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00:00Hello everyone, so happy to see everyone here.
00:13My name is Devondra Brown, I am the health equity director for the Louisiana Department
00:19of Health.
00:20We are so excited to have you all here today.
00:23We will be discussing achieving health equity through community engagement.
00:28And all of us here are health equity experts.
00:31I have here next to me Dr. Tori Harris and Dr. Chantelle Hebert-McGee.
00:37Welcome to Essence Health Hub.
00:41How are you doing ladies?
00:44Good, how are you?
00:47Doing well, doing well.
00:49We are going to jump right in.
00:51I know you all want to know who these ladies are and what they do.
00:54So if both of you can tell me, what do you do and how is that related to health equity?
01:00Hi, so I'm Dr. Tori Harris, as Devondra mentioned.
01:03I am the health and equity strategist at the New Orleans Health Department.
01:08I'm also an adjunct faculty member of the College of Public Health at Xavier University,
01:14XU, and also do consulting with a myriad of community health organizations.
01:21And my job is specifically around addressing racial equity in the New Orleans community
01:27and how do we undo racism using an equity lens.
01:30And so I spend a lot of time working with communities one-on-one to lift up their voices
01:37and translate that to our mayor and our city council.
01:47Good afternoon, everyone.
01:48I'm Chantelle Hebert-McGee.
01:50I am the Regional Medical Director for Southeast Louisiana, responsible for the health and well-being
01:55of 1.2 million people in this area.
01:59I've held various hats.
02:01I come from a background in tech and research as a consultant.
02:05Additionally, I am the founder of a non-profit that focuses on addressing health equity.
02:11And I think that sort of covers it in a nutshell.
02:18It does.
02:19It does.
02:20Thank you both, ladies.
02:21So we're going to jump right on in.
02:22I know all of us here, we're health equity professionals.
02:26All of you, you're impacted by health equity issues.
02:29But a lot of people don't even know exactly what health equity is.
02:34Can you please tell us a little bit about what health equity is and why it's important
02:38to the health of black America?
02:40So health equity, from my perspective, is helping everyone reach their full potential, making
02:48sure that everyone actually self-actualize and are able to achieve their dreams and aspirations
02:55and ensuring that we're not only dealing with their physical issues, but also their health.
03:00My good friend, Dr. Greggs, who's in the audience, always says that when we talk about reaching
03:06full potential, we think of kids who are in kindergarten.
03:08And when you ask, what does a four-year-old want to be, they all say they want to be five.
03:14Every single one of us want to be able to get to the next level, and we should ensure that within our health systems.
03:21Just to add on to that, not much to add, but statistically or by definition, it means that there is a statistical
03:31difference between a group of people where the burden of disease is on one of those groups.
03:38And it can be by race, ethnicity, gender, sexual orientation, or religion.
03:44And so our goal in equity is to optimize health, to assure that all aspects of life, including housing, where you live,
03:56or what we say in public health, where you live, learn, work, and play, is of quality for you to be your full self,
04:05mentally, physically, emotionally, economically.
04:09And so working on equity means not only just your individual health and your individual choices,
04:15but what are the policies that are influencing your health, where you live, learn, work, and play?
04:25There we go.
04:26That is so important.
04:27I think another thing we need to do is give you an example of how inequities kind of play out even in your day-to-day life.
04:35So do we have an example of an inequity?
04:38I'm going to let y'all think.
04:39I know one that I actually experienced myself is I went to the physician,
04:43and I know what I should be getting as a professional, right?
04:46I know what kind of services I should get.
04:48Well, I went to the gynecologist, and that gynecologist, I told him that I was having some pain during just intercourse,
04:56and he dismissed it totally.
04:58I was like, it's okay.
04:59It's normal.
04:59It happens.
05:00It's probably during your time of the month.
05:02And went on.
05:03Not only was that a male physician, that was a white male physician.
05:06And that is how racial inequities kind of help.
05:10That's what helps and hurts our disparities in America, right?
05:14I went to a female black physician immediately after, and she heard me, and she treated the issue.
05:21That is how we see it show up.
05:23Are there other examples of how inequities and how, like, the health care system almost, like, gives us a burden of those inequities from time to time?
05:31Well, thank you for sharing that personal story.
05:35My personal story is growing up in New Orleans and my family being from the Seventh Ward and having a long history there, generations,
05:44and their livelihoods kind of being demolished by the Claiborne Corridor.
05:49And the Claiborne Corridor is the I-10 overpass over Claiborne Avenue.
05:54It didn't become the Claiborne Corridor until the city attempted to get some grant funding, and then they named it that.
06:01But the building of that interstate removed economic development of over 100 black businesses on that street.
06:09It also led to flooding that we see today.
06:12Every time it rains, it floods.
06:14And it also meant the removal of Circle, I mean, Circle Food Store, where we walked to to get our, you know, four-for-one bell peppers.
06:24And so what you see now in that neighborhood is that there's a life expectancy of anywhere between 55 and 65 years old,
06:32where in Lakeview, a predominantly white neighborhood or area, the average life expectancy is 85 years old.
06:40I think it's improved only slightly in the last five years.
06:44But we can see direct linkage between the policy that led to the erection of that bridge, which the community did fight not to have.
06:55It was initially supposed to go around the French Quarter, I researched.
06:59But it ended up in the middle of the black community.
07:03So today, we suffer in that community.
07:06I say we because I'm a part of it, chronic disease, HIV, mental health stress, as well as the loss of financial development.
07:16And so I think that's my personal inequity story that I'm really fighting hard to overcome and reclaim that neighborhood.
07:26I would say for me, when I think of health inequity, I truly think about the psychological trauma that has been caused to people of color, particularly black women.
07:41My grandfather, his mother died during childbirth.
07:46And so he was raised by his grandmother.
07:48And he said that she died because she wouldn't let doctors cut on her.
07:55She said, they ain't going to let them kill me.
07:57They ain't going to cut me.
07:59And so she actually had cancer.
08:02And he said that she died in the bed, shriveled up, holding a bottle of alcohol, trying to ease her pain.
08:07So when I became a physician, I was trying to find logic.
08:11Why would she refuse to let a doctor cut on her?
08:15And so I thought that maybe because in the early 1930s, antibiotics were just coming around.
08:20They weren't widely available.
08:22And so after having surgery, it can lead to post-surgical infection.
08:26But then also, we know when they were trying to remove tumors, sometime they would touch other areas and would lead to tumor seeding and spreading all over the body.
08:35But even now, black women are afraid of being cut.
08:40We know the depth that happens when we're talking about women who are having postpartum hemorrhage, who are dying.
08:49We know about the story of Dr. Suzanne Moore, who was in the hospital last year with COVID-19.
08:56And she was asking for pain medication.
08:58She was asking to be treated properly.
09:00And there was implicit bias.
09:02Additionally, we know when it comes to blacks in general, we are more likely to have post-surgical complications, to have decreased follow-up visits, and to die after surgery.
09:16Additionally, our children are less likely to receive strong pain medication after fracturing a leg or an arm compared to kids who are white.
09:27So we are continually being cut, slashed, wounded, violated on a daily basis.
09:34So how do you say, I want to go and see a physician that does not respect me?
09:40And that's when I think of health equity.
09:42That is who I see.
09:43That's who I embody.
09:44I think about my ancestors, and I think about every other sister that's in this room.
09:49That is so powerful.
09:50Thank you so much.
09:51I know Dr. Courtney Phillips spoke earlier, right, about the work that we're doing with Louisiana Department of Health of trying to get additional clinicians of color.
10:01So we have a clinicians of color program that is trying to get not only more physicians that are representative of our black and brown community, but people throughout the health care network, right?
10:12So we need nurse practitioners, we need nurses, we need PTs, we need everyone that is interested in medical and any type of health care to get into the system, become a professional, have support throughout that.
10:27Because that's very important, right, is that we need that support, because that's what we're talking about, about the economic development, right?
10:33If you go into school, it's not only that you get into school, well, how are you going to pay for it all four years?
10:39How are you going to pay for it if you're going to go to get, you know, your MD?
10:43How is that going to happen?
10:44Who's going to help you, right, to get through those classes?
10:48And so it is more of a systemic issue, right?
10:51But you're also talking about the clinicians, and that's how we got on the clinicians of color.
10:55So tell me, as a clinician of color, what do you see clinicians doing to help health equity from where they are, from their platform, and how are they engaging the community in that health equity work?
11:09I think there has been a lot of focus on cultural competency.
11:13And while I do think that that is necessary, I think it truly requires cultural humility.
11:20You have to be humble enough to listen to your patient.
11:23There are so many patients who do not have the medical jargon to be able to articulate exactly what is going on with them, but they know there's something that's wrong.
11:33And for so long, we are dismissive of people that don't sound like us, that don't share the same vernacular.
11:40We know in the South how we sound.
11:41We know people that have that nice Creole and Cajun twang, and they sit there in that chair, and they try to tell you what's going on with them, but you look at them.
11:51I remember my grandmother would go to the hospital, and she would say, I got to put on my good clothes.
11:57Where my teeth at? Give me my teeth.
11:59And I would have to go and get that glass jar with that fix-a-dent or whatever was in it, and then she'll take it out and put them teeth in, and she'll smile and move them out around until she get it in place.
12:10And she'd say, do I look nice?
12:12Because people realize that physicians are human, and they judge people just like everyone else.
12:18So if you come into the doctor's office, and you're homeless, and you're smelling a little pungent, they're trying to get you off that room as quickly as possible.
12:26And so you have to not only be competent and be aware of what their condition is, but be humble enough to say, hey, this could be me.
12:35This could be someone that I love.
12:37How do I treat them appropriately?
12:40And as you were speaking to, when it comes to clinicians of color, we need more.
12:44We need to see people that are reflective of ourselves, people that represent us.
12:48So therefore, you feel that level of comfort to be able to discuss some of the personal matters that you may not necessarily want to come in and discuss.
12:56Oftentimes, we just treat conditions rather than actually treating the entire person.
13:01That's exactly right, Dr. Hebert-McGee.
13:06Thank you for that.
13:07So, Dr. Tori Harris, tell us then from the health agency perspective, right, how can public and private health agencies work to inspire innovation that creates opportunity for that community engagement to fold them into this health care?
13:25Because what Dr. Hebert-McGee talked about was the physician side, the clinical side.
13:30We want you to talk about that public health side, the private and public health sector.
13:34What can they do to really spark innovation and fold in the community when it comes down to health equity?
13:39So, in addition to the policy that we work on, I think you hear, we spoke about this earlier, this term equity going around, diversity, equity, inclusion.
13:53And the reality is, you do need someone in your organization who's focused on that.
13:59But the statistics show that the people who are assigned to those positions in hospitals and organizations usually quit within two to three years because they don't have the support to do the work.
14:11And it is very taxing, even from my own personal experiences, because you know what you need to do, but you need the support to do it.
14:20And sometimes, as a black woman working in an institution, you're also experiencing racism or inequities on your job.
14:30And so, I've had to learn how to balance my mental health and, you know, for lack of a better term, pop off, you know, when I feel the tensions have arisen.
14:41But one of the things I've learned that we all need to put into practice is something that Ms. Osborne was doing right before we started was meditation.
14:52And so, I do facilitate healing circles in my office.
14:55I facilitate healing circles in the community where we do self-reflection about our own biases, about our own experiences with racism, about how we show up and present in the world, and attempt to do cultural humility work.
15:15Because I think we can't advocate for racial equity if we don't understand what our own beliefs are.
15:22And I try to, try, encourage relationship building within our department and in the community.
15:31I think there's a tendency to think that equity is outward facing and it's only a community problem.
15:38And I don't have the issue because I'm the practitioner.
15:41And so, we have to do an inside-outside approach, which requires taking time because one of the tenets of white supremacy is to rush to make a policy.
15:53And so, you have to do business in a different way, meaning slow down, build relationship, take time to talk, take time to understand one another's identity.
16:06Then we can get to the strategy, because if we build the strategy before we do the healing, we're going to run into the same wall, which we've seen.
16:16We've been doing equity work for nearly 50 years, but the statistics haven't changed.
16:21So, it's going to take an inside-outside approach.
16:25It's not one person in the department who is the equity strategist.
16:29It has to be a team.
16:30It has to be sustainable over the long term.
16:35And quite frankly, I had to have a discussion with my director and I said, if I come to you and I say something you don't like, I need to assure that you're not going to fire me because it threatens your privilege or your biases.
16:50It challenges her.
16:52It challenges her.
16:52So, I had to challenge her.
16:53But I had to do my own self-reflection before I did that because I knew I was going to dysregulate if we became in a tense conversation about something.
17:05So, she has agreed to that, or I should just say the person has agreed to that.
17:10But that's a practice I try to employ with diversity, equity, and inclusion.
17:15Yeah, definitely.
17:17Great answers.
17:18Great answers.
17:18Wait, wait, wait.
17:19I have a sound bite on what she's saying.
17:21Thank you so much.
17:51When it comes to community engagement, members of the community need to have a voice.
17:57They need to be able to consent, to inform, and to empower healthcare practices.
18:04And we don't include them at the table.
18:07They're not part of the discussion.
18:09So, oftentimes, healthcare systems, hospitals, make unilateral decisions that impact communities without making any effort to engage them.
18:20I mean, sometimes we're going to go to the hospital because it's too far away.
18:24Yes.
18:25I mean, the price of the gas.
18:26I'm even like, Lord, do I want to draw out today?
18:29Maybe I'll get this Fitbit and get these steps in.
18:32I mean, but if it wasn't sweltering outside, I probably would walk.
18:35Right.
18:35But for those who don't have a choice, they can't.
18:38Because it's not as easy to get places in 98-degree weather on the bus.
18:43Right.
18:44And the second point that Dr. Harris made regarding policy is not just creating policy.
18:50It's putting policy into practice.
18:52Oftentimes, we take and put wallpaper on the wall when we need to do a whole renovation.
18:59We have foundations that are cracked.
19:01We have homes that are crumbling.
19:02But we want to take and put a new doorknob.
19:04We want to take and put a little upholstery up when we need to take and change the entire foundation.
19:10So, we don't only need new policies.
19:12We need comprehensive policies that can be sustainable.
19:15I'm done.
19:16I love it.
19:17I love it.
19:17No, I love getting on that policy high hearts.
19:20One of the things I also want you to walk away with about that policy thing is know that
19:25almost everything that happens in Congress, in your state politics, local politics, it
19:31is televised, y'all.
19:33Like, there is a need for us as community members to be a part of that political process because
19:39that's when the decisions are made.
19:41The decisions are made right there at the state capitol in every state.
19:45It doesn't matter just here in Louisiana.
19:47Every single state.
19:48You go to that state capitol, you can hear what your congressmen and women are doing,
19:53what your representatives are doing, and you can lobby and say what you want done for
19:59yourself.
20:00That is where real health equity, your action has to hit the pavement.
20:05You have to be there when the decisions are being made.
20:09And I know I just leave right on into a call to action because we want to make sure that
20:13they leave motivated and educated to get here and get their health right and to be a part
20:19of that process.
20:19Because that's all this is about is a community engagement.
20:22Here's your community.
20:24You know, this is your community.
20:25And everybody's a part of that.
20:27Male, female, trans, everybody in the spectrum.
20:31Black, brown, Mexican, blexican.
20:33It doesn't matter.
20:34We're all a part of this.
20:36And we have to advocate for our own health equity.
20:39So any other call to actions you want from this group?
20:43Yeah.
20:44If anything has taught us that we need to get out and vote, it's a lot of the Supreme Court
20:49and policy decisions that have been made in the last few weeks.
20:54But I was listening to Simone Sanders and she's a news correspondent, was formerly in the White
21:00House.
21:01And she was saying, we have to do more than just tell people to vote because people are
21:06apathetic to voting.
21:08You know, they're thinking that it just doesn't matter.
21:10And I would say it has to start, it could even start at the neighborhood level.
21:15And New Orleans is very neighborhood based.
21:19We have like 67 or 60 plus neighborhoods.
21:22And I actually go to neighborhood association meetings.
21:27I sit on the board of community health worker organizations.
21:32And so I think even though it requires much of my time after work or on the weekend, I make
21:38sure I'm present.
21:40And so I need you to make sure you're present because city council members go to those meetings
21:46to determine what the community wants, if they're going to build fast food or a strip
21:52club in your neighborhood, like they attempted to do in New Orleans East one time, the irrigated
21:58community.
21:59You know, if it were not for the New Orleans East community or the neighborhood association,
22:05that's what we would have, which also contributes to the tax base and our schools.
22:13So recognizing that everything is connected.
22:17And then I also tell my students, just watch the news and look for how things connect to
22:23your life.
22:23It matters.
22:25It connects to you personally, even though it seems like it's a million miles away.
22:30And so I think, and then also just being an advocate for yourself, staying informed about
22:36your body, your family history, and not being afraid to speak up in these meetings and saying,
22:43you know, my community does not want that.
22:45My community needs, because there is policy in New Orleans City Council where there was
22:51funding that was supposed to be diverted to the Claiborne Corridor, and it went to Lakeview
22:56back in the 50s, which contributed to the plumbing infrastructure today and during Hurricane
23:03Katrina.
23:03So just making your voice known makes decision makers and politicians change their minds about
23:12policy for your community.
23:16Wow.
23:17You said a mouthful, particularly about local politics.
23:20If I can take it to the national level, I would leave people, everyone in this room, know
23:27your history.
23:28When you know your history, you can ensure that the errors are not repeated.
23:34When we think about Jim Crow, not only were blacks and other minorities not allowed to have
23:43certain jobs or relegated to certain jobs, they were also not allowed to unionize.
23:50And if you're able to unionize, you're able to demand health care insurance.
23:57To this day, there are jobs in our population, people who are not able to get health care access
24:08because they're uninsured or underinsured, because they're caregivers.
24:14The people that we say are essential workers, grocery store employees, were the first to get
24:20infected by COVID-19 and succumb.
24:25We say we value them, but we don't give them PTO days.
24:29They don't get personal time, they don't get sick days if they don't work, they don't actually have any income.
24:37So how can you expect for that person to go to a physician's office if they're making minimum wage
24:44or if they are a day laborer, knowing that if they don't go to work, they may not eat that evening?
24:50And the reason I say this is that if we know our history and we know that there are policies
24:57that have been put in place, I mean, for well over 100 years to guarantee that certain people
25:04stay at a certain status, we have to actually deconstruct the structural barriers that are in place.
25:13And so it's more than just voting, it's actually sharing that knowledge with others,
25:17giving people the knowledge to know that they can go and make changes.
25:24And those changes not only by, because everyone can't write policy.
25:28And we know what's going on with voting, but we know that you can be an advocate.
25:33And maybe you can motivate that grandchild who has yet to register to vote because they are apathetic.
25:40Maybe you can take someone to a voting station.
25:43But more important, go to your city council meetings.
25:45Start at the local level, and then we're able to make the national change that's necessary.
25:51I love it.
25:52I love it.
25:53Thank you so much.
25:54I hope all of you leave here today completely motivated and educated about your health.
25:59We have had a great time and we appreciate your time.
26:02Thank you so much.
26:03We'll see you next time.
26:04Bye.
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