Child Study Center Grand Rounds 03.23.2021

Transcript

• 00:00Today, let me tell you what we
• 00:03have in store for next week.
• 00:05Another one that I'm very excited about.
• 00:08Next week we're going to have our
• 00:12next compassionate care routes.
• 00:14And we're going to be talking about.
• 00:16I don't have the title in front of me,
• 00:19just coined it, but I think it
• 00:22goes something along the lines of.
• 00:25Actually, do you have that
• 00:27the title on hand row?
• 00:32While Roe looks for the title,
• 00:33I can tell you that it's going to
• 00:35be about the work that we're doing.
• 00:37On eating disorders up on the on the
• 00:39pediatric floors where we have been
• 00:42absolutely overwhelmed by the number
• 00:43of such presentations we usually have,
• 00:46you know one or two every so often.
• 00:49But as you will hear,
• 00:51we've been literally flooded and overwhelmed,
• 00:53and we're trying to make sense
• 00:55of what that is,
• 00:57and so we're going to have a
• 00:59compassionate care rounds with
• 01:01the clinicians from all stripes
• 01:02of clinicians who have worked,
• 01:04we're going to talk about a specific case.
• 01:07But more broadly about what this means,
• 01:10so it's going
• 01:11to be very special,
• 01:13and the title is too little.
• 01:15Eating too many cases,
• 01:16microdroplets of trust
• 01:17toward national rehabilitate
• 01:18nutritional rehabilitation.
• 01:20Yeah, can you say it one
• 01:23more time slowly?
• 01:25I'm Mr too little.
• 01:27Eating too many cases.
• 01:29Microdroplets of trust?
• 01:30Tord nutritional rehabilitation.
• 01:33And there you have it,
• 01:35and we're going to thank you, Rob.
• 01:37And we're going to have a real,
• 01:39wonderful multidisciplinary cast for that.
• 01:41So, so that's next week.
• 01:43But this week, you know I wanted
• 01:45to introduce our wonderful speaker,
• 01:47but Rob Liberal, just like ARM,
• 01:49wrestled me, tackled me in fact,
• 01:51and he said, no, you're not doing it.
• 01:54I'm doing it.
• 01:55So I said, OK Liberal,
• 01:56if that's how you wanna do it.
• 01:59But you know, kidding aside,
• 02:00I am so grateful to Rob.
• 02:03Who who really has just like I was
• 02:05telling that Carol has been our paragon
• 02:08of timeliness and and always being there,
• 02:11I would say that Rob has been our
• 02:14paragon of identifying important topics.
• 02:17Wonderful speakers today is
• 02:18the second of three wonderful
• 02:21speakers the the first one that we
• 02:23had with Reverend Amanda right.
• 02:25I'm still seeing it in my in my mind's eye.
• 02:29It was an incredible talk
• 02:31and today by Charles he.
• 02:33Permitted me to call him Charles, not doctor.
• 02:36Centeio will not be an exception.
• 02:38We're in for a real treat and I
• 02:41will let my good friend rob the
• 02:43master of making this connection.
• 02:45Tell us about Doctor sent a place.
• 02:48Rob
• 02:48thank you. Doctor Martin.
• 02:50The Yale Child Study Center is a very
• 02:53special place I know this because
• 02:55last week Doctor Martin and Doctor
• 02:58Fernandez helped us bear witness to
• 03:01that rich and fruitful tradition of
• 03:03making the world a better place.
• 03:05By honoring the legacy of our
• 03:08dear and beloved Doctor Cohen.
• 03:11Who through a series of lectures honored him.
• 03:14And today it is my privilege to
• 03:17introduce a very special person in
• 03:21this very special virtual place who
• 03:24has 1 foot in academia and the other
• 03:28foot on the ground in the community,
• 03:31making the world a better place.
• 03:34And his name is the doctor Charles Centrio.
• 03:38Today, Doctor Santio was shared with us a
• 03:42lecture entitled understanding and reducing.
• 03:45Racial inequality for COVID-19 vaccination.
• 03:48Doctor Sentio is an assistant
• 03:50professor at the Rutgers School of
• 03:53Communication and Information in
• 03:56the Department of Library Science.
• 03:59He is also currently the Martin Luther King.
• 04:04Visiting professor and scholar at
• 04:07Massachusetts Institute of Technology.
• 04:09His research focuses on improving chronic
• 04:13disease outcomes for underserved populations.
• 04:16He is particularly interested in
• 04:19using both existing technology
• 04:22such as smartphones and tablets,
• 04:25and emerging technologies such as machine
• 04:28learning to improve health outcomes.
• 04:31He earned his PhD.
• 04:33In health informatics from the University of
• 04:37Michigan and while in pursuit of that degree,
• 04:40he also earned a master's degree
• 04:43in social work from University of.
• 04:46Michigan and later acquired a
• 04:48clinical license and social work.
• 04:52He also received an MBA from U of M Ann.
• 04:56Prior to that,
• 04:57a BA in mathematics and computer science
• 05:00at Central Connecticut State University.
• 05:03Clearly Doctor Santio is a
• 05:05musical intellectual.
• 05:06He has an incredible gift to be
• 05:09able to synthesize and assimilate
• 05:11diverse bodies of knowledge in novel,
• 05:14tangible and meaningful ways.
• 05:16He is the author of numerous articles
• 05:19and currently has a book chapter.
• 05:22Under review in their Rutlidge Handbook
• 05:24of Health Communication on the topic of
• 05:27community based health interventions.
• 05:29Will you please help me?
• 05:32Welcome Doctor Charlson TL to
• 05:34the Yale Child Study Center.
• 05:39Thank you, thank you so much,
• 05:41I appreciate it.
• 05:42Thanks for the warm introduction.
• 05:43Both Rosemary and Razan Rob,
• 05:45I certainly appreciate it.
• 05:46Thank you also for the an opportunity,
• 05:49at least virtually any way to return
• 05:51home to Connecticut where I grew up,
• 05:53I was born in Hartford and I
• 05:55grew up in Manchester before
• 05:57venturing off to two other places.
• 05:59So thank you again.
• 06:00I'd like to start the talk by just
• 06:03grounding our understanding or
• 06:04developing a common understanding,
• 06:06as I like to say for what health informatics.
• 06:09Is there are various definitions out there?
• 06:12This is 1 by Chuck Friedman
• 06:14who's a professor that I had
• 06:17at Michigan very commonly used.
• 06:19So basically,
• 06:20by definition it's important to
• 06:21understand that health informatics
• 06:23is definitionally interdisciplinary,
• 06:25and what it really involves are
• 06:27science domains or traditionally
• 06:29kind of science domains as well as
• 06:32application domains coming together
• 06:33to support scientific inquiry and
• 06:36problem solving, and that is about it.
• 06:39So science domains include
• 06:40information science where I come from.
• 06:43In terms of my doctoral training,
• 06:46computer science,
• 06:46where my undergraduate training was
• 06:49in along with various other sciences,
• 06:52cognitive science, communication,
• 06:53science, organizational science,
• 06:54decision sciences,
• 06:55and then application domains health.
• 06:57Obviously for this population
• 06:59includes community health,
• 07:01Health Communication, health,
• 07:02behavior, clinical care delivery,
• 07:04bio medical informatics or bio medical study,
• 07:07as well as social work and public health.
• 07:11And I picked these domains because my works.
• 07:15Tends to touch each of these areas,
• 07:17so combining the application domain
• 07:19and the science you get domain
• 07:21informatics so health informatics,
• 07:23biomedical informatics.
• 07:24So that's just a way for you to
• 07:27sort of decyfer when you hear
• 07:29health informatics and that term,
• 07:31this is the generally accepted definition,
• 07:34but the bottom line is that people
• 07:36are the users of health information,
• 07:39so health informatics,
• 07:40no matter where you are in terms
• 07:43of the type of work that you do.
• 07:46Ultimately points to that people, humans.
• 07:48We interact with information and
• 07:51that information can exert influence
• 07:53on us as well as we exert influence
• 07:56on it as we produce it OK.
• 07:58Now,
• 07:58common understanding what's HealthEquity.
• 08:00I'll go this one through this one
• 08:02a little bit quicker.
• 08:04I'm I'm assuming that we probably
• 08:06have more of a baseline understanding,
• 08:09but basically it's about assessing
• 08:11the differences in health status
• 08:13between groups of people and those
• 08:15groups can be defined by race or ethnicity.
• 08:18That's a common sort of grouping,
• 08:20and the grouping that I probably deal
• 08:23with the most, but also importantly,
• 08:25immigration status, disability,
• 08:27gender, sexual orientation, geography.
• 08:28And assets and I used the term Alice
• 08:31now which stands for asset limited
• 08:33income constrained an employed
• 08:35SES is a common sort of bucket
• 08:37for that or similar bucket,
• 08:39but Alice is a term that I see used more
• 08:42and more in the term I use now differences.
• 08:45What does that mean?
• 08:47Well,
• 08:47differences include the extent.
• 08:50Of a disease.
• 08:51As well as impact,
• 08:53so I don't want to take
• 08:56us through FB 101 here,
• 08:58but basically the prevalence
• 09:00is the proportion of cases in a
• 09:03population at a time, so incidences,
• 09:06incidents conveys information about
• 09:08the risk of contracting a disease,
• 09:10whereas prevalence indicates
• 09:12how widespread it is.
• 09:14And in the context of COVID,
• 09:16that's extremely relevant.
• 09:17I think we've all heard some of these
• 09:20terms released concepts as we've looked
• 09:22at the Daily News on COVID updates.
• 09:25Now just a little bit about equity,
• 09:27I could cite many different examples
• 09:29and I'll cite some later on.
• 09:31But for those of us who work in equity,
• 09:34and I've been working in
• 09:36equity for about 15 years now,
• 09:38Milwaukee is a city that's often used in
• 09:40illustrating HealthEquity or health inequity.
• 09:42It's a fairly segregated city
• 09:44with a large black population,
• 09:4540% in the city,
• 09:47and then 17% in Metro Milwaukee.
• 09:49And we don't quite understand why there
• 09:51are some various theories out there,
• 09:54but the point is that when you see
• 09:56HealthEquity numbers illustrative
• 09:58of a larger larger phenomenon,
• 10:00you see Milwaukee quoted quite a bit so.
• 10:04Infant mortality across the United States
• 10:06for blacks is more than twice that of whites.
• 10:09That's been the case for over a decade now.
• 10:13And in Milwaukee,
• 10:14as I've mentioned,
• 10:14low SES households are three
• 10:16and a half times more likely to
• 10:18die in the first year of life.
• 10:20So these sort of dramatic indicators,
• 10:22again persistent.
• 10:23This is before COVID became
• 10:25part of our binocular.
• 10:27These are persistent inequities,
• 10:29and Milwaukee is a good place to
• 10:32sort of illustrate these this data.
• 10:34These facts and this.
• 10:36These have been the case.
• 10:38As I mentioned for over a decade now.
• 10:43OK,
• 10:43I want to also emphasize that HealthEquity
• 10:46is a persistent human rights issue.
• 10:50I need to assert that because there's
• 10:53not universal agreement on this.
• 10:55I read a few years ago when I was delving
• 10:58more into policy that we fund our priorities.
• 11:02I'll say that again,
• 11:03we fund our priorities and HealthEquity
• 11:06is not necessarily something that
• 11:08has been funded.
• 11:09I'm going to put a quote up here and if
• 11:13we were in the room I'd ask for hands,
• 11:15but I want to read this to you.
• 11:18We are concerned about the constant
• 11:20use of federal funds to support
• 11:21this most notorious expression of
• 11:23segregation of all forms of inequality.
• 11:25Injustice in health is the most
• 11:27shocking and the most inhuman because
• 11:29it often results in physical death.
• 11:31The quote more of the quote I see
• 11:33no alternative to direct action and
• 11:35creative nonviolence to create awareness,
• 11:37to create, to create,
• 11:38not creative nonviolence to raise
• 11:40the conscious of the nation.
• 11:41Sorry bout that.
• 11:42I stepped over the last part.
• 11:44Does anyone know who famously
• 11:47said that in a speech?
• 11:49I'm gonna move on here.
• 11:51That's Doctor Martin Luther King Junior 1965.
• 11:54Annual meeting of Medical
• 11:56Committee for Human Rights.
• 11:57So this notion of HealthEquity that
• 11:59it exists going to get more to that
• 12:02later and that it's important,
• 12:04has been around.
• 12:05This is not a new thing and
• 12:07I want to make sure that we understand that.
• 12:11So when I say persistent inequity,
• 12:13I'm not talking about COVID.
• 12:14I'm certainly not even talking
• 12:16about the last decade or two
• 12:18when this work has proliferated.
• 12:19We've known about these
• 12:21inequities for quite some time.
• 12:23Now let's jump into the causes.
• 12:25As you might imagine, summer unclear.
• 12:27This is an interesting question.
• 12:29What causes health inequities?
• 12:31It seems may seem innocuous.
• 12:33But part of what makes it complex is
• 12:35that it brings together many academic
• 12:37disciplines and many different theories,
• 12:40many different approaches.
• 12:41During my PhD study in Information Science,
• 12:44I was exposed as you might imagine,
• 12:46to several different academic
• 12:48disciplines that are new to me.
• 12:50As Rob mentioned, I was a mathematics
• 12:53and computer science undergrad,
• 12:54so my pathway to social
• 12:56science was was long and Anan.
• 12:59Winding.
• 12:59However,
• 12:59given my description of health informatics,
• 13:02that's probably to be expected in
• 13:04terms of the interdisciplinarity.
• 13:06Of it,
• 13:06so my interest in HealthEquity
• 13:08was enhanced by my exposure to
• 13:10developmental psychology literature.
• 13:12This is literature that I'm sure
• 13:14many in the crowd are familiar with,
• 13:16specifically through one of my professors,
• 13:19Daniel Keating, who I mentioned by name here.
• 13:22One because he does wonderful work and two,
• 13:25he's just an excellent professor in person.
• 13:27I'm using his work here to explain
• 13:29or try to answer the question
• 13:32about what causes inequity.
• 13:33Again, persistent inequity.
• 13:35As I continue to to identify the root causes,
• 13:39I find myself even reading more
• 13:42literature and sociology, psychology,
• 13:44even history to understand context.
• 13:46So it's important if we're
• 13:48going to ask this question,
• 13:50we have to embrace different disciplines,
• 13:53different people, different literature.
• 13:54That's important now, the answers.
• 13:57What are they?
• 13:59They lie in two camps, essentially,
• 14:02historically and contemporarily,
• 14:04nature versus nurture.
• 14:05We're probably very familiar
• 14:07with the concepts.
• 14:09Are certain groups biologically
• 14:11or genetically predisposed to
• 14:13the risk of certain conditions?
• 14:16And their progression?
• 14:17Or do social factors play
• 14:19more of a role nurture?
• 14:22For the Pearly early part,
• 14:23I told you,
• 14:24I've been reading a lot of history,
• 14:25so for the early part of
• 14:27our country's history,
• 14:27nature was the prevailing belief.
• 14:30The science was influenced by
• 14:32the sentiments of the scientists.
• 14:34This is still the case.
• 14:36The psychologist Charles Thomas
• 14:38in 1985 published a paper in part
• 14:41that said quote science is a human
• 14:44activity which is hardly neutral.
• 14:46Objective or impartial?
• 14:48So it's important that when
• 14:49we talk about the science,
• 14:51some of us imply the purity of it.
• 14:54It's important for us to understand
• 14:56that there are human beings behind
• 14:59the collection of that data.
• 15:01The analysis of that data,
• 15:02the interpretation of that analysis,
• 15:04and the dissemination of it.
• 15:06After all, as an example,
• 15:08using enslaved Africans as free
• 15:10labor was in large part fueled by
• 15:12the notion that certain groups were
• 15:15genetically and biologically inferior.
• 15:17I'll expound upon Dubois his work
• 15:19in this area in a couple of slides,
• 15:22but back to Keaton cheating.
• 15:24He found he and others find
• 15:26that nature and nurture
• 15:28both play a role in outcomes,
• 15:30so individual differences.
• 15:31Cognitive, behavioral,
• 15:33physical and mental health are patterned
• 15:36by socioeconomic circumstances.
• 15:38And that health outcomes are influenced
• 15:40by many inter related factors.
• 15:42So things like poor health status,
• 15:44disease risk, risk factors and
• 15:47limited access to health care.
• 15:50Social determinants of health.
• 15:51Stoc. Hi, I'm going to talk
• 15:53about those quite a bit.
• 15:55Those are primarily the drivers.
• 15:58Now let's talk a bit about this.
• 16:02Here how do we get from social?
• 16:05Factors.
• 16:06To outcomes, again,
• 16:07an innocuous question on the surface,
• 16:10but there's a lot going on underneath here.
• 16:13OK. This arrow from social
• 16:20circumstances to outcomes.
• 16:23Is about predicting outcomes based on
• 16:25social economic status or Sep sometimes
• 16:28called social economic position.
• 16:32So let me go and review this circle a bit.
• 16:35I'm going to spend just a slide on
• 16:37this circle, 'cause it's it really
• 16:39gets at the heart of the answer to the
• 16:41question about what causes inequity,
• 16:43the interplay of nature and
• 16:45nurture both of them play a role.
• 16:47But the key questions again are what what
• 16:50social predictors matter more than others?
• 16:52And how do these predictors interact?
• 16:56Do they relate to different outcomes
• 16:58and what developed mechanisms
• 16:59might explain this arrow?
• 17:01Those of us who work with pathways clinical
• 17:03pathways were really concerned with this.
• 17:05How do we tie factors to two outcomes?
• 17:08What's the pathway?
• 17:11The short answer is we don't know really.
• 17:14They're hard to separate.
• 17:15You can imagine that it's really hard
• 17:17to isolate someone's socioeconomic
• 17:19position from where they live.
• 17:21These social determinants are interplayed.
• 17:23They're almost hopelessly connected,
• 17:25and I don't mean hopeless as there's
• 17:27no hope to do something about it.
• 17:30I mean,
• 17:30hopeless in terms of trying to segment them.
• 17:33Segment them are very difficult.
• 17:35However,
• 17:36what we do know what has been demonstrated
• 17:39is that as a whole social circumstances.
• 17:42Have a gradient.
• 17:44Here this is represented by
• 17:47the arrow to outcomes.
• 17:49Lower levels of socioeconomic
• 17:51status and social economic position
• 17:54uniformly are associated with lower
• 17:56levels of virtually any measured
• 17:59developmental health outcome,
• 18:01and its most frequently
• 18:04a linear relationship.
• 18:06So these factors, demographics,
• 18:09socioeconomic, residential.
• 18:12Actually can predict.
• 18:14Physical, mental, cognitive,
• 18:16and social competence is.
• 18:19So the answer is nature and nurture,
• 18:22but more specifically social factors,
• 18:25social determinants of health actually
• 18:27show linear relationships to outcomes.
• 18:32Now let's go to COVID for a minute.
• 18:36What's causing the COVID
• 18:39inequities that we see well?
• 18:42For people like me who have been
• 18:44working in HealthEquity for over a
• 18:46decade and there have been people who
• 18:48have been doing this a lot longer than
• 18:50I have before I learned how to spell
• 18:52PhD point to these social factors.
• 18:55So wouldn't it follow that social factors
• 18:59are also exerting influence on COVID,
• 19:03specifically risk of infection?
• 19:05Risk of hospitalization and mortality risk.
• 19:08Those are the three kind of markers
• 19:11that have been used since the
• 19:13beginning of the pandemic in terms
• 19:15of the work that I've looked at.
• 19:18Again, social factors for over
• 19:20100 years social factors,
• 19:21not genetic factors as was first
• 19:24speculated have been described as primary
• 19:26causal factors of health disparities,
• 19:28and we also find them in COVID.
• 19:31Risk of COVID infection,
• 19:34hospitalization and death.
• 19:35Just some more in terms of HealthEquity data.
• 19:41African American and Native American
• 19:43individuals have shorter life
• 19:45spans and more illness than whites.
• 19:48Hispanic immigrants initially tend
• 19:50to have relatively healthy profiles,
• 19:52but with increasing lengths of
• 19:55stay in the United States,
• 19:57their health tends to decline.
• 19:59That's also true of immigrants
• 20:02from African and Caribbean nations.
• 20:06Now, in terms of COVID.
• 20:09And think COVID social factors COVID
• 20:11social factors by the end of the talk,
• 20:13I hope that we're making that association.
• 20:16Let's look at the Bronx, New York City.
• 20:18Rob knows about the Bronx, don't you rob?
• 20:21Familiar, the Bronx had the has the lowest
• 20:23levels of income and education and highest
• 20:26proportion of black and Hispanic persons
• 20:28of any of the boroughs of New York.
• 20:30It also had the highest rate of
• 20:32COVID hospitalizations and deaths.
• 20:35This is data as of September.
• 20:38In contrast, Manhattan primarily
• 20:40predominantly white most affluent
• 20:41borough of New York City by far,
• 20:44had the lowest rates of hospitalizations
• 20:46and deaths related to COVID-19.
• 20:49Although it had the highest population
• 20:51density of any New York City borough.
• 20:55Again, this is data as of September.
• 20:58New York City reflects other
• 21:00major US centers. For example.
• 21:03Disproportionate death rates of black
• 21:05persons in Chicago are concentrated in four
• 21:08majority black neighborhoods, so we see.
• 21:11Almost as data was being collected
• 21:14around COVID racial disparities.
• 21:18So let's go back a bit.
• 21:19I told you I've been reading
• 21:21a little bit about history.
• 21:22I'm going to take you through
• 21:24a little bit of this.
• 21:25It's important to understand that
• 21:27racial health inequity did not start.
• 21:28Unfortunately,
• 21:29nowhere that end with COVID.
• 21:31But when did racial inequity emerging health?
• 21:33Well, the answer is pretty clear.
• 21:36Racial differences in health are
• 21:38present at the very inception of health
• 21:40records being kept in the United States.
• 21:43Up until an through the Civil War in 1861,
• 21:47physicians debated.
• 21:48Physicians these are trained individuals.
• 21:51Whether the already well known racial
• 21:54disparities were due to biology.
• 21:56Because blacks were inferior or
• 21:58social factors because many blacks
• 22:00were enslaved and lived in society.
• 22:02Steeped in white supremacy,
• 22:04steeped in white supremacy.
• 22:05At the time,
• 22:06the debate was rooted in politics
• 22:08as anti slavery physicians,
• 22:10which included the first generation
• 22:12of black doctors,
• 22:13argued that social factors were the drivers.
• 22:16These factors at the time defined
• 22:18the need for cheap labor and those
• 22:21conditions were what determined
• 22:22both the progression of disease.
• 22:25And health status of enslaved blacks
• 22:26in the South and impoverished blacks
• 22:28in the north. This work was captured.
• 22:31This biological versus social
• 22:33debate was captured by Dubois and
• 22:37his Seminole work the Philadelphia.
• 22:39Now Dubois was a trained sociologist.
• 22:42I think of him as the first
• 22:46HealthEquity scholar in our country.
• 22:49And he's also deeply,
• 22:50deeply into epidemiology.
• 22:51If I could talk to him,
• 22:53I'd love to talk to him about his epic work.
• 22:56'cause that's really what this is about as a.
• 22:59I read this book before I learned how to
• 23:02spell PhD and then I reread it after.
• 23:05And it's a book about epidemiology.
• 23:07Essentially.
• 23:07Now why am I bringing it up here?
• 23:10He can't rasted the biological point
• 23:12of view and his observation that.
• 23:15Uh, that social factors?
• 23:17Were in the vastly different conditions
• 23:21were at play, and I'm putting up.
• 23:24US knows that this is the
• 23:26I submit that Dubois is
• 23:29important to public health.
• 23:31United States ice snow is to to
• 23:34public health around the world.
• 23:36This is the famous water spicket
• 23:39that London physicians know.
• 23:40I identified was the cause of cholera.
• 23:43This kind of launched modern epidemiology.
• 23:47And I think that this work the
• 23:49Philadelphia is approach is as
• 23:51important in terms of racial equity,
• 23:53both in the United States and beyond.
• 23:58So Dubois argued that social
• 24:01advancements and vastly different
• 24:03living conditions were the causes
• 24:06of the known 1899 known racial
• 24:09differences in health outcomes.
• 24:11Now one more on Dubois.
• 24:13Before I leave what he pointed out,
• 24:15I pulled this quote from the Philadelphia
• 24:17and I think it's really important.
• 24:20I alluded to this earlier when I talked
• 24:22about we fund our priorities again,
• 24:24we fund our priorities.
• 24:26The most difficult social problem
• 24:28in the matter of health is the
• 24:30peculiar attitude of the nation
• 24:32towards the well being of the race.
• 24:35There have been few other cases in
• 24:36the history of civilized peoples
• 24:38where human suffering has been viewed
• 24:40with such peculiar indifference.
• 24:441899 Let's go back to social determinants.
• 24:49I want to ground us in a common
• 24:51understanding as I did for health
• 24:52informatics and for HealthEquity.
• 24:56And we see here what Dubois observed.
• 25:00Social advancement vastly
• 25:02different living conditions.
• 25:04Stop one moment Sir.
• 25:06OK, there are five central
• 25:09social determinants of health.
• 25:11Economic stability, education,
• 25:13social and community context,
• 25:15health and health care,
• 25:17neighborhood and built environment.
• 25:19And this. Diagram.
• 25:22From the Institute of Medicine.
• 25:24Helps articulate.
• 25:27Illustrate their interplay there all.
• 25:31They all can play a role.
• 25:33And some can play the role
• 25:35of role more than others for
• 25:37group for certain groups.
• 25:38But the point is in trying
• 25:40to isolate causal factors.
• 25:41This is perhaps what makes pathways
• 25:44so difficult to definitively describe
• 25:46is that they are all at play and
• 25:48they can be a play at different
• 25:50times for different individuals.
• 25:52So these are social determinants.
• 25:57And these determinants have been
• 25:59articulated for various groups.
• 26:01I've mentioned black.
• 26:03I've mentioned Latin ex but also Haitian.
• 26:07Afro Cuban Trinidad Ian
• 26:09Appalachian Poor Asian Americans,
• 26:11older adults, immigrants,
• 26:12individuals with disabilities,
• 26:14Native Americans.
• 26:15It goes on prisoners as well.
• 26:20Social determinants of health
• 26:22of health are not like gravity.
• 26:25They're not some natural law
• 26:27that just sort of happens.
• 26:29They are the drivers and the result of
• 26:32institutions that create and sustain them.
• 26:34They are populated these institutions
• 26:37by individuals who either actively make
• 26:39decisions to maintain an equity or perhaps.
• 26:42More commonly, they passively
• 26:44maintain an equity by simply looking
• 26:46the other way by not caring quite
• 26:48enough for the least of these.
• 26:49Back to Dubois is quote.
• 26:52When I first started started
• 26:54studying health inequity,
• 26:55I thought the healthcare system was broken.
• 26:58Maybe not.
• 26:59Perhaps like the criminal justice system,
• 27:02it's working as intended.
• 27:03Deanna Hoskins has seen the senior policy
• 27:06advisor for the Department of Justice,
• 27:08Bureau of Justice Assistance is noted.
• 27:12The criminal justice system is not broken.
• 27:14It is operating just as
• 27:16it's designed to operate.
• 27:18The cost,
• 27:18perhaps some of you are familiar
• 27:20with some of this data.
• 27:21The cost of imprisonment in jail in
• 27:23the past 20 years has grown as a faster
• 27:26rate than any other state budget item.
• 27:28It costs about $80.00 a
• 27:30day to house an inmate.
• 27:31And the United States spends in excess of
• 27:33$68 billion a year on corrections federal,
• 27:36state and local.
• 27:36I point this out because we should never
• 27:39assume that we're all united in our
• 27:41desire to eliminate racial inequity.
• 27:43I never assumed that.
• 27:46This is uphill. It's a noble fight.
• 27:48But there's a slope.
• 27:52To that line?
• 27:54OK, social determinants of
• 27:55health impact everyone,
• 27:56but not everyone equally important
• 27:58point here. It can impact all groups.
• 28:02But children in particular
• 28:04are especially vulnerable.
• 28:06Why well?
• 28:09Askeaton, another seven have taught
• 28:11me in terms of developmental.
• 28:13Children are especially vulnerable
• 28:14because the physical,
• 28:15social and emotional capabilities
• 28:17that develop early in life,
• 28:18which many of you are well steep,
• 28:21provide a foundation for life,
• 28:22course health and well being.
• 28:26As I mentioned,
• 28:27developmental scientists have settled
• 28:28on the nature versus nurture debate,
• 28:31both in concert matter.
• 28:32But how they interact with the course
• 28:35of development is still being described.
• 28:37What we do know,
• 28:39as I mentioned with Keating's work.
• 28:41But important nature,
• 28:43nurture interactions occur during
• 28:44early childhood development that set
• 28:47a course throughout someone's life.
• 28:52I'd like to also point out that
• 28:55systematic racism and colorism colorism
• 28:57prejudice or discrimination against
• 28:59individuals with dark skin tone.
• 29:02Among people of the same ethnic group.
• 29:05Are types of determinants which
• 29:06do not impact groups equally.
• 29:08So while social determinants impact all
• 29:10of us, they don't impact us all equally.
• 29:12Much like Kovit,
• 29:13I remember early in the pandemic
• 29:15where COVID is affecting us all.
• 29:17We're all being affected by kovid.
• 29:19That's largely true,
• 29:20but it's not affecting us all equally,
• 29:22and that was brought home to me
• 29:24more than at any other time.
• 29:26When I was freaked out like the rest of
• 29:29us have even walking out the door and
• 29:32going to the grocery store was an adventure.
• 29:36And anxiety.
• 29:38Yet when I talk on the phone with one
• 29:40of a friend I've had since 7th grade.
• 29:42Ann, I said you're out,
• 29:43what are you doing out? And it hit me.
• 29:46He's a mailman. He delivers the mail.
• 29:50He didn't have a choice.
• 29:52He was essential. And the people
• 29:55that we walked by in grocery stores,
• 29:57stocking shelves, essential workers.
• 29:58So we have to keep in mind that
• 30:01this pandemic and these determinants
• 30:03don't affect us all equal.
• 30:04And that's important for us
• 30:06to keep in mind me include.
• 30:07OK, structural inequities.
• 30:09I've mentioned that what are they?
• 30:12Well, they're important 'cause
• 30:15they undergird these drivers.
• 30:17They are the personal interpersonal
• 30:20institution and systematic drivers excuse me,
• 30:23such as racism, sexism,
• 30:25classism, ableism, xenophobia,
• 30:26homophobia,
• 30:27that make those identities salient
• 30:29to the fair distribution of
• 30:32health opportunities and outcomes.
• 30:36I want to point out here that there's a
• 30:40distinction in the American narrative.
• 30:42As you might imagine in the
• 30:45summer after Memorial Day.
• 30:47I was asked to talk to different groups
• 30:50in ways that I hadn't before about
• 30:53racial justice, and I'm not a race
• 30:56researcher by training or by identity.
• 30:58However, I do research and equity.
• 31:01I'm a person of color,
• 31:03therefore I bring myself to my work.
• 31:06So. What I so I did some homework
• 31:09so more reading of history,
• 31:11which has been extremely illuminated,
• 31:13instructed from.
• 31:15And I uncovered that there was a
• 31:17prevailing and Eric American narrative
• 31:19that draws a sharp line between
• 31:21the United States past and present.
• 31:25So within 60s and 70s marking a crucial
• 31:28before and after moment in that narrative,
• 31:32the narrative is search asserts
• 31:34that until the 1950s, U.S.
• 31:36history was shaped by the
• 31:38impacts of past slavery.
• 31:40American Indian removal,
• 31:41lack of rights for women,
• 31:43Jim Crow segregation periods of
• 31:46nativists restrictions on immigration,
• 31:47and waves of mass deportation of
• 31:50Hispanic immigrants, eugenics,
• 31:51the internment of Japanese Americans,
• 31:54Chinese exclusion policies.
• 31:56The criminalization of homosexual acts
• 31:59and more so think 50s pre 50s this past.
• 32:03And then after the 1950s.
• 32:06We had this rush to the present
• 32:09civil rights women's liberation,
• 32:11gay rights, disability rights movements,
• 32:13and their aftermaths.
• 32:14May have contributed or be contributing
• 32:17to this narrative that social,
• 32:20political, and cultural institutions
• 32:21have made progress towards equity,
• 32:23diversity and inclusion.
• 32:25DI it's a thing.
• 32:28Highlights include the Civil Rights
• 32:30Act of 64 Voting Rights Act of 65,
• 32:32Fair Housing Act.
• 32:34Title 9 American with Disabilities Act.
• 32:38Even the Affordable Care Act.
• 32:41And most recently, the Supreme Court
• 32:43case that legalized marriage equality.
• 32:46United States.
• 32:47Yes, that was progress.
• 32:49That is progress.
• 32:50However,
• 32:51when we look at remaining persistent
• 32:54structural inequity.
• 32:55I'd like us to reconsider
• 32:58that before after narrative,
• 33:00even after what I call this past summer
• 33:03of radical racial reconciliation.
• 33:06How much of that energy will be
• 33:08sustained and how will we know
• 33:10what indicators might we use
• 33:12'cause from a health standpoint,
• 33:14I'm still looking for evidence of that.
• 33:17Sharp distinction.
• 33:24Persistent racial inequity suggests
• 33:25that the distinction is not so good.
• 33:30OK, causes of racial inequity.
• 33:32I alluded to this a little earlier.
• 33:34For kovit or similar to the
• 33:37causes of persistent inequity
• 33:38for common chronic conditions.
• 33:40So I cited some data earlier
• 33:43about racial inequity,
• 33:44and we see that the structural social
• 33:47factors exert have exerted are
• 33:49exerting their influence on COVID-19.
• 33:51Again, risk of infection
• 33:53hospitalization and death,
• 33:54and that shouldn't shock us right?
• 33:57Wouldn't it wouldn't be surprising if we
• 34:00found that somehow these structural factors,
• 34:03which are by definition structural.
• 34:05Wouldn't be exerting an influence
• 34:07on covert outcomes for me early
• 34:09in the pandemic and I'll talk a
• 34:11little bit more about where my work
• 34:13is today and where it's headed.
• 34:15I saw a crisis room. Because these
• 34:20structural factors are structural.
• 34:22So what we found in some early data.
• 34:24This is a Banga is a wonderful
• 34:27mentor of mine.
• 34:28He's at the university.
• 34:30He's at NYU.
• 34:31School of Medicine does some
• 34:33wonderful work in population health.
• 34:34Published in JAMA in September.
• 34:37Addressing some of it questions
• 34:39about genetic predisposition
• 34:40predisposition to COVID infection,
• 34:42they ask that was out there
• 34:44reasonable questions to ask.
• 34:46But are people of color
• 34:48genetically predisposed?
• 34:49The questions were asked and answered
• 34:51by Gbenga and others that yes,
• 34:54social factors like greater proportion
• 34:56of essential jobs like my friend,
• 34:58my lifelong friend who delivers the mail
• 35:01continues to deliver the mail everyday.
• 35:04Never missed a day of work.
• 35:07Number of people in the household.
• 35:09Multi generations in the household,
• 35:11the things that we know
• 35:13predispose you to COVID risk.
• 35:15Also exert their influence
• 35:17disproportionately on people of color.
• 35:24So just as medical care alone.
• 35:27Has not rat eradicated
• 35:29racial inequities in health?
• 35:31Medical care alone will not
• 35:34result in racial, ethnic,
• 35:36ethnic inequities for COVID inequity.
• 35:40So I, as I've been reading about vaccine
• 35:42rollouts and I'll talk a little bit
• 35:44about some of that data in a moment.
• 35:47It occurred to me early
• 35:48on that this is great.
• 35:49Our bench scientists are going to work.
• 35:52And God level yes, we need that.
• 35:54Should create a vaccine.
• 35:57And they get. However.
• 36:01We also need the social scientists
• 36:03to bring that.
• 36:05Bench science genius to real.
• 36:10OK, it's important to understand.
• 36:11I'd like to discuss some
• 36:13work that I'm I'm into now.
• 36:15So early in the pandemic I
• 36:17speculated that social determinants,
• 36:18which I have been reading about
• 36:21studying and writing about for
• 36:22several years at that point.
• 36:24Combined. With people of color
• 36:27having high medical mistrust.
• 36:30Which was an area that I hadn't
• 36:32done much work in specifically.
• 36:34Also, the proliferation of
• 36:37misinformation and disinformation.
• 36:40But it was vital to understand perceptions.
• 36:43Particularly a future vaccine.
• 36:45This is back in the fall or actually this
• 36:48summer was going to affect behavior because.
• 36:50Part of what I'm really interested in
• 36:53is how do perceptions impact behavior?
• 36:57To what degree do they?
• 36:59Because they do.
• 37:01So.
• 37:03Given this high level of mistrust,
• 37:06given all, by the way,
• 37:08is an information scientist,
• 37:09I must point out that misinformation
• 37:12and disinformation or not the same.
• 37:14They aren't synonyms, misinformation,
• 37:15wrong disinformation,
• 37:16deliberately wrong.
• 37:17That's the new monik.
• 37:18Just information deliberate.
• 37:20They are not the same.
• 37:22Some people just don't know or some sources
• 37:24are not sure where as dis information is
• 37:27a deliberate attempt to decieve DDD got it,
• 37:29got the new mnemonic.
• 37:30That's the one I use.
• 37:32Use whatever one you wish.
• 37:34So in the early summer.
• 37:36Largely due to the perceptions
• 37:38and beliefs I was hearing upon
• 37:41my network of people of color.
• 37:44About where this came from.
• 37:46Who was responsible?
• 37:47What's going to happen when a
• 37:50treatment or a vaccine comes?
• 37:52Exacerbated by miss and disinformation.
• 37:54Remember back to the glorious
• 37:56time last summer and last fall
• 37:58and we were hearing all kinds of
• 38:01things about all kinds of topics.
• 38:03Some did some misinformation.
• 38:05I thought that we might have
• 38:09a crisis looming because.
• 38:11Vaccines don't make us safe, vaccinations do.
• 38:15So we need the bench scientists.
• 38:18To help us.
• 38:20Do their work to develop the vaccines,
• 38:23but that's part of the journey.
• 38:26What we're seeing now?
• 38:28Are where social determinants may
• 38:31exert their influence on vaccination.
• 38:34Because vaccines don't make
• 38:35us safe vaccinations.
• 38:38So a key tenant that I wanted to.
• 38:42Incorporate into this work which turned
• 38:44into the COVID and race project.
• 38:46The sites up is that intragroup
• 38:47differences were important to investigate.
• 38:49Largely in I mentioned earlier,
• 38:51bring myself to my work.
• 38:53I was when I, when I was trained,
• 38:55I was trying to mix methods.
• 38:57I do mixed methods work,
• 38:59but in my qualitative training I
• 39:01remember a particular lesson where it
• 39:03says the qualitative researcher goes
• 39:05in with an empty mind and an open mind,
• 39:08but not an empty head.
• 39:10An open mind, but not an empty head,
• 39:12and that resonated with me 'cause
• 39:14I bring myself to my work.
• 39:15How can you not?
• 39:16As a social worker,
• 39:17I know that you bring yourself to your work.
• 39:20You don't leave your experiences at the door.
• 39:23Or before you get into your analysis
• 39:25or before you start writing,
• 39:26it comes with you.
• 39:28Embrace it so I knew that black
• 39:30people of color were different.
• 39:33Rob and I may be people of color,
• 39:35but that might be we have similarities,
• 39:38but we also have distinctions
• 39:39and differences.
• 39:40So intergroup relations were
• 39:42important for me to understand.
• 39:44And there are.
• 39:45Validated acculturation skills that
• 39:47have been around for a couple of decades
• 39:50to measure intergroup difference.
• 39:52Because if we're going to create
• 39:54an intervention,
• 39:55or if we're going to target
• 39:57a group that's at risk,
• 39:59how do we possibly do that with just
• 40:02having all the Asian Americans in one
• 40:05group Latin X in another group, and?
• 40:09Blacks in another.
• 40:11So here's an opportunity to apply
• 40:14acculturation scales for me in my work.
• 40:17Anyway,
• 40:17to to test the hypothesis that
• 40:19intergroup differences would
• 40:20help target health information
• 40:22interventions and address potential
• 40:24racial inequities in vaccination.
• 40:25Again, at the time this was last May,
• 40:29I was interested in a future vaccine.
• 40:34Using mistrust and perceptions,
• 40:35we could measure that that's what we do.
• 40:37We ask questions and we try to measure
• 40:40and that's what we do in research.
• 40:42So what I did. Right in July, August,
• 40:47when I started at MIT, I connected with
• 40:51a behavioral economist at MIT, Dave ran.
• 40:55Added some of his expertise given
• 40:57he does online surveys all the
• 41:00time that measure perceptions.
• 41:03Again, this notion of interdisciplinary enter
• 41:06discipline work is extremely important if
• 41:09for in most cases I think I've heard of 1,
• 41:13there's no traditional academic
• 41:15Center for HealthEquity.
• 41:17HealthEquity, just like the virus doesn't
• 41:20care about your political leanings.
• 41:22Equity work doesn't care about
• 41:24what your doctorate isn't.
• 41:26Or where your academic home is.
• 41:29It's definitionally multidisciplinar,
• 41:31so we combine and we have
• 41:34run various experiments on.
• 41:36We've established it, yes intragroup.
• 41:40Racial perceptions do affect
• 41:41COVID perceptions.
• 41:42There's a strong.
• 41:43This is preview now where where our
• 41:46work hasn't been published yet.
• 41:48We're submitting a research brief end
• 41:50of this week early next that shows
• 41:53that there's a strong correlation
• 41:55where less acculturated participants
• 41:57have more negative vaccine attitudes.
• 42:00And this relationship is fully mediated
• 42:01by suspicion in the health care system,
• 42:03and that's something that all
• 42:05of us should care about.
• 42:06Those of us that touch patients
• 42:08or do work that eventually does.
• 42:11On the flip side,
• 42:13less acculturated participants are more
• 42:15likely also to have had themselves
• 42:18family or friends hospitalised due to Kovit.
• 42:21So it reveals differential exposure.
• 42:24To harm from cobett
• 42:33OK, so moving forward we are going to
• 42:37run more experiments to try to refine and
• 42:42finetune where perceptions connect to.
• 42:46Behavior, intended behavior and outcomes,
• 42:48and this is work that holds potential.
• 42:52I hope long after COVID.
• 42:56Or long after COVID is contained,
• 42:57let me say that.
• 42:59Because I think that there's quite an
• 43:01opportunity for us to get a little
• 43:03bit more refined and understanding
• 43:05where perceptions influence
• 43:07behavior which influence outcomes.
• 43:09So what we're doing now,
• 43:11we've applied for some funding
• 43:13internally at MIT.
• 43:14We've structured a project that
• 43:16has two central objectives first.
• 43:19We want to with a larger population measure,
• 43:22hasn't vaccine hesitancy and its
• 43:24underlying perceptions and beliefs in
• 43:26order to develop messaging approaches to
• 43:28help address the causes of his hesitancy,
• 43:31it's no longer sufficient to just
• 43:33say that people of color have
• 43:36higher mistrust therefore.
• 43:38I think that can be used as an excuse.
• 43:42To shut down the efforts.
• 43:44To reach people and meet them where
• 43:46they are and also understand the
• 43:48influence of structural factors like
• 43:50social determinants which may be
• 43:52presenting barriers to FactSet vaccination.
• 43:54This is important because
• 43:56there's emerging research.
• 43:57That suggests.
• 43:59That intention to receive a COVID
• 44:02vaccine may be actually higher among
• 44:04black Americans and other racial groups,
• 44:07specifically white men.
• 44:09May perhaps some of you have
• 44:11seen some of this data.
• 44:12This is a publish or it there was
• 44:15a poll that NPR help sponsor about
• 44:17a week and a half ago that found
• 44:20that 73% of adult black Americans
• 44:22intended to get the vaccine when
• 44:24it became available again when
• 44:26it became available to them.
• 44:28Higher than white men who leaned
• 44:32conservative or a Republican.
• 44:35So it's important to understand these
• 44:36inequities and that would be an equity
• 44:38and equity that we would want to address,
• 44:39or at least some of us would want to address.
• 44:43So preliminary data suggests that.
• 44:47Social determinants,
• 44:48not just medical mistrust.
• 44:51May explain racial disparities
• 44:53in vaccination rates,
• 44:55so we will solicit feedback on efforts
• 44:57made to get insight or to get to get
• 45:01vaccination to get further insights.
• 45:04So we're hopeful that these insights will
• 45:07will will help us address vaccination
• 45:09disparities and just real quickly
• 45:12here vaccination disparities by race
• 45:14are or reported all over the country.
• 45:17LA had a particularly interesting and
• 45:20comprehensive view where, as of February.
• 45:2214th you see the dramatic differences
• 45:25in race according to vaccination.
• 45:28Actual vaccination.
• 45:31Somewhat ironically, people of color
• 45:32are vaccinated at lower rates.
• 45:33They are at highest risk.
• 45:36OK, so in summary,
• 45:38what I would like to do is posit that
• 45:42provider credibility may have a link to.
• 45:46Outcomes of behavior and outcomes.
• 45:48I'm interested instead of or in addition to,
• 45:52measuring medical mistrust.
• 45:53I'd like to also measure
• 45:55credibility of provider,
• 45:56team health care system
• 45:58to help define a pathway,
• 46:00perhaps more definitively,
• 46:02from credibility to health
• 46:03behavior to outcomes,
• 46:05and that could provide us with a
• 46:08unique novel opportunity to address
• 46:10racial equity and cost of care.
• 46:12I add cost of care here because
• 46:15depending on the audience.
• 46:18As I alluded to earlier,
• 46:20addressing racial inequity.
• 46:21Does not necessarily hold
• 46:23the day when the argument,
• 46:25but when you combine the
• 46:28human side of inequity,
• 46:29reducing unnecessary suffering,
• 46:31and the financial side,
• 46:33reducing things like avoidable
• 46:35hospital utilization through Ed
• 46:37visits an unplanned admissions
• 46:39that tends to capture most of
• 46:41the audiences that I talked to,
• 46:43either wonderful.
• 46:44So collecting data among vulnerable
• 46:47communities understand credibility to
• 46:49measure its effect on behavior and outcomes.
• 46:51We can then assign a credibility
• 46:54index to healthcare institutions and
• 46:56provider teams and start to really
• 46:58test or continue to test how the
• 47:01patient provider relationship may
• 47:03influence health behaviors and outcomes.
• 47:05We could start with vaccination,
• 47:07but we could translate this to far
• 47:11beyond other health behaviors.
• 47:13So medical mistrust I would
• 47:16posit is important,
• 47:17but pathways are difficult to define.
• 47:21And it actually points the finger outwards
• 47:23towards individuals and communities,
• 47:25suggesting that something
• 47:26needs to be done to fix them.
• 47:28We need to create an invention
• 47:30to get their medical mistrust to
• 47:32reduce their medical mistrust.
• 47:34So they'll follow behaviors as recommended.
• 47:36I submit that a credibility is more
• 47:38of a inward look at the self to
• 47:41try to figure out what we can do
• 47:43to be more kredible clinicians in
• 47:45terms of their touching patients
• 47:47as well as health researchers
• 47:49like myself to actually.
• 47:51Understand what that what
• 47:53behavior that might influence like
• 47:55participation in health research.
• 47:59OK, as I conclude here.
• 48:02There are paths.
• 48:04There are not pathways specific pathways
• 48:07from perceptions like medical mistrust,
• 48:10discrimination, everyday racism,
• 48:12perceived racism in healthcare.
• 48:14Yes, there's a validated.
• 48:17Measure for perceived
• 48:19racism in healthcare PRM.
• 48:21That always strikes me as
• 48:22we have a measure for that.
• 48:24Which suggests that it might be a thing,
• 48:27so we see that perceptions as
• 48:30perceptions get more negative.
• 48:32Health behavior like seeking care,
• 48:34testing and screening.
• 48:35I check hemoglobin, A1C,
• 48:36check a cholesterol screens
• 48:38go down and then outcomes,
• 48:40like patients that go down.
• 48:42And as and also behavior like drug use,
• 48:46misuse, cigarette smoking,
• 48:47HIV risk behavior goes up,
• 48:49as does blood pressure,
• 48:50risk inflammation, risk,
• 48:52alcohol dependence.
• 48:52So we see that there are some
• 48:55associations if not pathways.
• 48:57So credibility.
• 48:58I would surmise is a novel way,
• 49:00a valuable way to assess the
• 49:03patient provider relationship.
• 49:04Because it focuses on the source
• 49:07of the mistrust.
• 49:08Us and it provides insight to
• 49:10refining some of these elusive
• 49:12pathways and insights on how
• 49:15perceptions influence behavior.
• 49:17With that, I'll pause.
• 49:18I'm going to keep this up that adipic,
• 49:21the integration of these
• 49:23various structural issues,
• 49:24and I welcome your questions,
• 49:26comments and rebuttals.
• 49:29The only rebuttal that I have
• 49:31for you Doctor Centeio is that
• 49:33we want you again and again,
• 49:35and again, and again and again.
• 49:38This has been so extraordinary, and I
• 49:40know there's going to be many questions.
• 49:42I saw things popping up in the in the chat,
• 49:45but I am so grateful and you
• 49:47have touch on so many things.
• 49:49I have questions but I I'll keep them.
• 49:52Let's start with Belinda,
• 49:53who had a couple of really hard
• 49:55hitting wonderful questions.
• 49:56Belinda
• 49:56go for it. Yes, this was wonderful
• 49:58and I'm sorry it wasn't my camera.
• 50:00My grandchildren are here this week. But we'd
• 50:04like to see him.
• 50:07There's a play. But I have a question
• 50:11about so as you were talking, Anne Anne.
• 50:13I've been doing some research
• 50:15and so forth for me.
• 50:17I believe gentrification is a new form
• 50:19of redlining, if that makes sense.
• 50:21Because once a community is cleaned out,
• 50:24you can't afford to go back into.
• 50:26For example, is my sons God brother bought.
• 50:29You know you St area in the
• 50:3160s and DC it got burned down.
• 50:34And so David bought a brownstone for
• 50:37say 250 for DC goes for $2,000,000
• 50:39or right about now is the tax rate.
• 50:42So there's no way so the community
• 50:45has totally changed and the other
• 50:47part of that when we talk about the
• 50:49social factors are they also still?
• 50:52Attached to racism.
• 50:53No, because it's a social construct
• 50:55that where we struggle struggle with
• 50:56some things for people of color.
• 51:00Certainly yes, perceptions are
• 51:02part of of social determinants and
• 51:04perceptions do influence behavior.
• 51:05Perceptions of maltreatment of discrimination
• 51:07that I'm not being treated equally,
• 51:10which is a foundational sentiment.
• 51:11So that's one thing you don't have to wait.
• 51:15You know this more than I do.
• 51:17I actually was reading about
• 51:19babies and water babies know.
• 51:21And what do we have to teach them?
• 51:24And there's an innate sense of
• 51:26justice that were born with,
• 51:28so I think that.
• 51:29Even if you don't know all about
• 51:31Tuskegee or you don't know all about
• 51:34Doctor Marion Sims and what he did
• 51:37with Anna Kahran other slave girls,
• 51:39you have a sense for any quality
• 51:41and part of why those kinds of
• 51:44historical anecdotes are still
• 51:45present is because the bias and
• 51:47injustice is still present.
• 51:52I'm trying to keep my answers short here.
• 51:55You are doing great.
• 51:57We really I I could listen to you
• 51:59for hours and I know that there's
• 52:01other people who have questions so.
• 52:04Walter, I saw you active on the chat.
• 52:07Amanda Detmer, Jose Pious,
• 52:09Lilia Benoit, in no particular order.
• 52:11But let's go for it.
• 52:18OK, well they're being shy
• 52:19while they're being shy.
• 52:21I have a couple of questions.
• 52:23First of all, I loved, loved,
• 52:24loved your shout out to qualitative
• 52:26methods and to the importance of people,
• 52:29and I think that you said something you said
• 52:32a couple I took a lot of notes by the way,
• 52:35but you said this is a bumper sticker.
• 52:38Vaccines don't make us safe.
• 52:40Vaccinations do and that we have,
• 52:42you know, warp, speed it ourselves
• 52:44to this blessing of a vaccine.
• 52:46But if we don't get it right through,
• 52:49knowing what hesitation
• 52:50and what people think,
• 52:51and we're going to find out
• 52:53through qualitative methods,
• 52:54so, so thank you for that.
• 52:56And and two,
• 52:57maybe a inner baseball questions,
• 52:58but you mentioned the group based
• 53:00medical mistrust scale in the PRM,
• 53:02the perceived racism and medical care
• 53:04are those actual scales where their
• 53:06concepts because their scales on them.
• 53:08Yeah, they're
• 53:09validated scales. Somehow.
• 53:10I have a collection in my in my notes of
• 53:13these scales that measure perceptions,
• 53:14and these are validated scales much
• 53:16like the acculturation skills.
• 53:18I can email them to you, you wonder.
• 53:22Yeah, and and and when I when I heard the
• 53:24term warpspeed about vaccine development,
• 53:27I thought that's that's great cool
• 53:29warp speed that I thought oh I bet
• 53:31social scientists weren't in the room
• 53:33when you when they met like that
• 53:35might not be good for all folks.
• 53:38The fact that it's rushed right out there.
• 53:41We need social too.
• 53:42Absolutely. And you know we have a a social
• 53:45question from Justin Justin. Go for it.
• 53:49Thank you for that amazing
• 53:50talk you mentioned.
• 53:51Something about immigrants saying that
• 53:53as they stay in America over time,
• 53:55it seems like their health outcomes
• 53:57start to resemble individuals.
• 53:58I've been in America for who look
• 54:01like them for a long period time.
• 54:03Can you speak more on that?
• 54:06Yeah, I can talk about how when
• 54:09Caribbean immigrants specifically,
• 54:10this is when I just have the top of my head.
• 54:14I'm doing some work with the OR
• 54:17proposing to work with the the National
• 54:20Cancer Institute about prostate
• 54:22cancer treatment and you find that.
• 54:24And this is this is found fairly consistency
• 54:27in the literature that the rates of
• 54:30prostate cancer for Caribbean immigrant men.
• 54:331st generation are lower
• 54:36than subsequent generations.
• 54:39So second generation immigrant health
• 54:41status is much worse than first,
• 54:43and it's like the Mexican or the
• 54:45Latin American paradox, right?
• 54:46So you get here and then I'll
• 54:48get to why in a moment.
• 54:50The short answer is we don't really know,
• 54:53but there are a couple of important.
• 54:57Sort of theories or or guesses,
• 54:59let's say so.
• 55:00Part of it is that to get here you
• 55:03have to have a certain health status.
• 55:06So there's this notion that the
• 55:08people that are predisposed to
• 55:10illness never make it to the shores,
• 55:12never make it here,
• 55:14so we're not getting a
• 55:15representative immigrant population.
• 55:17We're getting the people that make it here,
• 55:20and that's not representative,
• 55:21so that's part of an explicit
• 55:23explanatory factor.
• 55:24But what one of my wonderful
• 55:26treasured mentors, James Jackson,
• 55:28who passed recently?
• 55:29When I was talking to him about some
• 55:32of these equity issues and he was
• 55:35finding that when when people got here,
• 55:38their health status actually second
• 55:40generation was was was lesser than what.
• 55:43Why do you?
• 55:44What could that be?
• 55:46We don't know yet,
• 55:47but what he did cause me to
• 55:50think about what we discussed is
• 55:52that the impact of what's called
• 55:55weathering in the literature.
• 55:57The repeated sort of burdens.
• 55:59Trauma overtime actually wears
• 56:01on your your biological systems,
• 56:03your immune system,
• 56:04your ability to sort of deal with
• 56:08the the micro traumas of getting
• 56:10through the day or viewing the OR
• 56:13actually the trial of the officer
• 56:16who kneeled on George Floyd's neck
• 56:18and murdered him like just that.
• 56:21Just think about what I was talking
• 56:24to a colleague last summer who was
• 56:27appropriately aghast at that imagery
• 56:30that was flashed again and again and again.
• 56:33On our screens and and it happened
• 56:35to be a woman,
• 56:36a white woman who told me like
• 56:37that so terrible that's so true.
• 56:39And I said,
• 56:39how do you think it makes me feel as
• 56:41the person who's been in the back of
• 56:43a police car and spent the night in
• 56:45jail because of over aggressive policing?
• 56:47So if you're traumatized or outraged by that,
• 56:50what might that do to people
• 56:52that look like me?
• 56:54Charter home articulation and
• 56:56education and having a license and
• 56:58registration isn't a protective factor.
• 57:00I'm sorry under no no Charles.
• 57:02Let let me
• 57:03let me do this.
• 57:04What we're going to do in in Rosemary.
• 57:08We're gonna keep recording for a little bit.
• 57:11We're going to close now formally
• 57:13after Robla Brill's idea to you.
• 57:15But if you are so kind of
• 57:17Charles to stick around,
• 57:19I know that some of us would
• 57:22love to stay for the after.
• 57:24Party but I wanna I want to
• 57:26be mindful of peoples time.
• 57:28This has been absolutely extraordinary
• 57:30and I want to thank Rob Labrie.