Child Study Center Grand Rounds 04.26.22

May 18, 2022

Racial Inequities in American Medicine: Historical Perspectives and Present-Day Legacies

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00:04Thank you, Rosemary.
00:16Alright.
00:23Wonderful thank you, Rosemary.
00:25We'll be getting started
00:26in just a moment.
00:30So welcome everyone,
00:31it's just turned 1:00 o'clock.
00:33I know many more people will be joining,
00:35but I just like to start with the
00:37word of thanks to our speaker,
00:38doctor Roberts, and for being so
00:41flexible and accommodating today.
00:42As many of you will know,
00:45if you joined us in person in the Cohen
00:47auditorium over the last few weeks,
00:48you will have braved Arctic like conditions,
00:51and unfortunately the maintenance
00:52work meant that we couldn't be
00:54together in person to welcome
00:56Doctor Roberts to city center.
00:58However, and this is a very special two part.
01:00Viola Bernard lecture series.
01:01So we do hope we have the opportunity to
01:04welcome Doctor Roberts for the next part
01:07now before I pass you over to Attari develop,
01:09develop with formal introduction,
01:11I'd like to remind you that
01:12next week we'll be welcoming Dr.
01:14Joshua Gordon,
01:15the director of the National Institute for
01:17Mental Health to the Child Study Center.
01:19This will be in person and we
01:21will be back in the colon.
01:23I hear it's very balmy down
01:24there at the moment,
01:25and we'll be serving light refreshments,
01:28so there will be coffee available
01:30before the presentation.
01:32Will encourage you to come down just
01:33a little bit before 1:00 o'clock.
01:35We can share a coffee,
01:36listen to Doctor Gordon,
01:37speak about the future of mental
01:39health research here in the United
01:42States and we compose our questions
01:44about funding priorities for
01:45the and so now I'd like to ask
01:48the virtual microphone to Tara
01:50to introduce our speaker today.
01:53OK, thank you so much Kieran
01:55and good morning everyone.
01:57It is lovely or good afternoon.
01:59I should say to be here with you all today.
02:01I'm terribly office chair
02:03of diversity and inclusion.
02:05It is my pleasure to welcome you
02:07all to the first of a two part
02:09Viola Bernard Lecture for 2022.
02:11And before I introduce Doctor Carolyn
02:13Roberts, who's our speaker for today.
02:14I want to first take a moment to share some
02:17information about Doctor Viola Bernard,
02:19her life's work and her generosity
02:21to our center.
02:22Viola W.
02:23Bernard was a prominent New York
02:26psychiatrist psychoanalyst child welfare
02:28advocate and political activist,
02:30Dr Bernard was a founder of the
02:32field of community psychiatry,
02:33which sought to use psychiatric insights
02:36to address larger social purposes.
02:38She was an influential force in numerous
02:40child welfare organizations in New York City,
02:42was active in many
02:44professional organizations,
02:45and had particular expertise in the
02:47psychological issues surrounding
02:48adoption and infertility.
02:50Her work helped to expand adoptions to
02:52include children who had been systematically.
02:54Regionalized.
02:55Bernard Dr.
02:56Bernard helped found the Columbia
02:58University Center for Psychoanalytic
03:00Training and Research and was director
03:02of the university's division of
03:04Community and Social Psychiatry,
03:05a joint program of the Department
03:07of Psychiatry in Columbia School
03:08of Public Health.
03:09She also served as medical director of
03:12the Family Development Research Unit,
03:14a long term study of the PSYCHO
03:15which was a long term study of the
03:18psychodynamics of family formation.
03:19Her dedication to social justice,
03:22HealthEquity and innovation and
03:23the generosity of the Viola Bernard
03:26Foundation is part of what brings
03:28us together today.
03:29The Viola Bernard Foundation has
03:30a long history of supporting
03:32the child's study center,
03:33especially in the early 2000s,
03:35Doctor Bernard had little patience
03:37for band aid solutions and sought
03:39instead to take a multidisciplinary,
03:40multifaceted approach to complex problems.
03:43With the goal of producing
03:46sustainable and replicable solutions.
03:48It is this spirit and dedication of Viola,
03:50Bernard and the child study centers
03:53approach of discovery inspiring
03:55care that led to the establishment
03:57of the Viola Bernard Fund for
03:59Innovation and Mental Healthcare.
04:00While we'll soon announce some
04:02of the other ways that our center
04:03and those we serve will benefit
04:05from the Viola Bernard Fund today,
04:07we'll focus on the lecture series.
04:09And I'm eager to introduce
04:11Doctor Carolyn Roberts,
04:12who I think is a gem among our faculty.
04:14She's an historian of medicine and science,
04:17holds a joint appointment in
04:18the Department of History,
04:19History of Science and Medicine,
04:21and African American Studies.
04:23She also holds a secondary appointment
04:25at the Yale School of Medicine and the
04:27program in the History of medicine.
04:29Her research interests concerned
04:31the history of race,
04:32science and medicine in the context of
04:34slavery and the Atlantic slave trade.
04:37This includes attention to the
04:39critical role played by African and
04:41African descended medical and health
04:42knowledge in the Atlantic world.
04:44Doctor Roberts is currently working on
04:46several book manuscripts on these topics,
04:48including to heal and to harm,
04:50medicine knowledge and power
04:51in the British slave trade,
04:53which is under contract with
04:55Harvard University Press and is
04:56what informs our lecture today.
04:58The book traces the troubling.
05:00Relationship between the British slave trade
05:02and the development of modern medicine.
05:04Doctor Robertson covers the
05:06stories of doctors, patients,
05:07apothecaries and early pharmaceutical
05:09companies involved in the
05:11brutal form of human commerce.
05:13The book vividly demonstrates
05:15how the seeds of Big Pharma.
05:17New power dynamics in the doctor patient
05:20relationship and racial bias in medical
05:22care have roots in the slave trade.
05:24Doctor Roberts is an award winning educator.
05:26She is the 2021 recipient of Yale's
05:29prestigious Sydney Miskimen Claus Prize
05:31for teaching excellence in the humanities.
05:34Her teaching blends history with medical
05:36sociology and public health to explore
05:38present day crises related to race,
05:40racism and health,
05:41with which I imagine would
05:43have sparked a fast and deep
05:46partnership with Doctor Bernard.
05:47I know that I was fascinated
05:49by our conversation together
05:50and all that she had to share,
05:52that we were able,
05:53and I'm so thrilled that we
05:54were able to schedule.
05:55For two Viola Bernard lectures this year,
05:58please mark your calendars to return
06:00to hear Doctor Roberts on May 17th
06:02for her talk on diagnosing depression,
06:04race,
06:04medicine and melancholia in
06:06the Atlantic slave trade.
06:07But now I'm thrilled to welcome
06:10Doctor Carolyn Roberts and to
06:12hear her speak on today's topic.
06:14Welcome Doctor Roberts.
06:16Thank you so much, Tara.
06:17I really appreciate just the
06:20interactions that we've had.
06:22The conversations we've had,
06:23and I'm excited to be here.
06:26To do a first part talk and this
06:30is really going to allow us all
06:34to enter into the longer older
06:37history of race medicine in slavery,
06:41but also moving into the present.
06:43And so we're really going to be
06:45looking at a couple hundred of years
06:47of history together to begin to think
06:50about racial inequities in healthcare.
06:53And so I'm going to share my screen.
06:56And we will get started.
07:19So our talk is going to be in a three parts.
07:23We are going to begin thinking
07:25about early anti black attitudes.
07:27Our second part is going to look at
07:30racial inequities in healthcare from
07:32the slave trade to civil rights and then
07:35we will think about legacies today.
07:37So as you can see from this outline,
07:39we'll be spending a lot of time
07:41exploring the history of racial
07:44inequities in American medicine.
07:46And I believe that multidisciplinary
07:48solutions are required to solve our most
07:52pressing problems in advancing HealthEquity,
07:54and also in tackling anti racism in
07:57STEM and so today I want to make a plea
08:00for the important role that history has
08:03to play in our strategic initiatives.
08:09History has a diagnostic and
08:12rehabilitative capacity to help
08:14us think through where we are,
08:16how we got here, and how to move forward.
08:20So I invite you, as you engage with
08:23the historical content of this talk to
08:25see this history as a living history,
08:28which is very real, and indeed
08:30life and death consequences today.
08:35This young man's question is crucial to
08:37the beginning of our historical journey,
08:40and he asked this question in the
08:42protests over the summer in 2020.
08:44What do you see me as?
08:47And to answer that question,
08:49we are going to travel back to the
08:5115th century, meaning to the 1400s.
08:54In other words,
08:55we will travel back in time 600
08:57years when anti blackness took
08:59firm root in the European mind.
09:04This might bring up memories of you of your
09:08schooling in middle school and high school.
09:11When you learned about the age of Discovery
09:13and European global circumnavigation,
09:16this is important to our story.
09:18A new chapter in human history was born
09:21when Europeans began to circumnavigate
09:23the globe in the 15th century.
09:25Just think with all of this travel,
09:27Europeans were increasingly
09:29encountering human variety.
09:32There was new awareness of how the
09:34world's peoples were physically and
09:36culturally different from one another.
09:38But this did not bode particularly
09:41well for Africans.
09:42Now the language and ideas that I'm
09:45about to share will be upsetting
09:46and disturbing to some of you,
09:48but I think it's important that we get
09:51clear about how anti blackness began to
09:54circulate in Europe and the Americas.
09:56As you will see,
09:58these ideas also took root
10:00in medicine and science.
10:02And please also remember that
10:03what is being said is based on
10:06European biases and ethnocentrism.
10:11This is a quote from one of the earliest
10:14Portuguese chroniclers of Africa.
10:16The author writes that they lived like beasts
10:19without any custom of reasonable beings.
10:22They had no understanding of good,
10:23but only knew how to live
10:26in a beastial sloth.
10:28Such ideas would continue.
10:31According to Richard Ligan, in 1673,
10:34African women resembled animals.
10:37He wrote their breasts hanging down
10:39below their navels so that when they
10:41stoop at their common work of weeding,
10:44they hang almost to the ground that at a
10:47distance you would think they had six legs.
10:50African women not only looked like animals,
10:53but they gave birth with no
10:55pain like animals as well.
10:58One of the doctors that I study in the
11:00slave trade wrote a widely circulated
11:02text that included this description of
11:05African people quote their natural temper.
11:07Is barbarously cruel,
11:09selfish and deceitful.
11:10As for their customs,
11:12they exactly resemble their fellow
11:14creatures and natives,
11:15the monkeys.
11:20Science had a major role to play
11:22in this as well when Linnaeus
11:24began describing humans based on
11:27newly invented racial categories.
11:29This is how he described black people.
11:32Black phlegmatic hair,
11:34black frizzled nose, flat lips,
11:38tumid women without shame.
11:40They lactate profusely,
11:42crafty, indolent,
11:44negligent governed by Caprice.
11:51This is how we categorized white people.
11:54White sanguine muscular eyes blue
11:58gentle inventive governed by laws.
12:05What is particularly helpful to
12:07notice in this is that you can see
12:10how scientific understandings of
12:11human difference were embedded in
12:13European notions of culture, behavior,
12:16political structures and ideals of beauty.
12:20What we're seeing here is the mutual
12:23influencing between science and society,
12:26and it's nowhere more vivid than
12:28when it comes to biological fictions
12:30concerning racial difference.
12:35Given that Antiblackness had been
12:37operative for hundreds of years in
12:40the European and American mind long
12:42before the founding of the United
12:44States as an independent Republic.
12:46It should not be terribly surprising
12:48that these ideas appear in the language
12:51of our founding fathers in 1785,
12:54Thomas Jefferson famously wrote
12:56their griefs are transient.
12:59In other words, black people felt
13:01less emotional pain than white people,
13:04but they also feel less physical pain.
13:08Doctor Benjamin Ross,
13:09another founding father who was the
13:12first professor of chemistry in
13:14the US and also published the first
13:16psychiatric textbook in the US,
13:18wrote the following in 1799.
13:22He believed black skin was a form of
13:24leprosy and he wrote that it caused quote
13:28morbid insensibility in the nerves,
13:30meaning that black people were less sensitive
13:33to physical pain than white people.
13:36Now what the individuals that Doctor
13:38Rush quotes in his writings on
13:41leprosy is Doctor Benjamin Moseley?
13:44Doctor Mosley writes they are void
13:46of sensibility to a surprising degree
13:49they sleep sound in every disease.
13:52Nor does any mental disturbance
13:54ever keep them awake.
13:56They bear surgical operations
13:58much better than white people,
14:00and what would be a cause of
14:03insupportable pain to a white man?
14:05A ***** would almost disregard.
14:07So as you can see,
14:08the idea that black people don't feel
14:11the same level of physical or emotional
14:13pain as white people has a long history.
14:17But let's shift now to consider
14:19how these anti black attitudes
14:21became folded into health care.
14:41The transatlantic slave trade
14:43was the largest forced oceanic
14:46migration in human history.
14:48It was a watershed event in
14:51our collective human story.
14:53It began in 1441 with a
14:55Portuguese and ended in 1867.
14:58It lasted for 426 years,
15:02over 12 million in slave children,
15:05women and men were
15:06trafficked to the Americas,
15:07most of Western Europe was involved
15:10in this form of human trafficking.
15:13The slave trade presented a healthcare
15:16challenge that had never existed before.
15:19How can you traffic millions of enslaved
15:22Africans across the Atlantic so that
15:25they arrive alive and ready for sale?
15:28The British slave trade is important.
15:31Because the majority of enslaved
15:33people who arrived in the United States
15:36arrived on board British slave ships.
15:38And British slave ship medicine was based
15:41on systemic violence and dehumanization.
15:45One of the doctors first duties
15:47was to perform forced medical
15:49inspections prior to the voyage,
15:51enslave children, women and men were
15:53stripped naked from head to foot.
15:55Every single part of their bodies
15:58was studied. Inspecting one enslaved
16:01person could last four hours.
16:05They were beaten, kicked,
16:07whipped and punched.
16:08If they didn't comply.
16:10Women and girls were pinned down.
16:12Their legs were held open so
16:13doctors could check to see if
16:15they had previously born children.
16:17One observer noted that the women
16:19and girls wept uncontrollably.
16:24Slave trade healthcare required
16:26shipboard medical practice to be
16:28violent slave trade doctors agreed
16:31to practice medicine in hell.
16:33As one practitioner explained.
16:34Doctors had to be willing
16:36to not only treat diseases,
16:38but to take up arms against enslaved
16:41Africans who tried to kill them,
16:43and they also had to restrain
16:45African captives when they attempted
16:47self mutilation and suicide.
16:52On board thousands of slave ships,
16:53doctors whipped African
16:55captives who refused to eat.
16:57Then doctors treated the wounds they
16:59had just inflicted upon their patients.
17:02Medical practitioners were
17:04equipped with bullous knives,
17:06thumb screws and the speculum oris
17:08to force feed the enslaved which
17:10broke off their teeth in the process.
17:13Doctors were expected to compel
17:16life by any means necessary.
17:21And so a new form of health care
17:24management entered the world.
17:25This was a form of healthcare where
17:28medical violence against African
17:30and African descended people
17:32became an acceptable normative and
17:35institutionalized practice for centuries.
17:38This forced black people into a
17:41unique and troubling relationship
17:43with Western medicine before even
17:45setting foot in the United States.
17:48It characterized the kind of medical care
17:51that was deemed appropriate for black people.
17:53It also created a new understanding
17:56of the doctor patient relationship,
17:58a relationship that was violent
18:01and depersonalized,
18:02extractive and exploitative.
18:07Upon arrival in the United States,
18:09enslaved people were already trying to heal
18:12from the trauma and violence and medical
18:15abuse they experienced in slave trade,
18:17health care, and throughout the
18:19Americas enslaved people try to
18:22give medical care to one another.
18:24They developed their own medical systems.
18:26They blended medical knowledge from Africa
18:29with new medicinal plants in the Americas.
18:32However, they could not avoid white doctors
18:36who eventually needed their bodies.
18:38To advance medical science.
18:42Newspapers contained advertisements
18:44like this one offering cash for sick,
18:47enslaved people to be medical
18:51specimens during the 19th century,
18:53scientific medicine was beginning
18:55to take root in the United States,
18:58doctors needed bodies both alive and dead.
19:01To understand more about how organs
19:03and tissues were impacted by disease,
19:06there was an enormous demand for sick
19:08patients and cadavers for study.
19:10Yet the white population would not tolerate.
19:12Their bodies to be used in this manner.
19:15Slavery created a population of
19:17people who were forced to comply.
19:23This is a slave narrative written by an
19:26enslaved man named John Brown who was
19:29subjected to painful medical experiments.
19:32Yet John Brown was not alone.
19:34A slave named Sam was pinned down into a
19:37chair by 5 physicians so that his lower
19:40jawbone could be removed without anesthesia.
19:43Doctor Walter Jones in Virginia
19:45Ford boiling water on naked,
19:47enslaved pneumonia patients
19:49at 4 hour intervals.
19:51Doctor John Hardin stripped blood
19:53vessels from the limbs of an enslaved
19:56man and from 3 hogs to measure
19:58their arteries for comparison.
20:00Doctor James Douglas performed experimental
20:02eye surgeries on black subjects.
20:08One of the most important legacies
20:11of medical exploitation during
20:12slavery concerns the legacy of black
20:15women as the mothers of gynecology.
20:18As one British surgeon noted.
20:21You could cut into the bodies of
20:24negresses like you did rabbits or dogs.
20:30J Marion Sims, whose pictured
20:32at the far right did just that.
20:35He conducted experimental
20:37surgeries on enslaved women to
20:40cure vesicovaginal fistula.
20:42Enslaved women like Anarkia,
20:43who was pictured at center,
20:45was operated upon 30 * /,
20:48a period of five years without anesthesia.
20:51Although Ether was available.
20:53Sims believed black women didn't
20:55feel as much pain as white women.
20:58Over and over again he scarified
21:01sutured and re sutured the vagina.
21:04When the surgery was finally perfected
21:06with silver sutures rather than lead.
21:09Sims treated the white women of Montgomery
21:12and properly administered anesthesia.
21:19Sims remains a part of our lives today.
21:23His vaginal speculum is still
21:25used during gynecological exams.
21:31By utilizing the bodies of black women,
21:34doctors advance their understanding
21:36of how to remove burst ovaries,
21:39deliver stillborn children,
21:41stop intrauterine bleeding,
21:43fix fuse, labias,
21:45repair obstetrical fistula,
21:47remove ovarian tumors.
21:48The first full uterine removal
21:51was performed by Doctor Paul.
21:53Eve Susare inspections 30 of 37
21:57experimental cesarean sections were
21:59performed on black women in 18. 30
22:05but it wasn't just medical
22:07experimentation on the living.
22:09Enslaved people's dead bodies were
22:12dissected to advance medical science.
22:14This is an image of African American remain.
22:18Virginia Commonwealth University.
22:22In 2019, the remains were
22:24formally memorialized.
22:25Human remains of African Americans
22:27have been found at numerous medical
22:29school sites throughout the country.
22:34Here's another advertisement
22:35from the Charleston Mercury.
22:37No place in the United States
22:39offers as great opportunities for
22:42the acquisition of anatomical
22:44knowledge subjects being obtained
22:46from among the colored population in
22:48sufficient numbers for every purpose
22:51and proper dissections carried on,
22:53without offending any individuals
22:55in the community.
22:57Enslaved people's bodies became
22:59part of a lucrative national cadaver
23:01trade that shuttled black people's
23:03bodies from Texas to New Hampshire.
23:06As historian Daina Ramey Berry writes,
23:08few enslaved people rested in peace.
23:13Death did not end their commodification.
23:17I will now show one photograph.
23:20Of a dissection of an African
23:23American during this period.
23:24The image, however, is gruesome,
23:28so please avert your eyes as necessary.
24:15After slavery in the 100
24:18years between 1865 and 1965.
24:21The relationship between black
24:23people and American healthcare
24:25remained as fraught as ever.
24:27Black people went from being valuable
24:30human commodities to being a problem
24:32that needed to be controlled and
24:34brutalized to be kept in their place.
24:36Through the 1960s,
24:38segregation infected all aspects
24:40of the US healthcare system,
24:43whether by law or by custom,
24:45throughout the country.
24:49Deaths occurred because black
24:50people couldn't get to a hospital
24:53or doctor willing to treat them.
24:55Wasn't allowed into white hospitals.
24:57African Americans were put into
24:58waiting rooms that were little more
25:01than broom closets with a few chairs.
25:03Hospital wards for African Americans were
25:06often in dingy basements and backrooms.
25:09Many doctors black doctors during this
25:12period saw their patients at home.
25:16This was because black people
25:18wouldn't go to the hospital because
25:20they were treated terribly.
25:22You went to the hospital
25:23if you wanted to die.
25:28Because of poverty and segregation,
25:30the majority of black people had
25:32to live in deplorable conditions
25:34and it compromised their health.
25:36In the early 20th century,
25:38as black people succumbed to
25:40diseases like tuberculosis,
25:42doctors attributed their high mortality
25:44rate to the fact that they were
25:48black and biologically inferior.
25:50Not that they were living
25:52in deadly conditions.
25:53Not that they didn't have
25:55access to health care.
25:56Their race was the culprit,
25:58not the social conditions under
25:59which they were forced to live.
26:03One doctor wrote they had smaller brains,
26:06so they succumbed to all diseases.
26:08Unlike whites who are endowed with
26:11a better developed brain structure.
26:13So rather than showing black
26:15people sympathy or compassion,
26:17they were treated with disgust.
26:19Considered carriers of disease.
26:20And they were a people that
26:23many hoped would simply die off.
26:28As the vulnerable population largely
26:30kept out of the health care system,
26:33many who did get access to white medical
26:36spaces were abused and exploited in them.
26:39For most of the 20th century,
26:41for example, state sanctioned
26:43forced sterilizations were performed
26:45disproportionately on black women,
26:47often without their knowledge or consent.
26:50Fannie Lou hammer,
26:51the famous civil rights activist,
26:53went to a hospital in Sunflower County,
26:56Mississippi to have fibroids removed.
26:58She was given a hysterectomy
27:00without her knowledge or consent.
27:02Forced sterilization was such a common
27:04experience for black women in the South.
27:07That hammer called it the
27:09Mississippi appendectomy.
27:13And as we all know,
27:14the famous Tuskegee syphilis experiment
27:18occurred between 1932 and 1972.
27:22It was the longest involuntary and non
27:25therapeutic medical experiment conducted
27:27on human beings in the history of
27:30American medicine and public health.
27:33The US government performed this experiment
27:35on black men in Macon County, Alabama.
27:37The person overseeing the project would
27:40later become the director of the CDC.
27:44The men fought.
27:45They were getting free medical
27:47care to treat syphilis.
27:48This was a lie.
27:50The study was designed to observe
27:53untreated syphilis in black men.
27:56And so they pretended to
27:58give the men's medicine.
28:00They withheld lifesaving medicine
28:01so they could have observed how
28:03the disease killed black people.
28:07Syphilis kills you slowly.
28:09And often with excruciating pain.
28:12We know that some of the men went blind,
28:15some went insane, some became paralyzed,
28:18some suffered complications
28:20from cardiovascular disease,
28:21some became horribly disfigured.
28:50After slavery, black people knew.
28:53That they could only rely on each other.
28:56Groups of black women mobilized
28:58public health campaigns and black
29:00communities across the country.
29:02Groups like the National
29:04Association of Colored Women,
29:05which was the first national
29:07black organization in the US,
29:09had a Department of Health and hygiene.
29:13Their local chapters,
29:14such as this one from Newport RI
29:17Integrated Health, Education and
29:19Healthcare into their activities.
29:26***** Health Week was instituted
29:28and lasted from 1915 to 1951.
29:35The first half of the 20th century
29:37also brought us an increasing number
29:39of black healthcare professionals.
29:41They studied at Black medical schools.
29:44But they existed any segregated profession.
29:46They were barred from the AMA and
29:50so they founded organizations like
29:52the National Medical Association,
29:53which is still thriving today.
29:59Civil rights, as you know, would come.
30:01The Medical Committee on Human Rights was
30:03the medical arm of the civil rights movement.
30:06Hospitals would eventually
30:08desegregate during the late 1960s.
30:12But this means that black
30:14people have in theory.
30:16Only had greater access to
30:19white healthcare spaces.
30:21For 50 years. For 50 years.
30:27So think of your younger black
30:29senior citizens who would have
30:32grown up experiencing segregated
30:34healthcare across the country.
30:36This is living history.
30:38And it has deep legacies today.
30:52So we will focus on two legacies.
30:55The first is race based medicine
30:58and the 2nd is provider bias.
31:06It's over hundreds of years.
31:09We have been conditioned to invade
31:11and to invest racial difference with
31:13medical and scientific meaning.
31:15And as this July 2021 article explains,
31:18race continues to be misused as a proxy
31:21for genetic ancestry and ethnicity.
31:24When it comes to medical diagnosis,
31:26treatment and outcomes,
31:28often with harmful consequences.
31:30It's also clear from the genetic
31:33data that there are no clear
31:36boundaries in terms of genetic
31:39ancestry that correlate with what
31:41we call races in the United States.
31:44So one of the most pressing issues
31:47being discussed right now are diagnostic
31:49algorithms and practice guidelines
31:51that adjust or correct outputs based
31:54on a patient's race or ethnicity.
31:57Race has long been assumed to be a
31:59causal mechanism in a range of health
32:02outcomes rather than the social and
32:04structural determinants of health.
32:08The Spirometer is a good example.
32:11Slave owner and physician Samuel
32:13Cartwright promoted a long standing
32:16idea that black people have
32:18lower lung volumes than whites,
32:20and this was first suggested
32:22by Thomas Jefferson in 1785.
32:24Cartwright built his own spirometer
32:26to study difference in lung
32:28capacity between whites and blacks,
32:30and today we still race correct with the
32:35Spirometer continuing Cartwrights legacy.
32:37The problem is that no studies proven.
32:41That the differences some observed
32:43in lung volumes between whites
32:46and blacks is due to race.
32:50Studies conducted on pulmonary functions
32:53since 1922 have failed to show why
32:56such a difference seems to exist.
32:59It's our habit to turn to
33:01race as an explanatory factor
33:02because we have always done so.
33:08What we do know is that if we considered
33:11social class if we studied neighborhoods,
33:13people, zip codes and structural
33:16determinants such as disproportionate
33:18exposures to toxic environments,
33:20we can arrive at a more meaningful
33:22explanation of differences in
33:24pulmonary function that get at the
33:26conditions under which black people
33:28have suffered, lived and died.
33:34Coded has also raised new questions.
33:37Researchers are asking whether
33:39race adjustment with the spirometer
33:42exacerbates racial disparity.
33:43Disparities in COVID-19 recovery
33:46spirometers are used when patients
33:49are recovering from COVID.
33:51The authors of this paper suggest that
33:54if lower lung capacity volumes are
33:56considered normal for black patients.
33:58Clinicians can fail to diagnose patients
34:02with restrictive ventilatory dysfunction.
34:04Blacks are also less likely than
34:06white patients to be referred
34:08to pulmonary rehabilitation.
34:10And this despite the fact that Blacks
34:13received more pre more frequent
34:16pulmonary related hospitalizations.
34:19So since 1785.
34:20When Thomas Jefferson first
34:22suggested that blacks had lower
34:25pulmonary function than whites,
34:27now 237 years later we are
34:31still wrestling with this.
34:33We're still living in the
34:35aftermath of the racial logics
34:37that were present during slavery.
34:40But some Reese corrections that we can
34:43point to are a product of the 21st century.
34:48For example, if you are a black or
34:50Hispanic woman who previously had a
34:53C-section and you're now pregnant,
34:55the vaginal birth after cesarean risk
34:58calculator or VBAC gives you a much lower
35:01chance of success with a vaginal birth
35:04because of its race based algorithm.
35:06The doctor is more likely to recommend insist
35:09or even bully you into having a C-section.
35:13You are subjected to an unnecessary surgery
35:15which puts you at risk for blood loss,
35:18infection and longer recovery period.
35:24Just last year's race was
35:27removed from the algorithm.
35:30So this is good news.
35:33But why was it there in the first place?
35:36In 2007, the maternal fetal Medicine
35:39Network published data which
35:42suggested that successful VBAC
35:44occurred when women are younger,
35:47have lower BMI's, are white,
35:50have private health insurance,
35:52and are married.
35:54However, when the calculator was created,
35:56most of the social factors were removed,
35:58including insurance and marital status.
36:01Race became the primary determinant.
36:05So if you had two women of the
36:07same age and BMI based on race,
36:10they would have very different
36:11risks for vaginal birth.
36:13Based on this algorithm.
36:17So as you question and scrutinize
36:20how the category of race is used
36:23in your own work and practice.
36:26I would encourage you to consider
36:28these words from Nancy Krieger at
36:30Harvard School of Public Health.
36:33Bodies tell stories about and
36:35cannot be studied, divorced from
36:38the conditions of our existence.
36:41We like any living Organism,
36:44literally incorporate biologically
36:46the world in which we live.
36:50Including our societal and
36:53ecological circumstances.
36:54So what is the story that
36:57the body is telling?
36:58This story will in fact include race.
37:02But not as a meaningful scientific variable.
37:06More so as a social and structural reality.
37:10And it is a social and structural
37:12reality that often curtails, constrains,
37:14and chokes the lives of many.
37:17This is what people mean when they
37:19say that racism is the risk factor,
37:21not race.
37:24But racism, as we all know,
37:26is not just something out there in
37:28the world, it is in fact among us.
37:36Provider bias gained widespread
37:38attention in a national study conducted
37:41in 2002 called unequal treatment
37:43by the Institute of Medicine.
37:46The report sent shockwaves
37:48through the medical community.
37:50It was front page page news.
37:52There were many editorials.
37:54There were congressional hearings.
37:56One of the reports findings
37:58was that health care providers
38:00diagnostic and treatment decisions,
38:02as well as their feelings about
38:04their patients are influenced
38:06by patients race or ethnicity.
38:11So the key to understanding the
38:13evidence related to provider bias in
38:16healthcare are what we call differential
38:18treatment studies and you may have come
38:20across many of these studies before.
38:22These are studies that have been
38:25conducted where they standardize each
38:27patient in all aspects except race,
38:29controlling for confounding
38:31variables like insurance status,
38:33socioeconomic status,
38:34education and medical condition,
38:37and numerous studies have been
38:39done over the past 20 years.
38:41These are some of the results.
38:45For cardiac catheterization,
38:46women and blacks are less likely to be
38:50referred with black women being offered.
38:52The lowest rates of cardiovascular
38:54procedures.
38:55For rectal cancer,
38:56blacks are more likely to receive a
38:58permanent colostomy after surgery.
39:01For coronary artery surgery,
39:02blacks are less likely to be recommended.
39:05In intensive care unit blacks have less
39:08time with physicians for lung cancer,
39:1212.7% less likely to receive early stage
39:15curative surgery for prostate cancer,
39:18twice as likely to undergo
39:20removal of testicles.
39:22For pneumonia less likely to have
39:25blood cultures taken during the
39:27first two days of hospitalization.
39:29For appendicitis,
39:30black children less likely to
39:32receive adequate pain medication.
39:34For long bone fractures,
39:36less likely to receive
39:38adequate pain medication.
39:40For diabetes more likely
39:41to have a limb amputated.
39:44For heart transplants,
39:45less likely to be referred for a transplant,
39:48more likely to be prescribed
39:50ventricular assist devices.
39:56Some of this research began to make
39:58national news over the last few years.
40:01You can see here from 2020 racial
40:04disparities scene and how doctors
40:06treat pain even among children.
40:10Studies came out about medical students.
40:12For example, some medical students
40:14still think black patients
40:16feel less pain than whites.
40:21And then the new cycle started to
40:23report more frequently about the
40:25crisis of black maternal mortality.
40:27Black women are three to four
40:29times more likely to die during or
40:31after delivery than white women.
40:33We know that black women's pain
40:35is not listened to that health
40:37care providers believe black
40:39women exaggerate our symptoms.
40:41We are written off or not taken seriously
40:44and death has occurred as a result.
40:47You can be a star athlete
40:49or someone like lashonda.
40:54In January of 2019, Lashawnda,
40:57a healthy, 27 year old,
40:58pregnant black women,
41:00went to a hospital in Providence, RI.
41:02She was having a great deal of pain,
41:05but she wasn't listened to
41:06and she was sent home.
41:08When she returned home,
41:09she tweeted this.
41:13I've been having excruciating
41:15stomach pain, cramps,
41:16and they're not doing anything about it.
41:19My whole left stomach hard and in pain.
41:22I'm literally dying.
41:24And Lashonda did die.
41:27She was dead 24 hours later.
41:32The system is racist and we're
41:34all participating and we're
41:35all participants in the system.
41:44I had a a black woman come in with
41:47back pain who every time she coughed
41:50she would get chest pain and she
41:51was just there with that pain.
41:53She said Oh my chest,
41:54my chest and she had a very histrionic
41:56personality and so all the providers
41:58were inclined to just be like, OK,
42:00let's just give her some confidence
42:01and give him some confidence.
42:02So one day I was like let me put
42:03an EKG on you because I know I
42:05think the New England Journal study
42:07just came out that black women.
42:08You have the worst health outcomes
42:10with heart attacks because they're
42:12not listened to.
42:13So OK, let me let me just try this.
42:14So I've put an EKG on her and every
42:17time she coughed she had St elevation.
42:19She was having a heart attack
42:20and I said Oh my Oh my God.
42:22So they called the cardiologist and I
42:24said can you please catch this lady?
42:26Because I I think she has a
42:28bridge artery going through her,
42:30you know, myocardium.
42:31So when intrathoracic pressure is increased,
42:34is collapsing the artery and she's
42:36having cardiac issues and he said
42:38well suited to my outpatient clinic.
42:40So this woman will never show
42:41up to your outpatient clinic.
42:42I know this woman.
42:43I've known her for five years.
42:44She'll never show up.
42:45She's here in the hospital.
42:46She's gonna be here for a couple
42:48days back pain let's just do a
42:51calf and and he refused to the
42:53calf and so finally I said,
42:54you know I don't want this woman to become
42:57a statistic that black women get worse.
42:59Medical care around heart attacks
43:01than everybody else because the
43:04medical institution doesn't
43:05listen to them and he said are you
43:08calling me a racist and I said.
43:11Well,
43:11I.
43:14Well, I think our system is racist
43:16and we're all participating.
43:18We're all participants in the system and
43:20I'm trying to check myself and I had and
43:23I had to check myself and actually go.
43:25She's saying chest pain.
43:27Get an EKG like that's what
43:29you're trying to do.
43:30Why wasn't I doing it right?
43:32And so I think a part of it is just
43:34starting to unlearn our own implicit biases.
43:37From that we've been raised with
43:39in the society and challenge
43:41yourself with each patient.
43:43Counter now I just challenge
43:45myself when I'm looking at
43:47black indigenous Latino person.
43:49I challenged myself, OK?
43:50What am I not seeing?
43:51What am I not asking because I'm
43:53a part of the system and and and
43:56through that own self inquiry and
43:58examination I also now start,
44:00you know, talking with my colleagues.
44:02Look what I miss.
44:07So this is not about demonizing providers.
44:12Doctor Rupa Maria in this video
44:14explains that even the best
44:16meaning health care providers can
44:19find themselves living into this
44:21ongoing history of biased care.
44:24Stuck in a system that results
44:26in disparate treatment.
44:30In February, we marked the 20 year
44:33anniversary of the 2002 study that I
44:36mentioned earlier called unequal treatment.
44:38And this author asks why
44:40has so little changed?
44:42The author writes,
44:43quote today the disparities poor
44:45outcomes and higher death rates
44:47for nearly every medical condition.
44:50The panel examined and the structural
44:53racism underlying them remain.
44:56David Williams from Harvard School of
44:59Public Health explains that premature
45:01deaths of African Americans is the
45:03equivalent of a jumbo jet falling
45:05out of the sky every single day.
45:11So why is a little changed?
45:14There are many ideas that that
45:16people have and some of the.
45:19Ideas that are proffered by experts include.
45:22That talking about race is still a taboo.
45:26That healthcare providers are in denial about
45:29the part they might play in the problem.
45:32That there is complacency
45:33in our institutions.
45:35There's a lack of consistent political will.
45:38We have a fragmented healthcare
45:40system that makes universal
45:42solutions difficult to achieve.
45:44We have lack of data that would allow us to
45:48effectively track efforts to end disparities.
45:51And I would add.
45:53And that you can't begin to
45:55effectively solve the problem.
45:57When you don't understand how long
46:00the problem has been going on.
46:02History matters.
46:06One of the reasons I believe history
46:08is so important in our strategic
46:11initiatives for advancing HealthEquity.
46:13Is because it allows us to Orient
46:15ourselves and the challenges we face
46:17within a larger, older, bigger story.
46:22History helps us answer the
46:24question how did we get here?
46:26The negative attitudes our society
46:29holds about black people predate
46:31the United States by centuries.
46:34These negative attitudes were given
46:36scientific and medical validation and
46:39we inherited some of this as well.
46:42There's much that we have inherited,
46:44and then once inherited,
46:46we made it uniquely our own.
46:49Once we understand what we have inherited.
46:53And that we are part of this history.
46:56We can draw upon this foundational knowledge
46:59to better assess the challenges we face.
47:02We can be empowered to write a new story.
47:07History, for example,
47:08will help us with patient care.
47:11For example,
47:12if you don't know history,
47:14you don't understand how
47:15important it is to engender trust,
47:18particularly with older African
47:20American patients by referring
47:22to them with a formal address,
47:25Mr misses doctor,
47:26etcetera.
47:27The casual first name basis does not
47:30put a lot of our older black patients at
47:34ease unless you first ask permission.
47:37And there are deep historical
47:38reasons for this.
47:39This is just one of several examples.
47:45So history has salient vitality.
47:48It is never dead,
47:50not even sleeping, at worst napping.
47:53We can never entirely let
47:55go of the ongoing past,
47:57for it never lets go of us.
48:00To say dismissively,
48:01that's history or history is nothing
48:04to do with me is a profound error.
48:06We are fully historical creatures.
48:10Our consciousness and memory,
48:11bound up with pasts both near and remote.
48:15And rational present action demands insight
48:18into other people's pasts as well as our own.
48:22Thank you all so much for
48:24your time and attention.
48:26I'm going to stop sharing my screen now.
48:45Doctor Roberts, thank you so much for that.
48:48Really important.
48:52And difficult walk through
48:55history for us to understand.
48:58Some of the structural challenges and
49:01and how long they've been in place,
49:04which I think helps us to understand
49:07some of the the efforts required
49:10and steps required moving forward.
49:13So I thank you for for all of that,
49:15and I open up if there's any questions
49:18that people may have for Doctor Roberts.
49:38Amanda, is that your hand up this is. Hi
49:40thank you Doctor Roberts.
49:41I wanted to say I'd seen you pre COVID give
49:44a somewhat similar talk to the psychiatry
49:47department and this one was just as.
49:49Striking is that one and thank you so much.
49:52This is education that we all need
49:55and I think it's long overdue and
49:58I'm just so I just can't believe the
50:01wealth of information that you have
50:03condensed into just under an hour.
50:07And my question for you is can
50:10you share a little bit about?
50:12I guess what have been some of the
50:14hardest parts for you in putting this
50:17incredible body of work together.
50:20Both you know emotionally.
50:24Touches on some of the grand rounds
50:25that we have in our department.
50:27You know where we talk about the personal
50:31experiences that our providers have,
50:33so both emotionally but then.
50:34Also, how did you decide what to include?
50:36Because I'm sure there's so much more
50:39that there just wasn't
50:40room for. Yes,
50:41that's such a such a great,
50:44wonderful question. Yes, there is,
50:46so I'll answer the last question first.
50:49I think there's so much more,
50:51and you know, it's it's.
50:54It's difficult to decide because
50:57usually I teach this material.
51:00Picture this material spread
51:02out over an entire semester.
51:04You know 22 lectures a week over,
51:07you know 13 or 14 weeks with weekly
51:10discussion sections with hundreds of
51:12hundreds of students and so condensing
51:15it down has has has been challenging.
51:19I really appreciate the the question about.
51:25You know the way that I'm interpreting
51:26it as sort of the personal cost,
51:28the emotional cost to this kind of work.
51:33It it isn't easy. Umm?
51:37You know, I I've had to develop
51:40a lot of self care practices.
51:43Not only in terms of dealing
51:45with this work, but also.
51:48In being a professor who is
51:51giving this material to others?
51:55When I'm working with undergraduates
51:58with medical school students, school
52:01students from the School of Public Health.
52:04In the large lecture class,
52:06one of the large lecture classes I
52:08teach where we look at this material.
52:10Students will come up to me at the end.
52:13They will be in tiers.
52:14They will be crying.
52:15They'll come to office hours.
52:17The graduate teaching Fellows go
52:18into their discussion sections.
52:20They're emotional, they're upset,
52:23they're crying. And.
52:29One of the things that I've noticed.
52:33Is that in order to be the.
52:37Container or the vessel for
52:40very unsafe material. Umm?
52:45I have to walk a very careful line between.
52:52Making it real. To the
52:56listeners to the students.
53:02Putting myself into the story.
53:08Because the students.
53:12Need to understand the high stakes
53:15that are involved and that is that
53:19combination is one of the things
53:21that allows them to show up.
53:25Class after class week after week passionate.
53:31About what they can do. And so.
53:38My own sort of mindfulness
53:41practices meditation practices.
53:42I do cheat gong every day as well.
53:46I have to find a way of
53:50grounding myself and of.
53:53Being able to the hold this difficult
53:56history through journaling through writing.
53:58Actually, the book writing is
54:01incredibly therapeutic for me because
54:03I'm writing for a general audience,
54:04I'm writing for a broad audience,
54:06so anyone can pick up this book and I
54:08put myself into this book in terms of
54:10this is how he was doing the research.
54:12This is what I was finding.
54:14This is when my heart was breaking.
54:16This is when you know I was
54:19having nightmares and. You know?
54:22That we're coming from this material.
54:26Umm?
54:28But the one of the things that
54:30I want to mention about this.
54:34Is that?
54:37I've had to work really hard.
54:42To not let it become.
54:48To not be desensitized.
54:51And I know that in the kind of
54:53the Community that you're in and
54:55the kind of work that you do,
54:57that there's certain amounts of of
54:59of really important attachment and
55:02things like that that are necessary.
55:06But I've found that. For myself.
55:15The students are used to having this material
55:19come to them from a detached perspective.
55:24From oftentimes non black people and also
55:28often not anyone from BI POC background
55:32giving them this material skirting over it,
55:35moving quickly through it, never dwelling,
55:38never allowing the realities the harm,
55:41the horror, the terror,
55:44the ongoing cost of this. To ever land.
55:48And so for me, I've had to really work
55:52to sort of to to not let it become
55:55something that rolls off the tongue,
55:57which is part of the reason
55:59why you'll notice in the talk.
56:01That I had those moments of pausing.
56:04And I had those moments of let's all
56:08just dwell and and and just take this in.
56:13So I know I've spoken, I've spoken a lot,
56:15but yes, this was a a very rich question.
56:19Thank you for asking it.
56:20Thank you.
56:25Doctor Roberts I.
56:26I know that there's many
56:27who want to ask questions.
56:29Thank you, thank you profoundly.
56:31And and thank you for those post slides,
56:33which are very much needed.
56:35You, you showed the the the
56:38sculpture of Marion Sims,
56:39and I wonder if you could
56:41comment on the
56:42extraordinary work of. The author of
56:47medical apartheid, Harriet Washington
56:50I, I think of both of your works.
56:52You know, very much in the same line and
56:55and maybe you can comment about how that
56:57happened and how do we, as historical
56:59creatures that you told us
57:00how we deal with this.
57:02You know, sculptures are a very
57:03tangible example, but yeah, it's a.
57:07That's such a good question.
57:09You know there was like every like
57:13every one of our social movements.
57:16There was a lot of work going on at
57:19the grassroots organizing level and
57:21so the woman that you saw in front
57:25of the statue you know that was that
57:27was part of one of the protests that
57:30were going on where people were were
57:32standing up and saying like this
57:34is not OK and Harriet Washington's
57:37work is extraordinary because she
57:41she put together this research.
57:44In a space where people were telling
57:47her this is not a good idea like this
57:51is dangerous, what are you doing?
57:54You know Pfizer.
57:55It's interesting Pfizer owns the image.
57:58I don't know if you remember
57:59the image of the of J.
58:00Marion Sims and the enslaved women
58:03women that that that image the old
58:06historical drawing it's owned by Fizer,
58:08and you know Harriet Washington wanted
58:10to use that as the cover of her book and
58:13she wasn't permitted to do so because.
58:15Once they learned what the book was about,
58:17they were, you know,
58:18didn't want any part of that.
58:20So her work, you know she she
58:23really stepped forward at a time.
58:25So her book, I believe, came out in two.
58:29Is it 2004, 2006 about then?
58:32And and if you think about
58:35it in terms of timeline,
58:37the the the unequal treatment
58:40report comes out in 2002.
58:43You know,
58:43and people are really still just raw from,
58:47from from that knowledge and then
58:49her book comes out and starts
58:51to outline even more of this,
58:52which with really detailed research.
58:58And there were and there were
59:00lots of different community
59:02organizers that were involved.
59:03Young people that were at the forefront of
59:07trying to help get these statues removed.
59:11What should our relationship be?
59:14You know to to to these statues?
59:18You know the idea of the
59:21statues is very interesting.
59:23I I tend to think about it in
59:25a couple of different ways.
59:27You know, so you know.
59:29People often prefer a couple of
59:31different sort of scenarios.
59:33You know, we keep the statue,
59:35but then we properly annotate it
59:36and then maybe we have another
59:39statue like maybe beside.
59:40Maybe we kept up Jay Murray and Sims.
59:43Maybe we should have kept it up and
59:45then have another statue beside it of
59:47an ARCA that's done by by black artists.
59:50And you know, so there's there.
59:53There's a lot of you know
59:56ideas about equity and.
59:57Been telling you know,
59:59all sides of of these stories
01:00:01and and things like that.
01:00:03And to me sometimes these kinds
01:00:07of conversations feel a little
01:00:09bit like a distraction because.
01:00:14People don't tend to go to statues
01:00:19to learn history. You know?
01:00:23Oftentimes we walk by statues.
01:00:25They're not really thinking about them.
01:00:27They stand as a kind of memorial that's
01:00:31put in place by people that want to
01:00:35memorialize something specifically.
01:00:37And so the idea of just having
01:00:39more and more statues populating,
01:00:41populating our world,
01:00:43maybe that maybe that would
01:00:45do some of the work towards.
01:00:48You know,
01:00:48having black people be able to
01:00:51claim certain amounts of space and
01:00:53place in you know in in in our
01:00:56you know in our neighborhoods,
01:00:57in our city centers and and
01:00:59you know those kinds of things.
01:01:04Honestly, I really don't know.
01:01:08Because I think that.
01:01:11You know Brian Stevenson,
01:01:14who's just amazing.
01:01:16You know he talks about brick the
01:01:19the Confederate statues in Alabama.
01:01:22You know that black people should not have
01:01:24to look at these Confederate statues.
01:01:27You know of Alabama, these kids in
01:01:29Alabama shouldn't have to go into a,
01:01:30you know, schools named for
01:01:32Confederate Confederate Generals.
01:01:33And I agree with all of that.
01:01:36The amount of trauma and the sort
01:01:38of never being able to sort of free
01:01:42yourself spatially, geographically,
01:01:43from from those kinds of histories,
01:01:47I think, is really is is really devastating.
01:01:51It can be so demoralizing.
01:01:52For people and so I you know I I would
01:01:58love for there to be spaces where
01:02:01you know we do focus on like the
01:02:04history we really want to be proud of.
01:02:07And justice,
01:02:09and have those begin to populate our
01:02:13our our spaces that if a child is walking by,
01:02:17you know, and they see a statue
01:02:20of of Someone Like You know,
01:02:22Harriet Tubman.
01:02:23That it's an opportunity to learn
01:02:26about something like the Underground
01:02:29Railroad that we begin to to have
01:02:32statues to people that that we
01:02:34that we want to be proud of, yes.
01:02:38But I also you know I I wonder
01:02:40about like the role of the public
01:02:43square versus the role of museums
01:02:45and the role that museums should
01:02:47have in actually telling history and
01:02:50and and and and doing that work.
01:02:53And so so, you know,
01:02:54I'm a little so I guess you know,
01:02:57not answering this question very well.
01:03:00You know,
01:03:01I'm a little bit at cross purposes
01:03:03within myself in terms of what's
01:03:05the role of the public square
01:03:06and the harm that you know.
01:03:08Those public spaces can have on individuals.
01:03:12And then what are the limits of the
01:03:15public square as opposed to sort of a
01:03:18museum that really works to to to tell this?
01:03:21To tell this history and so yeah,
01:03:24I'm I'm.
01:03:25I'm definitely on the on the fence
01:03:28there and and would love to.
01:03:31Have more insight from others about this.
01:03:36Doctor Roberts, it seems like there
01:03:37might be a few more questions in Kieran
01:03:40O'Donnell is able to stay on and and
01:03:42with others if they have other questions.
01:03:44Thank you so much again.
01:03:45I look forward to your next talk
01:03:48in May and I you've given all of
01:03:51us so much to think about it.
01:03:52Most importantly,
01:03:53the importance of understanding
01:03:55history to be able to make
01:03:58important decisions about how we
01:04:00operate now and to really think
01:04:03about the importance of building.
01:04:05Cost and undoing the systems that exist.
01:04:09So thank you so very much.
01:04:11I must run,
01:04:11but I look forward to seeing you and
01:04:13Kieran thank you for staying on for
01:04:15whomever might have other questions.
01:04:17And Uttara thank you again, Doctor, Roberts.
01:04:20And so if anyone would like to
01:04:21stay on for a few more moments,
01:04:23we'll take any additional questions.
01:04:25Doctor Robertson, if that's OK with you,
01:04:27if you do have a few more moments
01:04:30with us and Robert Liberal.
01:04:32Thank you, thank you Doctor Roberts
01:04:35for your scholarship. Thank you.
01:04:36I I definitely feel like it.
01:04:38It's it's within the tradition
01:04:40of Harriet Washington
01:04:41Todd solving and and and others.
01:04:43And you you push the conversation forward
01:04:47and when we speaking about history in order
01:04:49to push the conversation forward,
01:04:51we have to look back. And you did a
01:04:53great job in looking back and I want
01:04:56and I was curious to know,
01:04:58have you or do you intend to
01:05:01look back at Yale's possible?
01:05:03Diabolical history when it comes to to,
01:05:06you know, racism and discrimination
01:05:08against people of color, and if so,
01:05:10and I know that you have some
01:05:11theological background. What would
01:05:13be the atonement for
01:05:15these institutions and these people?
01:05:18Thank you so much for that question,
01:05:21it's very timely you asking it because
01:05:24right now there is an initiative that's
01:05:27been going on that's come through President
01:05:30Salovey to look at Yale and slavery so
01:05:35that work was going on for the previous
01:05:38academic year and they're beginning to
01:05:40write it up and and to think about it.
01:05:44It is a as you rightly said,
01:05:47it is a diabolical history.
01:05:49It's a disturbing history.
01:05:51They look at not just slavery and and the
01:05:54relationship of the university to slavery,
01:05:57but also to the sort of
01:05:59the aftermath of slavery,
01:06:01the the support of the Confederacy,
01:06:04the the Jim Crow and and,
01:06:08and all the different mechanisms that were
01:06:11in place to sort of shore up and do that.
01:06:14The kind of reunion work of
01:06:17bringing North and South.
01:06:19Together at the expense of at
01:06:21the expense of of black people
01:06:24of their lives and experiences.
01:06:27Yale Medical School is beginning is going
01:06:29to begin in the coming academic year.
01:06:33Their own investigation from the
01:06:35perspective of the medical school,
01:06:37its relationship to to these issues as well.
01:06:44One of the things that the students
01:06:46that the the grad students and
01:06:47undergraduates that worked on
01:06:49the Ellen Slavery Project did,
01:06:50which was very important,
01:06:52I think for the medical school
01:06:54campus and the school public health.
01:06:56And for also the Child Study Center.
01:06:59Has to do with the the role of eugenics.
01:07:04Yale was the home for the American
01:07:07Eugenic Association.
01:07:08Many of the professors were in
01:07:11support of eugenics and helping
01:07:13to develop the eugenics science.
01:07:15And some of those individuals were part of,
01:07:19you know,
01:07:20early iterations of the medical school.
01:07:22The Child Study Center and and other places.
01:07:25And so there there it does.
01:07:28Hit close to home.
01:07:30And what does atonement look like?
01:07:33What does atonement look like?
01:07:36The some of the efforts have involved,
01:07:40you know, the Black,
01:07:41Black, New Haven you know,
01:07:45and and I think that to think
01:07:47about what atonement looks like,
01:07:49we do need to be in more conversations
01:07:52with with the New Haven community.
01:07:54One of the things that President
01:07:56Salve has done is part of Yale's
01:07:59atonement is has to do with paying
01:08:02taxes on real estate and and other
01:08:05initiatives like that sort of putting
01:08:08some financial heft behind it.
01:08:11I mean,
01:08:12it's it's hard to talk about financial
01:08:13health when you have such a large endowment,
01:08:15but you know,
01:08:17so.
01:08:17So those things are are underway
01:08:19at the moment.
01:08:23Doctor Robert, I think Howard just one
01:08:27moment to be Kerry Coughlin from Viola.
01:08:29Bernard Foundation has a has
01:08:30question for Doctor Roberts.
01:08:33It's more of a statement.
01:08:35First Viola Bernard foundation.
01:08:40We are so privileged to have Linda
01:08:43Mays the Child Study Center.
01:08:45And people like Doctor
01:08:47Roberts do the heavy lifting.
01:08:49This has been an important statement.
01:08:52We want to help disseminate
01:08:54just your message.
01:08:56Doctor Roberts. I look
01:08:57forward to the May 17th second session,
01:09:00but I thank everybody in the
01:09:03Community for allowing us to help
01:09:06you get the message
01:09:07out. It's been a very
01:09:09special one hour, so I thank
01:09:11you. Thank you. So much.
01:09:14This one where just I first of all thank
01:09:18you very much for a wonderful presentation.
01:09:20It's very moving to me and it's it's
01:09:23really in keeping with where we should
01:09:26be because this is a move in our country
01:09:29obviously about critical race theory
01:09:31where we're not supposed to look at
01:09:33things and it's only when you look at
01:09:36what's there historically that you can
01:09:38learn and grow and take responsibility.
01:09:40And the other thing is,
01:09:42I noticed that Harvard has just.
01:09:46As somebody might have mentioned,
01:09:47this A has given $100 million to look at
01:09:53and to try to rectify as much as they can.
01:09:57Their own participation in this in.
01:10:02This dark side of our history and
01:10:05I think that that's something
01:10:07that might be considered.
01:10:10In this university as well,
01:10:11because it can create.
01:10:16Entities for understanding this,
01:10:17and there's just the third thing,
01:10:20is that it's not either or
01:10:22that the statues are there.
01:10:24What's what's necessary is it's is
01:10:28both is the all the monuments are fine,
01:10:32but what they mean and the teaching and
01:10:34I'm reminded of the 60s where we get
01:10:37teachings and to and if it's comes from us,
01:10:42it has to come from us
01:10:44because and the teaching.
01:10:45Not from us, so it's not either
01:10:47or I want to thank you again.
01:10:50So welcome, thank you. We
01:10:53haven't the questions keep rolling
01:10:55in for you, Doctor, Roberts,
01:10:56and Belinda, I believe you have
01:10:58a question for Doctor Roberts.
01:11:00Can you hear me? Yes?
01:11:02OK, so I'm on the machine I forgot
01:11:04my iPad so I'm not on camera.
01:11:06Doctor Roberts thank you.
01:11:08The session was very
01:11:10triggering at the same time,
01:11:11but we've been talking about
01:11:13a lot of race relations and
01:11:14so forth in the city center.
01:11:15So we very much needed one thing I
01:11:18realized is I'm a New Haven and native.
01:11:214th generation and and the
01:11:23relationship between Yale and New
01:11:25Haven is very sporadic at times,
01:11:28and so I keep saying that we have
01:11:30to do that like you're literally
01:11:31smacked at in the middle of so.
01:11:33I grew up in the hill I'm
01:11:35if you're familiar with so.
01:11:36Howard Ave, Liberty,
01:11:37so we're smacked it in the
01:11:39middle of the hill,
01:11:40but our relationship is not as it should be,
01:11:42and we've been having these conversations,
01:11:44so I'm hoping that's going to change.
01:11:47At one point,
01:11:48like if you reach out to the
01:11:49leaders within the community,
01:11:51they have a very different
01:11:52concept of what you're look.
01:11:53And particularly,
01:11:54you mentioned like 3 or 4 generations ago.
01:11:56The baby boomers people still
01:11:58remember how they were treated.
01:12:00The childhood.
01:12:01So for example,
01:12:02I realized because I've worked
01:12:04at year for 30 something years.
01:12:07My health care is different,
01:12:09even though I struggle than someone
01:12:11from off the street because I,
01:12:12you know, I'm asking the Health Center,
01:12:15so we get treated differently,
01:12:17but if I was a black woman off the
01:12:18off the street or through a clinic,
01:12:20it's a very different concept,
01:12:23and so I just finished my masters
01:12:26as a therapist.
01:12:27Now larger family therapy and so of
01:12:29course I've had different types of clients.
01:12:32And so understanding that I
01:12:33look at the cult from the rates
01:12:34and understanding that there
01:12:36are some disparities.
01:12:36I have literally been on the line as
01:12:39we walk the client through to the ER.
01:12:42It's not hearing well,
01:12:44she's suicide ideation,
01:12:45which is not the case, and so we.
01:12:47We've got a lot of work to do.
01:12:49I appreciate you so much for taking this on.
01:12:51So thank you so much for your
01:12:53for your important comments.
01:12:55I I really do appreciate that.
01:12:58Yeah, and congratulations on your degree.
01:13:01It's wonderful. You're much needed.
01:13:04They need to see someone that looks
01:13:05like them that was, that is been
01:13:07my philosophy of this entire time.
01:13:10Yes indeed.
01:13:15Final questions for Doctor Roberts.
01:13:22Doctor Roberts, I think you can
01:13:24see why it's so important that we
01:13:26have you coming back for another
01:13:27session that was deeply moving.
01:13:29It was an important education and
01:13:31I just want to thank you once
01:13:33again for really a tree memorable
01:13:35around brands. Thank you.
01:13:37Thank you so much. It was
01:13:39wonderful to be with you today.
01:13:40Thank you all so much.