♪ ♪ YES, VIRGINIA, YOUR ZIP CODE MAY IN FACT BE A BETTER PREDICTOR OF YOUR HEALTH THAN YOUR GENETIC CODE.

STAY WITH US AS WE TALK WITH Dr. JOHN CHENAULT ABOUT THE SOCIAL DETERMINANTS OF HEALTH AND HOW THEY EFFECT US NEXT ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS PROVIDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

>> WE NOW RECOGNIZE THAT ROUGHLY 20% OF A PERSON'S HEALTH IS ACCOUNTED FOR BY THE HEALTHCARE THAT THEY RECEIVE AND THAT THE REMAINING 80% OR SO IS A CONSEQUENCE OF IDENTIFIABLE SOCIAL, POLITICAL DETERMINANTS OF HEALTH.

THESE SOCIAL POLITICAL DETERMINANTS OF HEALTH CAN BE BROKEN DOWN INTO THREE BROAD CATEGORIES.

ONE IS SOCIAL ECONOMIC FACTORS SUCH AS EDUCATION, EMPLOYMENT, FAMILY, SOCIAL SUPPORT, INCOME AND COMMUNITY SAFETY.

2: HEALTH BEHAVIORS SUCH AS TOBACCO USE, DIET AND EXERCISE, ALCOHOL USE AND SEXUAL ACTIVITY.

AND FINALLY 3: THE PHYSICAL ENVIRONMENT IN WHICH WE WORK AND LIVE.

SADLY, THE DIFFERENCES THAT WE NOW SEE IN HEALTH OUTCOMES BETWEEN GROUPS IS REFLECTIVE OF OUR HISTORY AND EXPERIENCE WITH OUR CURRENT ITERATION OF RACISM.

WE MAY CHOOSE TO DENY OR OBFUSCATE RACISM'S IMPACT BUT SADLY IT'S REAL AND NOT RIGHT.

TO TAKE US THROUGH THE SOCIAL POLITICAL DETERMINANTS OF HEALTH AND HOW THESE AND OTHER FACTORS NEGATIVELY IMPACT THE HEALTH FOR US ALL, WE HAVE AS OUR GUEST TODAY Dr. JOHN, CHENAULT.

Dr. CHENAULT OBTAINED A MASTERS OF LIBRARY AND INFORMATION SCIENCES FROM THE UNIVERSITY OF KENTUCKY AND EARNED BOTH AN M.A.

AND Ph.D.

IN PAN AFRICAN STUDIES FROM THE UNIVERSITY OF LOUISVILLE, A TRUE RENAISSANCE MAN.

Dr. CHENAULT IS AN ACCOMPLISHED MUSICIAN, LIBERTIST, POET AND PUBLISHER OF TWO BOOKS OF POETRY AND AUTHOR, PLAYWRIGHT AND NOMINATED FOR AN EMMY AWARD FOR THE SCRIPT FOR THE TELEVISION DRAMA YOUNG MEN GROW OLDER.

CURRENTLY Dr. CHENAULT IS THE DIRECTOR OF ANTI-RECIDIVISM ANTIRACISM INITIATIVES FOR THE OFFICE OF UNDERGRADUATE MEDICAL EDUCATION AT THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE.

Dr. SHE FAULT.

THANK YOU FOR BEING WITH US TODAY.

>> THANK YOU FOR INVITING ME TODAY.

>> I ALWAYS HAVE TROUBLE WITH EMMIES BECAUSE I WANT TO SAY ENEMAS.

A LONG HISTORY OF WORK.

I DON'T KNOW WHY.

I APOLOGIZE FOR STUMBLING OVER YOUR RECOGNITION.

>> THAT'S OKAY.

>> WHAT EXACTLY IS BEING A DIRECTOR OF ANTIRACISM NISHS INITIATIVES AT A MEDICAL SCHOOL ENTAIL?

>> IN MY CASE, THIS POSITION CAME ABOUT ON THE TAIL END OF THE BREONNA TAYLOR GEORGE FLOYD PROTEST THAT ROYALED THE COUNTRY AND MEDICAL SCHOOLS ACROSS THE COUNTRY WERE LOOKING AT HOW TO ADDRESS THE ISSUES OF RACISM WITHIN MEDICAL EDUCATION.

SO WHAT I GUESS WE COULD SAY, TO SORT OF SET THE STAGE FOR THIS, FOR THIS POSITION IN MY WORK, IS THAT MEDICINE IN THIS COUNTRY HAS BEEN BASED ON RACE AS A BIOLOGICAL CONSTRUCT SINCE THE 1700s.

AND THAT'S A FALSE CONSTRUCT.

AND SO MUCH OF WHAT MY JOB HAS BEEN DEVOTED TO IS EXPOSING THE HISTORY BEHIND THAT AND SHOWING HOW WE SHOULD GO THROUGH THE CURRICULUM INSTRUCTION, ET CETERA, AND PRACTICE, CLINICAL PRACTICE AND UPROOT THAT OLD IDEOLOGY, WHICH IS BASICALLY MEDICAL MALPRACTICE.

YOU CANNOT PRACTICE MEDICINE ON THE BASIS OF RACE.

HUMAN BEINGS ARE 99.9% IDENTICAL GENETICALLY SPEAKING.

AND ALL OF US ARE ADD MIXED.

WE ARE ALL MIXED WITH EACH OTHER OVER THOUSANDS AND THOUSANDS OF YEARS.

SO YOU CAN'T ISOLATE A GROUP AND SAY THEY'RE ONLY-- THEIR GENETIC HISTORY IS JUST THIS AND THEY'RE SEPARATE FROM ALL OTHER POPULATIONS.

THAT'S NOT POSSIBLE.

SO WE HAVE THIS COMMONALITY AS A RESULT OF OUR EVOLUTION.

WE HAVE IGNORED THAT HISTORICALLY AND TREATED PEOPLE ON THE BASIS OF THEIR OUTWARD PHYSICAL APPEARANCE, THEIR HAIR, TEXTURE, THEIR SKIN TONE, THEIR FACIAL FEATURES.

TRUST ME.

WHEN INFECTIOUS DISEASES OCCUR SUCH AS COVID, IT DOES NOT STOP AND OBSERVE A PERSON'S CHARACTERISTICS.

IT AFFECTS ALL HUMANS AND ANIMALS AS WELL.

>> YOU RAISE AN INTERESTING POINT.

NUMBER ONE, I'VE OFTEN WONDERED ABOUT RACE.

WHEN YOU SAY SOMEONE IS BLACK OR AFRICAN-AMERICAN PART OF THAT IS AN ETHNIC DEFINITION BUT WHEN WE TALK ABOUT AS RACE, ARE WE TALKING ABOUT BLACK, SOMEONE THAT IS SALLY HEMMINGS WHO IS THE, YOU KNOW, WITH THOMAS JEFFERSON OR TALKING ABOUT SOMEONE AS WE USED TO SAY BACK HOME WHO IS SO BLACK, THEY'RE BLUE BLACK.

I MEAN IF THEY'RE SUPPOSED TO CARRY THE SAME RACIAL BEHAVIOR FROM A MEDICAL PERSPECTIVE?

>> THAT'S THE FLAW IN THAT THEORY.

THAT'S THE PROBLEM WITH THAT THEORY.

NOT ONLY WAS SALLY HEMMINGS' FATHER WHITE, SHE SHARED THE SAME FATHER WITH MARTHA JEFFERSON, THOMAS JEFFERSON'S WIFE.

SHE WAS HIS HALF SIS-- HE WAS HER HALF SISTER, THE AUNT TO JEFFERSON'S CHILDREN.

PEOPLE WHO OBSERVED THAT HOUSEHOLD IN PARTICULAR WERE STUNNED BY THE RESEMBLANCE OF SALLY'S CHILDREN BY THOMAS WITH THOMAS HIMSELF.

IT WAS UNMISTAKABLE WHO THE FATHER WAS.

YET, BECAUSE OF THE LAWS OF THE VIRGINIA, WHICH WERE BASED ON WHAT WAS CALLED BLOOD QUANTUM, IN OTHER WORDS, THE PERCENTAGE OF AFRICAN ANCESTRY A PERSON HAD, JEFFERSON'S CHILDREN, ALTHOUGH SOME OF THEM COULD, WHAT WE CALL PASS FOR WHITE, WERE CLASSIFIED AS ENSLAVED INDIVIDUALS.

DOESN'T MATTER MA THEIR SKIN COLOR WAS.

WHAT MATTERED AND WHAT DETERMINED SLAVERY IN THIS NATION WAS THE STATUS OF THE MOTHER.

AS A 1642 THAT LAW WAS PASSED IN VIRGINIA.

THE STATUS OF THE MOTHER DETERMINED THE STATUS OF THE CHILD.

SO IF THE MOTHER WAS ENSLAVED, THE CHILDREN WOULD BE BORN INTO SLAVERY.

SO SLAVERY WAS MADE HER READ AREA-- HER READ TRI.

ER READ TERRY.

AND MANY OF THE CHILDREN THAT WERE BORN HAD WHITE FATHERS.

>> YOU MENTIONED A VIRUS DOESN'T REALLY CARE IF ONE IS CONSIDERED BLACK OR WHITE.

BUT IF YOU LOOK AT MALARIA AND ADAPTIVE RESPONSE TO THE PARASITE, WHEN YOU HAVE HEMOGLOBE INSICKLE-CELL, IS THAT MORE OF A GEOGRAPHIC ADAPTATION AS OPPOSED TO A GENETIC IN THE SENSE OF THIS IS A BLACK THING VERSUS THIS IS A WHITE THING?

>> SO YOU HIT ON ONE OF THE MAIN PROBLEMS IN OR DEALING WITH RACE-BASED MEDICINE AND THIS IDEA THAT THERE IS CERTAIN DISEASES THAT CLUSTER BASED ON RACE.

THEY CLUSTER BASED ON THE GEOGRAPHIC LOCATIONS.

SO FOR EXAMPLE, SICKLE-CELL ANEMIA IS THE DISTRIBUTION OF MALARIA, SO THIS IS AN INSECT BORN MOSQUITO BORN DISEASE.

WE SEE SICKLE-CELL IN THE MIDDLE EAST IN THE MEDITERRANEAN, IN WEST WEST WEST AFTERSHOCK-- WITH WEST AFRICA AND SOVIET UNION ASIA, WHERE THIS STRAIN EXISTS THAT YOU HAVE SICKLE-CELL.

NOW SICKLE-CELL EVOLVED AS A MUTATED GENE TO HELP PEOPLE SURVIVE MALARIA, AND SO ONE PARTICULAR GENE WOULD BE AFFECTED AND THIS RESULTED IN A DECREASING OF THE LONGEVITY OF THE HEMOGLOBE HEMOGLOBIN IN THE BLOOD.

IT SHORTENED THE LIFE EXPECTANCY BUT NOT FOR THE SINGLE GENE CARRIER THAT IT WOULD MAKE THEM ILL BUT IT WAS ENOUGH TO TAKE OUT THE EXCRETE THE INFECTIONS FROM THE MALARIA INFECTION SO THE PERSON COULD RECOVER.

THE PROBLEM BECAME WHEN TWO CARRIERS OF WHAT IS CALLED THE TRAIT OR THE INFECTED GENE REPRODUCED, THERE WAS A 25% CHANCE, WITH EACH PREGNANCY, THAT THE CHILD BORN FROM THAT WOULD INHERIT BOTH GENES AND IN THAT CASE, THEY HAVE DEVELOPED SICKLE-CELL ANEMIA.

THEY WOULD HAVE SICKLE-CELL ANEEM EXTRA WHEN MEANS THE MAJORITY OF THEIR BLOOD CELLS WOULD TAKE ON ABNORMAL SHAPE AND TAKE ON SIGNIFICANT HEALTH PROBLEMS, PAIN, STROKES, ET CETERA, SHORTENED LIFE EXPECTANCY.

>> EXACTLY.

>> WE CAN LOOK AT THAT AND UNDERSTAND THAT YOU CAN'T CLUSTER THESE DISEASES BASED ON SKIN COLOR OR SO CALLED ETHNICITY.

IT'S ABOUT THE GEOGRAPHICAL SPREAD OF THOSE MOSQUITOES AND THEIR IMPACT.

ANOTHER EXAMPLE HAS TO DO WITH SOME FORMS OF KIDNEY DISEASE.

SO WE NOW UNDERSTAND THAT THERE ARE SOME WEST AFRICAN-- FOR AFRICAN-AMERICAN WEST AFRICAN POPULATIONS THAT UNDER WENT A GENETIC MUTATION TO SURVIVE SLEEPING SICKNESS BORN BY THE TSI SUPPLY.

SO ANOTHER INSECT BORN DISEASE OF SIGNIFICANT VIRULENCE, MAJOR CAUSE OF MORBIDITY IN THAT REGION, A GENETIC ADAPTATION THAT HAD TO DO WITH METABOLIZING CALCIUM THAT HELPED TO KEEP THAT INDIVIDUAL ALIVE AND HELP THEM SURVIVE.

HOWEVER, THAT TRIGGERED SOME KIDNEY PROBLEMS IN THOSE PEOPLE WHO INHERITED THAT GENE.

SO SO THAT'S HOW NATURE IS.

WE CONSTANTLY ARE ADAPTING.

BUT THAT DOESN'T MEAN BECAUSE WE SUCCESSFULLY ADAPT TO ONE SET OF PROBLEMS THAT IT DOESN'T CREATE OTHER METABOLIC PROBLEMS DOWN THE ROAD.

>> THERE IS A-- WE ARE ALL BORN WITH A BLUEPRINT, OUR DNA, AND I THINK, WHICH WE TRADITIONALLY HAVE SAID GENETICS BUT OF COURSE YOU NOW ARE HAVING THIS NEW SCIENCE OF EPI GENETICS, THANKS THAT AFFECT HOW THAT DNA IS GOING TO BE EXPRESSED.

WHAT IS GOING TO TURN THINGS ON.

AND I THINK THAT HAS GOT TO GET US AWAY FROM THIS TERM OF RACE-BASED MEDICINE TO ONE OF IT'S PROBABLY GEOGRAPHIC, WHERE YOU ARE.

THINGS IN YOUR ENVIRONMENT THAT IMPACT YOU.

>> THAT AND WHEN WE TALK ABOUT EPI GENETICS, WE ARE TALKING ABOUT, IN THE CASE OF AFRICAN-AMERICANS AND OTHER PEOPLE THAT HAVE EXPERIENCED DISCRIMINATION, OPPRESSION ETC., WE ARE TALKING ABOUT THE INTERGENERAL RAKESAL TRANSFER OF TRAUMA SO WE ARE JUST GETTING A HANDLE ON THAT.

IN EPI GENETICS WE KNOW THERE ARE TURNING ON AND OFF OF GENES BUT THE TRAUMA THAT INDIVIDUALS EXPERIENCE, WOMEN EXPERIENCE IT COULD BE YOUR GRANDMOTHER OR MOTHER AND SLAVES GOING THROUGH JIM CROW, TRAUMATIZING EXPERIENCES, THEY MANIFEST IN MAYBE LOW BIRTH WEIGHT, AND THERE COULD BE OTHER FACTORS FOR THE CHILDREN.

BUT THEY COME INTO THE WORLD IMPACTED BY WHAT HAS HAPPENED A GENERATION OR TWO AGO.

THAT'S BEYOND THEIR COMPREHENSION, CONTROL, YOU KNOW, AND WE ARE JUST NOW BEGINNING TO UNDERSTAND THAT.

>> I THINK WE TOO OFTEN ASK ABOUT EVENTS THAT HAPPENED TO YOUR MOTHER, BUT THE REAL QUESTION IS WHAT HAPPENED TO YOUR GRANDMOTHER BECAUSE THAT IS-- >> THAT IS THE QUESTION.

>> TELL ME A LITTLE BIT ABOUT WHAT IS TYPICALLY CALLED SOCIAL DETERMINANTS OF HEALTH.

WHAT I PREFER THOUGH, POLITICAL DETERMINANTS.

YOU MAY COMBINE THE TWO BECAUSE THESE ARE NOT HAPPENSTANCE EVENTS FROM MY PERSPECTIVE.

BUT PLEASE.

>> THEY'RE NOT AND SO THIS CONCEPT COMES ABOUT IN THE 1970s.

AND THE AUTHOR OF IT IS A BRITISH EPIDEMIOLOGIST NAMED MICHAEL MARMAK AND HE DETERMINES THAT EVERY SECTOR OF SOCIETY CONSTITUTES A HEALTH SECTOR THAT HAS AN IMPACT ON AN INDIVIDUAL'S WELLNESS AND WE'LL BEING.

AND THOSE SECTORS ARE EDUCATION, TRANSPORTATION, HOUSING INSURANCE, HEALTH INSURANCE, ET CETERA.

AND SO WE CAN UNDERSTAND, JUST ON THE SURFACE, THAT IF THERE IS A LACK OF ANY OF THOSE OR IF, FOR EXAMPLE, YOUR HOUSING IS POOR, YOU LIVE IN AN ENVIRONMENT THAT IS HEAVILY POLLUTED, THESE ARE FACTORS AND DETERMINE NANTS OF YOUR HEALTH STATUS-- DETERMINANTS OF YOUR HEALTH STATUS IRRESPECTIVE WHERE YOU MAY START IN LIFE.

YOU MAY BE BORN HEALTHY AND WELL AND READY FOR THE WORLD, BUT YET YOU ARE LIVING IN THIS CIRCUMSTANCE WHERE YOU DON'T HAVE ACCESS TO THE BASICS THAT YOU NEED TO MAINTAIN AND PRESERVE YOUR HEALTH.

THAT'S WHERE THAT THEORY COMES FROM.

IT CALMS FROM SAYING HOW DIFFERING LEVEL OF ACCESS TO FOOD, ET CETERA, ET CETERA, IMPACT THE PERSON'S HEALTH.

>> IN MEDICAL TRAINING, AND I'M NOT THAT FAR REMOVED FROM BEING IN MEDICAL SCHOOL OR RESIDENCY-- OR MAYBE I I AM THAT FAR REMOVED.

WE ARE VERY COMFORTABLE WITH THE BIO MEDICAL ASPECTS.

BUT PERHAPS, AS YOU ARE INTIMATING, WE ARE NOT SO GOOD ON THE BIO CYCLE SOCIAL THINGS-- PSYCHOSOCIAL THINGS.

>> THAT'S CORRECT.

>> WHAT IS THE DIFFERENCE AND HOW DO YOU SEE THAT?

>> THERE IS A HISTORY, SINCE THE EARLY 20th CENTURY, OF TRAINING DOCTORS TO FOCUS ON IDENTIFYING, THROUGH DIAGNOSTICS WHAT IS THE PROBLEM.

COMING UP WITH A COURSE OF THERAPY, WHETHER IT'S PHARMACEUTICAL, SURGICAL, WHATEVER IT MAY BE, AND LOOKING AT THE PROGNOSIS AND WHAT IS GOING TO BE THE OUTCOME OF THAT, RIGHT?

THAT'S THE MODEL.

BUT THAT MODEL DID NOT TAKE INTO ACCOUNT THE PSYCHOLOGY OF THE PERSON INVOLVED AND/OR THE ENVIRONMENT.

NO ONE WAS QUESTIONING, YOU KNOW, WHEN A PATIENT CAME INTO THE OFFICE, WELL, WHERE DO YOU LIVE?

AND HOW DO YOU LIVE?

AND THOSE THINGS ARE CRITICAL BECAUSE MANY MINORITIZED PEOPLE, LATINOS AND AFRICAN-AMERICANS LIVE IN THE MOST POLLUTED COMMUNITIES IN THE NATION.

SO, YOU KNOW, THAT IS IMPORTANT TO BE ABLE TO ACCESS AND ASSESS BUT THAT HAS NOT BEEN PART OF THE MEDICAL EDUCATION.

IT HAS BEEN IN SOME INSTANCES, PARTICULARLY FAMILY MEDICINE, BUT GENERALLY SPEAKING, IT WAS NOT WIDELY EMBRACED ACROSS ALL SPECIALTIES IN MEDICINE, SO THAT'S A MAJOR DEFICIT.

SO WE HAVE TO MOVE TO INSTILL AND INCORPORATE THAT UNDERSTANDING, THAT A PERSON'S WELLNESS IS A HOLISTIC PROCESS.

IT'S NOT JUST A SHEET OF DATA WHERE YOU SEE, AGAIN THE BLOOD PRESSURE, THE BLOOD LEVEL, YOU KNOW, THE A1C AND ON DOWN THE LINE.

ALL THOSE THINGS CAN LINE UP PERFECTLY SO THAT THE PERSON PRESENTS A DATA SET THAT LOOKS LIKE THEY'RE IN OPTIMUM HEALTH BUT IN REALITY, WAS GOING ON INSIDE IN TERMS OF THEIR PSYCHOLOGY, THEIR MALADAPTATION TO THEIR CIRCUMSTANCES, THEIR STRUGGLE TO DEAL WITH THEIR CIRCUMSTANCES, THAT MAY BE UNDETECTED AND IGNORED.

>> HEALTH IS NOT MERELY THE ABSENCE OF DISEASE.

>> CORRECT.

>> SO WHAT YOU ARE TALKING ABOUT , WHO IS GOING TO LOOK AT THESE THINGS?

THE PSYCHOSOCIAL ISSUES THAT ARE IMPACTING HEALTH?

>> SO A LOT OF THIS COMES OUT FROM PUBLIC HEALTH EXPERTS WHO ARE LOOKING AT THE FACT THAT ALL HEALTH IS PUBLIC HEALTH.

SEE THAT'S WHAT WE HAVE TO GET TO UNDERSTANDING.

COVID SHOULD HAVE TAUGHT US THAT.

THAT YOU CAN HAVE A GATED COMMUNITY WITH MULTIMILLION DOLLAR HOMES, COVID DOESN'T CARE.

THE GATE MEANS NOTHING.

>> YOU MEAN STANDING IN FRONT OF MY HOUSE WITH MY GUNS IS NOT GOING TO-- >> COVID IS NOT GOING TO PAY ATTENTION TO THAT.

SO ALL HEALTH IS PUBLIC HEALTH.

YOU CANNOT WALL YOURSELF AWAY FROM THESE PROBLEMS.

SO THE PEOPLE THAT HAVE DONE THE MOST WORK ON THIS HAVE BEEN EPIDEMIOLOGISTS, PEOPLE IN THE PUBLIC HEALTH ARENA WHO ARE OBVIOUSLY LOOKING AT THE TRANSMISSION OF DISEASES ACROSS MILLIONS OF PEOPLE AS WE EXPERIENCED WITH COVID AND THE CAUSES OF AND THE LOSSES OF LIFE FROM THAT.

NOW LET ME SAY THAT THE SOCIAL DETERMINANTS OF HEALTH ONLY TAKE US SO FAR.

SO WE HAVE TO LOOK AT FUNDAMENTAL CAUSES.

>> OKAY.

>> FUNDAMENTAL CAUSE THEORY COMES ABOUT IN 1995.

IT'S THE CONCEPTION OF TWO PUBLIC HEALTH RESEARCHERS, JOE PHELAN AND JOSH LINK AND THEY DEVISED A THEORY AND THEY WANTED TO EXPLAIN WHY THE ASSOCIATION BETWEEN SOCIOECONOMIC STATUS AND HEALTH DISPARITIES PERSIST OVER TIME BUT EQUALLY IMPORTANT, THEY FOUND THAT RACE OUTWEIGHS THOSE SOCIAL ECONOMIC FACTORS.

AND BY THAT I MEAN THIS.

AND WE HAVE SO MANY EXAMPLES OF THIS.

THEIR THEORY EXPLAINS THE STATISTICAL ANOMALY, FOR EXAMPLE, OF WHITE WOMEN WITH THE LOWEST SOCIOECONOMIC STATUS IN THIS COUNTRY AND BY SOCIOECONOMIC STATUS, WE ARE TALKING ABOUT THEY DON'T HAVE HIGH SCHOOL DIPLOMA.

THEY DON'T HAVE-- THEY'RE ON LOW WAGE OR LIVING BELOW THE POVERTY LINE.

THEY DON'T HAVE ACCESS TO HEALTHCARE, ET CETERA.

BUT WHAT THEY DO HAVE IS A BETTER OUTCOME IN TERMS OF INFANT BIRTHS THAN AFRICAN-AMERICAN WOMEN WHO HAVE Ph.D.s, WHO ARE AT THE HIGHEST SOCIOECONOMIC STATUS IN THIS COUNTRY.

THIS IS NOT AN ANOMALY OR STATISTICAL OUTLIER.

I PRODUCE PRESENTED ON THIS 35 YEARS AGO TO THE NATIONAL ASSOCIATION OF SOCIAL WORKERS AND IT HAS NOT CHANGED.

AFRICAN-AMERICAN WOMEN WITH THE HIGHEST SOCIOECONOMIC STATUS IN THIS COUNTRY HAVE A HIGHER INFANT MORTALITY RATE THAN WHITE WOMEN WITH THE LOWEST SOCIOECONOMIC STATUS IN THIS COUNTRY.

FUNDAMENTAL CAUSE THEORY EXPLAINS THAT.

IT EXPLAINS THAT RACISM, SYSTEMIC RACISM IS UNDERNEATH ALL THESE OTHER ISSUES.

IT DRIVES FOOD INSECURITY, HOUSING INSECURITY, INCOME DISPARITIES, ALL OF THAT, WHICH ALL CONTRIBUTE TO THESE NEGATIVE HEALTH OUTCOMES, TO HIGHER INFANT MORTALITY, TO HIGHER MORBIDITY AND MORTALITY IN OUR COMMUNITY FROM ALL CAUSES.

SO WHEN YOU LOOK AT THE DATA, AND IT'S REALLY STATISTICAL NOISE BECAUSE WHEN WE LOOK AT THE DATA, WE ARE LOOKING AT EACH POINT REPRESENTS A FAMILY, A PERSON BUT WHAT WE HEAR WHEN THE MEDIA PRESENTS THIS IS AFRICAN-AMERICANS HAVE THE HIGHEST INCIDENTS OF PROSTATE CANCER, KIDNEY DISEASE, BREAST CANCER OF CERTAIN TYPES, ET CETERA, ET CETERA SO IN A SENSE, IT'S BLAMING THE VICTIM.

IT'S IDENTIFYING AFRICAN AMERICANS AS SOMEHOW DIFFERENT, THERE IS SOMETHING WRONG WITH THE BLACK BODY, RIGHT?

SO THAT'S WHAT RACISM FEEDS INTO, THIS MOTION WELL THERE IS SOMETHING ABOUT THEM THAT'S WHY THEY'RE NOT HEALTHY.

WHAT THAT DOESN'T TELL US DOESN'T ADDRESS THE LIVING CONDITIONS, THAT'S WHAT FUNDAMENTAL CAUSE THEORY TALKS ABOUT WHEN TALKING TO A PARTICULAR GROUP OF AFRICAN-AMERICANS, YOU OFTEN TIMES HEAR IT AS YOU'VE GOT BAD GENES AND HAVE I TO REMIND PEOPLE UNLESS YOU ARE WEARING JEANS THAT HAVE HOLES IN THEM, AND IT'S 0 DEGREES OUTSIDE, THOSE ARE THE ONLY BAD JEANS I'M AWARE OF.

YOU DON'T HAVE BAD GENES BUT WHAT IS GOING ON IS A FACTOR OF YOUR ENVIRONMENT.

IT SEEMS AS THOUGH THE CURRENT TREND IS TO PUT RESPONSIBILITY UPON THE INDIVIDUAL FOR THEIR POOR HEALTH OUTCOMES AND NEGATE ALL THESE OTHER THINGS IS THAT EFFECTIVELY WHAT MEDICAL RACISM LOOKS LIKE.

>> THAT'S WHAT MEDICAL APARTHEID LOOKS LIKE AND IT'S NOT JUST IMPACTING AFRICAN-AMERICANS IN THIS COUNTRY EITHER.

SO YES, BLAME THE VICTIM.

DON'T DO ANYTHING TO THINK ABOUT WHAT ARE THE FUNDAMENTAL CAUTION CAUSES OF THESE PROBLEMS AND FOR AFRICAN-AMERICANS AND LATINOS AND OTHER RACIALIZED PERSONS IN SOCIETY, THE FUNDAMENTAL CAUSE OF THESE PROBLEMS BREAK OUT INTO TWO CATEGORIES RED LINING AND RED LIKING HISTORICALLY MEANS GOING DENIED ACCESS TO HOUSING LOANS, ET CETERA.

I EXPAND THAT TO INCLUDE OCCUPATIONAL RED LINING, KEEPING PEOPLE IN THE LOWEST WAGE JOBS AND PAYING THEM LESS THAN WHITE FOLKS WHEN THEY DO THE SAME JOB WITH THE SAME SKILLS, ET CETERA.

THE OTHER IS BLUE LINING AND THAT'S OVER POLICING POLICE ARE USED TO PROTECT THE RED LINE COMMUNITY AND MAINTAIN THE BOUNDARIES AND BORDERS OF THE RED LINE COMMUNITIES.

BUT MORE IMPORTANTLY, POLICING IS USED TO EXTRACT IMMENSE AMOUNTS OF MONEY OUT OF THOSE POOR COMMUNITIES.

THROUGH COURT SUMMONS FEES AND FINES FINES AND TICKETS, ET CETERA, ET CETERA ONE EXAMPLE SINCE 2000, THE CITY OF NEW YORK HAS EARNED A HALF A BILLION DOLLARS ON FEES, SUMMONS, TICKETS.

IMPOSED ON THE POOREST COMMUNITIES IN NEW YORK CITY.

>> THAT'S FUNNY, WE ALL SHEAR ABOUT FERGUSON DOING IT-- LET ME ASK YOU THOUGH.

BRIEFLY.

HOW IS THE MEDICAL COMMUNITY TAKING TO THESE DISCUSSIONS?

ARE MEDICAL STUDENTS WILLING TO SIT DOWN AND HEAR THIS KIND OF THING OR ARE THEY SAYING LOOK, I HAVE TOO MUCH TIME TO WORRY ABOUT HOW DIABETES GOES, HEART DISEASE, HOW TO ORDER THE CT SCAN OR ARE PEOPLE RECEPTIVE TO THIS?

>> MY EXPERIENCE IS THAT MOST MEDICAL STUDENTS ARE EXTREMELY RESIPTIVE TO THESE ISSUES AND MANY OF THEM ARE ALREADY, BEFORE THEY COME TO MEDICAL SCHOOL VOLUNTEERING IN THEIR COMMUNITIES TO ADDRESS SOME OF THESE ISSUES.

THERE ARE A LOT OF VERY, VERY CONCERNED AND DEDICATED STUDENTS WHO ARE REALLY TRYING TO MOVE MEDICINE FORWARD.

THERE ARE OTHERS, HOWEVER, AND I SAY THIS IS A MAUL MINORITY-- A SMALL MINORITY THAT VIEW THIS AS AN IMPOSITION, AS SOMETHING THEY DON'T NEED TO DEAL WITH IN LEARNING, YOU KNOW, IN UNDERSTANDING AND MATRICULATING THROUGH THE MEDICAL CURRICULUM.

SO OUR PROBLEM IS THIS: THIS TYPE OF INFORMATION SOCIAL DETERMINANTS OF HEALTH, FUNDAMENTAL CAUSES, IS NOT ON THE MEDICAL EXAMS.

SO WHEN A STUDENT LOOKS AT WHAT THEY HAVE TO PREPARE FOR, WHAT THEY'RE GOING TO BE EVALUATED ON, THEY MEASURE WHAT IS VALID AND WHAT IS VALUABLE BASED ON THAT.

SO IF IT'S NOT ON AN EXAM THEY WONDER WHY ARE WE GOING THROUGH ALL THIS.

WELL, WE ARE GOING THROUGH ALL THIS BECAUSE THAT IS THE HISTORY OF MEDICINE IN COUNTRY AND AND IF YOU DON'T DEAL WITH THAT STRUCTURAL HISTORY, THAT SYSTEMIC HISTORY OF RACISM, THEN WE ARE GOING TO STILL HAVE THE SAME PROBLEMS OF, FOR EXAMPLE, 76,000 AFRICAN-AMERICANS DYING EVERY YEAR FROM ALL CAUSES.

AND THESE ARE PREVENTIBLE DEATHS.

>> ADDRESSING THESE ISSUES.

DO WE HAVE TO ADDRESS THEM ONE AT A TIME OR DO BEE HAVE TO ADDRESS THEM ALL AT ONCE?

>> WELL, I'M OF THE MIND THAT ALL HEALTH IS PUBLIC HEALTH AND THAT INCLUDES MENTAL HEALTH AND WE CANNOT SEPARATE AND COMPARTMENTALIZE THESE THINGS OUT.

WE HAVE TO ADDRESS THEM HOLISTICALLY.

AND WE HAVE TO START WITH THE FUNDAMENTAL PROBLEMS THAT WE ARE EXPERIENCING NOW ABOUT CLIMATE AND ENVIRONMENTAL CHANGE.

YOU AND I ARE OLD ENOUGH TO REMEMBER THE EXPRESSION THE LONG, HOT SUMMER AND THIS IS BACK IN THE 60S.

THERE WASN'T A LOT OF AIR CONDITIONING.

WE KNEW WHEN THE TEMPERATURE WENT UP, THERE WAS GOING GOING TO BE TROUBLE.

HUMAN RESPONSE.

IT ENGENDERS AGGRESSION AND ALL THIS OTHER STUFF.

MAGNIFY THAT BY A THOUSAND AND MAKE IT 12 MONTHS OUT OF THE YEAR.

THAT'S WHAT CLIMATE CHANGE IS DOING.

WE HAVE PSYCHOLOGISTS WHO STUDY SEASONAL EFFECTIVE DISORDER.

WHEN IT IS WINTER TIME IN THE NORTHERN LATITUDES AND NO SUN LIGHT, PEOPLE HAVE TO USE ARTIFICIAL LIGHT TO CHEER THEMSELVES UP.

WE ARE EXPERIENCING SEASONAL EFFECTIVE DISORDER 2K 4 HOURS A DAY-- 24 HOURS A DAY.

EVERY DAY.

>> THE SONG WAS 98° IN THE SHADE TOO HOT.

THANK YOU VERY MUCH FOR BEING WITH US.

>> THANK YOU FOR INVITING ME.

>> INTERESTING DISCUSSION.

I WANT TO THANK YOU FOR BEING WITH US TODAY.

AS YOU HAVE HEARD, JUST HEALTH IS NOT MERELY THE ABSENCE OF DISEASE.

THERE ARE MANY SOCIAL AND POLITICAL FACTORS THAT IMPACT ON OUR WELL-BEING.

TO PLACE BLAME OR HOLD INDIVIDUALS TOTALLY RESPONSIBLE FOR THEIR HEALTH STATUS WRONGLY DISMISSES THE ILL PACT AND SIGNIFICANCE OF THESE EXTERNAL FACTORS.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH AT ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH" AND I DO HOPUAL TAKE TIME TO LOOK AT WHAT ARE THE POLITICAL AND SOCIAL DETERMINANTS OF HEALTH IN YOUR NEIGHBORHOODS AND COMMUNITIES AND WHAT CAN YOU DO TO HELP ALLEVIATE THEM TO MAKE THIS A BETTER PLACE FOR US ALL.

THANK YOU FOR BEING WITH US AND LOOK FORWARD TO SEEING YOU AGAIN NEXT WEEK ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.