1 00:00:08,875 --> 00:00:11,010 WELCOME TO THE CLINICAL CENTER GRAND ROUNDS, 2 00:00:11,077 --> 00:00:14,814 A WEEKLY SERIES OF EDUCATIONAL LECTURES FOR PHYSICIANS AND 3 00:00:14,881 --> 00:00:17,450 HEALTH CARE PROFESSIONALS BROADCAST FROM THE CLINICAL 4 00:00:17,517 --> 00:00:20,420 CENTER AT THE NATIONAL INSTITUTES OF HEALTH IN 5 00:00:20,487 --> 00:00:22,222 BETHESDA, MD. 6 00:00:22,288 --> 00:00:25,759 THE NIH CLINICAL CENTER IS THE WORLD'S LARGEST HOSPITAL TOTALLY 7 00:00:25,825 --> 00:00:29,462 DEDICATED TO INVESTIGATIONAL RESEARCH AND LEADS THE GLOBAL 8 00:00:29,529 --> 00:00:32,399 EFFORT IN TRAINING TODAY'S INVESTIGATORS AND DISCOVERING 9 00:00:32,465 --> 00:00:34,567 TOMORROW'S CURES. 10 00:00:34,634 --> 00:00:43,810 LEARN MORE BY VISITING US ONLINE AT HTTP://CLINICALCENTER.NIH.GOV 11 00:00:43,877 --> 00:00:47,247 >> GOOD AFTERNOON AND WELCOME TO 12 00:00:47,313 --> 00:00:48,782 TODAY'S CLINICAL CENTER GRAND 13 00:00:48,848 --> 00:00:49,115 ROUNDS. 14 00:00:49,182 --> 00:00:51,384 THE CME CODE FOR TODAY IS 50 15 00:00:51,451 --> 00:00:53,920 PIEF 54, PLEASE TEXT THE CODE TO 16 00:00:53,987 --> 00:00:55,922 THE NUMBER YOU SEE ON THE SLIDE 17 00:00:55,989 --> 00:00:57,857 FOR KRET EDUCATIONALS TO THIS 18 00:00:57,924 --> 00:00:59,692 LECTURE, WE INVITE TO YOU YOIN 19 00:00:59,759 --> 00:01:02,929 IN ON THE LECT OUR FOR THOSE 20 00:01:02,996 --> 00:01:06,366 APPLYING FOR CME, YOU WILL 21 00:01:06,433 --> 00:01:07,333 RECEIVE A FEEDBACK SURVEY VIA 22 00:01:07,400 --> 00:01:10,336 E-MAIL EMPLOY IT WILL BE USED TO 23 00:01:10,403 --> 00:01:11,971 PROVIDE IMPORTANT FEEDBACK ABOUT 24 00:01:12,038 --> 00:01:14,507 THIS RESENTATION AND INVITES TO 25 00:01:14,574 --> 00:01:15,809 YOU SUBMIT TOPICS FOR FUTURE 26 00:01:15,875 --> 00:01:18,144 GRAND ROUNDS TO WHICHICS. 27 00:01:18,211 --> 00:01:19,879 FOLLOWING THE PRESENTATION, WE 28 00:01:19,946 --> 00:01:22,549 WILL TAKE QUESTIONS FOR THE 29 00:01:22,615 --> 00:01:26,419 SPEAKER AT MICROPHONES IN THE 30 00:01:26,486 --> 00:01:26,753 AISLE. 31 00:01:26,820 --> 00:01:28,488 THOSE ONLINE CAN SCROLL DOWN AND 32 00:01:28,555 --> 00:01:32,358 CLICK THE LIVE FEEDBACK BUTTON 33 00:01:32,425 --> 00:01:33,893 ON THE VIDEOCAST WEBSITE. 34 00:01:33,960 --> 00:01:36,196 QUESTIONS WILL BE TAKEN IF TIME 35 00:01:36,262 --> 00:01:37,797 PERMIT AS THE END OF THE 36 00:01:37,864 --> 00:01:38,264 PRESENTATION. 37 00:01:38,331 --> 00:01:47,307 AS PART OF THE NATIONAL MINORITY 38 00:01:47,373 --> 00:01:50,677 HEALTH MONTH, DR. PEREZ-STABLE, 39 00:01:50,743 --> 00:01:52,345 WHO WORKS ON PROGRAMS TO 40 00:01:52,412 --> 00:01:53,513 RESEARCH AND ADVANCE KNOWLEDGE 41 00:01:53,580 --> 00:01:56,516 AND UNDERSTANDING OF HEALTH 42 00:01:56,583 --> 00:01:57,517 DISPARITIES, IDENTIFIES 43 00:01:57,584 --> 00:01:59,152 MECHANISM TO REDUCE HEALTH 44 00:01:59,219 --> 00:02:01,120 DISPARITIES AND DEVELOPS 45 00:02:01,187 --> 00:02:02,255 EFFECTIVE INTERVENTIONS TO 46 00:02:02,322 --> 00:02:03,323 REDUCE HEALTH DISPARITIES IN 47 00:02:03,389 --> 00:02:05,925 COMMUNITIES AND CLINICAL 48 00:02:05,992 --> 00:02:06,960 SETTINGS. 49 00:02:07,026 --> 00:02:07,794 DR. PEREZ-STABLE EARNED HIS 50 00:02:07,861 --> 00:02:09,095 BACHELOR IN ARTS AND MEDICAL 51 00:02:09,162 --> 00:02:09,896 DEGREE FROM THE UNIVERSITY OF 52 00:02:09,963 --> 00:02:11,664 MIRROR IMAGE AMILLIO AND 53 00:02:11,731 --> 00:02:12,599 COMPLETE RESIDENCY IN PRIMARY 54 00:02:12,665 --> 00:02:15,268 CARE AND INTERNAL MEDICINE AND 55 00:02:15,335 --> 00:02:16,236 FELLOWSHIP IN INTERNAL MEDICINE 56 00:02:16,302 --> 00:02:18,404 AT THE UNIVERSITY OF CALIFORNIA 57 00:02:18,471 --> 00:02:19,939 SAN FRANCISCO WHERE HE BECAME A 58 00:02:20,006 --> 00:02:21,207 PROFESSOR OF MEDICINE AND A 59 00:02:21,274 --> 00:02:23,309 CHIEF OF DIVISION OF INTERNAL 60 00:02:23,376 --> 00:02:24,744 MEDICINE OR REMAINED CLINICALLY 61 00:02:24,811 --> 00:02:27,480 ACTIVE IN PRIMARY CARE INTERNAL 62 00:02:27,547 --> 00:02:29,082 MEDICINE AND SUPERVISING AND 63 00:02:29,148 --> 00:02:34,153 TEACHING STUDENTS AND RESIDENTS. 64 00:02:34,220 --> 00:02:35,989 DR. PEREZ-STABLE JOINED NIMHD IN 65 00:02:36,055 --> 00:02:37,524 2015 AND CHARTED THE 66 00:02:37,590 --> 00:02:38,324 EN--STRATEGIESITUTES POSITION ON 67 00:02:38,391 --> 00:02:41,528 THE CUTTING EDGE OF SCIENCE OF 68 00:02:41,594 --> 00:02:43,062 MINORITY HEALTH AND HEALTH 69 00:02:43,129 --> 00:02:43,763 DISPARITIES. 70 00:02:43,830 --> 00:02:45,298 THROUGH THIS INSTITUTE, IT HAS 71 00:02:45,365 --> 00:02:46,332 PRODUCED A COLLECTION OF 72 00:02:46,399 --> 00:02:49,002 RESOURCES THAT GUIDE AND 73 00:02:49,068 --> 00:02:50,904 FACILITATE AND PROMOTE HEALTH 74 00:02:50,970 --> 00:02:51,170 EQUITY. 75 00:02:51,237 --> 00:02:54,307 RECOGNIZED AS A LEADER IN LATINO 76 00:02:54,374 --> 00:02:57,677 HEALTHCARE AND DISPARITIES 77 00:02:57,744 --> 00:02:59,145 RESEARCH, DR. PEREZ-STABLE HAS 78 00:02:59,212 --> 00:03:01,047 HAD 3 DECADES OF RESEARCH ON 79 00:03:01,114 --> 00:03:03,016 SMOKING CESSATION AND TOBACCO 80 00:03:03,082 --> 00:03:09,656 CONTROL IN THE LATIN POPULATION 81 00:03:09,722 --> 00:03:11,824 AND THE CLINICAL STUDIES, 82 00:03:11,891 --> 00:03:12,992 SUPPORTING RESEARCH ON MINORITY 83 00:03:13,059 --> 00:03:14,961 AGING AND CLINICAL AND COMMUNITY 84 00:03:15,028 --> 00:03:16,429 SETTINGS AND AADDRESSING 85 00:03:16,496 --> 00:03:17,297 RESEARCH QUESTIONS, CLINICAL 86 00:03:17,363 --> 00:03:19,699 QUESTIONS SUCH AS HYPERTENSION, 87 00:03:19,766 --> 00:03:23,403 ASTHMA, DIABETES AND DEMENTIA. 88 00:03:23,469 --> 00:03:24,904 DR. PEREZ-STABLE HAS PUBLISHED 89 00:03:24,971 --> 00:03:26,639 OVER 300 PEER REVIEWED ARTICLES 90 00:03:26,706 --> 00:03:28,041 AND CONTINUOUSLY FUNDED BY THE 91 00:03:28,107 --> 00:03:30,276 NIH WHILE HE WAS THE DIRECTOR OF 92 00:03:30,343 --> 00:03:32,278 THE UCSF CENTER FOR DIVERSE AND 93 00:03:32,345 --> 00:03:33,112 AGING COMMUNITIES WHICH IS 94 00:03:33,179 --> 00:03:34,180 FUNDED BY THE NATIONAL 95 00:03:34,247 --> 00:03:34,881 EN--STRATEGIESITUTE OF AGING AS 96 00:03:34,948 --> 00:03:38,017 WELL AS WHEN HE WAS DIRECTOR OF 97 00:03:38,084 --> 00:03:39,686 THE UCSF MEDICAL EFFECTIVENESS 98 00:03:39,752 --> 00:03:40,954 RESEARCH CENTER FOR DIVERSE 99 00:03:41,020 --> 00:03:41,254 POPULATIONS. 100 00:03:41,321 --> 00:03:44,457 HE HAS BEEN A CAREER MENTOR PER 101 00:03:44,524 --> 00:03:46,225 MANY STUDENTS, RESIDENTS AND 102 00:03:46,292 --> 00:03:47,594 FACULTY, RESEARCH MENTOR FOR 103 00:03:47,660 --> 00:03:49,095 OVER SEIVET MINORITY 104 00:03:49,162 --> 00:03:50,496 INVESTIGATORS ANDA AN ELECTED 105 00:03:50,563 --> 00:03:52,131 MEMBER OF THE NATIONAL ACADEMY 106 00:03:52,198 --> 00:03:53,866 OF MEDICINE AND NATIONAL ACADEMY 107 00:03:53,933 --> 00:03:55,535 OF SCIENCE AS WELL AS AMERICAN 108 00:03:55,602 --> 00:03:57,670 SOCIETY OF CLINICAL 109 00:03:57,737 --> 00:03:58,071 INVESTIGATION. 110 00:03:58,137 --> 00:03:59,639 THE TIELT OF THIS PRESENTATION 111 00:03:59,706 --> 00:04:02,442 TODAY IS SCIENCE AND MINORITY 112 00:04:02,508 --> 00:04:04,444 HEALTH AND HEALTH DISPARITIES 113 00:04:04,510 --> 00:04:04,711 RESEARCH. 114 00:04:04,777 --> 00:04:08,815 PLEASE JOIN ME IN WELCOMING 115 00:04:08,881 --> 00:04:09,215 DR. PEREZ-STABLE. 116 00:04:09,282 --> 00:04:09,916 THANK YOU. 117 00:04:09,983 --> 00:04:12,218 >> THANK YOU. 118 00:04:12,285 --> 00:04:12,619 [ APPLAUSE ] 119 00:04:12,685 --> 00:04:14,721 >> SO THANK YOU TOM FOR THAT 120 00:04:14,787 --> 00:04:16,122 KIND INTRODUCTION, IT'S NICE TO 121 00:04:16,189 --> 00:04:17,757 BE IN A CLINICAL CONTEXT, EACH 122 00:04:17,824 --> 00:04:19,492 THOUGH I'M NOT GOING TO SAY A 123 00:04:19,559 --> 00:04:21,628 WHOLE LOT ABOUT CLINICAL ISSUES, 124 00:04:21,694 --> 00:04:24,797 A LITTLE BIT IN THIS TALK AND I 125 00:04:24,864 --> 00:04:26,733 APPRECIATE THE ACKNOWLEDGMENT OF 126 00:04:26,799 --> 00:04:28,501 MINORITY HEALTH MONTH, IT'S BEEN 127 00:04:28,568 --> 00:04:30,203 BUSY. 128 00:04:30,269 --> 00:04:32,672 WE JUST HOSTED DR. LOU SULLIVAN 129 00:04:32,739 --> 00:04:35,608 ON MONDAY FOR SORT OF AN ORAL 130 00:04:35,675 --> 00:04:37,310 HISTORY SESSION AND DR. SULLIVAN 131 00:04:37,377 --> 00:04:39,712 IS 90 YEARS OLD AND I ONLY HOPE 132 00:04:39,779 --> 00:04:42,148 TO BE AS WELL AS HE WAS ON 133 00:04:42,215 --> 00:04:44,851 MONDAY WHEN I GET TO 90. 134 00:04:44,917 --> 00:04:47,387 SO I LIKE TO START THIS TALK 135 00:04:47,453 --> 00:04:48,821 ABOUT SAYING A FEW THINGS ABOUT 136 00:04:48,888 --> 00:04:54,727 WHAT CAN WE DO WITH SCIENCE TO 137 00:04:54,794 --> 00:04:55,495 REDUCE HEALTH INIQUITIES. 138 00:04:55,561 --> 00:04:59,065 I WILL START WITH THE 139 00:04:59,132 --> 00:05:00,667 STANDARDIZED MEASUREMENT OF 140 00:05:00,733 --> 00:05:02,935 SOCIAL AND DEMOGRAPHIC 141 00:05:03,002 --> 00:05:04,671 POPULATIONS THAT SHOW HOW 142 00:05:04,737 --> 00:05:05,271 BEHAVIORIAL RESEARCH AND--THIS 143 00:05:05,338 --> 00:05:07,306 IS A NO BRAINER FOR CLINICAL 144 00:05:07,373 --> 00:05:08,708 SCIENTISTS BUT IN CLINICAL 145 00:05:08,775 --> 00:05:10,543 SCIENCE WE DON'T DO THAT AS WELL 146 00:05:10,610 --> 00:05:12,178 AND IN CLINICAL CARE, WE HAVE 147 00:05:12,245 --> 00:05:12,512 NOT. 148 00:05:12,578 --> 00:05:13,713 IT HAS GOTTEN A LOT MORE 149 00:05:13,780 --> 00:05:16,049 TRACTION TO THINK ABOUT SOCIAL 150 00:05:16,115 --> 00:05:17,550 DETERMINANTS OF HEALTH IN 151 00:05:17,617 --> 00:05:19,519 EVALUATING HOW YOUR PATIENT IS 152 00:05:19,585 --> 00:05:21,654 DOING AND CERTAINLY, IT STARTS 153 00:05:21,721 --> 00:05:22,288 WITH STANDARDIZED DEMOGRAPHICS 154 00:05:22,355 --> 00:05:24,691 AND I WILL COME BACK TO THIS. 155 00:05:24,757 --> 00:05:28,695 WE NEED MORE EMPHASIS ON DATA 156 00:05:28,761 --> 00:05:29,829 SCIENCE, DISCOVERY THROUGH DATA 157 00:05:29,896 --> 00:05:33,232 SCIENCE, BIG DATA BECAUSE WE'RE 158 00:05:33,299 --> 00:05:34,400 MOVING INTO A WORLD WHERE MORE 159 00:05:34,467 --> 00:05:35,802 AND MORE DATA WILL BE AVAILABLE, 160 00:05:35,868 --> 00:05:37,503 NOT JUST FROM THE ELECTRONIC 161 00:05:37,570 --> 00:05:39,205 HEALTH RECORD AND TRYING TO 162 00:05:39,272 --> 00:05:41,474 HARMONIZE THOSE AND MAKE THEM 163 00:05:41,541 --> 00:05:43,943 USEABLE FOR RESEARCH AND CARE, 164 00:05:44,010 --> 00:05:47,580 BUT ALSO IN POPULATION HEALTH, 165 00:05:47,647 --> 00:05:50,817 WITH SURVEYS AND OTHER KINDS OF 166 00:05:50,883 --> 00:05:53,453 DATA, SPATIAL DATA AS WELL AS 167 00:05:53,519 --> 00:05:54,754 SURVEYS THAT ARE OFTEN DONE OR 168 00:05:54,821 --> 00:05:56,723 DATA THAT ARE COLLECTED FOR 169 00:05:56,789 --> 00:05:59,926 OTHER PURPOSES SUCH AS CLIMATE 170 00:05:59,992 --> 00:06:01,160 OR DISTRIBUTION OF CERTAIN 171 00:06:01,227 --> 00:06:01,461 BUSINESSES. 172 00:06:01,527 --> 00:06:05,865 WE NEED TO BE AN ENGINE FOR 173 00:06:05,932 --> 00:06:06,899 PROMOTING DIVERSITY AND TGF BETA 174 00:06:06,966 --> 00:06:09,235 AND CLINICAL WELCOMER FORCE 175 00:06:09,302 --> 00:06:09,836 DESPITE THE CHALLENGES THAT 176 00:06:09,902 --> 00:06:11,804 EXIST AND I WILL SHOW YOU DATA 177 00:06:11,871 --> 00:06:13,039 TO SUPPORT SOME IM PERICAL 178 00:06:13,106 --> 00:06:16,075 EVIDENCE TO SUPPORT WHY THIS IS 179 00:06:16,142 --> 00:06:18,244 GOOD AT REDUCING INIQUITIES AS 180 00:06:18,311 --> 00:06:22,348 WELL AS WHERE THE STATE OF THE 181 00:06:22,415 --> 00:06:25,818 FIELD IS TODAY. 182 00:06:25,885 --> 00:06:27,987 THE PANDEMIC REALLY MADE 183 00:06:28,054 --> 00:06:29,922 COMMUNITY ENGAGEMENT HIGHLIGHTED 184 00:06:29,989 --> 00:06:30,957 AS AN IMPORTANT RESEARCH 185 00:06:31,023 --> 00:06:35,061 PLATFORM IN WHICH TO MAKE CHANGE 186 00:06:35,128 --> 00:06:37,663 IN OUR SOCIETY AND I BELIEVE 187 00:06:37,730 --> 00:06:40,166 THAT IN NIH THERE IS NOW MORE OF 188 00:06:40,233 --> 00:06:41,367 A COMMITMENT TO CONTINUE THIS 189 00:06:41,434 --> 00:06:44,904 AND I WILL COME BACK TO THIS AS 190 00:06:44,971 --> 00:06:45,104 WELL. 191 00:06:45,171 --> 00:06:47,206 I WOULD ARGUE THIS IS AN 192 00:06:47,273 --> 00:06:47,940 ESSENTIAL COMPONENT OF ANYTHING 193 00:06:48,007 --> 00:06:51,544 WE DO IN HUMAN RESEARCH. 194 00:06:51,611 --> 00:06:52,478 AND FINALLY, WE NEED TO 195 00:06:52,545 --> 00:06:53,813 IMPLEMENT WHAT WE KNOW AND 196 00:06:53,880 --> 00:06:56,215 ESPECIALLY IN THE CONTEXT OF 197 00:06:56,282 --> 00:06:56,616 PROMOTING EQUITY. 198 00:06:56,682 --> 00:06:58,618 WE KNOW HOW TO TREAT 199 00:06:58,684 --> 00:07:00,019 HYPERTENSION, WE KNOW HOW TO 200 00:07:00,086 --> 00:07:03,489 KROAT DIABETES, AT LEAST IN 201 00:07:03,556 --> 00:07:05,858 80-85% OF THE POPULATION, IT 202 00:07:05,925 --> 00:07:06,959 SHOULD BE MANAGED WELL AND YET 203 00:07:07,026 --> 00:07:09,562 THE GROUPS THAT HAVE THE LEAST 204 00:07:09,629 --> 00:07:11,397 WELL CONTROL IN THESE 2 CHRONIC 205 00:07:11,464 --> 00:07:14,567 CONDITIONS ARE PEOPLE WHO ARE 206 00:07:14,634 --> 00:07:15,802 DISADVANTAGED IN SOME WAY, 207 00:07:15,868 --> 00:07:19,839 EITHER POOR OR BY RACE 208 00:07:19,906 --> 00:07:20,106 ETHNICITY. 209 00:07:20,173 --> 00:07:22,241 NOW, NIMHD HAS THE 210 00:07:22,308 --> 00:07:23,643 RESPONSIBILITY OF DESIGNATING 211 00:07:23,709 --> 00:07:24,944 POPULATIONS WITH HEALTH 212 00:07:25,011 --> 00:07:27,547 DISPARITIES, THAT IS MY ROLE AS 213 00:07:27,613 --> 00:07:29,816 THE DIRECTOR, THE AUTHORITY FROM 214 00:07:29,882 --> 00:07:31,951 CONGRESS IN THE TOP 3 BULLETS 215 00:07:32,018 --> 00:07:33,853 CAME IN OUR ORIGINAL 216 00:07:33,920 --> 00:07:36,422 LEGISLATION, SO RACIAL AND 217 00:07:36,489 --> 00:07:37,023 ETHNIC MINORITY POPULATIONS 218 00:07:37,089 --> 00:07:38,791 WHICH IS NOT A STATIC FIELD, SO 219 00:07:38,858 --> 00:07:40,793 I WILL COME BACK TO, POOR PEOPLE 220 00:07:40,860 --> 00:07:46,232 OF ANY RACE AND ETHNICITY ACROSS 221 00:07:46,299 --> 00:07:48,100 THE COUNTRY, UNDERSERVED RURAL 222 00:07:48,167 --> 00:07:49,602 RESIDENTS, WE HEARD FROM 223 00:07:49,669 --> 00:07:51,337 DR. SULLIVAN ABOUT HOW THAT CAME 224 00:07:51,404 --> 00:07:53,139 ABOUT IN THE PROCESS OF CONGRESS 225 00:07:53,206 --> 00:07:56,943 IN 2000 AND SEXUAL AND GENDER 226 00:07:57,009 --> 00:07:58,711 MINORITIES AND PERSONS WITH 227 00:07:58,778 --> 00:07:59,412 DISABLES ARE DESIGNATED 228 00:07:59,478 --> 00:08:03,082 POPULATIONS THAT I HAD THE HONOR 229 00:08:03,149 --> 00:08:06,018 TO DECLARE THE SGM COMMUNITY IN 230 00:08:06,085 --> 00:08:08,721 THE YEAR 2016 AND PERSON WITH 231 00:08:08,788 --> 00:08:11,557 DISABILITIES JUST LAST 232 00:08:11,624 --> 00:08:11,824 SEPTEMBER. 233 00:08:11,891 --> 00:08:13,359 A UNIFYING FACTOR FOR ALL THESE 234 00:08:13,426 --> 00:08:15,428 POPULATIONS IS A CERTAIN AMOUNT 235 00:08:15,494 --> 00:08:16,128 OF SOCIAL DISADVANTAGE THAT 236 00:08:16,195 --> 00:08:18,664 EXISTS FROM BEING SUBJECT TO 237 00:08:18,731 --> 00:08:20,499 DISCRIMINATION OR RACISM, AND 238 00:08:20,566 --> 00:08:22,001 FROM BEING UNDERSERVED IN 239 00:08:22,068 --> 00:08:23,636 HEALTHCARE IN SOME WAY. 240 00:08:23,703 --> 00:08:26,706 NOW, IN HEALTH DISPARITIES 241 00:08:26,772 --> 00:08:28,341 RESEARCH OR SCIENCE, WE BELIEVE 242 00:08:28,407 --> 00:08:31,878 THAT RACE AND ETHNICITY AS A 243 00:08:31,944 --> 00:08:33,746 SELF-IDENTIFIED SOCIAL 244 00:08:33,813 --> 00:08:34,447 CONSTRUCT, AND SOCIOECONOMIC 245 00:08:34,513 --> 00:08:35,715 STATUS HOWEVER IT IS MEASURED, 246 00:08:35,781 --> 00:08:37,583 WHETHER IT BE BY INCOME OR 247 00:08:37,650 --> 00:08:39,585 EDUCATION OR OTHER METRICS, 248 00:08:39,652 --> 00:08:41,254 REALLY HAVE THE FUNDAMENTAL 249 00:08:41,320 --> 00:08:42,889 DRIVERS OF HEALTH DISPARITIES IN 250 00:08:42,955 --> 00:08:46,192 ALL POPULATIONS, AND IN OUR 251 00:08:46,259 --> 00:08:46,425 SCIENCE. 252 00:08:46,492 --> 00:08:49,562 THIS INTERSECTIONALITY OF RACE 253 00:08:49,629 --> 00:08:51,397 AND ETHNICITY, SOCIOECONOMIC 254 00:08:51,464 --> 00:08:55,635 STATUS, AGE, GENDER WITH RURAL 255 00:08:55,701 --> 00:08:56,168 POPULATIONS, SEXUAL GENDER 256 00:08:56,235 --> 00:08:57,270 MINORITY AT THAT TIMEUS AS WELL 257 00:08:57,336 --> 00:08:58,571 AS PEOPLE WITH DISABLES ARE 258 00:08:58,638 --> 00:09:01,240 CRITICAL WAYS TO LOOK AT THIS IN 259 00:09:01,307 --> 00:09:03,042 OUTCOMES AND FOR THIS YOU OFTEN 260 00:09:03,109 --> 00:09:04,944 NEED LARGE SAMPLE SIZES OR 261 00:09:05,011 --> 00:09:06,579 FOCUSED STUDIES JUST ON THESE 262 00:09:06,646 --> 00:09:06,913 POPULATIONS. 263 00:09:06,979 --> 00:09:10,783 WE BELIEVE THAT APPLYING THIS 264 00:09:10,850 --> 00:09:11,918 INTERSECTIONALITY LENS AS OUR 265 00:09:11,984 --> 00:09:14,120 SOCIETY HAS BECOME MORE COMPLEX 266 00:09:14,186 --> 00:09:15,321 TO ALL DEMOGRAPHIC FACTORS AND 267 00:09:15,388 --> 00:09:17,056 TO ALL CLINICAL CONDITIONS ARE 268 00:09:17,123 --> 00:09:18,224 WORTH WHILE THINKING ABOUT AND 269 00:09:18,291 --> 00:09:20,626 DOING TO THE POINT OF 270 00:09:20,693 --> 00:09:20,993 MEASUREMENT. 271 00:09:21,060 --> 00:09:22,762 SO IF YOU DON'T ASK, YOU DON'T 272 00:09:22,828 --> 00:09:25,631 KNOW, SO MEASURING THEM IN A 273 00:09:25,698 --> 00:09:27,833 STANDARDIZED WAY BECOMES 274 00:09:27,900 --> 00:09:28,200 IMPORTANT. 275 00:09:28,267 --> 00:09:29,035 I ALSO--TRYING TO MOVE OUR 276 00:09:29,101 --> 00:09:33,105 INSTITUTE AND THE FIELD TO STOP 277 00:09:33,172 --> 00:09:34,273 COMPARING EVERYTHING TO WHITE 278 00:09:34,340 --> 00:09:37,810 AMERICANS, TO SAY, WELL, THIS IS 279 00:09:37,877 --> 00:09:40,846 AN ODDS RATIO OF 2.1 COMPARED TO 280 00:09:40,913 --> 00:09:41,113 WHITES. 281 00:09:41,180 --> 00:09:42,848 NOW WE SHOULD HAVE ASPIRATIONAL 282 00:09:42,915 --> 00:09:44,050 GOALS WHERE EVERYONE SHOULD BE 283 00:09:44,116 --> 00:09:46,152 AT AND THEN, SEE HOW WELL, 284 00:09:46,218 --> 00:09:48,287 DIFFERENT GROUPS ARE IN 285 00:09:48,354 --> 00:09:48,988 ACHIEVING THAT. 286 00:09:49,055 --> 00:09:51,691 ON THE 1 HAND, WHITE AMERICANS 287 00:09:51,757 --> 00:09:53,626 WILL NOT BE THE MAJORITY 288 00:09:53,693 --> 00:09:54,760 POPULATION IN THE UNITED STATES 289 00:09:54,827 --> 00:09:57,196 PROBABLY WITHIN THE NEXT 15 TO 290 00:09:57,263 --> 00:09:59,999 20 YEARS, BASED ON DEMOGRAPHIC 291 00:10:00,066 --> 00:10:01,968 PROJECTIONS, SECOND POINT IS 292 00:10:02,034 --> 00:10:04,570 THAT THERE ARE SUBPOPULATIONS, 293 00:10:04,637 --> 00:10:07,173 SPECIFICALLY LATINOS AND ASIANS, 294 00:10:07,239 --> 00:10:08,908 WHO ACTUALLY OFTEN HAVE BETTER 295 00:10:08,975 --> 00:10:11,010 HEALTH OUTCOMES THAN WHITES, SO 296 00:10:11,077 --> 00:10:13,446 WE NEED TO THINK, MOVE AWAY FROM 297 00:10:13,512 --> 00:10:17,917 THAT COMPARISON AND COMPARE TO 298 00:10:17,984 --> 00:10:18,818 GOALS. 299 00:10:18,884 --> 00:10:21,120 NOW,-ETHNICITY QUESTIONS JUST 300 00:10:21,187 --> 00:10:21,354 CHANGED. 301 00:10:21,420 --> 00:10:24,657 THOSE OF YOU WHO LOOK AT THE 302 00:10:24,724 --> 00:10:26,959 FEDERAL REGISTER IN MARCH, SO 303 00:10:27,026 --> 00:10:30,529 JUST LAST MONTH BECAME OFFICIAL 304 00:10:30,596 --> 00:10:33,599 RULE FROM THE OFFICE OF 305 00:10:33,666 --> 00:10:35,668 MANAGEMENT AND BUDGET, AND THE 306 00:10:35,735 --> 00:10:37,069 CHIEF STATISTICIAN OF THE UNITED 307 00:10:37,136 --> 00:10:38,571 STATES MADE THE DECLARATION THAT 308 00:10:38,637 --> 00:10:40,172 THESE HAVE CHANGED NOW THIS HAS 309 00:10:40,239 --> 00:10:43,509 BEEN IN DEVELOPMENT FOR ABOUT 2 310 00:10:43,576 --> 00:10:44,777 YORES. 311 00:10:44,844 --> 00:10:45,911 IT WAS ACTUALLY PREVIOUSLY 312 00:10:45,978 --> 00:10:47,680 APPROVED IN THE YEAR 2016 BUT 313 00:10:47,747 --> 00:10:49,982 NEVER REACHED THE STAGE OF RULE 314 00:10:50,049 --> 00:10:52,284 AND WITH THE NEW ADMINITRATION 315 00:10:52,351 --> 00:10:55,287 IN 2017, IT WAS MOSTLY SET 316 00:10:55,354 --> 00:10:57,023 ASIDE, NOT ENTIRELY BUT MOSTLY 317 00:10:57,089 --> 00:10:59,558 SET ASIDE EMPLOY SO THE FIRST 318 00:10:59,625 --> 00:11:02,395 THING TO NOTE IS THAT THE CENSUS 319 00:11:02,461 --> 00:11:04,497 ALWAYS ASKED A 2 PART QUESTION, 320 00:11:04,563 --> 00:11:05,931 MANY PEOPLE INCORPORATED THIS, 321 00:11:05,998 --> 00:11:07,600 WHAT IS YOUR ETHNICITY, THERE 322 00:11:07,666 --> 00:11:10,036 WAS 1 ETHNICITY IN THE WORLD, 323 00:11:10,102 --> 00:11:12,104 HISPANIC, NONHISPANIC, SO YOU 324 00:11:12,171 --> 00:11:14,306 WERE IDENTIFIED AS BEING 325 00:11:14,373 --> 00:11:15,841 HISPANIC LATINO OR NONHISPANIC 326 00:11:15,908 --> 00:11:18,310 LATINO, AND THEN YOU ASK ABOUT 327 00:11:18,377 --> 00:11:19,745 RACE, THAT'S OVER, THAT'S NO 328 00:11:19,812 --> 00:11:20,546 LONGER THE RECOMMENDATION OR 329 00:11:20,613 --> 00:11:22,415 REQUIREMENT I SHOULD SAY FOR 330 00:11:22,481 --> 00:11:23,916 FEDERAL ENTITIES IS TO DO THESE, 331 00:11:23,983 --> 00:11:26,652 1 QUESTION, HOW DO YOU IDENTIFY 332 00:11:26,719 --> 00:11:27,953 YOURSELF AND THEN YOU HAVE 7 333 00:11:28,020 --> 00:11:30,256 OPTIONS LISTED HERE IN THE 334 00:11:30,322 --> 00:11:33,359 VIOLET COLOR SO WHITE, PLAQUE OR 335 00:11:33,426 --> 00:11:34,060 AFRICAN AMERICAN, AMERICAN 336 00:11:34,126 --> 00:11:38,097 INDIAN OR ALASKA NATIVE, ASIAN, 337 00:11:38,164 --> 00:11:39,465 PACIFIC ISLANDER, HISPANIC OR 338 00:11:39,532 --> 00:11:41,867 LATINO, AND MITTED EASTERN AND 339 00:11:41,934 --> 00:11:43,335 NORTH AFRICAN. 340 00:11:43,402 --> 00:11:45,337 AND IF YOU USE THIS TERMINOLOGY, 341 00:11:45,404 --> 00:11:50,309 IT'S JUST WHAT THE CENSUS WILL 342 00:11:50,376 --> 00:11:50,743 USE. 343 00:11:50,810 --> 00:11:53,079 WE WILL THEN GET CLOSER TO 344 00:11:53,145 --> 00:11:54,146 STANDARDIZED TERMINOLOGY IN HOW 345 00:11:54,213 --> 00:11:55,815 WE REFER TO RACIAL AND ETHNIC 346 00:11:55,881 --> 00:11:56,715 POPULATIONS IN THE UNITED 347 00:11:56,782 --> 00:11:57,316 STATES. 348 00:11:57,383 --> 00:12:00,586 NOTICE 2 THINGS, THE MULTIRACIAL 349 00:12:00,653 --> 00:12:02,121 OPTION, OR MORE THAN 2 RACES AS 350 00:12:02,188 --> 00:12:03,989 IT WAS FRAMED BEFORE, IS NOT 351 00:12:04,056 --> 00:12:06,992 THERE SO THEY WILL BUILD IN AN 352 00:12:07,059 --> 00:12:07,927 ALGORITHM SO THAT IF YOU CHECK 353 00:12:07,993 --> 00:12:12,531 ALL THAT,A MRI AND YOU CHECK ALL 354 00:12:12,598 --> 00:12:14,934 IN THAN 1 BOX, YOU WILL BE 355 00:12:15,000 --> 00:12:16,135 CONSIDERED MULTIRACIAL, AND EACH 356 00:12:16,202 --> 00:12:17,269 OF THE CATEGORIES, I DIDN'T HAVE 357 00:12:17,336 --> 00:12:19,171 THE SPACE IN THE SLIDE TO LIST 358 00:12:19,238 --> 00:12:21,474 ALL THE COUNTRIES, THE 6 MOST 359 00:12:21,540 --> 00:12:23,776 COMMON HERITAGE COUNTRIES ARE 360 00:12:23,843 --> 00:12:25,444 LISTED SO THAT THIS MORE 361 00:12:25,511 --> 00:12:27,079 DETAILED SECONDARY DATA WILL 362 00:12:27,146 --> 00:12:27,813 ALSO BE REQUIRED. 363 00:12:27,880 --> 00:12:33,152 SO IF YOU'RE WHITE, IT WILL 364 00:12:33,219 --> 00:12:34,186 LIST, ENGLAND, GERMANY, ITALY, 365 00:12:34,253 --> 00:12:35,788 ET CETERA AND IF YOU'RE PLAQUE 366 00:12:35,855 --> 00:12:37,623 OR AFRICAN AMERICAN, IT WILL 367 00:12:37,690 --> 00:12:38,657 LIST CERTAIN COUNTRIES IN 368 00:12:38,724 --> 00:12:40,860 AMERICA AND THEN THE CARIBBEAN, 369 00:12:40,926 --> 00:12:42,862 AND AMERICAN INDIANS, TRIBES, 370 00:12:42,928 --> 00:12:47,032 ASIAN INDIAN, ET CETERA AND 371 00:12:47,099 --> 00:12:51,137 AMONG LATINOS, MEXICO, PUERTO 372 00:12:51,203 --> 00:12:52,505 RICO, CUBA EL SALVADOR, 373 00:12:52,571 --> 00:12:54,340 GUATEMALA ARE THE MOST COMMON 374 00:12:54,406 --> 00:12:55,407 COUNTRIES LISTED BUT THERE'S 375 00:12:55,474 --> 00:12:56,809 ROOM TO WRITE IN OTHER. 376 00:12:56,876 --> 00:12:59,111 THE OTHER MAJOR CHANGE IS THE 377 00:12:59,178 --> 00:13:01,213 ADDITION OF MIDDLE NORTHEASTERN 378 00:13:01,280 --> 00:13:01,680 AND AFRICAN. 379 00:13:01,747 --> 00:13:03,782 IT HAD BEEN PROPOSED AND 380 00:13:03,849 --> 00:13:04,817 ADVOCATED FOR FOR SOMETIME AND 381 00:13:04,884 --> 00:13:09,221 IT IS NOW OFFICIALLY A CATEGORY 382 00:13:09,288 --> 00:13:10,856 IN THE FEDERAL REQUIREMENTS OF 383 00:13:10,923 --> 00:13:12,625 COLLECTION OF DATA ON RACE AND 384 00:13:12,691 --> 00:13:15,828 ETHNICITY AND THIS IS KNOWN AS 385 00:13:15,895 --> 00:13:17,830 SP15, IT WAS ORIGE NAWILLLY FROM 386 00:13:17,897 --> 00:13:21,000 1997, THIS IS THE SECOND TIME 387 00:13:21,066 --> 00:13:24,303 IT'S BEEN CHANGED, DATING BACK 388 00:13:24,370 --> 00:13:25,337 TO 1977. 389 00:13:25,404 --> 00:13:28,007 SO WHAT IS RACE AND ETHNICITY 390 00:13:28,073 --> 00:13:32,244 MEAN IN FIRST OF ALL, WE--YOU 391 00:13:32,311 --> 00:13:33,279 KNOW--THERE'S A GENERAL 392 00:13:33,345 --> 00:13:34,713 CONSENSUS AT NIH AS WELL, ACROSS 393 00:13:34,780 --> 00:13:35,881 THE HEALTH OF RESEARCHERS THAT 394 00:13:35,948 --> 00:13:39,218 THIS IS A SELF-IDENTIFIED SOCIAL 395 00:13:39,285 --> 00:13:39,685 CONSTRUCT. 396 00:13:39,752 --> 00:13:41,754 IT DOES HAVE APPLICATION 397 00:13:41,820 --> 00:13:42,054 GLOBALLY. 398 00:13:42,121 --> 00:13:43,622 IN A COUNTRY LIKE THE UNITED 399 00:13:43,689 --> 00:13:44,823 STATES, WE GENERATED THE 400 00:13:44,890 --> 00:13:47,126 CATEGORIES AS YOU SAW, BASED ON 401 00:13:47,193 --> 00:13:49,261 WHAT THE POPULATION DEMOGRAPHICS 402 00:13:49,328 --> 00:13:51,330 ARE, OTHER COUNTRIES MAY HAVE 403 00:13:51,397 --> 00:13:52,631 DIFFERENT CATEGORIES, OR NAME 404 00:13:52,698 --> 00:13:54,466 THEM DIFFERENTLY, LIKE IN THE 405 00:13:54,533 --> 00:13:56,769 UNITED KINGDOM, AND IN LATIN 406 00:13:56,835 --> 00:14:02,408 AMERICA BUT THIS IS SOMETHING 407 00:14:02,474 --> 00:14:04,843 THAT APPLIES GLOBALLY UNTIL THE 408 00:14:04,910 --> 00:14:06,545 HUMAN SPECS ADD MIXES ENOUGH, 409 00:14:06,612 --> 00:14:07,713 WHERE THERE'S REALLY NO 410 00:14:07,780 --> 00:14:08,380 DIFFERENCES BECAUSE EVERYBODY'S 411 00:14:08,447 --> 00:14:10,382 MIXED WITH EACH OTHER, AND IT 412 00:14:10,449 --> 00:14:11,350 HASN'T HAPPENED AND IT WON'T 413 00:14:11,417 --> 00:14:15,521 HAPPEN IN MY LIFETIME ALREADY, 414 00:14:15,588 --> 00:14:17,122 THIS CONSTRUCT WILL CONTINUE TO 415 00:14:17,189 --> 00:14:19,758 HAVE SOCIAL AND DEMOGRAPHIC 416 00:14:19,825 --> 00:14:22,294 MEANING AND BY CONSEQUENCE 417 00:14:22,361 --> 00:14:24,096 MEANING ON HEALTH. 418 00:14:24,163 --> 00:14:27,233 IT'S BASED ON THE GEOGRAPHIC 419 00:14:27,299 --> 00:14:29,101 ORINIGEIN OF HUMANS OUT OF EAST 420 00:14:29,168 --> 00:14:30,402 AFRICA HOW THEY MIGRATED OUT TO 421 00:14:30,469 --> 00:14:33,606 PARTS OF THE GLOBE AND 422 00:14:33,672 --> 00:14:36,242 SUBSEQUENTLY MIX BEGINNING MOST 423 00:14:36,308 --> 00:14:38,210 DRAMATICALLY AROUND 1500 WITH 424 00:14:38,277 --> 00:14:39,745 THE EUROPEAN COLONIZATION OF THE 425 00:14:39,812 --> 00:14:40,012 AMERICAS. 426 00:14:40,079 --> 00:14:42,281 BUT IT HAS BEEN GOING ON AT A 427 00:14:42,348 --> 00:14:45,050 SLOW RATE ALL FROM THE BEGINNING 428 00:14:45,117 --> 00:14:47,686 OF THE HUMAN DEVELOPMENT, AND 429 00:14:47,753 --> 00:14:49,555 ETHNIC GROUP MAY NOT SHARE 430 00:14:49,622 --> 00:14:50,756 PHENOTYPES, SO AN ETHNIC GROUP 431 00:14:50,823 --> 00:14:53,692 COULD BE BASED ON GEOGRAPHY, ON 432 00:14:53,759 --> 00:14:56,862 CULTURAL, ON CULTURE, ON 433 00:14:56,929 --> 00:14:59,431 RELIGION, ON AFFINITYS ARE THAT 434 00:14:59,498 --> 00:15:00,966 ARE NOT PHENOTYPICALLY 435 00:15:01,033 --> 00:15:02,268 ADEPTIFIED SO LATIN AMERICA IS A 436 00:15:02,334 --> 00:15:03,869 GOOD EXAMPLE, LATIN AMERICA IS A 437 00:15:03,936 --> 00:15:06,538 MIX OF THE INDIGENOUS PEOPLE, 438 00:15:06,605 --> 00:15:08,607 THE EUROPEAN COLONIALISTS AND 439 00:15:08,674 --> 00:15:11,043 THE AFRICANS WHO WERE BROUGHT 440 00:15:11,110 --> 00:15:14,113 OVER AS SLAVES OF WHICH ABOUT 441 00:15:14,179 --> 00:15:16,315 2/3RDS WENT ACTUALLY TO THE 442 00:15:16,382 --> 00:15:18,484 CARIBBEAN AND SOUTH AMERICA 443 00:15:18,550 --> 00:15:21,220 PRIMARILY, BRAZIL AND THE REST 444 00:15:21,287 --> 00:15:23,222 CAME TO THE UNITED STATES 445 00:15:23,289 --> 00:15:23,455 MOSTLY. 446 00:15:23,522 --> 00:15:24,456 THERE ARE BIOLOGICAL FACTORS, 447 00:15:24,523 --> 00:15:26,392 THAT CAN BE MEASURED HERE, MOST 448 00:15:26,458 --> 00:15:29,395 OF THEM ARE ON GENETIC ANCESTRY, 449 00:15:29,461 --> 00:15:37,336 BUT ALSO METABOLIC PATHWAYS AND 450 00:15:37,403 --> 00:15:39,405 CLEARLY SHARED BEHAVIORS, CLUOF 451 00:15:39,471 --> 00:15:40,339 THEICAL CLUSTERS THAT BE CREATED 452 00:15:40,406 --> 00:15:41,640 AND WE BELIEVE THAT THIS IERK 453 00:15:41,707 --> 00:15:46,278 DENTITY OF RACE AND ETHNICITY, 454 00:15:46,345 --> 00:15:47,546 REFLECTS IN MANY WAYS THE LIVED 455 00:15:47,613 --> 00:15:48,380 EXPERIENCE AND IN THE UNITED 456 00:15:48,447 --> 00:15:53,952 STATES IN PARTICULAR, THIS IS 457 00:15:54,019 --> 00:15:54,520 SIGNIFICANT FOR RACE 458 00:15:54,586 --> 00:15:55,321 DISCRIMINATION EXPRESSION AND AS 459 00:15:55,387 --> 00:15:58,223 WELL AS IN OTHER CONTEXT POVERTY 460 00:15:58,290 --> 00:15:59,892 OR ADVERSITY IN LIFE, HERE'S A 461 00:15:59,958 --> 00:16:01,927 FEW EXAMPLES OF HOW RACE AND 462 00:16:01,994 --> 00:16:03,796 ETHNICITY MATTER. 463 00:16:03,862 --> 00:16:05,731 THIS IS DATA FROM THE FLOABAL 464 00:16:05,798 --> 00:16:07,499 BURDEN OF DISEASE U.S. HEALTH 465 00:16:07,566 --> 00:16:11,036 DISPARITIES PROJECT WHICH IS AN 466 00:16:11,103 --> 00:16:15,507 INTRAMURAL PROJECT OF THE 467 00:16:15,574 --> 00:16:18,510 NATIONAL INSTITUTE OF MINORITY 468 00:16:18,577 --> 00:16:20,112 HEALTH AND HEALTH DISPARITIES, 469 00:16:20,179 --> 00:16:23,148 WE'VE SEEN THIS AND KNOWN IT IN 470 00:16:23,215 --> 00:16:24,683 THE CDC SIMILAR PUBLISHED DATA 471 00:16:24,750 --> 00:16:25,984 AROUND THE SAME TIME. 472 00:16:26,051 --> 00:16:27,619 WE KNOW LATINOS HAVE THE LONGER 473 00:16:27,686 --> 00:16:29,188 LIFE EXPECTANCY FOR AT LEAST 20 474 00:16:29,254 --> 00:16:31,023 YEARS, THIS IS NOT AN ARTIFACT, 475 00:16:31,090 --> 00:16:33,025 THIS IS REAL, THIS HAS BEEN VERY 476 00:16:33,092 --> 00:16:34,893 CONSISTENT DATA NOW FOR ABOUT 30 477 00:16:34,960 --> 00:16:37,730 YEARS AND LAT TIN OS ARE 478 00:16:37,796 --> 00:16:39,898 HETEROGENIUS BUT ASIANS ARE EVEN 479 00:16:39,965 --> 00:16:41,767 MORE HETEROGENIUS AS A GROUP AND 480 00:16:41,834 --> 00:16:43,836 WE SEE THIS PHENOMENA EMPLOY AND 481 00:16:43,902 --> 00:16:46,038 WE SEE WHITES IN THE MIDDLE, 482 00:16:46,105 --> 00:16:47,106 CLOSE TO THE GREEN TOTAL LINE, 483 00:16:47,172 --> 00:16:50,142 AND YOU NOTICE THE DIRE 484 00:16:50,209 --> 00:16:51,777 SITUATION THAT AMERICAN INDIANS 485 00:16:51,844 --> 00:16:53,712 AND ALASKA NATIVES HAVE EVEN 486 00:16:53,779 --> 00:16:55,347 THOUGH THERE'S A TREMENDOUS 487 00:16:55,414 --> 00:16:56,982 AMOUNT OF UNCERTAINTY AROUND 488 00:16:57,049 --> 00:16:59,017 THESE ESTIMATES GIVEN BOTH THEIR 489 00:16:59,084 --> 00:17:01,086 SMALL SIZE AND THE 490 00:17:01,153 --> 00:17:01,687 MISCLASSIFICATION CHALLENGES 491 00:17:01,754 --> 00:17:03,889 THAT EXIST WITH AMERICAN INDIAN 492 00:17:03,956 --> 00:17:05,157 AND ALASKA NATIVES FREQUENTLY 493 00:17:05,224 --> 00:17:07,693 MIXED WITH OTHER POPULATIONS. 494 00:17:07,760 --> 00:17:10,829 AND THEN AFRICA AMERICANS NOTICE 495 00:17:10,896 --> 00:17:12,097 IMPROVING ALONG WITH THE REST OF 496 00:17:12,164 --> 00:17:14,433 THE GROUPS VERY SLOWLY NOW SINCE 497 00:17:14,500 --> 00:17:17,236 2010 AND PROJECTIONS ARE THAT 498 00:17:17,302 --> 00:17:20,205 THESE WILL CONTINUE TO SLIGHTLY 499 00:17:20,272 --> 00:17:21,640 IMPROVE, THIS IS PRECOVID BY THE 500 00:17:21,707 --> 00:17:22,074 WAY. 501 00:17:22,141 --> 00:17:23,275 WE ALSO FUNDED AN ANALYSIS OF 502 00:17:23,342 --> 00:17:26,512 WHAT WE CALL THE ECONOMIC BURDEN 503 00:17:26,578 --> 00:17:28,614 OF RACIAL, ETHNIC AND RACIAL 504 00:17:28,680 --> 00:17:30,249 HEALTH INIQUITIES IN THE U.S. 505 00:17:30,315 --> 00:17:32,785 ISSUES THESE FACTORED IN NOT 506 00:17:32,851 --> 00:17:34,486 JUST PREMATURE MORTALITY BUT 507 00:17:34,553 --> 00:17:37,456 ALSO EXCESS MEDICAL CARE 508 00:17:37,523 --> 00:17:39,091 EXPENDITURES AND LOSS LABOR 509 00:17:39,158 --> 00:17:40,626 MARKET PRODUCTIVITY AND USED 510 00:17:40,692 --> 00:17:42,361 NATIONAL DATA FOR NATIONAL 511 00:17:42,428 --> 00:17:44,029 CENTER FOR MORTALITY DATA, 512 00:17:44,096 --> 00:17:45,431 BEHAVIORIAL RISK FACTOR SURVEY 513 00:17:45,497 --> 00:17:47,232 AND THE MEDICAL EXPENDITURE 514 00:17:47,299 --> 00:17:50,135 PANEL SURVEY WHICH IS A COHORT 515 00:17:50,202 --> 00:17:51,770 STUDY FROM THE AHRQ, AND 516 00:17:51,837 --> 00:17:53,305 COMPARED TO A HEALTH EQUITY 517 00:17:53,372 --> 00:17:55,874 GOAL, WHERE SHOULD WE BE AND USE 518 00:17:55,941 --> 00:17:56,875 HEALTHY PEOPLE 2030 AS 519 00:17:56,942 --> 00:17:58,510 DEVELOPING WHAT WOULD BE THE 520 00:17:58,577 --> 00:18:02,147 HEALTH EQUITY GOALS AND YOU SEE 521 00:18:02,214 --> 00:18:04,450 THE ECONOMIC BURDEN FOR RACIAL 522 00:18:04,516 --> 00:18:07,553 AND ETHNIC MINORITY GROUPS IN 523 00:18:07,619 --> 00:18:08,287 2018, 1 YEAR, 451 BILLION 524 00:18:08,353 --> 00:18:10,289 DOLLARS EMPLOY NOW THE NIH 525 00:18:10,355 --> 00:18:11,657 BUDGET IS A LITTLE OVER 10% OF 526 00:18:11,723 --> 00:18:13,759 THAT AND IF WE LOOK AT IT BY 527 00:18:13,826 --> 00:18:15,494 EDUCATIONAL LEVEL, WE CAN SEE, 528 00:18:15,561 --> 00:18:18,764 AND COMPARE IT TO COLLEGE 529 00:18:18,831 --> 00:18:20,065 GRADUATE WE SEE THE BURDEN GO 530 00:18:20,132 --> 00:18:21,834 ALMOST TO A TRILLION DOLLARS, SO 531 00:18:21,900 --> 00:18:26,738 THESE ARE SOCIAL FACTORS THAT 532 00:18:26,805 --> 00:18:27,806 CAN BE INTERVENED UPON OR 533 00:18:27,873 --> 00:18:29,875 FOCUSED ON THAT CAN MAKE A 534 00:18:29,942 --> 00:18:32,177 DIFFERENCE IN POPULATION HEALTH 535 00:18:32,244 --> 00:18:32,778 FOR OUR COUNTRY. 536 00:18:32,845 --> 00:18:33,912 SO BACK TO THE MEASUREMENT ISSUE 537 00:18:33,979 --> 00:18:36,148 IS WHAT SHOULD WE DO IN A 538 00:18:36,215 --> 00:18:36,548 CLINICAL CONTEXT? 539 00:18:36,615 --> 00:18:39,618 NOW RESEARCHERS WHO DO THIS 540 00:18:39,685 --> 00:18:41,019 WORK, IN DISPARITIES OFTEN IN 541 00:18:41,086 --> 00:18:42,521 OTHER CONTEXT, KNOW HOW TO DO 542 00:18:42,588 --> 00:18:45,090 THIS BUT WE DON'T DO A GREAT YOB 543 00:18:45,157 --> 00:18:46,925 IN A CLINICAL CONTEXT OF GETTING 544 00:18:46,992 --> 00:18:49,962 AT THE SOCIAL DETERMINANTS OR 545 00:18:50,028 --> 00:18:52,397 DEMOGRAPHIC FACTORS WITH A FEW 546 00:18:52,464 --> 00:18:53,031 EXCEPTIONS. 547 00:18:53,098 --> 00:18:53,966 OUTSIDE OF NIH, ALL THE PATIENTS 548 00:18:54,032 --> 00:18:56,668 WHO COME TO A CLINICAL SETTING 549 00:18:56,735 --> 00:18:58,437 WILL KNOW THEIR INSURANCE, 550 00:18:58,504 --> 00:19:00,072 RIGHT, AND WILL USUALLY KNOW 551 00:19:00,138 --> 00:19:01,440 THEIR SEX AND USUALLY KNOW THEIR 552 00:19:01,507 --> 00:19:03,909 AGE BUT AFTER THAT IT DROPS OFF 553 00:19:03,976 --> 00:19:06,512 SIGNIFICANTLY, SO THE OMB CENSUS 554 00:19:06,578 --> 00:19:07,646 CATEGORIES FOR RACE ASK 555 00:19:07,713 --> 00:19:09,181 ETHNICITY, I WOULD STRONGLY 556 00:19:09,248 --> 00:19:11,783 RECOMMEND THAT WE USE IN A 557 00:19:11,850 --> 00:19:12,851 STANDARDIZED WAY AND IT SHOULD 558 00:19:12,918 --> 00:19:15,521 BE ASKED IN A STANDARDIZED WAY, 559 00:19:15,587 --> 00:19:17,422 IT SHOULD BE LEFT TO OH, YOU 560 00:19:17,489 --> 00:19:18,824 KNOW YOU LOOK LIKE THIS AND LEFT 561 00:19:18,891 --> 00:19:22,060 UP TO A FRONT DESK, IT SHOULD BE 562 00:19:22,127 --> 00:19:23,729 SELF-REPORTED IN A STANDARDIZED 563 00:19:23,795 --> 00:19:24,162 WAY. 564 00:19:24,229 --> 00:19:26,698 OTHER THINGS LIKE EDUCATIONAL 565 00:19:26,765 --> 00:19:29,134 ATTAINMENT IS A CRITICAL 566 00:19:29,201 --> 00:19:29,568 PREDICTER OF HEALTH. 567 00:19:29,635 --> 00:19:32,371 IT'S ALSO A PREDICTER OF HOW YOU 568 00:19:32,437 --> 00:19:34,239 COMMUNICATE WITH SOMEONE. 569 00:19:34,306 --> 00:19:35,841 I WOULD ARGUE RACE AND ETHNICITY 570 00:19:35,908 --> 00:19:37,042 ARE AS WELL, SO FOR THE 571 00:19:37,109 --> 00:19:38,777 CLINICIAN TO KNOW WHO IS MY 572 00:19:38,844 --> 00:19:39,845 PATIENT, WHERE ARE THEY COMING 573 00:19:39,912 --> 00:19:41,947 FROM, NOT JUST WHO I THINK THEY 574 00:19:42,014 --> 00:19:43,048 ARE, BUT KNOW WHERE THEY'RE 575 00:19:43,115 --> 00:19:44,983 COMING FROM, THIS IS PART OF 576 00:19:45,050 --> 00:19:48,153 THAT INITIAL UNDERSTANDING THAT 577 00:19:48,220 --> 00:19:50,522 WE'RE NOT AS CLINICIANS CARING 578 00:19:50,589 --> 00:19:51,924 FOR DISEASES, WE'RE ACTUALLY 579 00:19:51,990 --> 00:19:54,493 CARING FOR PEOPLE WITH THE 580 00:19:54,560 --> 00:19:57,029 CONDITIONS ORIGINAL WHO ARE 581 00:19:57,095 --> 00:19:59,464 HEALTHY OR COMING FOR PREVENTION 582 00:19:59,531 --> 00:19:59,898 INTERVENTIONS. 583 00:19:59,965 --> 00:20:02,634 MANY OTHER FACTORS, SEXUAL 584 00:20:02,701 --> 00:20:03,468 ORIENTATION, GENDER IDENTITY, 585 00:20:03,535 --> 00:20:04,603 DISABILITY STATUS, DO WE ISSUE 586 00:20:04,670 --> 00:20:06,438 IN THAT ON THE BASIS OF FUNCTION 587 00:20:06,505 --> 00:20:07,472 OR CATEGORY, DO WE AUTOMATICALLY 588 00:20:07,539 --> 00:20:10,108 SAY YOU HAVE A DISABILITY IF YOU 589 00:20:10,175 --> 00:20:12,377 HAVE HAD A PARTICULAR CHRONIC 590 00:20:12,444 --> 00:20:15,814 DISEASE PROBLEM OR DO WE ASK A 591 00:20:15,881 --> 00:20:17,583 STANDARDIZED SET OF QUESTIONS 592 00:20:17,649 --> 00:20:18,650 BASED ON FUNCTION, MOSTLY 593 00:20:18,717 --> 00:20:21,253 AROUND, CAN YOU CARE FOR 594 00:20:21,320 --> 00:20:22,854 YOURSELF AND CAN YOU CARE FOR 595 00:20:22,921 --> 00:20:24,056 YOURSELF, TAKE CARE OF YOURSELF 596 00:20:24,122 --> 00:20:25,924 IF YOU'RE ALONE IN TERMS OF 597 00:20:25,991 --> 00:20:27,225 FINANCES AND SHOPPING AND 598 00:20:27,292 --> 00:20:31,830 COOKING AND THINGS OF THAT TYPE, 599 00:20:31,897 --> 00:20:33,799 MUCH WHAT THE GERIATRICIANS HAVE 600 00:20:33,865 --> 00:20:36,001 BEEN DOING FOR QUITE SOMETIME TO 601 00:20:36,068 --> 00:20:36,935 REALLY EVALUATE THAT STATUS. 602 00:20:37,002 --> 00:20:38,470 WE ALSO NEED TO KNOW WHERE 603 00:20:38,537 --> 00:20:39,838 PEOPLE LIVE AND A COMMUNITY 604 00:20:39,905 --> 00:20:42,908 MEASURE IS IMPORTANT, NOT 605 00:20:42,975 --> 00:20:45,110 KNOWING YOU KNOW WHEN I REMEMBER 606 00:20:45,177 --> 00:20:47,980 NOT KNOWING AS A CLINICIAN AT 607 00:20:48,046 --> 00:20:49,681 UCSF, STARTING AS A RESIDENT, 608 00:20:49,748 --> 00:20:50,816 THERE WOULD BE PATIENT WHO IS 609 00:20:50,882 --> 00:20:52,951 TAKE 3 BUSES TO GET TO UCSF 610 00:20:53,018 --> 00:20:56,154 WHICH IS IN ANOTHER NEIGHBORHOOD 611 00:20:56,221 --> 00:20:57,222 IN SAN FRANCISCO, AND KNOW WHERE 612 00:20:57,289 --> 00:20:59,191 THEY LIVE, WHAT IS THE MISSION 613 00:20:59,257 --> 00:21:00,626 DISTRICT LIKE, WHAT IS THE 614 00:21:00,692 --> 00:21:01,693 POPULATION LIKE? 615 00:21:01,760 --> 00:21:03,528 AND DOING A COMMUNITY MEASURE 616 00:21:03,595 --> 00:21:06,298 MAY NOT BE THAT DIFFICULT IF WE 617 00:21:06,365 --> 00:21:08,266 USED EXACT ADDRESS, WE CAN 618 00:21:08,333 --> 00:21:10,335 ACTUALLY IMPUTE DATA FROM CENSUS 619 00:21:10,402 --> 00:21:11,637 TRACKS, WE DON'T DO THAT EACH 620 00:21:11,703 --> 00:21:13,271 FOR OUR RESEARCH NECESSARILY, 621 00:21:13,338 --> 00:21:15,107 BUT THIS IS A DIRECTION I THINK 622 00:21:15,173 --> 00:21:16,975 THAT WE HAVE THE CAPABILITY OF 623 00:21:17,042 --> 00:21:19,277 DOING THIS AND THE TECHNOLOGY TO 624 00:21:19,344 --> 00:21:20,078 DO IT. 625 00:21:20,145 --> 00:21:23,115 NOW ACCESS TO FOOD, JOBS, 626 00:21:23,181 --> 00:21:23,949 TRANSPORTATION, HOUSING, GREEN 627 00:21:24,016 --> 00:21:26,051 SPACE, SAFETY, SORT OF THE 628 00:21:26,118 --> 00:21:26,952 STRUCTURAL SOCIAL DETERMINANTS 629 00:21:27,019 --> 00:21:28,920 OF HEALTH ARE ALL AVAILABLE FROM 630 00:21:28,987 --> 00:21:31,523 CENSUS IF WE IMPUTE IT AND THERE 631 00:21:31,590 --> 00:21:33,725 ARE RESEARCH EFFORTS THAT ARE 632 00:21:33,792 --> 00:21:35,994 WORKING ON THINGS, CREATING 633 00:21:36,061 --> 00:21:38,096 THINGS LIKE THE EXPOSOME THAT 634 00:21:38,163 --> 00:21:39,264 WOULD INCLUE THESE KINDS OF 635 00:21:39,331 --> 00:21:42,968 THINGS AS WELL AS PM2.5 636 00:21:43,035 --> 00:21:46,238 EXPOSURE, AND OTHER FACTORS THAT 637 00:21:46,304 --> 00:21:49,107 MATTER IN INFLUENCING HEALTH. 638 00:21:49,174 --> 00:21:50,275 WE'VE COLLABORATED WITH 639 00:21:50,342 --> 00:21:51,910 SCIENTISTS ACROSS NIH AND ACROSS 640 00:21:51,977 --> 00:21:56,348 THE COUNTRY IN CREATING A 641 00:21:56,415 --> 00:21:57,616 PORTFOLIO OF MEASURES THAT WE 642 00:21:57,683 --> 00:22:00,018 CALL THE SOCIAL DETERMINANTS OF 643 00:22:00,085 --> 00:22:01,253 HEALTH MEASURES COLLECTION, THE 644 00:22:01,319 --> 00:22:07,325 WEB LINK IS ON THE SLIDE, WE 645 00:22:07,392 --> 00:22:09,027 HAVE THE--OUR SYMBOL, OUR 646 00:22:09,094 --> 00:22:10,662 WEBPAGE, I SHOULD SAY ON THE 647 00:22:10,729 --> 00:22:13,498 PHOENIX TOOL KIT IS THE 3 LITTLE 648 00:22:13,565 --> 00:22:15,834 HOUSES HERE AND WITHIN 2 CYCLES 649 00:22:15,901 --> 00:22:19,538 OF REVIEW OF TRYING TO CREATE 650 00:22:19,604 --> 00:22:20,939 THAT MEASURES, THAT HAVE BEEN 651 00:22:21,006 --> 00:22:23,575 USED IN NATIONAL STUDIES OR WELL 652 00:22:23,642 --> 00:22:25,510 VALIDATED FOR DIFFERENT 653 00:22:25,577 --> 00:22:25,944 CONSTRUCTS. 654 00:22:26,011 --> 00:22:28,413 MOST OF THE EFFORTS HAVE GONE TO 655 00:22:28,480 --> 00:22:30,348 ADDRESSING ISSUES AROUND 656 00:22:30,415 --> 00:22:31,516 MEASURING STRUCTURAL SOCIAL 657 00:22:31,583 --> 00:22:33,585 DETERMINANTS AND THE 1S MOST 658 00:22:33,652 --> 00:22:36,455 RECENTLY VETTED IN DECEMBER OF 659 00:22:36,521 --> 00:22:38,457 2022 ARE LISTED ON THE SLIDE, 660 00:22:38,523 --> 00:22:40,325 THINGS LIKE HEALTHCARE 661 00:22:40,392 --> 00:22:41,359 COMMUNICATIONS, INTERNET ACCESS, 662 00:22:41,426 --> 00:22:45,430 WATER QUALITY ACCESS, THERE ARE 663 00:22:45,497 --> 00:22:48,233 ALSO A SET OF MEASURES THERE ON 664 00:22:48,300 --> 00:22:50,068 DEMOGRAPHICS, THINGS LIKE 665 00:22:50,135 --> 00:22:51,503 INDIVIDUAL SOCIAL DETERMINANTS, 666 00:22:51,570 --> 00:22:53,171 THINGS LIKE FOOD INSECURITY, 667 00:22:53,238 --> 00:22:56,975 HOUSING SECURITY, EVERY DAY 668 00:22:57,042 --> 00:22:58,577 DISCRIMINATION KALE AND THOSE 669 00:22:58,643 --> 00:23:01,980 MOSTLY HAVE BEEN BORROWED FROM 670 00:23:02,047 --> 00:23:03,482 THINGS THAT EXISTS ON THE 671 00:23:03,548 --> 00:23:05,150 WEBSITE OR NATIONAL STUDIES DONE 672 00:23:05,217 --> 00:23:06,885 BY THE CDC, AND IT'S TIME 673 00:23:06,952 --> 00:23:09,054 BECAUSE OF THE OMB CHANGES AS 674 00:23:09,121 --> 00:23:11,022 WELL AS OTHER REASONS THAT WE 675 00:23:11,089 --> 00:23:14,326 RESILIENCE VIEW THOSE AND UPDATE 676 00:23:14,392 --> 00:23:14,860 THEM. 677 00:23:14,926 --> 00:23:17,062 AND AND WE ALSO REGENERATED THE 678 00:23:17,129 --> 00:23:18,497 STAFF AND THE WORKFORCE TO GUIDE 679 00:23:18,563 --> 00:23:20,499 US AS TO WHERE ARE WE FUNDING, 680 00:23:20,565 --> 00:23:21,700 WHAT ARE WE LOOKINGA THE AND I 681 00:23:21,767 --> 00:23:23,135 WILL POINT OUT A COUPLE THINGS 682 00:23:23,201 --> 00:23:25,137 HERE, FIRST THE MAIORITY OF THE 683 00:23:25,203 --> 00:23:28,039 GRANTS THAT WE FUND AT NIMHD AS 684 00:23:28,106 --> 00:23:30,742 WELL AS AT NIH ARE IN THIS 685 00:23:30,809 --> 00:23:31,877 INDIVIDUAL COLUMN, EVEN AT OUR 686 00:23:31,943 --> 00:23:33,311 INSTITUTE WHEN WE LOOK AT THIS, 687 00:23:33,378 --> 00:23:34,846 WELL OVER HALF, YOU KNOW 688 00:23:34,913 --> 00:23:38,049 3-QUARTERS OF THE GRANTS ARE 689 00:23:38,116 --> 00:23:38,784 FOCUSED ON INDIVIDUALS. 690 00:23:38,850 --> 00:23:41,286 IT'S HARDER TO DO RESEARCH IN A 691 00:23:41,353 --> 00:23:45,257 SOCIETAL LEVEL OR EVEN A 692 00:23:45,323 --> 00:23:45,857 COMMUNITY LEVEL, OR 693 00:23:45,924 --> 00:23:47,592 INTERPERSONAL LEVEL, SO THAT'S A 694 00:23:47,659 --> 00:23:48,960 DIRECTION I THINK WE'VE BEEN 695 00:23:49,027 --> 00:23:50,595 TRYING TO NUDGE THE FIELD 696 00:23:50,662 --> 00:23:51,596 TOWARDS THROUGH SPECIAL 697 00:23:51,663 --> 00:23:51,997 ANNOUNCEMENTS. 698 00:23:52,063 --> 00:23:55,634 IF YOU ASK ME WHAT'S THE CAUSAL 699 00:23:55,700 --> 00:23:57,869 DIRECTION HERE OF HEALTH 700 00:23:57,936 --> 00:23:58,570 DISPARITIES OR INIQUITIES, IT'S 701 00:23:58,637 --> 00:24:00,539 PROBABLY MORE RIGHT TO LEFT OR 702 00:24:00,605 --> 00:24:04,442 SOCIETAL TO INDIVIDUAL THAN IT 703 00:24:04,509 --> 00:24:05,310 IS INDIVIDUAL TO SOCIETY. 704 00:24:05,377 --> 00:24:08,046 THEN WE HAVE THE DOMAINS OF 705 00:24:08,113 --> 00:24:09,581 INFLUENCE, THE EXPLOSION IN 706 00:24:09,648 --> 00:24:12,117 INFORMATION ABOUT BIOLOGY, THAT 707 00:24:12,184 --> 00:24:14,019 WE'VE KNOWN FOR THE LAST 25 708 00:24:14,085 --> 00:24:16,221 YEARS BEGINNING WITH THE HUMAN 709 00:24:16,288 --> 00:24:17,389 GENOME PROJECT, BEHAVIORIAL 710 00:24:17,455 --> 00:24:18,456 ISSUES, PHYSICAL AND BUILT 711 00:24:18,523 --> 00:24:19,624 ENVIRONMENT, THAT ALSO HAD AN 712 00:24:19,691 --> 00:24:23,361 EXPLOSION IN THE LAST 25 YEARS 713 00:24:23,428 --> 00:24:24,896 IN DATA AND IN SCIENCE AROUND 714 00:24:24,963 --> 00:24:26,531 WHAT DOES IT MEAN TO LIVE IN 715 00:24:26,598 --> 00:24:28,600 THIS NEIGHBORHOOD WHEN YOU HAVE 716 00:24:28,667 --> 00:24:30,902 NO ACCESS TO FRESH FRUITS AND 717 00:24:30,969 --> 00:24:31,703 VEGETABLES THAT ARE NOT 718 00:24:31,770 --> 00:24:33,205 AVAILABLE UNLESS YOU HAVE A 719 00:24:33,271 --> 00:24:35,340 MOTOR VEHICLE, YOU OWN A MOTOR 720 00:24:35,407 --> 00:24:38,109 VEHICLE AND THERE'S REALLY POOR 721 00:24:38,176 --> 00:24:38,910 PUBLIC TRANSPORTATION, SO, 722 00:24:38,977 --> 00:24:40,278 IMAGINE, WE TELL THAT PATIENT, 723 00:24:40,345 --> 00:24:41,213 WELL, YOU HAVE DIABETES, YOU 724 00:24:41,279 --> 00:24:42,948 HAVE TO BUY THIS KIND OF FOOD 725 00:24:43,014 --> 00:24:45,784 AND THEN THEY CAN'T ACCESS IT. 726 00:24:45,851 --> 00:24:46,952 AND THEN THE SOCIAL CULTURAL 727 00:24:47,018 --> 00:24:48,053 ENVIRONMENT AND SEE THE 728 00:24:48,119 --> 00:24:48,854 HEALTHCARE SYSTEM, I WANTED TO 729 00:24:48,920 --> 00:24:52,991 MAKE SURE THAT THAT WAS INCLUDED 730 00:24:53,058 --> 00:24:56,061 FIRST BECAUSE I USED TO PRACTICE 731 00:24:56,127 --> 00:24:56,995 PRIMARY CARE AND INTERNAL 732 00:24:57,062 --> 00:24:58,296 MEDICINE AS YOU HEARD AND I KNOW 733 00:24:58,363 --> 00:25:01,032 THIS MATTERS TO PEOPLE'S HEALTH 734 00:25:01,099 --> 00:25:03,368 AND SECOND THE HEALTHCARE--THE 735 00:25:03,435 --> 00:25:04,302 HEALTHCARE SETTING CAN BE A 736 00:25:04,369 --> 00:25:05,670 PLACE WHERE WE MAKE DISPARITIES 737 00:25:05,737 --> 00:25:07,906 WORSE OR WE CAN REALLY HELP TO 738 00:25:07,973 --> 00:25:10,675 MITIGATE THEM AND THE EXAMPLE OF 739 00:25:10,742 --> 00:25:13,445 CONTROLS CHRONIC DISEASES IS 1. 740 00:25:13,511 --> 00:25:14,846 NOW I WILL GIVE YOU SOME 741 00:25:14,913 --> 00:25:17,616 RESEARCH EXAMPLES OF THINGS WE 742 00:25:17,682 --> 00:25:19,818 HAVE FUNDED THAT HAVE AND I 743 00:25:19,885 --> 00:25:21,653 THINK IMPACTED HEALTHCARE, SO, 744 00:25:21,720 --> 00:25:24,322 DURING COVID, WE DO A LOT OF 745 00:25:24,389 --> 00:25:27,659 RAPID TURN AROUND FUNDING. 746 00:25:27,726 --> 00:25:29,394 THIS WAS A PARTICULARLY CREATIVE 747 00:25:29,461 --> 00:25:31,429 COMPETITORS ECTOMYOSIN THAT'S 748 00:25:31,496 --> 00:25:33,865 ACTUALLY NIAID PICKED UP THIS 749 00:25:33,932 --> 00:25:35,800 GRANT, IS VACCINE MESSAGING 750 00:25:35,867 --> 00:25:36,301 PLATFORMS AND EMERGENCY 751 00:25:36,368 --> 00:25:38,403 DEPARTMENT ANDS IT WAS DONE IN 752 00:25:38,470 --> 00:25:39,771 SAN FRANCISCO IN THE 753 00:25:39,838 --> 00:25:41,273 SAN FRANCISCO GENERAL HOSPITAL, 754 00:25:41,339 --> 00:25:43,174 SO YOU SEE 500 ADULTS, EXPOSED 755 00:25:43,241 --> 00:25:46,778 TO A 4 MINUTE VIDEO, FEATURING 756 00:25:46,845 --> 00:25:49,314 RACE CONCORDANT PHYSICIAN AND 1 757 00:25:49,381 --> 00:25:51,416 PAGE INFORMATIONAL FLYER FOR 758 00:25:51,483 --> 00:25:53,351 PATIENTS AND CLINICIANS AND 759 00:25:53,418 --> 00:25:57,289 THERE WAS GREATER VACCINE 760 00:25:57,355 --> 00:25:58,290 ACCEPTANCE AFTER EITHER HALF AN 761 00:25:58,356 --> 00:26:01,593 OUR OR 6 HOURS AFTER THE ISHT 762 00:26:01,660 --> 00:26:03,561 VENTION EXPOSURE AND GREATER 763 00:26:03,628 --> 00:26:05,297 VACCINE UPTAKE, 30 DAYS AFTER 764 00:26:05,363 --> 00:26:07,866 THE EMERGENCY DEPARTMENT VISIT 765 00:26:07,933 --> 00:26:09,701 AND THERE WERE LARGER EFFECT 766 00:26:09,768 --> 00:26:11,369 SIZE FOR LATINOS AND 767 00:26:11,436 --> 00:26:12,971 PARTICIPANTS WITHOUT A PRIMARY 768 00:26:13,038 --> 00:26:13,905 CARE PHYSICIAN FOR WHOM THEY 769 00:26:13,972 --> 00:26:15,974 BEING ASK FOR QUESTIONS. 770 00:26:16,041 --> 00:26:18,410 NOW WHEN WE LOOK BACK AT WHAT 771 00:26:18,476 --> 00:26:19,244 HAPPENS DURING COVID, MANY 772 00:26:19,311 --> 00:26:20,545 LESSONS CAN BE LEARNED BUT 1 OF 773 00:26:20,612 --> 00:26:23,548 THE THINGS WE WERE ABLE TO DO IS 774 00:26:23,615 --> 00:26:25,216 REALLY UNDERSTAND THE HUGE 775 00:26:25,283 --> 00:26:27,152 DISPARITIES THAT EXISTED AT THE 776 00:26:27,218 --> 00:26:28,820 BEGINNING IN MARCH AND APRIL OF 777 00:26:28,887 --> 00:26:30,755 2020 THAT PERSISTED FOR A WHILE 778 00:26:30,822 --> 00:26:33,992 AND THAT WE WERE ABLE TO, IF YOU 779 00:26:34,059 --> 00:26:36,361 WISH, LEVEL THE PLAYING FIELD 780 00:26:36,428 --> 00:26:42,567 FOR THE MOST PART BY THE FALL OF 781 00:26:42,634 --> 00:26:44,369 2022. 782 00:26:44,436 --> 00:26:46,271 THESE ARE COVID-19 ASSOCIATED 783 00:26:46,338 --> 00:26:49,174 DEATHS IF 2020 AND 2021, AND THE 784 00:26:49,240 --> 00:26:50,709 LIFE EXPECTANCY FOR FOR 2021 WE 785 00:26:50,775 --> 00:26:52,944 WILL SEE THIS IMPACT, WE TALKED 786 00:26:53,011 --> 00:26:55,280 ABOUT WO-3 YEARS OF LIFE 787 00:26:55,347 --> 00:26:56,948 EXECANCY LOST FOR AFRICAN 788 00:26:57,015 --> 00:26:57,682 AMERICANS, LATINOS, AMERICAN 789 00:26:57,749 --> 00:26:59,918 INDIANS AND ALASKA NATIVES AND 790 00:26:59,985 --> 00:27:00,819 YOU SEE WHY. 791 00:27:00,885 --> 00:27:03,888 THE COVID ASSOCIATED DEATHS BY 792 00:27:03,955 --> 00:27:05,190 RACE AND ETHNICITY, WERE DOUBLE, 793 00:27:05,256 --> 00:27:06,958 TRIPLE IN THESE POPULATIONS 794 00:27:07,025 --> 00:27:09,027 COMPARED TO ASIANS OR TO WHITES 795 00:27:09,094 --> 00:27:11,096 AND WHITES WERE NOT EXACTLY 796 00:27:11,162 --> 00:27:13,031 EXEMPT FROM HAVING EXCESS 797 00:27:13,098 --> 00:27:14,933 MORTALITY IN CERTAIN PARTS OF 798 00:27:15,000 --> 00:27:15,767 THE COUNTRY. 799 00:27:15,834 --> 00:27:17,802 BY 2022, YOU SEE MUCH NARROWER 800 00:27:17,869 --> 00:27:20,972 DIFFERENCES AND IN FACT, YOU SEE 801 00:27:21,039 --> 00:27:23,208 THAT THE EXAMPLE OF LATINOS, NO 802 00:27:23,274 --> 00:27:25,543 DIFFERENCE FROM WHITES, YOU SEE 803 00:27:25,610 --> 00:27:27,912 AFRICAN AMERICANS, SLIGHTLY 804 00:27:27,979 --> 00:27:30,015 HIGHER BY ABOUT 15-20%, NOT 805 00:27:30,081 --> 00:27:35,787 TRIPLE THE DEATH RATES IN 806 00:27:35,854 --> 00:27:37,555 AMERICAN INDIANS CONTINUE TO BE 807 00:27:37,622 --> 00:27:40,959 SOMEWHAT HIGHER BUT AGAIN 808 00:27:41,026 --> 00:27:42,360 MARKEDLY IMPROVED. 809 00:27:42,427 --> 00:27:44,462 THIS WAS A TRIUMPH OF BOTH 810 00:27:44,529 --> 00:27:45,997 FORMATION, MESSAGING TO THE 811 00:27:46,064 --> 00:27:48,266 COMMUNITIES, THE MOBILIZATION OF 812 00:27:48,333 --> 00:27:50,301 THE PROFESSIONALS, AND THE 813 00:27:50,368 --> 00:27:52,637 COMMUNITY LEADERS AND ALL THE 814 00:27:52,704 --> 00:27:53,938 DIFFERENT ACTIVITIES THAT NIH 815 00:27:54,005 --> 00:27:56,207 WAS VERY MUCH INVOLVED WITH THAT 816 00:27:56,274 --> 00:27:57,409 THE WHOLE DEPARTMENT OF HEALTH 817 00:27:57,475 --> 00:27:59,177 AND HUMAN SERVICES AS WELL AS 818 00:27:59,244 --> 00:28:03,515 THE COUNTRY WAS INVOLVED WITH. 819 00:28:03,581 --> 00:28:04,315 TURNING TO CARDIOVASCULAR DEC, 820 00:28:04,382 --> 00:28:07,886 THIS WAS A STUDY PUBLISHED A 821 00:28:07,952 --> 00:28:10,121 YEAR AGO IN THE ANNALS OF 822 00:28:10,188 --> 00:28:13,324 INTERNAL MEDICINE AND THIS IS 823 00:28:13,391 --> 00:28:15,193 DISPARITIES AND STATIN FOR 824 00:28:15,260 --> 00:28:16,127 PREVENTION OF CARDIOVASCULAR 825 00:28:16,194 --> 00:28:17,929 DISEASE. 826 00:28:17,996 --> 00:28:19,964 NOW IN MY OWN PERSONAL PRACTICE 827 00:28:20,031 --> 00:28:21,733 AND IN READING THIS LITERATURE, 828 00:28:21,800 --> 00:28:24,936 YOU KNOW 10 YEARS AGO, I WOULD 829 00:28:25,003 --> 00:28:27,605 HAVE A HARDER TIME ARGUING FOR 830 00:28:27,672 --> 00:28:28,573 PRIMARY PREVENTION USING A 831 00:28:28,640 --> 00:28:30,108 STATIN, SO THIS IS MEDICALIZING 832 00:28:30,175 --> 00:28:31,276 YOUR LIFE, TAKE A DRUG EVERY 833 00:28:31,342 --> 00:28:34,245 NIGHT BECAUSE YOU WILL LIVE 834 00:28:34,312 --> 00:28:37,949 LONGER AND THE BENEFIT WAS THERE 835 00:28:38,016 --> 00:28:39,050 PROBABLY FOR MEN AUTOMATIC YOU 836 00:28:39,117 --> 00:28:41,920 HAD TO KIND OF SCRATCH A LITTLE 837 00:28:41,986 --> 00:28:42,153 BIT. 838 00:28:42,220 --> 00:28:43,855 DEFINITELY NEVER CLEAR FOR WOMEN 839 00:28:43,922 --> 00:28:45,423 IN MY MIND BASED ON RANDOMIZED 840 00:28:45,490 --> 00:28:46,458 TRIALS BUT FOR SECONDARY 841 00:28:46,524 --> 00:28:48,393 PREVENTION, SO IFFY WOO KNOW YOU 842 00:28:48,460 --> 00:28:50,328 HAVE CORONARY DISEASE, YOU 843 00:28:50,395 --> 00:28:51,362 HAVEN'T HAD ANYTHING HAPPEN TO 844 00:28:51,429 --> 00:28:53,965 YOU YET BUT WE KNOW YOU HAVE 845 00:28:54,032 --> 00:28:55,266 CORONARY DISEASE, THE DATA ARE 846 00:28:55,333 --> 00:28:58,303 COMPELLING THAT YOU SHOULD BE ON 847 00:28:58,369 --> 00:29:01,573 THIS DRUG AND WE SEE THAT FOR 848 00:29:01,639 --> 00:29:02,273 AFRICAN AMERICAN WOMEN, 849 00:29:02,340 --> 00:29:04,008 MULTIRACIAL MEN, WOMEN OF ANY 850 00:29:04,075 --> 00:29:05,710 GROUP WERE LESS LIKELY TO DO IT, 851 00:29:05,777 --> 00:29:08,179 THESE WERE BASED ON NATIONAL 852 00:29:08,246 --> 00:29:10,248 HEALTH AND SURVEY, 2015 TO 2020. 853 00:29:10,315 --> 00:29:12,650 SO TO ME THIS IS A SIGN THAT WE 854 00:29:12,717 --> 00:29:14,619 KNOW IT WORKS, YET WE'RE NOT 855 00:29:14,686 --> 00:29:15,920 IMPLEMENTING IT AND WE'RE OFTEN 856 00:29:15,987 --> 00:29:18,256 NOT IMPLEMENTING IT IN THE MOST 857 00:29:18,323 --> 00:29:19,057 DISADVANTAGED GROUP OR PERHAPS 858 00:29:19,124 --> 00:29:20,758 IN THE CASE OF WOMEN, 859 00:29:20,825 --> 00:29:22,193 FREQUENTLY, THEY DON'T GET HEART 860 00:29:22,260 --> 00:29:24,696 ATTACKS, RIGHT IN IT'S ONLY MEN 861 00:29:24,762 --> 00:29:25,964 AND THAT STEREOTYPE PLEEF 862 00:29:26,030 --> 00:29:29,467 PERSISTS TO THIS DAY. 863 00:29:29,534 --> 00:29:31,102 WE CAN ALSO ADJUST OR THINK 864 00:29:31,169 --> 00:29:35,006 ABOUT HOW WE ADJUST RISK FACTORS 865 00:29:35,073 --> 00:29:36,474 IN TERMS OF CARDIOVASCULAR 866 00:29:36,541 --> 00:29:37,742 DISEASE MORTALITY, THIS IS AGAIN 867 00:29:37,809 --> 00:29:40,345 DATA FROM THE NATIONAL HEALTH 868 00:29:40,411 --> 00:29:41,846 AND NUTRITION EXAM NATION SURVEY 869 00:29:41,913 --> 00:29:42,680 AND WHEN YOU SLEEP APNEA AND 870 00:29:42,747 --> 00:29:43,982 OBESITYY BLACK BHIET DISPARITIES 871 00:29:44,048 --> 00:29:46,551 CAN BE REDUCED IF YOU AJUST FOR 872 00:29:46,618 --> 00:29:47,619 METABOLIC OR BEHAVIORIAL RISK 873 00:29:47,685 --> 00:29:49,254 FACTORS WHETHER IT'S SMOKING, 874 00:29:49,320 --> 00:29:51,122 DIABETES AND THESE OTHER SOCIAL 875 00:29:51,189 --> 00:29:56,027 DETERMINANTS SUCH AS FOOD 876 00:29:56,094 --> 00:29:57,162 INSECURITY AND UNEMPLOYMENT. 877 00:29:57,228 --> 00:29:59,364 THE DEMOGRAPHIC AND HAVING LOWER 878 00:29:59,430 --> 00:30:01,599 SOCIOECONOMIC STAT US, WE STILL 879 00:30:01,666 --> 00:30:03,835 SEE CARDIOVASCULAR DEC 880 00:30:03,902 --> 00:30:04,669 MORTALITY, HIGHER FOR AFRICAN 881 00:30:04,736 --> 00:30:06,905 AMERICANS COMPARED TO WHITES AND 882 00:30:06,971 --> 00:30:09,641 CERTAINLY A LATINOS AND A GROUP 883 00:30:09,707 --> 00:30:13,511 OF OTHER RACE AND NHANES ARE 884 00:30:13,578 --> 00:30:13,845 LOWER. 885 00:30:13,912 --> 00:30:17,315 THIS PARTICULAR STUDY LOOKED AT 886 00:30:17,382 --> 00:30:19,050 THE PERCUTANEOUS, AND THIS IS 887 00:30:19,117 --> 00:30:23,421 USING LARGE DATA SETS, 888 00:30:23,488 --> 00:30:24,455 PERCUTANEOUS CORON AREY 889 00:30:24,522 --> 00:30:25,857 INTERVENTION AND WITH 890 00:30:25,924 --> 00:30:27,325 CARDIOLOGISTS IN THE AUDIENCE, I 891 00:30:27,392 --> 00:30:28,660 WON'T TELL YOU ABOUT THIS 892 00:30:28,726 --> 00:30:30,728 LITERATURE BUT IT'S CLEAR THAT 893 00:30:30,795 --> 00:30:33,231 IF SOMEONE'S HAVING AN ACUTE 894 00:30:33,298 --> 00:30:34,799 THROMBOTIC EVENT IN THEIR 895 00:30:34,866 --> 00:30:35,733 CORONARY ARTERY, THE FASTER WE 896 00:30:35,800 --> 00:30:37,802 CAN GET TO THEM, THE FASTER 897 00:30:37,869 --> 00:30:39,571 THEIR OUTCOME WILL BE, SO THIS 898 00:30:39,637 --> 00:30:42,106 IDEA OF GETTING IT QUICKLY, THIS 899 00:30:42,173 --> 00:30:43,274 ASSOCIATED WITH THE CORONARY 900 00:30:43,341 --> 00:30:44,342 ISHT VENTION AS BECOME A 901 00:30:44,409 --> 00:30:47,645 STANDARD BY WHICH WE CAN COMPARE 902 00:30:47,712 --> 00:30:49,013 THE QUALITY OF CARE FOR THE 903 00:30:49,080 --> 00:30:50,181 LEADING CAUSE OF DEATH IN THE 904 00:30:50,248 --> 00:30:52,550 UNITED STATES, SO OBVIOUSLY AN 905 00:30:52,617 --> 00:30:55,720 IMPORTANT CONDITION. 906 00:30:55,787 --> 00:30:58,489 AND IN ALL PAYOR NONPUBLIC 907 00:30:58,556 --> 00:31:00,124 DISCHARGE INFORMATION FROM 908 00:31:00,191 --> 00:31:01,859 CALIFORNIA SO FROM 2006-2020 YOU 909 00:31:01,926 --> 00:31:05,396 SEE THE SAMPLE SIZE OVER 600,000 910 00:31:05,463 --> 00:31:06,231 PATIENTS WITH MYOCARDIAL 911 00:31:06,297 --> 00:31:07,432 INFARCTION AND AJUSTING IT FOR 912 00:31:07,498 --> 00:31:09,601 THEIR ZIP CODE, SO LOOKING AT 913 00:31:09,667 --> 00:31:12,604 THEIR ZIP CODE TO GET THE AREA 914 00:31:12,670 --> 00:31:13,972 DEPRIVATION INDEX, SO WHAT IS 915 00:31:14,038 --> 00:31:15,173 THE FACTOR OF WHERE YOU LIVE, 916 00:31:15,240 --> 00:31:17,141 YOUR COMMUNITY HAVE ON DO WITH 917 00:31:17,208 --> 00:31:18,376 YOUR HEART ATTACK OUTCOME, YOU 918 00:31:18,443 --> 00:31:18,910 WILL ASK? 919 00:31:18,977 --> 00:31:20,878 WELL THIS IS DATA THAT SAYS THAT 920 00:31:20,945 --> 00:31:25,850 AT THE END OF 1 YEAR, THE SAME 921 00:31:25,917 --> 00:31:28,987 DAY, PERCUTANEOUS INTERVENTION, 922 00:31:29,053 --> 00:31:31,556 3.1% AND 5.1% ABSOLUTE GREATER 923 00:31:31,623 --> 00:31:33,725 LIKELIHOOD OF RECEIVING IT IF 924 00:31:33,791 --> 00:31:35,827 YOUR AREA OF DEPRIVATION INDEX 925 00:31:35,893 --> 00:31:37,795 WAS LOWER, SO YOU WERE WERE A 926 00:31:37,862 --> 00:31:39,330 BETTER COMMUNITY IN EMERGING ITS 927 00:31:39,397 --> 00:31:46,037 OF OVERALL MEASURES. 928 00:31:46,104 --> 00:31:47,372 8 PERCENT LIKELIHOOD OF 929 00:31:47,438 --> 00:31:48,773 RECEIVING PCI DURING 930 00:31:48,840 --> 00:31:50,608 HOSPITALIZATION AND 2.1% LOWER 931 00:31:50,675 --> 00:31:53,411 30 DAY MORTALITY AND EVEN AT 1 932 00:31:53,478 --> 00:31:55,747 YEAR MORTALITY, A 3.9%, ABSOLUTE 933 00:31:55,813 --> 00:31:58,883 LOWER, SO THIS IS I THINK GOOD 934 00:31:58,950 --> 00:32:01,552 EVIDENT THAT THE SOCIAL 935 00:32:01,619 --> 00:32:02,620 DETERMINANTS, YOUR STRUCTURAL 936 00:32:02,687 --> 00:32:03,588 SOCIAL, YOUR COMMUNITY WHERE YOU 937 00:32:03,655 --> 00:32:06,658 LIVE IN, REALLY MATTERS TO YOUR 938 00:32:06,724 --> 00:32:08,493 HEALTH OUTCOME, SO THAT'S WHY, 1 939 00:32:08,559 --> 00:32:11,996 OTHER REASON WHY CLINICIANS 940 00:32:12,063 --> 00:32:13,731 SHOULD PAY ATTENTION, TOO, THIS 941 00:32:13,798 --> 00:32:16,267 AN INTERESTING STUDY, A NEGATIVE 942 00:32:16,334 --> 00:32:17,869 CLINICAL TRIAL, IT'S PERIDONTAL 943 00:32:17,935 --> 00:32:20,371 DISEASE TREATMENT AFTER STROKE 944 00:32:20,438 --> 00:32:23,341 OR TRANSIENT ESCHEMIC ATTACK, A 945 00:32:23,408 --> 00:32:24,542 LOT HAS BEEN HYPOTHESIZED AND 946 00:32:24,609 --> 00:32:28,179 WRITTEN ABOUT THE ROLE OF 947 00:32:28,246 --> 00:32:29,380 CHRONIC INFLAMMATORY AND ORAL 948 00:32:29,447 --> 00:32:31,683 INFLAMMATION IN THE ORAL CAVITY 949 00:32:31,749 --> 00:32:32,383 PARTICULARLY FOCUSED ON 950 00:32:32,450 --> 00:32:35,253 PERIDONTAL DISEASE AND HOW THEY 951 00:32:35,320 --> 00:32:37,388 MAY PRECIPITATE THROMBOTIC 952 00:32:37,455 --> 00:32:38,790 EVENTS IN THE CEREBRAL 953 00:32:38,856 --> 00:32:40,458 VASCULATURE AS WELL AS IN THE 954 00:32:40,525 --> 00:32:41,759 CORONARY ARTERIES AND THIS WAS A 955 00:32:41,826 --> 00:32:44,062 STUDY THAT LOOKED AT PEOPLE OVER 956 00:32:44,128 --> 00:32:47,999 18, HOSPITALIZED WITH A RECENT 957 00:32:48,066 --> 00:32:49,634 ISOTOPE CHEEMIC STROKE OR TIA 958 00:32:49,701 --> 00:32:52,370 AND HAD AT LEAST 5 NATURAL 959 00:32:52,437 --> 00:32:54,372 TEETH, SIGNS OF MODERATELY 960 00:32:54,439 --> 00:32:55,239 SEVERE PD. 961 00:32:55,306 --> 00:32:56,908 AND THEY GOT INTENSIVE TREATMENT 962 00:32:56,974 --> 00:33:07,518 FOR THE PERIDONTAL DEC A SIMPLE 963 00:33:07,885 --> 00:33:09,721 POINT OF INTERVENTION WAS NOT IN 964 00:33:09,787 --> 00:33:11,389 THE OPTIMAL PLACE, MAYBELET 965 00:33:11,456 --> 00:33:13,391 STANDARD TREATMENTS HAVE GOTTEN 966 00:33:13,458 --> 00:33:15,393 BETTER ON YOU NEED A MUCH LARGER 967 00:33:15,460 --> 00:33:16,327 SAMPLE SIZE TO MAKE A DIFFERENCE 968 00:33:16,394 --> 00:33:20,398 BUT THIS IS SOMETHING THAT 969 00:33:20,465 --> 00:33:20,631 SHARE. 970 00:33:20,698 --> 00:33:23,401 TURNING TO DIABETES AND 971 00:33:23,468 --> 00:33:24,769 OUTCOMES, AGAIN, KIND OF OUT OF 972 00:33:24,836 --> 00:33:28,539 THE BOX THINKING ABOUT HOW TO 973 00:33:28,606 --> 00:33:29,774 IMPROVE DIABETES, CONTROL. 974 00:33:29,841 --> 00:33:32,543 THIS IS FROM AN INVESTIGATOR WHO 975 00:33:32,610 --> 00:33:34,512 WAS IN MILWAUKEE AT THE TIME AND 976 00:33:34,579 --> 00:33:37,582 THIS DPROWP TOOK FINANCIAL 977 00:33:37,648 --> 00:33:39,083 INCENTIVES, WITH TECH BASED 978 00:33:39,150 --> 00:33:40,718 DIABETES EDUCATION INTERVENTION 979 00:33:40,785 --> 00:33:41,853 TO FOCUS ON 60 AFRICAN 980 00:33:41,919 --> 00:33:44,155 AMERICANS, SO IT WAS PROOF OF 981 00:33:44,222 --> 00:33:46,657 CONCEPT STUDY, WITH TYPE 2 982 00:33:46,724 --> 00:33:48,426 DIABETES AND IN POOR CONTROL. 983 00:33:48,493 --> 00:33:51,329 THEY DIVIDED THE STRATIFIED THE 984 00:33:51,396 --> 00:33:53,164 POOR CONTROL FROM 8-10% WHICH WE 985 00:33:53,231 --> 00:33:54,799 WOULD ALL AGREE AND OVER 10% 986 00:33:54,866 --> 00:33:58,136 WHICH IS REALLY POOR, AND THEN 987 00:33:58,202 --> 00:33:59,337 RANDOMIZED TO FINANCIAL 988 00:33:59,404 --> 00:34:01,539 INCENTIVES, ALL LIMITED TO $300, 989 00:34:01,606 --> 00:34:03,374 SO THIS IS--THIS IS SUBSTANTIAL 990 00:34:03,441 --> 00:34:06,177 BUT NOT A HUGE AMOUNT OF 991 00:34:06,244 --> 00:34:07,445 FINANCIAL INCENTIVES, AND THEN 992 00:34:07,512 --> 00:34:09,180 STUDIED THE DIFFERENT WAYS OF 993 00:34:09,247 --> 00:34:11,149 GIVING THE FINANCIAL INCENTIVES, 994 00:34:11,215 --> 00:34:14,886 SO THE FIRST MESSAGE IS THAT 995 00:34:14,952 --> 00:34:16,587 DOING LOW FREQUENCY, MODERATE 996 00:34:16,654 --> 00:34:18,489 FREQUENCY OR HIGH FREQUENCY 997 00:34:18,556 --> 00:34:19,991 INSEBTIVES, YOU KNOW EVERYONE 998 00:34:20,057 --> 00:34:23,094 DROPPED THEIR A1C, BUT YOU HAD A 999 00:34:23,161 --> 00:34:25,296 SIGNIFICANT DROP IN A1C ALMOST 1000 00:34:25,363 --> 00:34:27,298 TO 8.1% OVER THE COURSE OF THESE 1001 00:34:27,365 --> 00:34:30,201 90 DAYS, 3 MONTHS OF TREATMENT 1002 00:34:30,268 --> 00:34:32,537 AND THIS IS A--SORT OF THE MODEL 1003 00:34:32,603 --> 00:34:36,073 OF DOING CASH INCENTIVES TO 1004 00:34:36,140 --> 00:34:38,009 PROBABLY INDUCE BEHAVIOR CHANGE 1005 00:34:38,075 --> 00:34:40,111 IN SOME WAYS OR PROVIDE ENOUGH 1006 00:34:40,178 --> 00:34:41,712 MONEY FOR HEALTHY FOOD, THE 1007 00:34:41,779 --> 00:34:45,116 EXACT MECHANISM IS UNCLEAR, BUT 1008 00:34:45,183 --> 00:34:48,519 IT CLEARLY IS ANOTHER APPROACH 1009 00:34:48,586 --> 00:34:49,353 THAT WOULDN'T NECESSARILY BE 1010 00:34:49,420 --> 00:34:50,855 SOMETHING WE WILL THINK ABOUT 1011 00:34:50,922 --> 00:34:52,490 FROM A CLINICAL SIDE, WE THINK 1012 00:34:52,557 --> 00:34:54,459 WELL, YOU NEED A SECOND DRUG OR 1013 00:34:54,525 --> 00:34:57,028 YOU NEED THIS OR YOU NEED TO 1014 00:34:57,094 --> 00:34:59,931 REALLY MODIFY YOUR DIET AND BUT 1015 00:34:59,997 --> 00:35:01,866 TO ACTUALLY FACILITATE THIS 1016 00:35:01,933 --> 00:35:02,733 THROUGH CASH INCENTIVES, THERE'S 1017 00:35:02,800 --> 00:35:05,770 A LOT OF DATA ON CASH INCENTIVE 1018 00:35:05,837 --> 00:35:07,705 INTERVENTIONS, MOSTLY IN THE LOW 1019 00:35:07,772 --> 00:35:09,006 AND MIDDLE INCOME COUNTRIES IN 1020 00:35:09,073 --> 00:35:10,708 OTHER KINDS OF ACTIVITIES, BUT 1021 00:35:10,775 --> 00:35:12,910 INCORPORATING MORE OF THIS INTO 1022 00:35:12,977 --> 00:35:15,213 HEALTH, THIS IS--A VARIATION ON 1023 00:35:15,279 --> 00:35:17,114 WHAT--THIS IS ALSO KNOWN AS 1024 00:35:17,181 --> 00:35:18,182 BEHAVIORIAL ICNATIONAL LIBRARY 1025 00:35:18,249 --> 00:35:19,383 OF MEDICINICS IS AN IMPORTANT 1. 1026 00:35:19,450 --> 00:35:21,686 AND THEN THE WHOLE IDEA OF DID 1027 00:35:21,752 --> 00:35:24,422 NEIGHBORHOOD MATTER AND DOES 1028 00:35:24,489 --> 00:35:25,723 NEIGHBORHOOD COHESION BUFFER 1029 00:35:25,790 --> 00:35:28,125 FOOD INSECURITY AND TYPE 2 1030 00:35:28,192 --> 00:35:30,661 DIABETES, AND AGAIN, SECONDARY 1031 00:35:30,728 --> 00:35:32,396 NATIONAL HEALTH DATA ANALYSIS, 1032 00:35:32,463 --> 00:35:34,031 LATINOS WITH LOW FOOD SECURITY, 1033 00:35:34,098 --> 00:35:35,833 HAD 2 TIMES THE ODDS OF HAVING 1034 00:35:35,900 --> 00:35:37,902 DIABETES COMPARED TO THOSE WHO 1035 00:35:37,969 --> 00:35:39,003 WERE FOOD SECURE. 1036 00:35:39,070 --> 00:35:40,872 SO IN THIS FIELD OF THINKING 1037 00:35:40,938 --> 00:35:43,207 ABOUT HOW YOU FACTOR IN ALL 1038 00:35:43,274 --> 00:35:44,175 THESE DIFFERENT THINGS, WE 1039 00:35:44,242 --> 00:35:45,877 ACTUALLY NEED BETTER WAYS OF 1040 00:35:45,943 --> 00:35:47,745 MEASURING SOME OF THESE 1041 00:35:47,812 --> 00:35:49,714 CONCEPTS, SO WHAT IS 1042 00:35:49,780 --> 00:35:50,548 NEIGHBORHOOD COHESION, DO WE 1043 00:35:50,615 --> 00:35:51,749 REALLY KNOW HOW TO MEASURE THAT, 1044 00:35:51,816 --> 00:35:54,619 WE USE SOME QUESTIONS ABOUT WHAT 1045 00:35:54,685 --> 00:35:58,890 WE CALL NEIGHBORHOOD COHESION IN 1046 00:35:58,956 --> 00:36:00,358 TERMS OF SAFETY OR DO YOU KNOW 1047 00:36:00,424 --> 00:36:02,560 YOUR NEIGHBORS, DO YOU INTERACT 1048 00:36:02,627 --> 00:36:04,929 WITH YOUR NEIGHBORS, DO YOU HAVE 1049 00:36:04,996 --> 00:36:05,863 A COMMUNITY CONNECTION WHERE YOU 1050 00:36:05,930 --> 00:36:07,999 GO TO MEET WITH PEOPLE IN YOUR 1051 00:36:08,065 --> 00:36:10,067 NEIGHBORHOOD, WHAT IS YOUR 1052 00:36:10,134 --> 00:36:12,136 NEIGHBORHOOD, WE ASK PEOPLE, 1053 00:36:12,203 --> 00:36:14,772 TAKE A GOOG EPI-BLAST MAP AND 1054 00:36:14,839 --> 00:36:17,508 DRAW A LINE AROUND WHERE YOUR 1055 00:36:17,575 --> 00:36:18,209 NEIGHBORHOOD IS. 1056 00:36:18,276 --> 00:36:19,510 IT'S A GOOD EXERCISE TO GO THRU 1057 00:36:19,577 --> 00:36:21,078 AND PEOPLE ARE OFTEN USING THEIR 1058 00:36:21,145 --> 00:36:22,480 NEIGHBORHOOD WHERE THEY SHOP, 1059 00:36:22,547 --> 00:36:24,415 VISIT THEIR CHURCH OR OTHER 1060 00:36:24,482 --> 00:36:26,317 ACTIVITY WITH THEIR WORK, AND IT 1061 00:36:26,384 --> 00:36:28,219 DOES VARY ACCORDING TO WHETHER 1062 00:36:28,286 --> 00:36:29,987 OR NOT, WHAT KIND OF A CITY YOU 1063 00:36:30,054 --> 00:36:33,157 LIVE IN OR IN A MORE RURAL OR 1064 00:36:33,224 --> 00:36:33,658 SUBURBAN AREA. 1065 00:36:33,724 --> 00:36:36,561 AND SO THINKING IN THESE TERMS, 1066 00:36:36,627 --> 00:36:40,064 I THINK IS A DIFFERENT DIRECTION 1067 00:36:40,131 --> 00:36:41,332 FOR CLINICAL RESEARCH, THAT 1068 00:36:41,399 --> 00:36:44,001 NEEDS TO HAPPEN AS WE GET BETTER 1069 00:36:44,068 --> 00:36:48,539 UNDERSTANDING OF THESE FACTORS. 1070 00:36:48,606 --> 00:36:49,907 NOW, CHRONIC DISEASES ARE YOU 1071 00:36:49,974 --> 00:36:56,447 KNOW VERY PREVALENT SO WE KNOW 1072 00:36:56,514 --> 00:36:58,049 THIS, MORE THAN 11 IS VERY 1073 00:36:58,115 --> 00:37:00,685 COMMON AND MOST ADULTS, 2/3RDS 1074 00:37:00,751 --> 00:37:03,588 OF THOSE OVER 65 HAVE 2 OR MOWR 1075 00:37:03,654 --> 00:37:05,890 CHRONIC CONDITIONS AND WE'RE NOT 1076 00:37:05,957 --> 00:37:07,658 JUST TALKING ABOUT OFTIOARTRITIS 1077 00:37:07,725 --> 00:37:08,926 AND HYPERTENSION, THE LIST OF 1078 00:37:08,993 --> 00:37:09,994 MORE CHON THINGS ARE WELL KNOWN 1079 00:37:10,061 --> 00:37:11,729 TO MOST OF THIS AUDIENCE, WE 1080 00:37:11,796 --> 00:37:14,599 ALSO KNOW THAT PEOPLE OVER 40 1081 00:37:14,665 --> 00:37:23,274 ABOUT 69% TAKE A PRESCRIPTION 1082 00:37:23,341 --> 00:37:26,110 DRUG AND AT THREEOF THE 22% USE 1083 00:37:26,177 --> 00:37:27,845 5 PRESCRIPTION DRUGS A DAY OR 1084 00:37:27,912 --> 00:37:29,013 SOMETIMES LESS THAN DAILY. 1085 00:37:29,080 --> 00:37:34,085 BUT RESEARCH WE DO CLINICALLY 1086 00:37:34,151 --> 00:37:35,486 ALMOST ALSO FOCUSES ON 1 DISEASE 1087 00:37:35,553 --> 00:37:37,188 AT A TIME AND WE DO HYPERTENSION 1088 00:37:37,254 --> 00:37:39,290 AND WE DO HYPERTENSION AND WE DO 1089 00:37:39,357 --> 00:37:41,225 CHRONIC LUNG DISEASE, WE DO 1090 00:37:41,292 --> 00:37:41,959 CHRONIC LUNG DISEASE, WE DON'T 1091 00:37:42,026 --> 00:37:43,594 THINK ABOUT ALL THE OTHER THINGS 1092 00:37:43,661 --> 00:37:44,328 THAT AFFECTING OUR INDIVIDUALS 1093 00:37:44,395 --> 00:37:54,939 AND OUR STUDIES AND THIS WE HAD 1094 00:37:59,110 --> 00:38:00,378 A FUNDING OPPORTUNITY FOR THIS 1095 00:38:00,444 --> 00:38:01,579 AND ESSENTIALLY GOT MOW 1096 00:38:01,646 --> 00:38:04,348 APPLICATIONS THAT WERE EITHER ON 1097 00:38:04,415 --> 00:38:09,120 TARGET OR FUNDABLE, WE HELD A 1098 00:38:09,186 --> 00:38:19,730 SCIENTIFIC WORKSHOP THIS YEAR TO 1099 00:38:25,202 --> 00:38:27,038 ADDRESS THIS, AND NOW ADD TO 1100 00:38:27,104 --> 00:38:28,339 THIS COMPLEXITY OF MORE THAN 1 1101 00:38:28,406 --> 00:38:29,540 DISEASE, THE WHOLE IDEA OF 1102 00:38:29,607 --> 00:38:36,280 PREVENTION, OH BY THE WAY, YOU 1103 00:38:36,347 --> 00:38:42,486 HAVE TO GET YOUR YOU NEED TO GET 1104 00:38:42,553 --> 00:38:44,622 SCREENED FOR COLON CANCER OR 1105 00:38:44,689 --> 00:38:46,223 LACK OF INTEGRATION AND 1106 00:38:46,290 --> 00:38:47,992 HEALTHCARE SERVICES AND IN MANY 1107 00:38:48,059 --> 00:38:58,536 WAYS NIH LIVES IN A DOUBLE. 1108 00:39:00,071 --> 00:39:01,939 WELL ARE EXAMPLES OF GOOD 1109 00:39:02,006 --> 00:39:02,606 INTEGRATED HELT SERVICES MOSTLY 1110 00:39:02,673 --> 00:39:04,175 OUT IN THE WESTERN PART OF THE 1111 00:39:04,241 --> 00:39:06,811 UNITED STATES, SOME IN THE 1112 00:39:06,877 --> 00:39:13,984 NORTHEAST, NOT IN WAWASHINGTON 1113 00:39:14,051 --> 00:39:20,958 DC AREA AND THIS AND THESE 2 ARE 1114 00:39:21,025 --> 00:39:22,026 MAINLIOR HEALTHCARE PROBLEMS IN 1115 00:39:22,093 --> 00:39:22,693 OUR HEALTHCARE SYSTEM, NOW LET 1116 00:39:22,760 --> 00:39:28,199 ME TURN TO THE ISSUE OF RACISM 1117 00:39:28,265 --> 00:39:29,700 OR DISCRIMINATION, AND THAT IS 1118 00:39:29,767 --> 00:39:31,535 PERVASIVE IN OUR SOCIETY AND 1119 00:39:31,602 --> 00:39:35,573 HEARD A LOT ABOUT SINCE 2020 AND 1120 00:39:35,639 --> 00:39:37,374 AND DATA FROM THE KAISER FAMILY 1121 00:39:37,441 --> 00:39:43,447 FOUNDATION SURVEY ON RACISM 1122 00:39:43,514 --> 00:39:44,181 DISCRIMINATION, THEY CHAISM THE 1123 00:39:44,248 --> 00:39:45,716 QUESTIONS OF COURSE AND RELEASE 1124 00:39:45,783 --> 00:39:48,219 THESE DATA, THE 1S I'M SHOWING 1125 00:39:48,285 --> 00:39:49,787 YOU HERE IN DIAGRAM OF 2023, BUT 1126 00:39:49,854 --> 00:40:00,231 THE QUESTION IS IN THE 1127 00:40:08,072 --> 00:40:09,273 HEALTHCARE VISITS ISSUES SO YOU 1128 00:40:09,340 --> 00:40:11,542 SEE THE AFRICAN AMERICANS, AND 1129 00:40:11,609 --> 00:40:12,510 THE RACIAL ETHNIC MINORITY 1130 00:40:12,576 --> 00:40:13,410 POPULATIONS THAT THEY COLLECTED 1131 00:40:13,477 --> 00:40:16,313 DAILY BASIS THEA ON WERE IN THE 1132 00:40:16,380 --> 00:40:17,748 10-12% RANGE AND 3% FOR WHITE 1133 00:40:17,815 --> 00:40:27,792 AMERICANS SO CLEARLY WE HAVE A 1134 00:40:27,858 --> 00:40:28,025 PROBLEM. 1135 00:40:28,092 --> 00:40:29,994 IN SOCIETY WHERE WE SHOULD BE 1136 00:40:30,060 --> 00:40:31,295 THE ANSWER, QUEE STILL HAVE A 1137 00:40:31,362 --> 00:40:33,230 PROBLEM, BUT IT DOESN'T EXIST IN 1138 00:40:33,297 --> 00:40:34,465 MY NEIGHBORHOOD IS THE WRONG 1139 00:40:34,532 --> 00:40:35,733 RESPONSE AND LOOKING FOR WAYS TO 1140 00:40:35,800 --> 00:40:40,504 FIRST OF ALL ACKNOWLEDGE IT AND 1141 00:40:40,571 --> 00:40:41,605 ADDRESS IT DIRECTLY IN WHATEVER 1142 00:40:41,672 --> 00:40:42,773 WAYS WE CAN, WE DON'T HAVE A 1143 00:40:42,840 --> 00:40:44,642 CURE FOR THIS, I THINK IS REALLY 1144 00:40:44,708 --> 00:40:46,877 IMPORTANT, NOW IN A RESEARCH 1145 00:40:46,944 --> 00:40:48,512 CONTEXT, WE THINK OF THIS, WELL, 1146 00:40:48,579 --> 00:40:49,914 WHAT'S THE RESEARCH CONSTRUCK 1147 00:40:49,980 --> 00:40:50,881 ABOUT RACISM AND ALMOST ALL THE 1148 00:40:50,948 --> 00:40:54,118 WORK WE KNOW ABOUT HAS BEEN DONE 1149 00:40:54,185 --> 00:40:55,152 IN THE INTERPERSONAL, LIKE THE 1150 00:40:55,219 --> 00:40:58,489 PRIOR QUESTION WE DID, SO THERE 1151 00:40:58,556 --> 00:41:00,858 ARE GOOD MEASURES, THERE'S GREAT 1152 00:41:00,925 --> 00:41:04,461 STUDIES THAT ASSOCIATE HAVING 1153 00:41:04,528 --> 00:41:06,630 HAD EXPERIENCED DISCRIMINATION 1154 00:41:06,697 --> 00:41:07,832 ASSOCIATED WITH CERTAIN HEALTH 1155 00:41:07,898 --> 00:41:10,234 OUTCOMES, IN A VARIETY OF 1156 00:41:10,301 --> 00:41:12,203 DIFFERENT CONTEXT, MOST CLEARLY 1157 00:41:12,269 --> 00:41:14,605 ON BEHAVIOR, SUBSIDIARY STANCE 1158 00:41:14,672 --> 00:41:16,440 USE, CONTROL, MENTAL HEALTH 1159 00:41:16,507 --> 00:41:17,408 SYMPTOMS IN ADOLESCENCE AND 1160 00:41:17,474 --> 00:41:21,412 ADULTS BUT IT ALSO HAPPENS WITH 1161 00:41:21,478 --> 00:41:22,012 CERTAIN CARDIOVASCULAR 1162 00:41:22,079 --> 00:41:25,983 REACTIVITY STUDIES AS WELL AS 1163 00:41:26,050 --> 00:41:27,017 METABOLIC CHANGES AND THEN 1164 00:41:27,084 --> 00:41:29,086 FURTHER DOWN YOU GO, THE HARDER 1165 00:41:29,153 --> 00:41:31,689 TO MAKE A CAUSAL INFERENCE 1166 00:41:31,755 --> 00:41:33,257 ALTHOUGH THERE ARE DATA SUPPORT 1167 00:41:33,324 --> 00:41:35,693 THAT, NOW IT APPEARS THAT IN 1168 00:41:35,759 --> 00:41:38,095 DISCRIMINATION WORK, I'VE BEEN 1169 00:41:38,162 --> 00:41:39,964 FOLLOWING, INCLUDING SOME FROM 1170 00:41:40,030 --> 00:41:42,032 OUR INTRAMURAL INVESTIGATORS 1171 00:41:42,099 --> 00:41:43,300 THAT LIFETIME EXPOSURE IS REALLY 1172 00:41:43,367 --> 00:41:44,602 WHAT IS MOST IMPORTANT AS 1173 00:41:44,668 --> 00:41:45,903 OPPOSED TO WHAT IS HAPPENING IN 1174 00:41:45,970 --> 00:41:47,438 THE LAST YEAR, OR WHAT HAPPENED 1175 00:41:47,504 --> 00:41:50,341 TO YOU LAST WEEK. 1176 00:41:50,407 --> 00:41:51,976 AND THIS MORE RECENT EVENTS ARE 1177 00:41:52,042 --> 00:41:52,943 LESS RELEVANT TO WHAT HAPPENS 1178 00:41:53,010 --> 00:41:55,946 AND I THINK IN THE--MET MODEL OF 1179 00:41:56,013 --> 00:41:59,450 ADVERSE EVENTS FOR CHILDREN, 1180 00:41:59,516 --> 00:42:01,418 THIS SORT OF CUMULATIVE CHRONIC 1181 00:42:01,485 --> 00:42:04,288 STRESS OF BEING EXPOSED TO 1182 00:42:04,355 --> 00:42:05,322 DISCRIMINATION OR ADVERSITY, IS 1183 00:42:05,389 --> 00:42:10,394 THE MODEL OF HOW THIS RESULS IN 1184 00:42:10,461 --> 00:42:12,263 HEALTH PROBLEMS 30-40, 50 YEARS 1185 00:42:12,329 --> 00:42:12,496 LATER. 1186 00:42:12,563 --> 00:42:13,998 INTERNALIZED RACISM IS ANOTHER 1187 00:42:14,064 --> 00:42:16,166 WAY SO HOW DO INDIVIDUALS 1188 00:42:16,233 --> 00:42:19,803 SUPPLEMENT THIS, THEY ACCEPT 1189 00:42:19,870 --> 00:42:21,238 INFERIORITY IN SOME WAYS PEOPLE 1190 00:42:21,305 --> 00:42:23,841 HAVE COINED THE TERM OR USED THE 1191 00:42:23,908 --> 00:42:25,843 MEASURE CALLED JOHN HENRYISM, 1192 00:42:25,910 --> 00:42:27,111 WORK, WORK, WORK, BECAUSE THAT'S 1193 00:42:27,177 --> 00:42:28,279 WHAT YOU ARE EXPECTED TO DO 1194 00:42:28,345 --> 00:42:30,481 UNTIL YOU DIE OR BIOLOGICAL 1195 00:42:30,547 --> 00:42:31,715 INFERIORITY AND THERE ARE WAYS 1196 00:42:31,782 --> 00:42:33,450 AT GETTING AT THE BIOLOGY OF 1197 00:42:33,517 --> 00:42:34,551 THIS THROUGH MEASURES SUCH AS 1198 00:42:34,618 --> 00:42:36,020 ALOE AT THAT TIMIC LOAD, PEOPLE 1199 00:42:36,086 --> 00:42:38,789 HAVE ALSO STUDIED THINGS LIKE 1200 00:42:38,856 --> 00:42:43,027 TELOMERE LENGTH IN THIS REGARS. 1201 00:42:43,093 --> 00:42:45,896 ADOLESCENCE I'VE BEEN ASKED 1202 00:42:45,963 --> 00:42:46,530 ABOUT PERCEIVED SOCIETAL 1203 00:42:46,597 --> 00:42:47,865 DISCRIMINATION, SO WHAT DO YOU 1204 00:42:47,932 --> 00:42:50,334 THINK IS GOING ON OUT THERE AND 1205 00:42:50,401 --> 00:42:50,834 THAT'S BEEN ASSOCIATED. 1206 00:42:50,901 --> 00:42:52,903 SECOND HAND EFFECTS OF RACISM 1207 00:42:52,970 --> 00:42:54,738 HAVE HARDLY BEEN STUDIED SO 1208 00:42:54,805 --> 00:42:56,173 WHAT'S IT LIKE FOR SOMEONE WHO 1209 00:42:56,240 --> 00:42:58,475 GROWS UP WITH A VICTIM OF RACISM 1210 00:42:58,542 --> 00:42:59,677 AND DISCRIMINATION WHO DOESN'T 1211 00:42:59,743 --> 00:43:00,611 NECESSARILY HAVE INSIGHT INTO 1212 00:43:00,678 --> 00:43:05,416 THAT AND THEN MOST RECENTLY WE 1213 00:43:05,482 --> 00:43:09,486 FOCUS ON STRUCTURAL INSTITUTION 1214 00:43:09,553 --> 00:43:10,821 AND DISCRIMINATION, RELATED TO 1215 00:43:10,888 --> 00:43:12,222 POLICIES WHERE THE RED LINES 1216 00:43:12,289 --> 00:43:16,393 MAPS OF THE 1930S AND 40S ARE 1217 00:43:16,460 --> 00:43:17,494 REALLY THE MOST INFAMOUS IN 1218 00:43:17,561 --> 00:43:19,096 TERMS OF HOW THE USES MANAGED 1219 00:43:19,163 --> 00:43:23,801 THAT AT THAT TIME AND LED TO 1220 00:43:23,867 --> 00:43:27,471 INIQUITIES, IN ACCUMULATION OF 1221 00:43:27,538 --> 00:43:31,508 EQUITY OF ECONOMIC EQUITY OF 1222 00:43:31,575 --> 00:43:33,444 HAVING ACETS FOR AFRICAN 1223 00:43:33,510 --> 00:43:35,379 AMERICANS AND TO SIMILAR EXTENT, 1224 00:43:35,446 --> 00:43:36,814 ALTHOUGH MAYBE LESS SEVERE FOR 1225 00:43:36,880 --> 00:43:39,116 LATINO AMERICANS IN THE U.S. 1226 00:43:39,183 --> 00:43:42,519 SO THIS, IS 1 STUDY FROM 1 OF 1227 00:43:42,586 --> 00:43:45,356 OUR TENURED TRACK INVESTIGATORS 1228 00:43:45,422 --> 00:43:46,757 LOOKING AT DISCRIMINATION 1229 00:43:46,824 --> 00:43:48,025 SOCIETIED WITH ALL CAUSE 1230 00:43:48,092 --> 00:43:49,727 MORTALITY WITH THE MULTIETHNIC 1231 00:43:49,793 --> 00:43:50,828 STUDY OF ABNORMAL GLUCOSE 1232 00:43:50,894 --> 00:43:51,462 TOLERANCELER O SCLEROSIS, AND 1233 00:43:51,528 --> 00:43:54,331 YOU CAN SEE IN THIS ANALYSIS 1234 00:43:54,398 --> 00:43:55,833 THAT EVERY DAY DISCRIMINATION 1235 00:43:55,899 --> 00:43:58,435 WAS NOT NECESSARILY SIGNIFICANT 1236 00:43:58,502 --> 00:43:59,303 ALTHOUGH IT TREPPEDDED TO THAT 1237 00:43:59,370 --> 00:44:01,705 WAY BUT THE LIFETIME 1238 00:44:01,772 --> 00:44:04,208 DISCRIMINATION WAS AND BOTH ALL 1239 00:44:04,274 --> 00:44:05,642 CAUSE MORTALITY AND IN LIFETIME. 1240 00:44:05,709 --> 00:44:08,946 THIS IS AN ANALYSIS OF CAUSE OF 1241 00:44:09,013 --> 00:44:11,015 DEATH THAT WE OFTEN IGNORE AGAIN 1242 00:44:11,081 --> 00:44:13,617 IN THE CLINICAL SETTING WHICH IS 1243 00:44:13,684 --> 00:44:15,052 FIREARM RELATED DEATHS AND DATA 1244 00:44:15,119 --> 00:44:18,022 FROM THE CDC AND 1 OF OUR 1245 00:44:18,088 --> 00:44:18,989 TENURED TRACK INVESTIGATORS JUST 1246 00:44:19,056 --> 00:44:21,625 LOOKED AT THE CDC WONDER 1247 00:44:21,692 --> 00:44:25,029 DATABASE AND SHOWED THAT FOR 1248 00:44:25,095 --> 00:44:26,163 BLACK CHILDREN AND ADOLESCENTS 1249 00:44:26,230 --> 00:44:27,331 THIS IS THE LEADING CAUSE OF 1250 00:44:27,398 --> 00:44:30,467 DEATH IN THE UNITED STATES, 1251 00:44:30,534 --> 00:44:32,870 FIREARMS AND IT'S IT'S REALLY 1252 00:44:32,936 --> 00:44:35,773 SOBERING TO SEE THIS AND WHERE 1253 00:44:35,839 --> 00:44:38,642 SHOULD OUR RESPONSIBILITY AS 1254 00:44:38,709 --> 00:44:39,710 HEALTHCARE SYSTEMS YOU KNOW OUT 1255 00:44:39,777 --> 00:44:42,713 THERE TAKING CARE OF POPULATIONS 1256 00:44:42,780 --> 00:44:46,283 OR CLINICAL SCIENTISTS BE IN 1257 00:44:46,350 --> 00:44:47,785 ADDRESSING ISSUES SUCH AS THIS, 1258 00:44:47,851 --> 00:44:50,654 IT'S TRICKY, I KNOW, IT'S NOT 1259 00:44:50,721 --> 00:44:51,822 STRAIGHT FORWARD, BUT IT IS A 1260 00:44:51,889 --> 00:44:52,990 CHALLENGE THAT WE NEED TO LOOK 1261 00:44:53,057 --> 00:44:55,292 FOR WAYS TO STEP UP, SO IN 1262 00:44:55,359 --> 00:44:56,727 WINDING DOWN JUST SOME GENERAL 1263 00:44:56,794 --> 00:45:00,597 THINGS, THE PATIENT CLINICIAN 1264 00:45:00,664 --> 00:45:01,632 COMMUNICATION LABORATORY IS A 1265 00:45:01,698 --> 00:45:05,803 POWERFUL TOOL THAT WE HAVE BOTH 1266 00:45:05,869 --> 00:45:09,239 UPDATER STUDIED AND 1267 00:45:09,306 --> 00:45:09,640 UNDERAPPRECIATED. 1268 00:45:09,706 --> 00:45:10,307 SO PEOPLE, INDIVIDUALS OUT 1269 00:45:10,374 --> 00:45:13,077 THERE, YOU KNOW LIKE TO LOOK AT 1270 00:45:13,143 --> 00:45:14,578 THEIR CLINICS, THEY MAY HAVE 1271 00:45:14,645 --> 00:45:18,482 LOST TRUST TO SOME EXTENT IN THE 1272 00:45:18,549 --> 00:45:19,283 HEALTHCARE SYSTEM CERTAINLY IN 1273 00:45:19,349 --> 00:45:20,717 SCIENCE, HAVE YOU THE COVID 1274 00:45:20,784 --> 00:45:22,686 PANDEMIC, ALL THESE THINGS THAT 1275 00:45:22,753 --> 00:45:24,188 HAVE BEEN HAPPENING, HOPEFULLY 1276 00:45:24,254 --> 00:45:25,823 WE CAN RECOVER THAT AND SOME OF 1277 00:45:25,889 --> 00:45:27,758 THAT BUT USUALLY PEOPLE STILL 1278 00:45:27,825 --> 00:45:30,861 TRUST THEIR DOCTOR, THEY STILL 1279 00:45:30,928 --> 00:45:33,030 TRUST THEIR HEALTHCARE, THEIR 1280 00:45:33,097 --> 00:45:34,431 CLINICIAN AS SOMEONE THEY COULD 1281 00:45:34,498 --> 00:45:38,836 RELY ON SO THAT'S THE POWER OF 1282 00:45:38,902 --> 00:45:39,870 THAT COMMUNICATION AND IT'S 1283 00:45:39,937 --> 00:45:41,371 BUILT ON THIS SUSTAINABLE 1284 00:45:41,438 --> 00:45:43,006 LONG-TERM RELATIONSHIPS AND WE 1285 00:45:43,073 --> 00:45:45,542 HAVE IM PERRIC DATA TO SAY THAT 1286 00:45:45,609 --> 00:45:46,643 PATIENTS ARE MORE SATISFIED WHEN 1287 00:45:46,710 --> 00:45:48,245 THEY HAVE BETTER COMMUNICATION 1288 00:45:48,312 --> 00:45:49,546 WITH L CLINICIAN, BETTER 1289 00:45:49,613 --> 00:45:53,250 ADHERENCE AND IN SOME CASES, 1290 00:45:53,317 --> 00:45:54,184 IMPROVED HEALTH OUTCOMES. 1291 00:45:54,251 --> 00:45:56,720 LISA COOPER WHO IS AT HOPKINS 1292 00:45:56,787 --> 00:45:58,021 DID ELEGANT QUALITATIVE STUDIES 1293 00:45:58,088 --> 00:46:01,225 20 YEARS AGO SHOWING THAT VISITS 1294 00:46:01,291 --> 00:46:02,059 IN CONCORDANT AFRICAN AMERICAN 1295 00:46:02,126 --> 00:46:03,894 PATIENTS AND DOCTORS WERE MORE 1296 00:46:03,961 --> 00:46:07,131 PATIENT CENTERED AND LONGER BY 1297 00:46:07,197 --> 00:46:08,765 2-3 MINUTES MUCH LANGUAGE 1298 00:46:08,832 --> 00:46:12,035 CONCORDANCE LEADS TO BETTER 1299 00:46:12,102 --> 00:46:13,537 LANGUAGE MEDICINE ADHERENCE FOR 1300 00:46:13,604 --> 00:46:14,938 LATINOS AND FROM A STUDY IN 1301 00:46:15,005 --> 00:46:18,542 KAISER AND A VALUE PLACED ON 1302 00:46:18,609 --> 00:46:19,910 COMMUNICATION SKILLS, IT'S 1303 00:46:19,977 --> 00:46:21,178 UNDERVALUED IN EVERYTHING WE DO 1304 00:46:21,245 --> 00:46:23,046 IN TERMS OF SELECTING STUDENTS 1305 00:46:23,113 --> 00:46:25,849 FOR MEDICAL SCHOOLS, SELECTING 1306 00:46:25,916 --> 00:46:30,020 RESIDENTS, AND IN SELECTING 1307 00:46:30,087 --> 00:46:31,188 CLINICIANS AND FACULTY AND I 1308 00:46:31,255 --> 00:46:33,023 THINK IT'S AN IMPORTANT AREA WE 1309 00:46:33,090 --> 00:46:34,758 NEED TO RECOVER AS MUCH AS 1310 00:46:34,825 --> 00:46:35,425 POSSIBLE. 1311 00:46:35,492 --> 00:46:36,994 NOW IN PROMOTING HEALTH EQUITY 1312 00:46:37,060 --> 00:46:39,563 IN HEALTHCARE, THERE ARE A 1313 00:46:39,630 --> 00:46:40,697 NUMBER OF MACROSTRATEGIES IF YOU 1314 00:46:40,764 --> 00:46:42,966 WISH THAT CAN BE IMPLEMENTED, SO 1315 00:46:43,033 --> 00:46:45,669 FIRST IS EXPANDING ACCESS, SO IN 1316 00:46:45,736 --> 00:46:51,675 THE U.S. TODAY WE HAD THE 1317 00:46:51,742 --> 00:46:52,309 AFFORDABLE CARE ACT EXPERIMENT, 1318 00:46:52,376 --> 00:46:55,112 AND IT HAS WORKED I IT HAS 1319 00:46:55,179 --> 00:46:57,548 BECOME, I DON'T WANT TO SAY 1320 00:46:57,614 --> 00:46:58,415 INSTITUTIONALIZED IS TOO STRONG 1321 00:46:58,482 --> 00:47:01,351 BUT ACCEPTED AND EACH APPROVED 1322 00:47:01,418 --> 00:47:02,553 BY THE MAIORITY OF THE 1323 00:47:02,619 --> 00:47:03,787 POPULATION, WE STILL HAVE ABOUT 1324 00:47:03,854 --> 00:47:07,057 10 STATES THAT HAVE NOT EXPANDED 1325 00:47:07,124 --> 00:47:09,026 MEDICAID, LATINOS OR HISPANICS 1326 00:47:09,092 --> 00:47:10,227 HAD THE MOST UNINHURRED GROUP IN 1327 00:47:10,294 --> 00:47:13,397 THE UNITED STATES, SO WE HAVE 1328 00:47:13,463 --> 00:47:14,765 GOOD SYSTEM TO COVER CHILDREN, 1329 00:47:14,831 --> 00:47:16,633 LESS THAN 2% OF CHILDREN ARE 1330 00:47:16,700 --> 00:47:18,368 UNINSURED AND IT SHOULD BE UNDER 1331 00:47:18,435 --> 00:47:22,906 1%, WE HAVE A GOOD SYSTEM, 1332 00:47:22,973 --> 00:47:24,641 MEDICARE TO TO COVER ADULTS OVER 1333 00:47:24,708 --> 00:47:28,345 65 BUT IT'S THAT 18-64 GROUP 1334 00:47:28,412 --> 00:47:29,880 THAT IS--THAT SUFFERS THE MOST 1335 00:47:29,947 --> 00:47:31,615 FROM HEALTH INSURANCE, THAT 1336 00:47:31,682 --> 00:47:32,950 SUFFERS FROM LACK OF HEALTH 1337 00:47:33,016 --> 00:47:34,318 INHURRANCE BECAUSE OF 1338 00:47:34,384 --> 00:47:35,719 EMPLOYMENT, THEY'RE MUCHED IN AN 1339 00:47:35,786 --> 00:47:37,688 OCCUPATION THAT DOES NOT PROVIDE 1340 00:47:37,754 --> 00:47:40,557 HEALTHCARE IS AS A POTENTIAL 1341 00:47:40,624 --> 00:47:45,596 BENEFIT AND THIS IS WHERE 20% OF 1342 00:47:45,662 --> 00:47:47,464 LATINOS ARE UNINSURED MAYBE 1343 00:47:47,531 --> 00:47:48,999 COMPARED TO 14-15% OF AFRICAN 1344 00:47:49,066 --> 00:47:50,267 AMERICANS AND UNDER 10% FOR 1345 00:47:50,334 --> 00:47:53,470 WHITES AND ASIAN AMERICANS. 1346 00:47:53,537 --> 00:47:54,905 THE OTHER IS PATIENT CENTERED 1347 00:47:54,972 --> 00:47:56,073 CARE, I ALREADY TALKED ABOUT 1348 00:47:56,139 --> 00:47:58,375 THIS, WE REALLY NEED TO 1349 00:47:58,442 --> 00:48:00,544 STRENGTHEN PRIMARY CARE IN OUR 1350 00:48:00,611 --> 00:48:01,011 COUNTRY. 1351 00:48:01,078 --> 00:48:02,212 WE USED TO EMPHASIZE IT AND 1352 00:48:02,279 --> 00:48:04,214 REWARD IT, NOW THE PRIMARY CARE 1353 00:48:04,281 --> 00:48:06,183 CLINICIAN, CAN'T DO EVERYTHING, 1354 00:48:06,250 --> 00:48:07,918 BUT A PRIMARY CARE CLINICIAN CAN 1355 00:48:07,985 --> 00:48:10,988 CERTAINLY BE THAT TRUSTED FIRST 1356 00:48:11,054 --> 00:48:14,091 POINT OF CONTACT FOR CHRONIC 1357 00:48:14,157 --> 00:48:16,159 DEC, FOR PREVENTION, FOR NEW 1358 00:48:16,226 --> 00:48:18,562 PROBLEMS AND FOR THEN CONNECTING 1359 00:48:18,629 --> 00:48:20,397 TO THE SPECIALTY NEIGHBORHOOD 1360 00:48:20,464 --> 00:48:21,932 AND THIS NOTION IS STRONG IN 1361 00:48:21,999 --> 00:48:23,767 SOME PARTS OF THE COUNTRY AND 1362 00:48:23,834 --> 00:48:25,602 ABSENT IN OTHER PARTS OF THE 1363 00:48:25,669 --> 00:48:26,069 COUNTRY. 1364 00:48:26,136 --> 00:48:29,806 IT IS BEING REPLACED IN PART BY 1365 00:48:29,873 --> 00:48:30,641 CONCIERGE MEDICINE WHERE YOU PAY 1366 00:48:30,707 --> 00:48:32,542 A FEE AND YOU GET ACCESS TO A 1367 00:48:32,609 --> 00:48:37,080 DOCTOR, TO A CLINICIAN, AND THE 1368 00:48:37,147 --> 00:48:38,548 CONCIERGE MEDICINE HASN'T BEEN 1369 00:48:38,615 --> 00:48:42,219 STUDIED BUT MY SENSE IS THAT IT 1370 00:48:42,286 --> 00:48:43,854 MOSTLY DRAWS ITS PATIENTS FROM 1371 00:48:43,920 --> 00:48:45,255 THE HEALTHY POPULATION AND ONCE 1372 00:48:45,322 --> 00:48:47,090 PEOPLE GET SICK, THEY GO 1373 00:48:47,157 --> 00:48:47,357 ELSEWHERE. 1374 00:48:47,424 --> 00:48:49,559 AND SO I THINK THIS IS A REALLY 1375 00:48:49,626 --> 00:48:52,596 IMPORTANT AREA THAT WE NEED 1376 00:48:52,663 --> 00:48:55,699 BETTER DIRECTION IN FROM POLICY 1377 00:48:55,766 --> 00:48:57,100 WISE, COORDINATION ASSISTANCE, 1378 00:48:57,167 --> 00:48:59,002 WE LEARNED A LOT ABOUT WHAT GOOD 1379 00:48:59,069 --> 00:49:00,837 PATIENT NAVIGATORS CAN BE IN 1380 00:49:00,904 --> 00:49:02,439 GUIDING PEOPLE THROUGH COMPLEX 1381 00:49:02,506 --> 00:49:04,074 SYSTEMS BOTH TO BE ON THE 1382 00:49:04,141 --> 00:49:05,142 TRANSPLANT LIST, TO MAKE SURE 1383 00:49:05,208 --> 00:49:07,711 THAT THEY END UP GETTING 1384 00:49:07,778 --> 00:49:09,846 REFERRED FOR DIALYSIS WHEN THEY 1385 00:49:09,913 --> 00:49:11,148 NEED IT OR WORK UP AN 1386 00:49:11,214 --> 00:49:15,485 ABNORMALITIES NORM AT KREENING 1387 00:49:15,552 --> 00:49:18,255 TEST ON ABNORMAL MAMMOGRAM, 1388 00:49:18,322 --> 00:49:19,222 SCREENING TEST, CHEST CT FOR 1389 00:49:19,289 --> 00:49:20,724 EXAMPLE, AND THEN TARGET 1390 00:49:20,791 --> 00:49:21,958 CONDITIONS PEOPLE WITH SEVERE 1391 00:49:22,025 --> 00:49:24,261 MENTAL DISORDERS WHO ARE IN THE 1392 00:49:24,328 --> 00:49:26,430 EMERGENCY ROOM 5 TIMES A MONTH 1393 00:49:26,496 --> 00:49:27,831 DURING WORKING HOURS AND YOU 1394 00:49:27,898 --> 00:49:30,133 KNOW WHY WASN'T A HEALTHCARE 1395 00:49:30,200 --> 00:49:31,535 SYSTEM WANT TO INVEST IN 1396 00:49:31,601 --> 00:49:32,336 MANAGING THAT DIFFERENTLY THAN 1397 00:49:32,402 --> 00:49:35,272 HAVING THEM SHOW UP IN THE 1398 00:49:35,339 --> 00:49:36,106 EMERGENCY ROOM? 1399 00:49:36,173 --> 00:49:38,875 SIM LOORLY FOR SEVERELY OBESE 1400 00:49:38,942 --> 00:49:40,811 PATIENTS WE GET A LITTLE BIT BET 1401 00:49:40,877 --> 00:49:42,813 THEY'RE WE GET MORE END OF LIFE 1402 00:49:42,879 --> 00:49:43,747 CARE, PALLIATIVE CARE IN PLACE 1403 00:49:43,814 --> 00:49:46,850 TO MANAGE THOSE PATIENTS, HOW WE 1404 00:49:46,917 --> 00:49:48,885 LEVERAGE IT AND HEALTH RECORD TO 1405 00:49:48,952 --> 00:49:50,987 IMPROVE EQUITY THERE'S A LOT OF 1406 00:49:51,054 --> 00:49:52,856 POTENTIAL, IT'S GOTTEN BETTER, 1407 00:49:52,923 --> 00:49:56,193 IN THE LAST 10 YEARS, YOU CSF, I 1408 00:49:56,259 --> 00:49:58,428 SPRBSED IT AS A CLINICIAN, AS 1409 00:49:58,495 --> 00:49:59,463 I'VE GOTTEN OLDER, I EXPERIENCED 1410 00:49:59,529 --> 00:50:03,300 IT AS A PATIENT, HOW MUCH BETTER 1411 00:50:03,367 --> 00:50:04,935 THE PORTALS ARE AND HOW MUCH 1412 00:50:05,001 --> 00:50:06,303 BETTER COMMUNICATION THERE CAN 1413 00:50:06,370 --> 00:50:08,038 BE THROUGH THE GOOD FUNCTIONING 1414 00:50:08,105 --> 00:50:08,538 SYSTEMS. 1415 00:50:08,605 --> 00:50:12,142 AND THEN HAVING PERFORM APSE 1416 00:50:12,209 --> 00:50:13,543 MEASUREMENTS. 1417 00:50:13,610 --> 00:50:14,945 SO HOSPITALS FOR A LONG TIME 1418 00:50:15,011 --> 00:50:16,680 BEING REWARDED FOR SHORTER 1419 00:50:16,747 --> 00:50:18,882 LENGTHS OF STAY, RIGHT? 1420 00:50:18,949 --> 00:50:20,150 SO THE WORST THING THAT WOULD 1421 00:50:20,217 --> 00:50:22,452 HAPPEN IN A HOSPITALIZED PATIENT 1422 00:50:22,519 --> 00:50:25,155 IS YOU ARE DECERTIFIED NOW TO A 1423 00:50:25,222 --> 00:50:26,089 CHRONIC CARE FACILITY PAYMENT 1424 00:50:26,156 --> 00:50:28,258 LEVEL AND THEN, YOU KNOW, THE 1425 00:50:28,325 --> 00:50:29,860 PATIENT HAS TO GO SOMEWHERE SO 1426 00:50:29,926 --> 00:50:31,695 THEY STAY THERE UNTIL THEY LAND 1427 00:50:31,762 --> 00:50:33,597 SOMEWHERE, SO WHAT IF WE CREATE 1428 00:50:33,663 --> 00:50:34,898 INCENTIVES FOR HOSPITALS TO ALSO 1429 00:50:34,965 --> 00:50:38,535 LOOK AT EQUITY, SO, IF THEIR 1430 00:50:38,602 --> 00:50:42,873 READMISSION RATE IS 15% FOR 1431 00:50:42,939 --> 00:50:44,941 CARDIOVASCULAR CONDITIONS, IN 1432 00:50:45,008 --> 00:50:46,243 GENERAL, BUT AUTO20% FOR AFRICAN 1433 00:50:46,309 --> 00:50:47,077 AMERICANS FOR EXAMPLE JUST TO 1434 00:50:47,144 --> 00:50:48,512 THROW A NUMBER OUT THERE, WHAT 1435 00:50:48,578 --> 00:50:51,815 CAN YOU DO HOSPITAL TO MAKE THIS 1436 00:50:51,882 --> 00:50:52,883 COMCLOSER TO 15 AND REWARD IT 1437 00:50:52,949 --> 00:50:57,053 SIPS WE LIVE IN THAT KIND OF 1438 00:50:57,120 --> 00:50:57,287 SYSTEM? 1439 00:50:57,354 --> 00:50:58,522 ALREADY TALKED ABOUT COMMUNITY 1440 00:50:58,588 --> 00:50:58,822 ENGAGEMENT. 1441 00:50:58,889 --> 00:51:00,957 I THINK THIS IS AN ESSENTIAL 1442 00:51:01,024 --> 00:51:02,459 COMPONENT IN BOTH RESEARCH AND 1443 00:51:02,526 --> 00:51:06,229 CLINICAL CARE, SO KNOW WHAT YOUR 1444 00:51:06,296 --> 00:51:06,663 COMMUNITY IS ABOUT. 1445 00:51:06,730 --> 00:51:08,331 ANECDOTE ABOUT HOW THE CANCER 1446 00:51:08,398 --> 00:51:12,502 CENTERS, ABOUT 15 YEARS AGO WERE 1447 00:51:12,569 --> 00:51:13,970 GIVEN THE MANDATE THAT WE NEED 1448 00:51:14,037 --> 00:51:16,406 TO KNOW WHAT THEIR CATCHMENT IS, 1449 00:51:16,473 --> 00:51:17,741 AND WADO YOU NEED TO KNOW ABOUT 1450 00:51:17,808 --> 00:51:18,675 THE CANCER CENTER AND WHAT DO 1451 00:51:18,742 --> 00:51:20,343 YOU NEED TO DO ABOUT THE CANCERS 1452 00:51:20,410 --> 00:51:22,112 IN YOUR CATCHMENT AREA, SO FOR 1453 00:51:22,179 --> 00:51:24,281 YOUR HEALTH SYSTEM THAT WOULD BE 1454 00:51:24,347 --> 00:51:26,049 KNOW YOUR POPULATION, WHERE ARE 1455 00:51:26,116 --> 00:51:27,851 YOUR PATIENTS ADMITTED FROM, 1456 00:51:27,918 --> 00:51:30,420 THERE'S ONLY 1 MAYO CLINIC, 1457 00:51:30,487 --> 00:51:30,620 RIGHT? 1458 00:51:30,687 --> 00:51:32,856 AND THEY GET PATIENTS REFERRED 1459 00:51:32,923 --> 00:51:34,191 FROM ALL OVER THE WORLD AND ALL 1460 00:51:34,257 --> 00:51:35,258 HOSPITALS GET SOME OF THAT 1461 00:51:35,325 --> 00:51:37,294 REFERRAL BUT MOST OF THEM DRAW 1462 00:51:37,360 --> 00:51:39,629 THEIR PATIENTS FROM THEIR 1463 00:51:39,696 --> 00:51:42,199 IMMEDIATE GEOGRAPHIC AREA AND I 1464 00:51:42,265 --> 00:51:43,700 THINK MOST ARE NOT THAT 1465 00:51:43,767 --> 00:51:46,736 FAMILIAR, THAT ENGAGED WITH 1466 00:51:46,803 --> 00:51:49,039 THOSE COMMUNITIES IN A WAY TO 1467 00:51:49,105 --> 00:51:50,207 IMPROVE THE COMMUNITIES HEALTH 1468 00:51:50,273 --> 00:51:51,608 AND RECOGNIZES THE IMPORTANCE OF 1469 00:51:51,675 --> 00:51:53,877 HEALTH AND NOT JUST HELT CARE 1470 00:51:53,944 --> 00:51:56,847 AND RESOURCES TO PROMOTE 1471 00:51:56,913 --> 00:51:57,714 HEALTHIER COMMUNITIES. 1472 00:51:57,781 --> 00:51:59,983 A WORD ABOUT SEAL, THE COMMUNITY 1473 00:52:00,050 --> 00:52:00,784 ENGAGEMENT ALLIANCE THAT WAS 1474 00:52:00,851 --> 00:52:04,788 STOOD UP DURING THE COVID 1475 00:52:04,855 --> 00:52:06,256 PANDEMIC BETWEEN NIMHD AND 1476 00:52:06,323 --> 00:52:07,891 NATIONAL HEART LUNG AND BLOOD 1477 00:52:07,958 --> 00:52:08,158 INSTITUTE. 1478 00:52:08,225 --> 00:52:09,693 WE PROUD OF THE ACCOMPLISHMENTS 1479 00:52:09,759 --> 00:52:15,031 TO DATE BUT THIS IS A LONG-TERM 1480 00:52:15,098 --> 00:52:16,867 EFFORT WITH 21 TEAMS ACROSS THE 1481 00:52:16,933 --> 00:52:17,701 COUNTRY, WE'RE SHIFTING FROM 1482 00:52:17,767 --> 00:52:21,671 COVID TO CHRONIC DISEASES SO YOU 1483 00:52:21,738 --> 00:52:24,941 WILL HEAR--WE PUT IT OUT AS TO 1484 00:52:25,008 --> 00:52:28,512 MY PEERS MY DIRECTORS, MY PEER 1485 00:52:28,578 --> 00:52:30,380 DIRECTORS LAST FALL AS A MODEL 1486 00:52:30,447 --> 00:52:32,048 AND SAY, YOU KNOW, THIS IS WHAT 1487 00:52:32,115 --> 00:52:33,783 WE'RE DOING, WE COULD DO OTHER 1488 00:52:33,850 --> 00:52:34,918 THINGS, WE CAN'T DO EVERYTHING, 1489 00:52:34,985 --> 00:52:36,820 BUT WE CAN DO OTHER THINGS 1490 00:52:36,887 --> 00:52:40,824 BESIDES WHAT WE DID WITH COVID. 1491 00:52:40,891 --> 00:52:43,660 FINALLY, JUST A WORD THIS 1492 00:52:43,727 --> 00:52:47,864 DIVERSITY OF THE WORKFORCE, 1493 00:52:47,931 --> 00:52:48,965 THERE'S GOOD IM PERICAL DATA 1494 00:52:49,032 --> 00:52:52,435 THAT IF YOU TRAIN MORE WELL TIN 1495 00:52:52,502 --> 00:52:53,803 O AND AFRICAN AMERICAN DOCTORS 1496 00:52:53,870 --> 00:52:56,139 THAT MORE MINORITY PATIENTS, 1497 00:52:56,206 --> 00:52:58,842 MORE INSURES AND/OR UNINSURED 1498 00:52:58,909 --> 00:53:00,510 PATIENTS AND MORE POOR PATIENTS 1499 00:53:00,577 --> 00:53:01,144 WOULD HAVE HEALTHCARE. 1500 00:53:01,211 --> 00:53:05,649 THIS IS A STUDY FROM THE MEDICAL 1501 00:53:05,715 --> 00:53:08,919 EXPENDITURE SURVEY, PANEL SURVEY 1502 00:53:08,985 --> 00:53:12,022 FROM 2010 INVESTIGATOR WE FUNDED 1503 00:53:12,088 --> 00:53:13,056 ALTHOUGH HE DID THE WORK BEFORE 1504 00:53:13,123 --> 00:53:16,059 WE GAVE HIM THE GRANT, RACIAL 1505 00:53:16,126 --> 00:53:18,895 AND IGHT NICK MINORITY DOCTORS 1506 00:53:18,962 --> 00:53:22,432 CARE FOR PATIENT WHO IS 1507 00:53:22,499 --> 00:53:27,170 SELF-IDENTIFY AS MINORITY YET WE 1508 00:53:27,237 --> 00:53:28,805 MAKE UP 53 PARIS OF PATIENTS, 1509 00:53:28,872 --> 00:53:30,774 AND THESE PHYSICIANS WERE LIKELY 1510 00:53:30,840 --> 00:53:33,176 TO CARE FOR PATIENTS WITH BOTH 1511 00:53:33,243 --> 00:53:34,678 MEDICAID AND NO HEALTH INSURANCE 1512 00:53:34,744 --> 00:53:37,047 AND THESE ARE DOUBLE AMC DATA, 1513 00:53:37,113 --> 00:53:38,982 SORRY FOR THE COMPLICATED SLIDE 1514 00:53:39,049 --> 00:53:42,953 BUT THE BOTTOM LINE IS MEDICAL 1515 00:53:43,019 --> 00:53:45,522 SCHOOL GRADUATES IN 21 AND 22, 1516 00:53:45,589 --> 00:53:47,090 LOOK AT AFRICAN AMERICANS, IT'S 1517 00:53:47,157 --> 00:53:50,794 SEIVET% OF THE PHYSICIANS ARE 1518 00:53:50,860 --> 00:53:51,461 GRADUATING PHYSICIANS ARE 1519 00:53:51,528 --> 00:53:54,598 AFRICAN AMERICAN AND 6% ARE 1520 00:53:54,664 --> 00:53:57,601 LATINO AND HISPANIC, ADD UP THE 1521 00:53:57,667 --> 00:54:00,637 FEW NATIVE PACIFIC HAWAIIAN 1522 00:54:00,704 --> 00:54:03,607 PACIFIC ISLANDERS AND YOU YOU WE 1523 00:54:03,673 --> 00:54:05,709 MAKE UP ABOUT 33% OF THE U.S. 1524 00:54:05,775 --> 00:54:06,209 POPULATION IN 2020. 1525 00:54:06,276 --> 00:54:08,445 I'M NOT ASKING FOR DEMOGRAPHIC 1526 00:54:08,511 --> 00:54:09,279 EQUIVALENCE OR EQUITY BECAUSE 1527 00:54:09,346 --> 00:54:11,781 THAT'S NOT GOING TO HAPPEN BUT 1528 00:54:11,848 --> 00:54:13,783 WE HAVE TO DO BETTER AND THERE 1529 00:54:13,850 --> 00:54:15,418 ARE MANY CHALLENGES TO GET 1530 00:54:15,485 --> 00:54:15,652 THROUGH. 1531 00:54:15,719 --> 00:54:17,520 SO I WILL END JUST A FEW 1532 00:54:17,587 --> 00:54:20,423 HIGHLIGHTS, YOU KNOW I MENTIONED 1533 00:54:20,490 --> 00:54:21,891 INTERSECTIONALITY, WE ALWAYS 1534 00:54:21,958 --> 00:54:22,759 TALK ABOUT MULTILEVEL 1535 00:54:22,826 --> 00:54:24,227 INTERVENTIONS AND IN THE 1536 00:54:24,294 --> 00:54:26,229 CLINICAL RESEARCH, SO INTERVENE 1537 00:54:26,296 --> 00:54:27,697 WITH PATIENTS, INTERVENE WITH 1538 00:54:27,764 --> 00:54:30,567 CLINICIAN ANDS SYSTEM, AND 1539 00:54:30,634 --> 00:54:32,168 DELIVERY SO THAT'S WHAT WE ARE 1540 00:54:32,235 --> 00:54:33,470 ASKING YOU TO THINK ABOUT. 1541 00:54:33,536 --> 00:54:34,871 IN THE CLINICAL SETTING, IT 1542 00:54:34,938 --> 00:54:37,073 LENDS ITSELF TO THAT, 1543 00:54:37,140 --> 00:54:38,475 IDENTIFYING MECH INFORMS ARE 1544 00:54:38,541 --> 00:54:40,076 IMPORTANT, WE TALKED ABOUT 1545 00:54:40,143 --> 00:54:42,145 COMMUNICATION AND THEN 1546 00:54:42,212 --> 00:54:42,812 IMPLEMENTING STRUCTURAL CHANGES, 1547 00:54:42,879 --> 00:54:45,382 SORT OF THE IDEA, MAKE THE 1548 00:54:45,448 --> 00:54:46,516 STAIRS EASILY AVAILABLE AND EASY 1549 00:54:46,583 --> 00:54:48,518 TO USE IF YOU'RE ABLE TO WALK UP 1550 00:54:48,585 --> 00:54:50,620 THE STAIRS AS OPPOSE TO GOING UP 1551 00:54:50,687 --> 00:54:53,056 1 FLOOR IN THE ELEVATE SO I WILL 1552 00:54:53,123 --> 00:54:53,657 END WITH THAT, THANK YOU VERY 1553 00:54:53,723 --> 00:54:54,824 MUCH FOR YOUR ATTENTION AND I'M 1554 00:54:54,891 --> 00:54:59,963 HAPPY TO TAKE QUESTIONS HERE OR 1555 00:55:00,030 --> 00:55:00,196 ONLINE. 1556 00:55:00,263 --> 00:55:10,473 [ APPLAUSE ] 1557 00:55:14,344 --> 00:55:14,411 >> HI. 1558 00:55:14,477 --> 00:55:14,844 >> TOM, YES. 1559 00:55:14,911 --> 00:55:16,946 >> SO WE GREW UP IN THE MILITARY 1560 00:55:17,013 --> 00:55:18,581 HEALTH SYSTEM AND WHILE I THINK 1561 00:55:18,648 --> 00:55:20,116 THE MILITARY HELG SYSTEM BEN 1562 00:55:20,183 --> 00:55:21,985 APPROXIMATE FISHIARYS HAVE BEEN 1563 00:55:22,052 --> 00:55:22,986 COMPARED AGAINST BENEFICIARIES 1564 00:55:23,053 --> 00:55:28,858 OF OTHER HEALTH SYSTEMS IN SOME 1565 00:55:28,925 --> 00:55:30,760 REGARDS IN EMERGING ITS OF 1566 00:55:30,827 --> 00:55:32,262 PRIMARY CARE, OVERALL HEALTH, 1567 00:55:32,328 --> 00:55:37,467 SORT OF MORE GLOBAL MEASURES OF 1568 00:55:37,534 --> 00:55:38,635 HEALTH,IME NOT SO SURE THAT'S 1569 00:55:38,702 --> 00:55:43,707 BEEN DONE AND THE REASON WHY I'M 1570 00:55:43,773 --> 00:55:48,478 INTERESTED IS BECAUSE SOME SORT 1571 00:55:48,545 --> 00:55:50,113 OF CULTURAL CONNECTIONS IN THE 1572 00:55:50,180 --> 00:55:51,281 MILITARY HEALTH SYSTEM PROVIDERS 1573 00:55:51,347 --> 00:55:53,983 HAVE LOTS AND LOTS OF WAYS TO 1574 00:55:54,050 --> 00:55:55,618 IDENTIFY THE SOCIAL DETERMINANTS 1575 00:55:55,685 --> 00:56:04,928 THAT THEY HAVE ACCESS TO 1576 00:56:04,994 --> 00:56:06,863 RESOURCES TO HELP THOSE WHO ARE 1577 00:56:06,930 --> 00:56:09,933 LESS ABLE TO PROVIDE FOR 1578 00:56:09,999 --> 00:56:10,467 THEMSELVES. 1579 00:56:10,533 --> 00:56:13,670 SO I'M INTERESTED IN YOUR 1580 00:56:13,737 --> 00:56:15,305 KNOWLEDGE REALLY ABOUT LOOKING 1581 00:56:15,371 --> 00:56:17,173 AT THE MILITARY HEALTH SYSTEM 1582 00:56:17,240 --> 00:56:19,175 AND UNDERSTANDING IT FROM THE 1583 00:56:19,242 --> 00:56:21,177 HEALTH DISPARITIES POINT OF 1584 00:56:21,244 --> 00:56:23,012 VIEW, THANKS. 1585 00:56:23,079 --> 00:56:26,015 >> SO YOU IDENTIFY GAP IN MY 1586 00:56:26,082 --> 00:56:27,117 KNOWLEDGE, I DON'T KNOW MUCH 1587 00:56:27,183 --> 00:56:28,051 ABOUT THE MILITARY SYSTEM. 1588 00:56:28,118 --> 00:56:29,819 THERE HAVE BEEN A NUMBER OF MANY 1589 00:56:29,886 --> 00:56:32,489 ACTUALLY STUDIES ON THE VA 1590 00:56:32,555 --> 00:56:34,457 POPULATION WHICH I GUESS YOU GD 1591 00:56:34,524 --> 00:56:37,560 SAY IT'S NOT REALLY AN EXTENSION 1592 00:56:37,627 --> 00:56:40,663 BUT IT SORT OF IT FOR WHO'S 1593 00:56:40,730 --> 00:56:42,932 ELIGIBLE FOR VETERAN'S BENEFITS 1594 00:56:42,999 --> 00:56:45,468 AND THERE'S CLEAR LESS GAP IN 1595 00:56:45,535 --> 00:56:46,202 THE HEALTH DISADVANTAGE BETWEEN 1596 00:56:46,269 --> 00:56:50,707 BLACK AND WHITES IN THE VA 1597 00:56:50,774 --> 00:56:51,074 SYSTEM. 1598 00:56:51,141 --> 00:56:52,575 IN FACT, THERE'S A STUDY THAT 1599 00:56:52,642 --> 00:56:54,210 PROBABLY DONE MORE THAN 20 YEARS 1600 00:56:54,277 --> 00:57:00,150 AGO THAT SHOWED THAT MORTALITY 1601 00:57:00,216 --> 00:57:02,786 FOR EXAMPLE, PNEUMONIA WAS LOWER 1602 00:57:02,852 --> 00:57:05,522 FOR AFRICAN AMERICANS LOOKING AT 1603 00:57:05,588 --> 00:57:07,590 THE VA HEALTHCARE, SORRY, SOME 1604 00:57:07,657 --> 00:57:10,026 OF THAT IS I THINK MORE UNIFORM 1605 00:57:10,093 --> 00:57:11,528 HEALTHCARE IS MORE LEVEL PLAYING 1606 00:57:11,594 --> 00:57:12,729 FIELD OF YOU'RE IN THE SYSTEM, 1607 00:57:12,796 --> 00:57:13,696 YOU'RE GETTING ATTENTION AND I 1608 00:57:13,763 --> 00:57:15,899 THINK THE VA HAS EVOLVED IN A 1609 00:57:15,965 --> 00:57:17,767 DIRECTION ALONG SOME OF THESE 1610 00:57:17,834 --> 00:57:21,371 LINES OF STRONG PRIMARY CARE, 1611 00:57:21,437 --> 00:57:23,273 MORE TEAM CARE, MORE LOOKING AT 1612 00:57:23,339 --> 00:57:25,008 THE ASSPEBTS OUTSIDE OF THE 1613 00:57:25,074 --> 00:57:28,545 HEALTHCARE SETTING AND ALSO, 1614 00:57:28,611 --> 00:57:30,213 THERE'S DIFFERENT POPULATIONS 1615 00:57:30,280 --> 00:57:32,882 THAT GO IN THE MILITARY, 1616 00:57:32,949 --> 00:57:33,983 FREQUENTLY THE AFRICAN AMERICAN 1617 00:57:34,050 --> 00:57:36,286 WHO IS VOLUNTEER FOR THE 1618 00:57:36,352 --> 00:57:40,657 MILITARY WERE HEALTHIER THAN THE 1619 00:57:40,723 --> 00:57:41,925 REST OF THE COMMUNITY AND FOR 1620 00:57:41,991 --> 00:57:43,326 WHITES IT MAY HAVE BEEN THE 1621 00:57:43,393 --> 00:57:44,794 OPPOSITE, SO YOU SAW THE 1622 00:57:44,861 --> 00:57:45,929 NARROWING OF THE GAP. 1623 00:57:45,995 --> 00:57:48,131 ONE OF MY POST DOCS IN THE LAB 1624 00:57:48,198 --> 00:57:50,366 HAS BEEN ANALYZING DATA ON THE 1625 00:57:50,433 --> 00:57:53,002 SURVEY OF INCARCERATED PERSONS, 1626 00:57:53,069 --> 00:57:54,737 AND WE SEE SIMILAR KIND OF 1627 00:57:54,804 --> 00:57:56,172 RESULTS, NOW THIS IS ONLY A 1628 00:57:56,239 --> 00:58:00,610 SURVEY, IT'S NOT HELT CARE, BUT 1629 00:58:00,677 --> 00:58:02,679 ON SELF-REPORT OF MENTAL HEALTH 1630 00:58:02,745 --> 00:58:03,980 AND PHYSICAL HEALTH ISSUES, 1631 00:58:04,047 --> 00:58:05,782 WHITES AND BLACKS ARE MUCH 1632 00:58:05,849 --> 00:58:08,117 CLOSER AND IN SOME THINGS BLACKS 1633 00:58:08,184 --> 00:58:10,620 ARE HEALTHIER IN THE PRISON 1634 00:58:10,687 --> 00:58:13,957 SYSTEM IN THAT CONTEXT, THIS IS 1635 00:58:14,023 --> 00:58:15,291 ABOUT 20,000 RESPONDENTS TO THIS 1636 00:58:15,358 --> 00:58:16,993 SURVEY, SO I THINK THAT THIS IS 1637 00:58:17,060 --> 00:58:19,896 AN AREA THAT COULD BE 1638 00:58:19,963 --> 00:58:20,997 POTENTIALLY USED TO LEVERAGE, 1639 00:58:21,064 --> 00:58:22,966 SAY, OH WE CAN DO IT IN THE 1640 00:58:23,032 --> 00:58:25,368 MILITARY, WHY CAN'T WE DO IT IN 1641 00:58:25,435 --> 00:58:26,569 OTHER CONTEXT AND NOT ENOUGH OF 1642 00:58:26,636 --> 00:58:28,171 THAT PROBABLY HAS BEEN DONE, SO 1643 00:58:28,238 --> 00:58:38,281 I AGREE. 1644 00:58:38,348 --> 00:58:38,615 THANKS. 1645 00:58:38,681 --> 00:58:39,315 YES? 1646 00:58:39,382 --> 00:58:40,717 >> SO I WANTED TO SAY THAIRK YOU 1647 00:58:40,783 --> 00:58:43,853 FOR YOUR TALK BEFORE I ASK MY 1648 00:58:43,920 --> 00:58:44,120 QUESTION. 1649 00:58:44,187 --> 00:58:44,487 >> THANK YOU. 1650 00:58:44,554 --> 00:58:46,890 NSO 1651 00:58:46,956 --> 00:58:47,123 N-- 1652 00:58:47,190 --> 00:58:48,758 >> SO I HAD QUESTION ABOUT SOME 1653 00:58:48,825 --> 00:58:50,393 OF THE IMPLEMENTATIONS YOU WOULD 1654 00:58:50,460 --> 00:58:51,361 RECOMMEND FOR MORE RURAL 1655 00:58:51,427 --> 00:58:54,063 COMMUNITIES AND FOR LACK OF A 1656 00:58:54,130 --> 00:58:56,432 BETTER TERM HEALTHCARE AND 1657 00:58:56,499 --> 00:59:00,403 GROCERY DESERTS. 1658 00:59:00,470 --> 00:59:05,608 WOULD YOU--HOW WOULD YOU 1659 00:59:05,675 --> 00:59:07,310 RECOMMEND GOING ABOUT PREVENTING 1660 00:59:07,377 --> 00:59:08,511 CHRONIC ILLNESSES IN MANY OF 1661 00:59:08,578 --> 00:59:10,914 THESE LOW AND MIDDLE INCOME 1662 00:59:10,980 --> 00:59:11,314 COMMUNITIES. 1663 00:59:11,381 --> 00:59:14,450 WOULD YOU CARE MORE FOR 1664 00:59:14,517 --> 00:59:15,952 PREVENTION RATHER THAN OR WOULD 1665 00:59:16,019 --> 00:59:18,655 YOU CARE MORE FOR PREVENTION 1666 00:59:18,721 --> 00:59:19,956 WANT TO SHIFT MORE FOR 1667 00:59:20,023 --> 00:59:20,757 PREVENTION RATHER THAN TREATMENT 1668 00:59:20,823 --> 00:59:22,725 OR WOULD YOU JUST STILL WANT TO 1669 00:59:22,792 --> 00:59:24,560 GIVE MORE MEDICINE FOR EXAMPLE, 1670 00:59:24,627 --> 00:59:27,330 LIKE THAT JUST CAME UP WHEN YOU 1671 00:59:27,397 --> 00:59:33,136 WERE DISCUSSING HOW DOCTORS 1672 00:59:33,202 --> 00:59:33,603 WEREN'T--I MIGHT HAVE 1673 00:59:33,670 --> 00:59:37,340 MISUNDERSTOOD WAS THAT DOCTORS 1674 00:59:37,407 --> 00:59:38,541 WEREN'T PRESCRIBING STATIN TO 1675 00:59:38,608 --> 00:59:41,077 WOMEN OR? 1676 00:59:41,144 --> 00:59:41,644 YEAH? 1677 00:59:41,711 --> 00:59:41,978 >> CORRECT. 1678 00:59:42,045 --> 00:59:43,746 YOU ASKED ABOUT LOW INCOME AND 1679 00:59:43,813 --> 00:59:47,150 COMMUNITIES OR RURAL COMMUNITIES 1680 00:59:47,216 --> 00:59:47,750 OR BOTH? 1681 00:59:47,817 --> 00:59:49,252 >> BOTH JUST FOR PREVENTION 1682 00:59:49,319 --> 00:59:50,453 RATHER THAN-- 1683 00:59:50,520 --> 00:59:50,987 >> RIGHT, RIGHT. 1684 00:59:51,054 --> 00:59:56,626 THE EASY ANSWER IS TO SAY YOU 1685 00:59:56,693 --> 00:59:59,262 NEED BOTH, PREVENTION YOU NEED 1686 00:59:59,329 --> 01:00:00,296 HEALTHCARE FOR SOME PREVEPTATIVE 1687 01:00:00,363 --> 01:00:02,699 MEASURES BUT YOU NEED TO THINK 1688 01:00:02,765 --> 01:00:05,535 ABOUT COMMUNITY CONTEXT FOR 1689 01:00:05,601 --> 01:00:07,704 OTHERS AND SO YOU DON'T NEED AS 1690 01:00:07,770 --> 01:00:11,474 MUCH A DOCTOR OR CLINICIAN TO DO 1691 01:00:11,541 --> 01:00:13,076 PREVENTION, YOU NEED STRUCTURAL 1692 01:00:13,142 --> 01:00:17,347 CHANGE IN HOW PEOPLE ARE ABLE TO 1693 01:00:17,413 --> 01:00:18,748 BOTH INCREASE PHYSICAL ACTIVITY, 1694 01:00:18,815 --> 01:00:22,251 AFFORD OR ACTUALLY HAVE ACCESS 1695 01:00:22,318 --> 01:00:24,687 TO HEALTHIER NUTRITION OR LESS 1696 01:00:24,754 --> 01:00:26,255 ACCESS TO NOT HEALTHY NUTRITION, 1697 01:00:26,322 --> 01:00:28,691 YOU KNOW, THE HIGHLY DENSE 1698 01:00:28,758 --> 01:00:30,660 CALORIC STUFF THAT IS NOT 1699 01:00:30,727 --> 01:00:32,628 EXPENSIVE THAT REALLY IS 1700 01:00:32,695 --> 01:00:37,133 PROBABLY MORE HARMFUL TO US THAN 1701 01:00:37,200 --> 01:00:39,102 WE EVEN ASSUME IN TERMS OF 1702 01:00:39,168 --> 01:00:41,871 CARDIAC DISEASE IN THE LONG-TERM 1703 01:00:41,938 --> 01:00:43,072 AND CAUSING METABOLIC 1704 01:00:43,139 --> 01:00:44,540 DYSFUNCTION AND CANCER. 1705 01:00:44,607 --> 01:00:47,643 SO I THINK YOU NEED BOTH 1706 01:00:47,710 --> 01:00:47,944 STRATEGIES. 1707 01:00:48,011 --> 01:00:51,047 AND THERE'S ALSO THIS SORT OF 1708 01:00:51,114 --> 01:00:53,750 EXTRA ISSUES ABOUT POLLUTION FOR 1709 01:00:53,816 --> 01:00:57,720 EXAMPLE AND WE KNOW THAT 1710 01:00:57,787 --> 01:00:59,288 PARTICULARLY, THE MATTER, THE 1711 01:00:59,355 --> 01:01:01,391 POLLUTION 2.5 IS GOING UP AND UP 1712 01:01:01,457 --> 01:01:03,693 AND UP, AND IT IS ASSOCIATED 1713 01:01:03,760 --> 01:01:07,430 WITH INCREASE RISK OF PEL 1714 01:01:07,497 --> 01:01:08,564 MONITORARY DISEASE, STROKE, AND 1715 01:01:08,631 --> 01:01:10,099 WE KNOW SOME THINGS THAT NEED TO 1716 01:01:10,166 --> 01:01:12,969 CHANGE IN ORDER TO MAKE THIS 1717 01:01:13,036 --> 01:01:16,172 BETTER, AND SO I THINK THESE ARE 1718 01:01:16,239 --> 01:01:16,839 ALL MACROFACTORS THAT WILL 1719 01:01:16,906 --> 01:01:19,208 MATTER TO MAKE THE POPULATION 1720 01:01:19,275 --> 01:01:21,377 HEALTHIER, BUT YOU ALSO NEED 1721 01:01:21,444 --> 01:01:21,677 HEALTHCARE. 1722 01:01:21,744 --> 01:01:24,647 I MEAN PEOPLE IN A HEALTHY 1723 01:01:24,714 --> 01:01:25,915 COMMUNITY MAY HAVE ACESES TO 1724 01:01:25,982 --> 01:01:27,650 THESE GOOD THINGS BUT MAYBE THE 1725 01:01:27,717 --> 01:01:29,152 FREEWAY GET TORN DOWN, IT WILL 1726 01:01:29,218 --> 01:01:30,553 NEVER HAPPEN, BUT YOU KNOW YOU 1727 01:01:30,620 --> 01:01:32,655 DON'T HAVE TRUCKS GOING BY, 1728 01:01:32,722 --> 01:01:34,023 DIESEL TRUCKS GOING BY WHERE YOU 1729 01:01:34,090 --> 01:01:37,260 LIVE ALL THE TIME BUT I STILL 1730 01:01:37,326 --> 01:01:37,894 CAN GET SICK. 1731 01:01:37,960 --> 01:01:39,562 YOU STILL CAN GET HYPERTENSION 1732 01:01:39,629 --> 01:01:41,164 OR YOU CAN STILL HAVE AN INJURY 1733 01:01:41,230 --> 01:01:43,032 AND YOU NEED A PLACE TO GO, SO 1734 01:01:43,099 --> 01:01:47,070 YOU NEED QUALITY HEALTHCARE AND 1735 01:01:47,136 --> 01:01:50,339 I THINK WITHIN HEALTHCARE, WE 1736 01:01:50,406 --> 01:01:54,177 OFTEN GET SORT OF--WE MEANING 1737 01:01:54,243 --> 01:01:56,179 THE HEALTHCARE PROVIDERS AND 1738 01:01:56,245 --> 01:01:58,548 SYSTEMS ENAMORED IN NEW THINGS, 1739 01:01:58,614 --> 01:01:59,949 NEW TECHNOLOGY, NEW THERAPIES, 1740 01:02:00,016 --> 01:02:01,717 SOMETIMES THE OLD STUFF ACTUALLY 1741 01:02:01,784 --> 01:02:02,885 WORKS QUITE WELL, WE JUST DIDN'T 1742 01:02:02,952 --> 01:02:05,988 GET IT TO PEOPLE, AND THERE'S NO 1743 01:02:06,055 --> 01:02:14,730 BIG PIEWSH --PIEWSH TO PROMOTE 1744 01:02:14,797 --> 01:02:16,265 THEM WHY THE THEY TILL GO ALONG, 1745 01:02:16,332 --> 01:02:18,434 YOU WILL SEE THEY MAY CHANGE THE 1746 01:02:18,501 --> 01:02:19,735 WAY WE PRACTICE A PARTICULAR 1747 01:02:19,802 --> 01:02:22,071 CONDITION, I THINK WE NEED TO BE 1748 01:02:22,138 --> 01:02:22,972 OPEN TO BOTH. 1749 01:02:23,039 --> 01:02:25,541 WE CAN'T ASSUME 1 OR THE OTHER. 1750 01:02:25,608 --> 01:02:26,409 >> ONE LAST QUESTION? 1751 01:02:26,476 --> 01:02:29,946 >> DON'T GO AWAY, I WILL CLOSE 1752 01:02:30,012 --> 01:02:30,880 THE SESSION. 1753 01:02:30,947 --> 01:02:32,748 I WANT TO SAY THANK YOU VERY 1754 01:02:32,815 --> 01:02:35,284 MUCH FOR YOUR COMPREHENSIVE 1755 01:02:35,351 --> 01:02:36,686 POWERFUL PRESENTATION, LIKE ANY 1756 01:02:36,752 --> 01:02:37,854 GREAT PRESENTATION, IT RAISES 1757 01:02:37,920 --> 01:02:39,489 MORE QUESTIONS THAN ANSWERS AND 1758 01:02:39,555 --> 01:02:41,357 SO, THANK YOU FOR YOUR 1759 01:02:41,424 --> 01:02:41,691 LEADERSHIP. 1760 01:02:41,757 --> 01:02:44,393 I THINK IN OUR COUNTRY, THERE'S 1761 01:02:44,460 --> 01:02:45,094 THIS RECONNING THAT'S 1762 01:02:45,161 --> 01:02:46,295 CONSIDERING OVER THE PAST FEW 1763 01:02:46,362 --> 01:02:48,431 YEARS THEY THINK HAS BEEN LONG 1764 01:02:48,498 --> 01:02:49,532 OVERDUE BOTH IN OUR COMMUNITIES 1765 01:02:49,599 --> 01:02:50,399 AND CLINICAL SETTINGS AND I WANT 1766 01:02:50,466 --> 01:02:54,971 TO THANK YOU FOR YOUR LEADERSHIP 1767 01:02:55,037 --> 01:02:55,671 WITH NIMHD. 1768 01:02:55,738 --> 01:02:58,241 >> THANK YOU SO MUCH TOM. 1769 01:02:58,307 --> 01:02:58,541 THANK YOU. 1770 01:02:58,608 [ APPLAUSE ]