>>WHEN IT COMES TO ISSUES FACING THE AFRICAN-AMERICAN COMMUNITY IN CENTRAL FLORIDA, THERE ARE IMPORTANT, SOMETIMES DIFFICULT, CONVERSATIONS TO BE HAD, CONVERSATIONS THAT DO MORE THAN ADDRESS THE CHALLENGES, BUT ALSO PRESENT OPPORTUNITIES FOR BREAKING THE CYCLE.

HELLO, I'M STEVE MORT.

WELCOME TO THE LATEST IN OUR NEWSNIGHT CONVERSATIONS SERIES, BREAKING THE CYCLE, LOOKING AT KEY ISSUES FACING CENTRAL FLORIDA'S AFRICAN-AMERICAN FAMILIES.

WE RECENTLY HELD A SERIES OF LISTENING SESSIONS WITH BLACK COMMUNITY LEADERS TO FIND OUT WHAT THEY FELT WITH THE ISSUES WE SHOULD BE TALKING ABOUT.

OVERWHELMINGLY, THEY TOLD US THEY WANTED TO HEAR MORE ABOUT SOLUTIONS TO SOME OF THE SYSTEMIC PROBLEMS FACING THE COMMUNITY.

IN THIS DISCUSSION, WE'RE TACKLING INEQUITIES IN HEALTHCARE AND THE DISPARITIES THAT PEOPLE OF COLOR OFTEN EXPERIENCE IN TERMS OF ACCESS AND OUTCOMES.

MY COLLEAGUE FROM WFTV CHANNEL 9, DARALENE JONES, IS WITH ME TO HELP MODERATE THIS DISCUSSION.

DARALENE.

>>THANKS STEVE FOR HAVING ME.

ACCORDING TO THE CDC NUMBERS, THE LIFE EXPECTANCY AMONG AFRICAN-AMERICAN PEOPLE IS LOWER THAN WHITES.

THE AGENCY SAYS, "SYSTEMIC RACISM IS LARGELY RESPONSIBLE FOR THIS DISPARITY."

THE NATIONAL INSTITUTES OF HEALTH SAYS, "RACIAL AND ETHNIC MINORITIES SUFFER HIGHER RATES OF CHRONIC ILLNESSES AND PREMATURE DEATHS."

THE COVID-19 PANDEMIC HAS BROUGHT HEALTH INEQUITIES INTO STARK RELIEF, COMMUNITIES OF COLOR, INCLUDING AFRICAN AMERICANS, ARE EXPERIENCING HIGHER RATES OF HOSPITALIZATIONS AND DEATHS THAN WHITE PEOPLE.

RESEARCH BY THE KAISER FAMILY FOUNDATION FINDS THE BLACK POPULATION VARIES FAR WORSE THAN THE WHITE POPULATION AND 72% OF MEASURES RELATED TO HEALTHCARE.

FOR EXAMPLE, AFRICAN-AMERICAN WOMEN HAVE THE HIGHEST PERCENTAGE OF PREMATURE BIRTHS AND INFANT MORTALITY.

AND STEVE, THE NUMBERS JUST DON'T LIE.

>>THEY REALLY DON'T.

WELL, JOINING US IN THE STUDIO FOR THIS IMPORTANT CONVERSATION ARE JENNIE JOSEPH, A MIDWIFE BASED IN WINTER GARDEN.

SHE'S THE PRESIDENT OF COMMONSENSE CHILDBIRTH AND DR. CANDICE JONES, A PEDIATRIC PHYSICIAN WITH EDGEWATER PEDIATRICS.

THANK YOU BOTH SO MUCH FOR BEING HERE, REALLY APPRECIATE IT.

CANDICE, LET ME JUST START WITH YOU.

IN FLORIDA, HILLSBOROUGH AND MANATEE COUNTY COMMISSIONERS RECENTLY DECLARED RACISM, A PUBLIC HEALTH CRISIS.

DO YOU AGREE?

>>ABSOLUTELY.

MANY ORGANIZATIONS ACROSS THIS NATION, IF I CAN REMEMBER, EVEN OUR SURGEON GENERAL HAS DECLARED SOME CRISES THIS PAST YEAR.

WE KNOW THAT RACISM IS A CORE DRIVER OF HEALTH INEQUITY.

IN MY OWN ORGANIZATION, THE AMERICAN ACADEMY OF PEDIATRICS HAS A POLICY STATEMENT ABOUT THE IMPACT OF RACISM ON CHILDREN'S HEALTH.

THEY SAY THAT RACISM IS A CORE DRIVER OF HEALTH INEQUITY BECAUSE IT ROBS PEOPLE OF COLOR OF THEIR OPPORTUNITY TO REACH THEIR FULL POTENTIAL.

IT DISADVANTAGES THEM FROM THE ACCESS THEY NEED TO GET THE CARE THAT THEY NEED.

AND SO IT INCREASES THEIR RISK OF SOME OF THOSE SOCIAL DETERMINANTS OF HEALTH, LIKE POVERTY, LACK OF INSURANCE, LOW SOCIOECONOMIC STATUS OR EDUCATION.

AND, ONE THAT WE'RE TALKING ABOUT TODAY, HAVING POORER ACCESS TO HEALTHCARE.

>>JENNIE, INEQUALITY AND ACCESS TO HEALTHCARE IS A REAL PROBLEM.

OUTLINE FOR US THE INEQUALITIES THAT YOU KNOW AND HAVE SEEN FIRSTHAND THAT EXISTS.

>>YES.

I MEAN, I THINK IT'S REALLY IMPORTANT THAT WE FRAME IT NOW IN THIS LANGUAGE.

USING THE WORD RACISM REALLY MAKES IT SENSIBLE BECAUSE WE'VE, UP TO NOW, KIND OF GONE WITH RACE IS THE FACTOR.

RACE IS THE REASON, SO IT'S RACISM NOT RACE.

AND WHEN WE TALK ABOUT INEQUALITY, PARTICULARLY IN MY WORLD, WHICH IS, OF COURSE, MATERNAL CHILD HEALTH, WHAT WE ARE SEEING IS OUTCOMES THAT ARE DIFFERENT BASED ON THE IMPACT OF THAT RACISM.

WHETHER IT'S STRUCTURAL OR INSTITUTIONAL, IT'S NOT ALWAYS PERSONAL.

IT'S NOT EVEN, SOMETIMES PEOPLE ARE NOT AWARE THAT, THAT'S WHAT'S HAPPENING, BUT THAT MAKES A DIFFERENCE.

I'VE GOT MY TWO LITTLE HATS BECAUSE I USE THESE AS A WAY TO LOOK AT THE PROBLEM.

MORE BLACK BABIES ARE GOING TO WEAR THIS SIZE HAT BECAUSE THEY'RE GOING TO BE BORN PREMATURE THAN THE AVERAGE WEIGHT.

THE BIRTH WEIGHTS OF BLACK BABIES ARE ALWAYS LOWER AND THEY'RE MORE LIKELY TO BE IN NEONATAL CARE AFTER DELIVERY THAN ANY OTHER RACE.

THERE'S NO REASON FOR THAT, PHYSIOLOGICALLY.

THIS IS WHEN IT COMES DOWN TO REALLY REALIZING THAT IT IS THE LACK OF ACCESS TO QUALITY, SAFE, CULTURALLY-COMPETENT CARE THAT MAKES A DIFFERENCE BETWEEN WHETHER YOUR BABY'S GOING HOME WITH YOU WHEN YOU LEAVE THAT HOSPITAL OR GOING TO AN INCUBATOR IN THE NICU.

>>I'M A MOM, MYSELF, SO I UNDERSTAND EXACTLY WHAT YOU'RE TALKING ABOUT, BUT I WANT OUR VIEWERS TO UNDERSTAND WHAT YOU'RE TRYING TO SAY, WHICH IS THAT THE HEALTHCARE STARTS AT THE BEGINNING.

>>YES, MA'AM.

PEOPLE REALLY JUST NEED TO UNDERSTAND THE DIFFERENCE BETWEEN HOW YOU DELIVER HEALTHCARE IS SO IMPORTANT THAT IT CAN ACTUALLY BE THE DIFFERENCE BETWEEN LIFE AND DEATH.

WE HAVE A VERY HIGH MORTALITY RATE IN THE UNITED STATES, PARTICULARLY AMONG PEOPLE OF COLOR.

BLACK WOMEN ARE THREE TO FOUR TIMES MORE LIKELY TO DIE IN PREGNANCY AND BIRTH IN AMERICA.

AND THERE'S NO REASON FOR THAT OTHER THAN THE LACK OF CARE AND SUPPORT THAT THEY WELL DESERVE, BUT ARE BEING DENIED DUE TO MOSTLY INSTITUTIONAL RACISM, CLASSISM, SEXISM, AND THE POWER DYNAMICS THAT HAVE OUR MEDICAL SYSTEM, I'M GOING TO SAY IT OUT LOUD, BROKEN.

>>I WANT TO TALK ACTUALLY A LITTLE BIT MORE ABOUT OUTCOMES, BUT LET ME JUST ASK YOU CANDICE, BECAUSE ONE OF THE THINGS THAT YOU MENTIONED WAS THOSE OTHER SOCIAL DETERMINANTS IN YOUR FIRST ANSWER, LIKE SORT OF HOUSING, EDUCATION, WEALTH, ACCESS TO NUTRITION, FOOD DESERTS, AND THINGS LIKE THAT.

I WONDER WHETHER WE CAN LOOK AT SOME OF THESE HEALTH DISPARITIES THROUGH THOSE LENSES.

IS THERE AN OVERLAP BETWEEN OTHER SOCIAL DETERMINANTS THAT PEOPLE EXPERIENCE AND THEIR ACCESS TO HEALTHCARE?

>>IT'S ALL CONNECTED, THAT ACCESS TO HEALTHCARE IS A SOCIAL DETERMINANT ITSELF.

IT'S ALL CONNECTED.

MY HEALTH OUTCOME IS MORE LIKELY TO BE WORSE IF I AM LIVING IN POVERTY.

I DON'T HAVE INSURANCE.

I DON'T HAVE A CAR.

ALL OF THOSE SOCIAL DETERMINANTS ARE STRUGGLING, AND SO IT ALL IMPACTS MY HEALTH AND CONNECTS.

THE CORE DRIVER AGAIN, TO YOUR POINT, IS RACISM, IS THE STRUCTURES, THE POLICIES, THE SYSTEMS THAT ARE IN PLACE THAT ROB PEOPLE OF THE OPPORTUNITIES THEY NEED TO GET THOSE THINGS.

>>YOU MENTIONED INSURANCE THERE, AND I WONDER HOW MUCH COMES DOWN SIMPLY TO AN ABILITY TO PAY?

HOW MUCH OF A KEY PART OF THE PROBLEM IS THAT?

LET'S START WITH YOU.

>>IT'S A PROBLEM, BUT I DON'T THINK IT'S THE WHOLE PROBLEM BECAUSE YOU CAN HAVE INSURANCE AND THEN YOU HAVE TO PAY A CO-PAY AS WELL SO THAT'S A PROBLEM, BECAUSE SOME PEOPLE CAN'T DO THAT.

BUT SOME PEOPLE DON'T HAVE ANY INSURANCE, BUT EVEN WHEN, FOR INSTANCE, MY PATIENT POPULATION HEAVILY MEDICAID, THEY HAVE THE INSURANCE, THEY COME INTO CARE, BUT I STILL SEE WORSE HEALTH OUTCOMES BECAUSE OF ALL THE OTHER SOCIAL DETERMINANTS IN THEIR LIFE.

>>WHEN YOU GO TO A HOSPITAL, YOU ARE TREATING A POPULATION THAT YOU KNOW NEEDS ACCESS TO HEALTHCARE, RIGHT?

BUT THAT DOESN'T HAPPEN IN EVERY COMMUNITY.

SOMETIMES, THOSE PATIENTS WITH MEDICAID ARE TREATED AS THOUGH THEY DON'T HAVE INSURANCE.

>>EXACTLY.

>>EVEN THOUGH, IT'S INSURANCE.

>>I THINK WE'VE GOT A PIECE HERE THAT IF WE WERE TO UNPACK IT, THERE'S THE CONNOTATION, THE STIGMATIZATION.

THESE KINDS OF THINGS SORT OF OVERFLOW INTO HOW WE ARE, WHETHER CONSCIOUSLY OR UNCONSCIOUSLY, BIASED IN HOW WE PROVIDE CARE.

FOR EXAMPLE, I KNOW IT'S A STANDARD.

YOU LOOK AT THE MEDICAID CARD OR THE INSURANCE CARD, AND SOMEHOW THAT INSTANTLY CHANGES HOW THINGS ARE DONE.

AGAIN, NOT TO CAST ANY ASPERSIONS ON ANY ONE PARTICULAR HOSPITAL OR SYSTEM, BUT WHEN YOU HAVE TO ADMIT A PATIENT AND THIS PATIENT HAS THIS TYPE OF INSURANCE, PUT HER IN THIS KIND OF ROOM, THAT RIGHT THERE, THAT'S THE STRUCTURAL WAY IT SHOWS UP.

THE OTHER THING IS THAT WE HAVE THIS SORT OF DILEMMA WHERE WE, AS A SOCIETY, ASSUME THAT FOLK WHO ARE LOW INCOME OR UNINSURED OR UNDERINSURED ARE PROBLEMATIC AND THEREFORE ARE EXTRA BURDEN ON THE REST OF US.

>>THERE'S THOSE KINDS OF CONNOTATIONS THAT SHOW UP.

AND THEN LASTLY, TO DR. JONES' POINT, WE HAVE THE MAIN ISSUE WHERE YOU HAVE INSURANCE AND THAT'S SUPPOSED TO AFFORD YOU SOME KIND OF SAFETY NET, BUT IT DOESN'T.

IT ACTUALLY WORKS AGAINST YOU BECAUSE PRICES AND ALL OF THESE DIFFERENT AREAS WHERE IT'S SOMEWHAT OF A, ALMOST A RACKET, IF YOU WILL, WHERE THE INSURANCE ITSELF IS GOING TO BE DETRIMENTAL TO YOUR GETTING SERVICES THAT YOU MIGHT NEED BECAUSE OF, WELL, IT'S NOT COVERED OR YOU HAVE TO PAY EXTRA OR YOUR PROVIDER IS NOT ON THE PLAN.

THESE THINGS ARE ALSO STRUCTURAL, BUT THEY ARE ALSO DETRIMENTAL.

IT'S A REALLY DEEP, AND I THINK UNETHICAL WAY OF PROVIDING CARE, GIVEN THE RESOURCES THAT WE HAVE, THIS IS THE MOST AFFLUENT COUNTRY IN THE ENTIRE WORLD.

SO HOW DO WE GET AWAY WITH MATERNAL MORTALITY RATE THAT BRINGS US DEAD LAST IN THE DEVELOPED NATIONS?

I THINK IT'S QUITE SHAMEFUL.

>>WE CAN GO A LITTLE DEEPER EVEN TO TOXIC STRESS.

>>YES.

>>TO CHRONIC STRESS, THAT WOMEN OF COLOR EXPERIENCE FROM RACISM, FROM THESE TYPE OF STRUCTURAL AND SYSTEMIC ISSUES THAT PUT THEM AT RISK FOR HAVING THAT PRETERM BABY, THAT PUTS THEIR BABY AT RISK FOR HAVING INFANT MORTALITY.

THERE'S SO MANY LAYERS THERE, THE STRESS OF THE TRAUMA OF RACISM AND SYSTEMS THAT OVERLOAD OUR BODY AND WEATHERS OUR BODY, IS ALSO A CONTRIBUTING FACTOR TO SOME OF THESE DISPARITIES AND RATES IN MATERNAL AND INFANT MORTALITY, AS WELL.

>>ONE OF THE THINGS THAT I'VE HEARD FROM SPEAKING TO PATIENTS, IS THAT THEY FEEL THAT WHEN THEY SPEAK OF PAIN, THEY'RE TREATED LESS.

THEY'RE TAKEN LESS SERIOUSLY IF THEY'RE AN AFRICAN AMERICAN THAN IF THEY'RE WHITE, IS THAT TRUE?

>>IT'S ABSOLUTELY TRUE.

I THINK THIS IS THE SAD CONUNDRUM THAT WE'RE IN BECAUSE WE ARE TALKING ABOUT HEALTHCARE SPECIFICALLY, BUT SOCIETY WIDE, NO MATTER WHICH ISSUE YOU TALK ABOUT, WHEN YOU LOOK AT IT FROM A POINT OF VIEW OF HOW DOES RACISM PLAY INTO IT?

THESE ARE THE DETRIMENTS OF RACISM.

WE CONSIDER UNDER OUR WORK AT COMMONSENSE CHILDBIRTH THAT WE'RE ALSO DOING JUSTICE WORK.

WE ARE FIGHTING FROM THE ANGLE OF BOTH END BECAUSE WE SEE THE MEDICAL AREAS, BUT WE KNOW THAT IT'S DEEPER THAN THAT.

WE ARE REALLY CLEAR ABOUT HEARING AND ACKNOWLEDGING PEOPLE WHEN THEY COME AND EXPLAIN, "THESE ARE THE BARRIERS I FELT, THIS IS THE SYSTEM, THESE ARE THE STRUGGLES."

WE HEAR THEM.

IN AND OF ITSELF, THAT SEEMS TO BE HEALING.

LIKE WE GET OUR MOTHERS, THEY HAVE FULL TERM BABIES.

THEY'RE NOT SUPPOSED TO, BUT THEY DO.

THEY ARE DOING REALLY WELL.

THEY'RE NOT HAVING AS MANY C-SECTIONS.

THEY ARE BREASTFEEDING.

THEY ARE GETTING BACK ON THEIR FEET AFTER THE BIRTHS.

WE SEE THAT HAPPENING.

THE ONLY THING WE CAN THINK OF AS TO WHY IT'S HAPPENING, NOT BECAUSE WE ARE DOING FANCY MIDWIFERY OR SPECIAL OBSTETRICS, IT'S BECAUSE WE'RE LISTENING AND WE'RE ACKNOWLEDGING, AND WE'RE RECOGNIZING.

WE SEE AND UNDERSTAND YOUR PAIN AND WE UNDERSTAND YOUR FRUSTRATION AND YOUR FEAR.

EVEN THOUGH WE CAN'T FIX IT, WE GET IT AND WE ARE AT LEAST ACKNOWLEDGING.

SO YOU GET THAT VALIDATION THAT IT'S NOT YOU, THIS OUTSIDE OF YOU, AND THAT SEEMS TO HELP.

>>THE EVIDENCE SHOWS US THAT WHEN AFRICAN-AMERICAN PATIENTS HAVE AFRICAN-AMERICAN PROVIDERS, THEY DO BETTER.

THEIR SATISFACTION IS BETTER CONNECTION, RELATIONSHIP, RELATABILITY, BUT THEIR OUTCOMES ARE BETTER.

THERE'S TONS OF RESEARCH TO SHOW THAT.

BABIES LIVE, MOMS HAVE HEALTHY DELIVERIES, WHEREVER THEY ARE.

THAT'S WHY I WAS MENTIONING KIND OF HAVING A BLACK PROVIDER TO ADVOCATE FOR YOU.

THE OUTCOMES ARE BETTER.

ONE OF THE AREAS IS TO INCREASE AND IMPROVE UPON HAVING BLACK MEDICAL PROVIDERS.

>>WE COULD TALK ABOUT THAT TOO.

>>AND WHY.

>>YES.

>>I MEAN, IS THERE SOME SORT OF A MATTER OF CULTURAL COMPETENCY?

I MEAN, IS THERE A LACK OF THAT, DO YOU THINK SOMETIMES?

>>YES.

>>ABSOLUTELY.

>>AND MORE CULTURAL HUMILITY THAN COMPETENCY BECAUSE IT'S NOT LIKE...

WHEN WE USED TO TEACH CULTURAL COMPETENCIES, WELL, YOU NEED TO UNDERSTAND THAT CHINESE PEOPLE, THEY DON'T WANT TO HAVE COLD FLUIDS.

THEY WANT WARM FLUIDS.

WE TALKED ABOUT COMPETENCY FROM THOSE ANGLES AS IF WE COULD ALL MASTER UNDERSTANDING INDIVIDUAL CULTURES AND THE FOIBLES OR THE WAYS.

WELL, NO, IT'S NOT THAT, IT'S THE HUMILITY THAT COMES WITH NO MATTER WHAT YOUR CULTURE, NO MATTER WHAT YOUR AREA THAT OTHERS YOU, OR HAS YOU MARGINALIZED, WE ARE STANDING RESPECTFULLY.

WE ARE MAINTAINING YOUR DIGNITY WHILE WE PROVIDE THE BEST EQUITABLE CARE THAT WE CAN.

NOT BECAUSE WE WANT TO MASTER LEARNING ABOUT YOUR PARTICULAR CULTURE, BUT THAT WE JUST RESPECT IT AS A MATTER OF COURSE.

>>IT'S A SHARED HUMANITY.

>>EXACTLY.

>>AND IT'S TREATING ME LIKE YOU WOULD TREAT YOUR MOTHER OR YOUR GRANDMOTHER.

>>EVERY TIME.

>>THAT'S WHAT IT IS, EVERY TIME.

>>EVERY PERSON, EVERY TIME.

>>SOME OF WHAT YOU'RE TALKING ABOUT CERTAINLY HAS MANIFESTED ITSELF AS WE'VE DEALT WITH THE COVID-19 PANDEMIC.

LET'S TALK ABOUT HOW THAT RELATES TO THE INCREASED HOSPITALIZATIONS, THE INCREASED INFECTION RATES AND THE INCREASED DEATHS FOR PEOPLE OF COLOR AND THEIR DISCOMFORT OF THE HEALTHCARE SYSTEM.

>>YES, THE DISTRUST.

THIS IS HISTORICAL AGAIN.

I MEAN, STEVE, FOR YOUR QUESTION EARLIER, IT'S REALLY, WE JUST HAVE TO GO BACK TO HOW THINGS HAVE BEEN SET UP IN THIS COUNTRY FROM THE TIME THAT AFRICANS WERE BROUGHT TO AMERICA AND HOW THEY CONTINUE.

THERE'S VARIOUS SITUATIONS BUT IT'S THE SAME SITUATION.

EACH TIME WE LOOK AT SOMETHING SUCH AS A NEW CRISIS, COVID 19 ON THE PANDEMIC, IT JUST BECOMES MORE OBVIOUS AGAIN, IT'S RIGHT BACK IN OUR FACE.

AND THE DISTRUST HAS BEEN BECAUSE OF DECADES, IF NOT CENTURIES, OF DISCRIMINATION, MALTREATMENT.

IN THE MEDICAL WORLD SPECIFICALLY, WE'VE GOT HORRENDOUS EXAMPLES SUCH AS THE TUSKEGEE INCIDENTS WHERE MEN THAT HAD SYPHILIS WERE NOT TREATED IN ORDER TO GET THE RESEARCH DONE.

HENRIETTA LACKS, HER CELLS ARE BEING USED EVEN TODAY WHEN SHE WAS THE PERSON WHO WAS UNAWARE, TOTALLY UNAWARE OF WHAT HAPPENED WITH HER BODY.

UNFORTUNATELY, IT'S HARD TO TRUST WHERE YOU HAVE A LEGACY, A CONTINUATION OF MISTREATMENT, UNETHICAL BEHAVIORS, LACK OF A CARE, OBVIOUSLY, BECAUSE HERE WE ARE IN 2022, STILL TALKING.

>>THERE IS THAT TRUST ISSUE, BUT THEN THERE'S ALSO THE ACCESS ISSUE, ISN'T THERE, ESPECIALLY WHEN IT COMES TO COVID 19.

WE HEARD MAYOR JERRY DEMINGS, FOR EXAMPLE, TALK A LOT ABOUT TRYING TO GET VACCINES INTO UNDERSERVED COMMUNITIES.

I MEAN, WAS THE COVID-19 PANDEMIC A GOOD EXAMPLE OF AFRICAN AMERICANS AND OTHER UNDERSERVED COMMUNITIES JUST NOT GETTING THE SAME RESOURCES AS OTHER PARTS OF THE COMMUNITY?

>>ABSOLUTELY.

WE CAN SEE THAT.

IT ALL BLEW UP IN NEW YORK FIRST AND I HAVE COLLEAGUES WHO ARE DOCTORS THAT I KNOW AND FOLLOW THERE THAT WAS POINTING OUT THE INADEQUACIES, THE HOLES IN OUR SYSTEM THAT WERE NEGLECTFUL OF PEOPLE OF COLOR.

WE SAW ESSENTIAL WORKERS BEING MOSTLY BLACK AND BROWN, HAVING TO GO OUT INTO THE WORKFORCE WITH THE PANDEMIC RAGING.

AND SO THEY'RE GOING TO BE THE ONES WHO GET IT, BRING IT BACK HOME TO MULTI-GENERATIONAL FAMILIES AND CONTINUE TO SPREAD.

EVEN WHERE THEY'RE LIVING IS MORE CROWDED IN MULTI-UNIT BUILDINGS, IT WAS JUST A SITUATION THAT PUT THEM MORE AT RISK AS WELL.

AND THEN IN SOME COMMUNITIES, THERE AREN'T QUALITY CLINICS OR DOCTORS THAT THEY TRUST OR THAT THEY CAN GET ACCESS TO OUTSIDE OF THEIR WORK TIME AND GET THE CARE THAT THEY NEED.

>>THERE'S SO MANY INADEQUACIES AND SHORTCOMINGS THAT WE COULD TARGET.

I THINK WE CAN IMPROVE UPTAKE IN TESTING AND VACCINES AND THINGS OF THAT NATURE BY REACHING OUT TO OUR COMMUNITY LEADERS, OUR TRUSTED MESSENGERS IN THE COMMUNITY, CHURCHES, PASTORS, LEADERS THAT PEOPLE KNOW, LOVE AND TRUST AND GET THE EDUCATION THROUGH THEIR COLLABORATING.

AND SO NO, PEOPLE ARE NOT GOING TO TRUST WHAT THEY SEE NECESSARILY ON MEDIA AND TV PER SE OR SOMEONE THEY'VE NEVER SEEN BEFORE TO COME SAY, "TAKE THIS VACCINE."

BUT THEY MAY TAKE IT IF IT COMES PACKAGED THE WAY THEY HEAR IT FROM THE PERSON THEY TRUST.

WE NEED TO DO MORE OF THAT AND THEN ALSO GETTING IT TO THEM.

MOBILE UNITS, PEOPLE HAVE ACCESS, TRANSPORTATION, MONEY, THEY HAVE TO WORK.

WHAT ABOUT AFTER HOURS?

WHAT ABOUT INTO THAT PARTICULAR COMMUNITY WITH THEIR TRUSTED MESSENGER?

THINGS LIKE THAT.

>>THIS IS NOT ON OUR SCRIPT, BUT I DO RECALL A TIME WHERE PEOPLE WERE QUESTIONING, THE LINES ARE SO LONG AT THESE TESTING SITES AND VACCINE SITES.

AND ONE OF THE THINGS I THOUGHT TO MYSELF WAS, THE PEOPLE IN THAT LINE ARE THE VERY PEOPLE WHO NEED TO BE AT WORK RIGHT NOW.

>>THAT'S RIGHT.

>>AND SO GUESS WHAT, THEY'RE GOING TO GIVE UP AND THEY'RE GOING TO SAY, "I GOT TO GET TO WORK BECAUSE I'VE GOT TO PUT FOOD ON THE TABLE.

I HAVE TO PICK UP MY CHILDREN."

ALL OF THOSE THINGS, IT'S LIKE A DOMINO EFFECT.

>>IT REALLY IS.

>>ALL CONNECTED.

ONE OF THE THINGS THAT WE SORT OF TOUCHED ON EARLIER WAS THE LACK OF DIVERSITY IN THE MEDICAL PROFESSION.

I DO WANT TO DIVE INTO THAT A LITTLE BIT MORE.

LET'S TALK BRIEFLY ABOUT THE HISTORY OF THE LACK OF DIVERSITY IN THE MEDICAL PROFESSION AND WHY IT'S NOW MANIFESTING AS A PROBLEM.

>>WELL, IT'S ALWAYS BEEN A PROBLEM.

IF YOU THINK, HISTORICALLY, ALL THE WAY BACK, WE WERE NOT GIVEN ACCESS TO HIGHER EDUCATION OR MEDICAL SCHOOLS.

WE HAD TO CREATE OUR OWN IN THE FORM OF HBCUS, HISTORICALLY BLACK COLLEGES AND UNIVERSITY, THEN SEEN AS LESS THAN, THOSE UNIVERSITIES AND STILL, TO THIS DAY, THAT MYTH PERPETUATES.

MANY OF US WOULD NOT BE EDUCATED.

ME BEING AN ALUM FROM MOREHOUSE SCHOOL OF MEDICINE, HAD WE NOT HAD THAT ACCESS.

THAT'S A HISTORICAL ROUTE THAT STILL, ALL OF THESE HISTORICAL THINGS, REACH INTO THE PRESENT DAY.

THEY DON'T JUST STOP ONCE WE PUT SOMETHING IN PLACE, THEY HAVE IMPACT INTO PRESENT DAY.

AND THAT'S WHAT WE NEED TO REALIZE.

>>ARE THESE THINGS OFTEN BASED ON GEOGRAPHY, ARE THERE CERTAIN PLACES WHERE THEY'RE WORSE THAN OTHERS?

>>THEY ARE.

I MEAN, I'M A MIDWIFE AND OF COURSE, FOLK DON'T SEE MIDWIVES VERY OFTEN.

IT'S AN UNUSUAL PROFESSION EVEN NOW, BUT YET THINK ABOUT AMERICA WAS DELIVERED BY MIDWIVES FOR CENTURIES, BLACK MIDWIVES, PARTICULARLY DELIVERED THROUGHOUT ENSLAVEMENT.

THEN OF COURSE, IN JIM CROW ERA, THEY DELIVERED MOST OF THE SOUTHERN STATES, BLACK AND WHITE PEOPLE.

THEY CONTINUED INTO THE MID FIFTIES UNTIL THEY WERE ERADICATED AS HOSPITALS AND OBSTETRICIANS TOOK OVER BIRTHING PEOPLE.

NOW WE HAVE THIS SORT OF COMPLETE SHIFT WHERE WE HAVE VERY FEW MIDWIVES AND PARTICULARLY MIDWIVES OF COLOR.

I HAVE OPENED THE ONLY BLACK-OWNED MIDWIFERY SCHOOL IN THE UNITED STATES, THE ONLY SCHOOL, AND WE'VE JUST GOTTEN ACCREDITED IN 2020.

WE ARE TRAINING BLACK MIDWIVES AND MIDWIVES OF COLOR RIGHT NOW.

WE ARE ALSO TRAINING COMMUNITY HEALTH WORKERS.

NOT ONLY BECAUSE OF COVID, BUT BECAUSE THAT HAS WORKED HISTORICALLY.

WE HAVE BIRTH WORKERS ON THE GROUND.

>>THEY SEE MOTHERS POSTPARTUM AT HOME.

THEY SUPPORT THEM WITH BREASTFEEDING.

WE FOUND THAT, THAT'S ANOTHER WAY TO BUILD A WORKFORCE AND TO BUILD A WORKFORCE THAT'S CULTURALLY DIVERSE AND MATCHES THE COMMUNITIES OF NEED.

WE FOUND THAT THIS IS A WAY TO REALLY GO BACK, IF YOU WILL, TO THE OLD WAYS.

THE MIDWIVES WERE COMMUNITY-BASED PROVIDERS.

THE COMMUNITY HEALTH WORKERS WERE COMMUNITY-BASED PROVIDERS.

WE'VE MOVED TOWARDS INSTITUTIONAL PROVISION OF CARE.

THAT'S WHERE WE NEED TO COME BACK FROM.

AND I THINK THE PANDEMIC HAS HELPED US RECOGNIZE THAT THE POWER OF THE COMMUNITY HEALTH WORKER IN GETTING THE MESSAGING ACROSS, LIKE YOU SAID, THAT'S THE WAY THAT PEOPLE BUILD TRUST AGAIN.

THAT'S WHAT WE ARE DOING IN TERMS OF MATERNAL CHILD HEALTH, BUT WE SUPPORT THE NEED FOR BIGGER INSTITUTIONS.

WE JUST NEED ACCESS TO GETTING OUR PROVIDERS IN THERE AS WELL.

>>I MEAN, JENNIE OUTLINED SOME OF THE THINGS THAT SHE'S ATTEMPTING TO DO TO SORT OF TRY TO RIGHT THIS WRONG.

HAS THERE BEEN PROGRESS IN YOUR MIND?

>>THERE HAS BEEN PROGRESS, FOR SURE.

WE CAN'T DENY THAT, BUT THERE'S STILL LOTS OF WORK TO BE DONE.

I THINK THAT WHAT I RECOGNIZE IS THE EFFORT OF MANY ORGANIZATIONS AND INDIVIDUALS LIKE YOURSELF TO PUT ON THAT LENS OF HEALTH EQUITY, AND TRY TO PROVIDE EQUITABLE CARE.

WE ARE SEEING THAT, THAT A LOT OF ORGANIZATIONS ARE COMING OUT WITH THEIR DIVERSITY, EQUITY, AND INCLUSION COMMITMENTS.

THEY'RE HAVING OFFICERS WHO ARE SUPPOSED TO BE ABLE TO HELP THAT ENTITY LOOK AT THINGS THROUGH AN EQUITABLE LENS.

THE PROBLEM IS, WE NEED TO GIVE THOSE PEOPLE POWER.

>>THAT'S RIGHT.

>>WE JUST CAN'T HAVE A TITLE AND THEY SIT THERE AND TALK AND TELL YOU WHAT TO DO, BUT YOU NEVER ACT ON IT.

AGAIN, NOT ONLY AT THE LOCAL COMMUNITY LEVEL, BUT WE ALSO NEED PEOPLE OF COLOR IN THE BOARD ROOM, HAVE A SEAT AT THE TABLE WHERE ALL OF THESE BIG POLICY, SYSTEMIC PLANS ARE MADE TO SAY, "HEY, THIS IS NOT GOING TO WORK FOR MY COMMUNITY."

TO ADVOCATE FOR YOUR COMMUNITY, AND ALSO HAVE THE POWER.

WE'VE GOT TO DIVIDE UP SOME POWER TO SAY, "OKAY, LITTLE GIVE AND TAKE SO THAT WE MAKE SURE EVERYONE IS TAKEN CARE OF."

BUT EVERYONE HAS TO BE REPRESENTED, I TOTALLY AGREE WITH YOU, AT THE HIGHEST LEVEL, ALL THE WAY DOWN TO THE COMMUNITY LEVEL.

>>LAST YEAR, WE WERE VERY BLESSED, REPRESENTATIVE KAMIA BROWN WAS ONE OF THE LEADERS.

OF COURSE, SHE HAD RECENTLY HAD A BABY AS WELL.

I THINK THAT HELPED INFORM HER INTEREST IN SUPPORTING MATERNAL HEALTH ISSUES, BUT THERE WAS A HEALTH EQUITY BILL THAT WAS PASSED.

WE WERE ABLE TO GET LANGUAGE INTO THE BILL, SUCH AS COMMUNITY HEALTH WORKER, MIDWIFE, DOULA.

THESE ARE TERMS FROM MY FIELD, MATERNAL CHILD HEALTH, WHERE WE KNOW THESE WORKERS ARE READY TO WORK, WE ARE BUILDING THAT WORKFORCE.

THAT BECAME POLICY LANGUAGE.

WE NOW NEED MEDICAID TO REIMBURSE.

LIKE WE NEED IT FOR REAL.

LIKE WE NEED INSURANCE COMPANIES TO PAY ATTENTION AND STOP PUTTING US ALL IN THESE CIRCLES TO GET PAID.

>>YOU RAISE MEDICAID THERE.

I WANTED TO DRILL DOWN INTO THAT AS A POSSIBLE SOLUTION.

ONE OF THE STATISTICS THAT I CAME ACROSS IN MY RESEARCH FOR THIS WAS SIX IN 10 UNINSURED ADULTS WHO WOULD BECOME ELIGIBLE IF ALL REMAINING STATES EXPANDED MEDICAID ARE PEOPLE OF COLOR.

I WONDER WHAT YOU SEE AS THE IMPORTANCE OF MEDICAID EXPANSION IN TERMS OF HEALTH ACCESS.

DO YOU THINK IT'S IMPORTANT?

I'LL ASK YOU FIRSTHAND.

>>ABSOLUTELY.

WE HAVE A HUGE GAP.

OUR PATIENT POPULATION IS MOSTLY MEDICAID, AS I SAID BEFORE, AT OUR PRACTICE.

BUT WE STILL HAVE SOME FAMILIES WHO WORK JUST ENOUGH NOT TO GET MEDICAID, BUT NOT ENOUGH FOR THEIR JOBS ARE NOT OFFERING INSURANCE, SO THEY HAVE NOTHING.

>>THAT'S RIGHT.

>>OR THE GENERAL WORKING POOR PERSON WHO WORKS REALLY HARD, BUT DOESN'T HAVE ENOUGH TO AFFORD THEIR HEALTHCARE.

I THINK THE ACA INSURED MANY PEOPLE INCLUDING INSURED MORE AFRICAN AMERICANS.

WE HAVE THAT AS PROOF THAT IT HAS WORKED SO WE DEFINITELY NEED MEDICAID AND MEDICARE EXPANSION.

WE KNOW HERE IN FLORIDA, THAT HAS BEEN A NO-GO, SO WE NEED TO BE ADVOCATING FOR THAT.

>>WHAT YOU SAID STUCK WITH ME, THEY NEED TO REIMBURSE, THEY NEED TO PAY.

WHEN YOU SAY IT LIKE THAT, IT REMINDS ME THAT, THAT'S PROBABLY WHY SOME HEALTHCARE PROVIDERS JUST DON'T DEAL WITH MEDICAID PATIENTS THAT ALL BECAUSE THEY DON'T WANT TO DEAL WITH THE RED TAPE THAT COMES WITH THAT AND IT'S AN ACCESS ISSUE THEN.

>>THAT IT IS, AND IT'S ALSO BACK TO RACISM AND UNFORTUNATELY, STRUCTURAL, THAT THE FACT THAT THE CONNOTATION THAT GOES WITH MEDICAID ADDS TO THE LIKE, "NO, I WON'T MESS WITH THAT.

I CAN'T AFFORD IT."

AS A PROVIDER, IT DECIMATES YOUR PRACTICE BECAUSE THE MEDICAID RATE IS SO MUCH VASTLY DIFFERENT TO THE INSURANCE RATE.

>>I WOULD SAY THAT THERE'S THIS MISCONCEPTION THAT MEDICAID IS NOT QUALITY CARE BECAUSE FOR OUR PRACTICE, WE DO MORE FOR OUR PATIENTS THAN MY OWN CHILDREN WHO HAVE PRIVATE INSURANCE GET IN WELL-TO-DO LAKE MARY.

I JUST WISH THAT THEY DID BETTER BY MEDICAID BECAUSE PEOPLE COME FROM ALL OVER, THEY DRIVE FROM FAR, AND THEY DON'T HAVE MUCH OF A CHOICE, WHEN THEY HAVE MEDICAID, OF WHO TO SEE, ANOTHER ACCESS ISSUE, THEIR OPTIONS ARE LIMITED.

>>THEN I WOULD SAY, MAKE SURE THAT PEOPLE KNOW HOW TO NAVIGATE THE CRAZY THAT IT IS TO ACTUALLY APPLY AND GET THESE INSURANCES.

WE DO MOST OF THAT WORK FOR OUR PATIENTS BECAUSE THEY CANNOT FIGURE IT OUT ON THEIR OWN BECAUSE RIGHT NOW, IT'S A COMPLETE BUREAUCRATIC NIGHTMARE AND EVERYBODY KNOWS IT, BUT WE JUST CARRY ON AS IF IT'S GOING TO FIX ITSELF.

IT WILL NOT.

>>WELL, SO MANY SYSTEMIC ISSUES, BUT I REALLY APPRECIATE YOU GUYS COMING IN AND TALKING THROUGH THESE REALLY DIFFICULT SYSTEMIC ISSUES THAT WE FACE NOT ONLY HERE IN CENTRAL FLORIDA, BUT THROUGHOUT THE NATION AS WELL.

THANK YOU SO MUCH FOR COMING IN.

REALLY APPRECIATE IT.

>>THANK YOU.

>>THANK YOU.

>>THAT IS ALL THE TIME WE HAVE FOR TONIGHT.

MY THANKS TO JENNIE JOSEPH AND DR. CANDICE JONES AND MY COLLEAGUE DARALENE JONES FROM WFTV CHANNEL 9.

YOU CAN FIND MUCH MORE OF THIS DISCUSSION ON OUR NEWSNIGHT CONVERSATIONS WEBSITE AT WUCF.ORG/CONVERSATIONS.

WE'LL BE BACK NEXT WEEK WITH OUR REGULAR PANEL OF REPORTERS TO DISCUSS THE TOP STORIES IN CENTRAL FLORIDA, UNTIL THEN TAKE CARE AND HAVE A GREAT WEEKEND.