>> THE UNITED STATES HAS THE BEST HEALTHCARE IN THE WORLD.

UNFORTUNATELY, WHERE YOU LIVE, HOW MUCH YOU MAKE AND YES, THE COLOR OF YOUR SKIN CAN IMPACT ACCESS TO THIS CARE AND SUBSEQUENT HEALTH OUTCOMES.

PLEASE STAY WITH US AS WE DISCUSS THE IMPACT OF RACISM ON HEALTH OUTCOMES NEXT ON KENTUCKY HEALTH.

THE AVERAGE LIFE EXPECTANCY IN THE UNITED STATES IS 78.7 YEARS.

FOR WHITES 78.6 YEARS AND AFRICAN-AMERICANS IT IS 75 YEARS.

THE KENTUCKY LIFE EXPECTANCY IS LOWER THAN THE U.S. AVERAGE AT 75.4 YEARS.

BUT THE DIFFERENCE BETWEEN WHITES AT 75.5 YEARS AND AFRICAN-AMERICANS 72.9 YEARS IS SIMILAR TO THAT TO THE U.S. AS A WHOLE.

OVERALL, AFRICAN-AMERICANS HAVE HIGHER RATES OF MORTALITY FROM EIGHT OF THE 10 LEADING CAUSES OF DEATH IN THE UNITED STATES THAN ANY OTHER RACIAL GROUP.

A 2004 REPORT CENTER THE INSTITUTE OF MEDICINE ENTITLED UNEQUAL TREATMENT FOUND A SIGNIFICANT DISPARITY IN CARE GIVEN TO AFRICAN-AMERICANS AND THIS CONTRIBUTED TO POOR SURVIVAL RATES.

A 1986 REPORT COMMISSIONED BY THEN HEALTH AND HUMAN SERVICES SECRETARY MARGARET HEXLER NOTED.

THAT IF AFRICAN-AMERICANS HAD THE STANDARD OF CARE AS WHITES, THE DIFFERENCE IN MORTALITY RATES WOULD DISAPPEAR.

BIAS AND RACISM INCREASE DISPARITIES IN HEALTH OUTCOMES BY LIMITING ACCESS TO QUALITY CARE AND INCREASING STRESSES THAT CONTRIBUTE TO PROBLEMS SUCH AS DEPRESSION, ANXIETY, INSOMNIA, HEART DISEASE, SKIN RASHES AND GASTROINTESTINAL PROBLEMS.

TO DISCUSS HOW RACISM AFFECT HEALTH OUTCOMES WE HAVE MISS DELANOR MANSON, CHIEF EXECUTIVE OFFICER OF THE KENTUCKY NURSES ASSOCIATION.

THANK YOU FOR BEING WITH US TODAY.

>> THANK YOU FOR INVITING ME.

>> ALWAYS A PLEASURE WHERE WE CAN HEAR THE SIDE FROM THE NURSES.

MY MAMA IS A NURSE AND MY WIFE IS A NURSE SO ONCE A NURSE, ALWAYS A NURSE.

>> ONCE A NURSE, ALWAYS A NURSE.

>> IS THERE A DISPARITY BETWEEN HEALTH OUTCOMES OF AFRICAN-AMERICANS VERSUS THE REST OF THE POPULATION?

>> ABSOLUTELY.

AND WE CAN LOOK AT THE HISTORICAL PERSPECTIVE OF HOW AFRICAN-AMERICANS HAVE BEEN TREATED BY THE HEALTHCARE SYSTEM.

BUT I CHOOSE TO KNOW ABOUT THAT HISTORICAL PERSPECTIVE, BUT IN REALITY, LET'S LOOK AT WHAT IS HAPPENING TODAY.

YOU KNOW, MANY AFRICAN-AMERICANS WILL NOT GO OR PARTICIPATE IN THE HEALTHCARE SYSTEM BECAUSE THEY DON'T FEEL RESPECTED.

THEY DON'T FEEL AS IF THEY WILL GET THE TREATMENT THAT THEY NEED, AND WHY BOTHER.

>> WHERE DOES THAT ORIGINATE THOUGH?

YOU HAVE TO TAKE ME BACK A STEP OR TWO.

>> WE COULD GO BACK TO DOES KEYING DOES KEYING TUSKEGEE.

THEY WERE NEVER TOLD THEY WERE PART OF A MEDICAL EXPERIMENT.

FOR 40 YEARS THAT WENT ON.

AND EVEN WHEN THERE WAS TREATMENT FOR SYPHILIS, THEY DIDN'T GET ACCESS TO THE PENICILLIN.

SO PEOPLE REMEMBER.

AFRICAN-AMERICANS HAVE SHARED THAT WITH FAMILY MEMBERS AND SO EVEN THOSE PEOPLE WHO DON'T REMEMBER, BUT THEY'VE HEARD ABOUT IT, AND THEN YOU THINK ABOUT HENRIETTA LAX, WHO, HER CELLS WERE USED AND SHE DIDN'T KNOW AND HER FAMILY DIDN'T KNOW BUT IT DID LEAD TO IMPORTANT IMPROVEMENTS IN HOW WE GET PERMISSION TO USE CELLS AND INFORMATION FROM OTHER PEOPLE.

SO THAT WAS VERY IMPORTANT.

>> I THINK ONE OF THE THINGS, IF YOU CAN SAY SILVER LINING WITH COVID-19, IT COMPLETELY BLEW OPEN THIS MYTH THAT EVERYBODY HAS EQUAL ACCESS AND EVERYTHING IS THE SAME FOR EVERYBODY ELSE.

HOW DO YOU SEE, WHEN WE SEE INCREASE INCIDENTS IN MORTALITY RATES IN THE AFRICAN-AMERICAN COMMUNITY FROM COVID-19 VERSUS OTHERS?

>> I WOULD LIKE TO KIND OF CHALLENGE YOU ON THAT TERM MYTH BECAUSE IT'S ONLY BEEN A MYTH FOR WHITE PEOPLE.

IT HASN'T BEEN A MYTH FOR BLACK PEOPLE BECAUSE THEY HAVE KNOWN.

AND THAT'S WHY THEY HAVE BEEN RELUCTANT TO SEEK HEALTHCARE IN THE AMERICAN HEALTHCARE SYSTEM.

YOUR QUESTION ABOUT, YOU KNOW,HOW DO I SEE IT?

>> YEAH.

>> I SEE IT WHILE SOCIAL DETERMINANTS OF HEALTH ARE PART OF THE REASON THAT WE HAVE THE DISPARITIES IN HEALTHCARE, DISPARITIES IN HEALTH, THE DISPARITIES IN HEALTHCARE ARE DIFFERENT THAN DISPARITIES IN HEALTH.

SO THE SOCIAL DETERMINANTS OF HEALTH HAVE LED TO DISPARITIES IN HEALTH AND THEN WHEN THEY ENTER THE SYSTEM, THE HEALTHCARE SYSTEM, THERE IS DISPARITIES IN HEALTHCARE IN THAT AFRICAN-AMERICANS ARE NOT TREATED THE SAME AS CAUCASIANS.

AND I CAN GIVE YOU AN EXAMPLE.

>> PLEASE.

>> MY FATHER, I WON'T SAY HOW OLD HE IS BECAUSE HE IS PROBABLY GOING TO WATCH THIS, BUT HE IS AN ELDERLY GENTLEMAN, AND HE WAS DIAGNOSED WITH PROSTATE CANCER.

HE HAD A VERY LARGE PROSTATE.

HIS PHYSICIAN SAID IT WAS GOING TO BE SLOW GROWING.

SO THEREFORE THERE WAS NO NEED TO BOTHER.

MY FATHER WAS IN HIS LATE 60S AT THE TIME.

AND THE PHYSICIAN JUST SAID WE'LL JUST WATCH IT.

I SAID WELL, YOU KNOW, WHY DON'T WE GET A SECOND OPINION.

HE SAID THERE IS REALLY NO NEED TO DO THAT.

I WAS LIKE, WE'RE DOING IT.

I GOT A SECOND OPINION FROM AN AFRICAN-AMERICAN DOCTOR AND HE SAID, HIS FATHER IS 101 YEARS OLD ALREADY.

YOUR FATHER IS VERY ACTIVE.

HE STARTED TALKING TO MY FATHER ABOUT WHAT HIS OPTIONS SHOULD BE AND THAT HE SHOULD CONSIDER TREATMENT, SERIOUSLY CONSIDER TREATMENT.

SO I'M STANDING AT THE ELEVATOR WITH MY FATHER AND I SAID DAD, WHAT DO YOU THINK.

HE SAID IT SOUNDS LIKE I NEED TO GET TREATMENT.

SO WHAT ABOUT YOUR OTHER UROLOGIST.

HE SAID WE'LL JUST TELL HIM WHAT HE IS GOING TO NEED TO DO.

I SAID THINK ABOUT THIS.

SHOULD WE GO BACK TO THE UROLOGIST WE JUST LEFT TO HAVE HIM PROVIDE YOUR TREATMENT?

HE SAID NO, I'VE BEEN WITH THIS OTHER DOCTOR FOR 20 YEARS SO I THINK I WILL JUST GO BACK AND TELL HIM WHAT I WANT TO DO.

WE WENT BACK TO SEE THE OTHER DOCTOR.

HE TOLD HIM WHAT HE WANTED.

AND HE SAID WELL, ARE YOU SURE YOU WANT TO DO THAT, JOHN?

AND I SAID HIS NAME IS Mr. MANSON FIRST OF ALL.

IT'S THAT WHEN THEY ARE AFRICAN-AMERICANS, THEY'RE GOING TO BE BOY UNTIL THEY DIE.

NO, HE IS Mr. MANSON UNTIL HE GIVES YOU PERMISSION TO CALL HIM SOMETHING DIFFERENT.

THAT'S A TERM OF RESPECT.

WELL, HE DID GIVE MY FATHER THE TREATMENT THAT HE REQUESTED.

MY FATHER RECOVERED VERY, VERY WELL.

HIS PSAs ARE SO LOW, THEY'RE MINISCULE.

AT ONE POINT MY FATHER'S PSA WERE 37.

BUT THEY WERE GOING TO WATCH IT.

>> TWO THINGS I HAVE TO COMMENT ON.

I AM FROM WASHINGTON D.C.

I TRAINED AT HOWARD UNIVERSITY AND EVERYONE WAS ALWAYS CALLED Mr. OR Mrs.. WE NEVER CALLED ANYONE, AND THE SATED SAD THING ABOUT MY WIFE, I DIDN'T KNOW HER FIRST NAME ON THE FIRST DATE BUT THAT'S ANOTHER STORY.

WE WERE ALWAYS Mr. AND Mrs.. AND TO THIS DAY, YOU KNOW, THE HAIRS GO UP ON THE BACK OF MY NECK WHEN I HEAR SOMEONE REFER TO A PATIENT BY THEIR FIRST NAME.

I REFUSE TO CALL A PATIENT BY THE FIRST NAME.

I INSIST ON BEING CALLED Dr. TUCKSON FOR THE SAME REASON.

BUT THERE ARE TWO THINGS IN THAT TALE YOU JUST SAID.

THE FIRST ONE IS ONE OF BIAS AND YOU ARE GOING TO HAVE TO TELL ME WHAT IS IMPLICIT AND EXPLICIT BIAS.

>> BE GLAD TO.

>> AND THEN WE'LL COME BACK TO WHY IS IT AFRICANS AFRICAN-AMERICANS DON'T EVEN TRUST AFRICAN AMERICAN PHYSICIANS OR NURSES OR OTHER HEALTHCARE WORKERS.

>> THOSE ARE GREAT QUESTIONS.

I WANT TO TALK FIRST ABOUT IMPLICIT AND EXPLICIT BIAS.

IMPLICIT BIAS IS WHERE DECISIONS ARE BEING MADE ON THINGS, PREJUDICES THAT INDIVIDUALS HAVE LEARNED AND THEY MAY BE AWARE OF THEM OR NOT.

AND IF THEY'RE NOT AWARE OF THEM, THEN THEY'RE IMPLICIT.

FOR INSTANCE, WHEN A PERSON IS NOT PRESCRIBED A MEDICATION BECAUSE THE PRESCRIBER MAY THINK THAT THAT PERSON CANNOT AFFORD THE MEDICATION, OR THAT THAT PERSON WILL NOT TAKE THE MEDICATION BECAUSE THEY DON'T KNOW HOW TO TAKE THE MEDICATION, THEN THAT MAY BE AN IMPLICIT BIAS BASED ON WHAT THEY'VE LEARNED IN THEIR LIFE PLACES.

THE EXPLICIT BIAS IS WHEN THEY KNOW THAT THEY FEEL THAT WAY AND THEY STILL REACT THAT WAY.

SO I THINK THAT WE IN THE HEALTHCARE PROFESSION, EVERYBODY HAS BIAS FIRST OF ALL.

EVERYBODY.

BUT WE NEED TO BECOME AWARE OF OUR IMPLICIT BIASES SO THAT THE IMPLICIT BIASES DON'T MAKE US MAKE MISTAKES IN HOW WE ARE TREATING PEOPLE, PEOPLE OF COLOR.

BLACK PEOPLE, NON-CAUCASIAN PEOPLE.

>> YOU KNOW, IN 1960, I KNOW THAT'S OLD-- 1916, THERE WAS A LAW PASSED IN ALABAMA THAT A WHITE NURSE DID NOT HAVE TO CARE FOR AN AFRICAN-AMERICAN MALE PATIENT.

NOW, WHY IS THAT IMPORTANT?

BECAUSE THE NEXT YEAR IN WINCHESTER, KENTUCKY, AN AFRICAN-AMERICAN WAS OPERATED ON IN AN OPERATE, PUT IN THE HOSPITAL IN WINCHESTER AND HE HAPPENED TO BE THE BUTLER OR SERVANT, THE GUY WHO WAS A PROMINENT BANKER IN KENTUCKY.

VERY PROMINENT GUY.

AND THE NURSING STAFF REFUSED TO CARE FOR HIM, IN SPITE OF THE FACT THAT THIS PROMINENT CITIZEN OF THE COMMUNITY SAID PLEASE TAKE CARE OF THIS GUY AND THE DOCTOR REFUSED AND WALKED OUT.

POST-OPEN DAY ONE, THE GUY HAD TO GO HOME.

>> THAT'S CALLED IMPLICIT-- EXPLICIT BIAS.

THEY KNEW.

AND IT HAPPENED THEN AND I THINK IT STILL HAPPENS NOW.

>> IT DOES HAPPEN NOW.

>> SO HOW DO YOU COUNTERACT THAT?

WHAT ARE THE STEPS THAT WE NEED TO WORK THROUGH THIS?

>> WELL, THERE ARE SOME THINGS THAT WE NEED TO START WITH.

FIRST OF ALL, WE NEED TO CHANGE SOME HEALTH POLICY AND SOME LAWS THAT-- BUT I LIKE TO START AT THE BEGINNING.

I THINK THAT HEALTHCARE PROFESSIONALS SHOULD ALL GET IMPLICIT BIAS TRAINING SO THAT THEY'RE AWARE OF THEIR BIASES SO THEY GET TO MAKE DECISIONS BASED ON THEIR KNOWLEDGE OF THEIR IMPLICIT BIASES.

IT DOESN'T MEAN THAT THEY'RE NOT GOING TO HAVE THEM BUT IT DOES MEAN THAT THEY BECOME AWARE OF THEM AND CAN USE THAT KNOWLEDGE TO MAKE GOOD DECISIONS ABOUT THE CARE.

AND I THINK THAT'S SOMETHING THAT WE OWE BLACK PEOPLE.

WE OWE BROWN PEOPLE.

WE OWE NON-CAUCASIAN PEOPLE.

AND I THINK THAT IT'S SOMETHING THAT EVERY HEALTHCARE PROFESSIONAL NEEDS TO HAVE, NO THE JUST NON-WHITE HEALTHCARE PROFESSIONS BECAUSE IT GETS TO YOUR SECOND QUESTION WHAT MAKES BLACK PEOPLE NOT TRUST PHYSICIANS AND HEALTHCARE PROVIDERS OF THEIR OWN RACE?

>> FIRST OF ALL, YOU MAY NOT REALLY APPRECIATE THIS, BUT BECAUSE WE ALL GO TO THE SAME SCHOOLS, WE ARE ALL LEARNING THE SAME THINGSMENT AND THERE ARE AFRICAN-AMERICANS, BLACK PEOPLE, NON-CAUCASIAN PEOPLE WHO HAVE BIAS AGAINST THEIR OWN PEOPLE.

AND THEY LEARNED IT IN THE SCHOOLS,THAT THEY WENT TO WITH THE CAUCASIAN PEOPLE SO IF THERE HASN'T BEEN AN INTENTIONAL EFFORT TO DISPEL THOSE PREJUDICE S BRAK PEOPLE, BROWN PEOPLE ARE GOING TO HAVE THE SAME BIASES THAT WHITE PEOPLE HAVE.

AND THEREFORE WHEN THEY'RE TREATING BLACK PEOPLE, THEY'RE TREATING THEM THE SAME WAY WHITE PEOPLE TREAT THEM.

THAT IS WHY THEY DON'T TRUST BLACK AND BROWN HEALTHCARE PROFESSIONALS.

SO WE ALL NEED IMPLICIT BIAS TRAINING.

WE ALL NEED TO GET THAT OUT ON THE TABLE AND WE ALL NEED TO MAKE A CONCERTED EFFORT TO RESOLVE THAT ISSUE.

THAT'S THE FIRST THING WE NEED TO DO.

>> ON THE OTHER HAND, SEVERAL STUDIES HAVE DEMONSTRATED THAT WHEN AN AFRICAN-AMERICAN PATIENT IS BEING TAKEN CARE OF BY AN AFRICAN-AMERICAN HEALTHCARE PROFESSIONAL, THE OUTCOMES ARE BETTER DISEASE FOR DISEASE, THEY TEND TO DO BETTER.

CLEARLY, IT'S ALMOST LIKE THE OLD SONG FROM CHEERS WHERE EVERYBODY KNOWS YOUR NAME.

WHEN YOU GO TO SOMEBODY THAT LOOKS, ACTS, TAWCTS AND LOOKS LIKE YOU, THAT'S ONE LESS BARRIER.

YOU WOULD THINK FOLKS WOULD AUTOMATICALLY GRAVITATE THERE.

>> I THINK IT'S A 50-50.

I REALLY DO BECAUSE BEING BLACK DOES NOT GET YOU A PASS WITH BLACK PEOPLE.

YOU STILL HAVE TO DEMONSTRATE THAT, AND EARN THE TRUST REGARDLESS OF THE COLOR OF YOUR SKIN BUT YOU MIGHT BE ABLE TO GET THE TRUST FASTER IF YOU SHOW UP IN BROWN SKIN OR BLACK SKIN.

>> NOTHING YOU HAVE SAID WOULD SUGGEST TO ME THAT JUST BECAUSE SOMEONE IS WHITE, THEY ARE NOT GOING TO PROVIDE GOOD CARE.

>> I WOULD NEVER SAY SUCH A THING, BUT I WILL SAY THAT AS HEALTHCARE PROFESSIONALS, WE ALL, REGARDLESS OF OUR COLOR, REGARDLESS OF OUR ETHNICITY, NEED TO BE AWARE OF OUR IMPLICIT BIASES.

>> WHAT ABOUT ON THE PART 69 PATIENT?

THEY COME IN WITH THEIR BIASES?

>> ABSOLUTELY.

BECAUSE WE ARE IN THE BUSINESS OF SERVICE WE ARE IN THE BUSINESS OF CARE TAKING, THE FIRST GROUP THAT NEEDS TO RESOLVE THE ISSUE, IT'S WITH US, PERIOD.

I DO THINK THAT THAT IS SOMETHING THAT WE, AS AMERICANS, WILL HAVE TO WORK ON.

WE HAVE 400 YEARS OF SETTING IT UP SO THAT WE HAVE WHITE SUPREMACY AND THE IDEA THAT ONE GROUP IS BELOW ANOTHER GROUP.

THAT IS NOT GOING TO BE RESOLVED OVERNIGHT.

AND WE HAVE WORK TO DO.

>> WHEN WE LOOK AT THE NUMBER OF HEALTHCARE PROFESSIONALS RIGHT NOW, I DON'T THINK THE NUMBER OF PHYSICIANS AND NURSES HAS KEPT PACE WITH OUR POPULATION.

>> I AGREE.

>> YOU ANTICIPATE THAT WE WOULD HAVE ABOUT 13% OF NURSES, 13% OF PHYSICIANS, ET CETERA, IN PLACES LIKE KENTUCKY, AT LEAST 8%.

HOW DO WE INCREASE THE NUMBERS OF HEALTHCARE PROFESSIONALS?

WHAT ARE THE STEPS THAT YOU SEE?

AND WHEN DO YOU START?

IS IT AT KINDERGARTEN?

IS IT AT THAT HIGH SCHOOL SENIOR, A PERSON WHO IS NOW IN COLLEGE?

>> ARE YOU REFERENCING-- >> LET'S TALK NURSING.

>> OKAY.

WELL FIRST OF ALL IN KENTUCKY WE HAVE 90,000 NURSES.

ABOUT 8% OF THOSE ARE AFRICAN-AMERICANS AND ABOUT 4% ARE ASIAN, HAWAIIAN, OTHER.

IN ORDER TO GET PEOPLE OF COLOR TO ENTER THE MEDICAL PROFESSION, NURSING, PER SE, WE HAVE TO START IN THE WOMB.

I SAY WE START EARLY.

WE START TALKING TO THOSE BABIES.

>> TALK ABOUT THE ULTRASOUND, GIVE THEM A BOOK TO READ.

>> THAT'S RIGHT.

BUT SERIOUSLY, I THINK WE NEED TO START IN ELEMENTARY SCHOOL.

WE NEED TO START WITH WHAT CHILDREN ARE SEEING ON TELEVISION.

THEY NEED TO SEE PEOPLE WHO LOOK LIKE THEM IN ROLES THAT THEY CAN FEEL LIKE THEY CAN DO IT, TOO.

YOU KNOW, WHEN BARACK OBAMA BECAME PRESIDENT, IT WASN'T THAT HE WAS THE BLACK PRESIDENT.

IT WAS THAT LITTLE BOYS AND GIRLS AROUND THE WORLD COULD SEE A POSSIBILITY FOR THEM.

WHEN MICHELLE WAS THE FIRST LADY, IT WASN'T BECAUSE SHE WAS A BLACK WOMAN AS THE FIRST LADY.

IT WAS BECAUSE PEOPLE COULD SEE POSSIBILITIES FOR THEM.

AND SO I SAY THAT WE START WITH MEDIA AND WE START WITH BOOKS, AND CONVERSATIONS AND WE, AS HEALTHCARE PROFESSIONALS, NEED TO BE OUT TALKING TO YOUNG PEOPLE ABOUT POSSIBILITIES OF WHAT THEY CAN DO TO SERVE THEIR COMMUNITY AND OTHER COMMUNITIES.

WE START NOW.

>> SO WITH THE SCHOOL SYSTEMS AS THEY ARE ROYALTY RIGHT NOW.

ARE WE PREPARING KIDS TO MAKE THOSE KINDS OF DECISIONS AS YOU SEE IT FROM YOUR PERSPECTIVE FROM THE KENTUCKY NURSES ASSOCIATION.

>> I SEE WE HAVE CHALLENGES.

I SEE WOO HAVE OPPORTUNITIES BECAUSE I GO TO ELEMENTARY SCHOOLS, HIGH SCHOOLS, PARTICIPATE WITH GIRS GROUPS AND LITTLE BOY GROUPS AND OF THE COLLEGES AND I KNOW THAT WE DON'T HAVE THE PERCENTAGES OF NON-CAUCASIAN STUDENTS THAT WE NEED IN ORDER TO PRODUCE, AS YOU SAY, THE PERCENTAGE OF NON-WHITE PROFESSIONALS.

>> BACKTRACK A LITTLE BIT TO THE SOCIAL DETERMINANTS OF HEALTH.

WE HAVE TO.

I MEAN THAT IS THE ROOT OF ALL GOOD AND BAD, THE GARDEN OF GOOD AND EVIL, IF YOU WILL.

SO FROM YOUR PERSPECTIVE IN HEALTHCARE, WHAT IS THE ROLE OF THE HEALTHCARE PROFESSIONAL IN THOSE?

I MEAN IT CAN'T JUST BE ABOUT WHEN THAT INDIVIDUAL COMES INTO THE OFFICE TO THE CLINIC OR TO THE HOSPITAL WHEN YOU ARE ENGAGING.

IT'S GOT TO BE SOMEWHERE ELSE.

SO DESCRIBE TO ME HOW YOU SEE THE ROLE OF NURSING OUTSIDE OF THE CONFINES OF THOSE THREE AREAS?

>> WHAT YOU DESCRIBED IS THE INTERSECTION OF THE PATIENT WITH THE HEALTHCARE SYSTEM.

NURSING IS A PROFESSION AND WE HAVE SUCH DIVERSE ROLES FOR NURSING THAT WE NEED TO BE WAY UPSTREAM IN THE WELLNESS PIECE.

AND THAT'S WHEN WE START TALKING ABOUT THE SOCIAL DETERMINANTS OF HEALTH.

WE SHOULD BE INVOLVED IN THE SCHOOLS TALKING ABOUT NUTRITION AND DIET AND EXERCISE.

WE NEED TO BE AT THE FOREFRONT OF PARTICIPATING IN MAKING SURE THAT THE SOCIAL DETERMINANTS OF HEALTH DO NOT LEAD THOSE FAMILIES TO AN UNHEALTHY AND ENTRANCE INTO THE HEALTHCARE SYSTEM.

THAT INCLUDES WATER, AIR, HOUSING FOOD, SECURITY ALL OF THOSE THINGS.

NURSES NEED TO BE INVOLVED AND WE SHOULD BE ADVOCATING FOR THOSE SOCIAL DETERMINANTS OF HEALTH TO BE HEALTHY SOCIAL DETERMINANTS OF HEALTH, NOT THOSE THAT ARE GOING TO LEAD TO DISPARITIES AND AS NURSES, WE ARE TAUGHT TO ADVOCATE FOR OUR PATIENTS AND THAT'S WHAT I LEARNED IN NURSING SCHOOL.

WELL, AS MY CAREER GREW, I LEARNED THAT ENTRANCE INTO THE HEALTHCARE SYSTEM WAS ONLY ONE PART OF HEALTH.

WE NEED TO GO UPSTREAM AND START ADVOCATING AT THE BEGINNING.

WE CAN START WITH MATERNAL CHILD EXPERIENCES TO MAKE SURE THAT BLACK MOTHERS GET ACCESS TO OB/GYN CARE.

WE NEED TO BEGIN AT THE BEGINNING.

>> THAT'S INTERESTING BECAUSE ONE OF THE FIRST AVENUES OF AFRICAN-AMERICANS INTO HEALTHCARE WAS THE MIDWIFE.

NOW SOME WERE FORMALLY TRAINED SOME NOT.

IT WAS INTERESTING HOW THEY WERE TEACHING WOMEN HOW TO BE MOTHERS WAS PART OF THAT.

>> THE REASON THEY CAME INTO BEING WAS BECAUSE THEY DO NOT GET ENTRANCE INTO A HOSPITAL TO GET QUALITY CARE BUT THEY COULD BE EXPOSED TO A MIDWIFE, HAVE THEIR BABY AT HOME THAT THEY COULD PUT IN A DRAWER BECAUSE THEY COULDN'T TAKE THEM TO THE HOSPITAL.

SO THE REALITY IS THAT MIDWIVES SERVED SUCH AN INCREDIBLE OUTLET FOR AFRICAN-AMERICANS.

THAT WAS THE BEGINNING.

THAT WAS THE EXPOSURE.

>> TELL ME ABOUT THE DISTRIBUTION OF NURSES IN TERMS OF URBAN POPULATIONS, UNDERSERVED WHEN I SPEAK OF URBAN, UNDERSERVED AREAS, PREDOMINANTLY MINORITY, VERSUS OTHER AREAS.

ARE WE SEEING AN EVEN DISTRIBUTION OR DO WE HAVE CLUSTERING WHERE THE MONEY IS WE HAVE A LOT OF NURSES BUT WE DON'T HAVE A LOT OF NURSES IN THE RIGHT PLACES.

IN THE RURAL AREAS, THERE IS A LACK OF NURSES AND IN SO MANY OF THOSE AREAS, WE HAVE NURSE PRACTITIONERS WHO ARE REALLY PROVIDING THE ACCESS TO CARE TO THOSE COMMUNITIES.

WE NEED THOSE NURSE PRACTITIONERS IN THOSE AREAS.

THEY GREW UP IN THOSE COMMUNITIES.

THEY WENT TO SCHOOL, THEY CAME BACK TO THOSE COMMUNITIES.

THEY'RE SERVING THOSE COMMUNITIES.

AND WITHOUT THOSE NURSE PRACTITIONERS, MANY OF THOSE COMMUNITIES WOULD NOT HAVE ACCESS TO CARE.

SO THE QUESTION IS, DO WE HAVE ENOUGH NURSES?

MAYBE.

MAYBE NOT.

BUT I CERTAINLY KNOW THAT WE DO NOT HAVE THE NURSES IN THE PLACES THAT WE NEED THEM.

>> WEARING YOUR HAT AS THE C.E.O., KENTUCKY NURSES ASSOCIATION.

ARE THE PROBLEMS THAT WE ARE SEEING IN THE URBAN AREA MIRRORED IN THE RURAL COMMUNITIES?

>> RELATION TO... >> ACCESS, UTILIZATION OF CARE, PATIENTS BECAUSE OF THE INSURANCE STATUS NOT BEING ABLE TO GET IN.

SOME OF THE SAME DISEASE PROCESSES WE ARE SEEING, PARTICULARLY IN TERMS OF APPALACHIA AND AREAS SUCH AS THAT.

I'M NOT TALKING ABOUT JUST OUTSIDE THE SUBURBAN AREAS.

I MEAN THE RURAL WHEN WE ARE TALKING ABOUT IN THE HOLLERS, ET CETERA AREA.

>> I WOULD SAY THAT THEY DO MIRROR A LOT OF WHAT WE ARE SEEING IN THE URBAN AREAS.

WE ALSO SEE, YOU KNOW, IN TERMS OF STAFFING, A LOT MORE CREATIVITY OF HOW YOU GET ALL THE PATIENTS AND FAMILIES TAKEN CARE OF.

ONE OF THE THINGS NURSES ARE WELL KNOWN FOR IS HOW TO MAKE DUE WITH NOTHING AND GET IT ALL DONE.

THAT'S WHAT NURSES DO.

>> INTERESTING.

WHEN I WENT TO MEDICAL SCHOOL, MY MOTHER GAVE ME TWO PIECES OF ADVICE AND I'VE YET TO BE ABLE TO PROFIT WRONG AND I'VE TOLD OTHERS.

NUMBER ONE SHE SAID NEVER MESS UP A BED THAT A NURSE MADE BECAUSE BACK IN THOSE DAYS, THE NURSES DID MAKE BEDS.

AND 2: LISTEN TO THE NURSE.

THEY PROBABLY KNOW MORE ABOUT WHAT IS GOING ON WITH THE PATIENT THAN YOU DO.

>> VERY SMART MOTHER.

>> I DO.

HOW HAVE YOU SEEN THE ROLE INTERCHANGE BETWEEN NURSES, PHYSICIANS AND OTHER HEALTHCARE PROVIDERS?

HOW HAS THAT EVOLVED FOR US?

>> I WAS IN THE NAVY FOR 27 YEARS.

>> THE THAT EXPLAINS A LOT.

[LAUGHTER] AND THE RELATIONSHIP BETWEEN NURSES AND PHYSICIANS IN THE MILITARY IS SO INCREDIBLY COLLEGIAL.

IT'S SCARY ACTUALLY.

THEY'RE VERY, VERY SUPPORTIVE.

SO WHEN I GOT OUT OF THE MILITARY AND WENT TO WORK IN THE CIVILIAN COMMUNITY, I REALLY DIDN'T UNDERSTAND A LOT OF THINGS I WAS SEEING.

IT WAS LIKE WHAT IS GOING ON HERE?

AND SO THAT WAS A LONG TIME AGO, YOU SEE.

THINGS HAVE CHANGED AND THERE IS A LOT MORE COLLEGIALITY BETWEEN NURSES AND PHYSICIANS TODAY AND EVEN MORE NOW WITH COVID.

WHEN WE LOOK AT THE SURVEYS ABOUT WORKING RELATIONSHIPS OF THE PROVIDERS, IT'S JUST AMAZING HOW PHYSICIANS AND NURSES AVIEW EACH OTHER VERSUSES PEOPLE WHO ARE WORKING OUTSIDE OF TAKING CARE OF COVID-19 PATIENTS.

THEY DON'T SEE THAT COLLEGIALITY AT ALL.

>> WITH ABOUT 45 SECONDS, ARE WE MAKING PROGRESS ON THE DIVERSITY ISSUE?

OR ARE WE TREADING WATER?

>> WE ARE TREADING WATER?

>> WHAT WILL IT TAKE TO TIP IT IN THE OTHER DIRECTION?

>> INTENTIONAL EFFORT, PLANS TO SUCCEED, BUT IT MUST BE INTENTIONAL.

IT'S NOT GOING TO HAPPEN BY OSMOSIS.

IT MUST BE INTENTIONAL.

>> ORGANIZED MEDICINE?

ORGANIZED NURSING, STUMBLING BLOCK, ROAD BLOCK OR CONTRIBUTING TO THE SOLUTION?

>> ORGANIZED?

EXPLAIN.

>> NATIONAL NURSING ASSOCIATION, AMERICAN MEDICAL ASSOCIATION AND GROUPS AT THE NATIONAL LEVEL.

>> I CAN SAY THAT THE AMERICAN NURSES ASSOCIATION PROVIDES A LOT OF SUPPORT TO US, THE KENTUCKY NURSES ASSOCIATION, FOR THINGS WE DON'T HAVE THE STAFF TO DO.

SO IN TERMS OF SURVEYS, WHEN WE HAD AN ISSUE WITH PPE, IT WAS THE NATIONAL NURSES ASSOCIATION, THE AMERICAN NURSES ASSOCIATION WHO WENT TO BAT TO MAKE SURE THAT WE COULD GET PPE.

AND SO AS WE ARE LOOKING AT MENTAL HEALTH, IT IS THE AMERICAN NURSES ASSOCIATION WHO IS HELPING US WITH OUR MENTAL HEALTH PROGRAMS.

SO THEY'RE NOT A STUMBLING BLOCK.

>> TRADITIONALLY SOME OF THE NATIONAL ORGANIZATIONS HAVE NOT BEEN, ESPECIALLY ON THE MEDICAL SIDE, HAVE NOT ALWAYS BEEN... OBVIOUSLY THEY'RE MAKING GREAT, GREAT STRAIDZ NOW.

>> I DIDN'T SAY IT WAS ALWAYS THAT WAY.

>> GOTCHA.

IT IS GETTING A LITTLE BIT BERT.

IN KENTUCKY STRIDES ARE BEING MADE.

>> ABSOLUTELY.

>> I WANT TO THANK YOU VERY MUCH FOR BEING WITH US.

IT IS A REAL PLEASURE TALKING TO YOU AND I LIKE TO THANK YOU FOR BEING WITH US TODAY ALSO.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF HOW RACIAL ATTITUDES IMPACT HEALTHCARE AND STEPS THAT WE MAY TAKE TO CORRECT THESE INADD QAWCIES.

IF I WISH TO WATCH THIS SHOW AGAIN OR ARCHIVED VERSION OF PAST SHOWS, 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.

PLEASE BE SAFE, WEAR YOUR MASK, MAINTAIN SOCIAL DISTANCING AND BE CONSIDERATE OF OUR NEIGHBORS