Towards Health Equity

Transcript

• 00:06Welcome to our
• 00:10general internal medicine.
• 00:12Let me get my microphone
• 00:14figured out here.
• 00:21I guess I'll just put
• 00:22this over here.
• 00:26Okay. Welcome everyone,
• 00:28who's present. And to the
• 00:29many people who are online,
• 00:31I understand
• 00:32there's even some Penn State
• 00:34guests online. So that's
• 00:37welcome to to Yale to
• 00:38you folks.
• 00:40So for the,
• 00:41meeting today, the CME code
• 00:43is
• 00:43five four eight three nine,
• 00:45and I keep hearing an
• 00:46echo over here. Excuse me.
• 01:00So I put this echo
• 01:02on here. I'm just gonna
• 01:02shut it off.
• 01:04Okay. I just wanna make
• 01:05sure.
• 01:06There we go. Thank you.
• 01:07Thanks very much.
• 01:09So, five, four eight three
• 01:11nine.
• 01:13So a reminder,
• 01:14if it's not on your
• 01:15calendar already, be sure to,
• 01:17mark down our upcoming, GIM
• 01:19retreats for the new academic
• 01:20year.
• 01:21December ninth, we'll have our
• 01:23research and scholarship,
• 01:24retreat at the West Campus.
• 01:26We'll have our professional,
• 01:28development,
• 01:29retreat, at the West Campus
• 01:30on February sixth.
• 01:33And then, in May, we're
• 01:34gonna be having our education
• 01:36retreat. I think we have
• 01:37a date for that. It's
• 01:38June
• 01:39fifth, I believe. So,
• 01:41mark your calendars for those
• 01:42all important retreats.
• 01:45Another reminder,
• 01:47September twenty seventh is GIM
• 01:49day at the Yale Bowl.
• 01:50We've been doing this for
• 01:51a number of years.
• 01:53You can't miss it. And
• 01:55we're playing Cornell.
• 01:57So it's, bring your families.
• 01:59It's gonna be a great
• 02:00day. We have the sky
• 02:01boxes up on top of
• 02:02the bowl, and, it's gonna
• 02:03be a lot of fun.
• 02:04So, please try to join
• 02:06us.
• 02:07Next week, we have our
• 02:10grand rounds at seven thirty.
• 02:12Monique Hitchcliff,
• 02:13will be presenting on renodes
• 02:16and digital ischemia, an update
• 02:18on scleroderma.
• 02:20And then at noon, we'll
• 02:21be having our educational strategies
• 02:23and faculty development session,
• 02:25building a career in medical
• 02:27education leadership. So don't miss
• 02:29both of those
• 02:30meetings next Thursday.
• 02:33Here's our usual disclosure slide.
• 02:35So this is a really
• 02:36special day for all of
• 02:37us. We get to welcome
• 02:38back Henania Henau, who's sitting
• 02:40right here,
• 02:42with her husband,
• 02:43Perry,
• 02:44and her son
• 02:46her son, Nolan, who I
• 02:47remember when he was this
• 02:48tall, but now he's this
• 02:49tall. So,
• 02:51time certainly goes by. So
• 02:53this is a fourth annual
• 02:54Henao lecture on diversity, equity,
• 02:57and inclusion.
• 02:58And you can see on
• 02:59the slide here the three
• 03:00private three, previous speakers.
• 03:03So,
• 03:04Ingenia,
• 03:05has had a wonderful life
• 03:07and a wonderful career, and
• 03:08she's still just getting started.
• 03:10So as outlined here, she
• 03:11was born in the Dominican
• 03:13Republic.
• 03:14She immigrated to New York
• 03:15City at the age of
• 03:16fifteen,
• 03:18and then did her training
• 03:19at Marymount College and back
• 03:20at my old stomping grounds
• 03:21at the University of Rochester.
• 03:24She then joined the faculty,
• 03:25at Emory where her career
• 03:27just took off
• 03:28amazingly.
• 03:30She became director of the
• 03:31department of multicultural affairs there
• 03:33and was the founding director
• 03:34of the International Medical Center
• 03:36at the Grady Health System.
• 03:39Fortunately for us, we recruited
• 03:41her here to be director
• 03:42of our primary care center.
• 03:44She joined our center, and
• 03:45she really turned the place
• 03:46around. And there's a number
• 03:47of you who practice there
• 03:48in the room and online
• 03:50and know what and he
• 03:51how he need to transform
• 03:53that practice both as a
• 03:54place for our patients and
• 03:55a place for our trainees.
• 03:58She, in two thousand sixteen,
• 03:59was appointed associate chair,
• 04:02for diversity, equity, inclusion in
• 04:03our department,
• 04:05and also then in two
• 04:06thousand seventeen,
• 04:07had took on a similar
• 04:08role in our office of
• 04:09graduate medical education,
• 04:11where she created and transformed
• 04:13our department and our institution's
• 04:15approach,
• 04:16to diversity, equity, and inclusion.
• 04:18And some of the initiatives
• 04:19she,
• 04:21led here at Yale are
• 04:22listed on the slide.
• 04:24And,
• 04:25the her foundational work,
• 04:28is being followed by doctor
• 04:30Emba
• 04:31who took her place
• 04:32over time.
• 04:34At Penn State, she was
• 04:35recruited
• 04:36to be vice dean of
• 04:37diversity, equity, and belonging where
• 04:39she's built her team,
• 04:41built a wonderful program,
• 04:42but she remains connected to
• 04:44us as an adjunct, professor.
• 04:47And throughout her career, she's
• 04:49won numerous awards at Emory,
• 04:51at Yale, and most recently
• 04:52at Penn State, the Dean's
• 04:53Award for Excellence in Teaching.
• 04:56She has produced wonderful scholarship
• 04:58over the years. I recommend
• 05:00these three articles in the
• 05:01slide, but particularly this article,
• 05:03an MD made in America
• 05:04published in the annals of
• 05:06internal medicine. It's a great
• 05:07piece.
• 05:08And so, Ingenia,
• 05:11we miss you. We love
• 05:12you, but we're glad you're
• 05:13back. So thank you for
• 05:14being here.
• 05:17And Abba will now introduce
• 05:18our today's speaker. Abba?
• 05:23Wonderful. Thank you so much,
• 05:25Patrick. And, of course, thank
• 05:26you to Ingenia and her
• 05:27family for being here. It's
• 05:28such a personal honor for
• 05:30me to get to honor
• 05:31you in in one small
• 05:32way for for all the
• 05:33work that you have done
• 05:34and continue to do.
• 05:35And it is equally my
• 05:37honor to present,
• 05:38this
• 05:39year's honoree,
• 05:40for the in Hena Henao
• 05:41lectureship in diversity equity inclusion,
• 05:43Doctor. Susanna Morales.
• 05:45I've gotten to know her
• 05:46over the last few months
• 05:47in our zoom calls. And,
• 05:49even in our session this
• 05:50morning with the Yale primary
• 05:51care residents, such an inspiring
• 05:53session, I think her heart
• 05:54for many things equity related,
• 05:56but especially community building really
• 05:58comes across, and I know
• 05:59our residents really left, the
• 06:00session feeling inspired.
• 06:02So a little bit about
• 06:03her her background. Doctor Morales
• 06:04obtained her undergraduate degree from
• 06:06Harvard University
• 06:07and her medical degree from
• 06:09Columbia.
• 06:10She then did her residency
• 06:11training in internal medicine at
• 06:13the Presbyterian Hospital of the
• 06:14City of New York, going
• 06:15on to join the faculty
• 06:17at Columbia Presbyterian Medical Center.
• 06:20They were lucky to recruit
• 06:21her, to the division of
• 06:22general internal medicine at Weill
• 06:23Cornell
• 06:24New York Presbyterian Hospital in
• 06:26the nineteen nineties. And she
• 06:27serves as associate professor of
• 06:29clinical medicine,
• 06:30associate director of the house
• 06:31staff training program, and vice
• 06:32chair for diversity,
• 06:34now at Cornell.
• 06:37Back in twenty seventeen, she
• 06:38served on the New York
• 06:39Presbyterian Hospital disaster medical response
• 06:41team in Puerto Rico. The
• 06:43following year, she became the
• 06:44principal investigator and director of
• 06:46the Diversity Center of Excellence,
• 06:48for diversity and health equity,
• 06:50received a two point seven
• 06:52million dollar grant from HRSA.
• 06:54And she's really been active
• 06:56in so many ways with
• 06:57primary care at the at
• 06:58the heart. She has an
• 06:59active primary care practice,
• 07:01has really been an advocate
• 07:02for marginalized and underserved communities
• 07:05throughout. She has particular interest
• 07:07in medical education around psychosocial
• 07:09aspects of medicine, diversity in
• 07:11health care workforce,
• 07:12immigrant health, health disparities,
• 07:14and has really been,
• 07:16leading work in terms of
• 07:17vaccine hesitancy and was a
• 07:19major player in a lot
• 07:19of the COVID nineteen policy
• 07:21work and community education.
• 07:23Doctor Morales,
• 07:24served as a member of
• 07:25the governing council of SGIM
• 07:27from two thousand to two
• 07:28thousand three and is now
• 07:29secretary chair. And she was
• 07:30talking about SGIM with our
• 07:31trainees, this morning. She's a
• 07:33board member of the United
• 07:34Hospital Fund where she chairs
• 07:36the program committee,
• 07:37and the Latin Latino Commission
• 07:39on AIDS. So it is
• 07:40really my honor, to welcome
• 07:41you. Thank you so much
• 07:42for being here in this
• 07:43particular moment. We were really
• 07:45looking forward to your talk
• 07:46entitled towards health equity. Please
• 07:48join me in welcoming doctor
• 07:49Ramos.
• 07:54Thank you so much.
• 07:56I'm honored to be here,
• 07:59and I just wanna
• 08:01make sure I'm paying attention
• 08:02to the time.
• 08:04Because as I was telling
• 08:06doctor Black, I always have
• 08:07too many slides.
• 08:10I have no disclosures.
• 08:12You've heard about doctor and
• 08:13you know doctor Henowen,
• 08:15but I just wanted to
• 08:19acknowledge besides all of her
• 08:20amazing
• 08:21accolades and achievements,
• 08:22I'm honored to call her
• 08:24a friend, an old friend.
• 08:25We've known each other a
• 08:26really long time. And to,
• 08:29be
• 08:31at
• 08:32her named lectureship
• 08:33is really fantastic.
• 08:35So thank you.
• 08:39So
• 08:40some background.
• 08:42First of all, how is
• 08:43health equity linked to diversity
• 08:44and inclusion?
• 08:46So I was looking at
• 08:47some of our colleagues, and,
• 08:48actually, doctor is,
• 08:49an STI colleague too,
• 08:51who wrote an article in
• 08:52the New England Journal this
• 08:53year,
• 08:55talking about,
• 08:57the cost of dismantling DEI.
• 09:00And as,
• 09:02Crystal
• 09:02said, DEI initiatives are structured
• 09:05efforts within organizations
• 09:07designed to create inclusive educational
• 09:09and work environments,
• 09:10redress discriminatory
• 09:12policies, and mitigate the effects
• 09:14of systemic inequities.
• 09:15And health equity is an
• 09:17aspirational goal, ensuring that everyone
• 09:19has a fair and just
• 09:20opportunity to be healthy. And
• 09:22I think that's,
• 09:24that's it in a nutshell.
• 09:26Doesn't seem like that would
• 09:27be too controversial, but hey.
• 09:30Achieving health equity requires removing
• 09:32structural and social barriers such
• 09:34as discrimination and limitations and
• 09:36access to care, education, employment,
• 09:38housing, and safe environments.
• 09:40Health equity initiatives target health
• 09:42care disparities affecting groups defined
• 09:44by race, ethnicity, age, language,
• 09:46gender, sexual orientation,
• 09:48ability, insurance status, or geography
• 09:50by increasing access to and
• 09:52quality of care. And I
• 09:54think that all of us
• 09:55are
• 09:56care for patients of varied
• 09:58backgrounds,
• 09:59of varied,
• 10:01potential disabilities and medical problems.
• 10:04And so we are all
• 10:05in the struggle to try
• 10:07to achieve the best health
• 10:08possible for all of our
• 10:10patients and for our communities.
• 10:12So I think health equity
• 10:13is all of our business.
• 10:15So I've always been very
• 10:16interested in health equity, but
• 10:18also in health disparities and
• 10:19and the role of the
• 10:20health of health care workforce
• 10:22diversity.
• 10:23We know that in terms
• 10:24of disparities that,
• 10:27this is this is, twenty
• 10:28nineteen to twenty twenty one.
• 10:30One of the one of
• 10:31the,
• 10:33results of the COVID pandemic
• 10:35was that everybody
• 10:36everybody's life expectancy dropped no
• 10:38matter what,
• 10:39your racial and ethnic background,
• 10:41but that, certain groups,
• 10:45were especially hard hit,
• 10:47and,
• 10:49that,
• 10:51African American and and especially
• 10:53American Indian, Alaska native groups
• 10:55were especially hard hit and
• 10:57were starting from a baseline
• 10:58that was already compromised.
• 11:00We know that there are
• 11:01differences in infant mortality rates,
• 11:03how many babies die in
• 11:04the first year of their
• 11:05lives by race and ethnicity,
• 11:07and that African American babies
• 11:08are particularly
• 11:10hard hit as well,
• 11:12that the accident of your
• 11:13birth where you happen to
• 11:14be born in the country,
• 11:17is going is a contributor
• 11:19or an association to infant
• 11:21mortality that certain
• 11:23states, especially the states,
• 11:25certain southern states, and states
• 11:27in the Midwest like South
• 11:28Dakota
• 11:29have much higher infant mortality
• 11:30rates, which is disturbing.
• 11:34And that maternal mortality rates
• 11:36also vary by race and
• 11:37ethnicity. One of the upsetting,
• 11:39realities is that the maternal
• 11:40mortality rate across the board
• 11:42for all groups,
• 11:44has been going up. Although
• 11:45some of that may have
• 11:46been changes in the way,
• 11:48some of the statistics were
• 11:50collected, but still,
• 11:53especially African American moms were
• 11:55much more likely to die
• 11:56in that peripartum period.
• 11:59And that the the age
• 12:00adjusted death rates for adults,
• 12:03also varies by race and
• 12:04ethnicity. And,
• 12:07again, African Americans being most
• 12:09burdened by this,
• 12:11you know, very concerning higher
• 12:12age adjusted death rate and
• 12:14Latino,
• 12:15Latinos actually having a lower
• 12:17age adjusted death rate. And
• 12:18you can see that also
• 12:20Latinos in maternal mortality
• 12:23and in terms of,
• 12:25infant mortality actually have better
• 12:28better outcomes. That's something that's
• 12:30called the the Latino paradox
• 12:31or the Hispanic advantage.
• 12:34It's a kind of an
• 12:35anomaly in epidemiology
• 12:37that a group that has
• 12:40similar rates of low income
• 12:42and so forth
• 12:43still is not as adversely
• 12:46affected in in terms of
• 12:47some of the vital statistics
• 12:48findings.
• 12:49But the problem is that
• 12:50the longer in this country
• 12:52and the second generation, the
• 12:53numbers get worse. And so,
• 12:55it seems to be related
• 12:56in part to something that
• 12:57you also see with immigrants
• 12:58in general that that first
• 12:59generation immigrant,
• 13:02folks tend to be healthier.
• 13:04And then you and finally,
• 13:08infant mortality and maternal mortality
• 13:10are much higher
• 13:11in our country than in
• 13:14the other wealthy countries
• 13:16in the world. And so
• 13:18we spend more on health
• 13:19care than any other country
• 13:20in the world, and yet
• 13:21we don't get,
• 13:23our money's worth.
• 13:25The United States has much
• 13:27higher rates than than all
• 13:28these other high income and
• 13:30middle income countries.
• 13:31And,
• 13:35so the question becomes why.
• 13:37And I think we're all
• 13:38aware of the biopsychosocial
• 13:41model of health that,
• 13:43even though we spend a
• 13:43lot of time in premed
• 13:45and those first two years
• 13:46of medical school learn learning
• 13:48about the molecules,
• 13:49that a lot of where
• 13:50the rubber meets the road
• 13:51is, in the upper part
• 13:53of this,
• 13:56in the society, nation, locality,
• 13:58community,
• 14:00social determinants of health. And
• 14:02social and structural determinants,
• 14:05conditions of daily life are
• 14:06responsible for a major part
• 14:08of health inequities inequities both
• 14:10between and within countries. This
• 14:12is the WHO definition. And
• 14:14the distribution of power, income,
• 14:16goods, and services globally and
• 14:17nationally and the circumstances of
• 14:19people's lives, their access to
• 14:21health care, schools, and education,
• 14:22conditions of work and leisure,
• 14:24their homes, communities, towns, cities,
• 14:26all deeply affect
• 14:27their chances of leading a
• 14:28flourishing life.
• 14:30It
• 14:31it doesn't mean that what
• 14:32we do, our health care
• 14:34doesn't matter at all, but
• 14:36probably it's a pretty small
• 14:38fraction
• 14:39of what ends up on
• 14:41the on the,
• 14:43in the end in terms
• 14:44of
• 14:45mortality and morbidity. So WHO
• 14:48had a big meeting in,
• 14:52in the twenty ten around
• 14:54twenty ten where they made
• 14:56a schematic
• 14:57looking at kind of upstream
• 14:58and downstream,
• 15:00social and structural determinants, where
• 15:01upstream there are things like
• 15:03the socioeconomic
• 15:04and political context, governance, macroeconomic
• 15:07policies, social policies, public policies,
• 15:09and then and cultural and
• 15:10societal values. And then downstream,
• 15:13some the socioeconomic
• 15:15position that a person might
• 15:16have, their social class, gender,
• 15:18ethnicity,
• 15:19with racism and a little
• 15:21parenthesis,
• 15:22education, occupation, income, and then
• 15:24downstream more the material circumstances
• 15:26that people are living in,
• 15:28their behaviors and biological factors
• 15:30and psychosocial factors
• 15:31with the health system playing
• 15:33a role and social cohesion
• 15:34and social capital playing a
• 15:36role, and all of these
• 15:37things impacting equity in health
• 15:39and well-being. So it's a
• 15:41complicated
• 15:42model, but I didn't think
• 15:43it was complicated enough. So
• 15:44I annotated it because I
• 15:46felt that,
• 15:48it didn't necessarily,
• 15:49you know, reflect
• 15:51so many of the other
• 15:52issues.
• 15:53I mean, they were trying
• 15:54to make it more simple.
• 15:54I made it more complicated.
• 15:55First of all, I felt
• 15:56that especially in our country,
• 15:58the the the role of
• 15:59racism and the history of
• 16:01racism and how that reverberates
• 16:03down the years in terms
• 16:05of the structural determinants really
• 16:07needed to be more prominent.
• 16:09But,
• 16:10how history and colonialism
• 16:12and slavery and how the
• 16:13the indigenous are treated,
• 16:15the history of of genocide
• 16:16against indigenous people,
• 16:18wasn't explicit,
• 16:20in terms of our country,
• 16:22the the phenomenon of what
• 16:24happens with political representation
• 16:26and or disenfranchisement.
• 16:28And then what I tell
• 16:29the students, like, the most
• 16:30boring thing of all, tax
• 16:32policy.
• 16:33But, like, what's more boring
• 16:34than that? But, actually, tax
• 16:35policy is, like, so important
• 16:37because,
• 16:38when you when you you
• 16:39know, in terms of having
• 16:41an equitable tax system and
• 16:43having the funds to actually
• 16:45provide a social safety net,
• 16:46it's really not boring at
• 16:47all.
• 16:48In addition,
• 16:50the their model didn't really
• 16:52explicitly address
• 16:54environmental and climate issues, which
• 16:56are more and more prominent
• 16:57now. We were seeing that,
• 16:59you know, everywhere is being
• 17:00affected by those. It didn't
• 17:01explicitly talk about the criminal
• 17:03legal system and the role
• 17:05of incarceration. We know that
• 17:07especially young men of color
• 17:08are much more likely to
• 17:09be incarcerated, have some role,
• 17:12some involvement with the with
• 17:13the
• 17:14criminal justice system and thus
• 17:16and then end up being
• 17:17unemployable
• 17:18and and so forth.
• 17:20The role of police violence,
• 17:21not only in terms of,
• 17:25you know, police
• 17:27deaths in police custody, but
• 17:28also what the impact that
• 17:30is in terms of the
• 17:31trust in,
• 17:33the policing system.
• 17:34It didn't really include,
• 17:37content around immigration and refugee
• 17:39policy. And, of course, right
• 17:40now, we're seeing how that
• 17:41is front and center in
• 17:42the in the in the
• 17:44national discourse
• 17:45and how that can reverberate
• 17:47to affect everything else.
• 17:49It didn't really explicitly talk
• 17:51about gender and gender identity
• 17:52and sexuality
• 17:53and how,
• 17:55sexual and gender minorities may
• 17:57especially burdened
• 17:59by lower access to care
• 18:00and potential discrimination in the
• 18:02health care setting. Didn't really
• 18:04explicitly talk about corporate actions.
• 18:06Of course, many corporations have
• 18:08positive impacts on lots of
• 18:09things, but there have been,
• 18:10you know, like, the opioid
• 18:11epidemic and the
• 18:13misbehavior of,
• 18:15and misdeeds of, pharmaceutical companies
• 18:17and other things may may
• 18:19especially
• 18:20harm health.
• 18:21It didn't really talk about
• 18:22the distribution
• 18:23of wealth
• 18:24and and the presence or
• 18:26absence of an economic safety
• 18:27net. And then on the,
• 18:30the built environment.
• 18:32And then on the,
• 18:34on the bottom right, I,
• 18:35you know, didn't say explicitly
• 18:37what some of the issues
• 18:38are in the health care
• 18:39system. How
• 18:40accessible is care? Is there
• 18:43insurance or lack thereof or
• 18:44kind of partial insurance? And
• 18:46we know that even Medicare
• 18:47is, like, kind of partial
• 18:48insurance because,
• 18:50elderly people still have trouble
• 18:51paying for their health care.
• 18:53How the health care system
• 18:54is structured. Is it primary
• 18:56care focused? Obviously, I'm preaching
• 18:57to the converted here.
• 18:59But,
• 19:00but, you know, in general,
• 19:02when you look at, countries
• 19:03that have more
• 19:07resources placed in the primary
• 19:08care setting and there are
• 19:09more primary care focused,
• 19:11all outcomes are better.
• 19:14It didn't really,
• 19:16you know, mention something like
• 19:18cultural and linguistic competence and
• 19:20how
• 19:20how able a health care
• 19:22system is to take care
• 19:23of people from varied backgrounds
• 19:24and languages,
• 19:26how community engaged
• 19:28that health care system is,
• 19:29how patient centered that care
• 19:31is,
• 19:32what the quality of the
• 19:33health care is. We know
• 19:34that there is huge variability
• 19:36in quality and safety,
• 19:38within systems and among systems,
• 19:42and then,
• 19:43and health care workforce diversity.
• 19:45It didn't really
• 19:47say explicitly what happens in
• 19:49that room with the doctor
• 19:50and health care provider and
• 19:52the patient and how issues
• 19:54of trust
• 19:55and potential bias,
• 19:58you know, usually unconscious,
• 20:00might impact
• 20:01what happens to that patient.
• 20:03And then it's and then
• 20:04I I wanted to throw
• 20:05in here some protective factors
• 20:06because a lot of this
• 20:07stuff is sad and difficult.
• 20:10What is it, despite all
• 20:11odds, that actually keeps people
• 20:13going? What what are some
• 20:14of the things that protect
• 20:15you? Well, social cohesion, arts
• 20:17and culture,
• 20:18faith and self help groups,
• 20:20advocacy and empowerment,
• 20:22traditional healing as a as
• 20:23an adjunct to medical care.
• 20:25And then what happens in
• 20:27in medical research? Who's deciding
• 20:29what's on the agenda and
• 20:30what isn't? And that's actually
• 20:31I made this slide way
• 20:32before twenty twenty five, but
• 20:34that's even more pertinent now.
• 20:36Is and is medical research
• 20:37actually happening in an unfettered
• 20:39way?
• 20:41So we know that we're
• 20:42a more we're a diverse
• 20:43country, but that in a
• 20:44few years, we're gonna be
• 20:45even more diverse. We're gonna
• 20:47be a majority minority country.
• 20:49And, we know that also
• 20:51we have very
• 20:53intense
• 20:54differences
• 20:55in
• 20:56wealth. And so we're right
• 20:57now, we are in our
• 20:58most unequal
• 21:00wealth
• 21:01moment for the last hundred
• 21:03years,
• 21:04since the gilded age. And,
• 21:06and that that wealth
• 21:08varies a lot by race
• 21:10and ethnicity. And so, annual
• 21:11income is different.
• 21:13But, median net worth, I
• 21:14think, actually has even more,
• 21:17striking,
• 21:20you know, image
• 21:21where white families are much
• 21:22more likely to have much
• 21:23more median net worth. So
• 21:25that's usually the the value
• 21:26of your home
• 21:27or your, like, savings or
• 21:29your retirement account.
• 21:31But you can see that
• 21:32for Latin Latin Latino and
• 21:35and African American folks, it's
• 21:36you know, the median net
• 21:37worth of family is maybe
• 21:39like the worth of a
• 21:40used car. That speaks to
• 21:41the lack of a safety
• 21:42net. If something goes wrong,
• 21:43if you lose your job,
• 21:44if you get sick, how
• 21:45much of a safety net
• 21:46do you have?
• 21:48Or is everything a catastrophe?
• 21:51So
• 21:52I mentioned health care workforce
• 21:53diversity, which is one of
• 21:54my interests. And,
• 21:55African Americans and Latinos are
• 21:57among the groups that are
• 21:58underrepresented in medicine,
• 22:00where whereas,
• 22:02African Americans are about twelve
• 22:03percent of the US population,
• 22:04Latinos around eighteen percent.
• 22:07The
• 22:08the, you know, we make
• 22:10up only about five percent
• 22:12of,
• 22:13physicians in the country
• 22:15and only about four percent,
• 22:17four to five percent,
• 22:18of the academic medicine faculty.
• 22:21And so,
• 22:23you know, the lack of
• 22:24a racially and ethnically diverse
• 22:26health care workforce is both
• 22:27of a result of and
• 22:29a contributor to health disparities
• 22:32and a result of also
• 22:33the lack of access to
• 22:34educational opportunity and,
• 22:37and so forth.
• 22:38But some of the benefits
• 22:39of a diverse workforce include
• 22:41serving the underserved.
• 22:42Minority physicians are more likely
• 22:44to practice primary care. And
• 22:45in twenty fourteen,
• 22:47a study was published that
• 22:49showing that physicians of color
• 22:50cared for over half of
• 22:52minority patients and seventy percent
• 22:54of non English speaking patients
• 22:55in the country. So a
• 22:57big part of the health
• 22:58care safety net serving,
• 23:00the underserved.
• 23:03That trust in minority physicians
• 23:05by minority patients was associated
• 23:07with better outcomes.
• 23:08And minority patients may prefer
• 23:10to choose minority physicians and
• 23:12are and tend to be
• 23:13more satisfied when care is
• 23:15provided by a physician of
• 23:16color. Now that that is
• 23:18not to say that I
• 23:19think that racial and ethnic
• 23:20concordance in all physician patient
• 23:22dyads is either
• 23:24possible or desirable.
• 23:26But,
• 23:27there may be patients that
• 23:28may benefit
• 23:30from that concordance.
• 23:32And what we also know
• 23:33from lots of literature and
• 23:34the business literature and education
• 23:36literature and in the health
• 23:37literature
• 23:38is that,
• 23:39diverse groups tend to make
• 23:41better decisions. And we are,
• 23:43of course, in medicine,
• 23:44a team sport. And so
• 23:46that,
• 23:47having that input from people
• 23:49from with lots of different
• 23:50perspectives
• 23:51is more likely to get
• 23:53us to
• 23:55to the to good answers.
• 23:58So when what we,
• 24:00established the Cornell Center for
• 24:01Health Equity in,
• 24:03about twenty seventeen and we're
• 24:04thinking about our our place,
• 24:06New York City,
• 24:08what we what we learned,
• 24:11in looking at some of
• 24:12the data is that even
• 24:13though we're, you know, a
• 24:14progressive city in a blue
• 24:16state, we actually have the
• 24:17most highly segregated educational system
• 24:19in the country,
• 24:21largely because of intense residential
• 24:23segregation
• 24:24and that there are really
• 24:25significant educational disparities in elementary
• 24:28school and higher
• 24:30going through, higher education.
• 24:33We know that,
• 24:34you know, the National Academy
• 24:36of Sciences has identified institutionalized
• 24:38racism as a barrier to
• 24:39minority success in higher education,
• 24:42and that,
• 24:44you know, there's data
• 24:45showing that admissions committee members
• 24:47have been found to have
• 24:48implicit bias,
• 24:50that application
• 24:51test and prep fees are
• 24:53barriers,
• 24:54especially for minority students who
• 24:55are more likely to be
• 24:56from low income backgrounds,
• 24:58and that at least in
• 24:59medicine, matriculation
• 25:00numbers for African American men
• 25:01have fallen below those from
• 25:03thirty five years ago. So
• 25:04it's not just that we're
• 25:05stagnant.
• 25:06In some ways, we're actually
• 25:08getting worse.
• 25:09Minority medical students,
• 25:12face bias in course grading,
• 25:15and and name mistreatment,
• 25:17microaggressions,
• 25:18isolation,
• 25:19racial bias, prejudice,
• 25:21and discrimination.
• 25:22And the imposter syndrome as
• 25:24con contributors to mental health
• 25:25disorders,
• 25:26PTSD, and burnout,
• 25:28in various studies.
• 25:31In terms of mentoring, few
• 25:32proven models from for successful
• 25:35mentoring programs,
• 25:37especially for, URM folks.
• 25:39But we know, of course,
• 25:41that mentoring is really important
• 25:42in professional development. It may
• 25:43be less accessible to minorities,
• 25:45to women as well.
• 25:47And female and minority mentees
• 25:49may prefer concordant mentors. Although,
• 25:52one of the things that
• 25:52we are we teach is
• 25:54that it's great to have
• 25:55a team of mentors of
• 25:56lots of different backgrounds,
• 25:58and that that can help
• 25:59to close some of those
• 26:00gaps.
• 26:02And
• 26:02minority faculty have higher attrition,
• 26:05are less likely to be
• 26:06promoted in academic medicine.
• 26:09They they report a paucity
• 26:10of mentors,
• 26:12promotion bias,
• 26:13may have high educational debt,
• 26:15which may make it harder
• 26:16to stay in the academic
• 26:17setting where,
• 26:19sadly, we get paid less,
• 26:21may have disproportionate
• 26:23responsibilities
• 26:23known as the minority tax,
• 26:26and can and have sometimes
• 26:28reported feeling invisible to colleagues
• 26:30or experiencing
• 26:31racial bias or less access
• 26:33to networking.
• 26:34So all of that data
• 26:36contributed to our wanting to
• 26:38design,
• 26:39a diversity
• 26:41center of excellence,
• 26:42application to HRSA, which you
• 26:44heard we we we received,
• 26:47which we were pretty excited
• 26:48about.
• 26:49We as part of our
• 26:50Cornell Center for Health Equity
• 26:51work. So our Cornell Center
• 26:53for Health Equity's mission is
• 26:54to achieve health equity in
• 26:56local, national, and global communities
• 26:58through partnerships
• 26:59for across campus collaborative research,
• 27:02education, service, and advocacy. And
• 27:03it's up upstate, downstate.
• 27:05You know, our medical school
• 27:06is in Manhattan, but our,
• 27:08obviously, our college is up
• 27:09in Ithaca.
• 27:12And we,
• 27:14we wanted our diversity center
• 27:16of excellence to be the
• 27:17educational
• 27:18part of things. It's university
• 27:20wide. There's a research core,
• 27:21an education core, community education
• 27:23core.
• 27:24And, Monica Safford is our,
• 27:27this is when we got
• 27:28our money because he were
• 27:29pretty psyched.
• 27:31And, we were having our
• 27:32first retreat,
• 27:33of our
• 27:35faculty, students, residents to help
• 27:37us plan
• 27:40our all of our different
• 27:41activities.
• 27:43So as was mentioned, we
• 27:44got, a big grant. And
• 27:46it's really it was a
• 27:46collaboration between us, the dean's
• 27:48office, the department,
• 27:50New York Presbyterian,
• 27:52philanthropy,
• 27:54and donations of time and
• 27:55effort, of course, from many
• 27:56faculty.
• 27:58We,
• 28:00and we just we developed
• 28:01a whole series of programs.
• 28:04First of all, premedical programs
• 28:06for high school students, including,
• 28:08the
• 28:09the, our our students and
• 28:11residents had founded an organization
• 28:13called Black and Latino men
• 28:14in medicine to try to
• 28:15address the issue of the
• 28:17poor representation,
• 28:18although it's not only for
• 28:19for men, but,
• 28:21but to try to sort
• 28:22of augment exposure for for
• 28:25young guys.
• 28:26And,
• 28:27so we they have a
• 28:28a pipeline program,
• 28:30for for young high school
• 28:32students.
• 28:34We also wanted to support
• 28:36a a program called a
• 28:37trip that our MET students
• 28:38run, and
• 28:39we,
• 28:40worked with,
• 28:42the Fordham
• 28:43University,
• 28:45STEM program
• 28:46with their high school and
• 28:48college students. This is the
• 28:49Black and Latino men in
• 28:50medicine trip to the African
• 28:52American Museum in Washington.
• 28:55We decided that,
• 28:56you know, we have a
• 28:57lot of colleges in New
• 28:58York,
• 28:59and I was sort of
• 29:00scratching my head. Why is
• 29:01it and a lot of
• 29:02kids of color go there,
• 29:03but they're not necessarily applying
• 29:04to medical school. So we
• 29:05wanted to link to several
• 29:07of the colleges locally.
• 29:09So we made a a
• 29:10linkage program with six schools,
• 29:13and we added slots to
• 29:14an existing successful program for
• 29:16minority pre meds or minority
• 29:18and underserved, it's not only
• 29:20for minority students, the Traveler
• 29:22Summer Research Fellowship.
• 29:23And we devised a careers
• 29:25in medicine
• 29:26enhancement program for the kids
• 29:28from our,
• 29:30from our linkage schools,
• 29:32which is eight week virtual
• 29:34program,
• 29:35where they focus on health
• 29:37equity, but also on career
• 29:38development and and make capstone
• 29:40presentations and capstone projects,
• 29:43learn about the the med
• 29:45school interview process, practice writing
• 29:47their essay,
• 29:48and have mentors who are
• 29:50physicians
• 29:51who and medical students that
• 29:53volunteer to mentor them.
• 29:55And this is one of
• 29:57our first classes.
• 29:58For medical students, we, it's
• 30:00actually the mentoring cascade, one
• 30:02of my it's one of
• 30:02my favorite programs. It's actually
• 30:03for med students, residents, fellows,
• 30:05and faculty. It's a team
• 30:06based mentoring program, and we
• 30:08meet several times a year.
• 30:10It's for minority and non
• 30:12minority,
• 30:13folks,
• 30:14but it is there is
• 30:16content related to diversity and,
• 30:19but also that idea of,
• 30:20like, developing your mentoring team
• 30:21and how do you develop
• 30:22your your action plan, and
• 30:24how do you be a
• 30:25good how do you to
• 30:26learn how to be a
• 30:26good mentee as well as
• 30:27a good mentor.
• 30:29And during the pandemic, we
• 30:31had to go virtual, and
• 30:32a lot of our focus
• 30:33was around support and sort
• 30:35of survival
• 30:36since they were especially our
• 30:37poor med students were very
• 30:39lonely,
• 30:40and so forth. So it's
• 30:41gone through many, different
• 30:44formats.
• 30:45We had community engagement
• 30:47with,
• 30:48the Women's Housing Economic Development
• 30:50Corporation
• 30:51Charter School in the South
• 30:52Bronx.
• 30:53You can see our little
• 30:54future doctors. They're pretty adorable.
• 30:56We, contributed to our school's
• 30:59work in, expanding cultural competence
• 31:01and health equity training for
• 31:02our med students and worked
• 31:04with our affinity groups like
• 31:05SNMA and LMSA and our
• 31:07LGBTs
• 31:08groups and our and others.
• 31:11And we supported medical student
• 31:12research and community engagement
• 31:14projects
• 31:15with providing funding.
• 31:17On the GME side,
• 31:19we
• 31:20we made what had been
• 31:21a department of medicine program,
• 31:22a hospital wide program,
• 31:24called make your match
• 31:26for residency applicants to learn
• 31:28about our NYP programs.
• 31:30We go to recruit at
• 31:32our
• 31:33affinity,
• 31:34organizations, our SNMA and LMS
• 31:36Ames meetings,
• 31:37and we have,
• 31:39a welcome back for interviewees
• 31:41and a and a welcome
• 31:42new intern
• 31:43party.
• 31:46And then a bunch of
• 31:47programs in faculty development. So,
• 31:49we had first, probably the
• 31:51most important one is our
• 31:53health equity research fellowship, which
• 31:55is in collaboration with Hunter
• 31:56College, which is part of
• 31:57our City University system.
• 32:00And
• 32:02it is a,
• 32:04it's not only for physicians,
• 32:06although largely physicians, but also,
• 32:09psychologists
• 32:10and,
• 32:12and PhD nurses and nurse
• 32:13practitioners,
• 32:14focused on health equity. We
• 32:16developed a program called the
• 32:17faculty development mentoring circles, which
• 32:19is, kind of a peer
• 32:20near peer mentoring program for
• 32:22interdisciplinary,
• 32:26faculty,
• 32:28and was a collaboration between
• 32:29our office of
• 32:31diversity and inclusion, our department,
• 32:33and the DCOE.
• 32:35And then we made something
• 32:36called the scholars in health
• 32:37equity program. When we had
• 32:38education scholars and research scholars,
• 32:41they had to apply. It's
• 32:42competitively selected.
• 32:44Our education scholars
• 32:46program has gone through five
• 32:48cohorts of about, six to
• 32:50eight people per year. And
• 32:51these are these are mainly
• 32:52clinician educators
• 32:54that of various departments
• 32:56that wanted to,
• 32:57learn
• 32:58about how to lead and
• 33:00and,
• 33:01provide culturally responsive
• 33:03anti racist patient care and
• 33:05teach about that and how
• 33:06to integrate that into their
• 33:07teaching. So we have program
• 33:09directors that have done it,
• 33:10clerkship directors, and so forth,
• 33:13but also to promote career
• 33:15development and medical education leadership.
• 33:16This is an interracial
• 33:18multidisciplinary
• 33:19program. Our our our concept
• 33:21was that, you know, again,
• 33:23health equity is everybody's mission.
• 33:25And a lot of people
• 33:26were interested in the issues
• 33:27but wanted to figure out
• 33:28how do I integrate it
• 33:29into my teaching while I
• 33:31also have to like, we
• 33:32were talking about with the
• 33:33residents today, but I also
• 33:34have to teach about the
• 33:35sodium and and all the
• 33:36other stuff.
• 33:38So they would have a
• 33:39monthly two hour group didactic
• 33:41meeting over a year,
• 33:43and,
• 33:44had guest expert lecturers. They
• 33:46would do written work, and
• 33:47they would have a mentored
• 33:48capstone project.
• 33:50And our outcomes included,
• 33:53you know, joining various of
• 33:55the education committees,
• 33:57awards,
• 33:58you know, winning medical education
• 34:00awards, becoming course directors,
• 34:03and so forth.
• 34:06The research scholars in health
• 34:08equity,
• 34:09program
• 34:10had sixteen
• 34:11faculty participants. Again, multiracial, multidisciplinary.
• 34:14These are mentored research projects.
• 34:16These are mini grants from
• 34:18between five to twenty thousand
• 34:21dollars to, you know, sort
• 34:22of pilot studies
• 34:23to help them hopefully go
• 34:25on to,
• 34:27obtain additional funding. And they
• 34:28would have, monthly research and
• 34:30progress meetings.
• 34:32And then COVID happened, and
• 34:35we got another it was
• 34:36sort of like, here's a
• 34:37check for a hundred fifty
• 34:38thousand dollars. What are you
• 34:39gonna do with it? And
• 34:40so we decided to make,
• 34:43more mini grant programs focused
• 34:45on on COVID nineteen health
• 34:47equity. So we made a
• 34:48faculty student research collaborative
• 34:51set of grants,
• 34:53which,
• 34:54so for example, Chris Gonzalez,
• 34:56one of our junior faculty
• 34:57of one of our former,
• 34:58health equity fellows,
• 35:01studied social distancing amongst Hispanic
• 35:03communities during the COVID nineteen
• 35:04pandemic.
• 35:05We,
• 35:07we had telehealth
• 35:08COVID nineteen innovation because everybody
• 35:10was suddenly having to do
• 35:12telehealth
• 35:13and academic community partnership,
• 35:15mini grants.
• 35:17And then, again, COVID came,
• 35:19and this was obviously not
• 35:20in the grant application that
• 35:22I had submitted before the
• 35:23pandemic, but a lot of
• 35:24our attention
• 35:25turned to COVID nineteen vaccination.
• 35:30We,
• 35:31you know, I have to
• 35:32admit, I was so excited
• 35:34to get my vaccine.
• 35:35I, you know, I was
• 35:36working in the hospital during
• 35:37COVID as, you know, in
• 35:38New York City. Like, it
• 35:40was we were the first
• 35:41city hit in in the
• 35:42states, and our hospital was
• 35:44one hundred percent COVID. It
• 35:45was a nightmare.
• 35:47Like, literally, every single bed
• 35:48was COVID.
• 35:50And,
• 35:51when the vaccine came, I
• 35:53would have to admit I
• 35:54was not expecting the fear
• 35:55that people were experiencing and
• 35:57the hesitancy.
• 35:58So many of us,
• 36:00got in got together within
• 36:02our institution, but also with
• 36:03New York City's Department of
• 36:04Health and various New York
• 36:06City medical schools coming together,
• 36:08especially to do
• 36:10to talk about, access, to
• 36:12advise about,
• 36:14the DOH's messaging
• 36:15and things like that. But
• 36:17we just, you know, we
• 36:18were
• 36:19If you think back to
• 36:19that time when we were
• 36:20all in lockdown and feeling
• 36:21pretty helpless,
• 36:23we decided, like, over, like,
• 36:25two weeks to come up
• 36:26with something that we called
• 36:27the COVID-nineteen
• 36:29STEM community education and empowerment
• 36:31internship.
• 36:32And we, you know, we
• 36:32thought we felt like we're
• 36:33working with all these young
• 36:34people. They're all on lockdown,
• 36:36and
• 36:37a lot of them wanna
• 36:38be doctors or somebody in
• 36:40health something in health. And
• 36:42so we decided to, like,
• 36:43put the word out in
• 36:44in their networks and social
• 36:46media, and we got eight
• 36:46hundred applicants in one week.
• 36:48And we decided to take
• 36:49everybody.
• 36:51And so we made that's
• 36:52the amazing thing you can
• 36:53do with Zoom. We also
• 36:55did vaccine,
• 36:56education ambassador training
• 36:59with our colleagues. But the
• 37:01and and worked with a
• 37:03whole bunch of community organizations.
• 37:04This is me with,
• 37:06with my little patients and
• 37:08their church in Brooklyn.
• 37:10We also,
• 37:12were on PBS Metro Focus
• 37:13talking about some of our
• 37:14efforts.
• 37:15And we're working with RWJ
• 37:18in their the conversation
• 37:21looking again at, trusted
• 37:23trusted,
• 37:24messengers, physicians, nurses, and community
• 37:27health workers,
• 37:28to talk about,
• 37:30COVID vaccination.
• 37:31But the COVID nineteen education
• 37:33program,
• 37:34we've actually
• 37:36it was actually a collaboration
• 37:38between,
• 37:40our colleagues from our various
• 37:41medical schools around the city,
• 37:43all buddies of mine.
• 37:45And, this is picture of
• 37:47one of our kids. Our
• 37:48guest speakers included certain public
• 37:50health leaders. Doctor Fauci actually
• 37:52sent a message, and these
• 37:54kids went wild.
• 37:56And,
• 37:58the our impact, we over
• 37:59the first three cohorts, we
• 38:00ended up having five cohorts.
• 38:02But over the just the
• 38:03first three cohorts,
• 38:04we had over a thousand
• 38:06students. We asked them to
• 38:07report how many people have
• 38:08you talked to about COVID
• 38:10vaccination
• 38:11or have read your,
• 38:14capstones.
• 38:15So they, you know, they
• 38:17reported, like, thirteen thousand people,
• 38:19and they had that they'd
• 38:20reached, like, six thousand people
• 38:22on on,
• 38:24on social media. And they
• 38:25told us things like,
• 38:27they learned how to tangibly
• 38:29create items to educate on
• 38:30the vaccine in a way
• 38:31best suited for people who
• 38:32are skeptical or afraid,
• 38:34how to better advocate for
• 38:35ethnic and racial minorities.
• 38:37I learned that misinformation
• 38:38stems from lack of health
• 38:39literacy,
• 38:40and I love learning about
• 38:41this importance of COVID vaccines
• 38:43and how to be empowered
• 38:44to be a voice for
• 38:45my community. So they we
• 38:46asked them each to do
• 38:47capstone projects. So they made
• 38:49infographics
• 38:50like this
• 38:51or this
• 38:53and then,
• 38:55or TikToks.
• 39:01I don't know, Isaac, about
• 39:02the music.
• 39:06Anyway, it's not it's just
• 39:09cute music,
• 39:11and she's pretty adorable herself.
• 39:15Yeah.
• 39:18But it is definitely nicer
• 39:19with the music.
• 39:28Anyway, it's okay. Are you
• 39:29sure? Yeah. We're we're good
• 39:31in the interest of time.
• 39:32So,
• 39:34our funding,
• 39:36our funding interval ended, and,
• 39:38of course, I'm not actually
• 39:39even sure what's happening with
• 39:41the centers of excellence program
• 39:42at this minute.
• 39:43But the mission
• 39:45continues, I think, and we
• 39:46are still continuous, several of
• 39:48our programs, from our diversity
• 39:49center of excellence.
• 39:53But
• 39:54part of what doctor Black
• 39:56asked me to talk about
• 39:57and think about and hopefully
• 39:58that we can dialogue about
• 39:59is our new reality.
• 40:02So,
• 40:04we are obviously in a
• 40:05very challenging moment where federal
• 40:07policies regarding diversity, equity, inclusion,
• 40:10language, and efforts,
• 40:11especially those impact in minorities
• 40:13and immigrants and women and
• 40:15LGBTQ
• 40:16people
• 40:16are changing,
• 40:18where
• 40:19research funding has been cut
• 40:21across the board.
• 40:23Our institution at Cornell is
• 40:25one of the,
• 40:26one of the institutions that's
• 40:27kind of been attacked.
• 40:29And so we've been in
• 40:30a very serious
• 40:32financial
• 40:34bind.
• 40:35There have been a lot
• 40:36of challenges to academic autonomy,
• 40:40cuts to health agencies
• 40:42and up you know, cuts
• 40:43that are coming up to
• 40:44Medicaid and and the health
• 40:45care safety net that are
• 40:46very concerning in terms of
• 40:47our patients,
• 40:50challenges to establish science,
• 40:52for example, to vaccine science.
• 40:54Obviously, this week, we've had
• 40:56hearings related to this.
• 40:58And then aggressive immigration enforcement
• 41:01affecting many of our patients
• 41:02as well as colleagues
• 41:04and extreme partisan divisions that
• 41:06makes it really hard to
• 41:07even talk about this
• 41:09stuff. And what's happened in
• 41:10our institutions, there have been
• 41:11leadership changes,
• 41:13you know, university presidents that
• 41:14have lost their jobs.
• 41:17Legal challenges
• 41:18are afoot
• 41:19to challenge some of these
• 41:20changes, but,
• 41:22that's
• 41:23been, you know, varied in
• 41:25outcomes.
• 41:26On our in our institutions,
• 41:27there have been efforts to
• 41:29change language and scrub websites
• 41:31and try to stay under
• 41:33the radar.
• 41:35Like I mentioned, financial crises
• 41:36at our institution, we've already
• 41:38had layoffs and
• 41:40departures, very demoralized faculty and
• 41:42trainees. I think a lot
• 41:44of us have felt kinda
• 41:45paralyzed not knowing what to
• 41:47do. Part of it is
• 41:47because in in so many
• 41:50areas
• 41:51of our current world and
• 41:53our lives,
• 41:55there may be things happening
• 41:56that we don't agree with.
• 41:58And and then, of course,
• 41:59that we may be experiencing
• 42:00moral injury in terms of,
• 42:02what we've what we are
• 42:04deciding.
• 42:05You know? What can I
• 42:06do? What does this compromise
• 42:07my integrity? How do I
• 42:09address this? Is doing nothing
• 42:11collaboration?
• 42:12And then a lot of
• 42:13fear.
• 42:14People are afraid to speak
• 42:15out
• 42:17and
• 42:19and don't wanna get in
• 42:20trouble and don't wanna get
• 42:21their institution in trouble, but
• 42:22also feel strongly
• 42:24about
• 42:25lots of things. And how
• 42:26do you even know to
• 42:27begin? So,
• 42:29so where do we go
• 42:30from here? And and Abba
• 42:31asked me to, you know,
• 42:33be inspirational. I have to
• 42:34admit I mean, just I
• 42:35I didn't say this at
• 42:36the beginning, but I've been
• 42:37very I I give talks
• 42:38all the time, but I've
• 42:39been very anxious
• 42:41about
• 42:42this talk partly because I
• 42:44felt like I don't have
• 42:45the answer here.
• 42:47And I don't think any
• 42:48of us have the perfect
• 42:49answer. There's a lot of
• 42:50unknowns. There's a lot of
• 42:52uncertainty.
• 42:53It's very stressful time. There's
• 42:55it's really hard for people
• 42:56to agree on stuff.
• 42:59But,
• 43:00some of the stuff that
• 43:00I came up with at
• 43:01least that maybe can help
• 43:03center us and and,
• 43:05think through this is I
• 43:07do feel like we need
• 43:08to recommit to our values.
• 43:10So if you really think
• 43:11it's important to, like, that
• 43:13disabled people should still have,
• 43:14you
• 43:15know, health care or, you
• 43:16know, that,
• 43:18that our institutions
• 43:19should welcome everyone
• 43:21to education,
• 43:23those are some important values.
• 43:25I do feel like it's
• 43:26important for us to speak
• 43:27the truth and not feel
• 43:28like we have to hide
• 43:29our our views,
• 43:31especially when it's
• 43:33related to things about science
• 43:34and health because we have
• 43:36people's lives in our hands,
• 43:37and we have a certain
• 43:38responsibility
• 43:39to,
• 43:40to society.
• 43:42We will need to restore
• 43:43and rebuild. We're in a
• 43:44time where there's been a
• 43:45lot of destruction of, you
• 43:47know, government agencies,
• 43:50you know, people losing their
• 43:52research and whole research programs
• 43:54being killed. But, you know,
• 43:56at some point, I do
• 43:57feel like we will be
• 43:59we will some of this
• 44:00will pass, and we will
• 44:02need to think about what
• 44:03are we gonna restore,
• 44:04what are we gonna rebuild.
• 44:05And was it, like, perfect
• 44:07before, you know, last year?
• 44:09No. So what is our
• 44:11vision
• 44:12for the future? It shouldn't
• 44:14just be, like, let's just
• 44:15turn back the clock and
• 44:16have it be just like
• 44:17it was before. There were
• 44:18still problems, and we need
• 44:19to think about what can
• 44:20we do to make things
• 44:21better.
• 44:22And,
• 44:23to
• 44:24so
• 44:25some proposed strategies
• 44:27on the I think we
• 44:28need to think about things
• 44:29on the individual, institutional,
• 44:31organizational,
• 44:31and community levels
• 44:33and to ask some questions.
• 44:35And I felt like,
• 44:36it's a little Talmudic here.
• 44:38Just, you know, what is
• 44:39my North Star as an
• 44:40individual? You know, it really
• 44:41is thinking looking internally first.
• 44:44And what are my values
• 44:46and priorities? We cannot fight
• 44:47every single battle. We have
• 44:49to think about what's most
• 44:50important to me and what's
• 44:52also most strategic that I
• 44:53can actually accomplish something.
• 44:56And how can I stand
• 44:57up for what I believe
• 44:58is right as an individual?
• 45:01But then as institutionally,
• 45:03we have a community. And
• 45:04as you mentioned before, you
• 45:06know, I've spent a lot
• 45:06of time trying to build
• 45:08community to think about communities.
• 45:10And in academia, however imperfect
• 45:12sometimes our academic institutions are,
• 45:15they are our professional homes,
• 45:17and they are places that
• 45:19we care for. And so
• 45:20our you know, we have
• 45:21to think about what our
• 45:22institution's values, how what can
• 45:25our institution do to promote
• 45:27science and community health. And
• 45:29it may not have been
• 45:29doing, like, a perfect job
• 45:31in that even before. Right?
• 45:32Because I think that one
• 45:33of our challenges for us,
• 45:35is that we are in
• 45:36a little bit of an
• 45:37ivory tower, and we're really
• 45:38busy and we're, like, our
• 45:39nose to the grindstone, but
• 45:40we don't necessarily
• 45:42always do the outreach and
• 45:44the intersection
• 45:45with our communities and our
• 45:46community organizations.
• 45:48We don't always do a
• 45:49great job at explaining science
• 45:51and explaining,
• 45:53things to the general public.
• 45:55I think, you know, that's
• 45:57doing our our communities a
• 45:59disservice.
• 46:00We have to think about
• 46:01why diversity and equity are
• 46:02important to us and how
• 46:03we promote them, and how
• 46:05we can support our patients,
• 46:06our learners, and our trainees,
• 46:08and how we support our
• 46:09faculty and staff, especially at
• 46:10this time of such
• 46:13division and such
• 46:14depression.
• 46:15And then organizationally,
• 46:17what professional organizations
• 46:19am I involved with or
• 46:20could I be involved with?
• 46:22Because I think that there
• 46:23is a role for professional
• 46:24organizations
• 46:25in
• 46:27addressing a lot of these
• 46:28matters.
• 46:30Professional organizations
• 46:31may not have some of
• 46:32the constraints that universities have.
• 46:34They're not grant dependent.
• 46:36They are,
• 46:37they are independent entities, and
• 46:39and they are trusted
• 46:42messengers also in the society.
• 46:43I think that professional organizations,
• 46:45for example, have a big
• 46:46responsibility,
• 46:48you know, to,
• 46:50provide accurate vaccine information to
• 46:52the public
• 46:53so that,
• 46:55the right choices can be
• 46:56made. And I think we
• 46:57can think about how to
• 46:58influence and work with our
• 46:59organizations for collective impact. And
• 47:01then on the community level,
• 47:03what community organizations or efforts
• 47:05am I or can I
• 47:06become involved with? Because
• 47:08even if people are saying,
• 47:09oh, well, you know, you're
• 47:10not supposed to do this
• 47:11anymore, the problems aren't gonna
• 47:13go away. Babies are still
• 47:14dying in the first year
• 47:15of their life. People are
• 47:16still chronically ill,
• 47:18and community
• 47:19want us to work with
• 47:20them. And we haven't necessarily
• 47:22always done
• 47:24the best that we could
• 47:25anyway. So this is an
• 47:26opportunity
• 47:27actually to go back to
• 47:28the basics.
• 47:30So are there organizations or
• 47:31efforts that I can support
• 47:32financially?
• 47:33Are there political organizations
• 47:35that may
• 47:36be be advocating
• 47:37for some of the things
• 47:39I think are important? And
• 47:40how can I participate in
• 47:41community education about science and
• 47:43to promote health careers and
• 47:45community health? If if young
• 47:47people aren't gonna have the,
• 47:48you know, adequate exposure,
• 47:50maybe we need to all
• 47:51have, you know, every division
• 47:52should have a pipeline program.
• 47:54I mean, I'm just saying
• 47:55for, like, just for kids
• 47:56of all backgrounds, just to
• 47:58get kids exposed and involved
• 48:00in STEM
• 48:01and excited about some of
• 48:03the things
• 48:04that we love.
• 48:05And then in terms of
• 48:06our own roles as advocates,
• 48:07kind of, you know, if
• 48:08you don't feel like you
• 48:09are know how to be
• 48:10an advocate, how can I
• 48:11get trained?
• 48:12Can my institution help train
• 48:14me in whatever it is?
• 48:15And how can I express
• 48:16my views? Should I be
• 48:17writing op eds? Should we
• 48:18be you know, what should
• 48:19we be doing?
• 48:21So final thoughts. We've we've
• 48:23faced adversity before.
• 48:25Our country, finally, after a
• 48:26bloody war, but finally did
• 48:28abolish slavery.
• 48:29It enfranchised women.
• 48:32We helped defeat Nazism.
• 48:34We enacted the Great Society's
• 48:36programs.
• 48:37We've done great things.
• 48:40Physicians and scientists eradicated
• 48:42smallpox from the from the
• 48:44globe
• 48:45and made HIV into a
• 48:46chronic disease and maybe something
• 48:47that we can eradicate in
• 48:49the future too. And we
• 48:50discovered COVID vaccines in a
• 48:52year.
• 48:53So,
• 48:55and our industry has our
• 48:57history has swung between progress
• 48:58and backlash. It's always been
• 49:00the story. There's progress, and
• 49:01then there's backlash.
• 49:04But as Martin Luther King
• 49:05said, the arc of the
• 49:06moral universe is long, but
• 49:08it bends towards justice. This
• 49:09is not gonna last forever.
• 49:10We can make it. So
• 49:12doctor Cine, going back to
• 49:13her,
• 49:14also recommended clear you know,
• 49:16clearly communicate the goals and
• 49:18the evidence for DEI and
• 49:19speak out against its dismantling,
• 49:21be sensitive
• 49:22to the toll on faculty
• 49:23trainees, and remain committed to
• 49:25science and justice. And I
• 49:26think that's good advice for
• 49:28all of us. And doctor
• 49:29Maybank, who's at the AMA
• 49:30now, but was a deputy
• 49:32commissioner of health in New
• 49:33York,
• 49:35who's really sacrificed a lot
• 49:36for her work in DEI,
• 49:38she wrote in another article
• 49:39in New York Journal. As
• 49:40DEI practitioners, we hold our
• 49:42values close and do this
• 49:43work because we love our
• 49:44families, our communities, ourselves, and
• 49:46humanity in general. In medicine,
• 49:47we are in the business
• 49:48of preventing death and saving
• 49:50lives. People are dying, and
• 49:51the moral imperative to acknowledge
• 49:52and honor the sanctity and
• 49:53miracle of life is a
• 49:55higher calling than serving any
• 49:57particular institution.
• 49:59I'll close with this. Doctor
• 50:00King,
• 50:01preparing for today made me
• 50:03go back to the basics.
• 50:04When I was an undergraduate,
• 50:05which I realize now was
• 50:07only ten years after Martin
• 50:08Luther King was killed,
• 50:10he his last book in
• 50:12the last year of his
• 50:13life,
• 50:14it was called Where Do
• 50:15We Go from Here, Chaos
• 50:16or Community?
• 50:17And he was you know,
• 50:19the country was in turmoil
• 50:21then. And, of course, he
• 50:22lost his life in part
• 50:23of that turmoil. But he
• 50:25wrote about building a multiracial
• 50:26coalition for civil rights,
• 50:28abolishing poverty for all. He
• 50:30was developing the Poor People's
• 50:31March,
• 50:33trying to develop that project,
• 50:35addressing militarism, opposing the war,
• 50:37the Vietnam War at the
• 50:38time. And he also wrote
• 50:39about dealing with backlash to
• 50:41progress.
• 50:42So I felt like it
• 50:44it it's ironic that this
• 50:45is now, you know,
• 50:47decades and decades ago.
• 50:49And but history is cyclic.
• 50:52So my my wish for
• 50:54all of us, and I
• 50:55felt like I was kinda
• 50:56bummed, and I
• 50:58how can I inspire? But
• 50:59it actually inspired me to
• 51:00think about this. To they
• 51:01want us to build community,
• 51:03envision the future. We can
• 51:05make things better.
• 51:06We can do this together.
• 51:10And that is the end.
• 51:18Thank you, Sunil. I was
• 51:19especially inspired by your final
• 51:21thoughts.
• 51:22Thank you for your spin
• 51:23up to New Haven to
• 51:24honor India, this Right. Any
• 51:26questions from the audience? I
• 51:28know there's about fifty people
• 51:29online as well. I
• 51:31understand you can speak up
• 51:32and ask questions if you'd
• 51:33like if you're online. Questions?
• 51:36I have a comment. Yes,
• 51:37Daniel. Yes. So I think,
• 51:38Jack, you know, it's really
• 51:39important for us to
• 51:42remind everyone that it's forty
• 51:44years since health disparities addressing
• 51:47health disparities became a national
• 51:49agenda.
• 51:50But I also think that
• 51:51in the midst of all
• 51:52of this, what I'm reminded
• 51:54of is that
• 51:56we, as researchers,
• 51:57have to do a better
• 51:58job
• 51:59in explaining
• 52:00our work and the impact
• 52:02to the broader society.
• 52:04Because if they understood
• 52:06the impact of what's going
• 52:08on, I think people feel
• 52:09on the street, but folks
• 52:10don't understand what we do.
• 52:13I agree. I I think
• 52:14that we we have you
• 52:16know, we don't do a
• 52:17good job necessarily at transmitting
• 52:19that information. And, of course,
• 52:20the way I look at
• 52:21issues of,
• 52:23health equity research and,
• 52:26and,
• 52:28you know, work on training
• 52:29young people and encouraging them
• 52:31to go to health careers,
• 52:33that benefits everyone.
• 52:35It's not something that only
• 52:36benefits
• 52:38some groups. It's you know?
• 52:40But
• 52:41just like
• 52:42you triage the most heavily
• 52:44injured person, you need to
• 52:46look at some of the
• 52:46people that are most heavily
• 52:48impacted to try to figure
• 52:49out how to help them.
• 52:51A lot I think that
• 52:51a lot of times, minority
• 52:52health is kind of the
• 52:53canary in the whole mind
• 52:54because,
• 52:56our patients that of color
• 52:58that are dealing with chronic
• 52:59disease and multiple medical problems,
• 53:02you know, I'm dealing with
• 53:02lots of social issues. You
• 53:04know, if we can learn
• 53:05how to improve their health,
• 53:06we're gonna be able to
• 53:07improve everybody's health because we're
• 53:09gonna learn from those lessons.
• 53:12Yeah. Yeah.
• 53:14I was just gonna say,
• 53:15I have a comment to
• 53:16say thank you, Ava and
• 53:17Patrick, for creating this space
• 53:19and you're so excited for
• 53:21being here because this is
• 53:22part of building community to
• 53:24be able to have a
• 53:25space
• 53:25to have these conversations.
• 53:27Because in many places,
• 53:29these are not open.
• 53:30In fact, when I was
• 53:31coming here, people were asking
• 53:33me if, if this was
• 53:34still happening and who is
• 53:35still calling a DEI.
• 53:37So it is we're in
• 53:39a very different difficult space.
• 53:41And one of the things
• 53:42I'm going to say added
• 53:43to the
• 53:46individual level is that we
• 53:47need to pay attention to
• 53:48the to our,
• 53:51health and and well-being
• 53:53in order for us to
• 53:54keep
• 53:55doing this work in this
• 53:56space. And that this also
• 53:58shall pass. We'll be in
• 53:59a better place as we
• 54:01continue to work together
• 54:02as a community.
• 54:04Health care,
• 54:05super important.
• 54:08Alana.
• 54:09I was just reflecting on
• 54:11this idea of
• 54:13communicating about the value of,
• 54:15you know, the the work
• 54:17that we do. And I
• 54:17I guess I wanted to
• 54:18maybe push back on it
• 54:19a little bit because
• 54:21I'm not sure that it
• 54:22is really a problem of
• 54:23information.
• 54:23Like,
• 54:24vaccines are maybe a good
• 54:25example of how we have
• 54:27really good information, and yet,
• 54:28like, that doesn't convince people.
• 54:31And, really, it seems more
• 54:33a question of,
• 54:35belief, emotion,
• 54:37values, culture.
• 54:38And, like, do you have
• 54:39any thoughts about how to
• 54:40get at those things? It
• 54:40seems so much harder to,
• 54:43I don't know, influence.
• 54:44Yeah.
• 54:47And I didn't I realized
• 54:49I hardly mentioned,
• 54:50except for using the word
• 54:52TikTok,
• 54:53social media. So we are
• 54:54in a different time in
• 54:56terms of information,
• 54:57how it's how it's disseminated,
• 55:00how the potential for misinformation
• 55:04that's out there. And I
• 55:05agree with you.
• 55:07There's,
• 55:10a lot of emotion that's
• 55:11at play. But I that
• 55:13said, though, I do feel
• 55:15that
• 55:18there hasn't
• 55:19I do feel like people
• 55:21you know, not everyone is
• 55:23gonna respond to everything that
• 55:24we do. But I think
• 55:25that there is a group
• 55:26of people that potentially
• 55:28can,
• 55:30resonate with
• 55:31personal outreach. I think that's
• 55:33one of the ways.
• 55:35But even not personal. Like,
• 55:37you know, what we experienced
• 55:38with our with our COVID
• 55:40students, obviously, they're predisposed to
• 55:41be interested in science. But
• 55:43still, these were, like, lay
• 55:44kids. They're they were young.
• 55:46Many of them,
• 55:49then went on to
• 55:51educate their families. And one
• 55:52of the things that happen
• 55:54every week, especially in the
• 55:55beginning when the vaccines first
• 55:56came out, it was like,
• 55:57I took my whole family
• 55:58to get the vaccine, and
• 56:00I convinced so and so.
• 56:01You know? So I think
• 56:02that,
• 56:03you know,
• 56:05there's a potential to disseminate
• 56:07some of these
• 56:08things
• 56:09in ways that we don't
• 56:10even expect.
• 56:12And,
• 56:14but there haven't really been
• 56:16a lot of interfaces
• 56:18between us and community organizations
• 56:21or community groups.
• 56:23And I think I think
• 56:24we could do better.
• 56:27Thank
• 56:28you so much for coming
• 56:29here and inspiring us.
• 56:31I really liked
• 56:33the the the and and
• 56:34congratulations on what you do,
• 56:36you know, in your community
• 56:37at Cornell at so many
• 56:38levels. I liked how you
• 56:41you end on an optimistic
• 56:42note. Right? And I I
• 56:43think
• 56:45some of us may struggle,
• 56:47right, with that, but I
• 56:49I I I I take
• 56:50to heart that we need
• 56:51to speak up.
• 56:53How do we inspire that
• 56:55optimism
• 56:56and and the belief that
• 56:58we can do better in
• 56:59our trainees?
• 57:00And then what you just
• 57:01said, how
• 57:02in our communities
• 57:04where our patients now might
• 57:05be scared
• 57:06to even see us because
• 57:08of
• 57:09ice and and and and
• 57:10and and fear. How do
• 57:12we reach that to to
• 57:15also convey
• 57:17those possibilities and that thought
• 57:19of autism?
• 57:21Thanks for that question. So
• 57:22first of all, in terms
• 57:23of,
• 57:24inspiring our trainees,
• 57:28you know, I I have
• 57:29found even though, you know,
• 57:30we all complain,
• 57:32I have found that actually
• 57:34being engaged in patient care
• 57:36is
• 57:37has been very comforting to
• 57:39me on a personal level
• 57:41that, you know, when the
• 57:42world is upside down, at
• 57:43least I can control this
• 57:45guy's hypertension
• 57:46and keep him from dying.
• 57:48You know? That I'm doing
• 57:49something constructive.
• 57:51And this this, you know,
• 57:53patient who, you know, doesn't
• 57:55have a nickel to his
• 57:56name,
• 57:57I'm doing something to help
• 57:58him. And so I think
• 57:59that's one thing that we
• 58:01are doing, you know, that
• 58:03that, we're doing God's work,
• 58:05you know, and that we
• 58:05need to remind our our
• 58:07residents that that's,
• 58:10that's compelling.
• 58:13Although meeting some of your
• 58:14residents today, they're pretty awesome
• 58:15and pretty pretty jazzed,
• 58:18about about
• 58:19their mission. So I'm very
• 58:21impressed by the group I
• 58:22met with.
• 58:23But I think how do
• 58:24we keep ourselves inspired? I
• 58:26mean, this is what I've
• 58:26been struggling to. I do
• 58:27feel like the self care
• 58:28thing,
• 58:30like, we wanna be informed,
• 58:31but we don't wanna be
• 58:32necessarily
• 58:34flooded
• 58:35with despair
• 58:36and fury. I was telling
• 58:38Abba, like, I got really
• 58:39irritated. It was you know,
• 58:40I came up on the
• 58:41train with a guy on
• 58:42the train that was, like,
• 58:43taking up the whole seat.
• 58:45And I was, like, really
• 58:46mad, and I was like,
• 58:47what is wrong? I mean,
• 58:48I didn't do anything to
• 58:49him, but I just was,
• 58:49like,
• 58:51fuming.
• 58:52And it was just you
• 58:53know, I think that, you
• 58:54know, there's we are all
• 58:56under stress, and it comes
• 58:57out in lots of different
• 58:59weird ways. And we need
• 59:00to
• 59:01figure out a way to
• 59:03get the information that we
• 59:04need, but not necessarily
• 59:07have morning, moon, noon, and
• 59:08night be
• 59:10engulfed
• 59:11in
• 59:12the negativity. I don't know
• 59:14the solution completely. But
• 59:17but I I do I
• 59:18think being at least conscious
• 59:20and aware of it is
• 59:21really important.
• 59:23In terms of the community,
• 59:24I do feel we may
• 59:25need to have
• 59:27other strategies
• 59:29to make our places feel
• 59:32safer.
• 59:33I know that,
• 59:34I did mention to you
• 59:35earlier, but, you know, one
• 59:37thing that besides being here
• 59:38with you today,
• 59:40yesterday,
• 59:40we at United Hospital, which
• 59:43was mentioned I'm on the
• 59:44board of,
• 59:45we have actually a health
• 59:46equity fellowship
• 59:47and which trains clinicians in
• 59:50health equity
• 59:52and and interventions.
• 59:54And one of our, my
• 59:55mentee,
• 59:57is working on
• 59:59developing a provider
• 01:00:00guidance on how to,
• 01:00:03help
• 01:00:05undocumented
• 01:00:06patients
• 01:00:07and, you know, to provide
• 01:00:08knowledge about immigration
• 01:00:09law
• 01:00:10and, you know, just to
• 01:00:11just to empower the providers
• 01:00:13because the providers feel very
• 01:00:14helpless and and also afraid.
• 01:00:17And so thinking about in
• 01:00:19our own institutions,
• 01:00:20how we can
• 01:00:21educate ourselves,
• 01:00:23figure out how we can
• 01:00:24protect patients within the institutions.
• 01:00:26Do we need to do
• 01:00:27a different kind of outreach
• 01:00:28and go to where people
• 01:00:29feel safer? I don't know
• 01:00:30all the answers, but I
• 01:00:31think that just doing nothing
• 01:00:33is probably not a good
• 01:00:33answer.
• 01:00:35Okay. So our celebration of
• 01:00:37the meeting will continue throughout
• 01:00:38the day. Humulating
• 01:00:40that. Thanks for having dinner
• 01:00:41this evening in her honor
• 01:00:43and in the honor of
• 01:00:43our speaker.
• 01:00:45Susanna, thank you for inspiring
• 01:00:47Thank you. Information.
• 01:00:49I will thank you for
• 01:00:50organizing,
• 01:00:51this event and these events.
• 01:00:53And, indeed, I thank you
• 01:00:54for being you, and, thank
• 01:00:56you for being here today.
• 01:00:57I really appreciate it.