- Thank you for joining us.

I'm Starla Sampaco host of Crosscut Now on KCTS 9 and your host for Inside the Newsroom.

Today's edition of Inside the Newsroom will focus on Hidden Barriers, our new documentary series that explores the bias, prejudice, and discrimination pervading our healthcare systems today.

Now, today, we're talking with Jen Dev who was a video producer at Crosscut focusing on race and immigration and she's also the Director behind Hidden Barriers.

The series also introduces us to the people working to eliminate these barriers to healthcare, people like Edwin Lindo who is also joining us today.

Edwin is the Assistant Dean for Social and Health Justice at the University of Washington, School of Medicine.

Hey Jen, hey Edwin, it's so good to see you here today.

- Hey, thanks for having us.

- Good to see you Starla.

- Thank you, well, before we jump in, I just want to let everyone know if you've seen Hidden Barriers you might recognize a familiar voice, mine.

I recorded the narration for the series but all credit for the reporting should go to Jen who was the mastermind behind Hidden Barriers.

So Jen, I want to start with you and just ask, why did you pitch this series in the first place?

I know that you've covered inequities and also race in the past before but why did you decide to focus on healthcare specifically?

- Absolutely, so I am a relatively recent transplant to Seattle, I came here three years ago and one of the first things folks were telling me, oh, you're gonna love the city, it's so progressive, it's so woke.

But when I started doing my reporting what I was hearing from communities of color and various people in the community where that, these same issues, these same inequities, the systemic racism was still present everywhere.

It was just hidden below the surface so people who didn't experience it weren't really as aware of it, perhaps because it wasn't blatant acts of racism or discrimination, right?

It was hidden, it was below the surface.

So I pitched a series that basically aimed to dig down underneath and explain some of these barriers that kind of pervade our systems and our institutions.

And we started out with education last year and then we moved into healthcare because to me those are two of the most important barriers to equity in general in our society.

- Right, right so it's kind of amazing to watch the episodes that are out right now because you cover a wide range of topics related to the barriers in healthcare, you talk about being model minority myth that affects Asian Americans and also language services like interpretation and things like that.

So how do you decide which topics to pursue for a documentary series like this or really the options are endless?

- Yeah, the answer is simple.

You ask people that are smarter than yourself.

You talk to people like Edwin.

I spoke to dozens of folks, not just researchers and academics, but nurses and patients and people at all spectrums of the healthcare system.

And I asked them, if you were doing this series, what would you focus on?

What do you think are the things that people aren't talking about enough?

And so from that, I came up with a short list of the eight topics that we ended up choosing to delve into this so I really can't take credit for that.

That was people who are working in the field now but pointed me in the right direction.

- Thank you, Jen and Edwin I now wanna turn to you I think your role is really quite interesting because you are working at UDaB School of Medicine but you also have this background in law, I also read that you teach critical race theory.

So tell me, what does an Assistant Dean for Social and Health Justice do and why did the UDaB decide to bring you in?

- Yeah, and I appreciate that question.

It is a unique position, it's only the second of its kind in the country.

And the other person who holds a similar one is a good friend of mine.

And we said, maybe we can get more of these positions throughout the country with medical schools focusing on social justice, health justice and I wanna be clear that the reason that my title says health justice is because I believe that is the ultimate place we'd like to achieve that we'd like to get to.

You know, you talk about health disparities, we talk about comorbidities, we talk about why certain communities are overburdened with diseases and health issues.

And medicine likes to sit and research, it likes to research things that most of the community already knows but it needs the quote unquote proof to suggest that it really is happening.

But even when that research is accomplished and it's not the necessarily the researcher's fault but you have the funders like these major funding organizations that never actually in the grant say, well and if you find any inequities, we want you to solve them.

I think part of my role is how do we bring the knowings of the injustices across the board from law, policy and in the medical field and say we have to be so much more holistic, what we call a practice that we can understand the issue and we have to simultaneously figure out ways to solve it.

But that is only accomplished when we're doing that with community and that's a big part of my job being one of the co-founders of Estelita's Library or being in the community, being a community organizer and saying that is just as valuable as being able to write a research paper or do pharmaceutical trials.

And that important doesn't fall on deaf ears thankfully that the School of Medicine said under in our new office, we have the Office of Healthcare Equity led by Dr. Paula Houston that said, we need this.

We need a critical eye in how medicine has not just fallen short, but has throughout history proven to be detrimental to the health and the bodies of many marginalized communities.

- That's interesting, Edwin I'm interested in getting your reactions to Hidden Barriers in Jen's coverage because I think for some viewers learning about prejudice and healthcare might've been new information or eye opening information but really a lot of this has been happening as you mentioned for a while.

So when you watched the series, was any of the information even surprising to you or did it pretty much align with your expectations based on what you know about healthcare in Washington?

- Yeah, it's not surprising at all, unfortunately, right?

Much of my work is situated in the history of racialized medicine, but what was beautiful is how Jen and you all were able to tell the story in a way for everyone to be able to grasp it, to digest it.

Because oftentimes I'm presenting in front of physicians and researchers and I'm referencing research papers and statistics that for a lot of communities one don't have the time, don't need to be interested in that but you all were able to digest it, translate it and say, look these are the issues that are occurring.

And a lot of those issues while it wasn't surprising to me, I'll tell you for certain that there's even physicians that aren't fully aware of the injustices that have crept into the medical system.

And I want to be clear, a lot of people may be watching and say, well he doesn't seem very fond of medicine, why is he in it?

And it's like James Baldwin, James Baldwin amazing writer who said, I love this country so much that I reserve the right to critique it.

I believe medicine has a place in doing exponential good.

It hasn't lived up to that honor yet.

There's people in it that are fighting to do that but it's gonna take some time, it's gonna take some unlearning, it's gonna take some interrogating.

But in that work, I think we developed something fundamentally different that is focused on health justice, focus on the most marginalized but we're gonna have to unlearn a lot of the harm that was taught throughout history.

And I want to encourage folks to watch this series because we talk about how the beginnings of medicine were around differentiating human bodies based on our melanin and that those beliefs are still existing today that leads to the stereotypes and the racist policies that we witnessed.

So when people say, well, Edwin, how do we solve the issues of racism in 2021?

I say we don't, we have to understand where it came from, the racism of today are just the vestiges, the legacy of racism from history past.

When we understand it more clearly, then we know what is happening today.

- I think it's interesting Edwin that you mentioned, sometimes even when you speak to physicians they're not quite, they're not as quite as aware as you think they should be about these issues.

So I'm very curious, as someone who works in health justice, what types of conversations are you having with these medical professionals about race and bias?

And in general, do you feel like folks are receptive to that information?

Or do you get a lot of pushback?

- Yeah, great question, so I wanna be clear so far, again there may be some people say, "Geez, medicine just seems bad."

We have to disassociate the system of medicine from the individuals of medicine.

The individuals are folks that have committed their lives to wanting to serve other people, learning an immense amount of knowledge so that when we present in front of them, they can take care of some of the most complex issues our bodies can present to them.

It's an amazing, amazing feat.

And so I give a tremendous amount of credit to that work and simultaneously knowing that they're good at it because they were able to learn it.

But that means the input is only as good as whoever is inputting that information, who is providing the knowledge, where is the knowledge coming from?

'Cause like a computer the outcome is only as good as what we put into it.

And I think our job is both in medical school but in all of our educational systems is providing the real understanding that there is nothing biologically different between the three of us here because we're at different races.

What's different is that we are experiencing the world fundamentally different than other people in our society and our communities.

And so when we say that black women have higher rates of death during pregnancy, or that Latinos have higher rates of diabetes, it's not because of their race, it's because of racism, it's because of poverty, it's because of food deserts and food mirages where folks can't get good access to healthy foods.

I'm a product of that, I grew up in a neighborhood where the corner store, the closest store to us, we had choices for sure.

People say, well, you made poor choices.

No, it just, the only choice I had was Doritos or Tostitos, either choice is gonna hurt me.

So how do we create conditions where the choices are actually equitable?

- So when you do speak to folks about critical race theory are you getting any pushback?

Not necessarily at UDaB, but you know in the work that you've done in your career do you get a lot of pushback when you talk about these issues?

Because I think it is easy for folks to get defensive, right?

- Yeah, I've experienced pushback for sure.

It's not the norm but there is pushback because we're talking about science and what unfortunately happens is people think that I'm presenting and my colleagues who do this work around the country are presenting our beliefs.

And the truth is this isn't about my belief or Harriet Washington's belief or any other amazing scholar.

It's about an actual science, we've researched this, we've done the work, we've been in community, we have interrogated the way society functions and we're just explaining how it works.

Believe me, I have a number of people who've said to me, "Edwin, if you just stopped being a victim, "things would go away, stop thinking you're the victim."

And my response is believe me being the victim is not the person or the position that I wanna hold.

Unfortunately, this country has shown me very clearly that I'm going to have a disadvantage for one reason or another because of the color of my skin or the color of the skin of my wife.

How do we know that?

Look at the news, you all have provided amazing, amazing stories around access to homes, people getting loans that they can't qualify for, people not getting loans that they do qualify for, people's homes being undervalued, just because they have pictures of black families in their homes, it's unfathomable yet it is so real.

- Jen, I wanna turn to you and hear your reaction to that.

Now, how are viewers responding to Hidden Barriers and the information that we're presenting in the series?

- I think overall the responses that I've gotten have been very positive.

A lot of nonprofits and community organizations who are working in this space have reached out to me, letting me know what they're working on.

These are folks who are in the trenches, in the community, seeing these issues every day.

And they wanna see more of this in the media because I think a lot of the coverage right now centers on coronavirus this and coronavirus that which is important to be sure, but as Edwin said these issues have been present since, I don't wanna say the beginning of time but certainly for hundreds of years.

And so, we need to address the history.

And so I mostly I'm hearing please continue covering this.

Here's another idea for a story.

Here's something else that's going on in the community that you should know about.

So it's been really great.

- Yeah, it makes me happy to hear that folks are, it's really resonating with them and they're asking for more coverage, my question for either of you is, it seems like over the past, maybe calendar year with coronavirus that seeing the disproportionate impacts of COVID-19 and also the BLM Movement, it seems like there's this heightened awareness of inequities, not just in healthcare but in other areas.

When we think about the medical community, you are the healthcare industry in particular.

Are we seeing a lot of changes in policies because the awareness is there but in terms of policies, is there any change happening?

- Go ahead Jen.

(laughs) - Oh, sorry, I see a lot of awareness.

I don't have the expertise to say what specific changes are happening, I know that there's a lot of conversations going on around these issues, on the access to health care front.

I know there's hope that we will figure out a more universal healthcare system soon.

Edwin, maybe you can speak more as to what else is going on.

- Yeah, I've seen a lot of people talk about it from national conferences to many Zoom meetings with thousands of people on them.

And nearly every presentation is talking about health equity, talking about let's raise awareness.

And I wanna be clear that that's one step in this process of development to actually move towards health justice.

What we then have to do like you're suggesting Starla is we have to sit with the discomfort that that means that changes will have to be made within our institutions.

The way we recruit physicians, the way that we learn about medicine, the way that we care about certain populations is gonna have to be different.

And when we call it out when someone says, "This wasn't very equitable."

Then we have to find a way to adjust, to change it.

And funny enough, that's actually how medicine works, right?

Medicine using the scientific method says here's a hypothesis, we're gonna test it.

If it proves that it doesn't work we're gonna come up with a new hypothesis.

So there's this iteration, this iterative process to growth and progress.

But for some reason, when we talk about racism, the iterative growth stops and it's like, whoa, racism what does it have to do with medicine?

And the truth is it has a lot to do with medicine.

It affects nearly every square inch of this country.

And we haven't actually called it what it is.

Thankfully, many public health institutions have declared racism as a public health issue.

Many hospitals are doing the same thing but that means and I think you were getting to this point, Starla that we now have to move on it.

We have to change the functioning of these institutions.

And it's gonna take the innovative minds of I think students and residents and folks who aren't even in these institutions yet because they're not bound by the reality of what currently exists.

They have the freedom of creatively and thinking with their imagination.

- Yeah, I think it's interesting that you bring up, how do we recruit more maybe folks of color into these fields or at least recruit folks who have an awareness of these issues?

It also leads me to think about retention.

You know, how do we retain more medical professionals of color, which also reminds me of a Crosscut story that we had done in December about Dr. Ben Danielson stepping down as the Medical Director at the Odessa Brown Children's Clinic.

I have the article right here and really quickly, he said that, "What it came down to was "examining his own complicity as a representative "of a hospital that does not treat people "of color as it should."

And so in November he resigned in protest, Edwin, what's your reaction to that news?

Was it shocking to you?

And do you think instances like this are even rare or has it been happening for so long but we just don't always get to hear about it publicly.

- Yeah, it's a story that shows the tenacity and the commitment that Dr. Danielson has, right?

That he is willing to say publicly what needs to be said.

And I'm so thankful that he shared with the world the experience that he had but he's also not just talking about one hospital, the way that I heard it and felt it was that it was an implication of medicine as a whole.

And that medicine has to step up, has to innovate and has to actually reckon with the racism that exists within its walls in a real way, in a way that it hasn't in the past.

And it's gonna say, and I keep reiterating it and sound like a broken record but it's gonna take folks saying, "Yeah, we're just not gonna allow the racism to exist here."

It has to be a culture change, it has to come from the top.

It has to be a voice, I always tell folks, it has to be a voice that says let's stop negotiating with injustice because that negotiation always ends up us being on the side of injustice, because the difference between justice and injustice, somewhere in the middle when we negotiate with it is not a good place.

And we have to be comfortable that we're gonna be shedding some relationships, that we're gonna be holding folks accountable.

And that we're also doing this because at the end of the day, our patients are gonna be better treated because of it.

- Jen, I wanna turn to you, I know that you had been working for Hidden Barriers for several months, right?

When this news broke, was it shocking to you to hear about it?

- I wouldn't say it was shocking.

I would say Dr. Danielson is probably one of the most kind of beloved figures in the community, working at Odessa Brown, very well known clinic here.

And it, I went to, in episode two you'll see that there was a rally that's Black Lives Matter activists and other folks put on and supported Dr. Danielson.

And all I kept hearing was how beloved he was in the community and how it was kind of a travesty that he felt the need that he needed to step down, leave his job to make a point to be heard that even though this this man who had attained such a high position, was so well respected, didn't feel like he could be heard until he stepped down from his position.

And that's what it took for him to be listened to really.

So that's what I was hearing from the community.

So it doesn't surprise me, I think it's one symptom of the issue that we've been talking about, that we've been seeing for a very long time.

- Thank you, Jen.

We have, I think about five minutes until the Q&A.

So I'm just gonna end with this question but I'll start with something that Edwin said in the series would said at the end of I think episode two, you said the data's there.

Racism is killing people but I don't think we need more research.

We need more action, so my question is how do we move from this awareness to action and accountability?

What needs to happen to make that change?

Edwin, we can start with you.

- All right, yeah, so let's give some framing of how medicine works, especially in academic medicine, right?

You have these major granting organizations that fund research and they fund programs within many universities across the country like the NIH and many others.

They say we'd like more research on X, Y, and Z.

Well, now they're now dictating where folks can get money to do research.

And it's a lot of money, we're talking about in the tens of millions of dollars.

And people's advancement and academic careers are reliant on how much money they can bring in for research.

And so it's a cycle that causes this to what I would call the research pandemonium, which is like let's just do all the research.

Let's continue to find the disparities that exist.

I think is now time for these funders to say, we can do research, there's an arm here that's necessary for that.

We wanna start investing in communities that can start solving these problems.

Because me knowing why us finding out that having a food desert causes health inequities or knowing that red lining had lasting effects in health causing people to have a higher rates of respiratory disease in the south end of Seattle which we now know in 2021 means that if you walk into a hospital with a respiratory disease like asthma you have a higher likelihood of mortality.

We know those things exist.

Who's gonna fund the work that says let's clean up the neighborhoods in Georgetown and White Center so that it doesn't have the higher rates of asthma, that it has the cleanest air.

How are we gonna fight against the fact that there are environmental racism issues like where the King County transit system runs through.

Those are questions that we have to wrestle with and help communities organize around.

We just haven't seen it yet.

- Thank you, Edwin, Jen before we move on to Q&A, do you have anything to add to that?

- Yeah, I can comment on this from my perspective as a member of the media, for example, awareness to action.

You know the media is all about building awareness and often that tends to center on what the problems are.

And I think we also have a responsibility to showcase more of the solutions, more of the organizations, the treatments, the things that are working to improve this issue.

We tend to focus so much on this is wrong.

This is all the doom and gloom as we call it but there is also a lot of positivity out there.

There's a lot of amazing community organizations.

I met dozens of amazing people over the course of the few months that are so passionate about this issue and so invested.

And so I think as members of the media, we need to showcase and highlight those stories more to let people know hey let's move in this direction.

This is kind of an example of the right thing to do.

- Thank you, Jen.

Now we have a few minutes for Q&A.

So let me pull up the questions from our audience.

So the first question, what do you think the media gets right and wrong and other reporting of, sorry, in reporting about people of color and healthcare.

What do you think the media gets right and gets wrong and their reporting of people of color and healthcare?

- Jen, I'll let you take that.

(chuckles) - Well, from what I've learned from Edwin and other folks I think there's a lot of emphasis on, people of color have poor health outcomes.

And often that's framed as in some it being their fault or it being some sort of genetic component to it.

And I think especially COVID has shown that it's really the inequities in the system.

So that's one thing that I would point out.

Edwin, do you have any others?

- No, I think you're on the right thread.

What happens is, and this is the vicious cycle.

Media gets its information from the professionals.

The professionals are the researchers.

The researchers are doing research to just find inequities or excuse me, to find what's wrong with certain communities, to find what disparities exist.

And I wanna be clear, I don't use the language disparity.

Disparity just means there's a difference in numbers.

I use the word inequity which means there are forces.

There are mechanisms in place that created that disparity.

But I think we do have to move away from putting the onus and the blame on the most marginalized in our community saying, well, what's wrong with them?

Why haven't they made different choices or decisions?

When I think journalism can do a great job still within its paradigm of journalism, authentic journalism in exploring beyond just a personal story and saying what is the systemic story here that's at play.

- Thank you, our next question here is, how has the pandemic exacerbated the barriers that people of color face in health care?

Who wants to take that one?

It's kind of a big one.

(laughs) - That's a big one, I'll give a quick answer.

And people have said this so many times.

It has just put a microscope on all the inequities that exist.

It's not that it exposed the new ones as they've always been there but the media, our education, television, social media, it wasn't part of the daily life.

And now we can't run from it, it is hitting us square in the face because our hospital beds are full, because resources are being allocated under scarcity, because our loved ones are dying.

And when the data tells us that black people are dying exponentially at higher rates because of COVID we have to pay attention, but I'll be very frank.

That same statistic is already existing with so many other comorbidities.

And yet we haven't acted as swiftly or with as much intention as I think we should.

- And I think we have time for one more question where we have to wrap this one is for Jen, in the episode about translators, how did you find your sources?

The story about Yvonne Ang is really incredible.

- Yvonne is amazing and I was very lucky to basically reached out to a bunch of community clinics, people in the area that are working with mostly communities of color.

So one of these was ICHS, International Community Health Services.

They have a couple of different clinics here in Seattle.

And I asked if there were translators that they could put me in touch with that I could speak especially for this particular episode on language access.

And that's how I came across Yvonne, who had a beautiful story of coming from Cambodia, where she was a refugee and landing in Seattle, not speaking a word of English and her experiences led her to eventually become an interpreter and help other people like her in her community access healthcare which she had a difficult time doing when she first came to the US.

So again it was just listening to the community members.

They point me in the right direction.

- Thank you, Jen.

Well, unfortunately we are about out of time.

So thank you to both of you for making time for us today.

- Absolutely, thanks for having me.

- Now, the next episode of Hidden Barriers will be released this Thursday.

You can watch the first four episodes on Crosscut.com.

There are links to the series below on this page and if you want to learn more about equity in the healthcare system, we'd love to see you at our next event on March 16th, featuring Dr. Ben Danielson.

The link to that event is below as well.

Thank you to all of you for tuning in.