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As stated by the American Public Health Association, declarations are an important first step to advancing racial equity and justice. In 2018, Milwaukee County, Wisconsin, became the first community to declare racism a public health crisis. Many communities have since done so, with the pace of adoption accelerating after the police killing of George Floyd and the protests for justice that followed, with nearly 200 declarations passing since May 2020. As of August 2021, 209 declarations of racism as a public health crisis have passed in 37 states. While resolutions and formal statements themselves are not necessarily legally enforceable, they create the opportunity for strategic action to eliminate racist policies and practices and adopt those that advance racial equity. This panel outlines how we can create a framework to drive changes to health policies, laws and resource allocation.
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LifestyleTranscript
01:00Please welcome our moderator, Cliff Barnes, partner at Epstein, Becker, and Green.
01:09Please welcome panelists, Micheline Davis, Esquire, President and CEO, National Medical Fellowships.
01:18Panelist, Dr. Cedric Bright, Beistein, for Medical Education and Admissions, Professor of Internal Medicine, the Brody School of Medicine at East Carolina University.
01:30Please welcome Dr. Aletha Maybank, Chief Health Equity Officer and Senior Vice President, American Medical Association.
02:23Our time in the United States has been 404 years, and during that period, 86% of the time has been slavery and apartheid.
02:36And that's the first two columns that you see on that slide.
02:4013% of the time, about 52 years, has been spent post-apartheid, moving towards equity.
02:51There is affirmative actions that have been taken to mitigate some of the historic causes.
03:01And that's lasted up to, as a practical matter, 2017, right after President Obama left office.
03:09And we've seen a rise in pro-white supremacy as well as a denial of racism.
03:21And up till today, as of, what, June 29th, when we got the opinion in the Students for Fair Admissions decision by the Supreme Court,
03:32which held that the Harvard Admissions Program violated the Constitution, the Equal Protection Clause.
03:41So that's some of the things that have occurred and where we are.
03:46The question is, how is that impacting health?
03:49And what we want to do is ask each of the panelists to make an initial comment about how our history and our current state impacts health.
04:01Thank you so much, Clifford.
04:04I think it's incredibly important that we are looking at the current state of black health through a lens that is actually filled with the kaleidoscope of the political determinants of health.
04:16So lots of times you will hear reference to the social determinants, and that is how you live, where you live.
04:24There's a wonderful quote by Dr. Iton that literally indicates that your zip code has a greater determinant on your lifespan than your genetic code.
04:33Well, that is because of the environment that we live in, that is because of the way in which many of us come from environments which are either food swamps or food deserts, and none of this is happenstance.
04:44The slide before you right now shows you the impact of American slavery, the time of legalized segregation, and right now also the Civil Rights Act.
04:55But you and I both know that we are still in a period of civil rights, that health care is undoubtedly the civil rights issue of our time.
05:02And what we have seen, what we are seeing, is that when you live in one of the most industrialized countries in the world,
05:10that for black and brown communities to still have issues in order to access clean, potable water, like we do in Flint, Michigan, and Jackson, Mississippi,
05:20and quite frankly, any urban environment where there is lead pipes bringing us our water, we know that we are still in the midst of a crisis.
05:28All of the zoning laws that permitted that are evidence of the systems and the policies, the rules, the regulations, and the laws that create for us environments
05:41where it is difficult for us to actually achieve sound health.
05:45So it's important that we're talking about this today on this stage, at this forum, because of the intersection between health and wealth,
05:56which I know my fellow panelists are going to talk to you about too, and the way in which, quite frankly,
06:01the same things that literally keep the racial wealth gap in place are the same things that are keeping our health outcomes
06:09for black Americans the worst in the nation.
06:13So, we're going to talk a little bit about some of these structured inequities.
06:21Actually, I think I'm going to pass this to you, Dr. May Bay.
06:27Good morning, everyone.
06:29Really fantastic to be on this panel, and thank you, Micheline and NMF, for bringing us here today.
06:34And on the previous slide, actually, you saw the graphic on the left that was well explained already,
06:40but on the right-hand side, it's this definition of racism and what we have learned and what the evidence shows us over and over again
06:47and what we know inherently that the challenges that we do have with health system are really rooted in racism.
06:54It is racism.
06:55You can tell, you know, I'm a rebel rouser sometimes, most of the times.
07:00You can tell, you know, your physician or your doctors or your health care professionals,
07:03we understand, and these folks up here have told you that the root of some of the issues that we're having is racism.
07:10And so, I always like to go through the definition of racism because I think it really helps just point out that confusion of oftentimes people have,
07:18well, is this racist or is it racist?
07:21And the reality is that racism is a system of power, right?
07:24It's power, but also oppresses people.
07:27It creates opportunities or structures opportunities that were already mentioned.
07:31It assigns value to you based on your skin color and typically unfairly disadvantages people of color.
07:40So, black people, we are disadvantaged by the system of racism and other people of color as well.
07:46And then unfairly advantages whites, so it benefits whites.
07:49And that, to me, is the important part that often doesn't even get discussed.
07:52We see lots of data on the disadvantages, but not on the benefits to whites in society.
07:58And as Kamara Jones will say, that completely saps the energy from our American society, the system of racism.
08:06Yeah, you're absolutely right.
08:08But the question becomes, how do we effectuate health?
08:12And what is the impact of what you just saw in front of you?
08:16And you can see these data that we have in front of us that talk about our longevity.
08:20And particularly, when we looked at what did COVID do to our health in the United States,
08:27and we actually saw a decline of almost three years of life expectancy in the black community just because of COVID.
08:35But there are other chronic conditions that we have that are related to our 400 years of experience here,
08:42our post-traumatic slave syndrome, as Dr. DeGruy would say, that impact us in the aspect of what we call epigenetics.
08:51And epigenetics is the changes that happens to our genetic code because of the inflammation in our bodies that are what we call an allostatic load.
09:02And allostatic load is just a medical term that means we have an amount of inflammation in our bodies that causes us to produce what is called more cortisone.
09:14And what that cortisol does is it increases the inflammation that leads to us having higher blood pressures.
09:22It leads to us being more prone for diabetes.
09:25It leads us to be more prone for any type of autoimmune diseases such as lupus and things of that nature.
09:31It leads us to be prone for things such as asthma.
09:34And so we need to understand that our health is a reflection of the environments that we live in, the water that we drink,
09:44the weathering that we have every time we ask the question, did that just happen to me because I'm black?
09:52Because how often, how much time do we spend thinking about when things happen to us,
09:58did that happen to me because I'm just Cedric?
10:01Or did that happen to me because I'm Cedric and I have a hue?
10:05You know, one of the things that's most interesting, I'm reading this book, it's called The Sum of Us.
10:10And what it talks about is the zero-sum game and how that is the framework for everything that is done in this country.
10:18And in that zero-sum game is this aspect that for somebody to win, somebody has to lose.
10:27And we have been chosen to be the losers.
10:32And so for everything that is done, stop and think about every piece of legislation that has been written in this country.
10:38Only the Voting Rights Act and the Civil Rights Act were things that have been positively written for us.
10:48Otherwise, everything else has been written to benefit others and not us.
10:55Let's talk a little bit.
10:58We've touched on this notion of racism and health care and the impact.
11:05We have the slide up right now that really talks about the ways in which racism impacts the social environment in which black people live.
11:19Can we talk a little bit about that?
11:20Right. So what we want to understand is how do we have a healthy society?
11:26And the way that we have healthy people in a society is because we have things such as prevention.
11:32We practice prevention.
11:33You know that there are two models of seeking health care.
11:37One is I proactively go to the doctor because I want to keep my health versus I am now sick and I can't do what I normally do.
11:47So now I am going to seek help to get back to health.
11:52Okay.
11:52And so most of many people who are working class have the second model that they continue to do what they do until they can't do it and then they seek health.
12:02That's not the way that you have healthy communities.
12:04Healthy communities start by through prevention, having mental health services, having cultural and linguistic appropriate competence services.
12:13That means having people that look like you treat you and more importantly, having people that don't look like you at least be culturally humble enough to be able to ask you the questions to better understand who you are such that they're able to treat you appropriately and individually according to what your needs are.
12:34If you don't have secure income, if you don't have secure housing, how healthy can you be?
12:43If you have neighborhoods that don't have a collective safety and efficacy, where we don't have green spaces, how healthy can we be?
12:54So we first have to look at this in reverse and I'm going to pass this on to Dr. Maybank to talk about the other way.
13:00Great. So the context of what's already been talked about already is that we all heard there are many things that impact our health.
13:09And that's often the challenge within this country is that our narrative and understanding of health is often a little bit off.
13:17It's really focused a lot of times on like the health care system, the hospitals, the doctors.
13:21That's what's on the right side of this graph, right?
13:25This whole context around the disease that you have, what are your risk behaviors and how is the hospital and doctor going to help you take care of it?
13:32But the reality is, is that that is not sufficient enough.
13:35Only a small part of our health actually is determined by what happens in the hospitals and doctor's offices.
13:41It's important. So I don't take that away.
13:43We need insurance. We need health insurance.
13:45We need the ability to be able to treat when we have illness and disease and also help us to prevent for immunizations and vaccines of that nature.
13:53However, that is not sufficient enough.
13:55And so when you move to the left side, you will see it says living conditions.
13:59So this was already elevated. So I'm not going to go too much in depth.
14:03Dictates how you're going to really react in terms of your bodies, the environments, the choices that you have to make whether they're healthy or unhealthy for yourselves and for your communities and your families.
14:14And then when you go further to the left, that talks about the institutions, the laws and the policies that are available or that are created that actually set up those living conditions.
14:24So tax policy, transportation policy, education policy, where you live, wealth, like all these policies that exist really dictate the living conditions.
14:34And then the furthest to the left, right, this is a part that rarely gets talked about, is that the lenses of like how these policies get created, through which they get created, oftentimes are through these systems of power and oppression.
14:49And I already mentioned the lens of racism.
14:51And there's the lens of white supremacy.
14:53And when I say that, I mean in the context of the false notion of the hierarchy of human value based on skin color with white being on top.
15:01That's the lenses through which oftentimes our laws and policies have been created historically and even in the present time.
15:07And it impacts the whole way down to the point of health.
15:10And there's a reason why we're going to, we're picking out all of these and really educating at this point in time,
15:15because there's different strategies that you use in order to help do something.
15:20Like people are always like, how do we do something?
15:22What do we do, you know, with this, all this, you know, that racism is tough, right?
15:28It's huge.
15:28It's big.
15:29It's heavy.
15:30What do we do in our immediate families?
15:32What do we do in our communities?
15:33What do we do within the context of this country?
15:37Yeah.
15:37With that question, and that's the next question, what do we do?
15:40How do we deal with it as a patient?
15:43How do we deal with it as an individual with influence in the healthcare sphere?
15:49Thank you, Cliff.
15:50I want to make certain that you understand that what Dr. Maybank just laid out for you is actually leading up to the fact that oftentimes when people say,
16:01what is the most important thing that you can do for your health?
16:04I consistently tell them, vote.
16:07None of these systems or these structures have been created on their own.
16:11It has been the racism of the individuals who have set up the systems and the structures through which we must navigate.
16:17But we want to make certain that you don't leave here in any way as if this sounds like it is so big.
16:22It is so all-encompassing.
16:24It has actually been laid out before you for so long that it seems like there's nothing that you can do.
16:31There undoubtedly is.
16:32One is to absolutely practice that right to vote, right?
16:35We saw this week every single person who sat out on the last election that permitted the former president to get in a place to elect Supreme Court and appoint Supreme Court justices to be in place.
16:46We just saw them gut affirmative action.
16:49I am an affirmative action baby, and I'm very proud to have been.
16:52But what I'm telling you is the fact that that is going to have earth-shaking consequences on the number of black and brown physicians that there will be in this world.
17:03And so it's really important that we make certain that you understand that there are ways that you can be equipped.
17:09One, begin to educate yourself about your own health.
17:12Practice your self-care.
17:14And your best way of actively doing that is ensuring that you understand what the numbers are around health care disparities as they pertain to those individuals in your demographic.
17:26Two, make certain that you raise your voice when you go to see your practitioner.
17:30Three, y'all go get a black practitioner.
17:34Dr. Maybank, Dr. Bright are both NMF alumni, and I am so proud of them.
17:40But let me tell you this.
17:42We need to make certain that you are being cared for individuals who understand with cultural competence and cultural humility where you come from and respect your traditions, your culture, and everything else about it.
17:53And to that point, you know, that's why it's so important that we develop these programs that help create pathways for our young people to reach the point of becoming health professionals.
18:06There's nothing in health care that we have too many of.
18:09And any place in health care is a place where we all belong.
18:12And so we spend time working on developing more pathways for students to become successful, competitive as it relates to getting admissions into different schools, whether it's nursing, whether it's medicine, whether it's physical therapy.
18:26It's all important.
18:28Why is it so important?
18:29Because if we have homogeneous schools and we go out and see a heterogeneous population, they can't understand who we are.
18:39We have to have heterogeneous schools such that people can develop that cultural competency by studying with people that don't look like them such that maybe some of that wears off on them.
18:51And when they see somebody that looks like that classmate, they can go, hey, my classmate thought about this and thought about it this way.
18:59Maybe they do.
19:00Let me ask a question to see if that's the case.
19:05And there's that part, right, in how we build.
19:08But I also think to the point of the power that's already inherently in us and has already been in us, there's an opportunity for us to build with us and for us.
19:17We have had to do that in the past.
19:19When we start, when we're excluded from certain spaces, what do we do?
19:22We create historically black colleges.
19:24We create schools.
19:25We do all kinds of things, med schools, all of that, in order to ensure that we are able to educate ourselves and our children.
19:31And that continues and it doesn't fall to the waistline because it's exhausting, right?
19:36Many of us who are doing this work inside institutions, wherever you are, it's exhausting to have to fight, to convince people to care about us, to even give, just look at our humanity.
19:46And so what do we do and where else can we put our energy?
19:49And I think at this time more than ever, we need to operate collectively.
19:53And I believe in self-care, but I also like the context of collective care.
19:58I heard Melissa Harris-Perry one time call it squad care.
20:00That's how we move, right?
20:02You all are here mostly with your friends and family.
20:04We love to be in community with one another.
20:06So let's hold each other accountable and let's help support each other in our health, but also in this important critical time where we need to fight for justice way more collectively than we ever had in my generation, at least.
20:19So in addition to voting, we need to find opportunities of other organizations or other justice movements or other people that are also fighting to get people not only, you know, to tell them to vote, but to help people get them to vote or to find out what other people are fighting for within their neighborhoods and the spaces that need to be created within neighborhoods so that you can be healthy.
20:40I think the biggest importance is how much we are going to rely on each other.
20:44And so this last slide actually here is called the Black Progress Index by the Brookings Institute and the NAACP.
20:50And Dr. Andre Perry, who we're all good friends with, you know, shared this.
20:54And I think it's a really important context.
20:56A lot of the data that showed, you know, shows the deficits, what we don't have as black people, the gaps, you know, more hypertension, more cancer, all those things that we need to know.
21:06But to me, we don't build from a context of deficit.
21:09We build from a context of strength and knowing what our strengths are.
21:13And so what they did with this to kind of break this down is this is looking at life expectancy again, how long we can live.
21:19And so they looked at cities across black cities, cities with majority black people across the country to see the cities that actually lived longer.
21:27And they found that a lot of some of these predominantly black cities, people lived longer and that there were conditions that were happening there.
21:34So instead of looking what was not there, they looked at the strengths.
21:38And so in this slide, which I can't see because my glasses, my glasses are on.
21:44That would be self-care.
21:48Wow, he got to cut me out.
21:50So there's income, home ownership, things that actually are pretty sensible, we have a sense of.
21:58If we own a home, you're more likely to have, you know, the opportunity to build wealth.
22:02You're actually more likely to live longer if you're able to do that and other opportunities within your neighborhood.
22:08So the whole point is we need to build on our strengths and our assets.
22:12Thank you for this conversation today.
22:17We hope you enjoyed it.
22:19Key is racism does not exist in a vacuum.
22:23Policies, practices that were discussed today are what manifested and perpetuated.
22:29And we talked about some of the ways that each of us, including voting and taking care of ourselves,
22:35understanding how we do that as an important component to fighting racism as a public health crisis.
22:44And we want to thank you for your participation and attendance at this session today.
22:53Thank you so much.
22:54Last point, last point.
22:56We got to play the long game.
22:58We spent too much time playing a short game.
23:01We need to play a long game.
23:05Keep your feet.
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