. We launched this series to provide insight into the status of the … response and shed light on remaining gaps in the system that must be addressed to limit the severity in the United States.

0:40

This pandemic has disproportionately affected black, indigenous, and people of color communities. Existing data shows that people in those communities are more likely to contact coven 19 and are at higher risk of being hospitalized. Or dying from the disease.

0:57

In a moment, our panelists will explore some of the root causes of these disparities, and discuss policy options to advance equity and Improved coven 19 outcome.

1:08

The Alliance for Health Policy gratefully acknowledges the National Institute for Healthcare Management Foundation and the Commonwealth Fund for supporting the … Webinar series. And you can join today’s conversation on Twitter at hashtag all Health Live, and follow us at all Health policy.

1:24

We want you all to be active participants, so please, get your questions ready.

1:28

To ask a question, please use the speech bubble icon on the right-hand side of your web browser. You can also use that icon in case you are experiencing any technical issues.

1:39

Finally, check out our website, all health policy dot org for background materials and a recording of today’s webinar, which will be made available there skin.

1:47

And now I am so pleased to introduce doctor Lauri Ceferin, Vice President of Delivery System Reform at the Commonwealth Fund who will moderate today’s discussion. Lori, thank you for being here.

1:59

Thank you. Thank you so much, Sarah. I’m so honored to have this conversation with all of you. Today, we’re in a moment of time that highlights the dual pandemics related to covert 19 and structural inequities attributed to systemic racism. But, we are seeing unfold in front of us, is a compounding of already existing inequities that are heightened when you add a pandemic to the mix. In addition to the health harms, there’s widespread economic and social disruption that harm those most vulnerable to inequity.

2:32

What we see on this slide. Next slide.

2:36

The radish and orange colors here indicate states where deaths and cases, more than proportional, to black people share of the population in each state. The disparate rates and deaths in cases are striking. And, if we go to the next slide, these inequities go beyond the African American community. They touch other communities of color, with striking and disparities existing for American Indian and Alaska Native populations. For example, in Wyoming, 30% of cases, compared to they’re making up, only 2% of the population, for latin X people, rates are two times higher in 30 states, and four times higher, in eight states.

3:17

There’s still additional data needed, and we don’t see the full extent. There’s major holes that remain, where almost up to half of cases still have no race or ethnicity data tied to them.

3:29

New efforts for data collection and new administration requirements may help fill the gap for states to report … data. So, from the time, covert 19, to cold in the US, and community spread of the virus became known, communities of color have been disproportionately burdened by the disease.

3:48

We go to the next slide. We really have to understand the conditions that perpetuate these disparities and frame the policy solutions to address these issues. Covert 19 is devastating communities. And as a society, we cannot ignore the root causes. These disparities arise as a result of systemic inequities that affect: where you live, where you work, your ability to access healthcare, and how you’re treated when you get there.

4:16

We have a true moment now, where there seems to be a collective understanding of the value of health, and what health means, and the structural and social impacts that affect health.

4:26

With that frame in mind, I would like to introduce our panelists for this session.

4:32

Today, we have three extraordinary individuals joining us in this conversation, about coven, 18, Health Inequities, and Opportunities for action. Particularly from a policy perspective.

4:44

Today, I’m pleased to be joined by doctor Rachel Hardman, Associate Professor at the University of Minnesota School of Public Health.

4:53

Doctor hartmann’s a reproductive health equity researcher who uses the tools of population, health science, and health services research to describe a critical and complex determinants of health inequities, racism.

5:07

Next, I’m pleased to introduce doctor Wisdom Powell, who’s Director of the Health Disparities Institute and Associate Professor of Psychiatry at u-conn Health and President of the American Psychological Association Division on Men and Masculinity. Doctor Pals, community based research, focuses on the role of modern racism and gender norms, an African American male health and outcomes, and health care and equities. Family. We have doctor Iniquity, President of Impact International, and the board Member of the Alliance for Health Policy. Doctor Iniquity is the leading voice in health policy and the social and structural determinants of health, working to create an equitable care system that makes meaningful changes, the people’s lives. Thank you all for joining us today. Now, pleased to turn it over to doctor Rachel.

5:58

hired him, doctor Heneman afternoon, everyone, and thank you to the organizers for having me. I’m really happy to be here and to discuss this important issue with you all today.

6:13

I’m going to start with a few comments just to frame where I’m coming from as we think about this issue. And I look forward to the discussion that we’ll handle over the next hour.

6:23

So we’ve all heard the words over and over the past few months that we are in an unprecedented time in our country.

6:30

And while that may be true for some of us, for those living in black and brown bodies and black and brown communities, many of the daily headlines of the disproportionate impact of Colvin is not new news into business as usual.

6:44

I recall in February reading about the novel Coronavirus for the first time and thinking. If this hits my community it’s going to be bad news.

6:52

And certainly that’s exactly what we’ve seen.

6:55

As you just heard from Lori Ampatuan, Americans have the highest mortality rates and most widespread incidence of disproportionate death related to Cogmed 19, making it such that one out of every 1625 black Americans in the general US population as now died from 19.

7:16

We also know that indigenous people are dying above their population share, particularly in places like new max.

7:23

It’s not a coincidence that the two populations in our country that have banned the physical burns, sanctuaries of injustice, are dying and our contracting comment at disproportionate rates than their counterparts.

7:38

And at the root of these illnesses and deaths as a history and legacy of racism in all of its forms from internal, internalized, institutional and structural.

7:48

Today, I’ll mostly talk about structural racism, and that means the totality of ways in which societies foster racial discrimination through: mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, healthcare and criminal justice, and defined by my friend and colleague, doctor Lyndsey, basically.

8:09

These patterns and practices in turn reinforce discriminatory, beliefs, values, and distribution of resources, and as we think about policy interventions, the focus here is going to have the greatest impact.

8:26

What we must recognize is that the social determinants of health, as you just heard, those conditions and the environments in which people are born, live, learn, work, play, worship, and age, are not just important indicators of health and well-being as my field of public health. And so while described over the years, But that these determinants are rooted instructional racism. So one is born lands, Works, And plays is rooted in legacies of segregation and White Flight practices of gentrification and environmental racism, local, zoning ordinances, all of which an aggregate confined, black, and brown people in residential areas where we are disproportionately exposed to toxins and pollutants.

9:10

As a result, black populations have higher rates of asthma cancer, and recent data suggests that chronic exposure to particulate matter and the air may contribute to risk and ask them comment 19, as much as 15% higher, and as much as 15% higher for Black Americans than that if their white counterparts.

9:32

We must see our policy as Health Policy and as my colleagues, doctor Medina and doctor Boyd describe, in our recent publication, Stolen Broths, and New England Journal of Medicine.

9:44

We have to understand that the social determinants of health at Mount raises, fundamental cause, and as my my colleague and mentor and friend, doctor Monica …, all the time, this cannot be different, and she’s right.

10:02

It’s time to deploy solutions that meet the urgency of the moment we’re in.

10:06

These solutions must have equity at the … rather than … on the backend.

10:11

And they must explicitly value black and brown, limes, with the understanding that if our communities do better, we all do better.

10:19

And this begins with divesting from Regional Health Inequities.

10:24

These are not signs of a system not function, Rather, they are functioning.

10:31

So when I think of unprecedented about coven, is that we’re, in a moment, where it is increasingly clear. What does not work? And we have the opportunity to build a new system. That values not black lines, and I look forward to having a discussion with you on the next 45 minutes, about what that can look like. Thank you.

10:52

Thank you so much, Rachel.

10:55

Now I’d like to turn it over to doctor Wisdom Powell.

11:01

Thank you for welcoming me to the panel, and for the opportunity to talk with you today about some of the issues that we are observing here in the state of Connecticut, which has bearing on the conversation that we’re having today.

11:17

And I’m hoping that folks can see my screen.

11:20

I like, yes, we can thank you.

11:22

I’d like to use the frame setup by a philosopher here exciters who first remarked that you can’t and could not ever step in the same river twice.

11:38

And while there are many, you know, probable interpretations of this now, famous quote, I will offer that you know, rivers, even with different currents, and different water is flowing on to you still offer an opportunity for us to in fact, step in the same river.

11:57

If history is a good teacher, as we’ve been told, in the Spanish flu pandemic of 1918, offers wisdom about pitfalls and missteps that might more effectively guide our covert 19 response strategies. As, you know, during this time, this unprecedented influenza pandemic claimed more than 600,000 American lives.

12:21

And even though we know that these lives were lost, and we know that even at this time, at that particular time, in our history, we saw, for the first time, a a sort of flattening, if you will, of the influenza mortality curve for blacks. Some offer that this decrease. mortality was related to more physical. Soundness of hardiness. But in hindsight were reminded that testing and treatments at the time were also unevenly. Distributed. That rates of infection in mortality were not consistently tracked and monitored among blacks. And, that, even while we were observing this reduction in mortality, we’re still seeing marked racial, differences in the distribution of resources and the quality of care. And then, exposure to systemic dehumanization and neglect.

13:10

And because we didn’t center these root cause explanations or lenses, as we were exploring opportunities for recovery and response, we didn’t track and monitor and focus on the preexisting social inequities. And so, we were less prepared for what we saw only a year later. And that was an uptick in mortality among blacks to not only surpass whites, but to return back to the prior rates. So, we failed in 19 18 to center equity, and more importantly, health equity in our pandemic response strategy.

13:45

And so, here we are standing at the mouth of a similar river. When we talk about health disparities In this conversation, we often forget that really the goal here is to advance opportunities for everyone to have a fair and just opportunity to live there healthiest that, while we’re talking about disparities, we really need to be talking about, how do we move the needle on systems, policies and procedures and practices that lead us to exacerbate preexisting disparities. We forget that the this disparities that we are observing both pre covert 19 in and now, have significant implications for health care spending and worker productivity, and, thus, impact our capacity to compete in the global marketplace that this is not a zero-sum game, that, in fact, what we invest in those groups who are most affected by disparities.

14:41

We actually create a broader social impact that creates a healthy community opportunity to live a fair and just life. We also know that, as our colleagues have pointed out, prior to my comments, that covert 19, it’s disproportionately impacting minority communities, but we also know that those data are somewhat incomplete.

15:03

And because we don’t system medically collect data that are disaggregated by race, ethnicity, language, preference, and other care demographics, we’re not getting the proper diagnosis that will fuel a tailor and effective intervention response. While we’re talking about disparities, affecting minority communities is important to note, that, in several states across the US, we’re seeing data emerge. To suggest that women appear to contract the virus at higher rates, But death rates are highest among men. And this is important to lift up, because, as we know, that in our country, despite medical innovations and advancements blackmails, still live shorter lives of all individuals and U S society creating a perfect storm for exacerbated, co-ordinating disparities in black, and brown men.

15:53

There are opportunities, as we’ve been discussing for legislative action, I believe, where there is political Will, there is a legislative way. And so we are committing ourselves to the systematic collection of race, ethnicity, and language data that we’re better positioned to make a dent in moving the needle on health equity.

16:13

We know that there are opportunities that exist within existing healthcare policy. For example, Medicaid Expansion which offered for the first time in our history an unprecedented opportunity for low-income and childless men to come onto Medicaid rolls. And then, data that we examine from North Carolina, a non expansion state, we discovered that if North Carolina had expanded Medicaid, that they could have potentially reduce the deaths of black men for colorectal cancer significantly.

16:43

We have opportunities to deploy and reimburse community health workers, revisiting our metrics and and our strategies for reimbursement, and paying for, for, for value. We also know that we can send your health equity by focusing on, those who are most vulnerable. And thinking about, especially especially the double threat, to health outcomes that are produced, and communities that are already facing systemic injustices and inequities due to race, ethnicity and other demographic identifiers.

17:17

We know that there’s a reason that we have these inequities that are not about individual behavior that are not rooted in genetics or or personality or biological substrates that. in fact, a fundamental root cause of health disparities related to call. The 19 and preexisting disparities are linked to the longstanding racism and discrimination, both inside and outside of healthcare systems. And while we’re talking about disparities in black and brown communities, we have to remember that there are other Shadow pandemics operating in the background. We know for example, that racialized violence that is experienced by communities of color. And even everyday racism has a diminishing impact on the trusted Individuals Stowe and Health system so that when we build, they will not come.

18:06

And the pandemic and of itself, is, has introduced potential trauma that is, felt collectively by all of us who have been forced to shelter in place as we try to flatten the curve. And so, as we’re thinking about same rivers, I hope that we’re thinking about the need to, to pay attention to the potential fallout from chronic disease, morbidity, and mortality, and mental health impacts of covert 19, and so that we, in fact, resist the natural tendency to step in the same river twice. And I look forward to having a conversation with all of you.

18:46

Thank you so much, doctor, Doctor Powell, Powerful and Nationality Around the Strong Rivers and doctor …, saying, you know, we’re in a moment where this is clear, and we know we need to do. So, doctor Iniquity and turning to you now, really looking forward to your thoughts and comments.

19:04

Thank you so much, Laurie, doctor Safran. And it’s wonderful to listen to Doctor Powell and doctor Hartmann. Give such wonderful introductions, I do want to take this moment to thank the Alliance for Health Policy for putting on this particular webinar, but really, for their series, around the covert the many issues around Corvid 19. Hopefully, everyone listening today will take something or two away from this conversation. I have certainly found them to be most informative and helpful in thinking about policy.

19:45

So, thank you to Sarah Dash, for just, this, you know, scale steering of this organization, especially at this difficult time. I do want to center a couple of my, my comments around policy. The policy implications.

20:01

A lot of our listeners, hopefully, are from, or, you know, members, offices, senators, offices, different agencies within the executive branch, people, young and seasoned who are in a position to craft the future of our response and what it looks like from a whole host of angles. Whether it’s research or funding, and investments. And I think, as we’re speaking about this issue, we want to be better positioned so that we don’t keep making the same mistakes.

20:34

I think the statistics speak for themselves. Black people are infected and die at disproportionate rates than their white counterparts. We’re seeing the exact same statistics among other people of color and minority populations. And it does, I think, what’s, what’s, what’s worse is that we’re not going to get a break the summer.

20:56

That’s actually what the data are pointing to covert infections, continue to spike, and, with the spike and Infections, we have the lagged indicators that will show up in a few weeks around hospitalizations. and the inevitable deaths that will follow. New models are actually predicting that in a couple of months, 200,000 Americans would have died from covert 19. If you compare that to wisdoms and slide just a few minutes ago where we lost 680 something people from the 1918 flu, that’s 100 years later.

21:32

And if it doesn’t look like, we have made really significant progress in our ability to handle, you, know, infectious respiratory diseases, that, you know, for which we have no cure. What we do have, however, are strong, stronger, better public health interventions that simply require a decision around how we deploy those interventions.

21:57

The United States is unique In this dismal outcome Cove in 19 affected I think spared no corner of the globe. And yet we are seeing outcomes and the most the richest country in the world that look like what you might expect to see in a much poorer developing country context.

22:22

These results are not inevitable.

22:25

At the same time, we can’t continue to admire the problem, especially when we’re talking about health disparities and health inequities.

22:34

I’m old enough to have been doing this for more than a decade, where much longer than a decade.

22:38

And I know that the literature around health disparities, health inequities span over a century knowing the statistics well, as important as they are, and we need to know them. But it won’t. It turns out it won’t lead us to solving the problem and addressing what we need to do structurally to combat the next pandemic, the next natural disaster, or the next public health crisis.

23:05

What we need to do, however, is, again, with the engagement of all of the relevant bodies, whether it’s academics, researchers, policymakers, on the Hill, executive agency, staff, et cetera, is to really articulate what the vision is for this country, when we do encounter the next natural disaster.

23:28

I think I will, I hope that our conversation, as we move forward, we’re really focused on empowering our citizen educators so that we make better decisions that are rooted in evidence.

23:42

We make better decisions around data collection. It is mystifying that decisions have been made to not collect race, ethnicity, and limited English proficiency. Data 10, 15 years ago, we had trick toolkits around how to do that better. The IOM unequal treatment report came out, I believe, it was 2002, 2003, articulating the necessity of this as part of health services, research and health policy.

24:11

So I think at the end of the day, what we’re talking about are better decisions by policymakers tied to accountability measures, so that everyone is incentivized to do the right thing. And so, think about to think about health equity as the primary lens through which we deal with public health crisis because we know what the inevitable outcomes will be. And I think with that, I’ll pause and transition back to Laurie for our conversation.

24:44

Thank you. Thank you, a death. And you’re absolutely right to health equity has to be a critical part of any policy decision, better decisions, and better accountability. And I think as Rachel and wisdom, and it is highlighted, health disparities are not a new phenomenon. We really have to act intentionally, to eliminate these disparities. We have to look at the data. We have to apply health equity framework. We have to think about how we allocate dollars, how we expand coverage, and how do we ensure that any policy or legislation that moves forward considers equity and measures the impact on communities of color.

25:19

And so we’re we’re really looking forward to your questions.

25:24

And so I’ll start out with doctor Herman. You know, I’d love to get your thoughts around healthcare and health policy. That’s often structure in silos. And I think doctor Pal wisdom painted a picture of the connection between structural racism and the … disparities and police brutality and the impact on those most vulnerable to Inequity. And so you know, I’d love for you to talk a little bit about the disproportionate incidents of Maternal mortality in black women also have sparked a national conversation, and how are these conversations similar, and what can we learn from the drivers of the disparities, and what are the policy options to overcome them?

26:08

All right, thanks, Lori. I think you’re exactly right, you know, we’ve we’ve seen this disproportionate incidence of maternal mortality in the US, and we know now that black women are 3 to 4 times, more likely to experience maternal mortality, and that’s led to a lot of conversations, and legislation, and policy, policy interventions to do something about that. And all too often, in the conversations centered, in these, in these silos, as you described, where, you know, public health with doing their thing, medicines doing their thing.

26:44

And, I think one of the other important pieces are problems, you know, we, we face, is that we, all too often viewing health, policy as social policy as health policy, right? So, we’re thinking, we’re not thinking about the connections between things that we wouldn’t necessarily deem as specifically as health policy. But what we’ve seen, you know, particularly, I think with Black Maternal Health, monitor this act of 2020 is, you know, an incredible amount of thought and work that’s gone into sort of bridging that gap in order to be really thoughtful and really intentional about the rising maternal mortality rate in the US. And the black maternity maternal mortality crisis in particular. So, you know, we see different, you know, different ways that legislation can improve, improve that, that crisis in our country. And I see a lot of the pieces. And then, if you look at sort of benign nine bills that were put forth in them under this act.

27:52

A lot of them apply to what we’re facing right now, with respect to coven, 18. And the disproportionate impact on black and Brown communities.

28:00

So, everything from, you know, that Social Determinants Vermont Act, where you were asking for to make key investments and advances in clinical research on the social determinants of health, and to really think about how all of these social factors. As, you know, we’ve heard before where you live work and play impact, health, you know, pieces of other pieces of that, that act like the Justice for Incarcerated Moms, Act, and the need to call for the need to study, and understand the scope and impact maternal mortality, and incarcerated populations. You know, just as we are seeing no significant significant impact of Kubernetes team and incarcerated populations and correctional facilities across our country and you know, certainly that ties into and cannot be disconnected from.

28:52

the, you know, current, the current price for change around police reform and police brutality and the criminalization of black and brown bodies in our country.

29:04

And I think that there’s a lot to think about with respect to legislation that has already been put forth, right To, to deal with other crises because it’s all part of the same, you know, the same root and the same foundation of structural racism. And so, leveraging, you know, the deep knowledge and expertise of folks working in all of these spaces is critical to to address the disparities issue as well.

29:33

Right, thank you. Thank you. And it seems that doctor pal wisdom hear your comments around stepping in the same river twice, really, really. The question for you, doctor …, you mentioned and community health workers, how can policymakers ensure that we invest not just short-term tracking tracing work for more broadly, but an expanded and expanded community health care workforce that can tackle the underlying morbidities and disparities that we’re seeing?

30:05

That’s an excellent question, because I think we do have to re-imagine what our health care workforce is going to look like. Because, first of all, we’re not training enough racial and ethnic minority physicians, nurses, health care workers to begin with, and not at a rate that would match the need and racial and ethnic minority communities. So we have to think about all the levers we have at our disposal to expand the workforce. And so, community health workers, who have always played a critical role in bridging communities of color to health systems and providers could play a play, a really prominent role in our recovery and response efforts, and also could be you leveraged. Again, to support us as we addressed the potential chronic disease fallout.

30:55

And, you know, as I know, alluded to in my comments, one of the concerns I have and many leaders have is that you know, because of the physical distancing requirements, many people were foregoing should know their routine preventive screenings And were not able to, you know, be in touch as they routinely or normatively were with their providers, so chronic disease management. We fear some chronic disease management may have fallen through the cracks and so if we think about our community health workers as a part of, as an important arm of the health system than we could use.

31:35

Leverage their talents and gifts to support us, and in reaching out to folks around preventive screenings, right? To help make community members where they are, where they live, they work, they play, etcetera. And, and, and to re-imagine what a, what a workforce development slash economic recovery strategy could look like if we were to open up new pathways to Community Health Worker certification for men and women, from communities of color, who have been edged out of employment opportunities as a part of the pandemic. So, we have to get creative. I believe, and there are lots of opportunities for us to expand the reach and impact. I mean, when you travel abroad to other countries, you see a more creative use of community health workers, and also more impact in return on investment, if you will, for it, for making those resource allocation decisions.

32:38

Absolutely. And you know, there’s a lot of data just showing the impact, as you mentioned, if community health workers, and really that connection to the community at the heart of health, at the heart of primary health care. Thank you, Howard.

32:51

How would you address the feeling of urgency? And in patients felt by so many living and working in hard hit communities, it’s hard to deny that structural racism wrought. By the way, the US Healthcare System is organized and financed as a commodity rather than a social public good. Oh, we attract for transformational change. Is this: Is this even possible?

33:16

Louis?

33:19

Go right ahead.

33:21

Is directed at me, like, I wasn’t sure I asked doctor doctor Antiquity as far as I was just by a great question.

33:32

There are many reasons for why this is urgent, or at least more urgent. And, I think it speaks to the fact that for some who may not have been paying attention to health equity or have been if you haven’t been steeped in this research or policy area, it might sound like this just bubbled up to the top, you know, a year or two ago. But I think, as I mentioned earlier, we have a century of work. At least where we have been taught where people have been talking about. This initially didn’t even start with race. And started with class poor people versus, you know, the gentleman in England, the workers in the, you know, the folks who get their hands dirty, their nails dirty versus the people who never have to touch soil or, you know, iron.

34:22

So, and you find that there’s great differences, that we have a lot of factors that intersect that leads people of color in this country, and in many others.

34:35

But in this country we’ll focus on people who are vulnerable for a whole host of reasons around education, income, and wealth where they are persistently at a disadvantage when it comes to access to resources, access to care, access to quality care, and has poor outcomes with respect to their health.

35:02

So, I hope, my hope is that we will seize the moment. I think it was Wisdom who mentioned that, you know, the protests that have arisen because of police brutality, and the the life and death situations that occur. When black men in particular encounter law enforcement has spread to, I think there’s a Twitter have. There’s a Twitter, Trending Twitter. Have a whole black eye view of black. And the idea of like Black in the ivory tower, black academics, people who are, who are seen to have made it made. It is in quotes when they come out and talk about their experiences and what it has taken for them to make it, or how they’ve made it in spite of significance.

35:48

Roadblocks, I think, starts to lend credence to this notion that we have a lot of work to do in virtually every facet of American life.

35:58

What it will take to seize this moment appropriately is leadership.

36:05

That, to me is the underlying factor if you don’t have people who can think about this, and the implications and think beyond the next when in a month. But, think about the long term implications in the next 10 years, in the next 20 years, and really begin to get us on.

36:23

To the place where we’ve got a strategy moving forward, Then, we will miss the moment, so, I do believe that with this, the confluence of voices, if you will, coming from every corner, in our society, we do have a wonderful opportunity. It doesn’t come around very often where you have not just black people speaking out against injustice or Hispanics speaking out against injustice, but everyone, lots of White people, are protesting because I think there’s a collective recognition by many that the current state cannot, It’s just not sustainable.

37:01

I do, if you don’t mind, Laurie, I want to go back to a question that you posed just a minute ago, because I do think something is worth clarifying. Why do we need more people of color in the healthcare workforce?

37:13

I think when we talk about it amongst ourselves, in the policy space or academic space, you take it for granted that that note, that the reason for that is, is, is understood. And I’m starting to pick up that, it’s probably not understood it just, I think it’s helpful to just tease that out.

37:29

People of color, people from particular communities are much more likely to go back to their communities after training.

37:36

So if you, if you raise, if you, if someone from, a rural part of Missouri, goes to medical school, they are much more likely to go back and serve and take care of patients in that rural part of Missouri. Rural advocates know this and have been doing this Grow Your Own. When it comes to nurses, nurse practitioners, PA’s, and physicians, for decades, the same thing applies to communities of color, because what you and gender, as they try to develop a trusted partner.

38:11

For that community, someone, that members of that community will trust someone who understands them. Understand the nuances and the idiosyncrasies related to that particular community for people of color.

38:25

You have the added ability to combat the long history, and abuse and antagonism long history of abuse and antagonism by some members of the medical community against communities of color. We have a long history. I’m sure most people on our call are quite familiar of black people being experimented on and, you know, having no effective and efficacious treatments withheld and not being, you, know, served as well being disrespected if, you know, Rachel Hardman is talking about maternal mortality. And when you listen to black women, talk about their experiences with, disrespect with, not being believed with, not being treated for pain, it just goes on and on this is not historical.

39:12

When Covert 19 broke out, a couple of months ago, we saw some French doctors on camera casually discussing experimenting on African children. I think it was African, Africans in general, on proven treatments that may or may not tell them the safety and the harm profile of those drugs were not being discussed. They were just going to know, the conversation was so casual, there was shocking. So, this has not, well, this isn’t in. Our history is not in the rear view mirror.

39:45

There’s a reason why we keep talking about the need to have more people of color in the medical profession and health professions and health policy professions, because without a representative group of folks at the table, you find that communities of color will continue to suffer from, you know, the inequities we’re talking about.

40:09

Thank you, it as A, and that leads very nicely into the next question. We’re getting a lot of questions from the audience, so thank you for your engagement and interest. I’m Rachel, I’d love for you to answer this question as well just else detracting, from your experiences in Minnesota, and the work that you’re doing, around anti racism training and health care.

40:30

Can you comment on how historical distrust of the health system is playing out in this pandemic and public health efforts? For example, especially around contact tracing tracing, or other public health efforts. What can local health departments do to improve community relations?

40:47

Rachel?

40:49

Yes. Thank you for that question, I think it’s such an important one.

40:54

You know, so, I, I am gonna fountain and born and raised here and currently living here aren’t flying was Murdered BioPharm Minneapolis Police Officer, eight blocks from my childhood home.

41:08

So, in addition to what we’ve seen, the impact that this has had on the country, you know, it’s a very real part of my my life right now and you know what, we, what we know is that this is a community. These are the communities that are already disproportionately impacted by all of that. You know, the long list and laundry lists of health inequities in our communities. And we also know from research that I’ve done with doctor Sarah along at a varsity at folks who report having any sort of negative encounters with police.

41:44

So even an encounter that they deem as unnecessary encounter, they are more likely to report having mistrust and medical institution. And I think understanding that, and what that means for this current moment, where N both, you know with respect to colvin and with respect to structural racism and how it’s playing out to police brutality in our community is incredibly important.

42:09

Because what happens then is you know this potential risks that folks who are out in the streets protesting athletes should be, you know, are, are certainly, you know, potentially exposing themselves. I’m putting themselves at greater risk for who are covered 19 and this mistrust may lead to no hesitation to get tested, hesitation to engage with contact …. And so here in Minnesota, I think, you know, we have, we have some great folks who are thinking about these issues and are working on that and have set up, you know, opportunities for no testing and communities and really making sure that that is available in the communities. Where protests are happening, I think the doctor pals mentioning of the community health, these community health workers is really, really important point. We know that community health workers have built trust within the communities and him off and often come from the communities that are most impacted.

43:16

And so, thinking about ways to keep people safe, and healthy community health workers, I think, is incredibly important. You know, we’re working here to make sure that Koby testing is accessible, and straightforward, and in free, and that people understand that, it’s free, and that, you know, they can decide how to get the results. So, you know, making sure, folks know we can send you a text is, you know, with your test results within 72 hours. And so, all of that, I think, is really important.

43:49

But if we’re not coupling that with sort of bigger policy initiatives around that protect communities and protect people, then it’s sort of a moot point, right? So if we don’t have, you know, hazard paid if we don’t have paid sick leave for the folks who we know are out there protesting and fighting for their livelihood but also are the essential workers working in grocery stores and working in places where they’re going to be more likely to be exposed. Then, you know, what we’re doing on the ground isn’t going to have the, the impact that we needed to have.

44:31

Thank you so much for that.

44:33

And so, many questions around, and I think these these can these can go to get I’ll try to collapse some of the questions just given, given the time, you know, what role does what role does, You know, what do we know about? For example, disparities in other countries. Is the US. an outlier? Why do we What do we know about? You know, other continents that are having variable incidences of covert 19 Wisdom can you can you give us some insight on that?

45:10

So I’m going to speak from the perspective of talking about men’s health, which is my area of expertise and then I’ll invite course my esteemed panelists to weigh in on some other statistics. But here’s what we know that, you know, around the world, we see males dying more prematurely from chronic disease. They have sort of like lighter life expectancy rose to women. And while there might be epigenetic and also genetic factors, biological factors contributing to these disparities. We know that they’re not all rooted in biology, because if they were, then we would see those same disparities across patterns of disparities across groups of men, from all racial and ethnic minority groups, and we don’t.

45:53

So, I’d like to lift up that the spurious, the not so serious case of George Floyd, right, where we have a black man who actually happened to to escape the grip of Covert 19 recovered from Code 19, only to perish as a consequence of a racialized violence. Right. And so, what this speaks to me in linking this back to the conversation about trust and how we turn a corner on disparities is, that we have to remember that mistrust of medical organizations by men like George, Florida, and other black men in the country who have reported higher levels of mistrust is not an attitudinal barrier right, but overs are legitimate response to systematic maltreatment.

46:43

And that mistrust Dickinson thins with cumulative interactions with systems and individuals and all the research that we’ve done over the past 20 years among black men, leaking mistrust of various outcomes. We found it, as doctor Hartmann pointed out, that men who experienced more everyday racism were less likely to trust medical organizations and systems despite other, you know, factors operating, and that this mistrust of above and beyond healthcare access insurance, and other factors contributed significantly to delays and preventive screenings. Now, why do I lift this up as we’re talking about global disparities?

47:20

While I’m talking about this, because I think it’s important to put it into context that, you know, while we are working to move the needle on disparities around the world, that we don’t treat mistrust is simply an attitudinal barrier that we addressed, again, the systems fractures and dysfunctions that have given rise to mistrust and in populations of people who are already disproportionately impacted. I think this has implications long term for global population health management. And if we don’t address it, then we, when we build it, as I’ve said before, black and brown populations will come. So all contract tracing efforts will be awarded. And people, even when we develop a vaccine, for co-ordinating will not, will not use, it will not allow themselves to avail, will not avail themselves of those services. So I think it’s a serious issue. And as we think about our healthcare spending in this nation, relative to the disparities, I think we should look to our global partners for different models of how we create payment structures or reform structure that actually match the, the, the issue at hand.

48:31

But present opportunities for sustained change and sustained advancement towards health equity.

48:42

So, thank you so much. It sounds like trust, and building empathy, and better decisions and accountability, really, having the framework around health equity. As we think about these, these interventions, we have so many great questions, and we’ll not, unfortunately, be able to get to all of them, but we will post the resources, as well as contact information for the panelists, and identify other areas, too, to do this again and, and explore, Explore that, they just an amazing conversation. And important conversation that we’re having today, so, I think we have time for for two, for two more questions. And so, one is around what are some of the most promising initiatives you’ve seen to address some inequities during the pandemic or beyond death. A: I don’t know if you want to take that one and then, and then we’ll have a final closing question for all of you.

49:36

Sure. I can start, and I think what the distinction I’d like to make is that the promising interventions at scale.

49:44

And, because I, I do think, while those utility and, you know, having a number of pilot projects that are, you know, you know, specific to particular communities, we really ought to be thinking about what can we do at scale.

50:03

And, there I see a lot of opportunity. I do think in 20 20 it is unconscionable that the CDC will put out reports or data where there’s 50% missing data on no demographic characteristics, especially race and ethnicity. So, even with the 50% that we did have, we saw that in some locales there were, you know, 80% of the people who died were Black, even though they represented no share of the population. that was in the teens.

50:33

So we have huge opportunities to do better.

50:39

There are, you know, I don’t.

50:41

I spoke with some health systems CEOs yesterday and learned that, say, you know, one major health system in New Jersey is seizing this opportunity to really think about re-investment in the community.

50:58

So to the extent we lacked PPE, we had pretty much every hospital that was hard hit by Kogod 19, lacks the personal protective equipment, masks, gowns, etcetera. Why? And, and we were entirely reliant on the supply chain. That was largely outside of the United States Manufacturing. That was outside of the United States in a global pandemic. What did we learn? Everybody will be wanting the same thing. So to the extent you’re able to make your own and have them readily available, you are better. You are better equipped to handle an infectious disease outbreak.

51:33

While this hospital system is thinking about investing in a community where they basically manufacturer PPE by, in that community, members of that community will be employed so you’re you’re addressing our, our supply of PPE, something that is critical. You are addressing chronic unemployment. You are addressing the ability to build wealth over time because these are intended to be very good and high paying jobs and skill building opportunities and you start to head out multiple birds. With that single stone, it requires members of the community on the economic side, on the educational side, and of course, the health system serving in this case as the anchor institution, coming together to really think about what I talked about earlier, this is not a one-year plan, we’re thinking at 5, 10, 15, 20 years ahead. What I think we need to see, again, is leadership.

52:34

Where we’re not continuously, are continually talking and describing the problem, but to really put in place funding and investments that get us to a place where we don’t want the same group of people to be at the mercy of the next pandemic or the next, you know, public health disaster. I will also say the literature on how public health disasters affect African American communities. Or no poor communities is rather thin, surprisingly thin. We usually come out and have a lot of New York Times excellent reporting, but the etiology of this phenomenon. when those disasters hit everybody, and then you see the sort of the breakdowns that occur at the societal level. And then at the public health level is not as robust as it should be, because we see a plant we saw play out in Katrina, we’ve seen it play out in a number of natural disasters. So we definitely need to invest a little bit more there, so that what to do and what actionable things to invest and are much clearer.

53:42

Great. Thank you so much. And I think you touched a little bit on my next question, which is, what are some or our next question from, from the audience? What are some specific legislative policies that are needed to really tackle the racial health inequities in black and brown communities? Rachel? do you want to take this first, and then wisdom, and then the design?

54:03

Sure, I will start.

54:05

Thanks, I think that’s an important question, and, No, I would start by saying, you know, certainly, universal health care, you know, starting with Medicaid and Medicare expansion, you know, we need to think about housing. And making sure that everyone has access to housing. And, you know, we have to think about, are the hospital closures that we’re seeing across across the country, particularly in rural communities, and also, in less rural communities, black communities, where African, predominantly African American communities, Where we’re seeing hospitals closing at alarming rates, which, you know, certainly is a significant access issue. And, so, I think, I would start, start with those those three big picture things, that are policy changes, that, I think, needs to happen.

55:02

You know, certainly more on the local community level, we have to be thinking, again, as I mentioned earlier, about how we offer paid sick leave and, how we offer tiled care and things like that. So, a lot of the social issues and the social determinants that are going to have a significant impact, on how people are able to weather the storm, both right now, but also, how it’s going to set us up to be able to, to thrive in the long term, as well.

55:35

Thank you, Wisdom. Yeah, so I’ll just lift up, I mean, so many, really exceptional examples have already been given. Let me just lift up two points. one is around mental health parity. And while we have some legislation in place to, to address some of the gaps in services, availability, around behavioral and mental health service treatment, we still have yet to bridge that gap for populations who are at greatest risk for disparities. And so I think we have to look really hard at our policies, around the provision of mental health services, and create better access points for those services to be delivered to those who are in greatest need. With a re imagine, if you will. How we’re going to be deploying those services given that we’re moving more into a telehealth.

56:25

A telephonic services provision environment that may be with us for the long haul, so there are many policies that have to be considered are some circumstances around the provision of the services that have to be considered. For example, many black and brown Sam, individuals live in inter-generational households, where there’s limited access to privacy, right for a for a telehealth or a telephonic visit. How are we protecting the privacy of those those individuals and creating care that is delivered in a comforting set? And how do we address the broadband access Wi-Fi ability, availability gap? I mean, we’ve talked about smart phones, but people also need broadband and Wi-Fi to really avail themselves of those kinds of services.

57:09

And then, finally, I think it’s really challenging for us to move towards health equity, when many, we still have an employer sponsored health insurance model for this, for this Nation, and that, to me, runs counter against what we know intuitively about underemployment and unemployment rates in brown and black communities. That means that many people will be edged out of even with the Affordable Care Act, provisions will be edged out of affordable health insurance. And so, we need health insurance coverage for all, regardless of employment status, and we have to be thinking about, as we … institutions in the aftermath of covert 19, what kind of trends as a transition assistance program, or model. Are we setting up? for folks said that when they re-enter communities? one, that we know that they’re healthy? And that they have a healthy place to physically distance or to be shelter, as we approach the second search load.

58:03

So those are, there’s some of the policy opportunities and levers I think we have at our disposal and issues that I think we have. Great, thank you. And then, NaN, I agree with everyone. I think we can move too far forward without an expansion and health insurance coverage, whether it’s through Medicaid or some of the other policy, discussion points around Medicare. But I think, you know, we need to think long and hard about that, because we’re now facing an environment where lots of people have lost their employer sponsored insurance.

58:43

So that’s, that’s critical. I do think we’re thinking about target training and care for target populations to address this critical issue of implicit bias and structural discrimination, if you will, within the healthcare system, and of course data collection, as I mentioned earlier, and tie those two as to payments, make them, and the require them as a condition for payment if you are to receive federal dollars. The last thing I’ll say is thinking creatively creatively around appropriations which we can’t solve social determinants of health within health alone, but we do have to think about perhaps investment. Federal investment, and funding of some of these initiatives through creative means. So maybe it’s labor rates as the committee of jurisdiction coming together with the folks at T Hot or Transportation.

59:39

And Housing and Urban Development, to think about a community outcomes focused investment plan, so that we’re not thinking consistently and silos, and are surprised when we don’t get the results we want.

59:53

Absolutely. Well, thank you so much. And, again, we have a moment now where there’s a collective understanding of the systemic origins of these health inequities, and some policy solutions that are experts have highlighted around enhanced data, targeting resources to communities in need. Whether it’s rural communities, African American communities, urban communities, where hospitals are closing, Expanding coverage, insurance coverage, mental health parity, anti racism training, tied to payment, protecting essential workers. And really thinking broadly about investing and strengthening. And social supports, thinking outside of silos. Thank you to our three extraordinary panelists, beta wisdom, wisdom, a day that we’re in a moment now, where I think we have the opportunity to make this change, and I really appreciate the conversation. And thank you to the audience for all your amazing questions.