3-23-23 Urban Academic Medical Centers and Their Neighbors

March 31, 2023

Information

3/23/2023

Cohen Auditorium and Zoom

Urban Academic Medical Centers and Their Neighbors: Then, Now, Next -- A Roundtable Discussion

Merlin Chowkwanyun, PhD, MPH

Author, All Health Politics is Local: Battles for Community Health in the Mid-Century United States

Benjamin Howell, MD, MPH, MHS

Assistant Professor of Medicine (General Medicine), Yale School of Medicine

Panelists

Mark T. Silvestri, MD, MHS

Virginia Spell

Katherine Tucker, DNP, RN, APRN-BC

ID9789

To CiteDCA Citation Guide

00:00Okay, hey, everybody.
00:02Hello people on zoom.
00:04Hello people here live.
00:06My name is Anna Reisman.
00:08I am the director of the Program
00:10for Humanities and Medicine and
00:11very glad to be here with you today
00:13for this talk on urban academical
00:15medical centers and their neighbors,
00:18I we have Merlin Chowkunyan,
00:21who is our keynote speaker.
00:23We also have moderator Ben Howell,
00:25and we have three wonderful panelists,
00:27and I will introduce all of them.
00:30Which will take me a few minutes.
00:31So but before I do that,
00:33I just want to say that Ben Howell is
00:36really the person who is behind this,
00:39this whole event.
00:40He will tell you about his
00:43longstanding friendship with Merlin,
00:46although they're just seeing each other
00:47today for the first time in a long time.
00:50But he approached me a couple months
00:52or probably six months ago and
00:54said can we bring Merlin in and.
00:57And can we put together a panel so it all,
00:59it all came together?
01:00Thanks to Ben. So thank you, okay.
01:04So Merlin Chakonyan is the Donald
01:06Jemsen professor of socio Medical
01:08Sciences at Columbia University.
01:11He trained in Columbia for
01:13his bachelor's degree,
01:14received an MPH from University
01:16of Pennsylvania and APHD,
01:18also from University of Pennsylvania.
01:20He's the author of all health politics
01:22is local community battles for
01:24medical care and environmental health.
01:27And is currently working on a book called
01:29Who Dies to be published by Norton,
01:31which reassesses how to think about
01:33the social determinants of health.
01:35He's also the Pi on toxic docs.org,
01:39a NSF funded repository that uses
01:42novel data science methods to make
01:44available millions of once secret
01:46documents on industrial poisons,
01:48and is currently serving on an
01:50expert advisory committee for
01:52the CDC on structural racism.
01:54So welcome,
01:56Merlin.
01:56Moderator Ben Howell is an assistant
01:58professor of medicine and the Yale
02:00School of Medicine with faculty
02:02appointments in the Sesh Center
02:03for Health and Justice in the
02:05program and Addiction Medicine.
02:07He received his medical degree
02:09from the University of California,
02:10San Francisco and an MPH from UC Berkeley.
02:14He completed residency and chief
02:16residency in the Internal Medicine
02:18primary care residency here
02:19at Yale New Haven Hospital,
02:21and following residency,
02:22he completed a health services research
02:24postdoc in the Yale School of Medicines.
02:26National Clinician Scholars Program,
02:28which is well represented here today.
02:31Clinically,
02:31Dr.
02:31Howell practices as a general
02:33internist both in the hospital and in
02:35outpatient settings with a focus on
02:36the treatment of substance use disorders.
02:40His research focus focuses on improving
02:42the health outcomes of individuals,
02:44families and communities impacted by
02:47mass incarceration and our panelists.
02:49So first, I will introduce Catherine Tucker.
02:53Who is the clinical program
02:55director for Heart and Vascular
02:57Center outpatient programs at
02:58Yale New Haven Hospital and the
03:00immediate past president of Southern
03:02Connecticut Black Nurses Association.
03:04She serves as the Yale New Haven
03:06Hospital DEI chair and the
03:08liaison to the Yale New Haven.
03:10Hospital president Doctor Keith Churchwell.
03:12She is currently the chair of the
03:14Target Blood pressure program and
03:16Barbershop initiative in New Haven,
03:17a collaboration with a heart and Vascular
03:20Center and the American Heart Association.
03:22Kathy leads A-Team,
03:23who works to educate communities
03:25affected by various health
03:26conditions like high blood pressure,
03:28diabetes and obesity by providing steps
03:30to improve health and quality of life.
03:33And Kathy received her bachelor's
03:36and master Science of Nursing from
03:38Quinnipiac and her doctorate of Nursing
03:41practice from Sacred Heart University.
03:43She is also a native of West Haven and
03:46currently serving as the Councilwoman
03:47for West Haven's 7th district.
03:49Welcome, Kathy doctor.
03:52Mark Silvestri is chief medical
03:54officer at Cornell Scott Hill Center
03:56Hill Health Center and assistant
03:58clinical professor in the division
04:00of Gynical Logic Specialties.
04:02At the Yale School of Medicine
04:04Department of OBGYN,
04:05doctor Silvestri originally came to
04:07Yale for his residency training and
04:09has stayed in New Haven ever since.
04:11He was also a postdoctoral fellow in the
04:13RWJ Foundation Clinical Scholars Program.
04:16He served as an administrative fellow
04:18with leadership of Yale New Haven
04:20Hospital and then joined the medical
04:22leadership of Cornell Scott Hill,
04:24a large,
04:25multisate,
04:25multispecialty community health
04:27system serving low income individuals
04:29across greater New Haven.
04:31And our final panelist is Virginia spell,
04:35who is currently the acting
04:36President and CEO of the Urban
04:38League of Southern Connecticut.
04:40With more than 25 years
04:42of nonprofit management,
04:43misses spell is focused on economic
04:46empowerment activities for
04:47individuals and families living in
04:49Fairfield and New Haven counties.
04:51Virginia spill is a longtime resident
04:53of New Haven and has worked on the
04:55community level to address racial
04:56inequity and racial segregation and housing,
04:58employment, and healthcare.
04:59She currently serves as president
05:01of the West River Neighborhood
05:04Services Corporation,
05:05shares the West River Neighborhood
05:07Revitalization Zone Committee,
05:08and is the chair of the Board of
05:10Directors for Continuum of Care.
05:12She also serves as a stakeholder in the
05:14Route 34 Corridor redevelopment project.
05:16Sispel is also an active member of the
05:19West River Community Resilience team.
05:21She's also a Co Pi on a multilevel
05:24multicomponent intervention,
05:25true Haven trusted residents and
05:27housing assistance to decrease
05:30violence exposure in New Haven.
05:32Welcome,
05:32Virginia.
05:35And I didn't say welcome Mark after
05:37I read yours, so welcome Mark.
05:41So the way this is going to
05:43work is I'm going to turn things
05:44over to Ben who will moderate.
05:46He will introduce Merlin briefly
05:49and and then we will hear from
05:52Merlin for about 2025 minutes and
05:53then our panelists will come up and
05:55Ben will moderate the discussion.
05:57We have a SL available for those
05:59people who need interpretation
06:01and closed captioning as well.
06:03And we should have plenty of time
06:06for your questions and comments.
06:08After we are done,
06:09so welcome everybody.
06:10Thank you for being here
06:16and I will keep my comments brief and so we
06:18can get to the the content of the evening.
06:20But as and I said I'm Ben Howell,
06:21I'm very excited that we were able to
06:24invite Merlin here to give his talk.
06:27As Anna hinted, when Merlin and I went
06:29to to college together at at Columbia,
06:31I should include that in my bio to to
06:32make sure there's actually a couple
06:34Columbia lions here in the audience.
06:36So we are well represented.
06:39We were both DJ's at the college radio
06:41station so there's a relationship that is
06:44spanned over over 20 years, but no one.
06:47Merlin published his book All
06:49Health Politics is local.
06:50I picked it up and a lot of the stories.
06:53Really resonated with it.
06:55My experience here in New Haven and
06:58with the role Yale New Haven has
07:00in the community here in probably
07:02many of the the tensions that have
07:04between the Community and the academic
07:06medical senator over the years,
07:08it seemed like a fertile opportunity
07:11to prompt a discussion for us today.
07:14So I'm really glad that we were able to
07:15get great panelists who represent many,
07:17many years.
07:18Of of work and and living here
07:20in the community of New Haven to
07:23help foster this discussion.
07:24Without further ado,
07:26I will see the podium to Merlin.
07:38Hi everyone, it's great to be here.
07:40I actually did a lot of research
07:42at Yale at the Sterling Library.
07:45I don't know where it is in
07:46relation to where we are,
07:47but I did a lot of research there and.
07:51I haven't been back to
07:51campus in a while though,
07:52so it's great to be here.
07:55I first want to say I'm just very
07:57appreciative of a lot of the labor that
07:59it takes to put on stuff like this.
08:01So I want to thank you again,
08:03Anna for running the series,
08:05Karen Cole back there for doing
08:07a lot of love behind the scenes
08:09scheduling and logistics,
08:10and of course Ben,
08:11the moderator and as he mentioned,
08:13occasional collaborator and as you also
08:16mentioned a guy I've known for 15 plus years.
08:20You probably don't remember this.
08:21In fact,
08:22I'm 100% certain you don't remember this.
08:24But you remember this part.
08:25So after college you worked for
08:28this dear and departed video
08:31store called Kim's Mondo Video.
08:33Other than days when people still
08:37rented DVD's and videos and stuff.
08:38And I remember one time,
08:40so I was still a little younger than that.
08:42I was still in college.
08:42I remember one time I really
08:45wanted to rent Titanic.
08:46Because I like Titanic,
08:47I sucker for romance and the
08:49kinds of emotions it starts out
08:51I really want to rent Titanic.
08:53And Ben was at the desk and you know,
08:56I knew he was a man of avant-garde,
08:59musical and aesthetic taste.
09:01So I really worried that he would
09:03make fun of me for renting Titanic.
09:05And so I actually thought about
09:07returning the movie on the shelf
09:09and coming back later time.
09:11But I decided not to do it,
09:12just went rented it and Ben
09:14did not make fun of me.
09:16Because he's a stand up great guy,
09:19and he still is, I'm glad to know.
09:23I'm also very humbled to be
09:25present with my Co panelists.
09:27I actually don't know a lot
09:29about New Haven history.
09:30One of the arguments of my book
09:32is that it's very important to
09:35learn about us locally specific
09:37characteristics of very specific places.
09:39And so I only know about New
09:41Haven in the broadest sketches.
09:43And so figuring out how the academic
09:45Medical Center as an institution has fun,
09:48how it's functioned here
09:49for better and for worse,
09:51is something I'm very much looking
09:54forward to dialoguing with you 3 today.
09:57So I'm very honored to be speaking with you.
10:01But Ben and mentioned that I've written
10:03this book and so I'll sketch out in 20
10:05minutes or so some of the things in
10:06this book that pertain to this larger
10:08conversation we're going to have today.
10:11Now this sounds like very crass marketing
10:14on one level and it certainly is,
10:17but on another level it isn't.
10:19I always say whenever I talk about this
10:22book that all the proceeds of this book,
10:24whether they're from book purchases
10:26or from talks I give about it.
10:29They go to my friend and comrade
10:32Sarah Nelson's labor union.
10:34President Nelson leads the
10:37Association for Flight attendants.
10:39This is the flight attendants union,
10:42and specifically my proceeds go to
10:44a Union Relief Fund that it runs
10:47for flight attendants who have been
10:49displaced by extreme weather events,
10:51many of which occur near airline hubs
10:54where a lot of flight attendants live.
10:57President Nelson is somebody who has
11:00been fighting for a vision of Labor
11:02organizing that sticks up for workers
11:04and better wages and contracts,
11:07of course,
11:07but it also focuses also on the
11:10larger communities and societies
11:12those workers live in.
11:14And that also includes sticking
11:16up for people.
11:17That is most of us who are not
11:20in unions as well.
11:21And it's really a model of,
11:22I think, ambitious,
11:24crosscutting political organizing
11:26that we really need right now.
11:28So I like to just mention President
11:31Nelson at the start of every talk,
11:33all right?
11:34Now,
11:34some of you might sense this title
11:37is actually a shameless rip off of
11:40former House Speaker Tip O'Neill and
11:43his famous quip that all politics is local.
11:46So if you're around in the 1980s,
11:49you know that Tip O'Neill was kind
11:51of the Nancy Pelosi of his time.
11:54He was also a very astute analyst
11:57of American politics,
11:58and when I was struggling with
12:00how to mold some of my material,
12:02I thought about O'Neill and something
12:04just really clicked by his famous line,
12:07all politics is local.
12:10O'Neill meant that the big swings
12:13in American life,
12:14whether it's changes in views
12:16on civil rights.
12:18Voter and political party realignments,
12:20even stuff like opposition to abortion,
12:23all those things.
12:24They don't fundamentally start with
12:26the Federal Congress or the Federal
12:29Supreme Court or national elections.
12:31They happen rather at the
12:33block and neighborhood level,
12:35and then they tend to bubble up.
12:37So if you really want to
12:39understand what's going on
12:40politically, you shouldn't just
12:41be looking at the national level,
12:43however important it is.
12:45You need to also zoom in and get granular.
12:49And so I took O'neal's insight
12:51and I slapped one word on it and
12:53I had a book title and framework.
12:56Now, his insight struck me as making
12:58a lot of particular sense for health.
13:00So most public health research
13:02of the kind that I do,
13:04and my colleagues as well,
13:05we prize this thing called generalizability.
13:09What we want to do is generate principles
13:12and elucidate causal relationships that
13:14are as universally applicable as possible.
13:18And so in public health work,
13:19you'll often get findings that say,
13:21X or Y variable affects Z health outcome.
13:25That's.
13:26Extremely useful information,
13:28for sure.
13:29But that quest for generalizability
13:32can also sometimes bleed out the local
13:35and specific context in which the
13:38people being studied are embedded.
13:41The people of New York, of Los Angeles,
13:44of Rochester, of Cleveland, and of New Haven.
13:48And yet that contextual stuff, I think,
13:51and Tip O'Neill certainly thought.
13:54Was and is hugely important.
13:57They're just often isn't a strong
13:59sense of specific setting or a sense
14:01of specific place in a lot of health
14:04policy discussion and public health work.
14:07And so I really wanted to restore
14:09that element here.
14:10I wanted to reinject local social topography.
14:14I want you, in other words,
14:16to see health policy not just as
14:20this unmoored statistical aggregate.
14:22Or just a national story like this,
14:24but I also want you to look at it like that.
14:29Okay.
14:29So I'm going to proceed now to three
14:32anchoring themes that I think will
14:34help us understand this historical
14:36role of the academic Medical Center in
14:39urban areas. And these are the themes.
14:41The first is affiliation or how
14:45academic medical centers increasingly
14:47become bound up with hospitals.
14:49And they're almost kind of unavoidable
14:51if you're in a city like this one
14:53or New York or Los Angeles or,
14:55you know, name your city.
14:57How did this affiliation process between
15:00academic medical centers and medical
15:02institutions like hospitals occur?
15:05Affiliation the second is community
15:07or how in the face of an institution
15:11like the Academic Medical Center?
15:13Academic medical centers have
15:15sometimes sought to bolster and
15:18include nonprofessional non physician
15:20voices of those who live around them,
15:23the community voice community,
15:25and the third is borders.
15:28So this is about the spoken but also
15:32sometimes unspoken boundaries that
15:34divide academic medical centers
15:36and those who live by them.
15:39And how that very tense and taught
15:42relationship has been negotiated over time.
15:45Now,
15:46before I head into the cases,
15:47I do want to say that there is sometimes
15:50a danger of drawing too tidy and neat
15:53of a parallel to a historical event.
15:56So a lot of the stories I'm
15:57going to tell you may remind you
15:59of something in the present,
16:01and I think that's useful.
16:02But I also think it's part of our goal.
16:04And This is why I'm really
16:05looking forward to our
16:06discussion. It's part of our goal also to
16:09figure out what's different and dare I say,
16:11also what has perhaps improved in the 40
16:15years hence stories I'm going to tell
16:17are all kind of in the 1960s and 1970s.
16:21All right. So with that note,
16:22let me start first with
16:24affiliation in New York City,
16:26where I just came from last night.
16:28So I want to take you back to 1961.
16:31I want you to just imagine you're
16:33regularly reading like the metro
16:35section of some New York City paper.
16:37So New York at the time and still
16:39now actually has the largest network
16:42of public hospitals in the country.
16:44Then it was around 20 hospitals,
16:46now it's about a dozen or so.
16:48But they were pretty beleaguered
16:50by the 1960s.
16:51And so if you were reading your
16:53newspaper on kind of a daily basis,
16:55you would encounter these hospital
16:56horror stories, dilapidated buildings
16:58that were falling apart,
17:01trouble staffing hospitals,
17:03difficulty attracting residents,
17:05you name it.
17:06This was a kind of a regular story
17:08in the late 1950s, early 1960s,
17:10about hospitals in New York City.
17:13And so the city did.
17:14What cities normally do
17:15and a thing like this,
17:16they convened a crisis panel and they
17:18said what are we going to do about this?
17:20And their solution to this was
17:22a kind of shock therapy.
17:24What they were going to do was they were
17:26going to take all of these public hospitals,
17:28almost all of which were purely public,
17:31city run, government run,
17:33government funded institutions and
17:35they were going to affiliate them
17:38with an academic Medical Center.
17:40The Columbia's, the Cornell's,
17:42the Mount Sinai's,
17:44the Montefiore's,
17:45you know, you name it.
17:46So it's essentially a subcontracting
17:49relationship whereby the academic
17:51Medical Center would get paid by
17:54the city to oversee everything from
17:57residency programs to staffing decisions
17:59to even infrastructural upkeep of
18:02buildings and stuff like that.
18:04And you see from this list here,
18:05this is from 1965,
18:07pretty much all of the public
18:09hospitals within a few years and all
18:12the fancy institutions got affiliated
18:14and coupled with one another.
18:17There's no need to read all of
18:18these individually,
18:19but the list just kind of conveys
18:22just how rapid and comprehensive
18:24affiliation was in New York.
18:27Now, as you can imagine,
18:28this probably did not sit well.
18:30This did not sit well with the
18:33previously autonomous public hospitals
18:35who really saw this as an incursion,
18:38a disruption of their autonomy on
18:41their longstanding ties that they had
18:44developed with their communities.
18:46So just to take one example,
18:48at City Hospital in Elmhurst in Queens.
18:51A group of advocates warned quote
18:54your family doctor can no longer
18:56be connected with your hospital.
18:58Your doctor may not be able to continue
19:01to maintain high standards of excellence.
19:04The kind of implication here being
19:06that Mount Sinai was going to come
19:08in and disrupt a number of people's
19:10patient doctor relationships,
19:12affiliations in many people's eyes
19:15also were really about something
19:17else. So just to continue
19:19reading off of that pamphlet.
19:20The conversion of public hospitals to
19:23affiliated facilities would result in,
19:25quote, a vast laboratory stressing
19:28research and teaching with its ward
19:32patients or and without influence
19:34serving as potential Guinea pigs.
19:37These were real fears.
19:38And I'm just sticking with this hospital
19:41in Queens just a little bit more.
19:43The County Physicians Guild also weighed in,
19:46and they characterized affiliation as,
19:48quote, forced absolutism.
19:50So those were all the claims about
19:54the possible horrors of affiliation,
19:58and some of them became true.
20:01So throughout the mid 1960s,
20:02we kept reading that newspaper.
20:04You would see that the newspaper started
20:07moving from covering the bad state of
20:10hospitals just in general to scandals
20:12around this affiliation program.
20:15It turned out that many of these
20:17academic medical centers were
20:19pocketing the government money and
20:21actually using it for other purposes
20:24besides running the public hospital.
20:26And even more scandalous,
20:28they were moving their least
20:30renumerative revenue generating patients,
20:32the ones that weren't making
20:34them a lot of money from bills,
20:35they were kind of moving them
20:37into the public hospital.
20:38So this is basically what
20:40we now call patient dumping.
20:42So the critique of affiliation
20:45starts to mount by 1968.
20:47There's one radical health advocacy
20:50organization that characterizes the
20:53affiliation program as exploitative and
20:56metaphorically it labels it a health empire.
21:00So the public hospitals,
21:01which are often utilized by poor
21:03patients of color, they are the colonies,
21:06and the private academic medical
21:08centers are the leeches,
21:10the colonizers.
21:10And this analysis was actually later
21:13expanded into a book that was published by
21:16Random House called American Health Empire.
21:19This was coedited by a health activist
21:23and writer at the time of someone
21:26by the name of Barbara Ahrenright,
21:29who plunged later into obscurity.
21:32So by the 1960s,
21:34with all of this, you know,
21:35this kind of mounting fatigue,
21:37newspaper exposes, etcetera,
21:38it was actually not very clear at all if
21:43affiliation would actually even survive.
21:45But affiliation,
21:46as we know, did survive,
21:48very much so.
21:49And that was because of a very new
21:52fiscal context that emerged in the mid
21:541970s rather suddenly when the entire
21:58country found itself mired in recession.
22:01And when cities like New York
22:03City were hit especially hard.
22:05So New York City almost famously
22:08defaulted on its debt in 1975.
22:11You see this famous headline
22:12here where the federal government
22:14refused to bail out New York City.
22:17And that plunges New York City
22:19into a very new and very jarring.
22:22Fiscal climate,
22:23kind of an austerity climate
22:25where budgets get very, very,
22:26very tight,
22:27budgets get slashed,
22:29and it was really hard for
22:31public hospitals to get along by
22:33themselves in a selfsufficient,
22:35independent manner with a city
22:37that is functioning under this
22:40kind of austerity sort of climate.
22:43Public hospitals, in short,
22:44were no longer in a fiscal position
22:47to sustain themselves without the
22:50resources that an affiliation provided.
22:53And so the fiscal climate of the
22:551970s, I think, is the central explanation
22:58for the ubiquity of affiliation today,
23:01and also the structural dependence
23:04that most public hospitals have
23:06in some way or the other on
23:09academic medical centers in cities.
23:11Definitely in New York,
23:12but also other cities as well.
23:15So, you know, whereas it looked rather
23:18uncertain in 1968 or 1969 about
23:21whether affiliation would survive,
23:23by the late 1970s,
23:25it's actually very hard to see any
23:28other means of sustaining public
23:30hospitals besides affiliation.
23:32And I still think that's the case today.
23:36There are very few health services
23:38now that are purely public that don't
23:40have some kind of contact with either
23:43an academic Medical Center or some
23:45kind of large healthcare network.
23:46And whether that's a good thing
23:48or a bad thing,
23:49I think is something for us to discuss now.
23:53I actually happen to think,
23:54and I was a little surprised
23:55to kind of conclude this,
23:57that I actually think New York City
23:59affiliation today works pretty well.
24:01There are more accountability mechanisms,
24:04more audits.
24:05Etcetera.
24:05To ensure that the sort of abuses I talk
24:09about don't don't happen at least as much.
24:12But we can talk about whether or not I'm
24:14being a little too optimistic there.
24:16Okay, let me move on to that
24:19second theme of community.
24:21I'm just going to admit I made a mistake.
24:22This should be in big letters.
24:23It should say community, but it doesn't.
24:26But in the 1960,
24:28there was this new agency called OEO.
24:31You know,
24:32Oreo without an ROEO,
24:34it's called the Office of Economic
24:36Opportunity during the Lyndon
24:38Johnson administration doled out
24:39tons of money to these really
24:41interesting Community level projects.
24:43It was actually run by Sergeant Shriver,
24:46the newscaster Maria Shriver's dad,
24:50and it had this rule called
24:53maximum feasible participation.
24:55So this basically was a mandate that said
24:58any community project that gets money.
25:01From these new OEO programs,
25:03if you get money,
25:05you have to have nonprofessional
25:07lay participation in how it's run,
25:10and usually this would be in the
25:12form of kind of a lay Community
25:14Board of some sort.
25:16But the big question, of course,
25:17is how much power do these lay
25:21boards really have?
25:22Now,
25:23what does maximum feasible
25:25participation actually mean?
25:27This is actually the exact words
25:29that were these are the exact words
25:31that were in the actual legislation.
25:33So in this book to explore this,
25:36I follow the trajectory of this
25:38community Health Center in the Watts
25:40neighborhood of South Central Los Angeles.
25:43Where most of Los Angeles's black
25:45population lived in the 1960s because
25:48of pervasive residential segregation
25:50and racism in the housing market,
25:52so the red shades here indicate that 90%
25:56or more of those census tracts are black,
26:00demographically.
26:01So this new watts center opens
26:04up here in 1967.
26:06That's a couple years,
26:07two years after the Watts riot of 1965.
26:11And it's a direct response to
26:14the huge resource deprivation
26:16that that Riot had exposed.
26:19And what this new center did
26:21was actually pretty ambitious.
26:22It was like $2,000,000 in $2,000,000 worth of
26:27money at at that level of currency valuation.
26:31It offered inpatient and outpatient services,
26:35and it opened to a lot of fanfare.
26:39But soon conflicts over governance
26:41overshadowed this kind of celebratory
26:44initial mood. One reason was
26:47that an academic Medical Center,
26:50the University of Southern California,
26:52the University of Southern California,
26:54or USC, was actually the one that was going
26:57to receive the OEO federal funds at the top,
27:01at the top for overseeing the project.
27:03So another thing about OEO was
27:05you usually had to funnel the
27:07money through some kind of inter.
27:09Intermediary middleman before it
27:10got down to the actual project,
27:13the Watts Health Center.
27:15So the intermediary here was USC.
27:18That produces no small amount of
27:22tension because in the past couple of
27:25decades USC have been rapidly expanding
27:27several miles directly north of Watts
27:30and bulldozing all kinds of houses,
27:33actual housing that stood in its way.
27:37There was this community organizer
27:39that I studied who was hired
27:41for this Watts health project.
27:42His name was Jim Bates,
27:44and for Jim Bates,
27:47USC's involvement aroused very
27:49justifiable suspicion.
27:51Jim Bates was a really fascinating guy.
27:53He was a black alumnus of USC.
27:55He had played football there a little bit,
27:57and then he went into community
27:59organizing and got hired by this project.
28:02And he wrote this memo where he
28:04summarized the sentiments and attitudes
28:07of watts residents rather bluntly,
28:09as follows.
28:10Quote we just don't want the
28:12University of Southern California
28:15in Watts under any circumstances.
28:18close quote,
28:20USC felt that suspicion right away.
28:23All three of the university's hand
28:25chosen administrators for this
28:27Watts Health Center were white.
28:29With the latter 2 assuming daytoday
28:31supervisor roles and you see
28:33them up there on the board chart.
28:35The other issue, though,
28:37wasn't just white administrators
28:39versus the mostly black neighborhood.
28:42And as the center's paid organizer,
28:44this guy, Jim Bates,
28:45also had a really thankless task.
28:48He had to form a mandated community
28:50Health Council.
28:51And it's highlighted over there
28:52and it says at the very top,
28:54neighborhood representation and cooperation.
28:56And he had to kind of build
28:59something to maximize that.
29:01But he really struggled from
29:02the outset to put it together.
29:05Now, Watts was mostly black,
29:07but that racial composition actually
29:09masked a lot of difference within watts.
29:13And this is actually a thing
29:14that I think isn't talked enough
29:16about both then and today.
29:18When we say Community,
29:19what do we mean by that?
29:21You know,
29:22what are the community's boundaries?
29:23Who is in it? Who is not in it?
29:25When we say Latinx Community,
29:27Asian community, black community,
29:29the community, you know who is in it.
29:31And when it comes to representation
29:33on a body like a community.
29:35The Navy Board who actually
29:36gets to sit on that body.
29:38And so that's what Bates was struggling
29:40with when he had to inform this,
29:42this Community Health Council.
29:44And what he ends up doing
29:46is he creates this really blunt tool.
29:48He's really exasperated over how to do this,
29:50but he creates this thing called
29:53a membership determining funnel.
29:55And it's basically a formula.
29:56It scores perspective Council
29:58members responses and interviews,
30:01and then he whittles them down
30:02by where they lived in watts,
30:04their age, their gender,
30:06how much education they had, etcetera.
30:08And he thought this was basically a crude
30:11but kind of ultimately necessary step
30:14towards creating an actual board that
30:16was at least somewhat representative.
30:19And I always take a look at this
30:21membership determining funnel thing,
30:23because it reminds me,
30:24actually of how hard it is to
30:27define and operationalize and
30:29implement something like community
30:31participation in real world practice.
30:33Here he was kind of trying to
30:35create as much variation and
30:38representativeness as possible.
30:40And to Bates and the center's credit.
30:43After these growing pains,
30:44this watts Health Center actually saw
30:47many decades of considerable success,
30:49and it also started to function
30:53eventually autonomously after USC
30:55phased itself out from the project,
30:57and it still exists today the center.
31:00I think one of the reasons for
31:02this was that there was this other
31:05fellow black physician named Rodney
31:07Powell who replaced some of those
31:09white USC physicians on the project.
31:12And he was somebody who I think
31:15really understood very sensitively
31:17the fraught dynamics and basically
31:19work to clarify how much power this
31:22Community council had and he basically
31:25proposed that it operate as a board of
31:27directors rather than get involved in
31:29every kind of little micro level decision.
31:32And I've always thought that Rodney
31:34Powell and that other fellow I
31:36was talking to about Jim Bates,
31:38they really exemplify too,
31:40just how important good interpersonal
31:43skills are when actually enacting
31:45something like community health or
31:47better relations between academic medical
31:50centers and projects like this one,
31:52and then the community at large.
31:54All right, my last case is about borders.
31:59So just imagine a black background
32:01and then it says borders.
32:03But I'll talk, you know,
32:05borders brings me to one of the
32:08less uplifting stories in my book.
32:10So I studied this area on the east
32:13side of Cleveland, which, like Watts,
32:16was also profoundly segregated and
32:19under resourced in the 1950s and 1960s.
32:22And I focused in particular
32:24on the Cleveland Clinic.
32:26So this is a map here that shows,
32:29yeah,
32:29the map here shows where the Cleveland
32:32Clinic is situated smack dab in the
32:34middle of this East Cleveland section.
32:36Now,
32:37I don't think I need to tell anybody here
32:40at a medical school that the Cleveland
32:42Clinic is not some quaint clinic.
32:45From the 1920s to the 1960s,
32:47the Cleveland Clinic developed
32:49into one of the most prestigious
32:51elite medical centers in the world.
32:542/3 of its clientele came from outside
32:58the county where Cleveland was located.
33:01And yet it was a profound contradiction
33:04because it was located in this
33:07neighborhood whose residents had pretty
33:09much no access to any of its fruits
33:13and. To add insult to injury,
33:16not only did the Cleveland Clinic
33:18not do anything for its low income
33:21African American neighbors,
33:22it also constantly expanded.
33:24So these are two aerial shots that I
33:27wanted to show you of the expansion
33:29over just a couple of decades.
33:31So on the left is the 1930s
33:32and on the right is the 1950s.
33:35And you can see on the left in the 1930s.
33:38There are homes there and then
33:41those homes are gone on the right.
33:44Side note, little side note,
33:46the Cleveland Clinic would actually
33:48not let me publish these in my book.
33:51And so I encourage you to take pictures
33:53of these and post them on Twitter,
33:56Instagram, TikTok, Reddit, Pinterest,
33:58and whatever else kids are using these days.
34:02This here is a map that kind of,
34:05you know, here, a little longer pose.
34:07All right.
34:09This here is a picture of a plan
34:12for a 30 block expansion where the
34:15Cleveland Clinic would have been
34:17the driving force behind this kind
34:20of new science and Medical Center.
34:22But as in Los Angeles,
34:24there was actually a riot in
34:26Cleveland in 1966,
34:28and that dramatically changed everything.
34:31The Cleveland Clinic executives
34:32actually really started to panic.
34:34They worried that people would actually
34:36come and torch the clinic next.
34:39They actually thought about picking up
34:41and just leaving Cleveland entirely.
34:43They pondered over whether or
34:45not they should set up their own
34:48private paramilitary force in case
34:50the National Guard was not enough.
34:52And they wondered,
34:54in their words whether they should start
34:56training what they called squad leaders.
34:59Who would be composed of men with
35:02previous combat experience and whether
35:04or not these men should be issued
35:06what they called ultimate weapons,
35:08which would be include firearms,
35:11pistols and rifles.
35:12For anyone who managed to enter a
35:16clinic building this kind of fear,
35:19the depth of this fear,
35:20a very racialized, very racist fear.
35:24I think really reflected widespread
35:27acknowledgement about medical
35:28exclusion in this neighborhood,
35:30not just among those who were excluded,
35:33but also among the excluders.
35:37And it actually ended up forcing
35:39the clinic to make a concession.
35:41So what it did was it promised it
35:43was going to build a primary care
35:46clinic on this east side of Cleveland.
35:49But the facility actually didn't
35:51get finished until the mid 1970s,
35:53almost a decade later.
35:55And for me,
35:56that clinic was always kind of 1/2 victory.
36:00By the mid 1970s, a lot of the energy,
36:02the political energy that had
36:04been unleashed by the riot kind
36:07of had disappeared.
36:08And so the clinic was actually
36:10back to its old tricks by the
36:121980s and once again expanding.
36:15And when it came to actual resources,
36:18the Cleveland Clinic really kicked
36:19in a pretty modest sum of money.
36:21It was about $200,000 for two years,
36:25but it was actually the county,
36:27the government,
36:28that ended up putting in most of
36:30the work and the money for this.
36:33You know,
36:34often times when an academic
36:35Medical Center is
36:36put on the defensive in a heated moment,
36:38it'll make all these kinds of lofty promises.
36:42But then when the moment is over,
36:44the commitments are often much more muted
36:47and modest than what they initially were.
36:50And so when you look at the picture
36:52of the clinic today, you know,
36:54it may have some more modest
36:56things that it does to reach out
36:58to its neighborhoods, neighbors.
36:59But the question I think still
37:02remains is this still an island
37:05in a sea of deprivation with a
37:08just a few nodes of contact?
37:10I think when many people think of
37:13an elite academic Medical Center
37:16with strained community ties,
37:18they tend to think of stuff like this
37:21stuff similar to what I've recounted
37:24here with the Cleveland Clinic.
37:26Let me close by reflecting in
37:27just my final couple of minutes,
37:29and I'm really looking forward to
37:31talking with everybody on just kind
37:33of what do we take away from this?
37:35Well, first,
37:36the experiences that I've described today.
37:40These kind of three cases,
37:41I think at the very least they did
37:45inaugurate very substantial zeitgeist change.
37:48So today there exists, at least minimally,
37:52some rhetorical commitment on the
37:55part of academic medical centers.
37:57To the residents around them,
37:59though you know how much that
38:02rhetoric actually moves.
38:03Beyond public relations, genuflection,
38:05of course, varies a lot,
38:07and that's something I'm really interested
38:09in getting into in our discussion.
38:11Second, a lot of these programs,
38:14like the Community Health Center in Watts,
38:16which again still exists,
38:17and the ones here in New Haven,
38:20New Haven is a place with,
38:21you know,
38:22some really good community health centers.
38:24They were and are actually very serious
38:27sources of not just medical care,
38:30but also training and jobs for
38:32people who live around them by
38:34virtue of their very existence.
38:36And that's no small feat either.
38:38They are part of a nationwide
38:41investment in longterm infrastructural
38:43improvement to alleviate stark
38:45maldistribution in medical care.
38:48I think we have to acknowledge
38:50and celebrate that third.
38:52I think an unresolved question is how
38:55much academic medical centers ought to
38:58be involved in these Community projects.
39:01So there's a wide spectrum of involvement,
39:04community projects,
39:05health projects that have no academic
39:07medical centers involved with them
39:09and ones that are basically run
39:11by the Academic Medical Center.
39:13And you know, I think instinctively because.
39:17People have heard and maybe seen things
39:20like the Cleveland Clinic's expansion
39:22in the in the mid 20th century.
39:24I think a lot of academic Medical
39:27Center involvement tends to
39:29elicit skepticism initially,
39:31understandably, and often rightfully.
39:33But I wonder if there's a way we can
39:36think about that a bit more rather
39:37than just dismissing it outright.
39:39And then fourth,
39:40I think it's worth probing what community
39:43participation should actually look like.
39:46This is a demand,
39:47both then and now,
39:48that morally,
39:49again,
39:49is very intuitive and very easy to
39:52get behind.
39:53But actually enacting
39:55community participation,
39:56defining what a community is,
39:59and actually acknowledging how much power
40:01that community does or doesn't have,
40:04those are much often harder questions
40:07that are sometimes glossed over.
40:09And then finally,
40:10I think we have to take stock of
40:12a very new landscape that's very
40:14different from the 1960s and 1970s.
40:16So as most of you in the room know on
40:19a health being at a medical school,
40:21Health Sciences campus,
40:23we're seeing a lot of mergers,
40:25acquisitions and consolidations in
40:27the healthcare space.
40:29These guys a couple years ago they tried to
40:31do something together and they ultimately
40:34pulled the plug on their initiative,
40:36but two of them.
40:38Amazon and JPMorgan are actually going in
40:41alone with their own healthcare venture,
40:44and it all makes the the local
40:47community battles around academic
40:48medical centers that I wrote about.
40:51You know about one hospital here,
40:52one controversy there,
40:54one community Health Center there,
40:56even one city.
40:57It all kind of seems a little
41:00quaint relative to the changes that
41:02might be coming on the horizon.
41:05Whatever we think of the
41:07academic Medical Center,
41:08we also may be heading towards a
41:10world where the Academic Medical
41:12Center is actually less central than
41:15it has been in the past half century.
41:17There are a lot of new actors in this space,
41:20and it leaves a lot of questions.
41:22And with that, I'm looking for this panel.
41:24Ben,
41:24should I just sit there and everyone else?
41:26Yeah.
41:31Yeah, actually, I'll ask our three
41:33panelists to come up as well. Dr.
41:35Tucker, Dr. Silvestri and misspell
41:38come up as well.
41:42I'm gonna take down the Basil's picture
41:47to move on.
41:50So we only unfortunately have one microphone.
41:53I obviously have a microphone up here,
41:55so you guys will have to share
41:58the microphone in your comments.
41:59When we the plan will be to have each
42:03of our panelists have 5 to 8 minutes to
42:06discuss some I will prime with a question.
42:08And then you can also reflect on
42:11what you heard from Merlin already.
42:14And after each of the three of you
42:15will potentially have a discussion.
42:16And then really open it up to the
42:19group as well as to people on the chat
42:21if they send in questions as well.
42:25First, I really want to obviously,
42:26Marilyn, you mentioned that New Haven and
42:28the specifics of Yale New Haven are not
42:31something you are intimately aware of.
42:32But rest assured,
42:33many of the things that you discussed
42:36as sort of do sort of permeate the
42:39history of this of our community.
42:41We are a highly segregated community.
42:45We are a majority minority city in a
42:48larger county that is majority white.
42:50Yale Mchaven serves as the Health
42:52Center for for both those community,
42:54both New Haven specifically and
42:56all the the suburbs and and most
42:59of southern Connecticut.
43:00We are sort of a community also
43:02affected by urban renewal and the
43:04deindustrialization of the midcentury.
43:06And so we had many of the issues
43:07that were affected,
43:08Cleveland and Los Angeles as well.
43:12I don't know,
43:13I'm just really excited
43:14about this conversation.
43:15I do want to acknowledge that the
43:18only human does has an obligation to
43:20report their Community health benefit
43:22and they do have a a triaminal report
43:25that they generate every three years.
43:27And you can look it up online and sort
43:29of see how they they report themselves,
43:31what are they doing,
43:32what they are doing for the community.
43:35They also report to the IRS how much
43:37of a community benefit in in monetary.
43:41Sense how much they they give back to me.
43:43I think it's on the order of $500 million,
43:46although almost 400 million of that
43:48is related to under compensated
43:50or uncompensated care that the
43:52hospital provides.
43:52So you can have a question about
43:54does that actually reflect the
43:56community benefit of the hospital.
43:58They're also the second largest employer
44:00in the city after the university.
44:04So with all those things,
44:05I do want to pivot to our discussion,
44:07I want to start with misspell as our.
44:10What's
44:14that? Oh, sorry for the camera.
44:16We got to get okay. We can reflect.
44:18We got mark in the picture now,
44:20so we can start.
44:22So although I do want to say that
44:24obviously I invited the three of you
44:26here because of your respective roles
44:27of Virginia role in the Community,
44:29Kathy, role in the hospital and mark
44:31your role the Community Health Center.
44:33But I want to acknowledge that all the three
44:35of you have many roles that you fulfill.
44:37And also that no person as Merlin
44:38mentioned can sort of speak for
44:41you know all the entity that all,
44:42the whole entity that they are representing.
44:44So with that caveat we will dive in.
44:47So I do want to start with Virginia.
44:50I generally want to hear your thoughts
44:53reflecting on what Merlin said and really.
44:56One question that always comes up
44:57sort of you are a New Haven resident,
44:59you live here in West River.
45:00I'm sure you have gotten
45:01healthcare here at Yelm Haven.
45:02I'm sure your neighbors and your family
45:04members have gotten healthcare at Yelm Haven.
45:06What is the perception of you and your
45:09neighbors of the care that they get
45:11or how responsive the hospital is?
45:13It's the needs of your community.
45:16I mean, we can, we can expand on that.
45:19But Virginia,
45:19if you could,
45:20at least 5 to 8 minutes to discuss that.
45:24So of course no
45:25community is a monolith
45:28and I can't speak for all of the residents
45:32in New Haven or even in West River Dwight,
45:35which is one of 10 communities
45:37in the city of New Haven.
45:39I think we've, we've always had a very
45:43tenuous kind of relationship with with
45:47the hospital and I think at the greatest.
45:53From a high level,
45:54I would assume that most folks
45:56are happy with their healthcare.
45:59I don't think anybody is unhappy
46:02with the service provided by
46:04Yellow Haven Health systems.
46:06There's been some changes with St.
46:08Rachel's campus, which I know we'll
46:10we'll we'll talk a little bit about.
46:11But for the most part,
46:14good care is provided by the health
46:16system in New Haven and I think most.
46:19Residents in the city would agree that
46:21that that we we receive good healthcare.
46:24What about how responsive the the hospital
46:26is to other communities beyond the
46:28individual care that the people receive?
46:34Well, you've really started something. So
46:38how residents in the city think
46:41about healthcare very broadly may
46:44be very different because you have.
46:47Communities that are significantly impacted
46:50by the change that happened with St.
46:52Ray fields, the change that's
46:54happened with you know removing
46:56the primary care service from the
46:58hospital and and sending it to.
47:03So my husband said 150.
47:05I was thinking about the healthcare center,
47:06so Cliff Cornell,
47:08Scott and and Fairhaven Clinic.
47:11So there there is definitely a
47:15strong feeling about whether or not.
47:17Community is represented when
47:19decisions like that are made about
47:22our healthcare and the greater
47:24impact that traveling to long
47:26north or traveling to a healthcare
47:29system outside of the hospital
47:30may have impacted families.
47:33Well, we can fill in some of the
47:35details for folks who don't know what
47:37specifically you're talking about,
47:38but you're referring to two things.
47:40#1, the Yamla Haven is now the only
47:43hospital in in our community where
47:45prior there were two hospitals, St.
47:47Rayfield's, the hospital Saint Rayfield's
47:49and and in Yamla Haven and now they
47:52are due to financial problems frankly
47:53at the hospital Saint Rayfield's.
47:55Yamla Haven purchased St.
47:56Rayfield's and so now there's only
47:58one hospital and two campuses and
48:00there we're still living through
48:02that legacy of that change.
48:03The second one is that when
48:04you don't even bought St.
48:05Rafael's,
48:06they moved some of the primary care
48:08services they provided there to a
48:10different location that instead
48:11of being in the community was
48:13arguably outside of the community.
48:15And that is something again and
48:17actually a good pivot to our
48:19representative from Cornell, Scott.
48:20Some of those primary care service
48:22previously offered by the hospital are
48:24now offered by the Community health centers.
48:26So with that we'll pivot to
48:28doctor Silvestri to Mark so.
48:30Cornell Scott is living the
48:32legacy of the OEO and then those
48:35innovations in the 60s and 70s.
48:38Still the the Community Health
48:40Center movement that started then
48:42and was funded as part of the
48:43Great Society is is is persisting
48:45now as Marilyn mentioned.
48:48So how how is I mean there are and
48:50that you I would love you to expand on
48:52what that means for Cornell. Scott.
48:54As far as their maximum feasible
48:56participation of the community,
48:59how Cornell Scott responds to community
49:01needs and also how they potentially fill
49:03in some of the gaps where potentially
49:05other healthcare systems aren't
49:06providing the care that the community
49:08needs and and can expand on that,
49:11sure. Thanks Merlin for a very
49:15engaging and entertaining also talk.
49:21Sometimes I wish I had lectures
49:22as engaging as you back when I
49:24was in school, but I think so.
49:29It's it's part of the nature and the DNA
49:31of how federally qualified health centers,
49:33or community health centers as
49:34they're colloquially known,
49:36were originally set up and established
49:39and by law are governed that we are
49:44kind of inextricably bound to our.
49:47Community, our Board of directors is
49:50comprised of at least 50% patients
49:54and members of the Community
49:56and that's by by federal law.
49:58But you know,
50:00I think it's probably even more
50:02importantly been part of just
50:04the DNA of who the organizations
50:05are from the very beginning now.
50:07I mean Cornell Scott Hill Health Center,
50:09which was originally Hill Health
50:10Center and then subsequently named
50:12after our founder Cornell Scott,
50:13the Cornell Scott Hill Health Center.
50:16Was originally formed by a partnership
50:20between members of the Hill
50:22community and members of the school.
50:24But the you know that that
50:26it's we're independently,
50:29we're an independent nonprofit
50:31and apparently governed by that
50:32board of Directors that remains
50:34majority community members.
50:35And so I think there are a number
50:37of elements of what we do that
50:39allow us to to remain plugged
50:41in with the Community and to try
50:43to be responsive to those needs.
50:44And it it's tied into just the nature.
50:47I think even of well it starts with
50:49a I think that we have a community
50:52outreach and marketing team and you know,
50:54their job obviously is to let the
50:57Community know about what we're
50:58doing in the services available,
50:59but it's also to get feedback from
51:01the community and bring them to us.
51:02So I mean they're doing obviously
51:04marketing and outreach events,
51:06but they're also doing mobile
51:08vaccination or or health clinics.
51:09And so all the time they're bringing
51:10back feedback to us, you know.
51:12For those of you know Carla Estelle Bragg,
51:14our director mark,
51:15they say it's taking four months to
51:17get a new primary care appointment
51:19that's too long.
51:20What can we do about that,
51:21you know and so we kind of get this
51:24real time ongoing feedback that I
51:26mean we want to be responsive to and
51:27guys what we do then we have medical
51:29services that are in the Community,
51:31not just our mobile health events but
51:32our school based health centers where
51:34we're in you know over a dozen schools
51:35we're interacting with principals,
51:37with superintendents,
51:38with parents and others there.
51:40Our homeless healthcare team that's
51:42in the shelters on the streets,
51:45interacting with harm or dust
51:47reduction task forces,
51:49trying to be responsive to the
51:51needs of particular communities.
51:52So the I think there are a number
51:55of ways that we try to obtain
51:57information and make sure that
51:58we know how the Community is
52:00feeling so we can be responsive.
52:01That's that's why we exist.
52:03If we if we cease to do that,
52:05we sort of lost,
52:07lost our way.
52:09So that to to push us a little
52:11bit on this relationship with
52:12the the Community Health Center,
52:14Cornell Scott and Yell New Haven is kind
52:16of like a triangle the the community,
52:18the hill Cornell Scott and then yell New
52:20Haven Hospital which is down the street.
52:23I'm sure that relationship between
52:24Cornell Scott and the hospital
52:26has evolved over the years.
52:29Can you speak to that a little?
52:30What are some of the tensions that
52:32you guys have when trying to both
52:34obviously serve the the same,
52:35the same community?
52:36What are ways that I can potentially
52:39improve that relationship going forward?
52:42Sure. And I know there are many
52:43in this room that have been
52:44here a lot longer than I have.
52:46I've lived in New Haven for 14 years,
52:49but I do I personally feel
52:51like I've seen an evolution
52:53even over even over that time.
52:56I would, I mean,
52:57I would say that. My impression,
53:00at least if you go back 15 years or so,
53:02was that it'd be the relationship
53:05was a little bit like 2 neighbors who
53:07live next to each other peaceably.
53:09Not, not a lot of hostility necessarily,
53:10but they don't necessarily
53:11interact or talk that much.
53:13I mean, you know,
53:15peaceable coexistence maybe or I
53:17think in in more recent years we've
53:21developed, I think it was a much
53:24more functional partnership where
53:26both organizations are leveraging.
53:28The the strengths and the strength of
53:34one another and and appreciating you
53:37know what we need to bring to the table
53:38and can bring to the Community also.
53:39So I think in that regard I mean
53:42and there's there been a few changes
53:44that I think have led to that.
53:46There's been, there been a lot more kind of
53:51transfers of folks between the organizations.
53:54You know, people who've come from the
53:56hospital or medical school to Cornell
53:57Scott or vice versa are sharing
54:00of an electronic health record,
54:02which kind of runs everything of how we do.
54:04That leads to a lot more visibility and
54:07transparency between the organizations.
54:09And then this partnership,
54:11ultimately the Primary care consortium
54:13with us adopting the primary
54:16care clinics from the hospital,
54:18we're at a place now and we can go
54:20into more details where I really think
54:22that we are able to take advantage of.
54:24Some of the resources of the Academic
54:26Medical Center and they're able to
54:28recognize and appreciate and let
54:30us do kind of what we do best.
54:32So I think there's still opportunities
54:35for for for work and.
54:38And if you want me to go into
54:39those now, no, no I think we
54:41should give give a doctor Tucker
54:42Kathy some time to talk as well.
54:44But that thank you for those comments.
54:47So. So Kathy you have worked at
54:48Yale New Haven for a long time
54:50and actually lived in in the
54:51greater New Haven for even longer.
54:53So you said both as a role
54:54in the hospital and a role,
54:55an important role in the Community.
54:58From your perspective how has that
55:01relationship between Yale New Haven
55:03and the Greater New Haven area evolved?
55:05And also I'd love to sort of because I think.
55:08Sometimes we people have a closed
55:10minded view of sort of the pressures
55:11at the hospital feels and I'm sure
55:13that you can speak to some of the
55:14pressures that the hospital feels
55:15about like they maybe they would
55:17love to do all these great things,
55:18but they're both financial and other
55:20pressures that limit what what they can do.
55:22So I'd love to to expand on
55:24those type of things if you can.
55:25Yeah, yes, I am a 27 year
55:29employee of the hospital.
55:31So I've been here, I grew up,
55:32all my nursing career has
55:34been here at the hospital.
55:35And I've seen the tensions over the years.
55:37I've seen the fights and the battles
55:39over the years between the community
55:41and the hospital and have learned
55:43a little bit about, you know,
55:44what it feels like to be on both sides of,
55:47you know, of that experience.
55:50I do happen to know because we're the
55:52ones that are charged with fixing it.
55:53You know, when when things go go
55:56wrong or they're not going very well,
55:58you know, so that it lands in our laps.
56:01But it's a real important thing
56:03to know that I think that the.
56:05The message really from the
56:07hospitals that they hear us,
56:08but it's a hospital first and a lot
56:11of times their position seems to
56:14not necessarily connect with the
56:16messages that are going on outside,
56:18but there's real work going on on the inside.
56:20And I know that personally
56:21because we've all been, you know,
56:22the people that kind of are
56:24trying to do the work.
56:25And I can just kind of Fast forward
56:27to now to say this is what I can tell
56:30you is happening now in the hospital.
56:32There has been the establishment of
56:33what is now the office of HealthEquity,
56:36right?
56:36Just based on all of the things that
56:38we know about health disparities and
56:39what we're showing up like in the
56:41Community or not showing up like in
56:43the Community and what we should do about it.
56:45There's a real effort to try to
56:47shift the culture of the organization
56:49internally and really just focus on
56:52teaching the employees in the hospital
56:54what they can do about addressing
56:56the social needs of the Community,
56:58social determinants of health.
56:59And things of that nature.
57:00So there's a lot of work going on there.
57:02There's been the establishment
57:04of relationships with community
57:06based organizations.
57:06So now we're asking patients about their
57:08financial needs and their transportation
57:10needs and their housing needs and such.
57:12There's an actual a mechanism that we can
57:14now use to connect people into the care.
57:16So it was one thing to ask the question and
57:19then not be able to do anything about it,
57:21but there's been a lot of effort on the
57:23part of the organization to really,
57:24you know, build those bridges.
57:26And then,
57:27you know,
57:28give US resources to kind of connect
57:30people into those resources to really
57:32help some of the other work is around
57:34the Community health needs assessment.
57:36And it was really interesting for
57:37me to hear part of the discussion
57:39talking about what is community,
57:40because that's been the age-old question.
57:42What is community?
57:43What does that look like?
57:44Who is the community and
57:46what we decided to do.
57:48And I do a lot of work as the
57:49liaison to Doctor Church.
57:51Well,
57:51now this is a recent appointment.
57:53But the work with the office
57:55of HealthEquity was really to
57:56kind of like to find out what,
57:58what do we mean by community and to
58:00do some work trying to kind of unpack
58:02the results of the Community health
58:04needs assessment and then reimagine
58:05what it can look like going forward.
58:08So a lot of what, you know,
58:11we did this past cycle was to really
58:14kind of like lean into the employees
58:17of the hospital who are residents.
58:19Of the community and use those folks
58:22and their opinion and their feedback
58:24about what could be done as a hospital
58:27better for them in the community.
58:28So that's kind of where we started, you know,
58:31trying to make some shifts and we're,
58:33you know, again,
58:33doing a lot of work going forward
58:36about the next cycle of the
58:38community health needs assessment.
58:39So
58:39yeah, that's why I have a I
58:40could ask a lot of questions,
58:42but I do want to let.
58:44Merlin sort of respond or interject
58:45on what he's heard and then
58:47after that maybe we if anyone
58:48has something they'd like to
58:49respond or we could open it up
58:51to the group after after Merlin
58:54no I've basically been just digest Oh yeah
58:57sorry yeah yeah they gave me my own yeah
59:04no, I've basically been kind of just
59:06digesting and and thinking but.
59:10Some, some takeaways.
59:12One is I'm very interested in hearing about.
59:15I mean often times like for me as
59:17somebody who I don't call myself
59:19a community based research at all,
59:21I'm not I I I look at paper all
59:24day and usually paper written
59:26by people who are deceased.
59:28So I for me community always has
59:32kind of an abstraction to it.
59:34And so it's been fascinating to
59:36hear from all three of you how
59:38you have enacted it.
59:39On the ground in some
59:41ways, in what actual mechanisms
59:43you have used to actually turn
59:48a moral kind of demand for community
59:52participation and avoidance of.
59:56Insular administrative decisions that have
59:58huge consequences for people's lives.
01:00:01How you've actually sought to thought
01:00:03to do that, I think there is kind of
01:00:06a foot to the pedal aspect to it.
01:00:08At some point you have to stop debating
01:00:10what community is and who is really
01:00:12the community and just try things.
01:00:13And I'd be interested to know more
01:00:16about what those mechanisms of
01:00:18community are like for example, Mark,
01:00:22how do you choose the 50% of the people
01:00:25who are on the board and that sort of thing,
01:00:27what kind of what kinds of
01:00:28frictions is that that bring up?
01:00:30But I'm fascinating to hear about that.
01:00:33The second thing I'd like to
01:00:35ask all of you actually is,
01:00:37I'm sure everybody in this room
01:00:39and everyone at this panel.
01:00:40Has felt the impact that 2020
01:00:44has had on the healthcare space,
01:00:47not just around issues of racism
01:00:50but I think larger issues about
01:00:53the distribution of resources and
01:00:55fairness and how we do public health.
01:00:57One of the things that I felt
01:01:01often is in the healthcare space.
01:01:04You know if you're the diagram
01:01:06like kind of the.
01:01:08The responsiveness of of big
01:01:11institutions in particular to disruption
01:01:14to social dislocations like that,
01:01:17it's like a big spike for a few years and
01:01:19then you get back into the doldrum period.
01:01:22And so I wondered,
01:01:23as people have been in this game a long time,
01:01:26how do you keep up that?
01:01:28Those that pressure and that interest when
01:01:30the when the broader public interest has
01:01:33receded after you know the 2020 moment.
01:01:36But my guess is that the office of
01:01:39HealthEquity that you mentioned is a
01:01:41direct consequence of 2020 because
01:01:43we got a new one too.
01:01:45And the question is you know is this
01:01:47going to be a real office or one that
01:01:50ultimately only exists on paper.
01:01:51And I think it all comes down to if if.
01:01:54If.
01:01:55That kind of social foment and the
01:01:57pressure can be maintained and
01:01:59I wonder about that.
01:02:01So those are kind of two reactions
01:02:03actually, mark, if you want to take that.
01:02:04The first question about the
01:02:06responsiveness or how do you how
01:02:08or if you know how Cornell Scott
01:02:10identifies the individuals to be on
01:02:12on the board and does that create,
01:02:14has there been tension with what the
01:02:16how they want the institution to move?
01:02:20Yeah. I'm not sure the answer to that
01:02:23question is probably super interesting.
01:02:24I mean candidates are identified by by any,
01:02:29by anybody in the organization,
01:02:31some anybody who's a patient
01:02:34and just as any board member
01:02:36of any organization would do,
01:02:37they kind of go through an
01:02:39interview and a vetting process.
01:02:40Obviously then the qualifications
01:02:41are more than just being a patient.
01:02:43You need to be able to serve as
01:02:45a board member and commit to that
01:02:46and what it would take and then.
01:02:48An interview by the the Board and
01:02:49the Governance Committee obviously
01:02:51it which is over 50% patients also.
01:02:54So it's it's sort of like any board it's
01:02:57just a requirement of of being a patient.
01:03:01So I don't know
01:03:03well now we get to the
01:03:04more juicy question. I'm
01:03:05sure others may have other opinions
01:03:06but that's that's actually the
01:03:07extent that I know of it because
01:03:08I'm I don't sit on the board myself
01:03:10sure actually I'd love to hear
01:03:11from Kathy in Virginia about
01:03:13Merlin's larger question about.
01:03:14The change in the hospital potentially
01:03:16partly in response to sort of
01:03:19social foment and how the does,
01:03:21I mean, I imagine the hospital
01:03:22wants to keep a commitment going
01:03:24forward but the pressure lets off.
01:03:26Does that stay.
01:03:27So what's your sense from the
01:03:28inside how that that happened?
01:03:30Yeah no, I I acutely feel the commitment
01:03:34by the hospital to operate differently.
01:03:37I think that the pandemic exposed.
01:03:41You know so much about where there were
01:03:42gaps in the care and the relationship
01:03:44between the community and where things
01:03:46could and should be done differently.
01:03:48And we saw the commitment during
01:03:51the pandemic to, you know,
01:03:53standing up testing centers and communities
01:03:56of color and you know, you know,
01:03:58when the vaccines were available,
01:03:59vaccinating people in the in communities
01:04:01have called, they did the work.
01:04:02They were really there.
01:04:03And I always say that the time to show up.
01:04:07Is when there's nothing going on.
01:04:09Because when the pandemic hit,
01:04:11if you weren't already there,
01:04:12you missed the bus.
01:04:14All right, so the hospital was already that.
01:04:16We already had relationships which
01:04:17made it easier for us to do that.
01:04:19Could it be better?
01:04:20Of course, it could be nobody's.
01:04:22We're not perfect.
01:04:23And I'm not sitting here saying that we are,
01:04:24there are opportunities to do things better.
01:04:26But I will say that they stood
01:04:29up in that moment,
01:04:30and I do feel the the connection.
01:04:33To the Community now very differently
01:04:35as a result of the work that had been
01:04:39done during that that period of time.
01:04:41But the office of HealthEquity is a
01:04:43system wide office of HealthEquity and it
01:04:46is you know being developed as we speak.
01:04:49And I'm actually here now
01:04:50in place of Doctor Lou Park,
01:04:51who's the medical director for the
01:04:53office of HealthEquity and Darcy Cobbs.
01:04:55Lomax was the director.
01:04:58And there's a whole team that
01:04:59they're assembling right now.
01:05:00So this thing is expanding.
01:05:02It's not getting smaller,
01:05:03it's getting bigger and it's moving faster.
01:05:05And there is a focus really on,
01:05:07you know,
01:05:08taking a look at our the health disparities,
01:05:10you know,
01:05:10that we have the ability to influence
01:05:12and impact and really going forward with
01:05:14making changes in how we deliver the care.
01:05:16So I don't see it as a,
01:05:17you know, a flash in a pan.
01:05:20I don't see it that way.
01:05:22That's not been the experience that I felt.
01:05:24I've seen flashes in the pan
01:05:25and this isn't that so.
01:05:28Actually a good pivot to Virginia.
01:05:29So you have been living in the
01:05:30community for a long time.
01:05:31You've seen efforts maybe in the past
01:05:34that maybe have not not persisted.
01:05:37What leverage do you feel
01:05:39like you have to impact the,
01:05:41do you feel like actually you respond?
01:05:43But I want to hear about your sense
01:05:44of how the leverage of the Community
01:05:46to keep the pressure on or New Haven
01:05:48in general to keep the pressure on for
01:05:50the hospital to be more responsive.
01:05:51So I would contend that the pressure
01:05:54on the hospital started before COVID.
01:05:57And I think their response to COVID
01:05:59was a result of the decision they
01:06:02made about moving the primary care.
01:06:04So the community was up in arms about that.
01:06:07And I think the hospital learned
01:06:09the lesson that they had not
01:06:11properly engaged the community,
01:06:12that it was a decision that was
01:06:14made behind closed doors without any
01:06:16conversation with the community.
01:06:18And it did not roll out the way
01:06:19the hospital thought it would,
01:06:21as it probably has had has over decades
01:06:24as we've seen the hospital expand.
01:06:27Into the the greater New Haven community.
01:06:30So the lesson was learned there
01:06:32that the community wants to be
01:06:35informed and engaged around decisions
01:06:37not just around our healthcare,
01:06:39but how the hospital is going
01:06:41to move through the city,
01:06:42how they're going to move into the
01:06:44community and what are the resource
01:06:46and what are the Community needs that
01:06:48we need the hospital to be responsive.
01:06:50Too, and I think because of the
01:06:53primary care situation,
01:06:54the hospital was well prepared
01:06:56when COVID hit.
01:06:58So we saw testing centers and vaccinations.
01:07:02We saw that system fall into
01:07:06place effortlessly because they,
01:07:08I believe they learn their lesson.
01:07:10I believe they understood what the
01:07:12need was going to be and what the
01:07:14response from the Community was going to be.
01:07:18I'm actually, I mean again
01:07:19I have followup questions,
01:07:20but I do want to open it up to the group.
01:07:23And also I know there was a question
01:07:25already online make sure we'll
01:07:26start with a question in the room.
01:07:28I'll have to repeat the question,
01:07:29but so keep it brief. I guess
01:07:32my question is
01:07:38thank you for your your talk.
01:07:40It really did kind of add some
01:07:43perspective to what the experience.
01:07:47I am a New Haven resident who was
01:07:50also employed by the hospital.
01:07:52I wonder if in your in your research you
01:07:58have looked at the relationship between
01:08:01the Medical Center and the academic
01:08:05institution and how that plays because
01:08:08this is very much a green person dance
01:08:12and the hospital and the community.
01:08:17University is, you know,
01:08:19separate but equally something you know,
01:08:22it's a.
01:08:23It's an interesting dynamic,
01:08:25and I wonder how that plays into the
01:08:30the success of the relationship
01:08:33between unity and Health Center.
01:08:38So I I will repeat the IT
01:08:39looks like the the ASL
01:08:40interpreter was able to hear it.
01:08:41So maybe the the people on
01:08:42the webinar could hear it.
01:08:43But I will just repeat the question briefly.
01:08:46The question was really focusing on in
01:08:49your research in Merlin specifically.
01:08:50So we talked about the
01:08:52academic mental center,
01:08:53but it's the Medical Center and the
01:08:55academic institution which both have
01:08:57their own I mean to to to improvise.
01:08:59Have their own sort of needs and demands.
01:09:03Did you look at that access as
01:09:05well between the university
01:09:06and the and the Medical Center?
01:09:09Yeah, I mean that's a terrific question.
01:09:12Yes and no. I think it's more of an implicit
01:09:15kind of thread than an explicit one.
01:09:18I the one thing I at some point when I
01:09:21was looking at academic medical centers
01:09:23in particular that I asked myself is.
01:09:27Is the tension between academic medical
01:09:29centers and their neighborhoods,
01:09:30is there something special about it or
01:09:33is it actually just bound up with the
01:09:37larger antagonism between say Yale and New
01:09:40Haven or Columbia and Harlem or you know,
01:09:43we can go on University of Chicago
01:09:45and the South South side etcetera?
01:09:47I think sometimes it is the same BLOB
01:09:50and there and community members are
01:09:52responding to kind of larger institutions
01:09:55that particularly pull their weight with
01:09:58or throw their weight around rather with
01:10:01real estate and economic and political
01:10:04control of large parts of the city.
01:10:07I also think there is a particular though
01:10:11a particular character to the Medical
01:10:14Center in neighborhood relationship.
01:10:17I actually think it's a very symbolic.
01:10:19There's a symbolic aspect to it too,
01:10:21because there's just something jarring
01:10:23about healing institution and often
01:10:27a very rich healing institution
01:10:29that's very technologically intensive
01:10:31and well capitalized.
01:10:32And the juxtaposition between
01:10:35that and deprivation,
01:10:36I think there's something
01:10:38about that gulf that.
01:10:40Emotionally resonates with people
01:10:43as quite unjust, quite unfair.
01:10:46Especially when,
01:10:47as in the case of Cleveland,
01:10:49the the the entity is also expanding
01:10:52literally to where they live.
01:10:55So in
01:10:55some, in some cases it's the
01:10:57it's the kind of larger BLOB,
01:10:59and in some cases it is the meta.
01:11:01There's particularities
01:11:02of the Medical Center.
01:11:04I think another issue, I think Ben
01:11:05talked to me about this the other day.
01:11:07I certainly know it's an issue in one
01:11:10of my previous stops in Philadelphia
01:11:12and it's all these institutions,
01:11:16medical or or the larger university
01:11:19entity are tax free, right.
01:11:21And so there's a big but you know,
01:11:24I mean nonprofit in in legal and name,
01:11:27but certainly.
01:11:29Lots of flush revenue coming coming
01:11:32through these institutions and so the
01:11:34big question is if that is happening,
01:11:37what kinds of policies might be put
01:11:39into place for these institutions
01:11:41to contribute something back and
01:11:44you know pilots is is 1 possible
01:11:47route I actually am interested
01:11:49in public benefit and how?
01:11:53I think it's actually a potential tool
01:11:56for community members and activists to
01:12:00use to press institutions to follow
01:12:02not just the letter of the law,
01:12:05but the spirit of the public
01:12:08benefit provisions,
01:12:09which have been considerably
01:12:11strengthened by the ACA.
01:12:13And I'd be curious to know from
01:12:16my New Haven Co panelists how
01:12:20that has actually played out.
01:12:22I I know certainly that there is what
01:12:26you might call charitably creative
01:12:29accounting and some at some academic
01:12:32medical centers where you know
01:12:34things like Medicaid reimbursements
01:12:37or Medicaid funded care is is
01:12:39counted somehow as public benefit.
01:12:41I think I think as I interpreted
01:12:44the spirit of that requirement
01:12:46and that mandate and the kind of
01:12:50larger social social movement.
01:12:52Reason why that that public benefit
01:12:55benefit requirement was passed.
01:12:57It's it's they're supposed to be
01:13:00spending it on real public health
01:13:02programs not just counting things
01:13:05that they already do as you know
01:13:08fulfilling that but I do that is
01:13:10also something that I think is
01:13:12unique to medical centers and in in
01:13:15terms of in terms of responsiveness
01:13:17to neighborhood
01:13:18pressure. So Kathy,
01:13:19to put you on this spot,
01:13:21so you you brought up that
01:13:22can we help benefit sort of
01:13:24what's your perspective on it?
01:13:26And I will say there is actually
01:13:28still continuing pressure
01:13:29in Congress about how the,
01:13:30how hospitals navigate that,
01:13:32that process of being a nonprofit.
01:13:35So I think it's a story
01:13:36that's still being told,
01:13:38but I'd love to hear your thoughts.
01:13:39Yeah, exactly. I think that's exactly
01:13:41what I'm saying is that we know that
01:13:43there's probably an opportunity to
01:13:45do things differently than what.
01:13:47Has been done in the past and that
01:13:49is that cycle we're we're kind of in
01:13:50the middle of right now and kind of
01:13:52redefining what that looks like or
01:13:54what that could look like in the past.
01:13:57You know I think you know it wasn't
01:14:00as transparent as we would like
01:14:01for it to be going forward.
01:14:03So that's that's all I can really
01:14:05say about that at this point because
01:14:07I don't really have the you know
01:14:08the depth of knowledge to be able to
01:14:10speak to what's actually been done
01:14:12and say it with credibility so but.
01:14:15But I do think that there's an
01:14:16opportunity for us to be a little
01:14:17bit more transparent and be more
01:14:18involved in the process that I do know.
01:14:22So actually, Mark,
01:14:25I mean I would, when I actually would give my
01:14:27hospital colleagues a lot of credit on this,
01:14:30we take care of a lot of uninsured patients.
01:14:33And I mean, I think one place where there
01:14:36can be very little debate about whether
01:14:38it's community benefit is the free and
01:14:40discounted care that the hospital provides
01:14:42to uninsured patients. I mean, we.
01:14:43For patients who don't have health insurance,
01:14:46we can get them essentially any
01:14:48medically necessary service what
01:14:49they need at the hospital.
01:14:50And I I don't know if it is
01:14:52that that way in other cities,
01:14:53but it it's it's phenomenal
01:14:56from our perspective.
01:14:57We don't have to spend a lot of time
01:14:59stressing about how we're going to
01:15:01get our patients what they need.
01:15:02The question about Medicaid and
01:15:04whether to count in community benefit,
01:15:06the gap between what Medicaid
01:15:08pays and what it costs to provide
01:15:10a service is interesting
01:15:12and in some regards.
01:15:15I wouldn't mind if academic medical
01:15:17centers got credit for that so
01:15:19to speak as community benefit
01:15:21because it might provide a little
01:15:23bit of an additional incentive to
01:15:25provide care to Medicaid patients.
01:15:27So you know you if you don't get
01:15:29credit so to speak for for the
01:15:31losses that you are are taking there,
01:15:33then the the incentive is to shift
01:15:35services away from Medicaid patients.
01:15:37So I think there's kind of two
01:15:39sides to that coin.
01:15:41No, it might be contextual too. Yeah.
01:15:43Especially with an if there's an
01:15:45institution that historically has slighted
01:15:48or tried to avoid Medicaid patients.
01:15:52So I would play the devil's advocate
01:15:54with that because as a community member,
01:15:57we don't see that part of the
01:15:59investment in the city, right.
01:16:01We see that as an investment
01:16:02in a in a patient's outcomes,
01:16:04which is important.
01:16:05But when you have streets that have potholes.
01:16:09When you have a very small tax base
01:16:11because of the university and the hospital,
01:16:14it's harder from a Community perspective
01:16:16to see the added value of giving
01:16:19that resource to the Community.
01:16:21We we have a phrase that we use.
01:16:22So I run a civil rights organization.
01:16:24We call it colored money when
01:16:26cities are disinvested and there
01:16:29are not buses that go out to Long
01:16:32Wharf to provide transportation
01:16:34to folks who need medical care.
01:16:37There's there's a disconnect
01:16:39between what the the community
01:16:40sees as an investment and what the
01:16:43hospital may see as an added value
01:16:45or an investment in a community.
01:16:48I'm not saying that it's not a value,
01:16:49it's it's a huge value because
01:16:51we know there are folks that are.
01:16:53Underinsured and uninsured.
01:16:54So it's important that folks get healthcare.
01:16:57But we also want the hospital and
01:16:59the university because we can't
01:17:00let them off the hook.
01:17:01We want them both to be invested
01:17:03in what the Community looks like.
01:17:06You know,
01:17:07if our if there's trash overflowing
01:17:09in receptacles by the hospital,
01:17:11what does that mean about the hospital's
01:17:14commitment to the neighborhood?
01:17:16You know, I live.
01:17:17In West River,
01:17:18my office is directly across the
01:17:20street from the Saint Refills Camp
01:17:22campus and where the new neoscience
01:17:24center is going to be built.
01:17:25And we as a community,
01:17:28we're excited because medical advancement
01:17:30is important to the community.
01:17:32However,
01:17:33investment in our communities
01:17:35is equally important.
01:17:37And what does that look like to a
01:17:39community member versus a hospital?
01:17:42There's another question in the.
01:17:51You know, are there other options
01:17:53with medical experience that are
01:17:55really going into creative grounds,
01:17:59really appreciated.
01:17:59The point about the buses and infrastructure,
01:18:02I just wonder, you know,
01:18:03and I appreciated that between the hospital
01:18:05is trying to get people in touch with
01:18:07resources and having this conversation,
01:18:09it's not important that as institutions
01:18:11are there any institutions?
01:18:13I think the country are really
01:18:16taking on the bigger issue
01:18:20of,
01:18:24well, I'll give you an answer that's kind
01:18:26of more of a referral and it's so I think
01:18:30a lot of people here may actually be
01:18:32familiar with the late Fitzhugh Mullen,
01:18:34who was a physician activist who
01:18:37ran this thing called Project Hope,
01:18:39which publishes the journal Health
01:18:42Affairs and he passed away I think.
01:18:45A couple, couple of years ago.
01:18:46But every time I would correspond
01:18:49with him fits as, as he was called,
01:18:52delighted in pointing out to me that
01:18:55Columbia ranked very low on the list of on,
01:18:58on a list of kind of academic medical
01:19:01institutions that contributed
01:19:02to their community.
01:19:04Every year he would put out this ranking
01:19:06and it would have it would include
01:19:09everything from spending on on, on.
01:19:13Programs and infrastructure and initiatives,
01:19:17community outreach stuff to the
01:19:19demographic composition of the
01:19:21kinds of people it it hired.
01:19:23And so he always loved to rid me
01:19:25about how haha Columbia is like
01:19:27in 59th place out of 60 years.
01:19:29So my answer is,
01:19:30I think that index is actually
01:19:32pretty was pretty powerful for me in
01:19:35terms of having a systemized rubric.
01:19:38So I would refer you to it at
01:19:41projecthope.org. Yeah, but.
01:19:44As well as these New Haven projects
01:19:46which sound great.
01:19:50I do want there's one question from
01:19:53the the chat that I'll put in bring
01:19:55it I think Kathy that it will sure
01:19:57you could hopefully address it.
01:19:59Unfortunately you're on the hot seat again.
01:20:03So I had the question is how do I talk
01:20:04with the C-Suite about this or how do
01:20:06we talk to the C-Suite about this.
01:20:07How do I get the them presumably the
01:20:10executives in the hospital to see
01:20:11importance of social justice and how at the.
01:20:14Academic Medical Center interacts with
01:20:15me that people live right around the
01:20:17the corner in fancy building around
01:20:19the corner from the fancy buildings.
01:20:20How do I get them to see that responsibility
01:20:23and then ask we have to address the
01:20:25food desert and transportation issues
01:20:26and need for job training programs and
01:20:28mental health treatment and health
01:20:29and and we should be doing more for
01:20:31the people right here in New Haven.
01:20:38It's true you know.
01:20:40Again you know they're.
01:20:42Your voices are very important
01:20:43and I think that you know,
01:20:45really just showing up to, you know,
01:20:47opportunities where I don't know when,
01:20:50if this is an employee, it's anonymous,
01:20:53it's an anonymous person.
01:20:54So obviously I can speak for
01:20:56employees of the hospital.
01:20:57We have mechanisms that we can
01:20:59speak to our leadership, you know,
01:21:01I'm not really sure what to
01:21:03advise about community outreach,
01:21:05but you know.
01:21:06There are probably mechanisms
01:21:08to reach the leadership.
01:21:09I don't know what to OfferUp
01:21:11in that in that regard,
01:21:13but I would say make your voice heard.
01:21:14Do
01:21:17you have something?
01:21:25Sure. And go ahead. And did any,
01:21:27did you have a question?
01:21:32I just find the paving specifically
01:21:35also generally in your experience in
01:21:37the studies you've done, what's the
01:21:42so new here? Just to be clear,
01:21:43New Haven does a very some very
01:21:45powerful unions that is pushing the
01:21:47university and the hospital and the
01:21:49city to do a better job so that we do
01:21:51feel that pressure here in the city.
01:21:56Well, I guess I could tie this
01:21:58actually to the person I opened.
01:22:00My remarks with Sarah Nelson,
01:22:03so she is identified with a brand
01:22:05of unionism that has sometimes been
01:22:07referred to as social justice unionism.
01:22:10And the idea behind social justice unionism,
01:22:12which is very controversial
01:22:13within the labor movement,
01:22:15is how wide should the
01:22:17purview of Labor unions be?
01:22:19Should labor unions only focus on
01:22:23aggressively getting amazing contracts
01:22:25and benefits and wages for their own
01:22:28workers within the circumscribed union?
01:22:30Or do labor unions actually
01:22:32have to not only do that,
01:22:34but also works often in coalition
01:22:38with community members to to address
01:22:42other parts of of the society really
01:22:45beyond just the workplace and the
01:22:48the rank and file a particular union.
01:22:50And in addition to President Nelson,
01:22:53I would say another exemplar of
01:22:55social justice unionism is the
01:22:57Chicago Teachers Union in Chicago,
01:22:59which has gone on strike.
01:23:00Two times over the past decade,
01:23:02but attracted huge community support.
01:23:05And I think it's largely because
01:23:06they did a lot of base building
01:23:09in Chicago neighborhoods.
01:23:10So people understood that the
01:23:11strike wasn't just quote UN quote,
01:23:13selfish teachers going on strike,
01:23:15but that they were fighting for
01:23:18better schools for people in the
01:23:21community and and also for a number
01:23:24of community improvements that
01:23:26may not have had anything directly
01:23:28to do with wages and benefits.
01:23:31So to answer your question about this,
01:23:32I think the social justice Union
01:23:34debate has actually been also
01:23:36a friction in health union,
01:23:38health worker unions.
01:23:39In a lot of the activism that I
01:23:42looked at in the 1960s and 1970s,
01:23:44I was actually surprised to see
01:23:46that in a lot of these debates about
01:23:50town and gown relationships and the
01:23:52racism of academic medical centers
01:23:54like the Cleveland Clinic and,
01:23:56you know, name all your other,
01:23:58name, all your other causes that.
01:24:00Some of the most militant and
01:24:03successful and left wing health
01:24:04worker unions were actually not
01:24:06very active in those campaigns.
01:24:09They were very active in the
01:24:11wages and benefits struggles,
01:24:12but less so on larger kind of health
01:24:16issues beyond wages and benefits.
01:24:19I think that's changing a lot,
01:24:21but I think it depends a lot on the local.
01:24:24And the leadership in the local,
01:24:26there's a lot of variation.
01:24:27So, you know,
01:24:29the Chicago Teachers Union does their thing,
01:24:31but you know the a FTUFT and New York
01:24:34City probably with a less holistic what,
01:24:39how about you?
01:24:40You
01:24:41probably have said on both
01:24:44sides of those conversations.
01:24:46Okay, fair enough.
01:24:47Okay, fair enough. Financial wealth.
01:24:50I do want to acknowledge that thank you
01:24:52we're we're at time now but so I do
01:24:55want to thank everyone for attending that.
01:24:57Thank you for our panelists
01:24:59for excellent conversation.
01:24:59Thank you Merlin for for priming
01:25:02the conversation with the research
01:25:04you've done and thank you the
01:25:06program the humanities medicine
01:25:08for hosting us and Doctor Reisman
01:25:10and Karen but yeah thank you.