March 2, 2021 • 63 mins
What if segregation didn’t actually end? And instead, American cities have become drawn along racial lines – exacerbating economic issues AND fueling the COVID pandemic? Join our hosts Justin Beck, Catherine Delcin and Deepti Pahwa, as they speak with Dr. Lawrence T. Brown, founder and director of the Black Butterfly Project. As a group, they’ll discuss the policies, practices, systems and budgets discussed in his new book, “The Black Butterfly: The Harmful Politics of Race and Space in America”. We’ll also hear from Dr. Brian Smedley, an advocate of health equity, whose work is creating opportunities for people of color and undoing the health consequences of racism. As always, we’ll talk about how to help our local health departments – and encourage innovation and technology integration – all while remaining empathetic, plus keeping an eye toward health equity for all.
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Episode Transcript
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Speaker 1 (00:01):
The legacy of racial segregation as relates to the COVID
pandemic is that hyper segregated cities served as ground zero
in terms of the mass spread of COVID nineteen in America.
If we didn't have American apartheid, if we didn't have
racial segregation to that degree, it would have made it
(00:22):
much harder for COVID to really pick up and spread
in a mess kind of way. That's Dr Lawrence T. Brown,
director of the Black Butterfly Project, Drawing on as many
years of social science research, policy analysis, and archival material,
Dr Brown recently published his first book, The Black Butterfly,
(00:43):
The Harmful Politics of Race and Space in America, a
fascinating look at the ongoing historical trauma caused by a
combination of policies, practices, systems, and budgets which are at
the root of uprisings and crises in hyper segregated cities
around the country. But there is reason for hope, as
Dr Brown offers up a wide range of innovative solutions
(01:04):
to help heal and restore redlined black neighborhoods across this country.
We also hear from Dr Brian Smedley, co founder and
executive director of the National Collaborative for Health Equity, a
project that connects research, policy analysis, and communications with on
the ground activism to advance health equity. In this role,
Dr Smedley oversees several initiatives designed to improve opportunities for
(01:28):
good health for people of color and undo the health
consequences of racism. The way that healthcare resources are distributed
here in the US is deeply inequitable. Often, those communities
that are sickest and in greatest need of access to
health care services and culturally appropriate services in their community
simply don't have that access. So the big takeaway for
(01:52):
me is that nations that cooperate together, that show a
level of social cohesion and solidarity, will do much better
in stopping the spread of the virus than those communities
characterized by deep divisions, such as here in the United States.
(02:12):
I'm Justin Beck, founder and CEO of Contact World. I'm
here with my co host Katherine Nelson and dep Pava,
and over the coming months we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
may not have all the answers, but you deserve to
(02:32):
understand what goes on in your neighborhood and the decisions
that will affect you and your family's health. Welcome back
everybody to Contact World. So today we're gonna hear from
Dr Lawrence T. Brown and Dr Brian Smedley. Previously, we've
talked about, you know, the political determinants of health and
the way that politics have influenced public health. But it
(02:56):
was interesting to learn how segregation in America has actually
caused this proliferation of COVID nineteen. It makes a lot
of sense that we're in the position we're in because
things that affect marginalized communities affect everyone. And it was
interesting the intersection between these two conversations because on one hand,
(03:16):
we don't have data because we've been trying to ignore
the data, right, we've been trying to sweep it under
a rug, because our country has an absolute history of
racial segregation and it has caused a lot of the
problems that we're experiencing today. Justin you bring a very
interesting point that I found personally very revelational. In the
(03:37):
midst of the crisis, our understanding of this inequity was
delayed and remains limited because many health care institutions, as
well as state and the federal government, they were still
to capture the demographic information on COVID nineteen because the
health equity data was not available. And one of the
most crucial things is a data to an approach that
(04:00):
can be used to address this very racial disparity in
the health care outcomes. And data does make a difference
because unless you can measure something, how can you even
think about solving that? Right? Yeah, and I agree with you,
but I think there is some sort of acknowledgement, especially
by the current administration. And what I enjoyed the most
(04:22):
about both interviews is that they both had some positive
policy changes and that's where we're going to see the difference.
And one example of that is the Health Equity Tracker
project that Daniel Dawes was leading, and they're starting to
tackle the data issues surrounding the pandemic and health equity
and it does really start with a commitment to saying, hey,
(04:44):
we have to find the data in order to address
the problems. It's was one into transparency in my open
and it's really about transparency and having integrity that you
will not use the data the way it should not
be used, and again building trust within the governments, within
the healthy institutions, within public institutions. But one has to
acknowledge that segregation by design is happening, and only then
(05:07):
we can make afoot towards conquering this problem. We're in
this position because we defunded public health and yet we
expect these heroes to perform more than a miracle and
trying to get us out of this situation. But the
concept of a community health workforce, I think is a
really strong one because if we're expecting marginalized communities to
(05:29):
strictly sign up online and that's the only way that
they're gonna get vaccinated, we're missing the point that these
digital divides are going to continue to create problems. So
community health workforces, whether it's through the Heroes Act or
whether it's through Biden's new executive orders around improving public
health infrastructure, is really exciting to think about. Yeah, and
(05:50):
also it conveys the seriousness and it's less remote when
you tell someone you have to log into a website
and you know, I'm sending my information over the airwaves.
I don't know where it's going to home. But if
there's an actual human knocking at my door, speaking to
me directly, then I'm more inclined to cooperate. It conveys
the seriousness but also the human interest. You know, whoever
(06:14):
is in that community is going to feel looked after
and cared for, as opposed to the desensitized way of
your on your own you go and you know, register
and if you don't, then good luck. If you don't
have a computer, or if you don't have access to
the internet, I guess you know, you just drew the
short stick there. I love your comment. You're cutting and
that reminds me of one of the conversations that I've
(06:35):
had long back with the last Smile health care worker,
and he told me that, you know, sometimes we just
talk about technology all the time solving these issues. There
are places and there are people for them. Even pen
and paper is technology, and humans are capable of using
that and bringing that access. We are trying to achieve
(06:56):
through technology. So if there is a hybrid solution that
we can come up with, that's what is going to
solve the problem in a sustainable way. All right, let's
dive into these powerful conversations and hear from two of
the most knowledgeable experts in this field. Hello, Dr Brown,
(07:21):
it's a pleasure to meet you. Hello, thank you so
much for taking the time to talk with me today.
And can you tell us a little bit about your
background and what led you to write The Black Butterfly. Well.
I was born in well Memphis, Tennessee. We lived in
West Memphis, Arkansas. Left there my family. We went to
the Houston area, went to moor House after graduating in
(07:45):
nine seven and major in African American studies. And across
the street from moor House was a public housing development
called Harris Holmes and they were in the third phase
of uprooting people as a part of Clinton's Hope six project,
which involved demolishing about a quarter million public housing units.
And so I think it was there that I really
(08:07):
sort of begin to question policies of displacement and how
and why African Americans are being uprooted, and I wanted
to know more about, like how government played a role
in that. So my master's degree was in public administration
at the University of Houston, where I picked up that
thread to try to understand a little bit more about
(08:27):
community development. And then I got interested in the health
angle of community development. So I went to University Tennessee
Health Science Center where I obtained my doctorate and health
outcomes and policy research. After finishing it led me to
Morgan State University in Baltimore, where I worked on my
post arctro fellowship became an a social professor. My research
(08:50):
kept looking at, you know, how neighborhoods impact health outcomes,
and that whole through line really led me to this book, right,
And was the initial interests to satisfy personal curiosities or
did you already have a plan in mind that this
is something that you're gonna work on and educate the
public as you are doing right now. I mean, I
(09:12):
think it more or less developed organically. I don't think
I had a master plan in mind, but I think
you can see how one interest, one degree kind of
led to the other. You know, I grew up well,
my hometown West Memphis, Arkansas's is small. It's like thirty
thou folks, and the county is rural. Arkansas is very
(09:32):
rural state. And so it's just thinking about the impact
of space on people's health and the impact of how
space is racialized and how that impacts people's health was
something that I think was there from the beginning, just
in terms of always being interested in, like urban policies,
what makes a space, you know, be the way that
(09:54):
it is now. And so with all of the cities
that I lived in, you're talking about Baltimore, Memphis, or
West Memphis, Arkansas, Atlanta, Georgia, Houston, Texas, and so it's
just you know, really sort of getting a good sense
of how these different cities meant you have different outcomes,
and then if you lived in different neighborhoods in those cities,
(10:15):
you had different health outcomes. You know, my background and
my intellectual interests led me to this work. And through
your work, how do you see the legacy of racist
policies in cities throughout the nation as a contributing factor
to the disparities of experience throughout the COVID nineteen pandemic. Well,
(10:35):
I mean the biggest contribution of urban policy to the
current pandemic is the municipalization of racial segregation. So the
ways by which racial segregation was shaped in urban areas.
Baltimore Mayor John Barry Mohole, he passed the first residential
racial zoning law in American history on December nineteenth, nineteen ten,
(10:58):
and so you have cities in the early nineteen hundreds,
they were still building out their sewer systems, they were
still building water filtration to clean water, they were still
connecting water lines. Many homes they didn't have plumbing, they
didn't have clean water, they didn't have sewer systems, which
(11:18):
meant that they were breeding grounds for infectious diseases like
influenza or like tuberculosis, especially yellow fever cholera. So those
are diseases that were high at the time. But the
way in which municipalities were allocating resources to white neighborhoods
and white blocks and not allocating those two black neighboroos
(11:42):
or black blocks at the time, that had a tremendous
impact on the infectious epidemics then, and then you go
further in time to where we are today, it has
a big impact on the COVID pandemic. Now, do you
think these allocations were in sorts intentionally depriving the minority
(12:04):
communities or was it maybe disproportionately done Well, it was
absolutely intentional. Number one, race was the reason. Like in Baltimore,
you saw in the Baltimore Sun, I talked about in
my book, how the Sun kept putting this headline out
and their articles Negro invasion. There's a Negro invasion homebuying
while black black people are coming. And so they weaponized,
(12:27):
they used propaganda to cause white Baltimoreans to engage in
the counter offensive against black homebuyers. And you see public
health actually being used as a rational for racial segregation.
The fact that black people had a higher rate of
tuberculosis and other diseases, that was a reason to then
(12:50):
segregate them. In effect, it was a neighborhood quarantine. So
you see in the Baltimore Sun again and other newspapers,
how the discourse of data and the way in which
Black people were stigmatized and demonized based on these health disparities.
Given the intentionality that you see both with newspaper headlines
(13:13):
with the implication of public health, with other media that
we're really spreading about the time, like the Birth of
a Nation by D. W. Griffith, which glorifies the Kukus Klan,
you can see how race is intentionally being used as
a ration now to effectuate racial segregation. And then if
you want to look at Jessica trouns Things book Segregation
(13:37):
by design. She shows empirically that that more racial segregation
that you see in the city, the less public resources,
the fewer public goods are being allocated per capita in
those cities, and definitely in those cities to black neighborhoods.
What would you say has been the most profound impact
(13:57):
of these type of policies on health vector is during
this pandemic. Firstly, we had the introduction of the virus,
so you had California, I believe Seattle, if I'm not mistaken,
cruise ships they sort of brought the virus to the nation.
But after the virus arrived, then it hit hyper segregated
(14:17):
cities the hardest. New York is a Category four hyper
segregated city, and I used category like a hurricane as
an analogy. Detroit was hit hard, Chicago was hit hard.
Those two are Category five hyper segregated cities. That's the
highest form of racial segregation that we have, and so
these cities were hit really really hard early on. If
(14:39):
you recall March in April of last year, hyper segregated
cities were the first hit. So the legacy of racial
segregation as it relates to the COVID pandemic is that
hyper segregated cities served as ground zero in terms of
the mass spread of COVID nineteen in America. If we
(15:00):
didn't have American apartheid, if we didn't have racial segregation
to that degree, it would have made it much harder
for COVID to really pick up and spread in a
mass kind of way. What else have you seen as
far as the tangential consequence of lockdowns depleted economies? For example,
you mentioned the city's Chicago and New York, the lower
(15:22):
opportunity streams on these communities of colors throughout this crisis.
There should have been universal basic income. There should have
been a massive infusion of resources from the federal government
that would actually have allowed people to stay home then
in a concentrated way. Instead, we had a president at
the time that was talking about reopening by easter and
(15:47):
that the deaths would be under a hundred thousand or
under sixty thousand at first, and here we are now
approaching five hundred thousand. We didn't lock down long enough.
I argued that capitalism was going to actually work against
our ability to fight this virus. We needed to develop
a strong response that was gonna help renters, help forty
(16:09):
million people that were thrown into unemployment. Initially, we need
to have a strong response to effectuate the type of
lockdown that was needed, and we did not do it.
So that is what has set up the tangential impacts.
We did a half hearted lockdown, and we haven't really
made any sort of strong effort around economic recovery. We
(16:30):
had a lot of big businesses spelled out, but in
terms of regular people, they got that one two thousand
dollar infusion, I believe back in the summer of last year,
and that just wasn't enough. And so we're actually, I
think getting ready to see much more economic impacts that
are going to be destructive in so many lives for
(16:52):
a long period of time because we did not arrest
our instincts to be this capitalist country at the outset,
and so we're gonna deal with the issues on the
back end with the new administration. What are your thoughts on,
you know, the direction that we're taking now. Do you
feel that there are appropriate measures being taken? Well, I mean,
(17:12):
certainly the new administration is, you know, a breath of
fresh air. You know, they's just getting their feet on
the ground. But I think there has to be a
lot more again, I think they're talking about maybe four
hundred or adding four hundreds to the six hundred in
terms of the next COVID stimulus package for people that's
not universal basic income. Universal based income is two thousand
a month, so I'm talking about universal basic income to
(17:35):
access secure people's financial needs. And then, even though there
is a rental moratorium, I believe that President Biden is
trying to extend now past the March deadline. You know,
I think we need to go a lot further because
not all states are honoring that rental eviction. Their courts
are not honoring it. So we need to really have
a strong, nationwide you can't get out of it strategy
(18:00):
that allows people to stay where they are, not be
put out of their homes. I think you've got to
put things in place to really stabilize housing and stabilize
people's income so that you don't have I think the
wave of desperation that's going to come after that moratorium
is lifted, because the rent is going to be do
and you're gonna have an eviction crisis. And then if
(18:23):
everybody is vaccinated at that point, you're going to see
a spike in COVID. So all of this has to
work together otherwise we're never going to get this virus
under control. Right, And you speak of desperation, do you
feel that some of the communities of colors are in
essence feeling desperate for the help that they should have gotten,
(18:44):
with the help that they should be getting, and how
do they take steps to get that help. I think
there is desperation, but in many ways, community of color
are really masters of resilience, and so you may not
see it. And the fact that people are dealing with
deaths and contracting COVID. I know my family, I've had
(19:07):
over ten members in Southern States, you know, contract the virus,
including my two grandparents. So it's hard to be engaged,
I think on the policy front side of it while
you're dealing with folks that are in the hospital, dealing
with folks in your family that are you know, passing away,
whether it's due to the disease or in the aftermath
of it. So we're trucking along in terms of the
(19:31):
room and the space to deal with the policy front.
I don't know that the advocacy is as much there
as it should be. But you know, in the middle
of a global pandemic. When you're at the bottom of
the social hierarchy, you know, that's gonna be tough to
do now. At the same time, there was the action
that was taken on election day. So you did see
(19:55):
black voters in cities like Atlanta, Philadelphia, Chicago, Pittsburgh, Detroit
come out and support a new administration in part because
they wanted a better COVID response. You know, you saw
Latino voters in Nevada and Arizona. Native American voters in
Apache County and Navajo County in Arizona helped put President
(20:18):
Biden over the top. So there was maybe to even
counteract my own point, there was that movement to actually say, hey,
we want a different president in part because we want
a better COVID response. There was that policy push. I
want to make sure I highlight that. Yeah, it's that
resiliency on top of their their own survival instincts. Yes,
(20:41):
how do you see the terrain ahead for vaccine distribution,
contact tracing and other interventions? And I know this is
just kind of broad, but you know, how do we
build trusts with our communities of color, How do we
establish fairness in the distribution of the vaccines? Tell me
your thoughts on those. Well, what I'm seeing right now
(21:03):
is a failure to engage in vaccine administration equitably. You
have white people coming in from other neighborhoods into black
and brown neighborhoods to get vaccinated before the black and
brown people that live in those neighborhoods. That story you're
seeing in Detroit and Philadelphia. They gave a twenty two
year old white gentleman, they gave him a contract to
(21:24):
deal with COVID, and they skipped over the black doctors
who have their own organization that I have built trust
and that should have gotten a contract like that. So
you're seeing the administration of the vaccine this inequity in
terms of both whereas being distributed. If you look in
the state of Maryland, demographically wider counties are getting more
(21:47):
vaccines per capita than demographically blacker counties. Then you have
the fact that the primary mode of vaccine administration is
to have people sign up online. Then those people living
in those redline marginalized sub prime communities that are dealing
with digital device they're going to be left out. So
I foresee the continuation of what we're seeing now vaccine
(22:11):
apartheid unless we actually engage in the strategy that I
think we should do, which is I believe the Heroes
Act from last year should be passed the creation of
a national Community health worker workforce. I would hire a
hundred thousand community health workers and I would have my
community health workers working with nurses and physicians, medical professionals
(22:36):
going out to communities, not waiting until people come into
the hospital, come into the vaccine site, come into you know,
the stadium where you have it set up, or drive
through when everybody don't have a car. You need a
group of folks gonna go out and I don't care
if they have to go door to door. You should
have people going out to make sure the vaccine is
(22:58):
a ministered in those communities that are really struggling, making
sure they have the access that they need, and build
trust along the way because a lot of people they
may say no right now, but that no could be
a wait and see. I'm gonna wait and see, but
maybe in three months I might say yes. So that's
another reason you need to community health work is to
(23:19):
be out communicating, out discussing, showing their face, having conversations.
That's the kind of interaction, that relationship building that's gonna
be needed, and you need people to do that, not technology,
not the internet. The way we're doing it now is
not gonna cut it. Yeah, I understand that. In our
previous episode, we're talking to Dr Yasmin and she was
(23:43):
explaining how there needs to be some level of atonement
and acknowledgement of wrongs from the past in order to
build that trust. As you mentioned, Absolutely, I wanted to
ask you about you kind of touched on it a little,
but you've had family you who have been hospitalized because
of COVID nineteen. First of all, has everyone recovered to
(24:06):
my knowledge, yes, everyone has recovered. Like I said, my
grandmother passed several months later, and I understand it was
from heart failure, not COVID. Sorry for your loss. Absolutely,
I celebrate her life. And even though she recovered and
died later. You know, COVID still has impacts people in
their cardiovascular system and many systems, even the neurological system.
(24:30):
My grandfather when he was hospitalized, he didn't remember who
his wife was, for instance, and later regained his memory.
So we're very thankful for that. We've heard that you've
described the medical system as raggedy throughout your experience. Can
you elaborate on that? Yeah, I mean the home health
care workers you have to call in Arkansas, I had
(24:52):
to call to you know, arrange that and make sure
that took place. You know. It's also the case where
in those smaller rural counties like Lee County, Arkansas doesn't
have a hospital. The hospital in Critton County where my
grandparents lived, I think had six beds for I see
you cases. So these are rural counties that you know,
(25:12):
if you get ten cases, that's a spike that a
lot of counties cannot handle if they don't have that
real health infrastructure. And this is America, the wealthiest country
on Earth, and we can't have health care infrastructure for
our people. That's why I called it ragged. It's a
shame and it's a hot mess trying to compensate as
(25:33):
an individual for these systemic failings and lack of funding.
You know, there's been the discussion the protests over defunding
the police, and what I want to point out to
a lot of people is that we've been defunding public
health for decades and that is why we are in
a situation now where we're relying on private corporations like
(25:56):
a Walgreens and the CVS to minister vaccines. Why do
have to rely on them if you have a good
public health system? Because we don't, and not because it's
not good as in the people aren't trying hard. Is
that we deeply underfunded, We defund public health in this nation.
You know, if you just dropped in from another planet,
if you look at COVID data, you would say, well,
(26:17):
America is the developing country. There's no way it could
be the most advanced, wealthiest country on Earth. But in
fact it is. Based on your background and everything that
you've described that you've done, you're an expert. So what
would your top list for policy initiatives be at addressing
the issues and the disparities that we've seen so far? Okay, Well,
(26:40):
for COVID, I'm looking at spatial equity testing early on
and the vaccine administration. Now, if your main locations are
in wealthier, wider communities, that's not spatial equity and racial equity.
You can't have racial equity without spatial equity because America
is so segregated. So where are your testing sites? Where
(27:01):
are your vaccine administration sites? If they're not in red
line sub prime low income communities, you've already failed spatial
equity in the response. Like I said earlier, Number two,
community health workers, community health workers. Community health workers got
to have an outreach component, not just to come see
us component. And then number three is that internet can't
(27:23):
be your only strategy. In fact, I'm not sure it
should be much of a strategy at all, given the
way we've seen people gain the system, people coming from wealthier,
wider communities, colonizing the vaccine supply, gentrifying vaccine administration. Those
are the top three things that I would look at
shifting from internet to person based through community health workers
(27:46):
and with a spatial equity approach, those would be my
top three for COVID overall. You know, health equity is important,
but alongside health equity, we have to have social solidarity.
And what is that social how there is realizing that
this whole country is in this mess together. Even though
(28:06):
the deaths are disproportionate among communities of color, you still
have a huge percentage of white people dying from this,
and so the thing is we're all in this. So
whatever good programs and strategies that we need, universal basic income,
this community health worker core that I'm talking about, having
spatial equity in the response. These things are going to
(28:28):
be helpful to everybody. So so this just has to
be like a strong mutual aid outreach, you know, working
to get folks vaccinated and in a holistic way that
when you're dealing with people on the COVID front, you're
also checking to make sure that their other needs are
being met. You know, how do we set up a
strategy where everyone's going to be having their needs met holistically? Absolutely?
(28:55):
Dr Brown, It certainly has been an enlightening conversation to
speak with you and care about the work that you've
done and how you're shedding much light to a lot
of important areas and key issues. Do you have any
final thoughts to share with our listeners. The biggest thing is,
you know, our issues as a nation right now are
(29:16):
really rooted in American apartheid, and American apartheid is a
system that was set up via racial segregation, colonization, uprooting communities,
particularly Native American, Latino African American communities. So we have
to have equity, we have to center equity, but at
the same time we need to also uplift, social solidarity,
(29:40):
the fact that we are all in this together. White
people are dying too. We want to make sure that
every community has what it needs, and if some communities
need more, we need to allocate more to those communities.
So COVID then can be a turning point for America
where we recognize what is really bedoubling us, what is
really destroying so many lives in this country. Because even
(30:03):
when you get rid of COVID, you're still going to
have those other epidemics. You're still gonna have deep poverty,
You're still going to have the four regions in our
country that are really struggling, the Southern Black Belt. You're
still gonna have Appalachia struggling. You're still gonna have Native
American tribal lands in the US Mexico border counties. So
these are all racial geographies where we have tremendous inequities,
(30:26):
and you realize that Appalachia means a lot of poor
white people are in that mix. And so that's what
we're saying. We're saying everybody, everybody needs to be on
board if we're gonna make this country the country that
it should be instead of lagging behind in so many indicators.
Very well said a great summary. I love what you
(30:47):
said about social solidarity. I think that probably should be
one of those buzzwords out there that we should all
be adopting and talking about. Thank you for taking the time.
Thank you, Bye bye. M What an honest and insightful
conversation with Dr Brown, and for anyone who needs to
understand why communities of color in this country continue to
(31:10):
struggle for access to some of the most basic health needs,
health needs that so many of us take for granted,
I encourage you to order his book, The Black Butterfly.
Now coming up, we'll hear from Dr Brian Smedley, another
torch bearer and lifelong advocate for health equity. Hi. Brian,
(31:38):
it's a pleasure to have you on our show today
and thanks for making the time so. Brian, you are
the co founder and executive director of National Collaborative for
Health Equity, a project that connects research, policy analysis, and
communications with on the ground activism to advanced health equity.
And you have been carrying the torch for actually said
(32:00):
every years now on undoing the health consequences of racism.
Tell me something more about your personal motivation to start
this health equity initiative in general, and also what got
you working on these topics. What's your personal story. Well, first,
thank you so much for having me. You know, health
equity is something that we should all be concerned about,
(32:21):
but I'm personally very deeply invested in it. I come
from a line of people who have committed themselves to
racial justice work. My mother is the late anthropologist Dr
Audrey Smedley, who wrote quite a bit about the concept
of race and how it originated here in North America,
essentially to subjugate and exploit, of course, indigenous populations and
(32:42):
then enslaved Africans and so forth. So that's really the
roots of today's health and equities, and given my mother's scholarship,
given the kinds of things that I've observed in my lifetime,
such as being born in Detroit in the nineteen sixties,
a city that was going through considerable demographic change. When
(33:03):
I was a little boy, we moved to a neighborhood
on the west side of Detroit that was somewhat integrated,
but like a lot of other cities in the United States,
as African Americans began moving into the neighborhood, white people
began to leave in significant numbers to the suburbs. And
that's the roots of modern day racial segregation, which I
(33:24):
have focused a lot of my work on because it's
actually at the root of many of the health and
equities that we see, particularly those inequities between African Americans
and whites. Most people don't recognize the role of residential
segregation as being foundational to health inequities. And moreover, most
Americans don't recognize the role of government and actively segregating
(33:48):
and separating different racial and ethnic groups and perpetuating that
segregation up until nineteen sixty four when those practices were
finally outlawed. So really my work is about addressing that
asking legacy of a structural form of racism, which is
residential segregation, and the role of government and many other
actors in creating and perpetuating that segregation, right, I mean,
(34:12):
it takes me to one of the common topics we
discussed with Dr Brown on our podcast as well, the
impact of housepiece that is racialized is impacting people's health.
And there's also I think a book which is Segregated
by Design that really examines exactly the topics that you're
kind of talking about, and touching on you're also the
Chief of Psychology and the Public Interest with American Psychological Association,
(34:35):
and you're leading a PAS efforts to apply the science
and practice of psychology to fundamental problems of human welfare
and social justice. What would you like to touch upon
these topics being kind of used in terms of the
context of the pandemic right now, you know, in the
last year, and how they may be different than what
it used to be in the past in terms of
(34:57):
how you've been doing your own work and the challenge
to sit on deck. Well, we're certainly in in our
lifetimes unprecedented times with the pandemic. We've seen that the
pandemic has upended so many aspects of life and tragically
has cut many lives short. The pandemic really just reflects
existing inequity. Those populations that have been marginalized politically, socially,
(35:20):
economically typically are most vulnerable to infection. They have higher
mortality rates. So here in the US context, African Americans,
Latin X populations, American Indian populations, and many others have
been hit particularly hard by the pandemic. So our effort
at the American Psychological Association and other groups working in
the racial equity and health equity space is to simply
(35:43):
uplift this inequity. It's my contention that we will not
get out of this pandemic unless we center and prioritize
equity concerns. No reason for this is pretty simple. You
can't leave any community behind and expect that we're all
going to be okay and healthy and that we're going
to ltimately defeat the virus. If we leave behind those
(36:03):
folks who are frontline essential workers, folks who are working
in nursing homes and other settings, who are disproportionately themselves
black and brown immigrant folks, if we leave these communities vulnerable,
then we will all ultimately be vulnerable. So we need
to address the needs of those most marginalized in those
most at risk, and to prioritize how we go about
(36:26):
reducing risk. So we know, for example, that we all
have to practice good public health practice wearing masks, washing hands,
physically distancing, but in some cases, in communities of color,
for example, those are very difficult to do, particularly if
you have overcrowded housing or people working in settings where
it's difficult to physically distance. We have to prioritize the
(36:46):
concerns of those communities if we're going to ensure that
none of us are at disproportionate risk and that we
can all ultimately come out of the virus healthier and stronger. Right,
I mean, the topics you touch upon a very valid
and actually quite and focus in news these days as well.
And and I believe one of the missions of you know,
your Health Equity Collaborative is to set up a promote
(37:07):
health equity by harnessing data. And I just want to
bring that aspect of data here. And you know, I
read a federal study that found that raise and ethnicity
data is missing for nearly half of coronavirus vaccine recipients,
and this lack of data is leading to an inequitable
response to the pandemic, which is of course, you know,
continuing to undel your burden communities of color as well.
(37:30):
In fact, the Biden administration created COVID nineteen Health Equity
Task Force has also an ambitious promise there of an
expansion of equity data collection. So, first of all, your
thoughts on that, and secondly, do you see these solutions
to such challenges in terms of equity data collection, which
has a major role to play here. Yes, that's a
(37:51):
wonderful question. Most folks would wonder, well, why data collection
doesn't sound very sexy? How does that help solve this
problem of this virus epidemia? Oology one oh one tells
us that we need to collect data, very thorough and
comprehensive data to understand where the virus is spreading, which
communities are getting hardest hit. And unfortunately, when the pandemic hit,
(38:12):
we had a very weak and ineffective federal response. It
left it to many of the states to be able
to forge strategies going forward, particularly with respect to data collection.
We have fifty plus different approaches to data collection being
used among the states, but we need comprehensive and complete
data collection on things like demographic information. We need to
(38:34):
know who's testing positive by race, ethnicity, socio economic status.
Data such as income, our education would be helpful. Where
do people live places obviously critically important to understand the
distribution and spread of the virus. Are folks with disabilities
disproportionately affected? Are people who are gender or sexual minorities
(38:54):
disproportionately affected? We simply don't have the data, but we
need to know this information so that we can target
strategies to help communities to reduce their risks. We need
data on who is getting tested, who's testing positive, who's
getting hospitalized if necessary, and what kinds of treatments might
they be receiving. We need data on vaccines. We know
(39:16):
that vaccine acceptance there's quite a bit of variation across
different communities, and there's a long history. That's a whole
another story. But unless we have the data to understand
who's getting vaccinated, again, it makes our public health response ineffectual.
It makes it difficult for us to target strategies to
ensure that we're getting vaccines, for example, where they're desperately needed. Again,
(39:37):
this is something that's going to ultimately be of concern
for all of us if we want to contain the
spread and ultimately defeat the virus. Right, I mean, all
of that makes complete sense in order to be able
to understand the population, to be able to address the
solutions towards it. Right to that extent, would you have
any examples or maybe initiatives or something that is in
(39:57):
the planning where you could talk about data to and
innovations in this health equity space to understand how communities
are responding to vaccine availability. We need data. We need
to be able to understand new applications such as artificial intelligence.
How does that help target vaccine distribution where it's needed.
For example, in some cases, artificial intelligence may be not helpful,
(40:20):
particularly in the racial ethnic context, as there's some data
to indicate that artificial intelligence may be operating differently on
the basis of race ethnicity in the US. We need
to be very clear about how we can best harness
technology and where there may be risks with new technologies
such as AI, other than the commonly talked about issues
(40:41):
like lacking data and infrastructure. Because of the inequities in
the system, What fragilities have highlighted or exposed most within
these martialized community ecosystems during the pandemic In specific, how
do they relate to psychological well being of people. We've
seen that the pandemic has exposed so many inequities and
(41:03):
so many risks, but the psychological risks are profound. We
have a combination of economic anxiety given the economic disruption
of the pandemic. We have fear of infection or transmission
of the virus to one's loved ones or family members
or others in the community, and then we have had
accompanied with the pandemic a resurgence of intolerance and expressions
(41:26):
of hate. The Asian American community here in the US,
for example, has been disproportionately targeted and victimized with assaults
both a verbal and physical in both virtual and physical spaces. Clearly,
we are in a very stressful time at the a
p A. We've been predicting a mental health tsunami emerging
(41:47):
as a result of the pandemic and the associated stresses,
and what it highlights for us is the need to
rebuild the mental health infrastructure. Sadly, over a number of decades,
we have disinvested in the public health and of structure
and mental health infrastructure here in the US, and so
we need to rebuild that because clearly the mental health
(42:07):
consequences that we're experiencing right now are deep and profound
and could have significant implications for the overall health status
of populations, for our ability to recover from the economic downturn,
and just to be resilient, to have our communities be
able to draw upon sources of strength and resiliency to
help them emerge from the pandemic stronger. So the mental
(42:30):
health consequences have been significant, and we are desperately in
need of ways to improve our ability to provide services.
You asked about innovation and technology earlier. One such innovation
is the increase in telehealth and tele mental health here
in the US, whereby people who are seeking psychotherapy, for example,
(42:51):
can find a provider and can interact either over a
video chat or telephone line. And this significantly reduces geographic
barriers to accessing therapeutic services. But it also from an
equity standpoint, reduces many cultural and linguistic barriers. So if
a person is seeking, for example, Spanish language mental health services,
(43:12):
but lives in a community where no such providers are available,
that person can simply look across the state where they
live in and attempt to access services from qualified providers.
So it opens up new opportunities for seeking assistance, and
from an equity standpoint, that kind of innovation is critically important. Yeah,
(43:35):
you bring in a lot of interesting topics here, but
one of the things which often strikes me is US
is facing public health crisis on a level not experience
for more than a hundred years now, right, it should
be reasonable to expect that all citizens can rely on
their government and health institutions to protect them. But for
(43:55):
many Black Americans and communities of color trust in the
girl and does not come easy. That you kind of
touched upon it as well, right, What would you say
is the reason for that? You know, we have a
long history and a sad history here in the US
of abuse at the hands of the scientific and medical establishment.
(44:16):
We've seen that African Americans have been abused in public
health research, such as in the infamous to Skegee experiments,
where African American males who had contracted syphilis were allowed
to go untreated so that researchers could understand the long
term effects of syphilis. Clearly unethical and something that should
never have happened and should not happen today. So you
(44:38):
have that history, plus you have the fact that there
are so many structural inequities. The way that healthcare resources
are distributed here in the US is deeply inequitable. Often
those communities that are sickest and in greatest need of
access to health care services and culturally appropriate services in
their community simply don't have that excess. Adding on top
(45:01):
of that, the fact that the United States remains a
nation that is focused on market based healthcare delivery. That
means we have no uniform national strategy for providing health
insurance coverage. We have no uniform national strategy for looking
at where we need to have our doctors, nurses, clinics, hospitals, etcetera.
So we in fact have multiple systems, many of which
(45:24):
merely replicate the inequities that already exist. So there are
many lessons to be learned about the proper role of
government and ensuring that we all have a basic level
of protection. And I'm very hopeful that despite the tragedy
of the pandemic, that we will learn those lessons that
there is a role for government to ensure a basic
(45:45):
level of access to health care and basic level of
public health services, and many other countries of course ensure
that all populations have at least some minimal level of
access to care. Right. I mean, it's very relevant point
that you talk about the role of government and how
they can make it more accessible in the health care.
But this brings me to another very important point, the
(46:07):
fact that marginalized communities and the communities of color are
more than ever now aware of these disparities in the
health care system, and now they're more than ever are
aware that they receive lower quality of care. Right and
during the pendiment, we often heard voices coming out and
speaking about the topics. So this is not only the
(46:28):
mistressed part, but it's also a level of awareness and
retaliation at times even right, So, is there a way
we can manage and handle this mistrust, so to say,
fear among these communities through better engagement, better communication. And
here I would in particularly like you to leaven into
(46:48):
your expertise in psychology and behavioral science as to how
to take corrective measures here. Sure, to your point, we
know that there are steps that we can take to
ensure that people have reliable, trustworthy information about the vaccine. So,
for example, given high levels of mistrust in the African
American community of the medical establishment and many other communities
(47:10):
as well, we know that there are some things that
we can do. First, begin to work with trusted community
leaders and advisers, folks who are working at the grassroots level,
be they working in community based organizations, nonprofit organizations, civic organizations,
faith institutions, and many others. Working with our trusted leaders
to provide accurate information is critically important. We also need
(47:34):
to ensure that we're working closely with community groups to
understand what are the concerns that communities may have about
accessing the vaccine. We need to better understand how do
we ensure that we're meeting other needs that communities may have.
It's not just related to vaccines. We need to ensure,
as I mentioned earlier, that we're all adopting good public
(47:54):
health behaviors, and so all of this is tied together
in terms of understanding trust not just in government, but
in all of our civic institutions. So that's why it's
important to begin to work with those trusted leaders that
are already present in communities and are already drawing upon
sources of strength and resiliency that already exists in these communities.
(48:16):
It's important to note that even though we're talking about
communities that are in many cases politically, economically, and socially marginalized,
these communities have tremendous sources of strength and resiliency that
we need to draw upon in times of crisis like this.
As very often it's said that you know, you often
listen to the voices of your own communities, and you
(48:36):
have to tap into that rather than coming it as
top down and personally. I work a lot in human
centered design, and I also believe that you have to
also tap into the moral intuition and values of these
communities to be able to communicate with them in what
resonates with them best. Right, let's think about COVID as
a trigger, you know, right now, I mean since March
last year, a few things changed. The nature of work changed,
(49:00):
onto exchanged. We know that people of color and marginalized
people were, you know, disproportionately impacted. It's a known fact now,
partially because they were the essential workforce during the pandemic
and they were vulnerable to this exposure. Another thing that
changed was the nature of education. We move from in
person to remote learning, and then the differential access to
(49:21):
broadband and strong technology, you know, that enabled people to
connect and learn differently, where marginalized populations again got left behind.
Right now, this is systemic and I am just trying
to bring that to the health equity perspective here in
the context of vaccine distribution. We see this trickle down
in the way the vaccine distribution is being done at
this point in time, where there is a digital divide. Now,
(49:44):
where does the entire health equity initiative can play a
role here in terms of reaching the people where they
are who have very limited access to technology. For instance,
do you have any solutions there? This is such an
excellent question because you're hying together again many of the
pre existing inequities and disparities in terms of access to
(50:05):
broadband internet, for example. These are all issues that were
critically important before the pandemic, and we're seeing how much
worse it's gotten. You mentioned things like children learning remotely.
There's some evidence that the kids are falling behind, and
again this disproportionately falls on the backs of children of color.
When we're talking about health, generally, the best predictor of
(50:28):
your health status as an individual is your educational attainment,
your educational level. And so we have left these children
behind who are most vulnerable at this time and who
experienced many challenges to remote learning. In some cases, we
have challenges with family care and child care that may
interfere with children's learning, inequitable access to broadband as you mentioned,
(50:50):
and then the challenges of children not having adequate nutrition.
In many cases we have children receiving breakfast lunch at
reduced or low cost or no cost. So these are
all deeply tied together, and you've asked about solutions. There
are some really interesting innovations happening in terms of remotely
(51:11):
bringing broadband to those communities that lack that access, ensuring
that children can go to centers in communities, for example,
where they can much more easily access broadband and at
the same time get some of the nutritional and social
services that they might need. So even though in some
cases schools are not open or are on a hybrid schedule,
(51:32):
or in other cases schools are just now returning to
in person learning, we have to ensure that we're addressing
the gaps that have occurred in the time where students
have been out of school, so ensuring that their opportunities
for remediation and helping children to get caught back up.
All of these things pose tremendous risk for these children
(51:54):
individually in terms of their opportunities in life and their
health outcomes. Broadly, but at all so affects all of
us as a society, as a community because again, to
the extent that we leave these kids behind is to
the detriment of the entire society. Tell me one think,
how could you or how we as a system rethink
(52:16):
race or racism in the context of health equity, and
in particular use of psychology to make a positive impact
on these critical site issues. First, we need to acknowledge
the global presence of the belief in human hierarchy, a
false notion that assigns value to some and denies value
and opportunity for others. And here in the u S context,
(52:38):
of course, European descendants are considered to have value. The
reality is that as a society, we allocate much more
in the way of societal opportunities to children of European descent,
while systematically posing barriers to opportunity for kids of color.
Psychologists have been studying this phenomena for many years, and
(53:01):
of course, psychologists have pioneered the notion of implicit bias,
the fact that people, even those with egalitarian views and
who are deeply anti racists, may harbor biases that they're
not consciously aware of that are automatically activated when we're
confronted with difference, whether it's difference on the basis of
skin color, gender, language, or any number of other factors.
(53:23):
So psychologists have tried to help the general public to
understand how these processes operate and to help us understand
that race is in fact a social construct, but racism
is very real because of the tendency for humans to
believe in forms of hierarchy. These, of course, are ideologically driven.
No child comes into the world believing that one group
(53:46):
is superior to another, but rather how we allocate socidal resources,
the cultural narratives that we hold. The kind of world
that we create for kids of color is often very
different for white kids, particularly here in the United States,
and these children see that they understand who is valued
and who's not when they see those kinds of conditions.
(54:07):
So we need to do much more to help people
to understand the fallacy of race. There is no biologic
or genetic underpinning to the notion of race. These so
called races that we have identified are purely social myth.
But rather, what we have done is to create a
society where people are valued differently on the basis of
(54:27):
things like skin color, hair texture, et cetera. Children see
that it's reflected in the inequities that we see across
a range of different outcomes, and it's my firm belief
that we are making progress towards helping people in this
society understand the fallacy of race, but the reality of
racism and importantly how destructive racism is for all of us.
(54:51):
I believe if we keep pushing to raise this level
of awareness, ultimately this will help us to lay a
foundation to create it a more egalitarian society, as we
have stated, that is our goal. So true, Brian, I mean,
I agree with every word you said right now, because
it's really the biases that you've kind of built in.
And one is working on the systemic and the infrastructure
(55:13):
part of it and the government role that is to
be played here. But I think the other part is
also really the biases that we have to fight from within.
And in the context of all we've talked about today,
does any you know initiative from government or local level,
federal level, state level, or any other country in the
world you have witnessed where the government has risen to
(55:35):
the recent challenges in particularly productive way. Well, we've certainly
seen wide variation globally in how governments are responding. We've
seen wide variation in the pandemic spread. We all can
learn quite a bit from New Zealand, which has had
great success in first getting the inhabitants of the country
(55:58):
to cooperate to work together other to do those public
health behaviors that we know from science are important, wearing
a mask, washing hands, physically distancing, and yet we still
have resistance to that science. In the United States, we
have people who believe it's a matter of their personal
freedom to not wear a mask, you know, that kind
(56:20):
of stance. While it may be ideologically comforting for some
flies in the face of science, and so we have
to come to a reckoning. We can either hold onto
our ignorance and be willfully proud and demand that we
have our so called freedoms to behave as we wish,
or we can recognize that our behavior affects others in
(56:42):
our communities. So just as we have certain freedoms, we
also have many responsibilities to understand how our behavior affects
others in our community. Same issue with vaccines. The more
people that we can get to accept the vaccine, the
more progress we will make toward reducing the spread. But
the big takeaway from me is that nations that cooperate together,
(57:07):
that show a level of social cohesion and solidarity, will
do much better in stopping the spread of the virus
than those communities characterized by deep division such as here
in the United States. I mean, you touch to a
very interesting topic here, and I'm forced to ask this question,
which is around science. Right, it's absolutely critical in the
(57:27):
pandemic response that you know, this push against science, anti
access movement for instance, or also not people not wearing masks,
or some even believing that COVID nineteen doesn't even exist. Right,
So this scientific fact versus misinformation leading to apprehensions. What
is the rule of psychology here? And I mean the
psychological dimension of the pandemic. You know, there are a
(57:51):
number of psychologists who have studied public health communications. How
do we ensure that our messages are being heard accepted,
and that we are conveying accurate information? Who needs to
convey that message? There's quite a bit of science on
this topic, and so we need to be prepared to
deploy those lessons learn from that science. We know pandemics
(58:14):
tend to elicit some of the worst aspects of our
tendencies as human beings. Pandemics create anxiety, They tend to
turn neighbor against neighbor. They tend to make us distrustful.
And if we already had a level of distrust in
our institutions that tends to get worse during the pandemic.
So understanding that yes, we are going to have factions,
(58:37):
we're going to have divisions during a time of extreme anxiety,
but understanding that there are ways that we can address
that anxiety and come together, and again understanding that our
ability to cooperate, to work together toward our goals as communities,
as a society is going to be far more constructive
(58:57):
towards flattening the curve. As we say, then the divisions
that we've seen, so this is often hard to convey,
and those sentiments that are solidly anti science, as you've indicated,
are difficult to change. But if we can help people
to understand again our collective responsibility and what we need
to do to protect each other, our families, our communities,
(59:20):
most people would be motivated by that kind of information
and would take the kinds of steps that are needed
to ensure that we understand our responsibilities to each other
right totally. Bang on, the strategic health communications is something
that we need to invest in, Brian, there were amazing insights.
We're very interested in humanizing our shared experiences, and here,
(59:43):
beyond your academic work, how has the recent pandemic affected you,
your family, your friendships, any stories there. Sure, for my family,
as with many other families, it is challenging. Right. We're
unable to travel, we're unable to see friends and family
as we once did. But those are relatively minor concerns
(01:00:04):
compared to what some other families have gone through. So
many families have tragically lost loved ones or have had
people get very sick in their families. I'm so fortunate
that we have not had that experience in my family,
and my heart goes out to those who have had
those kinds of tragic experiences. The best thing that we
can do for each other is to understand that even
though we must be physically distant, we need to be
(01:00:28):
socially together, and thankfully there are many many ways to
do that with technology today. We need to ensure that
we are expressing care for each other. We need to
ensure that we're communicating with each other, checking on what
we might need. Again, even as we're physically distancing, we
need to be socially showing solidarity. Right. I love the
(01:00:50):
message they're like, we need to be socially together and
that's what is important in these current times. Thanks Brian
for your insights and for all the work you are
doing that contributes to building the capacity for public health
to advance equity. And I'm particularly a fan of one
of your initiatives within your Health Equity Collaborative, which is
the Culture of Health leaders. I mean, we need this
(01:01:11):
foundational leadership development for people who want to advanced health equity,
and and we need to prepare and inspire people to
provide this transformative leadership to address health equity in these communities.
So thank you, thank you for doing all the work,
and thank you for speaking to us. Thank you so
much for having me. Racism is a public health issue.
(01:01:34):
It's been a humbling experience to talk about issues of
racial segregation and health equity in America through contact world
truth and health. We can't hide from truth. We can't
hide from these issues or pretend they don't exist. Black
and brown people are disproportionately affected by disease because our
system designed it that way. If I hear one more
(01:01:57):
white person say all live matter, as if anyone said
or suggested otherwise, I'm going to pop. While I'm embarrassed
about some of our history, I'm equally passionate about doing
my part and our part as a company with Contact
World to fix a broken system. We have to improve
health equity in this country, and most of what's broken
(01:02:20):
comes down to racial injustice dating back more than one years.
If you deny that, you're part of the problem. If
you allow racism, even passive racism, to happen around you,
you need to stand up to it and speak out
against it. Being silent is being complicit. I'm proud to
(01:02:40):
be part of this movement to reduce health disparities and
eliminate structural racism in this country. Thank you for being
a part of that too. We'll see you next time
on Contact World Truth and Health, We're going to talk
about data genocide with a troublemaker who speaks on behalf
of our American Indians and Alaska Natives. Listen to Contact
(01:03:04):
World of podcast on the I Heart Radio app or
wherever you get your podcasts.
The legacy of racial segregation as relates to the COVID
pandemic is that hyper segregated cities served as ground zero
in terms of the mass spread of COVID nineteen in America.
If we didn't have American apartheid, if we didn't have
racial segregation to that degree, it would have made it
(00:22):
much harder for COVID to really pick up and spread
in a mess kind of way. That's Dr Lawrence T. Brown,
director of the Black Butterfly Project, Drawing on as many
years of social science research, policy analysis, and archival material,
Dr Brown recently published his first book, The Black Butterfly,
(00:43):
The Harmful Politics of Race and Space in America, a
fascinating look at the ongoing historical trauma caused by a
combination of policies, practices, systems, and budgets which are at
the root of uprisings and crises in hyper segregated cities
around the country. But there is reason for hope, as
Dr Brown offers up a wide range of innovative solutions
(01:04):
to help heal and restore redlined black neighborhoods across this country.
We also hear from Dr Brian Smedley, co founder and
executive director of the National Collaborative for Health Equity, a
project that connects research, policy analysis, and communications with on
the ground activism to advance health equity. In this role,
Dr Smedley oversees several initiatives designed to improve opportunities for
(01:28):
good health for people of color and undo the health
consequences of racism. The way that healthcare resources are distributed
here in the US is deeply inequitable. Often, those communities
that are sickest and in greatest need of access to
health care services and culturally appropriate services in their community
simply don't have that access. So the big takeaway for
(01:52):
me is that nations that cooperate together, that show a
level of social cohesion and solidarity, will do much better
in stopping the spread of the virus than those communities
characterized by deep divisions, such as here in the United States.
(02:12):
I'm Justin Beck, founder and CEO of Contact World. I'm
here with my co host Katherine Nelson and dep Pava,
and over the coming months we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
may not have all the answers, but you deserve to
(02:32):
understand what goes on in your neighborhood and the decisions
that will affect you and your family's health. Welcome back
everybody to Contact World. So today we're gonna hear from
Dr Lawrence T. Brown and Dr Brian Smedley. Previously, we've
talked about, you know, the political determinants of health and
the way that politics have influenced public health. But it
(02:56):
was interesting to learn how segregation in America has actually
caused this proliferation of COVID nineteen. It makes a lot
of sense that we're in the position we're in because
things that affect marginalized communities affect everyone. And it was
interesting the intersection between these two conversations because on one hand,
(03:16):
we don't have data because we've been trying to ignore
the data, right, we've been trying to sweep it under
a rug, because our country has an absolute history of
racial segregation and it has caused a lot of the
problems that we're experiencing today. Justin you bring a very
interesting point that I found personally very revelational. In the
(03:37):
midst of the crisis, our understanding of this inequity was
delayed and remains limited because many health care institutions, as
well as state and the federal government, they were still
to capture the demographic information on COVID nineteen because the
health equity data was not available. And one of the
most crucial things is a data to an approach that
(04:00):
can be used to address this very racial disparity in
the health care outcomes. And data does make a difference
because unless you can measure something, how can you even
think about solving that? Right? Yeah, and I agree with you,
but I think there is some sort of acknowledgement, especially
by the current administration. And what I enjoyed the most
(04:22):
about both interviews is that they both had some positive
policy changes and that's where we're going to see the difference.
And one example of that is the Health Equity Tracker
project that Daniel Dawes was leading, and they're starting to
tackle the data issues surrounding the pandemic and health equity
and it does really start with a commitment to saying, hey,
(04:44):
we have to find the data in order to address
the problems. It's was one into transparency in my open
and it's really about transparency and having integrity that you
will not use the data the way it should not
be used, and again building trust within the governments, within
the healthy institutions, within public institutions. But one has to
acknowledge that segregation by design is happening, and only then
(05:07):
we can make afoot towards conquering this problem. We're in
this position because we defunded public health and yet we
expect these heroes to perform more than a miracle and
trying to get us out of this situation. But the
concept of a community health workforce, I think is a
really strong one because if we're expecting marginalized communities to
(05:29):
strictly sign up online and that's the only way that
they're gonna get vaccinated, we're missing the point that these
digital divides are going to continue to create problems. So
community health workforces, whether it's through the Heroes Act or
whether it's through Biden's new executive orders around improving public
health infrastructure, is really exciting to think about. Yeah, and
(05:50):
also it conveys the seriousness and it's less remote when
you tell someone you have to log into a website
and you know, I'm sending my information over the airwaves.
I don't know where it's going to home. But if
there's an actual human knocking at my door, speaking to
me directly, then I'm more inclined to cooperate. It conveys
the seriousness but also the human interest. You know, whoever
(06:14):
is in that community is going to feel looked after
and cared for, as opposed to the desensitized way of
your on your own you go and you know, register
and if you don't, then good luck. If you don't
have a computer, or if you don't have access to
the internet, I guess you know, you just drew the
short stick there. I love your comment. You're cutting and
that reminds me of one of the conversations that I've
(06:35):
had long back with the last Smile health care worker,
and he told me that, you know, sometimes we just
talk about technology all the time solving these issues. There
are places and there are people for them. Even pen
and paper is technology, and humans are capable of using
that and bringing that access. We are trying to achieve
(06:56):
through technology. So if there is a hybrid solution that
we can come up with, that's what is going to
solve the problem in a sustainable way. All right, let's
dive into these powerful conversations and hear from two of
the most knowledgeable experts in this field. Hello, Dr Brown,
(07:21):
it's a pleasure to meet you. Hello, thank you so
much for taking the time to talk with me today.
And can you tell us a little bit about your
background and what led you to write The Black Butterfly. Well.
I was born in well Memphis, Tennessee. We lived in
West Memphis, Arkansas. Left there my family. We went to
the Houston area, went to moor House after graduating in
(07:45):
nine seven and major in African American studies. And across
the street from moor House was a public housing development
called Harris Holmes and they were in the third phase
of uprooting people as a part of Clinton's Hope six project,
which involved demolishing about a quarter million public housing units.
And so I think it was there that I really
(08:07):
sort of begin to question policies of displacement and how
and why African Americans are being uprooted, and I wanted
to know more about, like how government played a role
in that. So my master's degree was in public administration
at the University of Houston, where I picked up that
thread to try to understand a little bit more about
(08:27):
community development. And then I got interested in the health
angle of community development. So I went to University Tennessee
Health Science Center where I obtained my doctorate and health
outcomes and policy research. After finishing it led me to
Morgan State University in Baltimore, where I worked on my
post arctro fellowship became an a social professor. My research
(08:50):
kept looking at, you know, how neighborhoods impact health outcomes,
and that whole through line really led me to this book, right,
And was the initial interests to satisfy personal curiosities or
did you already have a plan in mind that this
is something that you're gonna work on and educate the
public as you are doing right now. I mean, I
(09:12):
think it more or less developed organically. I don't think
I had a master plan in mind, but I think
you can see how one interest, one degree kind of
led to the other. You know, I grew up well,
my hometown West Memphis, Arkansas's is small. It's like thirty
thou folks, and the county is rural. Arkansas is very
(09:32):
rural state. And so it's just thinking about the impact
of space on people's health and the impact of how
space is racialized and how that impacts people's health was
something that I think was there from the beginning, just
in terms of always being interested in, like urban policies,
what makes a space, you know, be the way that
(09:54):
it is now. And so with all of the cities
that I lived in, you're talking about Baltimore, Memphis, or
West Memphis, Arkansas, Atlanta, Georgia, Houston, Texas, and so it's
just you know, really sort of getting a good sense
of how these different cities meant you have different outcomes,
and then if you lived in different neighborhoods in those cities,
(10:15):
you had different health outcomes. You know, my background and
my intellectual interests led me to this work. And through
your work, how do you see the legacy of racist
policies in cities throughout the nation as a contributing factor
to the disparities of experience throughout the COVID nineteen pandemic. Well,
(10:35):
I mean the biggest contribution of urban policy to the
current pandemic is the municipalization of racial segregation. So the
ways by which racial segregation was shaped in urban areas.
Baltimore Mayor John Barry Mohole, he passed the first residential
racial zoning law in American history on December nineteenth, nineteen ten,
(10:58):
and so you have cities in the early nineteen hundreds,
they were still building out their sewer systems, they were
still building water filtration to clean water, they were still
connecting water lines. Many homes they didn't have plumbing, they
didn't have clean water, they didn't have sewer systems, which
(11:18):
meant that they were breeding grounds for infectious diseases like
influenza or like tuberculosis, especially yellow fever cholera. So those
are diseases that were high at the time. But the
way in which municipalities were allocating resources to white neighborhoods
and white blocks and not allocating those two black neighboroos
(11:42):
or black blocks at the time, that had a tremendous
impact on the infectious epidemics then, and then you go
further in time to where we are today, it has
a big impact on the COVID pandemic. Now, do you
think these allocations were in sorts intentionally depriving the minority
(12:04):
communities or was it maybe disproportionately done Well, it was
absolutely intentional. Number one, race was the reason. Like in Baltimore,
you saw in the Baltimore Sun, I talked about in
my book, how the Sun kept putting this headline out
and their articles Negro invasion. There's a Negro invasion homebuying
while black black people are coming. And so they weaponized,
(12:27):
they used propaganda to cause white Baltimoreans to engage in
the counter offensive against black homebuyers. And you see public
health actually being used as a rational for racial segregation.
The fact that black people had a higher rate of
tuberculosis and other diseases, that was a reason to then
(12:50):
segregate them. In effect, it was a neighborhood quarantine. So
you see in the Baltimore Sun again and other newspapers,
how the discourse of data and the way in which
Black people were stigmatized and demonized based on these health disparities.
Given the intentionality that you see both with newspaper headlines
(13:13):
with the implication of public health, with other media that
we're really spreading about the time, like the Birth of
a Nation by D. W. Griffith, which glorifies the Kukus Klan,
you can see how race is intentionally being used as
a ration now to effectuate racial segregation. And then if
you want to look at Jessica trouns Things book Segregation
(13:37):
by design. She shows empirically that that more racial segregation
that you see in the city, the less public resources,
the fewer public goods are being allocated per capita in
those cities, and definitely in those cities to black neighborhoods.
What would you say has been the most profound impact
(13:57):
of these type of policies on health vector is during
this pandemic. Firstly, we had the introduction of the virus,
so you had California, I believe Seattle, if I'm not mistaken,
cruise ships they sort of brought the virus to the nation.
But after the virus arrived, then it hit hyper segregated
(14:17):
cities the hardest. New York is a Category four hyper
segregated city, and I used category like a hurricane as
an analogy. Detroit was hit hard, Chicago was hit hard.
Those two are Category five hyper segregated cities. That's the
highest form of racial segregation that we have, and so
these cities were hit really really hard early on. If
(14:39):
you recall March in April of last year, hyper segregated
cities were the first hit. So the legacy of racial
segregation as it relates to the COVID pandemic is that
hyper segregated cities served as ground zero in terms of
the mass spread of COVID nineteen in America. If we
(15:00):
didn't have American apartheid, if we didn't have racial segregation
to that degree, it would have made it much harder
for COVID to really pick up and spread in a
mass kind of way. What else have you seen as
far as the tangential consequence of lockdowns depleted economies? For example,
you mentioned the city's Chicago and New York, the lower
(15:22):
opportunity streams on these communities of colors throughout this crisis.
There should have been universal basic income. There should have
been a massive infusion of resources from the federal government
that would actually have allowed people to stay home then
in a concentrated way. Instead, we had a president at
the time that was talking about reopening by easter and
(15:47):
that the deaths would be under a hundred thousand or
under sixty thousand at first, and here we are now
approaching five hundred thousand. We didn't lock down long enough.
I argued that capitalism was going to actually work against
our ability to fight this virus. We needed to develop
a strong response that was gonna help renters, help forty
(16:09):
million people that were thrown into unemployment. Initially, we need
to have a strong response to effectuate the type of
lockdown that was needed, and we did not do it.
So that is what has set up the tangential impacts.
We did a half hearted lockdown, and we haven't really
made any sort of strong effort around economic recovery. We
(16:30):
had a lot of big businesses spelled out, but in
terms of regular people, they got that one two thousand
dollar infusion, I believe back in the summer of last year,
and that just wasn't enough. And so we're actually, I
think getting ready to see much more economic impacts that
are going to be destructive in so many lives for
(16:52):
a long period of time because we did not arrest
our instincts to be this capitalist country at the outset,
and so we're gonna deal with the issues on the
back end with the new administration. What are your thoughts on,
you know, the direction that we're taking now. Do you
feel that there are appropriate measures being taken? Well, I mean,
(17:12):
certainly the new administration is, you know, a breath of
fresh air. You know, they's just getting their feet on
the ground. But I think there has to be a
lot more again, I think they're talking about maybe four
hundred or adding four hundreds to the six hundred in
terms of the next COVID stimulus package for people that's
not universal basic income. Universal based income is two thousand
a month, so I'm talking about universal basic income to
(17:35):
access secure people's financial needs. And then, even though there
is a rental moratorium, I believe that President Biden is
trying to extend now past the March deadline. You know,
I think we need to go a lot further because
not all states are honoring that rental eviction. Their courts
are not honoring it. So we need to really have
a strong, nationwide you can't get out of it strategy
(18:00):
that allows people to stay where they are, not be
put out of their homes. I think you've got to
put things in place to really stabilize housing and stabilize
people's income so that you don't have I think the
wave of desperation that's going to come after that moratorium
is lifted, because the rent is going to be do
and you're gonna have an eviction crisis. And then if
(18:23):
everybody is vaccinated at that point, you're going to see
a spike in COVID. So all of this has to
work together otherwise we're never going to get this virus
under control. Right, And you speak of desperation, do you
feel that some of the communities of colors are in
essence feeling desperate for the help that they should have gotten,
(18:44):
with the help that they should be getting, and how
do they take steps to get that help. I think
there is desperation, but in many ways, community of color
are really masters of resilience, and so you may not
see it. And the fact that people are dealing with
deaths and contracting COVID. I know my family, I've had
(19:07):
over ten members in Southern States, you know, contract the virus,
including my two grandparents. So it's hard to be engaged,
I think on the policy front side of it while
you're dealing with folks that are in the hospital, dealing
with folks in your family that are you know, passing away,
whether it's due to the disease or in the aftermath
of it. So we're trucking along in terms of the
(19:31):
room and the space to deal with the policy front.
I don't know that the advocacy is as much there
as it should be. But you know, in the middle
of a global pandemic. When you're at the bottom of
the social hierarchy, you know, that's gonna be tough to
do now. At the same time, there was the action
that was taken on election day. So you did see
(19:55):
black voters in cities like Atlanta, Philadelphia, Chicago, Pittsburgh, Detroit
come out and support a new administration in part because
they wanted a better COVID response. You know, you saw
Latino voters in Nevada and Arizona. Native American voters in
Apache County and Navajo County in Arizona helped put President
(20:18):
Biden over the top. So there was maybe to even
counteract my own point, there was that movement to actually say, hey,
we want a different president in part because we want
a better COVID response. There was that policy push. I
want to make sure I highlight that. Yeah, it's that
resiliency on top of their their own survival instincts. Yes,
(20:41):
how do you see the terrain ahead for vaccine distribution,
contact tracing and other interventions? And I know this is
just kind of broad, but you know, how do we
build trusts with our communities of color, How do we
establish fairness in the distribution of the vaccines? Tell me
your thoughts on those. Well, what I'm seeing right now
(21:03):
is a failure to engage in vaccine administration equitably. You
have white people coming in from other neighborhoods into black
and brown neighborhoods to get vaccinated before the black and
brown people that live in those neighborhoods. That story you're
seeing in Detroit and Philadelphia. They gave a twenty two
year old white gentleman, they gave him a contract to
(21:24):
deal with COVID, and they skipped over the black doctors
who have their own organization that I have built trust
and that should have gotten a contract like that. So
you're seeing the administration of the vaccine this inequity in
terms of both whereas being distributed. If you look in
the state of Maryland, demographically wider counties are getting more
(21:47):
vaccines per capita than demographically blacker counties. Then you have
the fact that the primary mode of vaccine administration is
to have people sign up online. Then those people living
in those redline marginalized sub prime communities that are dealing
with digital device they're going to be left out. So
I foresee the continuation of what we're seeing now vaccine
(22:11):
apartheid unless we actually engage in the strategy that I
think we should do, which is I believe the Heroes
Act from last year should be passed the creation of
a national Community health worker workforce. I would hire a
hundred thousand community health workers and I would have my
community health workers working with nurses and physicians, medical professionals
(22:36):
going out to communities, not waiting until people come into
the hospital, come into the vaccine site, come into you know,
the stadium where you have it set up, or drive
through when everybody don't have a car. You need a
group of folks gonna go out and I don't care
if they have to go door to door. You should
have people going out to make sure the vaccine is
(22:58):
a ministered in those communities that are really struggling, making
sure they have the access that they need, and build
trust along the way because a lot of people they
may say no right now, but that no could be
a wait and see. I'm gonna wait and see, but
maybe in three months I might say yes. So that's
another reason you need to community health work is to
(23:19):
be out communicating, out discussing, showing their face, having conversations.
That's the kind of interaction, that relationship building that's gonna
be needed, and you need people to do that, not technology,
not the internet. The way we're doing it now is
not gonna cut it. Yeah, I understand that. In our
previous episode, we're talking to Dr Yasmin and she was
(23:43):
explaining how there needs to be some level of atonement
and acknowledgement of wrongs from the past in order to
build that trust. As you mentioned, Absolutely, I wanted to
ask you about you kind of touched on it a little,
but you've had family you who have been hospitalized because
of COVID nineteen. First of all, has everyone recovered to
(24:06):
my knowledge, yes, everyone has recovered. Like I said, my
grandmother passed several months later, and I understand it was
from heart failure, not COVID. Sorry for your loss. Absolutely,
I celebrate her life. And even though she recovered and
died later. You know, COVID still has impacts people in
their cardiovascular system and many systems, even the neurological system.
(24:30):
My grandfather when he was hospitalized, he didn't remember who
his wife was, for instance, and later regained his memory.
So we're very thankful for that. We've heard that you've
described the medical system as raggedy throughout your experience. Can
you elaborate on that? Yeah, I mean the home health
care workers you have to call in Arkansas, I had
(24:52):
to call to you know, arrange that and make sure
that took place. You know. It's also the case where
in those smaller rural counties like Lee County, Arkansas doesn't
have a hospital. The hospital in Critton County where my
grandparents lived, I think had six beds for I see
you cases. So these are rural counties that you know,
(25:12):
if you get ten cases, that's a spike that a
lot of counties cannot handle if they don't have that
real health infrastructure. And this is America, the wealthiest country
on Earth, and we can't have health care infrastructure for
our people. That's why I called it ragged. It's a
shame and it's a hot mess trying to compensate as
(25:33):
an individual for these systemic failings and lack of funding.
You know, there's been the discussion the protests over defunding
the police, and what I want to point out to
a lot of people is that we've been defunding public
health for decades and that is why we are in
a situation now where we're relying on private corporations like
(25:56):
a Walgreens and the CVS to minister vaccines. Why do
have to rely on them if you have a good
public health system? Because we don't, and not because it's
not good as in the people aren't trying hard. Is
that we deeply underfunded, We defund public health in this nation.
You know, if you just dropped in from another planet,
if you look at COVID data, you would say, well,
(26:17):
America is the developing country. There's no way it could
be the most advanced, wealthiest country on Earth. But in
fact it is. Based on your background and everything that
you've described that you've done, you're an expert. So what
would your top list for policy initiatives be at addressing
the issues and the disparities that we've seen so far? Okay, Well,
(26:40):
for COVID, I'm looking at spatial equity testing early on
and the vaccine administration. Now, if your main locations are
in wealthier, wider communities, that's not spatial equity and racial equity.
You can't have racial equity without spatial equity because America
is so segregated. So where are your testing sites? Where
(27:01):
are your vaccine administration sites? If they're not in red
line sub prime low income communities, you've already failed spatial
equity in the response. Like I said earlier, Number two,
community health workers, community health workers. Community health workers got
to have an outreach component, not just to come see
us component. And then number three is that internet can't
(27:23):
be your only strategy. In fact, I'm not sure it
should be much of a strategy at all, given the
way we've seen people gain the system, people coming from wealthier,
wider communities, colonizing the vaccine supply, gentrifying vaccine administration. Those
are the top three things that I would look at
shifting from internet to person based through community health workers
(27:46):
and with a spatial equity approach, those would be my
top three for COVID overall. You know, health equity is important,
but alongside health equity, we have to have social solidarity.
And what is that social how there is realizing that
this whole country is in this mess together. Even though
(28:06):
the deaths are disproportionate among communities of color, you still
have a huge percentage of white people dying from this,
and so the thing is we're all in this. So
whatever good programs and strategies that we need, universal basic income,
this community health worker core that I'm talking about, having
spatial equity in the response. These things are going to
(28:28):
be helpful to everybody. So so this just has to
be like a strong mutual aid outreach, you know, working
to get folks vaccinated and in a holistic way that
when you're dealing with people on the COVID front, you're
also checking to make sure that their other needs are
being met. You know, how do we set up a
strategy where everyone's going to be having their needs met holistically? Absolutely?
(28:55):
Dr Brown, It certainly has been an enlightening conversation to
speak with you and care about the work that you've
done and how you're shedding much light to a lot
of important areas and key issues. Do you have any
final thoughts to share with our listeners. The biggest thing is,
you know, our issues as a nation right now are
(29:16):
really rooted in American apartheid, and American apartheid is a
system that was set up via racial segregation, colonization, uprooting communities,
particularly Native American, Latino African American communities. So we have
to have equity, we have to center equity, but at
the same time we need to also uplift, social solidarity,
(29:40):
the fact that we are all in this together. White
people are dying too. We want to make sure that
every community has what it needs, and if some communities
need more, we need to allocate more to those communities.
So COVID then can be a turning point for America
where we recognize what is really bedoubling us, what is
really destroying so many lives in this country. Because even
(30:03):
when you get rid of COVID, you're still going to
have those other epidemics. You're still gonna have deep poverty,
You're still going to have the four regions in our
country that are really struggling, the Southern Black Belt. You're
still gonna have Appalachia struggling. You're still gonna have Native
American tribal lands in the US Mexico border counties. So
these are all racial geographies where we have tremendous inequities,
(30:26):
and you realize that Appalachia means a lot of poor
white people are in that mix. And so that's what
we're saying. We're saying everybody, everybody needs to be on
board if we're gonna make this country the country that
it should be instead of lagging behind in so many indicators.
Very well said a great summary. I love what you
(30:47):
said about social solidarity. I think that probably should be
one of those buzzwords out there that we should all
be adopting and talking about. Thank you for taking the time.
Thank you, Bye bye. M What an honest and insightful
conversation with Dr Brown, and for anyone who needs to
understand why communities of color in this country continue to
(31:10):
struggle for access to some of the most basic health needs,
health needs that so many of us take for granted,
I encourage you to order his book, The Black Butterfly.
Now coming up, we'll hear from Dr Brian Smedley, another
torch bearer and lifelong advocate for health equity. Hi. Brian,
(31:38):
it's a pleasure to have you on our show today
and thanks for making the time so. Brian, you are
the co founder and executive director of National Collaborative for
Health Equity, a project that connects research, policy analysis, and
communications with on the ground activism to advanced health equity.
And you have been carrying the torch for actually said
(32:00):
every years now on undoing the health consequences of racism.
Tell me something more about your personal motivation to start
this health equity initiative in general, and also what got
you working on these topics. What's your personal story. Well, first,
thank you so much for having me. You know, health
equity is something that we should all be concerned about,
(32:21):
but I'm personally very deeply invested in it. I come
from a line of people who have committed themselves to
racial justice work. My mother is the late anthropologist Dr
Audrey Smedley, who wrote quite a bit about the concept
of race and how it originated here in North America,
essentially to subjugate and exploit, of course, indigenous populations and
(32:42):
then enslaved Africans and so forth. So that's really the
roots of today's health and equities, and given my mother's scholarship,
given the kinds of things that I've observed in my lifetime,
such as being born in Detroit in the nineteen sixties,
a city that was going through considerable demographic change. When
(33:03):
I was a little boy, we moved to a neighborhood
on the west side of Detroit that was somewhat integrated,
but like a lot of other cities in the United States,
as African Americans began moving into the neighborhood, white people
began to leave in significant numbers to the suburbs. And
that's the roots of modern day racial segregation, which I
(33:24):
have focused a lot of my work on because it's
actually at the root of many of the health and
equities that we see, particularly those inequities between African Americans
and whites. Most people don't recognize the role of residential
segregation as being foundational to health inequities. And moreover, most
Americans don't recognize the role of government and actively segregating
(33:48):
and separating different racial and ethnic groups and perpetuating that
segregation up until nineteen sixty four when those practices were
finally outlawed. So really my work is about addressing that
asking legacy of a structural form of racism, which is
residential segregation, and the role of government and many other
actors in creating and perpetuating that segregation, right, I mean,
(34:12):
it takes me to one of the common topics we
discussed with Dr Brown on our podcast as well, the
impact of housepiece that is racialized is impacting people's health.
And there's also I think a book which is Segregated
by Design that really examines exactly the topics that you're
kind of talking about, and touching on you're also the
Chief of Psychology and the Public Interest with American Psychological Association,
(34:35):
and you're leading a PAS efforts to apply the science
and practice of psychology to fundamental problems of human welfare
and social justice. What would you like to touch upon
these topics being kind of used in terms of the
context of the pandemic right now, you know, in the
last year, and how they may be different than what
it used to be in the past in terms of
(34:57):
how you've been doing your own work and the challenge
to sit on deck. Well, we're certainly in in our
lifetimes unprecedented times with the pandemic. We've seen that the
pandemic has upended so many aspects of life and tragically
has cut many lives short. The pandemic really just reflects
existing inequity. Those populations that have been marginalized politically, socially,
(35:20):
economically typically are most vulnerable to infection. They have higher
mortality rates. So here in the US context, African Americans,
Latin X populations, American Indian populations, and many others have
been hit particularly hard by the pandemic. So our effort
at the American Psychological Association and other groups working in
the racial equity and health equity space is to simply
(35:43):
uplift this inequity. It's my contention that we will not
get out of this pandemic unless we center and prioritize
equity concerns. No reason for this is pretty simple. You
can't leave any community behind and expect that we're all
going to be okay and healthy and that we're going
to ltimately defeat the virus. If we leave behind those
(36:03):
folks who are frontline essential workers, folks who are working
in nursing homes and other settings, who are disproportionately themselves
black and brown immigrant folks, if we leave these communities vulnerable,
then we will all ultimately be vulnerable. So we need
to address the needs of those most marginalized in those
most at risk, and to prioritize how we go about
(36:26):
reducing risk. So we know, for example, that we all
have to practice good public health practice wearing masks, washing hands,
physically distancing, but in some cases, in communities of color,
for example, those are very difficult to do, particularly if
you have overcrowded housing or people working in settings where
it's difficult to physically distance. We have to prioritize the
(36:46):
concerns of those communities if we're going to ensure that
none of us are at disproportionate risk and that we
can all ultimately come out of the virus healthier and stronger. Right,
I mean, the topics you touch upon a very valid
and actually quite and focus in news these days as well.
And and I believe one of the missions of you know,
your Health Equity Collaborative is to set up a promote
(37:07):
health equity by harnessing data. And I just want to
bring that aspect of data here. And you know, I
read a federal study that found that raise and ethnicity
data is missing for nearly half of coronavirus vaccine recipients,
and this lack of data is leading to an inequitable
response to the pandemic, which is of course, you know,
continuing to undel your burden communities of color as well.
(37:30):
In fact, the Biden administration created COVID nineteen Health Equity
Task Force has also an ambitious promise there of an
expansion of equity data collection. So, first of all, your
thoughts on that, and secondly, do you see these solutions
to such challenges in terms of equity data collection, which
has a major role to play here. Yes, that's a
(37:51):
wonderful question. Most folks would wonder, well, why data collection
doesn't sound very sexy? How does that help solve this
problem of this virus epidemia? Oology one oh one tells
us that we need to collect data, very thorough and
comprehensive data to understand where the virus is spreading, which
communities are getting hardest hit. And unfortunately, when the pandemic hit,
(38:12):
we had a very weak and ineffective federal response. It
left it to many of the states to be able
to forge strategies going forward, particularly with respect to data collection.
We have fifty plus different approaches to data collection being
used among the states, but we need comprehensive and complete
data collection on things like demographic information. We need to
(38:34):
know who's testing positive by race, ethnicity, socio economic status.
Data such as income, our education would be helpful. Where
do people live places obviously critically important to understand the
distribution and spread of the virus. Are folks with disabilities
disproportionately affected? Are people who are gender or sexual minorities
(38:54):
disproportionately affected? We simply don't have the data, but we
need to know this information so that we can target
strategies to help communities to reduce their risks. We need
data on who is getting tested, who's testing positive, who's
getting hospitalized if necessary, and what kinds of treatments might
they be receiving. We need data on vaccines. We know
(39:16):
that vaccine acceptance there's quite a bit of variation across
different communities, and there's a long history. That's a whole
another story. But unless we have the data to understand
who's getting vaccinated, again, it makes our public health response ineffectual.
It makes it difficult for us to target strategies to
ensure that we're getting vaccines, for example, where they're desperately needed. Again,
(39:37):
this is something that's going to ultimately be of concern
for all of us if we want to contain the
spread and ultimately defeat the virus. Right, I mean, all
of that makes complete sense in order to be able
to understand the population, to be able to address the
solutions towards it. Right to that extent, would you have
any examples or maybe initiatives or something that is in
(39:57):
the planning where you could talk about data to and
innovations in this health equity space to understand how communities
are responding to vaccine availability. We need data. We need
to be able to understand new applications such as artificial intelligence.
How does that help target vaccine distribution where it's needed.
For example, in some cases, artificial intelligence may be not helpful,
(40:20):
particularly in the racial ethnic context, as there's some data
to indicate that artificial intelligence may be operating differently on
the basis of race ethnicity in the US. We need
to be very clear about how we can best harness
technology and where there may be risks with new technologies
such as AI, other than the commonly talked about issues
(40:41):
like lacking data and infrastructure. Because of the inequities in
the system, What fragilities have highlighted or exposed most within
these martialized community ecosystems during the pandemic In specific, how
do they relate to psychological well being of people. We've
seen that the pandemic has exposed so many inequities and
(41:03):
so many risks, but the psychological risks are profound. We
have a combination of economic anxiety given the economic disruption
of the pandemic. We have fear of infection or transmission
of the virus to one's loved ones or family members
or others in the community, and then we have had
accompanied with the pandemic a resurgence of intolerance and expressions
(41:26):
of hate. The Asian American community here in the US,
for example, has been disproportionately targeted and victimized with assaults
both a verbal and physical in both virtual and physical spaces. Clearly,
we are in a very stressful time at the a
p A. We've been predicting a mental health tsunami emerging
(41:47):
as a result of the pandemic and the associated stresses,
and what it highlights for us is the need to
rebuild the mental health infrastructure. Sadly, over a number of decades,
we have disinvested in the public health and of structure
and mental health infrastructure here in the US, and so
we need to rebuild that because clearly the mental health
(42:07):
consequences that we're experiencing right now are deep and profound
and could have significant implications for the overall health status
of populations, for our ability to recover from the economic downturn,
and just to be resilient, to have our communities be
able to draw upon sources of strength and resiliency to
help them emerge from the pandemic stronger. So the mental
(42:30):
health consequences have been significant, and we are desperately in
need of ways to improve our ability to provide services.
You asked about innovation and technology earlier. One such innovation
is the increase in telehealth and tele mental health here
in the US, whereby people who are seeking psychotherapy, for example,
(42:51):
can find a provider and can interact either over a
video chat or telephone line. And this significantly reduces geographic
barriers to accessing therapeutic services. But it also from an
equity standpoint, reduces many cultural and linguistic barriers. So if
a person is seeking, for example, Spanish language mental health services,
(43:12):
but lives in a community where no such providers are available,
that person can simply look across the state where they
live in and attempt to access services from qualified providers.
So it opens up new opportunities for seeking assistance, and
from an equity standpoint, that kind of innovation is critically important. Yeah,
(43:35):
you bring in a lot of interesting topics here, but
one of the things which often strikes me is US
is facing public health crisis on a level not experience
for more than a hundred years now, right, it should
be reasonable to expect that all citizens can rely on
their government and health institutions to protect them. But for
(43:55):
many Black Americans and communities of color trust in the
girl and does not come easy. That you kind of
touched upon it as well, right, What would you say
is the reason for that? You know, we have a
long history and a sad history here in the US
of abuse at the hands of the scientific and medical establishment.
(44:16):
We've seen that African Americans have been abused in public
health research, such as in the infamous to Skegee experiments,
where African American males who had contracted syphilis were allowed
to go untreated so that researchers could understand the long
term effects of syphilis. Clearly unethical and something that should
never have happened and should not happen today. So you
(44:38):
have that history, plus you have the fact that there
are so many structural inequities. The way that healthcare resources
are distributed here in the US is deeply inequitable. Often
those communities that are sickest and in greatest need of
access to health care services and culturally appropriate services in
their community simply don't have that excess. Adding on top
(45:01):
of that, the fact that the United States remains a
nation that is focused on market based healthcare delivery. That
means we have no uniform national strategy for providing health
insurance coverage. We have no uniform national strategy for looking
at where we need to have our doctors, nurses, clinics, hospitals, etcetera.
So we in fact have multiple systems, many of which
(45:24):
merely replicate the inequities that already exist. So there are
many lessons to be learned about the proper role of
government and ensuring that we all have a basic level
of protection. And I'm very hopeful that despite the tragedy
of the pandemic, that we will learn those lessons that
there is a role for government to ensure a basic
(45:45):
level of access to health care and basic level of
public health services, and many other countries of course ensure
that all populations have at least some minimal level of
access to care. Right. I mean, it's very relevant point
that you talk about the role of government and how
they can make it more accessible in the health care.
But this brings me to another very important point, the
(46:07):
fact that marginalized communities and the communities of color are
more than ever now aware of these disparities in the
health care system, and now they're more than ever are
aware that they receive lower quality of care. Right and
during the pendiment, we often heard voices coming out and
speaking about the topics. So this is not only the
(46:28):
mistressed part, but it's also a level of awareness and
retaliation at times even right, So, is there a way
we can manage and handle this mistrust, so to say,
fear among these communities through better engagement, better communication. And
here I would in particularly like you to leaven into
(46:48):
your expertise in psychology and behavioral science as to how
to take corrective measures here. Sure, to your point, we
know that there are steps that we can take to
ensure that people have reliable, trustworthy information about the vaccine. So,
for example, given high levels of mistrust in the African
American community of the medical establishment and many other communities
(47:10):
as well, we know that there are some things that
we can do. First, begin to work with trusted community
leaders and advisers, folks who are working at the grassroots level,
be they working in community based organizations, nonprofit organizations, civic organizations,
faith institutions, and many others. Working with our trusted leaders
to provide accurate information is critically important. We also need
(47:34):
to ensure that we're working closely with community groups to
understand what are the concerns that communities may have about
accessing the vaccine. We need to better understand how do
we ensure that we're meeting other needs that communities may have.
It's not just related to vaccines. We need to ensure,
as I mentioned earlier, that we're all adopting good public
(47:54):
health behaviors, and so all of this is tied together
in terms of understanding trust not just in government, but
in all of our civic institutions. So that's why it's
important to begin to work with those trusted leaders that
are already present in communities and are already drawing upon
sources of strength and resiliency that already exists in these communities.
(48:16):
It's important to note that even though we're talking about
communities that are in many cases politically, economically, and socially marginalized,
these communities have tremendous sources of strength and resiliency that
we need to draw upon in times of crisis like this.
As very often it's said that you know, you often
listen to the voices of your own communities, and you
(48:36):
have to tap into that rather than coming it as
top down and personally. I work a lot in human
centered design, and I also believe that you have to
also tap into the moral intuition and values of these
communities to be able to communicate with them in what
resonates with them best. Right, let's think about COVID as
a trigger, you know, right now, I mean since March
last year, a few things changed. The nature of work changed,
(49:00):
onto exchanged. We know that people of color and marginalized
people were, you know, disproportionately impacted. It's a known fact now,
partially because they were the essential workforce during the pandemic
and they were vulnerable to this exposure. Another thing that
changed was the nature of education. We move from in
person to remote learning, and then the differential access to
(49:21):
broadband and strong technology, you know, that enabled people to
connect and learn differently, where marginalized populations again got left behind.
Right now, this is systemic and I am just trying
to bring that to the health equity perspective here in
the context of vaccine distribution. We see this trickle down
in the way the vaccine distribution is being done at
this point in time, where there is a digital divide. Now,
(49:44):
where does the entire health equity initiative can play a
role here in terms of reaching the people where they
are who have very limited access to technology. For instance,
do you have any solutions there? This is such an
excellent question because you're hying together again many of the
pre existing inequities and disparities in terms of access to
(50:05):
broadband internet, for example. These are all issues that were
critically important before the pandemic, and we're seeing how much
worse it's gotten. You mentioned things like children learning remotely.
There's some evidence that the kids are falling behind, and
again this disproportionately falls on the backs of children of color.
When we're talking about health, generally, the best predictor of
(50:28):
your health status as an individual is your educational attainment,
your educational level. And so we have left these children
behind who are most vulnerable at this time and who
experienced many challenges to remote learning. In some cases, we
have challenges with family care and child care that may
interfere with children's learning, inequitable access to broadband as you mentioned,
(50:50):
and then the challenges of children not having adequate nutrition.
In many cases we have children receiving breakfast lunch at
reduced or low cost or no cost. So these are
all deeply tied together, and you've asked about solutions. There
are some really interesting innovations happening in terms of remotely
(51:11):
bringing broadband to those communities that lack that access, ensuring
that children can go to centers in communities, for example,
where they can much more easily access broadband and at
the same time get some of the nutritional and social
services that they might need. So even though in some
cases schools are not open or are on a hybrid schedule,
(51:32):
or in other cases schools are just now returning to
in person learning, we have to ensure that we're addressing
the gaps that have occurred in the time where students
have been out of school, so ensuring that their opportunities
for remediation and helping children to get caught back up.
All of these things pose tremendous risk for these children
(51:54):
individually in terms of their opportunities in life and their
health outcomes. Broadly, but at all so affects all of
us as a society, as a community because again, to
the extent that we leave these kids behind is to
the detriment of the entire society. Tell me one think,
how could you or how we as a system rethink
(52:16):
race or racism in the context of health equity, and
in particular use of psychology to make a positive impact
on these critical site issues. First, we need to acknowledge
the global presence of the belief in human hierarchy, a
false notion that assigns value to some and denies value
and opportunity for others. And here in the u S context,
(52:38):
of course, European descendants are considered to have value. The
reality is that as a society, we allocate much more
in the way of societal opportunities to children of European descent,
while systematically posing barriers to opportunity for kids of color.
Psychologists have been studying this phenomena for many years, and
(53:01):
of course, psychologists have pioneered the notion of implicit bias,
the fact that people, even those with egalitarian views and
who are deeply anti racists, may harbor biases that they're
not consciously aware of that are automatically activated when we're
confronted with difference, whether it's difference on the basis of
skin color, gender, language, or any number of other factors.
(53:23):
So psychologists have tried to help the general public to
understand how these processes operate and to help us understand
that race is in fact a social construct, but racism
is very real because of the tendency for humans to
believe in forms of hierarchy. These, of course, are ideologically driven.
No child comes into the world believing that one group
(53:46):
is superior to another, but rather how we allocate socidal resources,
the cultural narratives that we hold. The kind of world
that we create for kids of color is often very
different for white kids, particularly here in the United States,
and these children see that they understand who is valued
and who's not when they see those kinds of conditions.
(54:07):
So we need to do much more to help people
to understand the fallacy of race. There is no biologic
or genetic underpinning to the notion of race. These so
called races that we have identified are purely social myth.
But rather, what we have done is to create a
society where people are valued differently on the basis of
(54:27):
things like skin color, hair texture, et cetera. Children see
that it's reflected in the inequities that we see across
a range of different outcomes, and it's my firm belief
that we are making progress towards helping people in this
society understand the fallacy of race, but the reality of
racism and importantly how destructive racism is for all of us.
(54:51):
I believe if we keep pushing to raise this level
of awareness, ultimately this will help us to lay a
foundation to create it a more egalitarian society, as we
have stated, that is our goal. So true, Brian, I mean,
I agree with every word you said right now, because
it's really the biases that you've kind of built in.
And one is working on the systemic and the infrastructure
(55:13):
part of it and the government role that is to
be played here. But I think the other part is
also really the biases that we have to fight from within.
And in the context of all we've talked about today,
does any you know initiative from government or local level,
federal level, state level, or any other country in the
world you have witnessed where the government has risen to
(55:35):
the recent challenges in particularly productive way. Well, we've certainly
seen wide variation globally in how governments are responding. We've
seen wide variation in the pandemic spread. We all can
learn quite a bit from New Zealand, which has had
great success in first getting the inhabitants of the country
(55:58):
to cooperate to work together other to do those public
health behaviors that we know from science are important, wearing
a mask, washing hands, physically distancing, and yet we still
have resistance to that science. In the United States, we
have people who believe it's a matter of their personal
freedom to not wear a mask, you know, that kind
(56:20):
of stance. While it may be ideologically comforting for some
flies in the face of science, and so we have
to come to a reckoning. We can either hold onto
our ignorance and be willfully proud and demand that we
have our so called freedoms to behave as we wish,
or we can recognize that our behavior affects others in
(56:42):
our communities. So just as we have certain freedoms, we
also have many responsibilities to understand how our behavior affects
others in our community. Same issue with vaccines. The more
people that we can get to accept the vaccine, the
more progress we will make toward reducing the spread. But
the big takeaway from me is that nations that cooperate together,
(57:07):
that show a level of social cohesion and solidarity, will
do much better in stopping the spread of the virus
than those communities characterized by deep division such as here
in the United States. I mean, you touch to a
very interesting topic here, and I'm forced to ask this question,
which is around science. Right, it's absolutely critical in the
(57:27):
pandemic response that you know, this push against science, anti
access movement for instance, or also not people not wearing masks,
or some even believing that COVID nineteen doesn't even exist. Right,
So this scientific fact versus misinformation leading to apprehensions. What
is the rule of psychology here? And I mean the
psychological dimension of the pandemic. You know, there are a
(57:51):
number of psychologists who have studied public health communications. How
do we ensure that our messages are being heard accepted,
and that we are conveying accurate information? Who needs to
convey that message? There's quite a bit of science on
this topic, and so we need to be prepared to
deploy those lessons learn from that science. We know pandemics
(58:14):
tend to elicit some of the worst aspects of our
tendencies as human beings. Pandemics create anxiety, They tend to
turn neighbor against neighbor. They tend to make us distrustful.
And if we already had a level of distrust in
our institutions that tends to get worse during the pandemic.
So understanding that yes, we are going to have factions,
(58:37):
we're going to have divisions during a time of extreme anxiety,
but understanding that there are ways that we can address
that anxiety and come together, and again understanding that our
ability to cooperate, to work together toward our goals as communities,
as a society is going to be far more constructive
(58:57):
towards flattening the curve. As we say, then the divisions
that we've seen, so this is often hard to convey,
and those sentiments that are solidly anti science, as you've indicated,
are difficult to change. But if we can help people
to understand again our collective responsibility and what we need
to do to protect each other, our families, our communities,
(59:20):
most people would be motivated by that kind of information
and would take the kinds of steps that are needed
to ensure that we understand our responsibilities to each other
right totally. Bang on, the strategic health communications is something
that we need to invest in, Brian, there were amazing insights.
We're very interested in humanizing our shared experiences, and here,
(59:43):
beyond your academic work, how has the recent pandemic affected you,
your family, your friendships, any stories there. Sure, for my family,
as with many other families, it is challenging. Right. We're
unable to travel, we're unable to see friends and family
as we once did. But those are relatively minor concerns
(01:00:04):
compared to what some other families have gone through. So
many families have tragically lost loved ones or have had
people get very sick in their families. I'm so fortunate
that we have not had that experience in my family,
and my heart goes out to those who have had
those kinds of tragic experiences. The best thing that we
can do for each other is to understand that even
though we must be physically distant, we need to be
(01:00:28):
socially together, and thankfully there are many many ways to
do that with technology today. We need to ensure that
we are expressing care for each other. We need to
ensure that we're communicating with each other, checking on what
we might need. Again, even as we're physically distancing, we
need to be socially showing solidarity. Right. I love the
(01:00:50):
message they're like, we need to be socially together and
that's what is important in these current times. Thanks Brian
for your insights and for all the work you are
doing that contributes to building the capacity for public health
to advance equity. And I'm particularly a fan of one
of your initiatives within your Health Equity Collaborative, which is
the Culture of Health leaders. I mean, we need this
(01:01:11):
foundational leadership development for people who want to advanced health equity,
and and we need to prepare and inspire people to
provide this transformative leadership to address health equity in these communities.
So thank you, thank you for doing all the work,
and thank you for speaking to us. Thank you so
much for having me. Racism is a public health issue.
(01:01:34):
It's been a humbling experience to talk about issues of
racial segregation and health equity in America through contact world
truth and health. We can't hide from truth. We can't
hide from these issues or pretend they don't exist. Black
and brown people are disproportionately affected by disease because our
system designed it that way. If I hear one more
(01:01:57):
white person say all live matter, as if anyone said
or suggested otherwise, I'm going to pop. While I'm embarrassed
about some of our history, I'm equally passionate about doing
my part and our part as a company with Contact
World to fix a broken system. We have to improve
health equity in this country, and most of what's broken
(01:02:20):
comes down to racial injustice dating back more than one years.
If you deny that, you're part of the problem. If
you allow racism, even passive racism, to happen around you,
you need to stand up to it and speak out
against it. Being silent is being complicit. I'm proud to
(01:02:40):
be part of this movement to reduce health disparities and
eliminate structural racism in this country. Thank you for being
a part of that too. We'll see you next time
on Contact World Truth and Health, We're going to talk
about data genocide with a troublemaker who speaks on behalf
of our American Indians and Alaska Natives. Listen to Contact
(01:03:04):
World of podcast on the I Heart Radio app or
wherever you get your podcasts.
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