00:00Good afternoon, and welcome to another episode of the Health Equity Cipher, where you get to come to
00:04my kitchen table and hear from some of my very brilliant friends. Today, we're going to talk to
00:09Daniel Dawes, the author of The Political Determinants of Health. So he's here to talk
00:16to us today. Let's get a little historical context of how we got here when it came to COVID-19 for
00:20Black folks, and what should we be thinking about? Give us some context. Well, Joya, thank you so
00:25much for allowing us to have this discussion on a crisis within a crisis, right, that too few
00:31policymakers and leaders have been raising. We know that COVID-19 does not discriminate, but our
00:37current economic and social policies do, and so with that frame, I want to talk about, you know, some
00:43challenges, and we know that context matters, especially historical context. So let's put it
00:49in context. We know that coronavirus, much like many past pandemics, negatively impacts and further
00:55disadvantages communities of color. Well, on the bright side, we also know that our history has
01:02shown some successes, right, in times of crises, in bringing about a sea change when it comes to
01:08crafting more equitable and effective and inclusive health policies. So let's talk about, you know,
01:15what we have learned, lessons from the past in terms of those successes, and the times in which past
01:21leaders, African-American leaders especially, were successful in realizing more inclusive policies.
01:27So, you know, in 1865, obviously, that was the first time in our nation's history that we had a
01:34pretty robust equity or equitable policy that was passed, the Freedmen's Bureau Act, right? And what
01:42went into it is nothing short of a miracle, quite frankly, when folks, opponents of that effort
01:48constantly tried to bring down the bill. But it did see the light of day. And there was, you know,
01:54opportunities in there to address the social determinants of health, ensuring that newly
01:58freed people would have access to education and employment opportunities, security, clothing and food,
02:06etc., among others. Unfortunately, during that debate, they weren't successful in getting the
02:12health care access provisions, right? But they did get the other social determinants of health
02:18issues addressed in that one. Then you look at history, again, let's proceed almost 100 years
02:24after that, right, during the Truman administration, and talk about the efforts after World War II,
02:30when President Truman was trying desperately to get a comprehensive health reform, a really inclusive
02:35health policy passed, and wasn't successful. But he did manage to get some piecemeal legislation
02:41that would, you know, prevent hospitals from discriminating, or at least incentivize them to do
02:47right by integration, right, with the Hill-Burton Act. And then there are other efforts that we saw
02:55stemming from the Vietnam War, and so forth, that allowed a sea change in policy. So those are some
03:02pretty exciting times. When we think about leadership, and you raise leadership, right? Leadership also matters.
03:11So historical context matters, and today's leadership matters. And I think what we're seeing today is a
03:16regression in terms of leadership. So when you look at governmental responsibility over pandemic
03:24responses and best practices, it used to be that it was local governments and state governments
03:30that were charged with, you know, dealing with the pandemic. And what they realized was that they just
03:36didn't have the bandwidth, they did not have the resources, the capabilities to do an effective
03:42job. It was a hodgepodge approach. And so they actually deferred those rights that they had to the
03:49federal government back in the 1880s, all the way to the 1920s, and implemented policies that would allow
03:56the federal government to take over. So they do that. But today, what do we see? The federal government has
04:02been deferring to state governments, and state governments deferring to local governments,
04:07folks are confused. And again, all of the issues that we saw from that time period in the 1880s to the
04:131920s, we now see happening again, right? And it's going to magnify the disparities, already existing
04:20disparities in our society. And so many of our Black sisters and brothers live in those states, right?
04:25That the states are not doing the COVID-19, making the choices to have social distances.
04:34And so they have, so we're looking for leadership from some of our Black leaders. And we think about
04:39the data that's existed, and the few places that we have data currently are places where Black people
04:44are in, have a position where they can ask for that data. So South Carolina, Virginia, Michigan.
04:50Yes.
04:50This lack of having data is also a political determinant of health. Can you talk a little bit about that?
04:54Absolutely. Perhaps arguably one of the biggest determinants, political determinants, right?
05:00Because we know that if we don't have the data, then there's no problem, right? According to our
05:05policymakers. So no data, no problem. And no problem, no funding. No funding, no national attention to this
05:12issue. And so data is critical. And I want to thank you and other Black leaders who have been, and other
05:18minority leaders who really have been pushing this agenda to collect and disaggregate data, right,
05:24by race and ethnicity. Because if we don't have that data, we can't track the disparities in our
05:30community. And we can't monitor to ensure that our community are getting the resources that they need
05:36to weather this storm of COVID-19.
05:39So what do you think we should do now? What should Black folks do now? Now that we know we have these
05:43political determinants of health, now that we understand that normally during pandemics, people
05:47don't focus on equities, and that we end them, we're not counting people of color and what's
05:51happening with us, and we look back and see worsening outcomes. What can we do today? Let's see that book.
05:56Let's see the political determinants of health. First we can do is buy the book. It's important.
06:00All right. So what's another thing that we can do? Well, we can buy the book, we can read it and
06:06learn, but we also need to engage. And I think for many of us, we don't tie the political determinants
06:13of health to how long we live, our life expectancy and the quality of life that we will have in this
06:19country. It is so critical that we connect those dots for everyone in our community, that they
06:24understand, you know, how these political determinants dictate whether you have access to
06:30the resources, especially life-saving resources that we know are so critical today, right?
06:36So that, I think, is one. I think, you know, we talked about the times in our history when we were
06:41successful in creating a sea change when it comes to crafting more effective policies. And I think
06:46today there is an opportunity again, as our governmental leaders at all levels are crafting policies,
06:52right? Especially when you hear about a possible fourth stimulus bill that the House of Representatives
06:59is working on looking at bolstering infrastructure. So I think it's important we understand how even
07:07something simple as infrastructure, how that can impact our health and well-being in this country,
07:12right? Because our history has shown us that, yeah, laws that we perceive as facially neutral or
07:18non-discriminatory on its face, they have actually led to some discriminatory impacts in our community.
07:24You can take that Highway Act, for instance, and the fact that from the 1950s to the 1970s,
07:30we saw African-American communities being cut in half because they were building highways, right?
07:36Again, that was a federal policy implemented at the local level. And so as we tackle these
07:42infrastructure issues, let's take an equity lens to ensure that as they're implemented, they don't
07:47negatively impact our communities. But also, let's be proactive. And let's make sure that we are
07:52offering our policies that will tackle the political and the social determinants of health.
07:56Yes, thank you so much, Daniel. You've been a wealth of knowledge. And I hope that we can continue
08:00to have these kitchen table conversations as we both stay physically distant, but socially connected.
08:06And I want all of you to be well and stay home. Thank you.
08:10Yes.
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