- Your socioeconomic status and what you look like can factor into whether or not you have access to healthcare.

- Black physicians and nurses were needed to be central in the struggle for equality.

- We need need more Black doctors, especially Black primary care physicians.

- We can try to help our first responders when they are contending with the cynic behavior associated with PTSD.

- Advancing diversity and equity are both imperatives, but they are not the same thing.

- Blacks were among the very first Americans to use a form of vaccination, to protect themselves from disease.

(jazz music) - In a civilized society, healthcare disparities should not exist.

If you think that's an extreme statement, you're wrong, but I get it.

We live in a society that accepts a certain amount of unfairness and treatment towards other people, so I understand where you're coming from, but disparity is not normal or acceptable.

My opening statement raises really two questions.

First, are we a civilized society?

Because let's face it, if we're not and we agree that we're not, that kind of lets us off the hook, doesn't it?

Letting go of that title drastically lowers the expectations that we have towards how people treat us and how we treat others.

But then it raises even more questions around if we're not a civilized society, then what are we?

And what can any of us expect if we don't have civility in our society?

Second question is a lot easier, do healthcare disparities exist?

Yes, yes, they do, not worthy of a lot of discussion.

Now as a lawyer, I always like to define my terms before going into a discussion to make sure we're all on the same page, and we're all talking about the same thing.

So let's look at the word civilized, I struggled with which definition to use, but I chose this one.

Civilized is defined as showing moral and intellectual advancement, being humane, ethical, and reasonable.

Well, given the last four years of our society, I think we'd be hard pressed to identify any of those terms to the society that we live in and the way our society has behaved.

Next, society is defined as a large group of individuals who live together in an organized way and who make decisions regarding how they wanna live and then share the work that goes into living together.

Society can also be defined as an organization of individuals who come together for a specific purpose or to participate in specific activities.

That second definition is important because it opens up the idea of societies existing within other societies.

And I think that more closely represents what the United States looks like.

In our society, there's so much hate, division and aggression from so many different angles.

Worst of all, there is so much indifference to the sufferings of other human beings.

Instead of one big society, it appears that we are living and being multiple societies within societies, all expressing great care and concern for our personal causes, but not enough effort or care regarding uniting and working together.

It becomes a common technique to temporarily turn off our civility, to express ourselves and our anger and our frustration without the limitations that civility would put on us.

But when we take those breaks from civility, we start to break down the very foundations of civilization, and that cannot be a good thing.

Now, back to healthcare, first, a few disclosures, number one, I'm a healthcare lawyer.

I defend and represent healthcare professionals, health care companies in matters of regulatory compliance, litigation and enforcement.

So I live and breathe healthcare every day.

Number two, I come from a healthcare family.

I was born in Washington, DC and raised there and my father was a doctor who had a private practice and he was also on the faculty of Howard University Hospital.

Basically, my family was one of those where we talked about healthcare at the dinner table and through those discussions, I got a very unique view of healthcare from the Black perspective.

When my brothers and I got old enough, we spent a lot of time working in my father's medical practice, you know, free labor, basically.

Looking back, those were some of the greatest experiences that I had growing up and they taught me a lot of life lessons about running a small business and about what healthcare really looked like.

I don't think I realized it at the time, but my father's patients were almost 90% Black.

And the hospitals where my father worked in Washington DC were almost predominantly Black hospitals.

In fact, one of the main hospitals where he worked and the hospital where I was born, oddly enough, was a hospital named Friedman's Hospital.

Guess which demographic of patient probably was going there.

I realized as an adult that these demographics were not incidental and that my father had consciously chosen these populations to work with because he realized that there was a need for people of color to be able to get the best care possible.

He also realized that there was a benefit to them receiving the care from someone who looked like them, someone who understood their struggles and who could relate to their experiences in a way that allowed them to not only be open to receiving the care, but also open to educating themselves on a healthy lifestyle.

When you see the machine of healthcare from the inside like that, that can affect you.

You see a lot of things.

Inner-city healthcare comes with all of the stereotypes, lots of drug victims, gunshot victims, and a lot of people suffering from chronic diseases like obesity, high blood pressure and diabetes.

As I got older, I remembered making comparisons between what the healthcare system looked like in those inner-city hospitals and what it looked like in the hospitals in the suburbs where I grew up.

Probably the biggest thing I recognized was that a lot of the suffering that was taking place in these inner-city hospitals appeared to be from things that were preventable.

A lot of the suffering that I had seen was based on factors like not having access to healthcare prevention or nutrition, a lot of them were also forced to live in dangerous environments because that was what they could afford.

Also, the patients generally did not have access to things that prevent needing care in the first place, like regularly seeing a doctor and having routine, preventative, checkups and examinations.

When it comes to who gets health care, we all know that where you live, your socioeconomic status and what you look like can factor into whether or not you have access to healthcare or not.

If you have a job that provides health care insurance, it can be as easy as picking up the phone or getting on the internet to make a healthcare appointment.

But if you do not have healthcare insurance through your job or otherwise, or you have insurance, but you cannot afford that portion of your co-payment or deductible, then having healthcare insurance is just like not having any insurance at all, because you can't use it.

Then there is how much healthcare you can really access.

In wealthier communities, you have specialized doctors for whatever you might need, not true for poor communities.

In those communities, there are far few doctors, period, but all of those doctors that are there, they're usually general practice and can't do more of the specialized things.

As a result, some diseases and disorders go untreated and get worse, not because they couldn't be fixed, but because the system didn't provide a way for those treatments to happen or for the right kind of doctor to be available, to prevent that from happening.

While it may be comforting to claim that our society is civilized, we cannot reconcile that belief with the existence of healthcare disparities.

So maybe it's time that we got a little more uncomfortable and got to work on improving healthcare disparities and conditions for everyone.

(jazz music) - Right now, when you read up on the COVID world, it is truly shocking to see how easily COVID cases line up with the local, demographic and racial geographies.

There is no way a virus could so easily match up with segregated and exploited communities across the United States, except for the historical processes of segregation and exploitation in the United States.

Take a look at Chicago, LA County, Austin, where do you think African-Americans and Latinos live?

Are you following the colors?

Perhaps as frustrating, take a look at the zip codes in the same areas for COVID vaccination rates.

These are some of the more comfortable communities in their areas and because of their 1A and 1B status and broadly cast hands on the levers of power have disproportionately been able to access the vaccination.

These 75 and 65 year olds grew up at the same time as a Civil Rights Movement, but many in Latino and Black communities who came up with these movements, did not live long enough to get access to the vaccine, let alone witness the 2016 election.

There is a demographic in this discussion of vaccines, healthcare workers who have been given frontline access to the vaccines because they are and have been considered essential and essential to keeping people alive, essential to the crisis based, emergency room care we provide into society, essential to the feeling that we are doing our level best to let them know that we have their back.

Still interviews and conversations with people in emergency and healthcare settings emphasize that folks in the hospitals feel disposable and unappreciated.

This feeling is accentuated for workers, whom we have deemed essential for all of us to go forward.

The grocery store workers, the farm workers, the construction workers, that custodians school staff, they live the essential, disposable split.

The seeming indifference at the rates of COVID outbreaks by their work or their zip codes or their crowded multi-generational households in increasingly expensive cities, brings out the disposable nature of their work, COVID makes this more visible.

Now I work in the history of public health, the history of borders, and in ethnic studies.

What I try to do is find an analogous situation, bury myself in the relevant evidence and archives and involve myself in a reconstruction of this past.

It is an escape, but it is also an opportunity to be humble, to know how others have confronted difficult situations.

I want to jump back to the 1890s then the 1950s, and then to our present.

The 1890s marks the beginnings of Jim Crow to Plessy versus Ferguson decision.

The establishment of the National Medical Association, the 1895 Immigration Act, the takeover of Puerto Rico and the Philippines and the rise of concerns with TB across cities and towns.

And I want us to remember that concerns about disease also shaped race and politics back then, and is classic.

"The Philadelphia Negro," WB Du Bois painstakingly documented the impact of TB in Black neighborhoods, where Black people ostensibly had the opportunity to live freely since the Gradual Abolition Act of 1780.

For people like Du Bois and the National Medical Association.

Quote, "The most difficult social problem "in the matter of Negro health, is the peculiar attitude "of the nation towards the well-beings of the race."

That is disease provided a key way to measure the distance from equality and citizenship that are quote, the measure of the difference in advancement.

Black physicians and nurses were needed to be central in the struggle for equality.

It is always hard to wrap our head around this, but the 1890s also marked the high water moment in the representative nature of doctors with more women, African-Americans, Latinos and Eastern European doctors than ever before, when the powers that in this case, the Rockefeller Foundation looked at the situation where African-Americans, immigrants, high school graduates, Latinos, women, all were enrolled in medical schools while people were being exposed and dying of communicable diseases and workplace injuries, they consider this chaotic and disorderly and decided to do that's right, investigate medical training in the United States.

The foundation charged Abraham Flexner to review every medical school in the country and decide which schools were worthy of receiving Rockefeller Foundation support.

This was a pathbreaking moment because it established certification standards for all medical schools and only directed foundation support to these schools.

As part of the package, many schools did not meet the increased facility, Teacher Certification Standards and research-based medical curriculum.

And they ended up closing through a loss of funding and a variety of other reasons.

The Flexner Report also recommended designating specific schools to train Black physicians, to treat Black patients, because quote, "The practice of the Negro doctor "will be limited to his own race, which in its turn "will be cared for better by good Black physicians "rather than poor white ones."

Why care for Black health?

Well, the community is quote, "As far as the eye can see, "a permanent factor in the nation.

"They have rights and values as individuals, "besides the tremendous importance "that belongs to potential source "of infection and contagion."

That is, Black doctors will save the United States from Black people.

Within a decade, the number of women African-Americans Eastern European medical school graduates, who were also able to gain residencies in the United States dropped precipitously.

Moreover, Rockefeller Foundation funding meant that Meharry Medical School in Nashville and Howard University in Washington, DC became the de facto Black medical schools for the country.

These countries policies and practices meant graduating from the school, connected you through your working life with the fate of Black communities in the United States.

50 years later, how did this investment in segregated medical schools pay off?

What do the death rates from TB and the presence of doctors, tell us about the segregated investment?

First, let's take a look at the Du Bois standard for Texas.

Per our 1945, Texas study of quote "Latin American health conditions, "The TB death rate for African-Americans "varied between six to eight times "the rate for the general population.

"The TB death rate for Latin Americans "varied between seven and 12 times the rate "for the general population."

Now, why do I juxtapose death rates to the presence of minority physicians?

Consider that in 1945, most people knew how TB was transmitted.

The conditions that maintain TB and the treatment that was available, was horrifyingly expensive.

The death rates are instructive as African-Americans Latinos died to three to 12 times, the rates of the surrounding community.

As the rates fell across the United States, high death rates, persisted for Black and Latino communities consider the relative absence of minority physicians as a symptom of this neglect.

Given that Texas had the legally white, socially Mexican standard, each county in Texas decided what doctors were white and trained enough to be members.

In 1955, the Texas Medical Association opened its door to all certified members.

This is what the situation looked like in 1954 at the eve of this desegregation.

Together, the 138 Black physicians and the 161 Latin-American physicians, constituted 4% of all physicians in Texas.

The biggest single positive intervention in Black and Latino medical outcomes is still the 1964 Civil Rights Act and the 1965 Voting Rights Act.

Between 1965 and the mid-1980s, African-Americans and Latinos started living longer and this extended life, brought attention to all the chronic conditions that had gone undocumented and unseen.

Bringing Black and Latino physicians into hospitals has helped amplify these injuries and concerns.

As Texas State student Najha Marshall put in her thesis, when lupus crossed the color line, people started hearing the pain of Black women.

To me, as vaccines reduce hospitalization rates, what will the different positivity rates for COVID-19 mean for our communities?

I see the ways nonmedical public policy decisions like mask mandates, paid sick leaves, TIN numbers in exchange for COVID vaccinations.

The decision to distribute vaccinations by age group, not age and zip code and labor market sector for access.

Du Bois regularly pushed for political equality.

What I want us all to consider are the ways that political inequality, that is public policy shapes medical inequality, and death.

And after that, how a push for political equality will lead us down to a path of better health for us and for all of us, a way to make us less disposable and therefore more essential.

(in foreign language) (jazz music) - 13.8% of the United States population is Black.

Yet, according to the American Association of Medical Colleges, only 5% of physicians identify as Black or African-American.

At this point in history, we are going through a national shortage of physicians.

In every state, there are thousands of people struggling to gain access to preventative and curative medical care.

It is estimated that in 2033, there will be a shortage of 139,000 physicians, to meet the needs of the general public.

There are clearly not enough physicians right now to meet our general needs, but if you look closely at the data, we can clearly see that Black people are underrepresented in the field of medicine.

We are certainly underrepresented in many professional fields, but currently the lack of Black doctors serving our communities, has repercussions that go beyond prescriptions and surgery and deeper into the development of meaningful physician-patient relationships.

This shortage has its roots in systemic racism, but has been cultivated by our people's own fear of interaction with the medical system.

It is well-known that early on in the development of this nation, free a newly freed Black people, were not allowed the same access to education as their white counterparts.

Furthermore, as medical knowledge continued to advance, this gap in education and specifically medical education continued to widen.

For a long time, the only physicians available were white.

In fact, we had to wait more than half a century since the independence of this country before we're able to witness the first African-American with a medical degree, that's Dr. James McCune Smith.

In addition to this, American physicianhood has a checkered past, when it comes to its interaction with people of color, there have been atrocities committed against our race that make it hard for us to place our trust in modern medicine.

This in turn has led to a lack of interest in the field of medicine among our people.

When we sum it up, becoming a doctor is not something that interests us or even seems attainable.

What happens to a population that does not participate in preventative care?

What happens when we are underrepresented as leaders in population health?

We become over-represented in poor health statistics.

Treatable and preventable diseases like hypertension, diabetes, and high cholesterol go undiagnosed and untreated, this gives way to more severe disease and maladies, including heart attacks, strokes, and death.

Not only that, but these conditions continue to also limit the potential that we have as people by taking away from the time and monitor resources we have to do important things for ourselves, our families and our communities, and instead pouring them into managing late stage diseases.

We can even see the critical role that mistrust in and dissociation from the medical community is playing even right now, as we attempt to vaccinate the nation against COVID-19.

I have had people ask me if the vaccine is safe for Black people.

This speaks to the hesitancy to trust in our system of health, even in the midst of a global pandemic.

We must regain trust in the Black community in order to help mitigate the harmful effects of the diseases afflicting our people.

A big part of regaining that trust, lies in improving Black representation, seeing ourselves in the physician role and seeing physicians as part of our community.

If you can say things like that doctor is my cousin, my auntie, my nephew, this goes a long way in transforming our mental image of what a doctor should look like.

I'm not saying there needs to be less white doctors, in fact, we need our brothers and sisters of other colors to show compassion and further champion the cause of Black health in our communities.

This is being done in many cities and rural areas across this nation, but we need more Black doctors, especially Black primary care physicians.

Now, thankfully I am proof that there are few of us that belong to the fraternity of physicians.

Coming from Jamaica, a place where the population is about 90% Black, my perception of what a physician should look like is clearly different from the perception of young women and men growing up here in the United States.

I was also fortunate to have a grandfather that was a physician, so that helped inspire me and essentially allowing me to see myself in that role.

My wife who was born and raised here in the States is also a Black physician, and despite the odds being against her, she thankfully never had to question whether or not becoming a doctor was attainable for her.

She had encouragement from her parents, family members and teachers, but crucially her pediatrician, the first physician she ever met was a Black woman.

This underscores the pivotal point, that representation matters.

Because we can tell our kids, they can be whatever they want to be when they grow up, but if they don't see themselves in the fields that they're passionate about, this just ends up being another cliche.

So what are some of the ways we can make a difference?

Parts of the solution lies simply in highlighting the problem.

Thankfully, many universities, medical schools and residencies have recently become aware of the issue of representation and have actively taken steps to educate and recruit more diversely.

These actions collectively will go a long way, but what can we do?

For starters, we can continue to encourage our youth to help them understand that becoming a physician is hard work, but is not outside of their reach.

This means being visible and available in our communities for mentorship opportunities, tutoring, workshops, career days, et cetera.

In order to offer a glimpse of that perception to young, aspiring doctors, they have to see us.

Thankfully, this does not have to be hard.

A few weeks ago, I participated in a Zoom call where I was asked questions by some kids about what it's like to be a doctor, and I never had to leave my home and it only took about 30 minutes of my time.

So if you are a Black physician, seek out these opportunities, even if you're busy, to become actively engaged in the lives of future physicians, be available.

If you're not a physician and even if you're not Black, you have a role to play as well.

There are numerous organizations that I want to make you aware of because they could use your support and it could help a child that you know is interested in the field of medicine.

These include the Society of Black Academic Surgeons, the Association of Black Women Physicians and the National Medical Association.

These are organizations that are actively mentoring, informing, and awarding scholarships to children of color in order to help them pursue medical careers.

Consider donating to these organizations or connecting a child that you know with a mentor.

Here's a helpful and fun exercise for you and your child to try.

Make your kid an interviewer for a day, have them write down questions about what being a doctor is like, then seek out a few doctors for them to talk with.

Seek out a few Black physicians as well So they can see Black people in the field.

This does not have to be isolated to medicine, you can try this with any career field, but the need for more Black physicians is great.

And while every Black child does not have to grow up to be a doctor, they have to know that they have the choice and the ability to become one and to change the world for the better.

(jazz music) - There comes a time in a person's life that when they're contending with their brokenness and trying to get to redemption, they have to find a journey to help them seek and find redemption.

I'm going to share with you today my story, and it begins with an environment that was very volatile as a child.

From day to day was very unpredictable and difficult in my household.

We struggled through the traumatic events.

As a child during the 70s, some of the most prolific scars that I have, and that I carry as an adult are from growing up and being raised in a volatile environment and also being exposed as a first responder to the occupational hazards that I contended with.

Now, you see, as a child, my father was an alcoholic and he was a tyrant over my mother and I for many years.

We witnessed a substantial amount of physical and verbal abuse, which was very difficult for us.

And later, as I moved into the field as a first responder, the trauma as a child, coupled later as a first responder, made it very difficult for me to be able to diminish what we now call short term effects of trauma, which is now known as PTSD.

Society if you recall, was first exposed to PTSD subtly by members of the military.

The Vietnam War provided a platform and introduced America to the ill effects of PTSD.

Now, clinicians later were challenged with interpreting and diagnosing what the exposure to the traumatic events were.

After years of clinicians and studies, talking to each other about what was going on with our soldiers post-Vietnam War, research began to educate the leadership, excuse me, on what is now called a mental illness, which is now known as PTSD.

Dr. Tania Glenn is a clinician who specializes in caring for first responders who are contending with PTSD, very knowledgeable woman.

She has determined that first responders affected by PTSD to find the repeated exposure of the trauma of what it's called now, the reel effect.

He might say, it's like a Black and white movie being played inside of our brains.

The reel effect is the inability of an individual's brain to process the traumatic events effectively.

Instead, the trauma gets stuck in our brains and is played back like a movie reel over and over again.

When a person is affected by the reel effect, the accumulation of the trauma is now what we know as PTSD.

Some of the symptoms associated with PTSD are guilt, a disinterest in their activities, difficulties sleeping, and also forgetting the things that they once enjoyed.

As you listen to my story, you may ask yourself, well, you know, why did she choose a field in public safety?

Well, I'm gonna tell you, as a police officer, as a firefighter, as a medic and as a dispatcher, if you were to ask them all in the room, I guarantee you the thing that they would tell you the most is because they want to make a difference.

It's easy to lose sight as a citizen when you dial 911, "Hello, what is your emergency?

"Do you need police, fire, EMS or mental health?"

Is that what you're getting on the other end of the line?

As human beings, we see that they too are human beings at times and we forget about that.

So each call a first responder receives may very well trigger the reel effect.

Now working, so now seeing the worst at times in society can trigger what we call cynicism, the repeated exposure to the traumatic events in the form of assault, murder and hate crimes towards another human being creates a mentality of cynicism.

Now cynicism can manifest itself in a contemptuous attitude of distrust for humanity.

It's my belief that this behavior is what's plaguing the hearts of those in our society today and what we're contending and what we're seeing now about the methods that are being used by our public servants.

When you have seen people turn against public servants, likewise, we've also seen the ill effects of the harsh methods used by members sworn to protect our community.

Logically with any profession in our society, you're gonna see ethical and unethical people.

We're going to contend with them in our lives.

The question is, is how do we do that?

I think for me, being a first responder and having been in a position of leadership in the community, I fairly feel that vulnerability is a perfect place for us to step into an arena and demonstrate as leaders, how we can help those in the community and help other first responders.

It's my position that a public servant should explore the first step into this arena.

It also begins with the organizational leadership, the leadership, they have a moral obligation to preserve the sanctity of one of the most valuable, valuable resources and that's our first responder.

The leadership within the organization has a responsibility to locate assistance, conduit to help its members.

First responders must feel safe and they must be willing to be helped.

Ultimately, the organizational leadership has a due diligence, a due diligence in assisting its first responders.

An intricate member of the organization and helping them become and return back to our society community, but more importantly to their families.

The organizational leadership from my position has a role in fostering trust and/or reestablishing that boundary.

To achieve trust, the organizational leadership must come to terms with understanding what PTSD is.

Now, again, I'm gonna quote something from Dr. Tania Glenn.

So there's assumptions here that are often made about first responders.

It's dangerously assumed their first responders do not have the same psychological, emotional, or physical effects as a general population.

It's further assumed that they encounter stress, that they will manage it on their own and need no outside assistance.

It's further assumed that the first responders are extremely resilient or able to take on the trauma that they are exposed to in any situation.

Now, these assumptions by the members of the public in the organizational leadership have become very dangerous at times, and very well are probably the cynic behavior that members of our community are being affected by.

Poor decision-making by our first responders, because of this cynic behavior, I feel is one of the things that we can try to help our first responders when they are contending with the cynic behavior associated with PTSD.

Now, the organizational leadership in its role has a responsibility to reduce the negative ideologies and rhetoric ones, defining PTSD as being weak, the effective communication between the first responder and the organizational leadership while instituting protocols and resolving internal and external conflicts, ethically, is a good step in the right direction in assisting our first responders.

Rehabilitating its members and bringing them back into the organization and also bringing them back into the community that they once thrived in.

Now, is it worth the risk to endure the repeated occupational hazards as a first responder?

For some, becoming a first responder is deep in family tradition, others come from a military background.

Others have personal situations in their life that have directed them into this path, while others saw the prolific events on September the 11th, 2001, which drew them into this occupation.

Ultimately having seen and working alongside the hearts of these first responders, they each have a compelling story, but to truly serve in this capacity is very rare.

Each one of us has a family who we strive to care for and hope to return to at the end of our shift and at the end of our tour of duty.

Finally, the story I hope that I've shared with you, has captured at least eight minutes or so of your time and attention to PTSD and the importance of bringing awareness to this mental illness.

It's my understanding and decision that I became a first responder because I had a desire to serve and to help others who contend with similar stories, such as mine.

First responders are unique in that resilience is found in our pulse.

It's my desire to serve in this capacity, it was not achievement, it was not mine alone.

It's because of people that love me, such as Jess and Jake and the many others who helped me along my path, they were the ones, they were the ones truly that held the gap with a wedge, with love, with patience and resilience.

Thank you and God bless.

(jazz music) - After I joined Dell Medical School two and a half years ago, I knew upon hearing that I was the associate Dean for Health Equity, some people would ask, what does that mean?

I'm not sure a dean responsible for education, research, or even diversity would be asked that question, but equity is more of a value, a moral principle than it is a familiar educational domain.

And it remains a value that is not universally embraced.

Since I anticipated confusion about my role in my job negotiations, I suggested that my title should be different.

My future boss did not agree.

As Dean and Dell Meds leader, he was proud that my title reflected our school's mission and our commitment to social justice.

Many people assumed I was the new diversity dean, even though we already had one.

I started introducing myself by saying, "I am the Associate Dean for Health Equity, "it's not the diversity position," while wondering whether people simply saw me a Black woman, check two boxes, who was of course responsible for diversity.

Here's why it was important for me to distinguish diversity from health equity and why it's important to do so in every organization.

Words and titles matter, they signify power or lack of it and importance.

You have to understand them to use them correctly and to lead the work they represent.

Every medical school likely has a leader responsible for diversity, but not health equity exclusively.

Advancing diversity and equity are both imperatives, but they are not the same thing.

I arrived at Dell Med, prepared to explain to people what equity is and what it isn't, what I was there to do and what I wasn't, consistently reminding people that advancing equity was an institutional responsibility, not just mine.

I explained that health equity, assuring that everyone has a fair and just opportunity to be as healthy as possible requires addressing the roots of injustices, such as poverty and poor education, housing and medical care, to close the disparities and disease and death among marginalized and minoritized people.

And that health is the composite of one's emotional, social and physical wellbeing.

As a doctor, I have seen too many people suffer chronic disease and premature death because they lack one, two, or all three.

In medicine, we don't always distinguish health from medical care and equity can be misunderstood as equality, disparities, entitlements or redistribution, sometimes triggering reactions that people just need to pull themselves up by the bootstraps.

Additionally, even as society has acknowledged the deadly impact of social and structural inequities on health, there can be a tendency to medicalize social problems.

We don't always train doctors to treat social problems.

For example, teaching them to partner with communities to address food insecurity, instead of modeling how to counsel poorly nourished people to just eat better.

When asked what kind of a person can be a leader for health equity?

I suggest someone who can lead through complexity, misunderstandings, resistance to change, politics and competing priorities.

Someone who allows history and context to inform efforts to advance social justice.

Someone who can build a policy to advance social change inside an organization so that we can be of better service to people outside of it.

Someone whose work is inspired by the drum beat for justice, Dell Med's mission states that we will revolutionize the way people get and stay healthy, equity implies all people.

That means I was hired to help lead a revolution, revolution.

I have not yet figured out whether that word gives people more poor pause than another R word, racism.

Thanks to Ibram X. Kendi and others, discussing racism may be less polarizing than discussing revolution.

Words have so much meaning and nuances matter.

So I socialize the word revolution by encouraging colleagues to consider how we reward people who have revolutionary ideas, calling them disruptors, but shun those who promote revolution, considering them disruptive.

Still as the world reels in the face of the COVID pandemic and the resurgence of overt, racist and violent acts, I worry that some organizations have gotten more comfortable promoting anti-racism than they have recognizing and undoing racist policies they continue to nurture.

In building a culture of health equity, I have conceptualized the 5 R progression to represent where various people are located on our journey to advance it.

These 5 R's have become the scaffolding we have to climb to achieve it.

At the base, some people are at a point of reflection, they think about it.

Others contend there has been too much attention to equity, or they suggest it's not their job, they retreat.

Some are stuck in resignation, good luck, they tell me, believing nothing will ever change since culture, politics, money, racism, privilege, and power imbalance will always be blockades.

Some people engage in reformation.

They may tweak some things and chip away at the edges of our organizational processes while preserving the status quo.

Real transformation, revolution is our long-term goal.

We're not there yet, but I'm incrementally moving our organization to climb the scaffold with me, or eventually meet me at the top.

Not everyone will catapult to revolution.

Along the way, rather than sidelining racism, we have started to acknowledge how it exacerbates inequities.

I believe some version of the 5R progression exists in many organizations and in sectors trying to embed equity in their cultures.

If you are advancing equity, I hope this way of thinking about it, this kind of cultural transformation is useful.

If so, please differentiate equity from diversity while stressing the need for both.

And as our institutions confront structural inequities, hopefully they will avoid another R word, recitation.

Reciting anti-racist goals is not really action, nor is it revolutionary.

When I first started talking about my 5 R's, I wasn't sure whether including revolution would move me closer to success or to an early exit from my job.

Not that long ago, Dr. Joycelyn Elders, the former U.S.

Surgeon General, who was often criticized for her own choice of words, reminded me that the hardest word in the dictionary is really a C word, change.

I can't imagine a mission statement that says, we are going to change the way people get and stay healthy.

It's not very compelling.

I'll stick with revolution.

Revolutionary, maybe not, a matter of life or death, definitely.

(jazz music) - The start of the COVID 19 pandemic last year, marked the beginning of a new race to develop a vaccine for the disease.

By December, a winner had emerged when the CDC announced that it had provided emergency use authorization for the vaccine developed by Pfizer.

A few weeks later, a relative of mine called Tony was asked whether he would take vaccine he had just had a baby daughter.

And he was asked because we were concerned that that would help to protect the little baby.

Surprisingly, Tony declined to take the vaccine.

He was skeptical, he did not believe that it would make a difference in his life.

Most people believed that the very first vaccine was created by a man called Dr. Edward Jenner, who was a British scientist who developed the very first vaccine for smallpox.

Before then, smallpox was a deadly disease, which killed millions of people.

But seems a Dr. Jenner's vaccine was developed, scientists have been able to produce vaccines for a range of diseases, including hepatitis, measles, and now COVID 19.

Vaccinating all Americans to prevent the spread of COVID is now theoretically possible.

However, progress towards this goal has been hampered by concerns that Blacks are skeptical about vaccines.

These concerns are consistent with the evidence.

One study showed that only 41% of Blacks intend to take the vaccine, compared to 60% of whites and Hispanics and about 83% of Asians.

Are Blacks afraid of vaccines?

Are they unaware of the benefits the vaccines can provide?

From my perspective, these questions are distracting, and ignore the long history of Black involvement in the production and the use of vaccines.

You see, Blacks were among the very first Americans to use a form of vaccination to protect themselves from disease.

In 1721, more than 70 years before Dr. Jenner developed his vaccine, Onesimus, an African slave in Massachusetts taught his master, how he and all the slaves were able to develop immunity against the disease.

The process was simple.

They took pus from someone who was infected with smallpox and applied it to an open wound of someone who was uninfected.

This leads to the production of antibodies that helps to protect them from disease.

The process is also known as variolation and it has been practiced in Africa for hundreds of years before being brought to the United States by Black slaves.

Today, Black scientists are also actively involved in vaccine research and production.

In fact, Dr. Kizzmekia Corbett, a Black scientist at the National Institutes of Health played a leading role in the development of Moderna's COVID-19 vaccine.

What then explains why Blacks have the lowest levels in terms of their intentions to take the vaccine?

We can start from the legacy of broken trust and a history of the abuse of Black bodies to advance medical science.

It started during the period of slavery when Black slaves were routinely funneled into medical schools to provide patients that could be used to teach white students.

It continued in the 20th century with the Tuskegee study on the natural history of syphilis in the Negro male.

As part of the study, approximately 400 Black males with the disease were recruited without proper informed consent and were followed for a period of about 40 years without receiving adequate treatment for the disease.

Beyond the U.S. borders, this pattern of abuse is more prevalent in Africa where poor, voiceless and powerless people are easily accessible.

When I was conducting the research on the Ebola epidemic in West Africa and met a man who lost five members of his family to Ebola in one week.

Sadly, newsy pots now indicate that blood samples were from about 200 West Africans with the disease, possibly including the relatives of this man.

And these samples were sent abroad by scientists for research, without consulting the Africans who were themselves affected by the disease.

Things have not improved with the onset of the COVID-19 pandemic, in fact, to French doctors discussing how COVID 19 vaccine should be tested on live TV, suggested that the vaccine should be tested, not on a French nationals, but on Africans, yes, on Africans.

Apart from this pattern of abuse, there are all the factors that explain vaccine skepticism among Blacks.

One of these is having regular access to a healthcare provider.

Research indicates that vaccination rates are typically higher among people who regularly see a healthcare professional.

There's just one problem with this.

Blacks have the lowest rates of health insurance coverage, and as a result, they experience greater financial barriers to receiving regular healthcare.

When they do see healthcare professionals, they encounter all the barriers as well.

Research shows, for example, that the level of care received by a Blacks is typically lower than the level of care received by white patients.

Not surprisingly, scholars argue that these differences in levels of care received, could further explain why a Blacks are typically hesitant to take vaccines.

So how then do we move on from here?

achieving the goal of higher vaccination rates among Blacks requires significant shifts in the negative on Black health.

When this narrative is dominated by a focus on vaccine skepticism, we miss the forest for the trees.

Of more value is the need to place the concerns of Blacks, within a larger conversation on the need to improve their overall experiences in the healthcare system.

Such improvements would be much more holistic and not only address the problem of low vaccination rates, but all the more serious outcomes as well.

Are Blacks afraid of vaccines?

Don't let this question distract you from the larger issue of addressing the overall health concerns of Blacks.

You see, low vaccination rates do not imply that Blacks are afraid of vaccines, instead they're a symptom of a larger problem and that problem is the problem of racial inequalities in the U.S. healthcare system, thank you very much.

(jazz music)